Radial keratotomy in a patient with keratoconus.

A 30-year-old white male with keratoconus had uneventful radial keratotomy in his right eye. Although a good initial response was obtained with total correction of myopia and astigmatism, by 18 months postoperatively the entire result had regressed and the patient demonstrated reformation of the cone and regression to high myopia. Scarring occurred in the three inferior cuts overlying the cone. Cuts on the horizontal axis, and superiorly (above the cone), had a normal appearance with normal wound healing. Because of the nature of the wound healing overlying the portion of the cornea affected by the keratoconus and because of the total regression of effect, radial keratotomy in patients with keratoconus does not appear to be an effective modality.     

Bilateral severe keratoconus after laser in situ keratomileusis in a patient with forme fruste keratoconus

We report a case of bilateral keratoconus after laser in situ keratomileusis (LASIK). Before surgery, the patient had a forme fruste keratoconus, which evolved rapidly to a severe form of keratoconus in the months following LASIK. From this case, we conclude that forme fruste keratoconus is a contraindication to LASIK.     

Recurrent keratoconus in a patient with Leber congenital amaurosis

PURPOSE: Clinical history of a 17-year-old patient with Leber congenital amaurosis (LCA) with histologically proven recurrent keratoconus (KC) two years after corneal transplantation in one eye and a recurrence-like appearance with a more global contour on the other eye four years after corneal grafting is reported. The possible mechanisms for this recurrence are discussed in light of the fact that this is, to the best of our knowledge, the first penetrating keratoplasty reported in LCA. METHODS: Computerized videokeratography (CVKG) and specular microscopy were performed preoperatively. The patient underwent regrafting, and the excised corneal button was examined by light microscopy and transmission electron microscopy. RESULTS: Analysis of CVKG showed a keratoconus-like pattern on the right eye, with the left eye demonstrating the aspects usually seen in keratoglobus. Histologic examination revealed the features usually observed in progressed keratoconus. CONCLUSION: Recurrence of keratoconus in a graft has not yet been described after such a short time until now. A "true" recurrence of the disease is postulated; it could be caused by an "aggressive" genetic factor that also leads to the frequent KC in patients with LCA. This mechanism also could explain the high incidence and rapid progress of KC in this disease.     

Insufficient accommodation in patient with keratoconus

The accommodation response in 10 unoperated patients with keratoconus (mean, 28.3 years) and 10 age-matched normal individuals (mean, 25.8 years) was examined. Using infrared high-speed optometer and iriscorder, quasistatic accommodation and concomitant pupillary response were simultaneously measured by controlling a fixation target for accommodation with a microcomputer. The amplitude of the accommodation response was markedly lower in patients with keratoconus (2.8 +/- 1.4 Diopter) than in controls (4.7 +/- 1.3 Diopter: p less than 0.005). The maximum pupillary responses during far to near accommodation was also significantly decreased in the keratoconus group (0.25 +/- 0.24) when compared with controls (0.56 +/- 0.15; p less than 0.001), despite no statistical difference in pupillary size in the far point between the two groups. The above two pathologic parameters were not found to correlate with the severity of keratoconus. These results suggest that some predisposing abnormalities may exist in the iris and ciliary body of patients with keratoconus, which may be responsible for a paretic pupil that occasionally occurs after corneal transplantation in these patients.     

Keratolysis following excimer laser phototherapeutic keratectomy in a patient with keratoconus

PURPOSE: We report a case of keratolysis following phototherapeutic keratectomy (PTK) for a subepithelial nodule in a patient with keratoconus. METHODS: A 29-year-old male with keratoconus who became contact lens intolerant because of a raised subepithelial nodule was treated with excimer laser phototherapeutic keratectomy (PTK). RESULTS: The epithelium failed to heal postoperatively, and progressive keratolysis led to a central descemetocele by the eighth postoperative day. The patient was managed with a penetrating keratoplasty. CONCLUSIONS: Excimer laser phototherapeutic keratectomy has been shown to be an effective treatment for subepithelial nodules in patients with keratoconus. Rapidly progressive keratolysis is a potential complication of this procedure.     

Corneal melting after cross-linking and deep lamellar keratoplasty in a keratoconus patient

We present the case of a 45-year-old patient with severe atopic disease and keratoconus who suffered from corneal melting following cross-linking and deep anterior lamellar keratoplasty (DALK) due to subclinical infection with Herpes simplex virus (HSV). Penetrating keratoplasty and intensive antiviral and immunosuppressive medical treatment were necessary to control the infection. The case demonstrates the difficulties in the treatment of keratoconus in patients with severe atopic disease.     

Postkeratoplasty endophthalmitis by Alcaligenes faecalis: a case report

PURPOSE: To describe a postkeratoplasty endophthalmitis owing to Alcaligenes faecalis that resolved with medical management. METHODS: Case report and review of literature. RESULTS: To best of our knowledge, postkeratoplasty endophthalmitis caused by A. faecalis has not been reported in literature. The source of infection was found to be the donor tissue. The organism isolated was resistant to gentamicin, which was the only antibiotic present in the storage medium (McCarey and Kaufman medium). The patient was treated aggressively with topical, systemic and intravitreal antibiotics. The endophthalmitis resolved completely within two weeks. CONCLUSION: A. faecalis is a gram negative, non-spore forming rod that can cause endophthalmitis if donor tissue is contaminated with the organism. Clinical suspicion, review of bacterial culture and sensitivity report from donor tissue, anterior chamber and vitreous taps, along with early therapy with appropriate antibiotics can lead to resolution of infection.     

Implantation of Artisan toric phakic intraocular lens following Intacs in a patient with keratoconus

We report a 24-year-old man with bilateral keratoconus in whom Intacs (Addition Technology, Inc.) were implanted in both eyes. The procedure was followed by Artisan toric phakic intraocular lens (Ophtec) implantation to correct the residual myopic and astigmatic refractive error.     

Femtosecond laser-assisted keratoplasty combined with cataract extraction in a patient with keratoconus and oculocutaneous albinism

In this study, we present a case of a 58-year-old male patient with oculocutaneous albinism, keratoconus, total cataract, and glaucoma originating from father-daughter incest. He underwent femtosecond laser-assisted keratoplasty with “open-sky” cataract extraction and posterior chamber intraocular lens implantation. One week after surgery his uncorrected visual acuity improved from hand motion to 20/200. Six months later corneal K values were 49.1 D in the flat and 50.0 D in the steep meridian. The graft had a central corneal thickness of 488 µm and was well fitted. The patient''s quality of life improved substantially due to the surgery. To the best of our knowledge, this is the first report on the association of albinism with advanced keratoconus, total cataract, and glaucoma. Moreover, no previous report on femtosecond laser-assisted keratoplasty using VisuMax femtosecond laser system with “open-sky” cataract extraction is available in the literature. The VisuMax femtosecond laser-assisted keratoplasty ensures fast patient rehabilitation in such challenging cases.