Prashant Bhartiya

Laser in-situ keratomileusis after penetrating keratoplasty.

Laser in situ keratomileusis (LASIK) after penetrating keratoplasty has been used more commonly for the correction of myopia or myopic astigmatism and less so for hypermetropia or hyperopic astigmatism. The primary goal after LASIK in such cases is resolution of sufficient myopia and astigmatism to allow spectacle correction of the residual refractive error and decrease anisometropia. All sutures should be removed prior to LASIK and the interval between penetrating keratoplasty and LASIK should be a minimum of 1 year. Preoperative evaluation includes refraction, slit-lamp biomicroscopy, corneal topography, and specular microscopy. The technique of LASIK surgery after penetrating keratoplasty is similar to the standard procedure. However, many variations have been described. These include maneuvers during surgery such as augmentation with arcuate cuts on the stromal bed and topographically guided LASIK. Other variations are relaxing incisions followed by LASIK surgery and sequential treatment by LASIK, that is, raising of the flap as a first stage procedure followed by ablation if required, 4 to 6 weeks later after relifting the flap in the second stage. Improvement in both uncorrected visual acuity and spectacle-corrected visual acuity, as well as a decrease in spherical equivalent, cylinder, and anisometropia, has been reported in various studies. All grafts were clear and no occurrence of wound dehiscence has been reported. Intraoperative complications include hemorrhage, microkeratome failure, flap buttonhole, dislocation, and perforation. Postoperative complications include undercorrection, decentered ablation, and regression. Re-enhancements after LASIK following keratoplasty are possible with acceptable visual outcome.

Central lamellar keratoplasty with peripheral intralamellar tuck: a new surgical technique for keratoglobus.

Purpose. To report a new technique of lamellar keratoplasty in a case of keratoglobus. Methods. A patient with bilateral keratoglobus with maximal thinning in the juxtalimbal periphery underwent a lamellar procedure in the right eye. The visual acuity was 3/60. Refraction was not possible due to severe irregular astigmatism, and the central pachymetry was 430 &mgr;m. A central 8.5 mm diameter lamellar dissection along with a peripheral intrastromal pocket up to the limbus was fashioned. The donor corneal button (12 mm) denuded of its endothelium was beveled at the periphery to create a flange. This flange was tucked into the peripheral pocket and the graft was sutured with interrupted nylon sutures. Results. No intra-or postoperative complication was encountered. Reepithelialization was complete within 1 week. At 1 month postoperatively, the preoperative keratometric astigmatism of >12 D decreased to <2.75 D. The spectacle-corrected visual acuity at 1 month was 6/18. Conclusions. This new technique of central lamellar keratoplasty with intralamellar tucking of the peripheral flange for keratoglobus not only provides optical clarity and tectonic support but also helps in preservation of the host limbal stem cells.

Central Penetrating Keratoplasty With Peripheral Intrastromal Tuck

Purpose: To report a new technique of central penetrating keratoplasty with peripheral intrastromal tuck in cases of chronic corneal decompensation. Methods: Central penetrating keratoplasty with peripheral intrastromal tuck was undertaken in 8 eyes with chronic corneal decompensation. An 8-mm donor tissue with a peripheral flange of 2 mm was fashioned and sutured into a 7.5-mm recipient bed having a 2-mm intralamellar pocket. Sixteen full-thickness interrupted sutures were passed. Suture removal was possible as early as 1 month, and all sutures were removed by 4 months. Results: Postoperative BCVA improved to 20/40 to 20/80 in all eyes, and astigmatism was <4 diopters in all cases at the last follow-up, which ranged from 5 to 16 months. Conclusions: Central penetrating keratoplasty with peripheral intrastromal tuck is a useful technique because it allows early suture removal and visual rehabilitation.

Goat eye with human nucleus for phacoemulsification training.

model eye and HOAs and IOL position measurements were repeated. In addition, there was no significant difference in 3rd, 4th, and total HOAs root mean square except spherical aberration in C20.00 D IOLs. We therefore considered IOL position to have little influence on HOAs except spherical aberration. If the tilt and decentration of the IOL is significant, IOL positions influence HOAs in our model eye. We changed our model eyes IOL folder for displacement of IOL. We are measuring HOAs of the model eye to determine the effects of IOL displacement.dFutoshi Taketani, MD

Hyperplastic persistent pupillary membrane associated with subacute angle-closure glaucoma

We describe a case of hyperplastic persistent pupillary membrane (HPPM) with good visual acuity associated with angle-closure glaucoma. Both gonioscopy and Ultrasound biomicroscopy showed a narrow, occludable angle. A diagnosis of subacute angle closure was made and Nd: YAG iridotomy was undertaken in both eyes. Patients with HPPM may be at an increased risk of angle-closure glaucoma.