RESUMEN
A 21-year-old woman had crosslinking for keratoconus in the right eye; the left eye was scheduled for penetrating keratoplasty. Five days postoperatively, she presented with geographic epithelial keratitis and iritis. Analysis of tear samples by polymerase chain reaction confirmed the diagnosis. The patient was treated with oral steroids and acyclovir, with significant improvement. Two months postoperatively, the visual acuity was improved and there was no evidence of herpetic disease recurrence. Crosslinking can induce herpetic keratitis with iritis even in patients with no history of herpetic disease. Early diagnosis and proper treatment are essential for a favorable outcome.
Asunto(s)
Iritis/virología , Queratitis Herpética/virología , Queratocono/tratamiento farmacológico , Fármacos Fotosensibilizantes/efectos adversos , Riboflavina/efectos adversos , Rayos Ultravioleta/efectos adversos , Activación Viral/efectos de la radiación , Aciclovir/uso terapéutico , Adulto , Colágeno/metabolismo , ADN Viral/análisis , Quimioterapia Combinada , Femenino , Glucocorticoides/uso terapéutico , Herpesvirus Humano 1/fisiología , Humanos , Iritis/diagnóstico , Iritis/tratamiento farmacológico , Queratitis Herpética/diagnóstico , Queratitis Herpética/tratamiento farmacológico , Reacción en Cadena de la Polimerasa , Lágrimas/virología , Agudeza VisualRESUMEN
PURPOSE: To study the long-term results of photorefractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) in low to moderate myopic corrections using the Pulzar Z1 system (CustomVis), a 213 nm wavelength solid-state laser. SETTING: University refractive surgery center. METHODS: This prospective noncomparative case series comprised 20 patients (40 eyes) who had refractive surgery using the Pulzar Z1 laser system. Manifest refraction, uncorrected visual acuity, best spectacle-corrected visual acuity (BSCVA), safety, predictability, stability, and confocal microscopy images were evaluated. RESULTS: Ten patients (20 eyes) had PRK and 10 patients (20 eyes) had LASIK. The mean follow-up was 13.9 months +/- 1.1 (SD) (range 12 to 17 months) and 14.6 +/- 1.2 months (range 12 to 18 months) in the PRK group and LASIK group, respectively. No eye lost a line of Snellen BSCVA during the follow-up period; 2 eyes (10%) gained 2 Snellen lines. There was a statistically significant decrease in spherical equivalent manifest refraction postoperatively in both groups (P<.05). Refractive stability was obtained during the first postoperative month and remained stable during the follow-up period, with no significant changes between any interval in both groups (P>.05). At the last follow-up, 95% of all eyes were within +/-1.00 diopter of emmetropia. No late postoperative complications were observed. CONCLUSION: Refractive surgery using the Pulzar Z1 213 nm wavelength solid-state laser was a safe, effective procedure in the treatment of low to moderate myopia.
Asunto(s)
Córnea/cirugía , Queratomileusis por Láser In Situ/métodos , Miopía/cirugía , Queratectomía Fotorrefractiva/métodos , Adulto , Córnea/patología , Femenino , Humanos , Láseres de Excímeros , Masculino , Microscopía Confocal , Miopía/diagnóstico , Complicaciones Posoperatorias , Estudios Prospectivos , Resultado del Tratamiento , Agudeza VisualRESUMEN
PURPOSE: To elucidate the distinct role of the intraoperative use of mitomycin C (MMC) on endothelial cell density after photorefractive keratectomy (PRK) in human eyes. DESIGN: Prospective, double-masked, randomized clinical trial. METHODS: One eye of 15 patients was treated with PRK with intraoperative use of topical 0.02% MMC (15 seconds), whereas the fellow eye was treated with Epipolis laser in situ keratomileusis (Epi-LASIK) in random order. Corneal confocal microscopy was performed in all eyes preoperatively and at one, three, six, and 12 months after the surgery. Moreover, three endothelial images were acquired in each of 15 preoperative-normal eyes to evaluate the repeatability of measuring endothelial cell density. Repeated measures analysis of variance was used to compare the temporal variations of endothelial cell density between the two techniques and the changes of endothelial cell density over time. RESULTS: The coefficient of repeatability of endothelial cell count was 148 cells/mm(2). Preoperative endothelial cell density was not significantly different between the two groups (P = .82). Moreover, the effect of the treatment on the temporal variation of endothelial cell density was insignificant (P = .83), whereas the differences between the preoperative and the postoperative endothelial cell densities reached statistical significance (P
Asunto(s)
Alquilantes/administración & dosificación , Endotelio Corneal/patología , Mitomicina/administración & dosificación , Queratectomía Fotorrefractiva , Recuento de Células , Terapia Combinada , Método Doble Ciego , Estudios de Seguimiento , Humanos , Cuidados Intraoperatorios , Láseres de Excímeros , Microscopía Confocal , Miopía/tratamiento farmacológico , Miopía/cirugía , Estudios ProspectivosRESUMEN
PURPOSE: To describe lipid-induced specific videokeratographic (VKG) corneal changes and subsequent resolution after eyelid washing. METHODS: VKG was performed with C-Scan corneal topography. In all patients an excessive meibomian gland lipid secretion was found with or without coexistent chronic posterior blepharitis. After the initial VKG, a meticulous cleaning of the lids with a mild alkali shampoo (10% Johnson's baby shampoo in sterile water) was done, first by gently scrubbing the closed eyelid fissure with the solution to mobilize and emulsify any Meibomian gland secretions followed by cleaning of the upper and lower margins individually, using Q-tip applicators soaked in the detergent. RESULTS: Three patients with tear film lipid layer excess (TFLE), which correlated with the presence of a superior or central corneal steepening in VKG, were studied. In two of the subjects, careful lid washing reversed either completely or partially this VKG effect, whereas in the last patient the VKG changes after artificially increasing the tear film lipid content is described. CONCLUSIONS: Meibomian gland lipid secretions may induce mainly superior and occasionally central VKG corneal steepening that is not correlated with any slit-lamp pathologic findings. Computerized corneal topography can help detect such corneal abnormalities, and their reversibility may distinguish them from other pathologic conditions (such as contact lens-induced warpage, eccentric ablations, irregular astigmatism, superior keratoconus).
Asunto(s)
Córnea/patología , Topografía de la Córnea , Enfermedades de los Párpados/etiología , Lípidos/efectos adversos , Glándulas Tarsales/metabolismo , Adulto , Córnea/metabolismo , Enfermedades de los Párpados/metabolismo , Enfermedades de los Párpados/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Irrigación Terapéutica/métodosRESUMEN
PURPOSE: To report a case of laser in situ keratomileusis (LASIK) in a patient with previous conductive keratoplasty. METHODS: A 48-year-old man underwent conductive keratoplasty for low hyperopic astigmatism (manifest refraction OD: +2.25 -0.50 x 77 degrees; OS: +2.50 -0.50 x 105 degrees). Three months postoperatively, UCVA was 20/25 and BSCVA was 20/20 in both eyes; manifest refraction OD: -0.25 -0.75 x 110 degrees; OS: +0.75 -0.75 x 50 degrees. Sixteen months after the operation, regression of refractive outcome was (manifest) OD: +1.75 -1.25 x 90 degrees; OS: +2.50 -0.50 x 85 degrees; UCVA was 20/40 in the right eye and 20/63 in the left eye and BSCVA was 20/20 in both eyes. LASIK was performed for hyperopic regression in the left eye using an automated microkeratome (Alcon SKBM, 130-microm plate; Aesculap-Meditec MEL 70 excimer laser). RESULTS: LASIK was uneventful and no intraoperative or postoperative complications related to the previous conductive keratoplasty procedure or LASIK were observed. Three months after LASIK and 19 months after the initial conductive keratoplasty, the patient's left eye was emmetropic; UCVA was 20/20(-2), BSCVA was 20/20 and manifest refraction was +0.25 -0.25 x 35 degrees. There was a uniform increase in topographical steepening. Visual acuity, refraction and topographic findings remained unchanged at 6 months. CONCLUSIONS: Even though our experience is limited, treatment of hyperopia with LASIK in an eye with refractive regression following previous conductive keratoplasty resulted in a predicted refractive outcome, with no complications, and improvement in visual acuity at 6 months follow-up.
Asunto(s)
Astigmatismo/cirugía , Córnea/cirugía , Electrocoagulación/efectos adversos , Hiperopía/cirugía , Queratomileusis por Láser In Situ/métodos , Astigmatismo/etiología , Topografía de la Córnea , Humanos , Hiperopía/etiología , Masculino , Persona de Mediana Edad , Resultado del Tratamiento , Agudeza VisualRESUMEN
A 56-year-old woman had conductive keratoplasty (CK) for residual hyperopia and astigmatism. Three years before the procedure, the patient had arcuate keratotomy, followed by laser in situ keratomileusis 2 years later for high astigmatism correction in both eyes. During CK, a corneal perforation occurred in the right eye; during the postoperative examination, an iris perforation and anterior subcapsule opacification were seen beneath the perforation site. The perforation was managed with a bandage contact lens and an antibiotic-steroid ointment; it had a negative Seidel sign by the third day. The surgery in the left eye was uneventful. Three months after the procedure, the uncorrected visual acuity was 20/32 and the best corrected visual acuity 20/20 in both eyes with a significant improvement in corneal topography. Care must be taken to prevent CK-treated spots from coinciding with areas in the corneal stroma that might have been altered by previous refractive procedures.