Diabetic retinopathy is the leading cause of blindness among persons of working age in the industrialized world. Regular ophthalmological examinations, timely laser therapy depending on the stage of the disease, and close interdisciplinary cooperation are essential to prevent loss of vision.
We report a case of capsular bag distension syndrome that developed 6 years after uneventful phacoemulsification with implantation of a foldable, single-piece acrylic intraocular lens (IOL) (AcrySof MA60BM). Slitlamp microscopy revealed a deep anterior chamber with no flare or cells. The posterior capsular bag was distended by a homogeneous milky substance between the back of the IOL and the capsular bag. Using a pars plana approach, a 23-gauge bimanual capsulotomy and anterior vitrectomy were performed. Microbiological analysis revealed Propionibacterium acnes in the material inside the capsular bag. The postoperative period was uneventful. Four weeks after surgery, visual acuity was restored and there were no signs of intraocular inflammation. The origin of late capsular bag distension is not fully understood; it may involve an infectious component with propionibacteria. A surgical approach and removal of the potentially infectious material can be considered as an alternative to neodymium:YAG capsulotomy.
Purpose:The point of interest of this retrospective case review is to study refractive changes caused by the hinged lamellar keratotomy and the refractive outcome after laser ablation in a second step within the scope of laser in situ keratomileusis (LASIK) in patients with penetrating keratoplasty.Methods:Data from eight patients obtained before lamellar keratotomy, before laser ablation, and three months later were evaluated. Keratotomies were performed with the Moria® LSK one and the Amadeus® 2 microkeratome, laser ablation was performed with the Schwind® Keratome I and the Wavelight® Allegretto WaveEyeQ.Results:Uncorrected visual acuity (UCVA) improved significantly from 1 [logMar] to 0.4 [logMar] at the last visit. Median gain of UCVA was 7.38 ± 2.96 Snellen lines. Best spectacle-corrected visual acuity did not change significantly. Preoperative manifest refraction spherical equivalent decreased from −4.02 ± 4.77 diopters (D) to −1.11 ± 2.45 D after laser ablation. Mean preoperative manifest astigmatism was −7.27 ± 3.65 D, after lamellar keratotomy −6.72 ± 3.68 D, and after laser ablation −2.08 ± 1.80 D. Manifest astigmatism did not change significantly after the keratotomy.Conclusions:Lamellar keratotomy causes biomechanical changes to the cornea. We favor a two-step LASIK in penetrating keratoplasty patients in order to improve precision and predictability of the refractive outcome.
PURPOSE: Children with dense superficial opacities of the cornea are at risk for developing amblyopia. This study evaluated the efficacy of phototherapeutic keratectomy (PTK) in severe cases of anterior stromal scarring. METHODS: Five eyes of five patients, aged 6 to 8 years, were included. Three children suffered from uveitis-associated band keratopathy, one child had anterior corneal stromal scarring due to viral infection, and one child had anterior basement membrane dystrophy. Phototherapeutic keratectomy was performed under general anesthesia using the 200 Hz ALLEGRETTO excimer laser. Optical treatment zone was 7.0 mm (one eye) and 8.0 mm (four eyes), and ablation depths were between 20 and 100 µm. Postoperative treatment consisted of bandage soft contact lens, topical preservative-free antibiotics, steroids, and artificial tears. Part-time occlusion therapy was continued, as prior to PTK. Because of the small cohort, statistical evaluation was not performed. RESULTS: Mean follow-up was 23.4±13.7 months (range: 10 to 41 months). Surgery and postoperative follow-up were uneventful, and no signs of infection or haze were noted. Preoperative best spectacle-corrected visual acuity was 0.4 to 3.0 logMAR (mean: 1.22±1.07 logMAR). Best spectacle-corrected visual acuity improved in four eyes and stabilized in one eye due to uveitis recurrence (mean 0.64±0.65 logMAR). Mean preoperative keratometric values changed from 45.60±0.90 to 44.90±3.00 diopters postoperatively. CONCLUSIONS: Dense superficial corneal opacity in children may be successfully treated with PTK. Phototherapeutic keratectomy was performed to increase corneal transparency and corneal surface smoothing thereby avoiding amblyopia. [J Refract Surg. 2007;23:703-708.]
Although both methods bear the risk of not detecting pre-existing FFKC, Scheimpflug imaging seems superior to placido-based corneal topography alone.
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