Late onset of acute angle-closure glaucoma following neodymium:YAG laser posterior capsulotomy.

Acute angle-closure glaucoma due to vitreous prolapse immediately following neodymium:YAG (Nd:YAG) laser posterior capsulotomy in eyes with posterior chamber intraocular lens implants is rare. Previously described cases were associated with advanced age, excessive amounts of laser energy, and a large-diameter capsular opening. The authors describe a case of acute angle-closure glaucoma occurring 21 days after Nd:YAG laser posterior capsulotomy in a young patient with a small-diameter capsule opening and a small amount of laser energy to stress the importance of close extended follow-up even in eyes with a theoretical low risk for this complication

Photorefractive keratectomy followed by same-day corneal collagen crosslinking after intrastromal corneal ring segment implantation for pellucid marginal degeneration.

A 28-year-old man with progressive pellucid marginal degeneration (PMD) had photorefractive keratectomy (PRK) followed by same-day corneal collagen crosslinking (CXL) for progressive PMD 12 months after intrastromal corneal ring segment implantation (Intacs). No intraoperative or early postoperative complications occurred. Nine months postoperatively, the uncorrected distance visual acuity improved from finger counting to 20/63 and the corrected distance visual acuity improved from 20/40 to 20/25. Corneal topography revealed a significant improvement in keratometry (from 46.73/38.67 to 44.92/39.01), which remained stable during the 9-month follow-up period. Despite the encouraging results, longer follow-up is necessary to evaluate the outcomes of this approach.

One-year follow-up of corneal confocal microscopy after corneal cross-linking in patients with post laser in situ keratosmileusis ectasia and keratoconus.

PURPOSE: To investigate corneal tissue alterations after corneal collagen cross-linking in patients with post laser in situ keratosmileusis (LASIK) keratectasia and keratoconus. DESIGN: Prospective comparative case series. METHODS: Five patients (5 eyes) with iatrogenic keratectasia after LASIK and 5 patients (5 eyes) with progressive keratoconus were included. All eyes underwent corneal cross-linking and were assessed by corneal in vivo confocal microscopy. Three normal/healthy and 3 post-LASIK without ectasia corneas were also examined as controls. RESULTS: All corneas revealed normal epithelial thickness before and after surgery. Images of both keratoconic and post-LASIK corneal ectasia eyes revealed similar morphologic alterations. The subepithelial nerve plexus was absent immediately after treatment; regeneration of nerves was evident after the third postoperative month. Keratocytes were absent from the anterior 300 mum of the stroma in the first 3 months while the posterior stromal density of keratocytes was increased. Corneal collagen fibers in the anterior stroma were distributed unevenly in a net-like formation. Full-thickness keratocyte repopulation in the anterior and mid-corneal stroma was detected 6 months after treatment. The corneal endothelium did not undergo any significant changes, since the cell density and hexagonality was not found altered during the follow-up period. CONCLUSIONS: Keratocyte nuclei apoptosis in the anterior and intermediate corneal stroma along with collagen alterations were observed during the first 3 postcorneal cross-linking months. Gradual keratocyte repopulation was demonstrated over the following months. Corneal alterations after corneal cross-linking were similar in both keratoconic and post-LASIK corneal ectasia eyes.