Shachar Tauber

Bacillus megaterium delayed onset lamellar keratitis after LASIK.

PURPOSE To report the history and clinical presentation of a 23-year-old man who developed delayed onset lamellar keratitis in his right eye 2 weeks after uneventful LASIK for correction of myopia. METHODS Initial clinical presentation suggested an infectious etiology, which led to therapeutic elevation of the LASIK flap and further microbiologic investigation with bacterial cultures. RESULTS Bacterial cultures revealed Bacillus megaterium, which was sensitive to all antibiotics against which it was tested. Twenty-four hours after initiating aggressive topical and oral antibiotic therapy, symptomatic relief occurred in the affected eye. The patients uncorrected final visual acuity at 1-year follow-up was 20/15 in the right eye, and the stromal bed developed a faint peripheral non-visually significant scar. CONCLUSIONS This case is an unusual presentation and course for microbial keratitis following LASIK, which occurred despite aseptic technique and fluoroquinolone antibiotic prophylaxis. Following refractive surgery one should be prepared to culture the lamellar interface in cases of suspected microbial keratitis and begin aggressive antibiotic therapy.

Descemetocele formation in a patient with a postoperative corneal dellen

Dellen formation generally follows localized evaporation and dehydration of the cornea. The condition follows a disruption in the ocular tear film and usually can be managed conservatively with lubricants. We recently treated a patient with a postoperative dellen that progressed to a descemetocele and required a patch graft to prevent perforation. Recognition of this potential complication emphasizes the need to begin treatment immediately after the onset of dellen.

Precise temperature control of donor cornea tissue with reusable passive thermal container.

Purpose: To describe a new reusable passive thermal shipping container for domestic and international transport of human donor cornea, which maintains air temperature for 72 consecutive hours of harsh hypothermic and hyperthermic environmental challenges. Methods: The passive thermal container (PTC) was prepared by storing the device at −30°C for 8 hours. On full activation of the biphasic wax-based compound, 2 human corneas for research and future histological studies were secured in either of 2 similarly prepared PTCs or 2 polystyrene containers with wet ice. Three thermal data loggers were enclosed in the bottom, side, and middle of each payload area. The container was then exposed to hyperthermic (range, 21.1 to 51.7°C) or hypothermic (range, 15.6 to −28.9°C) external temperatures for 72 hours after which all corneas were removed, and the air temperature readings from the loggers were reviewed. Results: Air temperature stability was measured at 5-minute intervals. The PTC maintained steady acceptable air temperatures for 71.13 consecutive hours in the hyperthermic challenge and 60.33 consecutive hours in the hypothermic challenge. The polystyrene containers with wet ice did not maintain a payload temperature between 2 and 8°C for more than 8 consecutive hours during the hypothermic challenge and never achieved industry regulation temperatures during the hyperthermic challenge. Conclusions: We present a novel method for transporting human corneal tissue that ensures proper air temperature stability between 60 and 71 hours in harsh hypothermic and hyperthermic environments, which is also reusable. There may be applications for this technology in both domestic and international transportation of corneal tissue.

Comparison of hand-held, suction, and automated trephines on experimental corneal wound size

ABSTRACT Three trephines were tested to determine their uniformity in creating a circular opening during penetrating keratoplasty. Twenty‐ one globes (seven per instrument) were trephined with a hand‐held, suction or automated trephine. The mean astigmatism was greatest with the hand‐held device (mean 0.73 cm) and least with the automated trephine (mean 0.50 cm). The automated and the suction trephines (mean astigmatism 0.51 cm) may result in reduced corneal astigmatism during penetrating keratoplasty.