Sonia H. Yoo

Infectious keratitis after LASIK

PURPOSE To report the clinical course, management, and outcomes of culture-proven infectious keratitis in 15 eyes of 13 subjects after LASIK. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Fifteen eyes of 13 subjects who underwent LASIK and developed culture-positive keratitis. INTERVENTION Infectious keratitis was encountered in the operative eyes between 1 day and 450 days. Cultures were obtained, and topical antibiotic therapy was administered in all cases. Some cases required flap lifting, irrigation, and soaking of the bed with antibiotics, flap amputation, or further surgical intervention. MAIN OUTCOME MEASURES Time periods from onset to diagnosis, from clinical diagnosis to clinical resolution, final acuities, microbiologic profiles, and medical and surgical interventions were reviewed. RESULTS Onset of symptoms of infection varied, depending on the infectious organism. Bacterial organisms tended to present earlier, whereas mycobacterial and fungal organisms had a later mean onset of presentation. Furthermore, the atypical organisms such as mycobacteria, fungus, and acanthamoeba also had a more delayed diagnosis, resulting in a prolonged disease course. CONCLUSIONS Infectious keratitis after LASIK is a potentially vision-threatening complication. Onset of symptoms varies depending on causative agents. Furthermore, atypical organisms in the interface or beneath the flap can pose both diagnostic and therapeutic dilemmas. Location in the interface can make it more difficult to culture the organisms and prevent adequate penetration of topical antibiotics.

Femtosecond laser-assisted cataract surgery.

Femtosecond laser-assisted cataract surgery provides surgeons an exciting new option to potentially improve patient outcomes and safety. Over the past 2 years, 4 unique laser platforms have been introduced into the marketplace. The introduction of this new technology has been accompanied by a host of new clinical, logistical, and financial challenges for surgeons. This article describes the evolution of femtosecond laser technology for use in cataract surgery. It reviews the available laser platforms and discusses the necessary modifications in cataract surgery technique and the logistics of incorporating a femtosecond laser into ones practice.

One-Year Results and Anterior Segment Optical Coherence Tomography Findings of Descemet Stripping Automated Endothelial Keratoplasty Combined With Phacoemulsification

OBJECTIVE To report 1-year results and anterior segment optical coherence tomography findings of Descemet stripping automated endothelial keratoplasty combined with phacoemulsification in patients with cataract and Fuchs endothelial dystrophy. METHODS Twelve eyes of 11 patients with at least 1-year follow-up were retrospectively reviewed. Measured variables included best spectacle-corrected visual acuity, refractive spherical equivalent and predictability, anterior corneal keratometric values, complications, and anterior segment optical coherence tomography findings. RESULTS The mean follow-up was 14.33 months (range, 12-18 months). The best spectacle-corrected visual acuity was unchanged (8%) or improved (92%) in all eyes compared with the preoperative levels. A mean (SD) discrepancy between the targeted postoperative refraction and the actual postoperative spherical equivalent refraction (hyperopic shift) of 1.46 (0.76) diopters (D) (range, -0.05 to 3.14 D) was observed. A significant correlation existed between the ratio of central graft thickness to mean peripheral donor corneal lenticule thickness at 3 mm and induced hyperopic shift (R(2) = 0.65, P < .001). CONCLUSIONS Descemet stripping automated endothelial keratoplasty combined with phacoemulsification and intraocular lens implantation in patients with coexisting Fuchs endothelial dystrophy and cataract improved best spectacle-corrected visual acuity without progressive time-dependent complications. A correlation exists between donor corneal lenticule shape and induced hyperopic shift.

Femtosecond Laser-Assisted Sutureless Anterior Lamellar Keratoplasty

PURPOSE To report the technique and small case series results of femtosecond laser-assisted sutureless anterior lamellar keratoplasty (FALK) for anterior corneal pathology. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Twelve consecutive eyes from 12 patients with anterior corneal scarring. INTERVENTION Femtosecond laser-assisted sutureless anterior lamellar keratoplasty. MAIN OUTCOME MEASURES Measured parameters included femtosecond laser settings, technique, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and complications. RESULTS Mean follow-up was 12.7 months (range, 6-24). No intraoperative complications were found. Uncorrected visual acuity (VA) improved in 7 eyes (58.3%) compared with preoperative VA. The mean difference between preoperative and postoperative UCVAs was a gain of 2.5 lines (range, unchanged-7 lines). Best-corrected VA was unchanged or improved in all eyes compared with preoperative levels. The mean difference between preoperative and postoperative BCVAs was a gain of 3.8 lines (range, unchanged-8 lines). In 2 eyes, adjuvant surgical procedures were performed (one treated with phototherapeutic keratectomy and the other with photorefractive keratectomy). Six patients (50%) developed dry eye after FALK, which improved during the follow-up period. No graft rejection, infection, or epithelial ingrowth was found in this series of patients. CONCLUSIONS Femtosecond laser-assisted sutureless anterior lamellar keratoplasty could improve UCVA and BCVA in patients with anterior corneal pathology.

Prevention, diagnosis, and management of acute postoperative bacterial endophthalmitis

&NA; This distillation of the peer‐reviewed scientific literature on infection after cataract surgery summarizes background material on epidemiology, etiology, and pathogenesis, describes the roles of surgical technique and antibiotic prophylaxis in prevention, and discusses diagnostic and therapeutic interventions in cases of suspected endophthalmitis. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Long-Term Results of Femtosecond Laser-Assisted Sutureless Anterior Lamellar Keratoplasty

PURPOSE To evaluate the long-term results of femtosecond laser-assisted anterior lamellar keratoplasty (FALK) for anterior corneal pathologies. DESIGN Retrospective, noncomparative, interventional case series. PARTICIPANTS Thirteen consecutive patients who underwent FALK for anterior corneal pathologies. INTERVENTION Femtosecond laser-assisted sutureless anterior lamellar keratoplasty. MAIN OUTCOME MEASURES Best spectacle-corrected visual acuity (BSCVA), manifest refraction, need for adjunctive surgery, and complications. RESULTS Follow-up ranged from 12 to 69 months (mean = 31 months). The BSCVA was significantly improved over preoperative values at the 12-, 18-, 24-, and 36-month visits. A BSCVA greater than 20/30 was achieved in 54% of patients at the 12-month visit when all 13 patients were available for follow-up, in 50% and 33% of patients at the 18- and 24-month visits, respectively, when 12 patients were available, and in 60% and 50% of patients at the 36- and 48-month visits when 5 and 2 patients were available, respectively. The BSCVA of the eye that completed the 60- and 70-month visits was 20/50. Patients achieved a mean gain of 5 lines of BSCVA at the 6-, 12-, 18-, and 24-month visits, 4 lines at the 36-month visit, 5 lines at the 48-month visit, and 6 lines at the 60- and 72-month visits. Two patients lost a mean of 1.5 lines of BSCVA because surface haze developed after photorefractive keratectomy (PRK) and granular dystrophy recurred in the graft. At a mean of 5 weeks postoperatively, 83.3% of patients achieved BSCVA within 2 lines of that recorded at the 24-month visit. At the 12-month visit, mean spherical equivalent and refractive astigmatism were -0.4 diopters (D) and 2.2 D, respectively, with no significant shift from preoperative values or values recorded in different follow-up visits. Adjunctive surgeries included phototherapeutic keratectomy, PRK, cataract extraction, and epithelial ingrowth debridement. Complications included residual corneal pathology, mild interface haze, anisometropia, recurrence of pathology, haze after adjunctive PRK, dry eye, epithelial ingrowth, and suspicious ectasia. CONCLUSIONS Femtosecond laser-assisted sutureless anterior lamellar keratoplasty improves the BSCVA of patients with anterior corneal pathologies with rapid visual rehabilitation and no significant induced astigmatism. Our preliminary results indicate that FALK results remained stable throughout the follow-up period.

Management of pellucid marginal corneal degeneration with simultaneous customized photorefractive keratectomy and collagen crosslinking

A 34-year-old woman had simultaneous photorefractive keratectomy and corneal collagen crosslinking with riboflavin-ultraviolet-A irradiation for the treatment of progressive pellucid marginal corneal degeneration in both eyes. No intraoperative or early postoperative complications occurred. Twelve months postoperatively, the uncorrected visual acuity was assessed at 20/40 in both eyes compared with counting fingers preoperatively. The corrected visual acuity also improved from 20/50 and 20/63 to 20/25 and 20/32 in the right eye and left eye, respectively. Corneal topography revealed a significant improvement in both eyes. Despite the encouraging results, longer follow-up is necessary to confirm the stability of the results.

Histopathologic Examination of Failed Grafts in Descemet's Stripping with Automated Endothelial Keratoplasty

PURPOSE To study the histopathologic features of 19 corneal posterior lamellar grafts in eyes for which Descemets stripping with automated endothelial keratoplasty (DSAEK) has failed. DESIGN Retrospective case series with clinicopathologic correlation. PARTICIPANTS Nineteen cases of DSAEK failures undergoing repeat DSAEK or penetrating keratoplasty. METHODS The histopathologic results of posterior lamellar grafts (also termed DSAEK grafts), recipient corneas, or both from 19 cases of failed DSAEK were examined. MAIN OUTCOME MEASURES Abnormalities in the DSAEK graft and in the interface between the recipient cornea and the DSAEK graft were assessed. RESULTS Histopathologic features in 19 failed DSAEK grafts revealed attenuation of endothelial cells (16 cases) and presence in the graft-host interface of fibrocellular tissue (11 cases), retained Descemets membrane (5 cases), epithelial ingrowth (4 cases), or a combination thereof. Four DSAEK grafts had full-thickness corneal layers at 1 edge. CONCLUSIONS Presence of interface material, such as fibrocellular tissue, retained Descemets membrane, and epithelial ingrowth, are potential causes of dislocation. Endothelial attenuation was the most common finding in failed grafts. Decentered DSAEK grafts with full-thickness corneal layers at 1 edge are a potential cause for epithelial ingrowth.

Tacrolimus ointment 0.03% in the eye for treatment of giant papillary conjunctivitis.

Purpose: To report a case of refractory giant papillary conjunctivitis (GPC) treated by using topical tacrolimus 0.03% ointment. Methods: A 16-year-old white boy with a history of GPC was referred to our department for severe GPC with eye itching, tearing, photophobia, discharge, and blepharospasm. The patient had received previous treatments with antihistamines, mast cell stabilizers, topical corticosteroid ointments, and surgical resection-cryopexy of GPC that were ineffective. Results: Topical tacrolimus 0.03% ointment (Protopic; 0.5 cm) was applied into the lower fornix twice a day. An improvement of the patients symptoms was observed during the first 5 days of therapy, and the GPC was resolved within 15 days. After 1 month of continued topical tacrolimus ointment treatment, there was no evidence of GPC. Topical tacrolimus was tapered during the next 2 months. Six months after treatment, there were no GPC findings, and no side effects were reported. Conclusions: Topical tacrolimus 0.03% ointment for severe GPC, refractory to conventional therapy, appears to be an effective alternative treatment.

Femtosecond-assisted astigmatic keratotomy for post-keratoplasty irregular astigmatism

We describe the technique of femtosecond-assisted astigmatic keratotomy (AK) in a post-keratoplasty patient with irregular, nonorthogonal astigmatism. Using the keratoplasty software, an anterior arcuate side cut (400 mum thick, 6.5 mm diameter) was created using the femtosecond laser in a 68-year-old woman with irregular astigmatism 28 years after penetrating keratoplasty for keratoconus. No intraoperative or postoperative adverse events were seen during the follow-up period. Six months after the procedure, the uncorrected visual acuity improved from 20/60 to 20/50 and the best spectacle-corrected visual acuity, from 20/50 to 20/32. The mean manifest astigmatic correction decreased from 4.00 diopters (D) to 0.50 D; corneal topography showed a significant improvement in irregular astigmatism. The technique of femtosecond-assisted AK is simple and efficient for managing irregular and nonorthogonal astigmatism in post-keratoplasty patients and may overcome the limitations of earlier techniques.