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Corneal graft detachment without corneal edema after descemet stripping automated endothelial keratoplasty.

Purpose: To report the case of a patient who underwent Descemet stripping automated endothelial keratoplasty complicated by corneal graft detachment without corneal edema. Methods: Case report. Results: A 60-year-old man with bilateral decompensated endothelium 10 years after cataract extraction and anterior chamber intraocular lens implantation underwent combined anterior chamber intraocular lens explantation with iris-sutured posterior chamber intraocular lens implantation and Descemet stripping automated endothelial keratoplasty on the right eye. On the second postoperative day, the corneal graft was attached. Two weeks postoperatively, slit lamp examination revealed a double anterior chamber resulting from corneal graft detachment. The corneal graft was reattached by repositioning and injecting air. One week later, the corneal graft had detached again, creating a double anterior chamber. No corneal edema was present. Nine months postoperatively, the cornea remained clear, although a double anterior chamber was still evident as a result of the detached corneal graft. Conclusion: Despite post-Descemet stripping automated endothelial keratoplasty corneal graft detachment, the cornea remained without edema.

Combined clear cornea phacoemulsification and trabecular aspiration in the treatment of pseudoexfoliative glaucoma associated with cataract

Abstract Background: In the present prospective randomized study the effectiveness and safety of trabecular aspiration combined with clear cornea phacoemulsification (phaco) was compared to clear cornea phaco alone in patients with pseudoexfoliation (PEX) glaucoma and visually disabling cataract. Methods: Twenty-seven patients suffering from visually significant cataract (visual acuity <5 Snellen lines) and PEX glaucoma were randomly assigned to either phaco combined with trabecular aspiration (14 eyes of 14 patients) or phaco alone (13 eyes of 13 patients). Inclusion criteria for glaucoma were IOP ≤22 mmHg under treatment with up to two antiglaucomatous agents, excluding pilocarpine 4%, and no previous surgery or laser trabeculoplasty treatment. Clear cornea phaco with foldable acrylic intraocular lens (IOL) implantation was carried out in all patients uneventfully. Trabecular aspiration was performed using a special probe in the inferior 180 deg of the angle after IOL implantation. Results: Follow-up duration ranged from 12 to 18 months. In the combined procedure group there was a statistically significant decrease in postoperative IOP during the whole follow-up period (P<0.01), while in 9 of the 14 patients the IOP was controlled without medications at the last examination. In the phaco alone group a statistically significant decrease in postoperative IOP was recorded at 9 and 12 months after surgery (P<0.05), while in 4 of the 13 patients the IOP was controlled without medications at the last examination. Comparing the two groups, a statistically significantly lower number of medications was being used in the combined procedure group at the last recorded examination (P<0.05). Conclusions: It seems that the combined clear cornea phaco and trabecular aspiration procedure in cases of PEX glaucoma associated with cataract is a safe and effective method. This technique controls IOP more effectively and with fewer postoperative medications than clear cornea phaco alone.

Twelve years' continuous wear of the same therapeutic soft contact lens: a case report.

Purpose To describe a case of a patient who had worn the same therapeutic soft contact lens (TSCL) continuously for twelve years, since he had failed to attend normal follow-up visits. Methods Microbiological histological and scanning electron microscopic (SEM) studies of conjunctiva, cornea and TSCL were done. Results Cultures were negative. Corneal histology revealed mild stromal edema and mild epithelial parakeratosis. Corneal SEM was remarkable for the preservation to some extent of normal corneal epithelial specialization with microtricae and microvillae. SEM of the TSCL showed a ruffed multi-layer surface with several cracks including different types of cells. Conclusions The patient showed surprising tolerance to the continuous wear of the same contact lens for 12 years.

Spontaneous Regression of Choroidal Neovascularization in a Patient with Pattern Dystrophy

Purpose. To present a case of a patient with pattern dystrophy (PD) associated choroidal neovascularization (CNV) that resolved spontaneously without treatment. Methods. A 69-year-old male patient was referred to our unit, for evaluation of a recent visual loss (metamorphopsias) in his left eye. Fundus examination, fundus autofluorescence imaging, and fluorescein angiography showed a choroidal neovascular membrane in his left eye. Since visual acuity was satisfactory the patient elected observation. Clinical examination and OCT testing were repeated at 6 and 12 months after presentation. Results. Visual acuity remained stable at the level of 0.9 (baseline BCVA) during the follow-up period (12 months). Repeat OCT testing showed complete spontaneous regression of the choroidal neovascular membrane without evidence of intra- or subretinal fluid in both follow-up visits. Conclusions. Spontaneous regression of choroidal neovascularization can occur in patients with retinal dystrophies and associated choroidal neovascular membranes. The decision to treat or observe these patients relies strongly on the presenting visual acuity, since, in isolated instances, spontaneous resolution of choroidal neovascularization may occur.

Acute comitant esotropia after cataract surgery.

A 52-year-old woman developed comitant esotropia after cataract surgery. The ocular history was significant for accommodative esotropia; preoperatively, she manifested peripheral fusion with central suppression. Immediately postoperatively, the patient was diplopic with comitant esotropia and was treated with extraocular muscle surgery. The appearance of horizontal strabismus after cataract surgery in patients with a history of accommodative esotropia, especially those with subnormal binocularity, is a possible complication that should be discussed with the patient.