Untersuchungen der Hornhaut mittels optischer Kohärenztomographie

Introduction. This study evaluated the clinical use of optical coherence tomography (OCT) for two-dimensional representation of the cornea. Patients and methods. Noncontact slitlamp-adapted OCT was used in selected cases to evaluate pathologically altered corneas and to measure the central corneal thickness and curvature. Results. OCT provided correlation between differences in reflection and morphological changes. Scar tissue resulted in hyperreflective light scattering, wheras cystic lesions were hyporeflective. Precise biomorphometry also allowed representation of intrastromal and retrocorneal changes. Central corneal thickness measured by OCT yielded reproducible values and corneal curvature could be calculated from the optical signals of the corneal surface. Conclusions. OCT provides high-resolution representation of the cornea and exact evaluation of its morphology, thickness, and curvature. Due to the noncontact, simple, and rapid examination using the slitlamp the corneal OCT method is a promising additional diagnostic modality.     

LASIK mit superiorem Hinge und Scanning-Spot-Excimerlaserablation zur Korrektur von Myopie und myopem Astigmatismus Einjahresergebnisse einer prospektiven klinischen Studie an 100 Augen

Purpose. Recently laser-in-situ-keratomileusis (LASIK) has been increasingly used to correct refractive errors. The purpose of this investigation was to evaluate the safety, efficacy, predictability, stability and complications using the scanning spot excimer LASIK technology. Patients and methods. The results of 100 consecutive LASIK operations carried out between 2/1998 and 2/1999 on 60 patients (mean age 37 years, range 20–55 years) have been evaluated. The Hansatome? microkeratome with a superior hinge (flap diameter: 9.5 mm) and a scanning spot excimer laser (Technolas C-Lasik 217) were used in all cases. The mean spherical equivalent of the subjective manifest refraction was ?6.96±2.87 diopters (D), the mean sphere was ?6.47±2.71 D and the mean astigmatism was ?0.98±0.94 D. In 6% of the eyes preoperative visual acuity was not better than 20/40. Examinations were performed preoperatively, after 1 and 7 days, after 1, 4 and 12 months. Safety, efficacy, predictability, stability and complications were calculated using the datagraph software (version 1.11). Results. All 100 eyes were examined after 1 day and 1 week, 96 after 1 month, 95 after 4 months and 92 after 1 year. Following 1 year none of the eyes lost 2 or more lines of best corrected visual acuity, 99% were within ±1 line and 1% gained 2 lines (safety index 1.03). In 92% of all eyes an uncorrected visual acuity of ≥0.5 was reached, in 77% ≥0.8 and in 51% ≥1.0 (efficacy index 0.89). For 60 eyes (65.21%) a refractive correction of±0.5 D was necessary, for 82 eyes (89.13%) ±1.0 D and for 91 eyes (98.91%) ±2.0 D. The mean spherical equivalent after 1 year was ?0.15±1.31 D. Between 1 and 12 months a mean regression of ?0.14 D occurred. On the request of the patients, 5 eyes were retreated during the study period for under- or overcorrection. Complications due to the microkeratome did not occur. Corneal infections were not observed, a diffuse lamellar keratitis (DLK) was seen in 12 cases, but all cases healed with no loss of visual acuity. In 7 eyes a slight decentration of the ablation was observed using corneal topography, which in one case caused an increase in glare sensitivity. Conclusions. LASIK with superior hinge and scanning spot excimer photoablation is suitable for the correction of myopia (up to a maximum of ?12 D) and for myopic astigmatism (up to a maximum of ?5 D). The refractive results showed a high stability during the 12-month study period but there is still room for improvement of the predictability.     

Photorefractive keratectomy after intrastromal corneal ring segment explantation

PURPOSE: To describe a case of photorefractive keratectomy after removal of intrastromal corneal ring segments from the cornea. METHODS: During United States Food and Drug Administration Phase III Trials for intrastromal corneal ring segments (ICRS), the implanted segments were removed from the cornea of the right eye of a patient because of dissatisfaction with glare, halos, and fluctuating vision. Ten months after ICRS explantation, the-patient underwent a photorefractive keratectomy procedure to the same eye. RESULTS: One month after removal of the ICRS, the patient's manifest refraction was within +/- 0.50 diopters of his original manifest refraction. Photorefractive keratectomy was planned to the same eye 6 months later. At the first attempt, the epithelium could not be removed with the laser and scrape technique, and residual epithelium was noted at the vertical meridian (12 o'clock) corneal incision site, which had been used for ICRS surgery and explant; therefore, the procedure was aborted. At the second attempt, with a mechanical epithelial brush (AMOILS Epithelial Scrubber; Innova, Inc, Toronto, Canada), the epithelium was removed with ease. After this, photorefractive keratectomy was done without difficulty or complication. At his most recent 8-month postphotorefractive keratectomy examination, the patient had an uncorrected visual acuity of RE: 20/16, with a manifest refraction of -0.75 to 0.75 x 170 degrees, a faint haze at the site of the stromal channel, and a small scar at the incision site on slit-lamp examination. CONCLUSIONS: Intrastromal corneal ring segments can be readily removed from the cornea, if required. In this case, the refraction returned to its preoperative state soon after the explant procedure and remained stable over time. Photorefractive keratectomy was performed as a secondary refractive surgical procedure after the removal of ICRS without difficulty or complication. However, removal of the epithelium is probably best accomplished with the use of an epithelial brush, considering the changes in the epithelial adherence in a postsurgical cornea. Further studies are required to establish the safety and efficacy of secondary refractive surgical procedures after ICRS explantation.     

Incidence of postoperative endophthalmitis in a high-volume cataract surgicentre in Canada

Objective: To determine the incidence of endophthalmitis at a high-volume, multisurgeon Canadian surgicentre and compare the endophthalmitis incidence, incision techniques, and prophylactic regimens with other published data in the worldwide literature.Design: Retrospective, consecutive case series.Participants: Patients (13931 eyes) who underwent cataract surgery at the Kensington Eye Institute, Toronto, Ont., from January 9, 2006, to January 6, 2008.Methods: Cases of endophthalmitis were identified from surgeon quality assurance reports. Prophylactic regimens, incision techniques, organisms cultured, and visual outcomes were reviewed in each case. All surgeons were surveyed regarding their incision techniques and prophylactic regimens.Results: Endophthalmitis developed in 6 eyes (incidence 0.043%). No causative organism predominated, and only 1 patient had severe vision loss to less than counting fingers. More cases of endophthalmitis (4 of 6) occurred in patients not receiving fourth-generation fluoroquinolones, despite ∼75% of surgeons using these drugs before and after surgery (odds ratio 6.3, relative risk 6.3). No intracameral antibiotics were used in any cases, and all incisions were clear corneal.Conclusions: Our incidence of postoperative endopthalmitis after cataract surgery was 0.043%. Slight evidence of reduced endophthalmitis with the use of fourth-generation fluoroquinolones was noted. Our endophthalmitis incidence compares favourably with other published rates in the medical literature, and this rate was achieved without intracameral antibiotic use in a centre that uses exclusively topical anesthesia and clear corneal incisions.     

Toric intraocular lenses. Clinical results and rotational stability

Background. Correction of an astigmatism at the time of cataract surgery can be achieved in two different ways, by alteration of the corneal curvature or by implantation of a toric intraocular lens (toric IOL). In the latter, in addition to the wound architecture and IOL calculation, the influence of rotational stability in the capsular bag is most important for the refractive result. Patients and methods. This retrospective study included 26 eyes from24 patients with a corneal astigmatism of 2.5–11 D before cataract surgery of which 24 eyes showed a congenital astigmatism and 2 eyes an astigmatism after keratoplasty. After phakoemulsification a three-piece toric PMMA customised IOL (6.5/13.75 mm) was implanted into the capsular bag. Subjective and objective refraction as well as keratometry and corneal topography were performed pre- and postoperatively. The axis of the toric IOL cylinder was marked and could be measured precisely in the postoperative period. The surgically induced astigmatism (SIA) was calculated. Results. At a mean follow-up time of 12 months after the implantation of a toric IOL, all eyes showed a reduction of total astigmatism. The mean total refractive astigmatism could be reduced from 4.16 D±1.58 D preoperatively to 1.64 D±1.21 D postoperatively. In 6 out of the 26 eyes (23%) the toric IOL rotated more than 10° in the capsular bag and in all 6 cases the IOL rotation happened in the first 3 weeks postoperation. The IOL position was surgically corrected within 3–6 weeks after initial surgery and remained stable during the follow-up period. Conclusions. The implantation of a PMMA toric IOL is a promising procedure to correct higher levels of corneal astigmatism in cataract surgery. The initial rotational stability of the haptics in the capsular bag still has to be improved and the corneal SIA has to be reduced by smaller incisions. Therefore, three-piece foldable IOLs with a new haptic design are under development.     

Differentiation between dyslexia and ocular causes of reading disorders

Background. Dyslexia is defined as a reading and/or writing disability persisting after exclusion of organic causes. Studies show that ocular disorders, especially small refraction errors, hypoaccommodation and symptomatic heterophoria, are often not detected or treated in cases of reading and/or writing problems which were otherwise diagnosed as dyslexia. Methods. We evaluated the data of patients referred to our department from December 1997 to March 2000 with the diagnosis of dyslexia. Results. We found ocular disturbances in 28 (84.8%) out of 33 children, 26 (78.8%) showed improved reading after therapy. They had mostly accommodative problems: uncorrected hyperopia, hypoaccommodation and/or exophoria compensated by accommodative convergence (pathophoria). Conclusions. Our results underline the importance of the correction of even small refraction and/or motility errors in the presence of reading and writing difficulties.     

Intrakorneale granulomatöse Entzündung

Introduction. We report a patient suffering from lattice corneal dystrophy and with a corneal granuloma 8 months after phototherapeutic keratectomy (PTK). Case report. PTK was performed in a 33-year-old man with hereditary lattice corneal dystrophy. An intracorneal tumor was found in the right eye 8 months after treatment. There was no indication of previous foreign body injury. Detailed clinical examinations yielded no evidence of the cause or nature of the tumor. For this reason an excision was performed. Results. Histological examination revealed a dense inflammatory infiltration of the deeper corneal stroma with epithelioid cells, histiocytes, lymphocytes, eosinophilic leukocytes, and giant cells of the Touton type. There was no indication of a generalized granulomatous inflammation. Conclusion. A monosymptomatic, intracorneal, granulomatous infiltration is very rare and has not previously been described in a case of lattice corneal dystrophy. This may have been a case of xanthogranuloma or sarcoidosis. Strangely, the granuloma occurred only several months after PTK; nevertheless, a pathogenetic connection seems unlikely.     

Intrastromal corneal ring segments in a patient with previous laser in situ keratomileusis

PURPOSE: Intrastromal corneal ring segments (ICRS; Intacs) were inserted in a patient with residual myopia of -3.375 D (spherical equivalent) 10 months after laser in situ keratomileusis (LASIK). METHODS: A standard intrastromal corneal ring segment implantation technique was used with the addition of intraoperative ultrasonic pachymetry in 4 quadrants at the 7-mm zone to insure adequate stromal thickness for segment insertion. RESULTS: Four months after ICRS surgery and 14 months after LASIK, the patient had uncorrected visual acuity of 20/20 and a cycloplegic refraction of plano -1.00 x 23 degrees. CONCLUSION: Implantation of intrastromal corneal ring segments in an eye with previous LASIK resulted in additional corneal flattening with a decrease in residual myopia and improved uncorrected visual acuity.     

Intracameral anesthesia with lidocaine in cornea guttata

Background. Combined topical and intracameral anesthesia has become increasingly popular in cataract surgery. We analyzed the use of intracameral anesthesia in patients with corneal dystrophy who had undergone cataract surgery. Patients and methods. We measured the number of endothelial cells in 40 eyes with Fuchs' corneal endothelial dystrophy preoperatively as well as three times postoperatively (after 1 day, 4 weeks, and 3 months). Performing sponge anesthesia, the additional application of 0.15 ml lidocaine 1% was randomized. Results. The lidocaine group showed the following loss of endothelial cells in the central cornea: 1 day postoperatively 9.2%, 4 weeks later 9.7%, and 3 months after surgery 10.7%. The other group had a postoperative loss of endothelial cells in the central cornea of 8.8% (1 day), 9.3% (4 weeks), and 10.5% (3 months). No significant differences between the two groups were observed. Conclusions. Cornea guttata is not a contraindication for the use of intraocular lidocaine.     

Biomorphometry of corneal epithelium with slit lamp-adapted optical coherence tomography

Introduction. The purpose of this study was to evaluate the biomorphometry of the corneal epithelium with slitlamp-adapted optical coherence tomography (OCT). Patients and methods. In a clinical study, slitlamp-adapted OCT of the cornea was performed in 15 patients before and immediately after therapeutic corneal abrasion. Central corneal epithelium thickness measurements were compared to the pre- and postoperative central corneal thickness. Results. Preoperatively, the corneal epithelium could be visualised from the highest OCT light reflections at the interfaces air-tear film and epithelium-Bowman's membrane. The preoperative mean geometrical central epithelial thickness determined with OCT ranged from 65±12 μm to 72±14 μm (45–92 μm). The mean difference of the pre-and postoperative central corneal thickness was 48±19 μm (9–79 μm). This resulted in a deviation from the direct epithelial thickness measurements of 26–33%. The reproducibility of the geometrical epithelial thickness was ±9 μm. Conclusions. Slitlamp-adapted OCT enabled a noncontact evaluation of the corneal epithelium. The difference between direct and indirect corneal epithelium thickness measurements could be related to the partial optical inclusion of the precorneal tear film and the Bowman's membrane. With some restrictions the biomorphometry of the corneal epithelium with slitlamp-adapted OCT seems to be a valuable technique to monitor therapeutical and refractive procedures of the cornea.     

Should indications for amniotic membrane transplantation be altered in concurrent rheumatoid polyarthritis?

Background. Amniotic membrane transplantation (AMT) shows good results in corneal epithelial defects or ulcerations. However, in patients with rheumatoid arthritis (RA) these corneal defects represent a somewhat greater challenge. We address the question whether AMT has to be indicated differently in RA patients. Patients and methods. We retrospectively analysed 25 AMTs performed between October 1998 and August 2000 in 22 patients for corneal epithelial defects and ulcerations. In 8 patients (11 AMTs) RA was present (group A) and no RA (group B) was found in 14 patients (14 AMTs). Results. Epithelial closure could be achieved in 24/25 cases after a mean of 24.9 days. In 15/25 cases the epithelium remained closed over a minimum of 3 months (successful AMT). In group B, 12/14 AMTs (85.7%) were successful, but only 3/11 AMTs (27.3%) were successful in group A. Discussion. In addition to the pronounced keratoconjunctivitis sicca, immune-mediated inflammatory aspects are suspected to be the reason for the poor results of AMT in RA patients. But as alternative surgical procedures (e.g. keratoplasty) implicate specific problems in RA, we believe that after failure of conservative treatment AMT is a reasonable procedure for corneal defects even in RA patients.     

Rezidivierende Erosio corneae nach mechanischen Traumata Ergebnisse der transepithelialen phototherapeutischen Keratektomie

Background. Recurrent corneal erosion is a common clinical disorder characterised by repeated spontaneous breakdown of the corneal epithelium. The pathomechanism is due to abnormalities of the adhesion complex between the corneal epithelium and the stroma. In addition to local medical treatment, bandage lenses, debridement and anterior stromal puncture, patients can also be treated by excimer laser phototherapeutic keratectomy. Methods. We present a series of 45 eyes where a transepithelial therapeutic excimer photoablation (t-PTK) was carried out after recurrent erosions caused by mechanical trauma. We used the flying spot excimer laser Technolas 217-C (Bausch&; Lomb Surgical) and the scanning spot laser MEL70 (Aesculap Meditec). Treatment was performed in the relapse-free period. The zone of ablation measured 6–9 mm and the ablation depth10–30 μm. The mean follow-up period was 7 months (range 3–22). Results. After the first t-PTK treatment, 41 eyes remained without a relapse, but 8 patients had persistent symptoms, 4of which had a new epithelial breakdown and in 2 patients a second t-PTK had to be carried out. Conclusions. T-PTK appears to be a safe and effective procedure for treatment of recurrent corneal erosion. However, relative contraindications, such as a previous chemical burn, must be taken into account.     

��bereinstimmung subjektiver und objektiver Refraktionsmessungen nach INTRACOR-Femtosekundenlaser-Behandlung

Background

The goal of this study was to determine the accuracy of autorefraction measurements in patients after INTRACOR intrastromal femtosecond laser treatment of presbyopia by comparing the agreement between the subjective and objective refraction.

Patients and methods

In this study the data of 19 patients with a mean age of 56.5±6.0 years following INTRACOR treatment were analyzed pre-operatively and 12 months postoperatively. Measurements of the subjective refraction and the results of the autorefractor Nidek-660A in miosis were compared. INTRACOR is a refractive intrastromal femtosecond laser treatment to correct presbyopia. During the procedure a series of five concentric rings in the central stroma are cut which cause a change in the curvature of the cornea.

Results

The differences in sphere and spherical equivalent between subjective refraction and autorefraction were not significant (t-test p>0.05 and Wilcoxon test p>0.05). Comparing the cylinder of the two measurements a significant difference (t-test p<0.05) was found. Focusing on the difference of the postoperative measurements of the subjective refraction and autorefraction a correlation (within ±0.5?D) of 89% in the sphere, 100% in cylinder and 68% in the spherical equivalent was detected. With one exception the differences in sphere, cylinder and the spherical equivalent were within ±1.25?D. In several patients the performance of the autorefraction with the Nidek-660A was somewhat complicated and the measures had to be repeated frequently.

Conclusion

The agreement between subjective refraction and objective measurements of the Nidek-660A of patients following INTRACOR-treatment was good. However there was a significant difference in the cylinder values. Therefore thorough comparison of measurements obtained with the autorefractor and the subjective refraction is recommended.     

Intrastromal corneal ring segments for management of keratoconus

Keratoconus is a progressive corneal ectasia, which can be managed both by conservative measures like glasses or contact lenses in non-progressive cases or surgical procedures like collagen crosslinking (CXL) with or without adjuvant measures like intrastromal corneal rings segments (ICRS) or topography guided ablation. Various kinds of ICRS are available to the surgeon, but it is most essential to be able to plan the implantation of the ring to optimize outcomes.

Aims:

The aim of this study is to evaluate the visual outcome and progression in patients of keratoconus implanted with ICRS.

Materials and Methods:

Two different types of ICRS-Intacs (Addition Technology) and Kerarings (Mediphacos Inc.) were implanted in 2 different cohorts of patients and were followed-up to evaluate the outcome of the procedure. All patients underwent a complete ocular examination including best spectacle corrected visual acuity, slit lamp examination fundus examination, corneal topography and pachymetry. The ICRS implantation is done with CXL to stop the progression of the disease. Improvement in uncorrected visual acuity (UCVA), best spectacle corrected visual acuity and topographic changes were analyzed.

Results:

A significant improvement in keratometry and vision was seen in both groups.

Conclusion:

ICRS have been found to reduce corneal irregularity and flatten keratometry with improvement in UCVA and best corrected visual acuity.     

Corneal complications after hematopoietic stem cell transplantation

Aim. To evaluate the incidence and clinical course of corneal complications in patients with severe dry eye syndrome after hematopoietic stem cell transplantation (HSCT). Patients and methods. 50 consecutive patients (aged 9–65 years; average=42±11 years) with Sjögren-like syndrome after hematopoietic stem cell transplantation were examined. In order to assess the severity of the dry eye syndrome, the frequency of blinking and break-up time were determined and Schirmer-I, fluorescein,and rose bengal tests were carried out.Biopsy and histological examination were performed in cases with suspected conjunctival graft-versus-host reaction. Results. Patients with Sjögren-like dry eye syndrome were referred within an average of 13 months after HSCT (SD±20 months).The follow-up was up to 83 months (mean: 10.2 months,SD±14.97).Of the 50 patients 15 developed severe corneal complications with significant loss of vision which resulted in enucleation of the eye in 1 patient.Of these 15 patients 4 had a viral and 2 a bacterial keratitis,7 had trophic corneal thinning and sterile ulcers.Two patients had limbal stem cell insufficiency or pseudomembranous conjunctivitis, both due to conjunctival graft-versus-host reaction.Another patient developed a toxic keratopathy, probably induced by cyclosporin A eye drops.Of 50 patients 35 presented with signs of an inactive or active conjunctival graft-versus-host reaction which could be proven histologically in 26 patients. Discussion. Patients with Sjögren-like dry eye syndrome after hematopoietic stem cell transplantation are at high risk to develop corneal complications.These complications may result from an aggressive extension of the graft-versus-host reaction towards the conjunctiva and/or the lacrimal gland and seem to occur more often during the period of reduction of systemic immunosuppressive therapy.Furthermore, infectious as well as trophic or toxic corneal complications may be supported by local immunosuppressive therapy.We suggest frequent ophthalmological checks of patients receiving hematopoietic stem cell transplantation who need local immunosuppressive therapy or are in the phase of reduction of systemic immunosuppressive therapy     

Delayed in-the-bag implantation of intraocular lens

Objective: To report delayed in-the-bag intraocular lens (IOL) implantation for patients who had undergone simultaneous phacoemulsification and vitreoretinal surgery.Design: Interventional case series.Participants: Delayed IOL implantation surgery was performed for 3 patients who had undergone simultaneous phacoemulsification and scleral buckling or vitrectomy surgery.Methods: The medical records of each patient, including the surgical findings and final refraction status, were reviewed retrospectively.Results: Successful in-the-bag IOL implantation surgeries without capsular tear were achieved 3 to 5 months after the initial surgeries. The postoperative refractive error ranged from plano to −1.00 D.Conclusions: Successful in-the-bag IOL implantation and satisfactory refraction were achieved in patients who had undergone simultaneous phacoemulsification and scleral buckling or vitrectomy surgery.     

Clinical utility of femtosecond laser-assisted astigmatic keratotomy after cataract surgery

Purpose

To examine the clinical utility of femtosecond laser-assisted astigmatic keratotomy (FSL-AK) for eyes after cataract surgery.

Methods

Eight eyes of 6 patients with an intraocular lens and corneal astigmatism of 2.0 diopters (D) or more underwent FSL-AK. The mean preoperative manifest cylindrical refraction was 2.88 ± 0.64 D and the mean corneal astigmatism was 2.84 ± 0.83 D. Paired symmetrical arcuate incisions were created with the same settings, except for the incision depth. Uncorrected distance visual acuity (UDVA), manifest cylindrical power, and surgically induced astigmatism (SIA) were measured at 1 day, 1 week, and 1 month postoperatively. Fourier analysis of corneal topography and incision depths measured with anterior-segment optical coherence tomography were evaluated 1 month postoperatively.

Results

In all eyes, the UDVA improved at 1 week and 1 month postoperatively, and the manifest cylinder also decreased postoperatively, while the SIA showed overcorrections in 6 eyes. Fourier analysis showed decreases in spherical and regular astigmatic components and increases in higher-order irregularity. The mean incision depth was measured as 60 µm deeper than the intended depth.

Conclusion

The FSL-AK effectively reduced corneal astigmatism and improved the UDVA, although it was demonstrated that the deeper incisions led to overcorrection.

     

Surgically induced astigmatism after 3.0 mm temporal and nasal clear corneal incisions in bilateral cataract surgery

Aims:

To compare the corneal refractive changes induced after 3.0 mm temporal and nasal corneal incisions in bilateral cataract surgery.

Materials and Methods:

This prospective study comprised a consecutive case series of 60 eyes from 30 patients with bilateral phacoemulsification that were implanted with a 6.0 mm foldable intraocular lens through a 3.0 mm horizontal clear corneal incision (temporal in the right eyes, nasal in the left eyes). The outcome measures were surgically induced astigmatism (SIA) and uncorrected visual acuity (UCVA) 1 and 3 months, post-operatively.

Results:

At 1 month, the mean SIA was 0.81 diopter (D) for the temporal incisions and 0.92 D for nasal incisions (P = 0.139). At 3 months, the mean SIA were 0.53 D for temporal incisions and 0.62 D for nasal incisions (P = 0.309). The UCVA was similar in the 2 incision groups before surgery, and at 1 and 3 months post-operatively.

Conclusion:

After bilateral cataract surgery using 3.0 mm temporal and nasal horizontal corneal incisions, the induced corneal astigmatic change was similar in both incision groups. Especially in Asian eyes, both temporal and nasal incisions (3.0 mm or less) would be favorable for astigmatism-neutral cataract surgery.     

Avastin use in high risk corneal transplantation

Background

Corneal neovascularization is a major risk factor for graft failure after corneal transplantation. The purpose of this study was to investigate the effect of subconjunctival, perilimbal, and/or intrastromal bevacizumab (Avastin®) on corneal neovascularization in patients with penetrating keratoplasty (PKP).

Methods

Fourteen eyes of 14 patients with high risk corneal transplantation and corneal neovascularization after PKP (nine men and five women with a mean age of 63 years) were included in this non-comparative interventional case series. Indications for PKP were: vascularized leucomas after herpetic keratitis and chemical burn, advanced pseudophakic bullous keratopathy with superficial and deep corneal vascularization, keratoconus, severe infection in hereditary corneal dystrophy, and failed corneal grafts. Subconjunctival, perilimbal, and/or intrastromal bevacizumab of dose of 2.5 mg/ 0.1 ml/ per affected quadrant was injected at the site of neovascularization in each patient at the end of surgery and/or at follow up visits. One or two injections were applied. At each visit a full eye examination with photo documentation was performed. Follow-up period was 2 to 8 months (mean 7.1 months).

Results

Decrease of corneal neovascularization was observed in eleven patients (78.6%). Regression of neovascularization with fading of small vessels was demonstrated. Despite high- risk patient pool, twelve grafts (85.7%) remained transparent for the period of observation, and patients maintained good visual acuity. In two patients with initial graft rejection and vascularization, subconjunctival and perilimbal application of bevacizumab was beneficial in overcoming the corneal inflammation and initial rejection. No adverse reactions have been detected to date in patients with subconjunctival, perilimbal, and/or intrastromal injection of bevacizumab.

Conclusions

Bevacizumab is an efficient and safe additional treatment option for improvement of prognosis in high-risk corneal transplantation with pre- and postoperative corneal neovascularization.

     

Simultaneous correction of post-traumatic aphakia and aniridia with the use of artificial iris and IOL implantation

Background

Combined post-traumatic aniridia and aphakia demand extensive and complex reconstructive surgery. We present our approach for simultaneous correction of this surgical situation with the use of the ArtificialIris (Dr. Schmidt Intraocularlinsen GmbH, Germany) with a foldable acrylic IOL Lentis L-313 (Oculentis, GmbH, Germany) sutured to its surface. The novelty (our first operation was on June 2010) of this surgical technique is based on the combined use of foldable (with closed haptics) IOL and Artificialiris to correct post-traumatic aniridia and aphakia.

Methods

Four consecutive cases of combined post-traumatic lesions of iris and lens, corrected with complex device ArtificialIris and foldable IOL. In two cases, the compound implant was sutured to the sclera in sulcus during the penetrating keratoplasty; in another case, it was positioned through a corneal incision of about 5.0 mm with transscleral fixation, and in one patient with preserved capsular support and possibility of IOL in-the-bag implantation the ArtificialIris was placed in sulcus sutureless through a clear corneal tunnel.

Results

Maximal follow-up was 6 months. The complex device was placed firmly fixed within the sulcus, including in the eye implanted without sutures, and showed a stable and centered position without any tilt or torque.

Conclusion

Management of post-traumatic aniridia combined with aphakia by haptic fixation of a foldable acrylic IOL on a foldable iris prosthesis appears to be a promising approach which gives the surgeon the possibility to correct a complex lesion with one procedure, which is less traumatic and faster. Existence of foldable materials, both iris and IOL, permits relatively small corneal incisions (4.0–5.0 mm). Moreover, the custom-tailored iris prosthesis gives a perfect aesthetic result.