Transscleral diode laser cyclophotocoagulation in a patient with ocular cicatricial pemphigoid.

The authors present a case of secondary glaucoma associated with silicone oil in a patient with ocular cicatricial pemphigoid successfully managed with transscleral diode laser cyclophotocoagulation. Six months following treatment, the patient remained satisfied and free of pain, with an intraocular pressure of 24 mm Hg without topical drops or oral acetazolamide. There was no evidence of exacerbation of ocular cicatricial pemphigoid and no adjustment was required to the patient's immunosuppressive therapy. This case suggests that transscleral diode laser cyclophotocoagulation may be safely used to control raised intraocular pressure in patients with ocular cicatricial pemphigoid without causing an exacerbation of the condition.

Effectiveness of cataract phacoemulsification with toric intraocular lenses in addressing astigmatism after keratoplasty.

PURPOSE: To assess the effectiveness of toric intraocular lenses (IOLs) in the management of post-keratoplasty astigmatism. SETTING: Public university hospital, Auckland, New Zealand. DESIGN: Retrospective case series. METHODS: The study analyzed post-keratoplasty eyes after cataract surgery and toric IOL (Acrysof SN60AT or T-flex 623T/573T) implantation. RESULTS: Twenty-six eyes were included. The mean age at cataract surgery was 57.1 years ± 11.2 (SD). Previous keratoplasty was penetrating (84.6%) or deep anterior lamellar (15.4%). Keratoconus (73.1%) was the major indication for keratoplasty. The mean IOL cylinder power was 6.85 ± 3.02 diopters (D). No IOL required postoperative realignment. The mean follow-up was 14 ± 11 months. The mean refractive spherical equivalent decreased significantly, from -3.67 ± 5.76 D to -0.58 ± 1.71 D (P=.01). The mean refractive astigmatism also decreased significantly, from -5.49 ± 3.72 D to -2.61 ± 2.10 D (P<.01). There was a significant improvement in the mean uncorrected distance visual acuity (UDVA) (from 1.12 ± 0.67 logMAR to 0.45 ± 0.39 logMAR) and in the mean corrected distance visual acuity (CDVA) (from 0.70 ± 0.66 logMAR to 0.15 ± 0.16 logMAR) from preoperatively to the last follow-up (both P<.01). Postoperatively, the UDVA and CDVA were 20/40 or better in 61.5% of eyes and 92.3% of eyes, respectively. CONCLUSION: Cataract surgery with toric IOL implantation was safe and effective in significantly reducing corneal astigmatism and improving visual acuity in a large cohort of post-keratoplasty eyes.

Lens Dislocation Following YAG Laser Peripheral Iridotomy.

A rare case where laser peripheral iridotomy resulted in crystalline lens dislocation into the vitreous cavity. The patient was managed with pars plana vitrectomy, fragmatome lensectomy, anterior chamber intraocular lens and surgical iridotomy with a final best corrected visual acuity of 6/9. Multiple episodes of laser peripheral iridotomy carries a risk of complete lens dislocation.