RESUMEN
PURPOSE: To report complications of radial thermokeratoplasty (RTK) when used in combination with either radial keratotomy (RK) or astigmatic keratotomy (AK). METHODS: RTK is a technique for the surgical correction of hyperopia and presbyopia. 600 degrees C burns are applied to the peripheral cornea for 0.3 seconds using a specialized cautery probe. The thermal energy generated shrinks stromal collagen and flattens the peripheral cornea. The central cornea is steepened producing a myopic shift. RESULTS: Two patients who had RTK in combination with either RK or AK are reported. Patient 1 was bilaterally hyperopic and presbyopic. The patient had RTK performed on the left eye in an attempt to make that eye myopic. The goal was to allow the left eye to be used for near vision. After RTK, the left eye was significantly overcorrected. The patient then had RK in the left eye which resulted in profound overcorrection with return of hyperopia. Postoperatively, examination revealed gaping of the RK incisions and poor epithelial wound healing. The patient also complained of severe ocular pain. Despite suturing the RK incisions, the eye remained hyperopic. The patient underwent two additional RTK procedures which failed to correct the induced hyperopia. The second patient had induced hyperopic astigmatism after undergoing RK. RTK was then performed to correct the hyperopia. However, the result was a worsening of the astigmatism. Two t-cut astigmatic keratotomies were then performed which improved the astigmatism but subsequently exacerbated the hyperopia. A second RTK procedure was then performed; however, it failed to correct the induced hyperopia. CONCLUSIONS: RTK is an unproved surgical technique for the correction of hyperopia and presbyopia that needs much further evaluation before broad clinical application can be supported.
Asunto(s)
Córnea/patología , Electrocoagulación/efectos adversos , Queratotomía Radial/efectos adversos , Complicaciones Posoperatorias , Errores de Refracción/etiología , Femenino , Humanos , Hiperopía , Masculino , Persona de Mediana Edad , Errores de Refracción/patología , Procedimientos Quirúrgicos Refractivos , Agudeza VisualRESUMEN
PURPOSE: Modern videokeratoscopy is useful in assessing corneal shape. The purpose of this study is to compare color-coded topographic maps using standardized scales with 1.0- and 1.5-diopter (D) intervals. The authors assessed the use of the two scales for detecting clinically relevant features of corneal topography such as regular astigmatism, irregular astigmatism, early keratoconus, and contact lens-induced corneal warpage. METHODS: A total of 50 normal corneas, 50 corneas with contact lenses, 50 that had keratoconus (25 early to moderate and 25 advanced), 50 that had penetrating keratoplasty, 20 that had extracapsular cataract surgery, 17 that had excimer laser photorefractive keratectomy for myopia, 10 that had radial keratotomy, 3 that had aphakic epikeratophakia, and 2 that had myopic epikeratophakia were analyzed with a corneal topographic analysis system. Color-coded maps with 1.0-D intervals (Maguire/Waring scale) and 1.5-D intervals (Klyce/Wilson scale) were compared. RESULTS: There were no topographic characteristics that were not appreciated with either scale for corneas with dioptric powers that fell within their ranges. Conversely, for corneas that had powers outside the range of the 1.0-diopter scale, but within the range of the 1.5-diopter scale, the former produced a map in which the flattest or steepest areas were artifactually smoothed. CONCLUSIONS: This study suggests that the Klyce/Wilson scale (constant, 1.5-D intervals) provides the best combination of sensitivity for detection of clinically significant topographic features and the widest range of coverage of powers that are found on a variety of normal, pathologic, and surgically altered corneas. The adoption of the Klyce/Wilson scale by all manufacturers of corneal topographic instruments as a primary standard will facilitate communication and will make the interpretation of corneal topography easier for both the expert and the novice.
Asunto(s)
Córnea/anatomía & histología , Córnea/patología , Enfermedades de la Córnea/diagnóstico , Procesamiento de Imagen Asistido por Computador/métodos , Extracción de Catarata , Lentes de Contacto , Enfermedades de la Córnea/patología , Enfermedades de la Córnea/cirugía , Humanos , Queratoplastia Penetrante , Queratotomía Radial , Estándares de Referencia , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadAsunto(s)
Enfermedades de la Córnea/tratamiento farmacológico , Fibronectinas/administración & dosificación , Administración Tópica , Adolescente , Adulto , Córnea/fisiopatología , Enfermedades de la Córnea/complicaciones , Úlcera de la Córnea/complicaciones , Úlcera de la Córnea/tratamiento farmacológico , Método Doble Ciego , Epitelio/fisiopatología , Femenino , Fibronectinas/uso terapéutico , Humanos , Masculino , Estudios Prospectivos , Resultado del Tratamiento , Cicatrización de Heridas/efectos de los fármacosRESUMEN
The rare association of DAA with TOF is reported in a young boy who underwent successfully at the age of 3 months an emergency shunt between the anterior (left) hypoplastic aortic arch and the LPA after the vascular ring was divided. Total correction of the cardiovascular malformation was performed at the age of 4 years. The cardiac catheterization, angiographic and operative findings as well as the management of the case are described. Ten other patients with this combination of anomalies were found on review of the literature, eight of whom had only palliative systemic to pulmonary artery shunts. Knowledge of the morphology of the DAA by angiocardiography is helpful in planning the management. Surgical shunts when done early for the treatment of a patient with repeated anoxic spells may reduce the gravity of psychomotor retardation. A staged surgical repair of TOF is recommended for infants having hypoplastic pulmonary arteries.