Phototherapeutic keratectomy with mitomycin C for corneal haze following photorefractive keratectomy for myopia

PURPOSE: To evaluate the safety and efficacy of phototherapeutic keratectomy (PTK) with single application of mitomycin C for patients with severe corneal haze following photorefractive keratectomy (PRK) for high myopia. METHODS: Eight eyes of seven patients were treated with PTK and intraoperative topical application of mitomycin C (0.02%) for severe corneal haze (grade 3) following PRK for myopia. RESULTS: All patients' visual performance improved significantly. Mean preoperative visual acuity (20/200 for both UCVA and BSCVA) improved significantly to 20/33 (0.6) and 20/30 (0.7) for UCVA and BSCVA, respectively. Six eyes (85.7%) had improved UCVA to 20/40 or better and gained five or more lines of UCVA. The corneal haze score decreased from grade 3 initially (for all eyes prior to PTK and mitomycin C) to a final mean haze score of 0.3 (range 0 to 0.5). Mean final spherical equivalent refraction achieved was -1.30 +/- 1.60 D (range -3.75 to +1.25 D). One eye gained only three lines of visual acuity due to regression and residual haze. No adverse effects related to the use of mitomycin C were recorded. CONCLUSION: PTK with a single intraoperative application of mitomycin C was safe and effective in reducing corneal haze and improving visual acuity in patients with severe corneal haze following PRK.     

A rare case of peripheral ulcerative keratitis associated with Behçet’s disease

We report a rare case of peripheral ulcerative keratitis (PUK) associated with Behçet’s disease. A 34-year-old female presented with right ocular pain persisting for 8 months. The patient had been treated for previously diagnosed Behçet’s disease. The corrected visual acuity was 20/32 in the right eye. Ocular examination revealed mild conjunctival hyperemia and a deep ulcerative lesion with perilesional haziness in the peripheral cornea. Autoimmune screening and corneal culture were negative. One month following treatment with topical and systemic immunosuppressants, the symptom had resolved. Slit-lamp examination showed a healed corneal lesion, and visual acuity improved to 20/20. Despite its rare occurrence, PUK can develop in patients with Behçet’s disease. Therefore, patients presenting PUK require examination for Behçet’s disease using a systemic evaluation.     

Topical thiotepa treatment for recurrent corneal haze after photorefractive keratectomy

PURPOSE: To describe the use of topical thiotepa in the treatment of recurrent haze after photorefractive keratectomy (PRK). SETTING: Gimbel Eye Centre, Calgary, Alberta, Canada. METHODS: Five patients with recurrent haze after myopic PRK were retreated with phototherapeutic keratectomy and topical thiotepa. Before retreatment, the best corrected visual acuity (BCVA) ranged from 20/40 to 20/200. Follow-up ranged from 3 to to15 months. RESULTS:Haze, uncorrected visual acuity (UCVA), and BCVA improved in all patients. Three eyes had a UCVA of 20/20(-2) or better and a BCVA of 20/20(-1) or better. The other 2 eyes experienced regression of the myopia and astigmatism and had a BCVA of 20/25(-1) or better. CONCLUSION: Topical thiotepa appeared to be an effective treatment for recurrent corneal haze following myopic PRK.     

Cornea sparing by endoscopically guided vitreoretinal surgery

PURPOSE: To report a series of eyes with acute severe corneal edema and vitreoretinal complications treated with endoscopic vitreous surgery without a keratoprosthesis to the cornea. DESIGN: Retrospective, small, noncomparative case series. PARTICIPANTS: Seven patients with unilateral acute severe corneal edema, poor view of the fundus, and vitreoretinal complications were reviewed. Five eyes were postcataract surgery, one eye was postpenetrating intraocular blunt trauma by a ferrous foreign body, and one eye had endophthalmitis. INTERVENTION: Vitreous surgery was performed on each eye under the guidance of endoscopy. Topical steroid treatment was administered to the cornea for several weeks after the vitreoretinal surgery, until the corneal edema had been completely resolved. MAIN OUTCOME MEASURES AND RESULTS: The edematous corneas recovered within an average of 9 weeks (range, 6-13 weeks). The preoperative visual acuity ranged from 6/90 to hand motion at 0.5 m, and the final postoperative visual acuity was 6/30 or better after an average follow-up of 14 months (range, 3-23 months). CONCLUSIONS: (1) Endoscopic surgery for vitreoretinal complications in eyes with acute severe corneal edema can obviate keratoprosthesis and keratoplasty. (2) By minimizing further damage to the corneal endothelium, endoscopic vitreoretinal surgery might benefit corneal recovery.     

Corneal ring segments (INTACS) for the treatment of asymmetrical astigmatism of the keratoconus. Follow-up after 2 years

OBJECTIVE: To evaluate the use of corneal ring segments (INTACS) for the treatment of asymmetrical astigmatism in keratoconus. MATERIAL AND METHODS: This prospective study involved nine eyes of seven patients who were operated on between December 1998 and June 2000. A case of keratoconus with opacified cornea was excluded from this study. The patients chosen were contact lens-intolerant. The surgical intervention was carried out under topical anesthesia. The INTACS (Addition Technology) corneal ring insert was inserted approximately 68% of the peripheral corneal depth and was centered to the cone of the cornea. RESULTS: No intraoperative complications occurred. We noted a flattening of the central cornea and a decrease in irregular astigmatism for all patients. Mean preoperative uncorrected visual acuity was less than 1/10. Postoperatively two eyes had an uncorrected visual acuity of 10/10, seven eyes showed an improvement from an uncorrected visual acuity of 2/10 to 7/10. CONCLUSION: We have observed that the flattening effect of INTACS inserts on the soft corneal keratoconic tissue and on the high astigmatic tissue seems greater than that produced in normal cornea. Implantation of INTACS resulted in a significant reduction in asymmetrical astigmatism of the keratoconus.     

Comparison of corneal surface effects of gatifloxacin and moxifloxacin using intensive and prolonged dosing protocols

PURPOSE: To compare the effects of the commercial formulations of moxifloxacin and gatifloxacin on rabbit corneal epithelium using two dosing protocols: high-frequency dosing for bacterial keratitis and cataract surgery prophylaxis. METHODS: Forty eyes of 20 New Zealand white rabbits were randomized to receive topical gatifloxacin, topical moxifloxacin, or no drops as controls. Eighteen eyes received 1 drop of antibiotic every 5 minutes for 15 minutes followed by 1 drop every 15 minutes for 4 hours. Twelve eyes received topical gatifloxacin or topical moxifloxacin 4 times a day for 10 days. Rabbits were euthanized, eyes enucleated, and the corneas separated, washed, and fixed; scanning electron microscopy was performed. Photomicrographs of three separate areas from the corneal apex were taken at x1200 and x3000 for each cornea. Two masked, experienced examiners then graded the corneal epithelial damage. RESULTS: In the high-frequency dosing group, mean corneal damage score for eyes treated with gatifloxacin was 1.593, that for moxifloxacin was 1.407, and control was 1.000. No statistically significant difference was found between gatifloxacin and moxifloxacin (P = 0.41), gatifloxacin and control (P = 0.14), or moxifloxacin and control (P = 0.23). In the cataract surgery prophylaxis group, mean corneal damage scores for eyes treated with gatifloxacin was 1.167, that for moxifloxacin was 1.368, and control was 1.000. No statistically significant difference was found between gatifloxacin and moxifloxacin (P = 0.23), gatifloxacin and control (P = 0.08), or moxifloxacin and control (P = 0.23). CONCLUSION: Despite differences in formulations, with short-term dosing neither gatifloxacin nor moxifloxacin appears to be toxic to the corneal epithelium in this rabbit model.     

Fascicular keratitis in children: can corneal phlycten be mobile?

Phlyctenulosis is an uncommon condition that usually affects children's cornea or conjunctiva. Although its exact aetiology is unknown, it is thought to be a non-specific delayed hypersensitivity reaction to staphylococci or other bacterial, fungal or parasitic antigens. Herein a case of a 3.5-year-old boy with corneal phlyctenulosis is described in whom the phlycten appears to have has migrated from its origin at the limbus to the central cornea (fascicular keratitis) and become visually disabling. At his last follow up he was asymptomatic. Some stromal scarring of the right cornea remained and his visual acuity improved in both eyes following treatment.     

A case of Stenotrophomonas maltophilia keratitis effectively treated with moxifloxacin

A 70-year-old man with a long history of diabetes mellitus presented to our hospital (Department of Ophthalmology, Sahm Yook Medical Center, Seoul, Korea) complaining of severe ocular pain and visual disturbance in his left eye that had started three days prior to admission. A round 3.7 × 5.0 mm dense central stromal infiltrate with an overlying epithelial defect was noted on slit-lamp examination. Following corneal scrapings and culture, topical 0.5% moxifloxacin and 0.5% tobramycin were administered hourly. A few days later, Stenotrophomonas maltophilia was isolated in a bacterial culture from a corneal specimen. According to the results of susceptibility tests, topical 0.5% moxifloxacin was given every hour and 0.5% tobramycin was stopped. The patient's clinical features improved steadily with treatment. The corneal epithelium healed rapidly, and the infiltrate resolved within four weeks of the initiation of treatment. The patient's best corrected visual acuity improved from hand motion to 20 / 25.     

Therapeutic effects of heparin on Pseudomonas-induced corneal ulceration.

Fifty organisms of Pseudomonas aeruginosa were injected intralamellarly in both eyes of 60 albino rabbits. Twenty-four hours later, all eyes were graded and stratified into six groups of ten rabbits with equivalent infections. Treatment was begun with gentamicin alone or 0.3% polymyxin B alone, and in combination with acetylcysteine, 0.3M edetate disodium, and 2.500 units/ml of heparin sodium, four times daily. We also compared topical colistin and colistin and topical heparin. After two weeks, those corneas treated with polymyxin B and topical heparin showed a reduction in ulceration, corneal thinning, and descemetocele formation compared to those treated with polymyxin B alone. Based on these studies, heparin was administered topically, four times daily, to three patients with Pseudomonas-induced corneal ulcers in addition to antibiotics. Before treatment all corneas showed evidence of corneal liquefaction and two of the corneas were in imminent danger of perforation. After therapy, no corneas perforated; one patient recovered visual acuity of 6/9 (20/30), one patient recovered visual acuity of 6/6 (20/20) after keratoplasty, and the third has a vascularized leukoma.     

Laser in situ keratomileusis in eyes with inactive herpetic keratitis.

PURPOSE: To evaluate the safety and outcome of laser in situ keratomileusis in eyes with inactive herpetic keratitis. METHODS: Prospective, interventional case series. In three eyes of three patients with inactive unilateral herpetic keratitis for a minimum period of 1 year, laser in situ keratomileusis was performed. Oral and topical acyclovir were prescribed perioperatively. No topical steroids were prescribed. RESULTS: Preoperatively, all three eyes had corneal stromal scars with induced astigmatism in two eyes and central stromal scar in one eye with best-corrected visual acuity of 20/120, 20/25, and 20/50, respectively. Postoperatively, the three eyes achieved uncorrected visual acuity of 20/20, 20/20, and 20/50, respectively, with decreased corneal scar. None of the patients developed herpetic keratitis reactivation during a minimum follow-up of 6 months. CONCLUSION: Laser in situ keratomileusis was safe and effective in the treatment of refractive errors and corneal scars in three eyes of three patients with inactive herpetic keratitis.     

Safety of undiluted intracameral moxifloxacin without postoperative topical antibiotics in cataract surgery

The objective of this study is to evaluate the safety of undiluted 0.5 % intracameral moxifloxacin for postoperative endophthalmitis prophylaxis in cataract surgery patients without the use of additional postoperative topical antibiotics. All phacoemulsification cataract surgeries performed by a single surgeon (B.A.) at the John A. Moran Eye Center from June 2012 to May 2015 were reviewed retrospectively. From June 2012 to April 2014, patients were given topical 0.5 % moxifloxacin postoperatively. From May 2014 to May 2015, all patients were given moxifloxacin intracamerally with no antibiotics postoperatively. The follow-up period was 1 month after surgery. Preoperative visual acuity and postoperative visual acuity, corneal edema, and anterior chamber reaction were recorded and compared between the two groups. 384 cataract surgeries were performed during the study period. None of the 384 eyes in the study developed endophthalmitis. Of those 384 eyes, 222 were included in the study for analysis based on the inclusion and exclusion criteria. 131 were part of the topical antibiotic group and 91 were part of the intracameral group. The differences in uncorrected visual acuity at 1 day postoperatively (p = 0.595) and best corrected visual acuity at 1 month postoperatively (p = 0.099) were not statistically significant. Differences in corneal edema (p = 0.370) and anterior chamber reaction (p = 0.069) at 1 day postoperatively and corneal edema (p = 0.512) and anterior chamber reaction (p = 0.512) at 1 month postoperatively were also not statistically significant. Undiluted 0.5 % moxifloxacin can be safely injected intracamerally following cataract surgery without additional postoperative antibiotic prophylaxis to prevent endophthalmitis without adverse effects on patient outcomes.     

Epithelial scraping for corneal epithelial ingrowth after laser in situ keratomileusis

BACKGROUND: Laser in situ keratomileusis (LASIK) is an effective method for correcting a wide range of myopia. However, complications sometimes occur. We report here a case treated with epithelial scraping two years and 4 months after surgery for epithelial ingrowth in the central cornea after LASIK. CASE: A 32 year-old woman who had undergone LASIK one year and 4 months before visited our hospital because of visual loss. At the first examination in our clinic, her best-corrected visual acuity was 20/60 in the right eye and 20/15 in the left eye. Epithelial ingrowth was observed in both eyes, but in the right eye, the epithelial ingrowth had reached the central cornea leading to the visual loss. The increased corneal stromal opacity decreased the visual acuity to 20/400. The patient decided to undergo epithelial scraping. The corneal flap was dissected again and epithelial scraping was performed on the stromal bed and back of the corneal flap. The visual acuity was improved from 20/400 to 20/40. However, the stromal opacity and the corneal astigmatism still remained. CONCLUSION: This case suggests that epithelial scraping should be performed immediately when ingrowing epithelium after LASIK begins to invade the central cornea.     

Topical bevacizumab and ocular surface neovascularization in patients with stevens-johnson syndrome

PURPOSE: To evaluate the efficacy and safety of topical bevacizumab on ocular surface neovascularization among patients with Stevens-Johnson syndrome. METHODS: This was a retrospective, interventional case report. Three eyes of 2 patients were examined. Bevacizumab (25 mg/mL) eyedrops were applied 4 times daily for a period of 3 months. Main outcome measures were improvement of symptoms, visual acuity, degree of ocular surface neovascularization, corneal opacification, conjunctival injection, and occurrence of adverse events. RESULTS: Both patients completed the 3-month observation period and reported that it significantly improved ocular comfort. At the end of the study period, visual acuity improved in all 3 eyes; all eyes were observed to have decreased ocular surface neovascularization, corneal opacification, and conjunctival injection. No serious adverse events were reported. CONCLUSIONS: Topical bevacizumab is well tolerated and may be effective in improving comfort and inducing regression of ocular surface neovascularization, conjunctival injection, and corneal opacification in patients with ocular surface disease caused by Stevens-Johnson syndrome. Further controlled and long-term studies are needed to fully evaluate the long-term effects of this novel treatment.     

Topographic predicted corneal acuity with intrastromal corneal ring segments.

PURPOSE: To evaluate predicted optical quality of the central anterior corneal surface before and after the intrastromal corneal ring segment (ICRS) refractive procedure using a clinical videokeratoscope and software index developed for that purpose. METHODS: Predicted corneal acuity, a topographically derived index provided with the EyeSys System 2000 videokeratscope, representing potential optical quality of the cornea, was assessed preoperatively and at postoperative month 3 in 94 eyes that received an ICRS to treat -1.00 to -6.00 D of myopia. Predicted corneal acuity was calculated by determining the difference between a measured cornea and its best-fit ellipses for reflected ring circumferences within the central 3 mm diameter zone. RESULTS: Preoperative predicted corneal acuity was 20/10 in 92 of 94 eyes (98%). At month 3 after the ICRS procedure, 48 (51%) of moderately myopic eyes were corrected to 20/20 or better, 96% (90 eyes) were corrected to 20/40 or better, and 98% of eyes (92 eyes) had a predicted corneal acuity of 20/10. For the eyes with a predicted corneal acuity of 20/10, spectacle-corrected visual acuity was normally distributed between 20/10 and 20/25. CONCLUSION: Predicted corneal acuity did not change significantly from baseline in eyes with an ICRS. This suggests that topographic irregularities in the central 3 mm of the cornea detectable by predicted corneal acuity software were not induced in the central cornea with the ICRS.     

Successful topical cyclosporin A in the therapy of progressive vascularising keratitis in keratitis-ichthyosis-deafness (KID) syndrome (Senter syndrome)

BACKGROUND: The keratitis-ichthyosis-deafness (KID) syndrome (Senter Syndrome) and its major criteria erythrokeratodermia, neuro-sensoric deafness and vascularising keratitis were defined in 1981. Several cases have been described since 1915, but up to now no causal therapy of this disease with sporadic occurrence has been found. Clinical experience using systemic Cyclosporin A (CsA) in the dermatological therapy of the KID syndrome differs. Up to now there has been no report on the use of topical CsA eye drops in the therapy of vascularising keratitis. HISTORY AND SIGNS: We report on a case of keratitis, ichthyosis and deafness (KID syndrome) in a 36-year old male. Both eyes were suffering from recurrent corneal ulcers (ulcus serpens corneae). No improvement had been observed on topical or systemic medication (including lubricants, antibiotics, steroids, etc.) during a history of more than two years. THERAPY AND OUTCOME: Topical CsA 2 % (eye drops, 3 times daily) was administered in addition to lubricants. After 3 months the deep corneal neovascularisations were significantly reduced. The corneal ulcer was closed and visual acuity increased from 20/400 (OU) to 20/100 (OD) and 20/200 (OS), respectively. CONCLUSION: A dose-dependent keratinocyte growth inhibition was found in vitro for cyclosporin A using ichthyosis skin samples. The reduction of activated T-lymphocytes and the resulting reduced HLA-Class-2 expression of conjunctiva and cornea as well as the inhibition of activated T-Cells in the lacrimal gland might be responsible. Nevertheless, the effect of topical CsA on the vascularizing keratitis in the KID syndrome is unknown.     

Ring keratitis from topical anaesthetic misuse

BACKGROUND: Topical anaesthetic abuse is now an established differential diagnosis of ring keratitis. Published evidence suggests that this condition often has a poor prognosis, with the eyes sometimes requiring penetrating keratoplasty or the patient becoming blind. METHOD: A case of topical anaesthetic abuse and its subsequent management is presented. Ocular examination including pachymetry and specular microscopy is reported. RESULTS: The cornea made an excellent recovery, allowing a visual acuity of 6/6. Pachymetry showed corneal thickening and specular microscopy demonstrated a decreased cell count in the affected eye. CONCLUSIONS: With prompt recognition and appropriate treatment the prognosis for these cases can be excellent. However, there is evidence to suggest permanent cellular damage to the endothelium.     

A case of noninflammatory corneal edema following anterior-posterior radial keratotomy successfully treated by topical steroids

BACKGROUND: Corticosteroids seems to affect the functions of corneal endothelial cells directly in addition to its anti-inflammatory effect. CASE: A 69-year-old male presented with left blurred vision and decreased visual acuity in both eyes. He had undergone anterior-posterior radial keratotomy for myopia in both eyes 40 years before. Both eyes showed mild corneal stromal edema in the pupil area. We diagnosed the condition as corneal edema secondary to cell loss and dysfunction of corneal endothelium after surgery. The stromal edema further advanced in the left eye one month later. The corneal thickness increased from the initial value of 619 to 631 microns. The corrected visual acuity decreased from 0.5 to 0.06. There were no signs suggesting inflammatory reaction. The left eye was then treated with topical corticosteroids as eye-drops and by subconjunctival injection. The corneal thickness decreased to 546 microns two months later with improvement of visual acuity to 0.5. CONCLUSION: This case illustrates that topical corticosteroids may be effective for corneal edema through their anti-inflammatory effect and possible activation of the endothelium.     

LASEK矫治薄角膜中低度近视远期效果

目的评价准分子激光上皮下角膜磨镶术（LASEK）矫治薄角膜（中央角膜厚度〈500μm）中低度近视的远期效果和安全性。方法回顾分析LASEK矫治中低度近视术后5～7年,对比术前薄角膜者与正常角膜厚度者的屈光度、视力、对比敏感度、眩光对比敏感度、角膜内皮细胞、角膜地形图。结果薄角膜组27例52眼,正常角膜厚度组31例62眼。两组术后随访均未见圆锥角膜病例。术后矫正视力均≥1．0。裸眼视力：薄角膜组≥1．0者49眼（94．23％）,〈1．0者3眼;正常角膜组≥1．0者58眼（93．55％）,〈1．0者4眼（x^2=0．0228,P〉0．05）。角膜Haze：薄角膜组0级49眼（94．23％）,0．5级3眼;正常角膜组0级60眼（96．77％）,0．5级2眼（x^2=0．4416,P〉0．05）。角膜内皮细胞形态两组均多为六角形,形态较一致,细胞边缘整齐;平均角膜内皮细胞密度：薄角膜组（2330±294）／mm^2,正常角膜组（2413±320）／mm^2（t=1．4310,P〉0．05）;平均角膜内皮细胞面积：薄角膜（420±78）μm^2,正常角膜组（447±92）／μm^2（t=1．6875,P〉0．05）。两组术后各空间频率对比敏感度、眩光对比敏感度均差无差别（P〉0．05）。结论LASEK矫治薄角膜中低度近视安全,效果稳定,未见圆锥角膜并发症。     

Late-onset interface inflammation associated with wearing cosmetic lenses 18 months after laser in situ keratomileusis

PURPOSE: To report a case of late-onset interface inflammation associated with wearing a cosmetic lens 18 months after laser in situ keratomileusis (LASIK). METHODS: A 25-year-old woman visited our hospital with visual disturbance and ocular pain in the left eye. The patient had undergone LASIK in both eyes 18 months ago and had been wearing cosmetic lenses intermittently for 6 months. The day before presentation, the patient had slept with cosmetic lenses. At presentation, best-corrected visual acuity was 2/200 in the left eye. Slit-lamp examination of the left eye revealed corneal edema and a diffuse granular white infiltrate at the interface. RESULTS: Intense topical steroid and antibiotic treatment resulted in resolution of interface inflammation. After 2 weeks, the corneal infiltrate had resolved, and best-corrected visual acuity had improved to 20/25. CONCLUSIONS: This case indicates that late-onset interface inflammation can develop in association with the use of cosmetic lenses in LASIK-treated eyes.     

Topical pefloxacin in bacterial keratitis

Problem: To evaluate the clinical efficacy and safety of topical pefloxacin 0.3% drops as the sole antibiotic used to treat culture positive bacterial corneal ulcers. Methods: Forty two consecutive Gram's smear-positive cases of bacterial corneal ulcers were enrolled for this prospective open labelled clinical trial. All patients underwent a complete clinical and microbiological work up and were put on topical 0.3% pefloxacin drops with supportive cycloplegic, vitamins and antiglaucoma therapy. Of 42 cases, 4 cases of mycotic keratitis and 6 culture negative cases were excluded from the study. Results: Positive microbiologic cultures were obtained in 84.2% (32 of 38) cases. Staphylococcus aureus (14/32; 43.7%) and coagulase negative Staphylococci (12/32; 37.5%) were the two most common organisms isolated. Resolution of the corneal ulcer was achieved in 31 out of 32 cases (96.9%) with a mean duration of 9.3 ± 5.3 days (range 3–21 days). Best corrected visual acuity of 20/200 or better was achieved in 65.6% of cases at 4 weeks post resolution. Corneal deposits were observed in one case which disappeared 8 days following discontinuation of therapy. Conclusions: Topical pefloxacin is effective as a single antibiotic agent for the treatment of bacterial keratitis.