Corneal Collagen Cross-Linking Mushroom Shape Demarcation Line Profile After Limited Bowman's Membrane Removal by Phototherapeutic Keratectomy.

PURPOSE: To report a corneal collagen cross-linking (CXL) mushroom shape demarcation line profile after limited Bowman's membrane removal by phototherapeutic keratectomy (PTK). METHODS: Case report. RESULTS: A twenty-one-year-old male with progressive keratoconus underwent mechanical epithelial debridement (at an 8.5 mm zone) followed by PTK (at a 5.0 mm zone and in a 10 µm depth) and CXL. No intra- or early postoperative complications were found. Evaluation of the corneal stromal demarcation line depth using anterior segment optical coherence tomography revealed a mushroom shape profile. CONCLUSION: It seems that removal of the Bowman's layer leads to greater depth of the corneal stromal demarcation line.

Central retinal vein occlusion and pseudoexfoliation syndrome.

PURPOSE: The purpose of this study was to investigate the existence of pseudoexfoliation syndrome (PXF) as a risk factor for the development of central retinal vein occlusion (CRVO). METHODS: This was a retrospective, comparative study of the prevalence of pseudoexfoliation in three groups of patients: 48 patients with CRVO, 164 patients with branch retinal vein occlusion (BRVO), and 70 control patients (70 eyes). All patients were phakic and had no previous diagnosis of glaucoma. Patients were matched in terms of age and systemic hypertension. All patients had normal intraocular pressure (IOP) at presentation (defined as less than or equal to 21 mmHg). RESULTS: In the CRVO group, 14 out of 48 patients were diagnosed as having PXF (29.17%). In the BRVO group, 14 out of 164 patients had PXF (8.5%), and in the control group, six out of 70 patients had PXF (8.6%). Differences of percentage between groups were statistically significant (P<0.001, χ(2) test). When comparing patient subgroup with ischemic CRVO with subgroup with non-ischemic CRVO, we found that in the ischemic CRVO group, 13 out of 27 patients were diagnosed as having PXF (48.15%), and in the non-ischemic CRVO group, one out of 21 patients was diagnosed as having PXF (4.7%; P<0.001, χ(2) test). The relative odds of having CRVO in patients with PXF versus patients without PXF were 4.406 (confidence interval [CI], 2.03-9.54). CONCLUSION: PXF and CRVO, especially ischemic, are strongly associated in our study. Our results indicate that PXF might be an independent factor for CRVO, as it is related with CRVO independently from glaucoma.

Descemet membrane detachment after heavy silicone oil removal from the anterior chamber.

PURPOSE: The aim of this study was to report a case of a central Descemet membrane detachment after heavy silicone oil removal from the anterior chamber. METHODS: This is a case report of a patient operated with scleral buckling and heavy silicone oil implantation for recurrent retinal detachment. In the patient's follow-up examination, silicone oil was found to completely fill the anterior chamber. He underwent silicone extraction through a paracentesis from the anterior chamber. Immediately after the surgery, a central Descemet membrane detachment combined with corneal edema was identified on slit-lamp examination, and confirmed by anterior segment optical coherence tomography. The detached Descemet membrane was tamponaded successfully with the air bubble injection technique. RESULTS: Four days later, the patient's cornea appeared to be clear, and the Descemet membrane was found to be attached to the corneal stroma with no presence of silicone oil in the anterior chamber. CONCLUSIONS: Descemet membrane detachment is a possible and rare complication that occurs after heavy silicone oil removal from the anterior chamber.

Anterior segment optical coherence tomography for demonstrating posterior capsular rent in posterior polar cataract.

AIMS/PURPOSE: To report the preoperative use of anterior segment optical coherence tomography (AS-OCT) for the determination of pre-existing posterior capsule defect in patients with posterior polar cataract. METHODS: Three patients presented with posterior polar cataract and were evaluated preoperatively using AS-OCT, revealing in one patient intact posterior capsule and in the other two a pre-existing posterior capsule defect not detectable by slit-lamp evaluation. All patients underwent phacoemulsification and intraocular lens implantation. RESULTS: Intraoperatively, AS-OCT findings were confirmed after cataract surgery in all patients. No intra- or late postoperative complications were noted. CONCLUSION: AS-OCT could be an additional useful imaging modality in these patients, essential for surgical planning and patient consultation.

Long-term follow-up of corneal collagen cross-linking for keratoconus--the Cretan study.

PURPOSE: The aim of this study was to present the long-term results of corneal collagen cross-linking (CXL) in patients with keratoconus. METHODS: In this prospective, interventional case series, patients with progressive keratoconus underwent CXL treatment according to the Dresden protocol. Visual, refractive, and topographic outcomes along with endothelial cell density were evaluated preoperatively and at 1, 2, 3, 4, and 5 years postoperatively. RESULTS: Twenty-one patients (25 eyes) were enrolled. The mean follow-up was 43.7 ± 12.2 (range, 24-60) months. Logarithm of the minimum angle of resolution (logMAR) mean uncorrected visual acuity and the mean best spectacle-corrected visual acuity improved significantly from 0.92 ± 0.54 and 0.29 ± 0.21 preoperatively to 0.63 ± 0.41 (P = 0.010) and 0.18 ± 0.18 (P = 0.011), respectively, at the last follow-up. Mean steep and mean flat keratometry readings reduced significantly from 52.53 ± 6.95 diopters (D) and 48.11 ± 5.98 D preoperatively to 49.10 ± 4.50 D (P < 0.001) and 45.58 ± 3.81 D (P = 0.001), respectively, at the last follow-up. The mean endothelial cell density was 2708 ± 302 cells per square millimeter preoperatively and did not change significantly (P > 0.05) at any postoperative interval (2593 ± 258 cells/mm at the last follow-up; P = 0.149). CONCLUSIONS: CXL seems to be effective and safe in halting progression of keratoconus over a long-term follow-up period up to 5 years postoperatively.

Combined topical application of a regenerative agent with a bandage contact lens for the treatment of persistent epithelial defects.

PURPOSE: The aim of this study was to report 3 cases of persistent epithelial defects (PEDs) successfully treated with the combined topical application of a regenerative agent (RGTA; Cacicol20, OTR3, Paris, France) with a bandage contact lens (BCL). METHODS: This is a case series. RESULTS: Three patients suffering from a PED for 4-8 weeks and unresponsive to conventional therapy were treated with the combined application of an RGTA (Cacicol20) and a silicone hydrogel BCL. The PED healed in all patients after 4-21 days, and no side effects were noted. CONCLUSIONS: The combination of an RGTA (Cacicol20) with a BCL seems to be an effective treatment for PED.

Treatment of superior limbic keratoconjunctivitis with topical tacrolimus 0.03% ointment.

PURPOSE: To report 2 cases of superior limbic keratoconjunctivitis (SLK) treated with topical tacrolimus 0.03% ointment (Protopic; Fujisawa Healthcare). METHODS: A female patient aged 52 years and a male patient aged 21 years presented with SLK in both eyes. Both patients had previously received several treatments [such as topical steroids and lubrication, contact lenses, silicone punctal plugs, and vitamin A eye drops], with no improvement. Because of poor response to initial management, the authors started treatment with topical tacrolimus 0.03% twice a day. Objective tarsal conjunctiva inflammation, bulbar conjunctiva findings (such as hyperemia and thickening), cornea staining, and subjective symptoms were evaluated. RESULTS: A week later, both patients were symptomatically better. Four weeks after treatment initiation, the signs of thickened and hyperemic superior conjunctiva, papillary reaction, and punctate keratopathy were almost resolved. Tacrolimus was successfully tapered in both the patients. There were no side effects. CONCLUSIONS: Topical tacrolimus 0.03% ointment may be considered an additional treatment option for SLK.

Topography-Based Keratoconus Regression.

PURPOSE: To report 3 cases of keratoconic patients who had progressive corneal topographic flattening during a 2-year follow-up period. METHODS: Case series. RESULTS: Three patients with bilateral keratoconus, each operated for advanced keratoconus in one of their eyes, were observed for possible progression of the disorder for a period of 2 years. During the 2-year follow-up period, topographic examination showed progressive corneal flattening in the nonoperated eye. Mean keratometry decreased in all patients, whereas topography showed significant flattening at the apex of the cone. Best-spectacle-corrected visual acuity increased in one of the patients, whereas the others had stable uncorrected and best-spectacle-corrected visual acuity during the follow-up period. All patients had positive family medical history for diabetes mellitus, but none of them was diabetic. CONCLUSIONS: This is the first report of topography-based keratoconus regression during a 2-year follow-up period.