Long-term results of MyoRing treatment of keratoconus.

PURPOSE: To study long-term results of MyoRing treatment of keratoconus. METHODS: Retrospective study of MyoRing implantation into a corneal pocket for keratoconus. RESULTS: Corneal thickness at the thinnest point remained unchanged, SIM K's, manifest sphere and cylinder were significantly improved at the first follow-up 9 months postoperatively and remained stable until the last follow-up about 5 years after surgery. Uncorrected and corrected distance visual acuity (UDVA, CDVA) were significantly improved at the first follow-up 9 months postoperatively and were further ameliorated until the last follow-up about 5 years after surgery. CONCLUSION: The treatment was safe and effective with continuing improvement of visual acuity during the 5 years after surgery.

Introducing a new parameter for the assessment of the tear film lipid layer.

PURPOSE: The differential diagnosis of dry eye syndrome is still a challenging task. The purpose of this study was to understand the relationship between a novel, objective clinical parameter, the "corrected lipid layer stabilization time," and commonly performed clinical tests for dry eye patients. METHODS: Data were obtained from a prospective clinical study with 59 patients of different subjective severity, as determined with the Ocular Surface Disease Index (OSDI). The dynamics of the tear film lipid layer were made visible through a white light source and were stored digitally. Because the distance between the upper and lower eyelid affects the lipid layer dynamics and varies significantly between subjects, the distance of the eyelids was determined and used to correct the lipid layer stabilization time. The resulting parameter was compared with common clinical procedures. RESULTS: The corrected lipid layer stabilization time has a highly significant correlation with tear film breakup time (Spearman r = -0.485, P < 0.01), Schirmer test without anesthesia (r = -0.431, P < 0.01) and with the Ocular Surface Disease Index (r = 0.498, P < 0.01). It also correlates with the lissamine green staining score (r = 0.379, P < 0.05), but shows no correlation with the osmolarity of the tear film. Without the correction for the eyelid opening, the correlations decrease considerably. CONCLUSIONS: These data suggest that the diagnostic value of the lipid layer stabilization time for the assessment of the severity of dry eye syndrome increases considerably when it is corrected by the distance of the eyelids.

Polytetrafluoroethylene (Goretex) for muscle elongation in the surgical treatment of strabismus with restricted motility.

PURPOSE: Repeated strabismus surgery as well as eye muscle fibrosis in various forms of strabismus, can be followed by restriction of the motility of the eye. Tendon elongation may be necessary if further improvement of the deviation and duction of the eye muscle is to be achieved. We used polytetrafluoroethylene (Goretex) and looked at its user comfort, compatibility and dose-rate relationship. METHOD: Three patients with consecutive exotropia after repeated operations for congenital esotropia, two patients with VI nerve palsy and residual head turn after combined convergence operation and one child with congenital fibrosis syndrome underwent muscle tendon elongation with Goretex (7-15 mm) of either the medial or the lateral rectus muscle, which had already been resected and/or recessed in former surgeries. Forced duction under general anaesthesia was restricted in all patients. RESULTS: The correction of the deviation in primary position (deviation at distance + 3 degrees to - 4 degrees and at near - 1 degrees to - 8 degrees ) and in side gaze was satisfactory and motility was clearly improved. There were no postoperative complications (infection, shrinkage, scarring) and the postoperative results in terms of the angle of deviation and the improvement in motility remained stable for 1-6 years. CONCLUSION: Polytetrafluoroethylene (Goretex) is a good material with which to resolve complicated cases of strabismus in which muscle tendon elongation for bulbus restriction is necessary.