One-year results after radiotherapy of choroidal neovascularization in age-related macular degeneration

Summary Choroidal neovascularization (CNV) associated with age-related macular degeneration is the major cause of legal blindness in Europe and the USA in patients aged more than 65 years, but Chakravarthy et al. has reported that radiotherapy has a beneficial effect on visual acuity. Methods: Since March 1996 we have treated 56 patients in cooperation with the Department of Radiotherapy at the Technical University in Munich. The total dose with external beam radiotherapy was 16 Gy in 8 fractions, delivered through an anterior oblique axis to spare the lens. Before the treatment and 3, 6 and 12 months after therapy, we performed a standardized visual acuity and contrast-sensitivity test (ETDRS, Pelli Robson Chard) and fluorescin angiography 6 and 12 months after therapy. Results: Twenty-five angiograms showed well-defined CNV and 31 not well-defined CNV. Six months after the treatment 15 patients had stable visual acuity within one line. Twenty-seven patients had lost more than one line of visual acuity. There was no difference between well and not well defined CNV's. One year after treatment the visual acuity remained stable within one line in 4 patients, no patient had an increase of two lines or more and 17 patients lost more then 2 lines of vision. We saw no side effects other than sicca symptoms in 3 patients. Conclusion: In our opinion, these results do not show that radiation treatment has a real beneficial effect on visual acuity. Further randomized studies are needed to demonstrate the efficiency of this treatment for choroidal neovascularization in AMD.      

Repeat laser coagulation of subretinal neovascularization in age-related macular degeneration

Introduction: Retinal laser coagulation (LC) of extrafoveal subretinal neovascularization (SRN) due to age-related macular degeneration (AMD) is the only sure therapy. Diagnostics, therapy and follow-up are presented in a case report. Case report: A 55-year-old woman had suffered from progressive reduction of visual acuity (with metamorphopsia) in both eyes (LE > RE) for 3 years. In the RE the visual acuity was 0.32 and in the LE 0.05. Funduscopy and fluorescein angiography revealed in both eyes the wet form of AMD.The extrafovealy located SRN of the RE was photocoagulated and had to be retreated three-times in 6 weeks due to persistence. For 8 months the findings in the RE have been stable. VA has been improved to 0.4 and no metamorphopsia has been found. Conclusion: Extrafoveal SRN should be treated by LC. Short-term follow-up (including FA) and in most cases several LCs are necessary to close the SRN and save the patients' reading vision.      

Management of submacular hemorrhage by tissue plasminogen activator and SF6 gas injection

Summary The formation of platelet-fibrin clots causes degeneration of foveolar photoreceptors by subretinal hemorrhage. Patients: Twenty-two patients with submacular hemorrhages were treated by intravitreal injection of 50 μg tpa and 0.5 ml SF₆ gas within 1 h. Biomicroscopy, fundus photography and fluorescein angiography were performed pre- and postoperatively. Further multifocal electroretinograms were recorded. Results: The subfoveolar hemorrhages were dissoluted and displaced out of the macular region. The visual acuity increased in 18 cases and ranged from hand movement and 0.3 to values between 1/10 and 0.5. Conclusions: Toxic and hypoxic damage of foveolar photoreceptors by subretinal hemorrhage can be prevented by early and minimal invasive fibrinolytic therapy. After localization of choroidal neovascularizations, treatment by focal laser coagulation is possible in some cases.      

Phototherapeutic keratoectomy (PTK) after keratoconjunctivitis epidemica

Background: Persistent and recurrent nummuli after epidemic keratokonjunktivitis (EKC) often lead to reduced visual acuity and increased glare. In spite of long-term topical steroid therapy nummuli often recur. We tried to treat persistent nummuli with phototherapeutic keratectomy (PTK). Patients: PTK with an excimer laser (193 nm) was performed in 13 eyes of 9 patients with nummuli. The nummuli were observed over 3–72 months (mean: 36 months). Preoperatively, the visual acuity was 0.1–0.9 (mean: 0.39 ± 0.22) and the brightness acuity test (BAT) was 0.05–0.5 (mean: 0.25 ± 0.15). Prior to PTK all eyes had been treated with local steroids several times for recurrent nummuli. Results: During the follow-up from 15 to 56 months (mean: 33 ± 11.5 ms), 11 eyes had an increase in visual acuity: 0.3–1.0 (mean: 0.63 ± 0.26). The reduction of glare was especially beneficial for the patients: 0.3–0,9 (mean: 0.55 ± 0.21). One patient had a recurrence of nummuli in both eyes 6 weeks after PTK. The subjective-induced spheric refractive change was − 2.5 D to + 2.0 D. The astigmatic error changed between − 2.0 D to + 1.5 D. Conclusion: PTK seems to be an effective method of treating persistent, recurrent nummuli after EKC. The low rate of recurrence of nummuli after PTK is remarkable.      

Correction of myopia and astigmatism using laser in situ keratomileusis

Patients and methods: In order to better define the potential advantages and risks of laser in situ keratomileusis (LASIK), we designed a prospective study including 73 eyes. Results: After 6 months, 62 eyes were examined. Myopia was corrected from –6.10 ± 3.12 (mean ± standard deviation) to + 0.04 ± 0.66 D, with 54 eyes (87.1 %) being within ± 1.00 D of emmetropia. Astigmatism was corrected from –1.07 ± 1.02 to –0.32 ± 0.89 D. Uncorrected visual acuity was 0.5 or better in 59 eyes (95.2 %) and 1.0 or better in 27 eyes (43.5 %) 6 months postoperatively. More than one line in best-corrected visual acuity was lost by 6 eyes (9.7 %), with most of these eyes being highly myopic. There was no change or a gain in lines in best corrected visual acuity in 42 eyes (66.1 %). Intraoperative complications arose in two eyes (2.7 %); in one eye, visual acuity was temporarily decreased. More treatments were performed in 7 eyes (9.6 %). Postoperatively, no haze, scars or central islands were detected. Patient satisfaction after LASIK was high: 97.3 % were pleased or very pleased with the result. Conclusions: In conclusion, LASIK is effective in the correction of myopia and myopic astigmatism. Although complications more frequently occurred in the correction of higher refractive errors, LASIK seems to be relatively safe compared with other refractive methods.      

Deep lamellar keratoplasty with the guided trephine system for transplanting fullthickness donor tissue

Background: Despite the fact that deep lamellar keratoplasty (DLKP) is less invasive than to penetrating keratoplasty (PKP), this procedure is rarely performed. We therefore investigated whether or not the DLKP technique we employed can achieve stable improvement of visual acuity. Materials and methods: Thirty-three eyes underwent TLKP for treatment of superficial corneal pathology. The donor tissue transplanted was suitable for PKP. The donor lenticule was obtained on the artificial chamber of the guided trephine system (GTS). The recipient cornea was trephined with the same trephine to a depth of 680 μm. Manual dissection was performed with a bevel-up blade. The donor lenticule with the endothelium peeled off was then sutured in with a 10 × 0 nylon double-running antitorque suture. Cortisone-antibiotic eye drops were administered postoperatively. Results: Throughout the series no complications occurred. The mean best corrected visual acuity (BSCVA) over glasses was 0.29 ( ± 0.21) preoperatively, 0.1 ( ± 0.11) at 1 week, 0.33 ( ± 0.14) at 1 month, 0.5 ( ± 0.13) at 6 months, 0.61 ( ± 0.16) at 1 year and 0.63 ( ± 0.15) at 2 years. Clinically, we observed two subpopulations. In the first group of 87 % of the cases, mean BSCVA was 0.67 ( ± 0.07) at 6 months. The remaining cases (BSCVA ≤ 0.25 at 6 months) achieved a mean BSCVA of only 0.2 ( ± 0.04) at 1 year. Mean corneal astigmatism measured 2.93 D ( ± 1.62) preoperatively, 2.69 D ( ± 1.18) at 1 month, 2.09 D ( ± 1.07) at 1 year, and 2.22 D ( ± 1.11) at 2 years. We did not observe any graft rejection. Conclusion: The technique reported for DLKP provides excellent matching of donor lenticule and recipient bed. Separation of donor and recipient stroma prevents interface healing. DLKP appears to be a safe procedure for the surgical treatment of superficial corneal pathology and may offer a clinically applicable alternative to PKP.      

Radiotherapy for choroidal neovascularization in age-related macular degeneration. A pilot study using low- versus high-dose photon beam radiation

Purpose: Several pilot studies have indicated that low-dose radiation therapy might have a beneficial effect on the course of choroidal neovascularization (CNV) in age-related macular degeneration (AMD). This study aimed to ascertain whether such treatment might halt the progression of neovascular AMD and whether a low or a high radiation dose should be applied. Patients: The patients comprised some randomized to 0 vs 10 vs 36 Gy of radiation and (after a change of the study protocol became necessary) others who participated in a prospective, controlled non-randomized pilot study. Enclosed were eyes with visual acuity of ≥ 0.1 and ≤ 0.6 revealing a juxta-subfoveal CNV either of the occult type (type 1) or the classic type (isolated or as part of a predominantly occult lesion). Results: Eyes treated with 10 Gy for occult CNV (n = 12) were subject to severe visual loss in 41.6 % of the cases compared to 38.5 % in the control group (n = 13) at 12 months of follow-up. For eyes treated with 10 Gy because of classic CNV, the corresponding figures were 33 % (n = 18) and 57 % (n = 14) respectively. At 18 months of follow-up, the percentages were 63 % and 75 % respectively. Fluorescein angiographic growth of classic and occult CNV could not be halted by 10 Gy, while a temporary growth retardation was observed in cases irradiated with 36 Gy. Conclusion: In the study presented, the natural course of occult CNV could not be improved by irradiation with 10 or 36 Gy. In cases of classic CNV, low-dose irradiation with 10 Gy postponed severe visual loss by a maximum of 18 months. A positive treatment effect was also observed in cases irradiated with 36 Gy; however, a 25 % incidence of radiation retinopathy seems unacceptable.      

YAG laser capsulotomy in multifocal intraocular lenses

Introduction: Multifocal intraocular lenses (MIOLs) have been implanted with good results for several years. Because the light is distributed between two or more focuses, there is slight light reduction for every picture. Capsular fibrosis can cause additional reduction of the amount of light to the retina. Patients and methods: A diffractive MIOL 811X from Pharmacia & Upjohn was implanted in 40 eyes of 40 patients. Within 1 year postoperatively, 13 patients underwent YAG Laser capsulotomy between the 4th and the 6th month. Before and after the YAG laser the visual acuity for distance and near vision was tested. In addition, a contrast test (Ginsburg test) was performed. Results: Before YAG laser capsulotomy, the visual acuity for distance without correction was 0.5 (± 0.17) and near vision J 2.4 (± 1.4). After the YAG laser procedure, uncorrected visual acuity improved to 0.65 (± 0.21) for distance and J 1 (± 0) for near vision. With the best distance correction the distance vision was 0.85 (± 0.18) and near vision was J 1.77 (± 0.89) before capsulotomy. After the YAG laser treatment, patients reached with best correction a visual acuity of 1.1 (± 0.24) at distance and J 1 (± 0) at near vision. The contrast equivalent acuity increased from 20/70 before the YAG laser treatment to 20/40 after ward. Discussion: Patients with a MIOL feel early visual discomfort due to capsular fibrosis. In most cases the patients still have good visual acuity, but decreased contrast sensitivity. Early YAG laser capsulotomy increases the visual acuity and the contrast sensitivity significantly.      

A prospective study investigating the long-term stability of changes in astigmatism following arcuate lamellar keratotomy (ALK): 3-year results

Introduction: The correction of low to moderate astigmatism is possible today by means of photoablation (PRK), while the treatment of moderate and higher astigmatism still involves refractive keratotomy. Experience has shown that cataract surgery, using modern tunnel techniques with self-healing incisions, results in earlier stability in both the refractive outcome and wound healing. In this study, we attempted to combine the advantages of lamellar keratotomy with those of a pair-wise T-incision as arcuate lamellar keratotomy (ALK). Patients and methods: The clinical outcome of 41 patients who underwent ALK was investigate in a prospective study over a period of 3 years. The pre- and postoperative investigations undertaken included the measurement of astigmatism using a Zeiss keratometer, uncorrected visual acuity, and corrected glare vision using a Humphrey autorefractor. All patients had astigmatism between 2.0 and 7.0 D. Together with a uniform arcuate incision, we used 7 mm (n = 26) and 8 mm (n = 15) mm zones for correction. Results: The average preoperative astigmatism was 4.01 ± 1.90 (median, 3.50) D. After a 3-year follow-up the average postoperative astigmatism was 1.59 ± 1.29 (median, 1.38) D. The astigmatic change induced (Jaffé) after 3 years was about 3.23 ± 2.23 (median, 3.16) D. The average uncorrected visual acuity (log MAR) before ALK was 0.20 ± 0.12 (median, 0.22) and after follow-up, 0.41 ± 0.14 (median, 0.39). Corrected glare vision before surgery was 0.23 ± 0.19 (median, 0.10) and afterwards, 0.25 ± 0.22 (median, 0.14). Conclusions: Arcuate lamellar keratomy (ALK) stood the test as a routine clinical procedure for correction of moderate astigmatism with stable postoperative functional outcomes. We did not find impairment of glare vision following this procedure.      

Classification of corneal topography after penetrating keratoplasty

Background: Semiquantitative classification of corneal topography after penetrating keratoplasty has the potential for focusing information about the areal dioptric power of the cornea. The purpose of this study was to objectify the procedure of manual semiquantitative classification using a Fourier transform of corneal topography power data and to correlate both methods. Patients and methods: Fifty patients each (30 keratoconus, 20 Fuchs dystrophy) underwent nonmechanical trephination (excimer laser MEL60, Aesculap-Meditec, Jena) in penetrating keratoplasty. All procedures (7.5-mm trephination diameter in Fuchs, 8.0 mm in keratoconus, double-running 10–0 nylon suture) were done by one surgeon. Pre-, intra- and postoperative treatment were identical. At the follow-up examinations, the keratometric astigmatism, qualitative and quantitative criteria of the automatic videokeratography, visual acuity and refraction were assessed. Corneal topography was classified both manually and based on Fourier coefficients. Results: After a mean follow-up of 24 ± 5 months, keratometric net astigmatism was 3.0 and 2.7 D with keratoconus and Fuchs dystrophy. Corneal topography analysis showed a higher orthogonality of the bow-tie shape and less asymmetry between opposite hemimeridians with increasing follow-up after keratoplasty. The semiquantitative classification showed a statistically significant correlation with the classification based on Fourier coefficients, especially with higher astigmatism and after suture removal (P = 0.04/0.01 before/after suture removal). Discussion: After nonmechanical trephination, the semiquantitative classification of corneal topography can be synthetized using Fourier analysis of corneal dioptric power data. In the future, this method may be favored for prediction of potential best-corrected visual acuity after penetrating keratoplasty.      

Correction of myopic astigmatism by combined treatment with PRK and T-incision and photoastigmatic refractive keratectomy

Background: In contrast to the correction of simple myopia there is no widely accepted technique for the correction of myopic astigmatism. Currently two techniques are available: the photoastigmatic refractive keratectomy (PARK) and the combination of arcuate keratotomies with standard PRK (PRK-T). Methods: In two groups, 67 patients underwent a correction of myopic astigmatism in a total of 87 eyes (19 by PRK-T and 68 by PARK), and were followed for 1 year. The spherical equivalent was − 6.7 D in both groups and the refractive astigmatism ranged from − 1.0 to − 6.5 D. The PARK procedure was performed by means of an elliptic ablation (Kertom I, Schwind) with a 5.8 × 8.1 mm zone. The PRK-T technique consisted of two arcuate keratotomies with a free optical zone of 7 mm and a standard myopic PRK at least 6 weeks later. Results: The 1 year follow-up was completed in 57 out of 87 eyes included in the study. At 1 year post-operation, 83 % of the PRK-T group and 80 % of the PARK group had an uncorrected visual acuity of 20/40 or better. The refractive astigmatism was reduced by 76 % in the PRK-T group and by 67 % in the PARK group. The spherical equivalent was − 0.59 ± 1.1 D at 1 year after PRK-T and − 0.28 ± 1.04 D after PARK. In three eyes of the PARK group (6.7 %) a visual loss of more than one Snellen line occured. Two of these eyes had a preoperative myopia of more than − 6 diopters. Conclusion: Both techniques have the potential to reduce myopic astigmatism, however, the success rate is not as high compared to spherical PRK. Also, the complication rate of 2.5 % in corrections to − 6 D is significantly higher than that with spherical myopic PRK.      

Combined immunosuppressive and surgical therapy of necrotic keratitis in rheumatoid arthritis

Introduction: Areactive forms of keratitis in patients with seropositive rheumatoid arthritis are inflammations threatening the visual acuity and integrity of the eye. They commonly occur in a rheumatologically inactive interval and have a poor prognosis. A retrospective evaluation of medicamentous and surgical strategies for a curative therapy with optical rehabilitation is necessary to optimise the treatment of patients with necrotic sclerokeratitis. Patients and methods: A total of 27 eyes of 22 patients (14 women and 8 men, ranging in age at the time of operation from 40 to 88 years; mean 68.7 years) with seropositive rheumatoid arthritis and secondary Sj?gren's syndrome were reviewed retrospectively. There were 17 eyes with necrotic keratitis and 9 eyes with necrotic sclerokeratitis. In one eye, necrotic sclerokeratitis with bacterial transmigrating keratitis and hypopyon occurred. Operations: In 8 cases we performed a perforating mini-keratoplasty, in 16 cases a tectonic and optical perforating keratoplasty, in 3 cases a tectonic sclerokeratoplasty, in 9 patients a combined keratoplasty and cataract extraction with posterior chamber lens implantation and in 1 case a partial conjunctival plasty. Follow-up ranged from 7 months to 4 years (average 2.8 years). Results: In all eyes, a sufficient tectonic and primary curative effect was achieved only under cyclophosphamide immunosuppression. In 3 cases, a rekeratoplasty had to be performed because of recurrent keratitis after changing the systemic cyclophosphamide therapy to methotrexate, glucocorticosteroids or non-steroid antiphlogistic agents. Visual acuity outcome was depending on the eccentricity of the keratoplasty and earlier affections of the eye. Postoperatively, the visual acuity improved in 23 eyes. In 3 cases, no change of visual acuity was achieved. Visual acuity deteriorated in one case from counting fingers to hand motions. Peri- and postoperative complications during the follow-up period were corneal infiltration around sutures in 4 eyes, graft rejecting reactions in 3 cases, and sicca syndrome in 6 cases. Conclusions: The intensive cooperation of ophthalmologists and rheumatologists enables the successful treatment of apparently hopeless situations in necrotic sclerokeratitis in patients with seropositive rheumatoid arthritis. The rate of complications under an immunosuppressive therapy with cyclophosphamide was found at average 2.8 years follow-up to be low. The indication for the combined therapy depends on the ophthalmological findings; rheumatologists and ophthalmologists should decide on the appropriate dosage for the systemic cyclophosphamide therapy. Topical glucocorticosteroid therapy alone is contra-indicated.      

Focal proliferation of retinal pigment epithelium as risk factor in age-related macular degeneration

Background: Clinical studies have demonstrated the relevance of focal RPE proliferations in early AMD as risk factors for visual loss caused by late AMD. Angiographically these focal RPE proliferations are characterized as small hypofluorescent spots with hyperfluorescent rim without leakage. Corresponding to histological and experimental studies they can be interpreted as small areas of occult choroidal neovascularizations covered by proliferated RPE cells. The characterization of the long-term prognosis of these lesions was the aim of the present study. Patients and methods: Ninety-eight patients (52 female, 46 male) were reexamined clinically and angiographically with a follow-up of 2–12 years (mean 6.5 years). Results: Visual loss of two lines or more could be observed in 64.5 % of patients with final visual acuity less than 20/100 in 24.5 % of patients. Morphologically the changes in visual acuity were related to the progression towards classical choroidal neovascularizations in 32.7 % of patients. In addition 11.2 % of patients demonstrated a regression of the small occult membrane with the development of small areas of RPE atrophy covering the size of the original occult neovascularization. In 10.2 % of the patients enlargement of the lesion was observed, resulting in a large occult choroidal neovascularization without signs of classical membranes, and in 45.9 % of patients the clinical and angiographical situation was unchanged. The most important prognostic factor correlating with visual loss was the presence of a disciform lesion in the fellow eye and of multiple drusen in the examined eye. Other factors like the size or location of the focal RPE proliferation and the duration of follow-up did not correspond with visual loss. Conclusions: Focal RPE proliferations in early AMD interpreted as small occult choroidal neovascularizations are associated with a high risk of visual loss. Especially if these lesions are associated with multiple drusen and a disciform lesion in the fellow eye, nearly all patients are at risk for visual loss. These changes may therefore characterize a special high-risk group for future prophylactic treatments in early AMD, but because of the high risk for the development of classical choroidal neovascularizations in this group, these results are also very important for the planning of prophylactic laser trials for drusen in early AMD.      

Pseudophakia in children with juvenile arthritis

Background: Cataract secondary to juvenile rheumatoid arthritis is a severe, vision-threatening complication in early childhood. Intraocular lens implantation is controversial. The follow-up of four pseudophakic eyes of three patients and their perioperative therapeutic regimen were retrospectively analyzed. Early and late postoperative complications are reported. Patients and methods: Both girls had lens aspiration and posterior lens implantation at the ages of 6 and 12 years, the boy at the age of 10 and 14 years. All patients had relapsing anterior uveitis. The follow-up time was 3 years (1–6 years). One girl was diagnosed with sarcoidosis, causing juvenile arthritis. Both girls had perioperative methothrexate and prednisolone therapy. The boy had azathioprine therapy at the time of his first cataract surgery; later he had no systemic therapy. Both girls' intraocular lenses were implanted at different eye hospitals. Results: Both girls had severe inflammatory reactions after surgery. At the hospitals both eyes had surgical revision for iris capture. In one case this was combined with exchanging the intraocular lens. Iris capture persisted for this eye and later vitrectomy with silicone oil filling was necessary to delay phthisis, resulting in amaurosis. For two pseudophakic eyes vitrectomy was necessary later because of severe vitreous opacities, but visual acuity was severely diminished by chronic cystoid macular edema and epiretinal membranes. The boy developed in his second eye intermittent iris bombata and persistent secondary glaucoma, visual acuity was stabilized at 0.5. Conclusions: Secondary cataract due to juvenile rheumatoid arthritis or sarcoidosis is a difficult situation for phacoemulsification with intraocular lens implantation in children. For severe inflammatory complications intense local and systemic anti-inflammatory therapy is mandatory. Visual prognosis is reduced for the uveitic posterior segment and glaucoma complications. IOL implantation can be recommended for only a very few patients.      

Ophthalmic plaque radiotherapy for age-related macular degeneration associated with subretinal neovascularization

PURPOSE: To evaluate ophthalmic plaque radiotherapy for the treatment of subretinal neovascularization associated with age-related macular degeneration. METHODS: In a prospective phase I clinical trial, we treated 23 patients (23 eyes) with ophthalmic plaque radiotherapy for subfoveal exudative macular degeneration. Palladium 103 ophthalmic plaque brachytherapy was delivered to a retinal apex dose of 1,250 to 2,362 cGy (rad). Early Treatment Diabetic Retinopathy Study type visual acuity determinations, ophthalmic examinations, and angiography were performed before and after treatment. Clinical evaluations were performed in a nonrandomized and unmasked fashion. RESULTS: Patients were followed up for a mean (+/-SD) of 19 +/- 10.7 months (range, 3 to 37 months). Six months after radiation therapy, three (16%) of 19 eyes had lost 3 or more lines of best-corrected visual acuity; 12 months after radiation therapy, four eyes (31% of 13 eyes), and 24 months after radiation therapy, only two (22% of nine eyes) lost 3 or more lines of visual acuity. No eye suffered sudden irreversible loss of central vision. No radiation retinopathy, optic neuropathy, or cataract could be attributed to radiotherapy within this follow-up period. CONCLUSION: Ophthalmic plaque radiotherapy can be used to treat neovascular age-related macular degeneration. In contrast to external beam radiotherapy, ophthalmic plaque radiotherapy is a unilateral treatment, which allows a larger dose to be delivered to the macula with less irradiation of normal ocular structures. We have found no sight-limiting complications at the doses, dose rates, and follow-up evaluated in this study.     

Phototherapeutic keratectomy (PTK) – a successful treatment for Thiel-Behnke dystrophy and its recurrences

Summary In recent years good results after treatment of different superficial corneal pathologies with the excimer laser 193 nm have been reported. Thiel-Behnke dystrophy is a hereditary form of anterior stromal dystrophy, a promising layer for successful phototherapeutic keratectomy (PTK). This type of dystrophy was first described in 1967 in Kiel. Patients and methods: Ten members of the original family of 1967 were re-examined at the University Eye Hospital, Kiel. A phototherapeutic keratectomy was performed in six eyes because of the typical honeycomb corneal surface irregularity and superficial haze. Two of these eyes had a recurrence of the primary disease on the graft. Four eyes had been untreated so far. The best spectacle corrected visual acuity preoperatively was between 20/200 and 20/40. For all treatments the MEL 60 excimer laser (Aesculap Meditec) was used. To even out the peaks and valleys of the irregular surfaces, modulating agents were applied in decreasing concentrations. The follow-up period is now between 8 months and 4 years. Results: All eyes showed significant visual improvement postoperatively with a best spectacle corrected visual acuity of 20/32 and higher. In one of the postkeratoplasty eyes with the longest follow-up after PTK, the original disease has begun to recur. Conclusions: Phototherapeutic keratectomy is a successful therapy for Thiel-Behnke dystrophy; it results in quick recovery of patients and their vision. Stable visual acuity and corneal transparency have been observed that last for years. Recurrences after penetrating keratoplasty or after PTK can be positively retreated. A (re-) keratoplasty may be postponed or avoided.      

Photodynamic therapy for the treatment of choroidal neovascularization secondary to rubella retinopathy

PURPOSE: To describe a patient for whom photodynamic therapy was used to treat subfoveal choroidal neovascularization secondary to rubella retinopathy. DESIGN: Interventional case report.METHODS: A 36-year-old man with subfoveal choroidal neovascularization secondary to rubella retinopathy was treated with photodynamic therapy using verteporfin. Outcome was followed up with subsequent fundus examinations, fluorescein angiography, and evaluations of best-corrected visual acuity. RESULTS: Two treatments of photodynamic therapy using verteporfin resulted in involution of the neovascular membrane, resolution of subretinal hemorrhage, and improvement in best-corrected visual acuity from 20/200 to 20/60 2 months after the second treatment. Owing to recurrence of active choroidal neovascularization, the patient required two more treatments of photodynamic therapy in the next 6 months, after which his best-corrected visual acuity was restored to 20/60. CONCLUSION: Photodynamic therapy may be an effective treatment for subfoveal choroidal neovascularization secondary to rubella retinopathy.     

Argon laser treatment in complications of angioid streaks

Five patients with subretinal neovascular complications of angioid streaks were treated with the argon laser. One patient, additionally had a central retinal vein occlusion with preretinal neovascularization. In four out of five cases we obliterated the subretinal neovascular membranes with ensuing improvement of visual acuity. In a follow-up period of 14 months on the average, the treatment appeared to be successful.     

Membrana neovascular yuxtapapilar asociada a drusas del nervio óptico

Clinical caseForteen year old patient presenting progressive decrease in visual acuity of the left eye after 3 months of evolution. On examination he presents bilateral drusen of papilla, associated with juxtapapillary neovascular membrane, which seriously compromises the vision and visual field of the left eye.ResultTreatment with 3 consecutive injections of intravitreal ranibizumab resulted in the inactivation of the neovascular membrane with reabsorption of subretinal fluid and improvement of the best corrected visual acuity of the left eye. After 9 months of follow-up, it was 20/20 and stable.ConclusionAlthough optic nerve head drusen are considered benign, neovascular membranes can be a complication. Anti-VEGFs are an effective alternative for treatment.     

Laser in situ keratomileusis (LASIK) in myopia: 2-year results

Background: Long-term results on LASIK are not available to date. We therefore evaluated the predictability, stability and complication rate after LASIK in moderate – to-high myopia. Patients and methods: We treated 70 eyes (41 patients) using the Automatic Corneal Shaper and the Keracor 116 excimer laser. Patients were followed for 1, 6, 12 and 24 months. Spectacle refraction, visual acuity, rate of retreatment, and patient satisfaction were evaluated. Results: At 24 months the results were as follows: Myopia −5 to −9.9 D (n =18): 94 % within 1 D; regression between 1 and 12 (12 and 24) months > 1 D in 6 % (6 %); uncorrected acuity 20/40 or better in 83 %; no loss of 2 ore more lines of visual acuity; 89 % highly satisfied. Myopia −10 to −14.9 D (n = 12): 88 % within 1 D; regression between 1 and 12 (12 and 24) months > 1 D in 20 % (0 %) ; uncorrected acuity 20/40 or better in 72 %; 4 % lost 2 or more lines of visual acuity; 96 % highly satisfied. Myopia −15 to −29 D (n = 22): 33 % within 1 D; regression between 1 and 12 (12 and 24) months > 1 D in 41 % (18 %); uncorrected acuity 20/40 or better in 7 %; no loss of 2 or more lines of visual acuity; 67 % highly satisfied. Conclusion: LASIK is an accurate, effective and stable procedure for correcting myopia of −5 to −10 D. Results are less precise in myopia up to −15 D, and some visual loss occurs in a number of patients. In myopia > −15 D, results are not satisfactory because of poor accuracy and low stability.