Journal of EuCornea最新文献

Purpose

To evaluate the efficacy of modified crosslinking (M-CXL) in the treatment of purulent corneal ulcers, including those of mixed etiology.

Methods

The M-CXL method consists of simultaneous cross-linking and frequent instillations (FI) of anti-infective solutions. We observed 36 patients (37 eyes) with purulent corneal ulcers (PCU) of various etiologies. The test group included 24 patients (24 eyes) who received 1–2 sessions of M-CXL with active conservative therapy. In the control group (12 patients, 13 eyes), only active conservative therapy was performed.

Results

Complete reduction of the purulent process was achieved in 18 (75%) eyes in 29.6 ± 9.38 days in the test group; and in 8 eyes (61.5%) in 50.4 ± 15.9 days in the control group. The efficiency of M-CXL ranged from 100% to 66.6% depending on depth and width (square area) of the infiltration in question. In cases where infiltration affected the entire stromal thickness, the M-CXL efficacy sharply decreased to 66.6%, even with its small (<6 mm) area. In cases where infiltrations extended to the Descemet’s membrane with an overall area >7 mm, the clinical effect of M-CXL was absent or insufficient.

Conclusion

In 75% cases, M-CXL showed complete reduction of PCU. Comparing with control groups, the duration of treatment in the test group decreased 42% (P less than 0.05). In infiltrations over a wide area affecting all the layers up to the Descemet’s membrane, resorbtion of the purulent focus was not achieved. However, it’s spread and purulent fusion were sufficiently suspended, thereby allowing therapeutic penetrating keratoplasty to be performed with a smaller graft diameter.

Thygeson's superficial punctate keratitis (TSPK) is a chronic, bilateral epithelial keratitis. Dr Philips Thygeson first reported TSPK in 1950. Although the etiology of TSPK remains unknown, it has been reported to be associated with viral and autoimmune pathologies. The disease course is characterized by exacerbations and remissions. The classical finding on slit lamp examination is the presence of distinctive coarse, raised, oval-shaped corneal epithelium lesions. Patients commonly present with ocular irritation and rarely with reduced visual acuity. Topical corticosteroids are the mainstay of treatment. Other less commonly used treatments included topical cyclosporine, contact lenses and corneal laser.

Introduction

The purpose of this report is to describe a case of Thygeson superficial punctate keratitis treated with hexamidine 0.1% eye drops.

Methods

Case presentation and literature overview.

Results

An 11-year-old patient was diagnosed with Thygeson superficial punctate keratitis and was successfully treated with hexamidine 0.1% eye drops after failing of traditional treatment. An overview of the etiology and treatment of Thygeson keratitis is given.

Conclusion

Our study is the first to report the use of hexamidine 0.1% eye drops as treatment for Thygeson superficial punctate keratitis. Further research is necessary to investigate the causative agent and optimal treatment for this disease.

Purpose

Refractive surgery promotes good quality of vision without optical correction in most cases. Conventional ablation has reduced effectiveness in irregular corneas, where custom ablations are usually a better option. We have evaluated the results of visual acuity and refraction in patients undergoing custom topography-guided ablation.

Setting

Oftalmocentro, Porto Alegre – RS – Brazil.

Design

This is a case series, retrospective, non-comparative study.

Methods

We studied 60 eyes from 48 patients who underwent topography guided customized refractive surgery, from October 2013 to September 2017, performed with excimer laser Schwind Amaris 750.

Results

Mean age was 44.2 years, being most men (56.6%). Patients with penetrating keratoplasty (PKP) encompassed 36.6% (n = 22), previous radial keratotomy (RK) 20.0% (n = 12), previous deep anterior lamellar keratoplasty (DALK) 16.6% (n = 10) and 26.5% (n = 16) with other diagnoses. Topo-guided surgeries were trans-photorefractive keratectomy (trans-PRK) (41.5%), femto laser-assisted in situ keratomileusis (femto-LASIK) (35.0%), laser-assisted in situ keratomileusis (LASIK) (11.6%) and photorefractive keratectomy (PRK) (11.6%). Cylinder refraction decreased from −3.91 D (±2.00) to −1.45 D (±1.43) (p < 0.01). The spherical equivalent (SE) decreased from −2.04 D (±1.85) to −0.65 D (±1.03) (p < 0.01). Best spectacle-corrected visual acuity (BSCVA) improved in 65% of eyes, from 0.55 (±0.23) to 0.69 (±0.24) (p < 0.01). Follow-up of 40 eyes from 30 patients demonstrated that the effect of the procedure was maintained during the studied period (24,45 ± 14,14 months).

Conclusion

Topography-guided ablation is safe and effective in reducing corneal irregularities, leading to an improvement in visual acuity in 2/3 of cases.

Aim/objective

Tectonic penetrating keratoplasty is technically difficult to perform in cases of large corneal perforations. Indeed, severe ocular hypotonia makes it difficult to achieve high-quality trephination. Therefore, it is essential to create a normotensive eye. We investigated the use of a piece of sterile cardboard to seal the globe before recipient trephination.

Methods

This is a retrospective case series. Patients treated with a new technique of tectonic keratoplasty for the management of large corneal perforations were studied. Main outcome measures were achievement of recipient trephination, preservation of globe integrity preservation and visual acuities.

Results

This case series included 6 eyes of 6 patients, with a mean age of 51 years (range, 21–79 years). The perforations were 4–7 mm in diameter. Five out of the 6 patients had undergone unsuccessful prior multilayer amniotic membrane transplantations. Mean follow-up period was 14 months (range, 6–24 months). The use of a piece of sterile cardboard to seal the globe made it possible to carry out a circular recipient trephination with a diameter identical to that of the donor corneal graft in all cases. Conjunctival flap and partial tarsorrhaphy were used in three patients and in one patient, respectively. Preservation of globe integrity was achieved in all cases. Visual acuity had improved at the end of follow-up in four patients.

Conclusions

We describe here a new surgical technique allowing achievement of a circular recipient trephination with a diameter identical to that of the donor corneal graft.