Localized flap melt after Nd-YAG laser treatment in recurrent post-LASIK epithelial ingrowth.

Neodymium: Yttrium-Aluminum-Garnet (Nd-YAG) laser treatment of epithelial ingrowth was found promising with high success rates in cases of primary post-LASIK epithelial ingrowth. However, the application range of this procedure is not well-known. For the first time, the authors report the outcome of a patient treated with Nd-YAG laser for multiple recurrences of post-laser in situ keratomileusis epithelial ingrowth.

Localized flap melt after Nd-YAG laser treatment in recurrent post-LASIK epithelial ingrowth / Derretimento localizado de flap após o tratamento por Nd-YAG laser para crescimento epitelial recorrente pós-LASIK

ABSTRACTNeodymium: Yttrium-Aluminum-Garnet (Nd-YAG) laser treatment of epithelial ingrowth was found promising with high success rates in cases of primary post-LASIK epithelial ingrowth. However, the application range of this procedure is not well-known. For the first time, the authors report the outcome of a patient treated with Nd-YAG laser for multiple recurrences of post-laser in situ keratomileusis epithelial ingrowth.

RESUMOO tratamento com laser de neodímio: Ítrio-Alumínio-Granada (do inglês, Nd-YAG Laser) para o crescimento epitelial primário pós-LASIK demonstrou altas taxas de sucesso. No entanto, os limites deste procedimento não são completamente conhecidos. Pela primeira vez, os autores relatam os resultados de um olho tratado com Nd-YAG laser para múltiplo crescimento epitelial pós-LASIK recorrente que desenvolveu um derretimento localizado do flap.

Effects of androgen replacement therapy on cornea and tear function in men with idiopathic hypogonadotropic hypogonadism.

PURPOSE: Idiopathic hypogonadotropic hypogonadism (IHH) is an endocrine disorder defined with the presence of typical clinical signs and symptoms plus laboratory confirmation of serum testosterone (T) levels lower than 300 ng/dl. Androgen replacement therapy (ART) is the first-step treatment of male IHH. To date, no clinical trial, which investigates the changes on corneal structure and tear function, of systemic ART in men have been published. The objective of this study was to investigate the effects of ART on cornea and tear function in patients with IHH. MATERIALS AND METHODS: This prospective, interventional study was conducted at the Gulhane Military Medical Academy, Ankara, Turkey, a tertiary referral military hospital. Thirty-four eyes of 17 men with IHH patients were evaluated with Schirmer I test, ultrasound pachymeter, applanation tonometer and confocal microscopy. A Testosterone compound (Sustanon® 250 mg) was administered by intramuscular injection in the course of a 3-week period to induce puberty, and human chorionic gonadotropin (Pregnyl® 5000 IU) was administered twice weekly for 3 months to induce fertility. The patients were re-evaluated at the third month of the treatment. Main Outcome Measures were Schirmer score, central corneal thickness (CCT), intraocular pressure (IOP), endothelial cell density, coefficient of variation and cell shape. RESULTS: Schirmer scores showed similar results after the treatment compared to pre-treatment levels (p = 0.14). There was no statistically significant difference in CCT and IOP compared to baseline data (p = 0.96, p = 0.73, respectively), and no significant differences were found in corneal endothelial cell density, percentage of cell size variability or hexagonality (p = 0.83, p = 0.58, p = 0.64, respectively). CONCLUSIONS: This is the first study that investigates the effects of ART on corneal structure and tear function in men. ART seems to have no short-term effects on corneal structure and tear function. Further publications of larger, long-term and controlled studies are needed.

Comparison of multimetric D index with keratometric, pachymetric, and posterior elevation parameters in diagnosing subclinical keratoconus in fellow eyes of asymmetric keratoconus patients.

PURPOSE: To compare the multimetric D index and other keratoconus-screening parameters in patients with clinical keratoconus in 1 eye and subclinical keratoconus in the fellow eye. SETTING: Medipol University Hospital and Birinci Eye Hospital, Istanbul, Turkey. DESIGN: Retrospective case-control study. METHODS: Patients with clinical keratoconus in 1 eye and subclinical keratoconus in the fellow eye and eyes of normal subjects were evaluated with a rotating Scheimpflug imaging system (Pentacam). Parameters included anterior curve analysis, keratometry (K) values, minimum corneal thickness, pachymetric progression index, Ambrósio relational thickness, posterior elevation, back difference elevation, and D-index values. The receiver operating characteristic (ROC) curves were analyzed to evaluate the area under curve (AUC), sensitivity, and specificity of each parameter. RESULTS: Forty-five patients and 67 normal subjects were evaluated. The pachymetric progression indices, posterior elevation, and the D-index measurements were statistically significantly higher whereas corneal thickness and Ambrósio relational thickness measurements were significantly lower in eyes with keratoconus or subclinical keratoconus than in eyes of normal subjects (P < .05). Using the ROC analysis, the AUC values of the mean steep K, minimum corneal thickness, pachymetric progression index minimum, Ambrósio relational thickness maximum, posterior elevation, back difference elevation, and D index to distinguish between subclinical keratoconus from control subjects were 0.52, 0.64, 0.71, 0.72, 0.71, 0.76, and 0.83, respectively. CONCLUSION: The new multimetric D index seems to be better than other single-metric parameters in diagnosing keratoconus and subclinical keratoconus with good specificity. However, the sensitivity levels of all parameters were relatively limited in the diagnosis of subclinical keratoconus. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Ultrasound biomicroscopy confirmation of corneal overriding due to improper suturing of full-thickness corneal laceration / Confirmação por biomicroscopia ultrassônica de encavalamento corneano devido à sutura inadequada de laceração de espessura total da córnea

We herein present a case with corneal overriding due to improper suturing of a full-thickness corneal laceration. There was a 2.5-mm difference between horizontal and vertical white-to-white measurements in the cornea. However, slit lamp examination failed to demonstrate the exact architecture of the laceration. Ultrasound biomicroscopy defined the wound edges thoroughly and confirmed the presence of corneal overriding. Six weeks after suture enhancement, the abnormal oval appearance of the cornea was absent and correct apposition of the corneal edges was seen on ultrasound biomicroscopy. Ultrasound biomicroscopy can be used in preoperative surgical planning of cases with complicated corneal lacerations. It can be used to adjust and enhance wound architecture in eyes with penetrating injury.

Apresentamos um caso com encavalamento corneano devido à sutura inadequada de uma laceração da córnea de espessura total. Houve uma diferença 2,5 mm entre as medidas do branco ao branco horizontais e verticais na córnea. No entanto, o exame da lâmpada de fenda não conseguiu demonstrar a arquitetura exata da laceração. A biomicroscopia ultrassônica definiu as bordas da ferida completamente e confirmou a presença de encavalamento da córnea. Seis semanas após a melhora da sutura, a aparência oval anormal da córnea havia desaparecido, e a correta aposição das bordas da córnea foi identificada na biomicroscopia ultrassônica. A biomicroscopia ultrassônica pode ser usada no planejamento cirúrgico pré-operatório de casos com lacerações corneanas complicadas. Ela pode ser utilizada para ajustar e melhorar a arquitetura da ferida em olhos com lesão penetrante.

Effects of 1% cyclopentolate hydrochloride on anterior segment parameters obtained with Pentacam in young adults.

PURPOSE: To investigate the effects of topically applied 1% cyclopentolate hydrochloride on anterior segment parameters obtained with a Pentacam rotating Scheimpflug camera in healthy young adults. METHODS: Anterior segment analyses of 25 eyes from 25 young adults (Group 1), before and after 45 min of 1% cyclopentolate hydrochloride application, were performed. For a control group (cycloplegia-free, Group 2), 24 eyes of 24 age- and sex-matched healthy cases were evaluated twice at 45 min intervals. The results obtained from the groups were compared statistically. RESULTS: The mean ages of the groups were 23.04 ± 3.42 (range, 18-29) and 22.4 ± 2.05 (range, 18-27) years for Groups 1 and 2, respectively (p=0.259). In Group 1, measurements between the two analyses were significantly different for the values of anterior chamber depth (ACD), anterior chamber angle (ACA), and anterior chamber volume (ACV) (p<0.05), whereas no statistical difference was found for the central corneal thickness (CCT) and keratometry (K1, K2) measurements. In Group 2, none of these parameters were statistically different between the two analyses. CONCLUSIONS: Topically applied 1% cyclopentolate hydrochloride caused an increase in the ACD and ACV values, and a decrease in the ACA value. However, it had no significant effect on the CCT and keratometry measurements. It is important to consider these effects when using the Pentacam device on young adults with cycloplegia and when applying it for various reasons.

Effects of 1% cyclopentolate hydrochloride on anterior segment parameters obtained with Pentacam in young adults / Efeitos do cloridrato ciclopentolato 1% sobre os parâmetros do segmento anterior obtidos com Pentacam em adultos jovens

Purpose: To investigate the effects of topically applied 1% cyclopentolate hydrochloride on anterior segment parameters obtained with a Pentacam rotating Scheimpflug camera in healthy young adults. Methods: Anterior segment analyses of 25 eyes from 25 young adults (Group 1), before and after 45 min of 1% cyclopentolate hydrochloride application, were performed. For a control group (cycloplegia-free, Group 2), 24 eyes of 24 age- and sex-matched healthy cases were evaluated twice at 45 min intervals. The results obtained from the groups were compared statistically. Results: The mean ages of the groups were 23.04 ± 3.42 (range, 18-29) and 22.4 ± 2.05 (range, 18-27) years for Groups 1 and 2, respectively (p=0.259). In Group 1, measurements between the two analyses were significantly different for the values of anterior chamber depth (ACD), anterior chamber angle (ACA), and anterior chamber volume (ACV) (p<0.05), whereas no statistical difference was found for the central corneal thickness (CCT) and keratometry (K1, K2) measurements. In Group 2, none of these parameters were statistically different between the two analyses. Conclusions: Topically applied 1% cyclopentolate hydrochloride caused an increase in the ACD and ACV values, and a decrease in the ACA value. However, it had no significant effect on the CCT and keratometry measurements. It is important to consider these effects when using the Pentacam device on young adults with cycloplegia and when applying it for various reasons. .

Objetivo: Pesquisar os efeitos do cloridrato de ciclopentolato a 1%, aplicado topicamente, em parâmetros do segmento anterior medidos com a câmera de Scheimpflug Pentacam em adultos jovens e saudáveis. Métodos: A análise do segmento anterior, de 25 olhos de 25 jovens adultos (Grupo 1), antes e após 45 minutos da aplicação de cloridrato ciclopentolato a 1%, foram realizados. Como grupo controle (sem cicloplegia, Grupo 2), 24 olhos de 24 pacientes saudáveis pareados por idade e sexo, foram avaliados duas vezes em intervalos de 45 minutos. Os resultados obtidos com os grupos foram comparados estatisticamente. Resultados: A média de idade dos grupos foram 23,04 ± 3,42 (18-29 anos) e 22,4 ± 2,05 (18-27) anos, respectivamente (p=0,259). No Grupo 1, as medidas entre os dois exames foram significativamente diferentes para os valores de profundidade da câmara anterior (ACD), ângulo da câmara anterior (ACA), e do volume da câmara anterior (ACV) (p<0,05 para todos), enquanto que não foram diferentes para a espessura corneana central (CCT) e ceratometria valores (K1, K2). No Grupo 2, nenhum destes parâmetros foi diferente entre os dois exames. Conclusões: Aplicação tópica de cloridrato de ciclopentolato a 1% causou um aumento nos valores de ACD e ACV e uma diminuição nos valores da ACA. No entanto, ele não teve nenhum efeito significativo sobre as medidas de CCT e ceratometria. É importante considerar esses efeitos sobre as medidas tomadas com Pentacam em adultos jovens com cicloplegia quando aplicá-las em diferentes situações. .

An unusual complication of blunt ocular trauma: a horseshoe-shaped macular tear with spontaneous closure.

A case of horseshoe-shaped macular tear after blunt trauma with the course of the tear and the relevant findings obtained by spectral-domain optical coherence tomography (SD-OCT) is described. A 21-year-old man who had suffered blunt trauma 5 days previously visited our clinic complaining of vision loss in his left eye. Ophthalmic examination and SD-OCT images revealed a horseshoe-shaped macular tear. A month later at the second visit, the macular tear was found to have spontaneously closed. There have been many cases reported previously of the spontaneous closure of traumatic macular holes. A horseshoe-shaped macular tear is an atypical clinical presentation. However, the mechanism of spontaneous closure is hypothetically as same as that for a macular hole. High-resolution images and three-dimensional maps taken with SD-OCT can provide more details on macular diseases and are more useful than time-domain OCT images.

Ultrasound biomicroscopy confirmation of corneal overriding due to improper suturing of full-thickness corneal laceration.

We herein present a case with corneal overriding due to improper suturing of a full-thickness corneal laceration. There was a 2.5-mm difference between horizontal and vertical white-to-white measurements in the cornea. However, slit lamp examination failed to demonstrate the exact architecture of the laceration. Ultrasound biomicroscopy defined the wound edges thoroughly and confirmed the presence of corneal overriding. Six weeks after suture enhancement, the abnormal oval appearance of the cornea was absent and correct apposition of the corneal edges was seen on ultrasound biomicroscopy. Ultrasound biomicroscopy can be used in preoperative surgical planning of cases with complicated corneal lacerations. It can be used to adjust and enhance wound architecture in eyes with penetrating injury.

Nonarteritic ischemic optic neuropathy developed after capsular block syndrome.

A 65-year-old man developed capsular block syndrome in the early postoperative period, following phacoemulsification surgery. After neodymium-doped yttrium aluminum garnet (Nd:YAG) laser anterior capsulotomy, the intraocular pressure remained elevated for 4 days despite antiglaucomatous medication. On the postoperative fifth day, nonarteritic ischemic optic neuropathy was diagnosed. To the best of our knowledge, this is the first report of a case with nonarteritic ischemic optic neuropathy associated with early postoperative capsular block syndrome after phacoemulsification surgery.

Scattered depressions with temporal preponderance in visual field test coexisting with optic disc temporal atrophy in cerebral arteriovenous malformation.

In this article, the unusual association of optic disc temporal atrophy associated with scattered depressions with temporal preponderance in visual field test resembling incomplete bitemporal hemianopsia is reported. A 22-year-old man with cerebral arteriovenous malformation (AVM), which was located adjacent to the inferomedial portion of the posterior limb of the right internal capsule at the level of lateral ventricle, revealed interesting and unexpected ophthalmological findings. Possible mechanisms including anatomical variant, previously larger AVM, and retrograde optic neuropathy were mentioned. This case also highlighted that the usual complaint of visual disturbance might associate with unusual visual field defect in cerebral AVMs.

Ocular injuries caused by metal caps of carbonated mineral water bottles.

BACKGROUND: Bottles containing carbonated drinks are potentially hazardous to the eye. In this study, we aimed to document the clinical characteristics and visual outcomes in a series of patients with ocular injury from flying metal caps of carbonated mineral water bottles. METHODS: Retrospective review of ocular injuries due to metal caps of carbonated mineral water bottles. RESULTS: Sixteen eyes of sixteen patients were included in the study. All of the patients were male, with a mean age of 24 years. Ten of the patients had a history of using improper tools for bottle cap removal. The left eye was involved in twelve cases and the right eye in four cases. All patients had contusion-type closed-globe injury. Varying degrees of hyphema were observed in all patients, and vitreous hemorrhage was present in four. The visual acuity at the last follow-up was 20/20 in 15 of the patients. CONCLUSION: The use of a bottle cap opener is essential for preventing ocular damage from pressed metal caps of carbonated drinks. In addition to popularising the use of screw cap bottles, warning labels that alert consumers about the possibility of eye injury should be placed on carbonated drinks with pressed metal caps.

Single and multiple injections of subconjunctival ranibizumab for early, recurrent pterygium.

PURPOSE: To assess the effect of single versus multiple subconjunctival ranibizumab injections in patients with an early pterygium recurrence. SETTING: Single-center, academic practice. STUDY POPULATION: Nine patients with early pterygium recurrence. OBSERVATIONAL PROCEDURE: Subconjunctival ranibizumab (0.5 mg/0.05 mL) was administered adjacent to pterygium recurrence. Group 1 (n = 5) received one injection; group 2 (n = 4) received three injections (time points 0, 2, and 4 weeks) with the ability to retreat as needed. MAIN OUTCOME MEASURES: Effect of ranibizumab on conjunctival hyperemia and corneal neovascular area over a 6-month follow-up period. RESULTS: In the single injection group, a decrease in conjunctival hyperemia was noted in all patients on postinjection day 1. At follow up, hyperemia grade fluctuated, although all patients had less hyperemia than at baseline. In the recurrent injection group, the median number of injections was 8.5 (range 7 to 9) over the 6 months. In spite of the repeated injections, the pattern of conjunctival hyperemia was similar to that of the single injection group. In group 1, corneal neovascularization remained relatively unchanged over the 6-month period in four patients and decreased in one patient by 24%. In group 2, corneal neovascularization increased in one patient by 39%, remained stable in one patient, and decreased in two patients by 34% and 44%. CONCLUSION: This is the first study to evaluate the role of ranibizumab in the treatment of an early pterygium recurrence and the first to compare multiple versus single injections. Recurrent injections did not appear to be superior to a single injection with regards to conjunctival hyperemia.

Preoperative detection of posterior capsule tear with ultrasound biomicroscopy in traumatic cataract.

UNLABELLED: We report ultrasound biomicroscopy (UBM) evaluation of a paintball-related traumatic cataract with a posterior capsule tear. Slitlamp examination revealed anterior and posterior subcapsular cataracts with a suspicious tiny posterior capsule tear within the larger area of posterior bulging. Ultrasound biomicroscopy (35 MHz) confirmed the presence of a sub-1.0 mm posterior capsule tear, which was clearly observed intraoperatively and postoperatively. This is the first report illustrating the high performance of 35 MHz UBM in detecting a sub-1.0 mm posterior capsule tear. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Quality of corneal lamellar cuts quantified using atomic force microscopy.

PURPOSE: To quantify the cut quality of lamellar dissections made with the femtosecond laser using atomic force microscopy (AFM). SETTING: Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA. DESIGN: Experimental study. METHODS: Experiments were performed on 3 pairs of human cadaver eyes. The cornea was thinned to physiologic levels by placing the globe, cornea side down, in 25% dextran for 24 hours. The eyes were reinflated to normal pressures by injecting a balanced salt solution into the vitreous cavity. The eyes were placed in a holder, the epithelium was removed, and the eyes were cut with a Visumax femtosecond laser. The energy level was 180 nJ for the right eye and 340 nJ for the left eye of each pair. The cut depths were 200 µm, 300 µm, and 400 µm, with the cut depth maintained for both eyes of each pair. A 12.0 mm trephination was then performed. The anterior portion of the lamellar surface was placed in a balanced salt solution and imaged with AFM. As a control, the posterior surface was placed in 2% formalin and imaged with environmental scanning electron microscopy (SEM). Four quantitative parameters (root-mean-square deviation, average deviation, skewness, kurtosis) were calculated from the AFM images. RESULTS: From AFM, the 300 µm low-energy cuts were the smoothest. Similar results were seen qualitatively in the environmental SEM images. CONCLUSION: Atomic force microscopy provided quantitative information on the quality of lamellar dissections made using a femtosecond laser, which is useful in optimizing patient outcomes in refractive and lamellar keratoplasty surgeries.

Corneal haze following disruption of epithelial basement membrane on ultra-high-resolution OCT following femtosecond LASIK.

PURPOSE: To analyze in vivo structural properties of a case with interface haze that developed after femtosecond laser-assisted LASIK. METHODS: Case report. RESULTS: A 42-year-old man underwent uncomplicated LASIK. Four months after the surgery he developed regression of his refractive error and interface haze in both eyes. Flap thickness was calculated as 73 µm and 81 µm in the right and left eyes, respectively. A novel ultra-high-resolution spectral domain optical coherence tomography (OCT) system was used to demonstrate in vivo morphology of the cornea. On ultra-high-resolution OCT, haze was demonstrated as increased bright white reflectivity of the flap interface. Areas of focal disruption of the basement membrane and Bowman layer corresponded with the most significant areas of interface haze. CONCLUSIONS: Our results support the hypothesis that haze after femtosecond LASIK may be a result of damage to the basement membrane and Bowman layer of the cornea.

Atypical presentation of Salzmann nodular degeneration diagnosed with ultra-high-resolution optical coherence tomography.

A 59-year-old woman presented with bilateral, peripheral, circular corneal infiltrates. There was a clear zone separating the outer margin of the degeneration from the limbus in both eyes. The inner margins were indistinct. Ultra-high-resolution optical coherence tomography (UHR-OCT) imaging demonstrated subepithelial infiltrations with epithelial thinning and corneal surface elevation. The infiltrate was accompanied by significant stromal scarring, which reached deep layers of the corneal stroma. UHR-OCT findings were consistent with Salzmann nodular degeneration. UHR-OCT can be used as an optical biopsy to diagnose atypical corneal degenerations without tissue sampling.

Persistent lamellar interface fluid with clear cornea after Descemet stripping automated endothelial keratoplasty.

PURPOSE: To describe clinical properties of a patient with persistent interface fluid syndrome and clear graft, 3.5 years after Descemet stripping automated endothelial keratoplasty (DSAEK). METHODS: Case report. RESULTS: A 69-year-old woman who had DSAEK in 2006 presented with a clear cornea (no corneal edema) and deep diffuse reticular haze in the right eye. Visual acuity was 20/40. Ultrahigh-resolution optical coherence tomography (UHR-OCT) imaging of the right eye demonstrated persistent interface fluid at the donor-recipient junction. The detachment between donor and recipient corneas was 70 µm at the center. There was no connection between the anterior chamber and the donor/recipient interface. CONCLUSIONS: Despite the persistent detachment of the donor cornea, the recipient cornea can remain clear in persistent interface fluid syndrome after DSAEK.