Postoperative visual acuity can be limited by post-keratoplasty astigmatism, even with a clear corneal graft. Astigmatism management can be performed by selective suture removal, adjustment of sutures, optical correction, photorefractive procedures, wedge resection, intra-ocular lens implantation, intracorneal ring segments, relaxing incisions with or without compression sutures and repeated keratoplasty. Relaxing incisions can be made in the graft, graft-host interface or host cornea. Despite the unpredictability of the method because the flat and steep meridians are usually not orthogonal after penetrating keratoplasty, with asymmetric power distribution, all the studies showed an overall reduction of refractive, keratometric or topographic astigmatism, ranging from 30% to 72% with manual or femtosecond-assisted techniques. Most patients with astigmatism higher than 6 diopters had residual cylinder less than or equal to 3 diopters, which can be treated by laser excimer ablation or secondary intraocular lens implantation.
Purpose: We report a case of unilateral exudative retinal detachment in a patient with thrombotic thrombocytopenic purpura (TTP), without associated hypertension, successfully treated with plasmapheresis. Case Report: A 46-year-old woman with a medical history of TTP presented with unilateral exudative retinal detachment. Biological and radiological assessment eliminated other causes of exudative retinal detachment, including hypertension. Plasma exchange was performed, followed by a rapid improvement in visual acuity and total disappearance of serous detachment. Conclusion: Exudative unilateral retinal detachment is a rare complication of TTP and can be successfully treated by plasma exchange.
Background: Evaluate the effectiveness of a hyperosmolar 5% sodium chloride treatment in corneal oedema.Design: This prospective, randomized study was conducted in a universitary ophthalmology department setting.Participants: 95 patients with post-operative corneal oedema were separated in 2 groups: 45 patients in group 1 treated with hypertonic eye drops; 50 patients in group 2 without anti-oedematous.
Methods:Patients in group 1 were treated with 5% sodium chloride hypertonic eye drops associated with 0.15% sodium hyaluronate in addition to the classical post-operative treatment for 1 month; and patients in group 2 were only treated with classical post-operative treatment (antibiotic, corticosteroids and artificial tears).
Main outcome measures:Visual acuity, pachymetry and density were measured at 1 day, 7 days, 1 month, 3 months and 6 months following surgery.
Results:Visual acuity was significantly better in group 1 than in group 2 at 7 days (0.85 ± 0.64 logMAR vs. 1.46 ± 0.8 logMAR, p=0.024) and one month (0.42 ± 0.35 logMAR vs. 1.03 ± 0.86 logMAR, p=0.04) but was no longer different at three and six months. Pachymetry decreased significantly in 7 days in group 1 (decrease of 17%, p=0.04), contrary to group 2 (p=0.96), but the difference between the 2 groups was not statistically significant (p=0.15). Corneal density was also not significantly different between the two groups.Conclusion: 5% sodium chloride hypertonic eye drops reduces significantly post-operative corneal oedema treatment as shown by the improvement in visual acuity at one week and the downward trend in pachymetry.
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