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Purpose To describe a technique which exploits the transparency and toughness of the pre-Descemets layer (Dua's layer) to safely perform deep anterior lamellar keratoplasty (DALK) and phacoemulsification at the same time. Methods Three DALK procedures combined with phacoemulsification were performed by the same surgeon using the big-bubble (BB) technique at the Research Institute of Ophthalmology, Cairo, Egypt. In two cases a type-1 BB, baring Dua's layer, was achieved and in one case a type-2 BB, baring the Descemet's membrane (DM), was achieved. The surgeries were video recorded and photo slit-lamp images were taken in the follow-up visits.Results DALK with phacoemulsification and lens implant was carried out in both patients where a type-1 BB was achieved. At a follow up of 18 months (first case) and 6 months (second case), the best corrected vision was 6/12 for each. In the case where a type-2 BB was achieved, the DM ruptured during injection of viscoelastic prior to capsulorhexis. The procedure was converted to a penetrating keratoplasty without phacoemulsification. Conclusion When a type-1 BB is achieved simultaneous DALK and phacoemulsification can be safely accomplished. Dua's layer allows a clear view for performing phacoemulsification with the added benefit of its toughness, which can maintain a stable anterior chamber for cataract surgery. This should not be attempted when a type-2 BB is achieved.

ABSTRACT.Purpose: This work aimed to study and evaluate the effect of subconjunctival bevacizumab injection in patients with corneal neovascularization (CNV) resulting from different ocular surface disorders. Methods: Ten eyes with CNV caused by different ocular surface disorders were studied. All eyes had both major and minor vessel CNV caused by factors such as healed corneal ulcers, long-standing chronic inflammatory diseases and corneal ischaemia (caused by contact lenses). All eyes received a single subconjunctival injection of 2.5 mg (0.1 ml) bevacizumab. Morphological changes in the major and minor vessels were evaluated using slit-lamp biomicroscopy and corneal photography. Results: Conspicuous recession of the minor vessels of CNV was observed in all eyes at 2 weeks post-injection. The extent of CNV of the major vessels was significantly decreased at 2 weeks post-injection. The level of CNV continued to decrease noticeably for 3 months and then stabilized for the remainder of the 6-month follow-up period. Parameters used for evaluation included the total area of CNV, which amounted to 14.0 ± 5.4% of the corneal surface pre-injection, compared with 9.4 ± 3.9% post-injection (p < 0.01), reflecting a mean decrease in CNV of 33 ± 8%, and the extent of neovascularization, which decreased from 4.3 ± 1.5 clock hours pre-injection to 2.4 ± 1.1 clock hours post-injection (p < 0.01). During the 6-month follow-up, none of the 10 eyes showed any complication that could be related to subconjunctival bevacizumab injection. Conclusions: Bevacizumab can be used safely and effectively for CNV resulting from different ocular surface disorders. It represents an effective treatment for minor vessel neovascularization caused by long-standing chronic inflammation (e.g. trachoma) or long-standing corneal ischaemia (e.g. contact lenses), as well as for major vessel neovascularization resulting from different causes. Bevacizumab was well tolerated over the 6-month follow-up period.

During a 2-year follow-up period, the use of topical cyclosporine A (0.05%) combined with mitomycin C (0.01%) as an adjunctive treatment after surgical excision in cornea and conjunctiva intraepithelial neoplasia and squamous cell carcinoma was found to prevent tumor recurrence, especially in extensive lesions, when surgical excision cannot ensure a tumor-free margin.

PurposeWe aimed to assess corneal biomechanics using the ocular response analyzer in patients with normal-tension glaucoma (NTG), and to evaluate the relationship between corneal biomechanics and visual field loss.MethodsThis was a prospective observational case series including patients with bilateral asymmetric NTG. For all patients, corneal hysteresis (CH), corneal resistance factor (CRF), CH − CRF difference, and central corneal thickness values were matched against the mean deviation (MD) of the visual field and the cup/disc ratio. For paired-eye comparison in each patient, both eyes were categorized into a better-eyes group and a worse-eyes group according to lower and higher corneal-compensated intraocular pressure readings, respectively. Statistical analysis was carried out with the independent-samples Student’s t-test, and the level of statistical significance was set at 0.05. Correlation was assessed using Pearson’s correlation coefficient.ResultsThe study included 240 eyes of 120 patients. CH was inversely proportional to the MD in the visual field (P=0.01). CRF in both eyes was inversely proportional to the MD of the visual field (P=0.01). CH − CRF difference was directly proportional to the MD of the visual field (P=0.01). For paired-eye comparison, lower corneal-compensated intraocular pressure was associated with higher CH, higher CRF, smaller cup/disc ratio, and less deterioration of MD of visual field.ConclusionCH, CRF, and CH − CRF are more powerful predictors of NTG progression than central corneal thickness.

Background: Ocular chemical burn induces devastating and permanent damage to the ocular surface. Rapid intervention is required for maximal visual rehabilitation. Amniotic membrane transplantation may save the ocular surface, however it introduces a potentially unnecessary surgical trauma in such compromised eyes. Amniotic membrane extract (AME) could be a practical substitute of amniotic membrane transplantation in acute chemical burn.Aim: The objective of the study was to evaluate the efficacy of topical AME in the management of acute ocular chemical burn.Methods: This is a noncomparative interventional case series. Four consecutive patients (6 eyes) with mild to moderate acute chemical burn, exhibiting persistent epithelial defect, inflammation, and haze despite extensive conventional therapy, were recruited. Topical AME was prepared and added to the conventional treatment within 2 days of the injury. Pain relief, inflammation, haze, and corneal epithelial healing were monitored.Results: Pain was significantly relieved, and inflammation was markedly reduced in all cases. The corneal epithelial defect rapidly healed, whereas visual acuity improved within 11 days (range, 4Y23 days). During an average follow-up period of 6 months (range, 3Y8 months), all eyes retained stable surface with improved corneal clarity without neovascularization or symblepharon.Conclusions: Topical application of AME could be an effective adjunct in the treatment of mild to moderate cases of acute chemical burns. It allows nontraumatic and early intervention to promote epithelialization; reduce pain, haze, and inflammation in acute phase; and prevent cicatricial complications in chronic phase. Future controlled studies with larger series may be considered to evaluate the overall efficacy and longterm results of such treatment. Currently, AME is not approved by the US Food and Drug Administration. (Tech Ophthalmology 2010;8: 146Y150)O cular chemical burn injury is a serious ocular emergency in which rapid, devastating, and permanent damage can occur. The severity of the injury correlates directly to exposure, duration, and the causative agent. Treatment of such injuries requires medical and surgical intervention, both acutely and in the long term. Regardless of the underlying chemical involved, the common goals of management include removing the offending agent, controlling inflammation, and promoting ocular surface healing with maximal visual rehabilitation. 1 Various medical therapies have been used to achieve these objectives including topical and systemic ascorbate, citrate, tetracycline, progesterone, and steroids. 2Y7 Previous studies revealed that early intervention with amniotic membrane transplantation (AMT) in mild and moderate chemical burns results in marked reduction of symptoms, rapid restoration of the ocular surface, and improved visual acuities while preventing cicatricial complications in the chronic stage. 8Y17 However, surgically performed AMT renders a relatively high cost and potentially unnecessary surgical trauma ...

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