Itamar Klemperer

Late bilateral keratectasia after LASIK in a low myopic patient.

PURPOSE To report a rare case of late bilateral ectasia developing after LASIK for low myopia without preoperative risk factors. METHODS A 21-year-old man underwent bilateral uneventful LASIK for low myopia of -2.75 diopters in both eyes. Preoperative corneal pachymetry was 531 microm in the right eye and 526 microm in the left eye. The total ablation depth was 46.8 microm in the right eye and 42.2 microm in the left eye. Preoperative corneal topography was normal and did not reveal forme fruste keratoconus. RESULTS Twenty-four months postoperatively, the patient developed bilateral inferior keratectasia of +0.50 -3.00 x 72 degrees in the right eye and +1.00 -2.75 x 99 degrees in the left eye. CONCLUSIONS Late keratectasia may follow LASIK for low myopia despite a thorough preoperative work-up.

Artisan aphakic intraocular lens in children with subluxated crystalline lenses

Purpose: To evaluate the results of Artisan® (Ophtec) aphakic intraocular lens (IOL) implantation in children with idiopathic subluxated lenses. Setting: Department of Ophthalmology, Soroka University Medical Center, Beer‐Sheva, Israel. Methods: This retrospective small case series comprised 4 eyes (3 children) with idiopathic essential subluxated lenses that had lens washout, lens capsule removal, Artisan IOL implantation, and peripheral iridectomy. The indications for surgery were reduced visual acuity and monocular diplopia. The main outcome measures were postoperative refraction and change in best corrected visual acuity (BCVA). Results: The postoperative follow‐up ranged from 8 to 10 months. After surgery, the BCVA was 6/12 or better in the 3 cases that could be recorded. Visual acuity improved by 2 or more Snellen lines in all 4 eyes. The postoperative spherical equivalent was within ±1.00 diopter in all cases. No significant postoperative complications were observed. Conclusions: In 4 eyes with a subluxated crystalline lens, implantation of an Artisan aphakic IOL improved visual acuity. Studies with a larger number of patients and longer follow‐up are necessary to confirm these results.

Prognostic factors in posterior open globe injuries (zone-III injuries)

Purpose:  The aim of this study is to describe and identify clinical characteristics, prognostic factors and visual outcome in a group of patients with posterior open globe injuries (zone III injury).

Herpes simplex virus keratitis after laser in situ keratomileusis.

PURPOSE To report two cases of herpes simplex virus (HSV) keratitis after laser in situ keratomileusis (LASIK). METHODS Interventional small case series. Two patients underwent uneventful LASIK. History of herpes labialis in one patient and herpetic eye disease > 10 years prior to intervention in the other patient was reported. Both patients developed stromal herpetic keratitis 6 weeks and 2 years after the procedure, respectively. RESULTS Treatment consisting of topical steroid drops and topical and systemic antiviral therapy was administered. Recurrences of the herpetic keratitis were seen after tapering of the topical steroids; four and three recurrences were observed, respectively. Final visual acuity was > 6/9 in both cases. CONCLUSIONS Herpetic keratitis after LASIK is an uncommon, possibly under-reported, entity. Even patients without history of herpetic eye disease can present with this complication. Oral antiviral prophylaxis may be appropriate when performing LASIK on patients with a history of ocular or systemic HSV infection.

Punctate inner choroidopathy : resolution after oral steroid treatment and review of the literature

CASE REPORT A case of punctate inner choroidopathy (PIC) that resolved after oral steroid treatment is described. The 25-year-old female patient presented with reduced visual acuity of several days duration. Results of fundus examination, fluorescein angiography, and indocyanine green angiography were consistent with PIC with a small choroidal neovascularization lesion nasal to the fovea. Visual acuity improved significantly after several days on oral steroid treatment. COMMENTS Although spontaneous resolution of the lesions can occur without any treatment, oral steroids in PIC may help achieve improved vision more rapidly. The clinical manifestations, differential diagnosis, and therapeutic modalities of this rare entity are discussed.

Central serous chorioretinopathy in patients receiving systemic corticosteroid therapy.

Central serous chorioretinopathy (CSCR) is characterized by a serous detachment of the neurosensory retina or the retinal pigment epithelium (RPE), or both, at the posterior pole. The etiology and pathogenesis of this disorder are still unknown. Several hypotheses have been proposed, including increased permeability of the choriocapillaris, defects in Bruch’s membrane and a defect in the diffusion-barrier function of the RPE. Among the possible risk factors for CSCR, corticosteroids (endogenous or exogenous) have been implicated in the pathogenesis of the disease.1–8 We present 2 cases in which CSCR developed in patients given oral steroid therapy and resolved after treatment was stopped. The previously reported cases and possible effects of corticosteroids on CSCR pathogenesis are discussed.

Rapid Spontaneous Resolution of Vitreomacular Traction Syndrome Documented by Optical Coherence Tomography

A 48-year-old woman presented with a 2-week history of metamorphopsia and reduced vision in her left eye. Visual acuity was 20/30 OS. Slit lamp biomicroscopy fundus evaluation revealed a dull foveal reflex. Optical coherence tomography (OCT) showed attachment of the posterior hyaloid to the macula and significant macular elevation. One month after presentation, visual complaints disappeared. OCT revealed complete posterior vitreous detachment and normal foveal thickness. Although rare, rapid spontaneous resolution of vitreomacular traction syndrome can occur. OCT is a helpful diagnostic tool for following these patients.

Toxic effects of subconjunctival 5-fluorouracil and mitomycin C on ciliary body of rats.

Purpose: The effects of subconjunctival injection of mitomycin C and different concentrations of 5-fluorouracil on the epithelium of the ciliary body of twenty Sprague Dawley SD rats was studied.Methods: Twenty rats were divided into four treatment groups.The first three groups received 0.2 ml of 5, 10, and 30 mg of 5-fluorouracil subconjunctivally respectively, and the fourth group 0.2 ml of 0.4 mg/ml mitomycin C subconjunctivally. The right eye received 0.2 ml of the antimetabolite,while the left eye was injected with 0.2 ml of saline subconjunctivally, as a control.The eyes were examined histologically, in a masked fashion, by light and bytransmission electron microscopy. In each treatment group, two eyes were examined after one week, and three eyes were examined one month after the subconjunctival injection. Results: Electron microscopy revealed toxic effects in the epitheliumof the ciliary body of all treatment groups. The 5-fluorouracil group revealed focal mitochondrial edema, enlargement of intercellular spaces, and dilatation of intracellular spaces. The mitomycin C group showed pyknotic nuclei,enlargement of intercellular spaces, and irregular flattened epithelial cells. Theseverity of changes correlated with concentration and length of exposure. No pathology was found by light microscopy in all groups.Conclusions: This study demonstrates that subconjunctival antimetabolites mitomycin C and 5-fluorouracil can penetrate the sclera and exert toxiceffects on the epithelium of the ciliary body, even in low doses. These changeswere only apparent by electron microscopy and were still present one month after theinjection. These findings may contribute to the theory that the application ofantimetabolites during or after surgery has a direct effect on the epithelium of the ciliary body, besides its known effect on the conjunctiva. Further studies are needed to evaluate its effect on intraocular pressure.

Posteriorly dislocated capsular tension ring.

A 69-year-old man who had pseudoexfoliation and significant nuclear cataract underwent cataract surgery in his right eye. At the beginning of the phacoemulsification, inferior zonulolysis was observed and a capsular tension ring was implanted. Anterior vitrectomy was also performed because of vitreous in the anterior chamber at the end of surgery. A tear in the posterior capsule could not be identified. Three days after surgery, the capsular tension ring was observed partially in the anterior vitreous. A 3-port pars plana vitrectomy was performed and the ring was removed. Three weeks later, the eye developed retinal detachment and was successfully repaired. Retinal complications can develop if the capsular tension ring moves into the vitreous.

Late-onset Pseudomonas keratitis after radial keratotomy and subsequent laser in situ keratomileusis: case report and literature review.

Radial keratotomy (RK) was the most frequently performed procedure for the correction of myopia in the late 1980s and 1990s. Bacterial keratitis is a known complication of RK.1–8 Although it is more frequent in the early postoperative period (days to weeks after surgery), bacterial keratitis can present even several years after the procedure and seriously complicate the visual outcome.8 In this report we present a case of Pseudomonas keratitis presenting 15 years after RK and review reported cases of delayed-onset bacterial keratitis after RK, including spectrum of microorganisms, pathogenesis, possible risk factors, treatment and visual outcome.