Dimitar Grupchev

КERATOCONUS MUST BE DIAGNOSED IN ADVANCE

Performing cataract surgery on a patient with keratoconus is not uncommon. Cataract surgery for this patient does require some additional testing and consideration for the best visual outcomes. Choosing the appropriate lens and lens power can be more challenging. Most patients with keratoconus have high negative spherical aberration and implantation of multifocal IOLs will result in loss of contrast sensitivity associated with these lenses wich will be magnified by the corneal irregularity. Also, decentration of IOL relative to the apex of the cone will induce coma and decrease quality of vision. Our goal was to describe the result after implantation of multifocal intraocular lens in patient with forme fruste keratoconus and to show that the preoperative selection of an appropriate IOL in such patient is the key for better visual function.

Blepharoplasty: One Touch - Serious Complication

1.1.Purpose:To describe and analyze a serious corneal complication following bilateral (4 lid) blepharoplasty by a plastic surgeon on patient with ultimate eye. 1.2.Case:A 59-year-old male with complicated eye history of pathological myopia, bilateral cataract surgery (June and September 2011) on both eyes and right eye vitrectomy (December 2012) following retinal detachment, decided to improve his esthetic appearance. After the plastic surgery procedure he had significantly decreased vision in his good eye. He was examined by an ophthalmologist 6 days after the plastic surgery and was diagnosed with severe bacterial conjunctivitis and a corneal foreign body. After adequate treatment it took 48 hours for the infection to be controlled but on biomicroscopy, although the cornea was absolutely clear, a strange linear lesion was identified. This lesion was apparently a result of electro-knife touch and was a reason for very poor vision of 0.1, which would not improve even with a pinhole. Corneal topography revealed 8 diopters irregular astigmatism. Anterior OCT demonstrated structural damage resulting in the reduction of corneal thickness to one half of its original size. In vivo confocal microscopy demonstrated a local area of keratocyte loss, with activation of the surrounding keratocytes. RGP lens improved the vision to useful 0.9, as the fellow eye had vision of 0.4 with notable metamorphopsia. 1.3.Conclusion:Although the complications of lower lid noninvasive blepharoplasty appear to be minimal, in the reported case corneal damage had a significant negative quality of vision and life impact. Protection of the eye surface and extreme care for the delicate anterior eye structures should be taken during surgery.