Pub Date : 2024-09-01Epub Date: 2024-09-16DOI: 10.1097/coa.0000000000000045
Alice C Jiang, Adrienne Coulter, David Myung, Julie M Schallhorn, Neel D Pasricha
Purpose: To report a case of Light Adjustable Lens™ (LAL, RxSight, Aliso Viejo, CA) implantation in a patient with bilateral 50-cut radial keratotomy (RK) and discuss related preoperative, intraoperative, and postoperative considerations.
Methods: A 78-year-old patient with history of bilateral 50-cut RK underwent phacoemulsification with implantation of LALs in both eyes one month apart. Although LAL technology was not approved specifically for addressing limitations in intraocular lens calculation post-RK due to corneal topography irregularity, the patient opted for this lens due to its ability to make post-operative adjustments to its refractive power. At postoperative month one following the second eye surgery, YAG capsulotomy was performed in both eyes. At postoperative month two following the second eye surgery, the patient began LAL adjustments spaced 1-2 weeks apart for a total of 2 LAL adjustments and 2 lock-in sessions.
Results: Our patient achieved a final refraction of -0.25 +0.25 × 110 with an UDVA of 20/20-2 in the right eye and -0.25 +0.50 × 135 with an UDVA 20/25-1 in the left eye.
Conclusions: The LAL may be a promising option for patients undergoing cataract surgery after RK, although further studies are needed to understand long-term changes in eyes with RK and the inability of LAL to address all aspects of corneal aberration.
{"title":"Bilateral Light-Adjustable Lens Implantation in a Patient With 50-Cut Radial Keratotomy.","authors":"Alice C Jiang, Adrienne Coulter, David Myung, Julie M Schallhorn, Neel D Pasricha","doi":"10.1097/coa.0000000000000045","DOIUrl":"10.1097/coa.0000000000000045","url":null,"abstract":"<p><strong>Purpose: </strong>To report a case of Light Adjustable Lens<sup>™</sup> (LAL, RxSight, Aliso Viejo, CA) implantation in a patient with bilateral 50-cut radial keratotomy (RK) and discuss related preoperative, intraoperative, and postoperative considerations.</p><p><strong>Methods: </strong>A 78-year-old patient with history of bilateral 50-cut RK underwent phacoemulsification with implantation of LALs in both eyes one month apart. Although LAL technology was not approved specifically for addressing limitations in intraocular lens calculation post-RK due to corneal topography irregularity, the patient opted for this lens due to its ability to make post-operative adjustments to its refractive power. At postoperative month one following the second eye surgery, YAG capsulotomy was performed in both eyes. At postoperative month two following the second eye surgery, the patient began LAL adjustments spaced 1-2 weeks apart for a total of 2 LAL adjustments and 2 lock-in sessions.</p><p><strong>Results: </strong>Our patient achieved a final refraction of -0.25 +0.25 × 110 with an UDVA of 20/20-2 in the right eye and -0.25 +0.50 × 135 with an UDVA 20/25-1 in the left eye.</p><p><strong>Conclusions: </strong>The LAL may be a promising option for patients undergoing cataract surgery after RK, although further studies are needed to understand long-term changes in eyes with RK and the inability of LAL to address all aspects of corneal aberration.</p>","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"3 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11542611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142607673","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-01Epub Date: 2024-09-16DOI: 10.1097/coa.0000000000000044
Sarah E Eppley, Neel D Pasricha, Gerami D Seitzman, Ashlin Joye, Alejandro Arboleda, Azam Qureshi
Purpose: Multicentric osteolysis nodulosis and arthropathy (MONA) syndrome is a rare autosomal recessive skeletal dysplasia. Caused by mutations in the matrix metalloproteinase 2 gene (MMP2) on chromosome 16q12, this syndrome has infrequently been associated with ophthalmic manifestations. Corneal opacities have been reported but not described or documented in detail.
Methods: Complete ophthalmologic examination and multimodal anterior segment imaging were used to characterize the corneal findings in a patient with MONA syndrome.
Results: A 19-year-old with MONA syndrome was referred for an eye exam based upon MONA screening recommendations. Visually insignificant peripheral corneal opacities were noted. Anterior segment optical coherence tomography (AS-OCT) demonstrated posterior stromal and endothelial hyperreflectivity. Confocal microscopy demonstrated an acellular peripheral endothelium with a normal central endothelium.
Conclusions: Corneal opacities can occur with MONA syndrome, which is caused by mutations in the MMP2 gene. In the patient presented here, the corneal opacities are peripheral, deep stromal, with sparing of the anterior stroma and epithelium.
{"title":"Multimodal Imaging of Posterior Corneal Opacities in Multicentric Osteolysis Nodulosis and Arthropathy (MONA).","authors":"Sarah E Eppley, Neel D Pasricha, Gerami D Seitzman, Ashlin Joye, Alejandro Arboleda, Azam Qureshi","doi":"10.1097/coa.0000000000000044","DOIUrl":"10.1097/coa.0000000000000044","url":null,"abstract":"<p><strong>Purpose: </strong>Multicentric osteolysis nodulosis and arthropathy (MONA) syndrome is a rare autosomal recessive skeletal dysplasia. Caused by mutations in the matrix metalloproteinase 2 gene (<i>MMP2</i>) on chromosome 16q12, this syndrome has infrequently been associated with ophthalmic manifestations. Corneal opacities have been reported but not described or documented in detail.</p><p><strong>Methods: </strong>Complete ophthalmologic examination and multimodal anterior segment imaging were used to characterize the corneal findings in a patient with MONA syndrome.</p><p><strong>Results: </strong>A 19-year-old with MONA syndrome was referred for an eye exam based upon MONA screening recommendations. Visually insignificant peripheral corneal opacities were noted. Anterior segment optical coherence tomography (AS-OCT) demonstrated posterior stromal and endothelial hyperreflectivity. Confocal microscopy demonstrated an acellular peripheral endothelium with a normal central endothelium.</p><p><strong>Conclusions: </strong>Corneal opacities can occur with MONA syndrome, which is caused by mutations in the <i>MMP2</i> gene. In the patient presented here, the corneal opacities are peripheral, deep stromal, with sparing of the anterior stroma and epithelium.</p>","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"3 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11537491/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142585082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-12DOI: 10.1097/coa.0000000000000042
S. Lahoti, Julia J. Shi, Mohamed Mohamed, William Waldrop, R. W. Bowman
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can cause significant keratopathy and lead to lasting visual effects. The main objective of this study was to describe an ocular presentation of DRESS treated with a modified suture-less and glue-less amniotic membrane graft technique. This study also provides a literature review of ocular DRESS manifestations and ocular management of the other severe cutaneous adverse reactions. This is a case review about an 82-year-old man with sepsis due to recent Mycobacterium tuberculosis, who presented with DRESS based on clinical findings. The patient was treated with a modified suture-less and glue-less amniotic membrane graft technique along with a Prokera corneal bandage placement. The patient had significant improvement of visual acuity and symptoms with this technique. Patients with significant corneal and conjunctival involvement associated with DRESS, similar to Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), may benefit from more aggressive treatment with amniotic membrane transplantation and Prokera corneal bandage placement to prevent scarring and subsequent vision loss. The modified technique described in this article can be used for patients who may be poor candidates for the operating room.
{"title":"Suture-Less and Glue-Less Amniotic Membrane Graft for Keratopathy and Early Keratinization in Drug Reaction With Eosinophilia and Systemic Symptoms Syndrome","authors":"S. Lahoti, Julia J. Shi, Mohamed Mohamed, William Waldrop, R. W. Bowman","doi":"10.1097/coa.0000000000000042","DOIUrl":"https://doi.org/10.1097/coa.0000000000000042","url":null,"abstract":"\u0000 \u0000 Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome can cause significant keratopathy and lead to lasting visual effects. The main objective of this study was to describe an ocular presentation of DRESS treated with a modified suture-less and glue-less amniotic membrane graft technique. This study also provides a literature review of ocular DRESS manifestations and ocular management of the other severe cutaneous adverse reactions.\u0000 \u0000 \u0000 \u0000 This is a case review about an 82-year-old man with sepsis due to recent Mycobacterium tuberculosis, who presented with DRESS based on clinical findings.\u0000 \u0000 \u0000 \u0000 The patient was treated with a modified suture-less and glue-less amniotic membrane graft technique along with a Prokera corneal bandage placement. The patient had significant improvement of visual acuity and symptoms with this technique.\u0000 \u0000 \u0000 \u0000 Patients with significant corneal and conjunctival involvement associated with DRESS, similar to Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN), may benefit from more aggressive treatment with amniotic membrane transplantation and Prokera corneal bandage placement to prevent scarring and subsequent vision loss. The modified technique described in this article can be used for patients who may be poor candidates for the operating room.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"1 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141653683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-11DOI: 10.1097/coa.0000000000000040
William R. Herskowitz, Christopher W. Seery, Matthew Camacho, Sander Dubovy, Ellen H. Koo
The purpose of our paper is to describe the outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with a history of known obstetrical forceps–related tears who developed clinically significant corneal edema in their eighth decade of life. Case series. Two patients with a known history of obstetrical forceps–related tears presented with corneal edema and vertical tears of Descemet membrane consistent with birth trauma. DMEK was performed for both cases. Case 1 underwent pseudophakic DMEK, and Case 2 underwent combined phacoemulsification and DMEK (triple-DMEK). DMEK grafts were fully attached in both cases at postoperative 1-day and 1-week appointments, as confirmed on slit-lamp examination and anterior segment optical coherence tomography. There was marked improvement in best-corrected visual acuity and corneal edema in both patients. We demonstrate that DMEK can afford excellent results in patients with a history of obstetrical forceps injury, who experience corneal edema later in life. In addition, we show that the triple-DMEK can be done successfully in this entity.
{"title":"Descemet Membrane Endothelial Keratoplasty for Late Corneal Edema Secondary to Obstetrical Forceps–Related Tears","authors":"William R. Herskowitz, Christopher W. Seery, Matthew Camacho, Sander Dubovy, Ellen H. Koo","doi":"10.1097/coa.0000000000000040","DOIUrl":"https://doi.org/10.1097/coa.0000000000000040","url":null,"abstract":"\u0000 \u0000 The purpose of our paper is to describe the outcome of Descemet membrane endothelial keratoplasty (DMEK) in patients with a history of known obstetrical forceps–related tears who developed clinically significant corneal edema in their eighth decade of life.\u0000 \u0000 \u0000 \u0000 Case series.\u0000 \u0000 \u0000 \u0000 Two patients with a known history of obstetrical forceps–related tears presented with corneal edema and vertical tears of Descemet membrane consistent with birth trauma. DMEK was performed for both cases. Case 1 underwent pseudophakic DMEK, and Case 2 underwent combined phacoemulsification and DMEK (triple-DMEK). DMEK grafts were fully attached in both cases at postoperative 1-day and 1-week appointments, as confirmed on slit-lamp examination and anterior segment optical coherence tomography. There was marked improvement in best-corrected visual acuity and corneal edema in both patients.\u0000 \u0000 \u0000 \u0000 We demonstrate that DMEK can afford excellent results in patients with a history of obstetrical forceps injury, who experience corneal edema later in life. In addition, we show that the triple-DMEK can be done successfully in this entity.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"70 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141655361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-14DOI: 10.1097/coa.0000000000000035
Eszter Szalai, Adrienne Csutak, Michael W. Belin
The aim of this study was to study the in vivo ultrastructure of Bowman layer with confocal microscopy in keratoconus patients with a spectrum of disease severity. Fifteen eyes of 12 patients with keratoconus were enrolled in this study. Patients were stratified into 2 severity groups (mild to moderate and advanced) based on maximum keratometry, posterior radius of curvature, and thinnest pachymetry obtained with anterior segment tomography. All study subjects underwent in vivo confocal microscopy (Heidelberg Retina Tomograph III Rostock Cornea Module, Heidelberg Engineering GmbH, Heidelberg, Germany) of the cornea. Seven eyes were classified as having mild-to-moderate keratoconus (mean age 29.14 ± 8.32 years) and 8 eyes were advanced (mean age 31.00 ± 8.62 years). In vivo confocal microscopy showed intact Bowman layer in all eyes with mild-to-moderate keratoconus. Fragmentations in Bowman layer were seen in 20% of eyes (3 eyes) with advanced keratoconus. We did not document ruptures in Bowman layer in mild-to-moderate keratoconus suggesting that Bowman layer fragmentation is a late manifestation of keratoconus and not a sign of early ectatic disease as historically reported.
{"title":"Fragmentation in Bowman Layer: An In Vivo Confocal Microscopy Study","authors":"Eszter Szalai, Adrienne Csutak, Michael W. Belin","doi":"10.1097/coa.0000000000000035","DOIUrl":"https://doi.org/10.1097/coa.0000000000000035","url":null,"abstract":"\u0000 \u0000 The aim of this study was to study the in vivo ultrastructure of Bowman layer with confocal microscopy in keratoconus patients with a spectrum of disease severity.\u0000 \u0000 \u0000 \u0000 Fifteen eyes of 12 patients with keratoconus were enrolled in this study. Patients were stratified into 2 severity groups (mild to moderate and advanced) based on maximum keratometry, posterior radius of curvature, and thinnest pachymetry obtained with anterior segment tomography. All study subjects underwent in vivo confocal microscopy (Heidelberg Retina Tomograph III Rostock Cornea Module, Heidelberg Engineering GmbH, Heidelberg, Germany) of the cornea.\u0000 \u0000 \u0000 \u0000 Seven eyes were classified as having mild-to-moderate keratoconus (mean age 29.14 ± 8.32 years) and 8 eyes were advanced (mean age 31.00 ± 8.62 years). In vivo confocal microscopy showed intact Bowman layer in all eyes with mild-to-moderate keratoconus. Fragmentations in Bowman layer were seen in 20% of eyes (3 eyes) with advanced keratoconus.\u0000 \u0000 \u0000 \u0000 We did not document ruptures in Bowman layer in mild-to-moderate keratoconus suggesting that Bowman layer fragmentation is a late manifestation of keratoconus and not a sign of early ectatic disease as historically reported.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140979185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-25DOI: 10.1097/coa.0000000000000033
J. Rivera Salazar, Jesús Lara Peñaranda, Fernando González del Valle, Javier Gálvez Martínez, José Juan Valdés González, J. M. Olalla Gallardo, R. Juárez Tosina, José Manuel Calzas Durán, Ángel Arias, A. Tejera-Muñoz
The study aimed to assess the effectiveness of a monthly application of topical 1% ivermectin cream, for 3 months, to the eyelids and eyelids margin, accompanied by gentle squeezing of meibomian glands and microexfoliation to the base of eyelashes, in the management of Demodex blepharitis. Thirty-eight patients diagnosed with Demodex blepharitis based on the presence of sleeves at the base of the eyelashes, telangiectasias, and signs of local inflammation with at least 4 Demodex mites observed at the lash roots were enrolled. Treatment involved applying 1% ivermectin topical cream using an eyelash brush in circular motion, gradually moving toward the eyelid margin. The procedure was repeated several times over 10 min by applying more cream. Each patient was evaluated before each treatment and 1 month after completion of the 3-month period. Significant improvements in symptoms and signs were observed, with the disappearance of cylindrical sleeves on the base of the eyelashes, telangiectasias, signs of inflammation, and a significant decrease in night itching. The Schirmer test showed no changes, while the tear breakup time test exhibited slight yet statistically significant enhancement. No adverse events were reported during the study. The results of this investigation establish that Demodex blepharitis can be effectively managed by the application of 1% ivermectin cream once a month over a three-month period. This treatment approach, in conjunction with the gentle squeezing of meibomian glands and eyelid margin microexfoliation to the base of the eyelashes, resulted in the disappearance of objective indicators, such as cylindrical sleeves and telangiectasia, along with a significant reduction in nocturnal itching.
{"title":"Treatment With Topical Ivermectin 1% Once a Month to Control Demodex Blepharitis","authors":"J. Rivera Salazar, Jesús Lara Peñaranda, Fernando González del Valle, Javier Gálvez Martínez, José Juan Valdés González, J. M. Olalla Gallardo, R. Juárez Tosina, José Manuel Calzas Durán, Ángel Arias, A. Tejera-Muñoz","doi":"10.1097/coa.0000000000000033","DOIUrl":"https://doi.org/10.1097/coa.0000000000000033","url":null,"abstract":"\u0000 \u0000 The study aimed to assess the effectiveness of a monthly application of topical 1% ivermectin cream, for 3 months, to the eyelids and eyelids margin, accompanied by gentle squeezing of meibomian glands and microexfoliation to the base of eyelashes, in the management of Demodex blepharitis.\u0000 \u0000 \u0000 \u0000 Thirty-eight patients diagnosed with Demodex blepharitis based on the presence of sleeves at the base of the eyelashes, telangiectasias, and signs of local inflammation with at least 4 Demodex mites observed at the lash roots were enrolled. Treatment involved applying 1% ivermectin topical cream using an eyelash brush in circular motion, gradually moving toward the eyelid margin. The procedure was repeated several times over 10 min by applying more cream. Each patient was evaluated before each treatment and 1 month after completion of the 3-month period.\u0000 \u0000 \u0000 \u0000 Significant improvements in symptoms and signs were observed, with the disappearance of cylindrical sleeves on the base of the eyelashes, telangiectasias, signs of inflammation, and a significant decrease in night itching. The Schirmer test showed no changes, while the tear breakup time test exhibited slight yet statistically significant enhancement. No adverse events were reported during the study.\u0000 \u0000 \u0000 \u0000 The results of this investigation establish that Demodex blepharitis can be effectively managed by the application of 1% ivermectin cream once a month over a three-month period. This treatment approach, in conjunction with the gentle squeezing of meibomian glands and eyelid margin microexfoliation to the base of the eyelashes, resulted in the disappearance of objective indicators, such as cylindrical sleeves and telangiectasia, along with a significant reduction in nocturnal itching.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"22 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140657960","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-10DOI: 10.1097/coa.0000000000000032
Ami Igarashi, Toshiki Shimizu, Hideaki Yokogawa, Akira Kobayashi, S. Yamagami, Takahiko Hayashi
Performing Descemet membrane keratoplasty (DMEK) in vitrectomized eyes can be challenging, owing to the compromised stability of the iris–lens diaphragm. This study presents a “bubble behind iris” technique in DMEK to achieve a shallower anterior chamber in vitrectomized and pseudophakic eyes. The patients with vitrectomized eyes who underwent DMEK between October 2022 and March 2023 were enrolled in this study. Following the insertion of the donor tissue into the anterior chamber, a 30-gauge blunt cannula was used to introduce an air bubble posterior to the iris. The depth of the anterior chamber was confirmed before unfolding the graft. Subsequently, the air bubble was carefully replaced with balanced salt solution insertion using the blunt cannula, and the anterior chamber was filled with gas for graft attachment. This study included 3 eyes of 3 patients (3 men; mean age 62.3 ± 8.5 years). The best spectacle corrected visual acuity and central corneal thickness improved in all eyes with no notable complications. The “bubble behind iris” technique is a straightforward and minimally invasive approach for maintaining an optimal anterior chamber depth during DMEK in vitrectomized and pseudophakic eyes.
{"title":"“Bubble Behind Iris” Technique in Descemet Membrane Endothelial Keratoplasty for Vitrectomized Eyes","authors":"Ami Igarashi, Toshiki Shimizu, Hideaki Yokogawa, Akira Kobayashi, S. Yamagami, Takahiko Hayashi","doi":"10.1097/coa.0000000000000032","DOIUrl":"https://doi.org/10.1097/coa.0000000000000032","url":null,"abstract":"\u0000 \u0000 Performing Descemet membrane keratoplasty (DMEK) in vitrectomized eyes can be challenging, owing to the compromised stability of the iris–lens diaphragm. This study presents a “bubble behind iris” technique in DMEK to achieve a shallower anterior chamber in vitrectomized and pseudophakic eyes.\u0000 \u0000 \u0000 \u0000 The patients with vitrectomized eyes who underwent DMEK between October 2022 and March 2023 were enrolled in this study. Following the insertion of the donor tissue into the anterior chamber, a 30-gauge blunt cannula was used to introduce an air bubble posterior to the iris. The depth of the anterior chamber was confirmed before unfolding the graft. Subsequently, the air bubble was carefully replaced with balanced salt solution insertion using the blunt cannula, and the anterior chamber was filled with gas for graft attachment.\u0000 \u0000 \u0000 \u0000 This study included 3 eyes of 3 patients (3 men; mean age 62.3 ± 8.5 years). The best spectacle corrected visual acuity and central corneal thickness improved in all eyes with no notable complications.\u0000 \u0000 \u0000 \u0000 The “bubble behind iris” technique is a straightforward and minimally invasive approach for maintaining an optimal anterior chamber depth during DMEK in vitrectomized and pseudophakic eyes.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"204 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140719873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.1097/coa.0000000000000029
Azin Abazari, Alessandro Abbouda, A. Cruzat, B. Cavalcanti, Deborah Pavan-Langston, P. Hamrah
The purpose of this study was to assess potential corneal reinnervation and recovery of corneal sensation in patients with severe neurotrophic keratopathy (NK) secondary to herpes zoster ophthalmicus (HZO) after treatment with topical autologous serum tears (AST). Four cases of HZO with severe NK were followed clinically and by serial laser in vivo confocal microscopy (IVCM, HRT3/RCM, Heidelberg Engineering GmbH) before and during treatment with 20% AST drops 8 times a day. Two masked observers reviewed the IVCM images and assessed corneal nerve alterations. At baseline, all patients had complete loss of corneal sensation. In addition, IVCM showed complete lack of the subbasal corneal nerve plexus in all patients. All 4 patients were refractory to conventional therapies and were treated with AST drops. All patients demonstrated significant nerve regeneration by IVCM within 3 to 7 months of treatment. The total nerve density increased to a mean ± SEM of 10,085.88 ± 2,542.74 μm/mm2 at the last follow-up. Corneal sensation measured by Cochet–Bonnet esthesiometry improved to a mean ± SEM of 3.50 ± 1.30 cm. Interestingly, 3 of 4 patients developed stromal keratitis with stromal thinning within weeks of corneal reinnervation, which was reversed by adding topical steroids. Autologous serum tears are effective in restoring corneal subbasal nerves and sensation in patients with severe NK secondary to HZO. However, this group of patients may require concurrent topical immunomodulation and antiviral therapy while on AST to prevent stromal keratitis.
{"title":"Corneal Reinnervation in Patients With Severe Neurotrophic Keratopathy Secondary to Herpes Zoster Ophthalmicus After Treatment With Autologous Serum Tear Drops","authors":"Azin Abazari, Alessandro Abbouda, A. Cruzat, B. Cavalcanti, Deborah Pavan-Langston, P. Hamrah","doi":"10.1097/coa.0000000000000029","DOIUrl":"https://doi.org/10.1097/coa.0000000000000029","url":null,"abstract":"\u0000 \u0000 The purpose of this study was to assess potential corneal reinnervation and recovery of corneal sensation in patients with severe neurotrophic keratopathy (NK) secondary to herpes zoster ophthalmicus (HZO) after treatment with topical autologous serum tears (AST).\u0000 \u0000 \u0000 \u0000 Four cases of HZO with severe NK were followed clinically and by serial laser in vivo confocal microscopy (IVCM, HRT3/RCM, Heidelberg Engineering GmbH) before and during treatment with 20% AST drops 8 times a day. Two masked observers reviewed the IVCM images and assessed corneal nerve alterations.\u0000 \u0000 \u0000 \u0000 At baseline, all patients had complete loss of corneal sensation. In addition, IVCM showed complete lack of the subbasal corneal nerve plexus in all patients. All 4 patients were refractory to conventional therapies and were treated with AST drops. All patients demonstrated significant nerve regeneration by IVCM within 3 to 7 months of treatment. The total nerve density increased to a mean ± SEM of 10,085.88 ± 2,542.74 μm/mm2 at the last follow-up. Corneal sensation measured by Cochet–Bonnet esthesiometry improved to a mean ± SEM of 3.50 ± 1.30 cm. Interestingly, 3 of 4 patients developed stromal keratitis with stromal thinning within weeks of corneal reinnervation, which was reversed by adding topical steroids.\u0000 \u0000 \u0000 \u0000 Autologous serum tears are effective in restoring corneal subbasal nerves and sensation in patients with severe NK secondary to HZO. However, this group of patients may require concurrent topical immunomodulation and antiviral therapy while on AST to prevent stromal keratitis.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"53 36","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400394","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-01-31DOI: 10.1097/coa.0000000000000023
Marcella Q. Salomão, A. Hoffling-Lima, Nelson Sena, Bernardo T. Lopes, Jaime Guedes, Renato Ambrósio
The aim of this study was to report multimodal refractive imaging findings that may predict ectasia susceptibility on nonoperated eyes of patients who developed post-LASIK ectasia in the fellow eye. This is a retrospective case series. The nonoperated fellow eyes of 5 patients who had unilateral LASIK with progressive ectasia underwent a comprehensive ophthalmologic evaluation and multimodal refractive imaging (MRI), including Pentacam HR and Corvis ST (Oculus; Wetzlar, Germany), along with segmental OCT (RTVue; Optovue, Inc, Fremont, CA). Different objective indices and parameters from the Pentacam, Corvis ST, and OCT were analyzed. None of the 5 cases showed ectasia detection on the Pentacam TKC (topographic keratoconus classification), and inferior–superior (IS) asymmetry values were lower than 1.0 D in all 5 cases. Corneal thicknesses at the thinnest points measured with the Pentacam were 530, 466, 517, 488, and 511 µ, and with the OCT were 512, 460, 508, 480, and 495 µ, in cases 1to 5, respectively. The keratoconus risk scoring system based on OCT measurements demonstrated a high risk in 2 patients. The BAD-D (Belin-Ambrósio Enhanced Ectasia Deviation) was higher than 1.22 in all 5 cases and higher than 1.6 in 2 cases. Four cases had ARTmax (Ambrósio Relational Thickness to the meridian with maximal progression increase) lower than 390. The PRFI (Pentacam Random Forest Index) was equal or higher than 0.12 in all 5 cases, and enhanced posterior elevation, which is calculated using data from the standard elevation map, excluding a 3.5-mm area centered on the thinnest point, was abnormal in all 5 cases. The value of the current version of the tomographic biomechanical index (TBI V1), derived from artificial intelligence (AI) algorithms, which integrate Scheimpflug-based tomography and biomechanical data, was equal or higher than 0.29 in 3 cases. Signs of ectasia susceptibility were detected in all nonoperated eyes based on multimodal imaging. These findings support the clinical relevance of such analysis when screening for ectasia risk among candidates for refractive surgery.
本研究的目的是报告多模态屈光成像结果，这些结果可以预测同侧眼发生 LASIK 术后异位症的患者的非手术眼异位症易感性。 这是一个回顾性病例系列。 5 位单侧 LASIK 患者的非手术同侧眼接受了全面的眼科评估和多模式屈光成像（MRI），包括 Pentacam HR 和 Corvis ST（Oculus；Wetzlar，德国），以及节段性 OCT（RTVue；Optovue, Inc，Fremont，加利福尼亚州）。对来自 Pentacam、Corvis ST 和 OCT 的不同客观指标和参数进行了分析。 在 Pentacam TKC（角膜地形图分类）中，5 个病例均未发现异位，所有 5 个病例的下-上（IS）不对称值均低于 1.0 D。用 Pentacam 测得的最薄点角膜厚度分别为 530、466、517、488 和 511 µ，用 OCT 测得的最薄点角膜厚度分别为 512、460、508、480 和 495 µ。基于 OCT 测量的角膜炎风险评分系统显示，2 名患者的角膜炎风险较高。所有 5 例患者的 BAD-D（Belin-Ambrósio 增强偏差）均高于 1.22，2 例患者高于 1.6。四个病例的 ARTmax（Ambrósio Relational Thickness to the meridian with maximal progression increase）低于 390。所有 5 个病例的 PRFI（Pentacam 随机森林指数）均等于或高于 0.12，所有 5 个病例的增强后方隆起均异常，增强后方隆起是使用标准隆起图的数据计算得出的，不包括以最薄点为中心的 3.5 毫米区域。当前版本的断层扫描生物力学指数（TBI V1）由人工智能（AI）算法得出，整合了基于 Scheimpflug 的断层扫描和生物力学数据，其中 3 例的数值等于或高于 0.29。 根据多模态成像技术，所有未接受手术的眼球都检测到了易患异位症的迹象。这些研究结果表明，在筛查屈光手术候选者的异位症风险时，此类分析具有临床意义。
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Pub Date : 2023-12-01DOI: 10.1097/coa.0000000000000025
Huy Tran, Linh Hoang, Yen Tran, Thảo Hạ, Kevin Ruder, Lina Zhong, Cindi Chen, Danny Yu, YuHeng Liu, Thomas Abraham, Armin Hinterwirth, Michael Deiner, Travis Porco, T. Lietman, G. Seitzman, T. Doan
Conjunctivitis epidemics and pandemics remain a global burden. This study aims to comprehensively identify pathogens associated with conjunctivitis in Vietnam. Patients with acute infectious conjunctivitis who presented to an outpatient clinic in Ho Chi Minh City, Vietnam, were enrolled from September 2022 to March 2023. Swabs were obtained from conjunctiva and anterior nares of all patients. Unbiased RNA deep sequencing (RNA-seq) was used to identify any replicating pathogens in the samples. Samples from 35 patients were analyzed. A pathogen was identified in 80% of the patients. In total, 72% (95% confidence interval: 54%–85%) were infected with either human adenovirus (HAdV)-D or HAdV-B. RNA viruses detected were rhinoviruses and human coronavirus 229E. Bacteria etiologies included Streptococcus pneumoniae, Hemophilus influenza, and Pseudomonas spp. One patient had coinfection of rhinovirus A and HAdV-B. Vittaforma corneae, a fungus, was identified in one patient. Corneal subepithelial infiltrates, pseudomembranes, or preauricular lymphadenopathy were not reported in any patient. Human adenoviruses are the common circulating pathogens associated with infectious conjunctivitis in Vietnam. HAdV species, however, seem to vary between geographic locations within Vietnam. Other underrecognized pathogens identified in this study, such as RNA viruses, suggest that broader pathogen surveillance may be beneficial.
{"title":"Pathogen Profiles of Infectious Conjunctivitis in Ho Chi Minh City, Vietnam","authors":"Huy Tran, Linh Hoang, Yen Tran, Thảo Hạ, Kevin Ruder, Lina Zhong, Cindi Chen, Danny Yu, YuHeng Liu, Thomas Abraham, Armin Hinterwirth, Michael Deiner, Travis Porco, T. Lietman, G. Seitzman, T. Doan","doi":"10.1097/coa.0000000000000025","DOIUrl":"https://doi.org/10.1097/coa.0000000000000025","url":null,"abstract":"\u0000 \u0000 Conjunctivitis epidemics and pandemics remain a global burden. This study aims to comprehensively identify pathogens associated with conjunctivitis in Vietnam.\u0000 \u0000 \u0000 \u0000 Patients with acute infectious conjunctivitis who presented to an outpatient clinic in Ho Chi Minh City, Vietnam, were enrolled from September 2022 to March 2023. Swabs were obtained from conjunctiva and anterior nares of all patients. Unbiased RNA deep sequencing (RNA-seq) was used to identify any replicating pathogens in the samples.\u0000 \u0000 \u0000 \u0000 Samples from 35 patients were analyzed. A pathogen was identified in 80% of the patients. In total, 72% (95% confidence interval: 54%–85%) were infected with either human adenovirus (HAdV)-D or HAdV-B. RNA viruses detected were rhinoviruses and human coronavirus 229E. Bacteria etiologies included Streptococcus pneumoniae, Hemophilus influenza, and Pseudomonas spp. One patient had coinfection of rhinovirus A and HAdV-B. Vittaforma corneae, a fungus, was identified in one patient. Corneal subepithelial infiltrates, pseudomembranes, or preauricular lymphadenopathy were not reported in any patient.\u0000 \u0000 \u0000 \u0000 Human adenoviruses are the common circulating pathogens associated with infectious conjunctivitis in Vietnam. HAdV species, however, seem to vary between geographic locations within Vietnam. Other underrecognized pathogens identified in this study, such as RNA viruses, suggest that broader pathogen surveillance may be beneficial.\u0000","PeriodicalId":72708,"journal":{"name":"Cornea open","volume":"91 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139014422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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