11/31. epikeratophakia: clinical results and experimental development. The clinical course and visual, refractive, and keratometric results of a consecutive series of epikeratophakia procedures carried out by the author are presented. Indications for the procedure included keratoconus and adult and paediatric aphakia. Follow up time ranged from two to fourteen months. The first five patients operated on received commercially obtained cryolathed lenticules. The final three cases received lenticules which were lathed by the author at room temperature using a recently developed technique. ( info) |
| epikeratophakia is a rapidly evolving surgical procedure for the refractive correction of aphakia. Even when Snellen acuity after epikeratophakia is normal, patients often report a subjective degradation of the visual image through the surgically corrected eye. To further define visual performance in the patient with optically successful epikeratophakia, we examined contrast sensitivity in two patients surgically corrected for monocular aphakia. Contrast thresholds were measured over a range of spatial frequencies using both computer-generated sinusoidal gratings and a commercially available wall chart system. The eye with epikeratophakia in each case was compared with the opposite normal eye with comparable acuity. One patient was also tested prospectively in the same eye both before and after surgery. Data demonstrate a depression of the contrast sensitivity function in the middle and high spatial frequencies induced by the placement of an epikeratophakia lenticule when compared with the normal eye or contact lens-corrected, preoperative aphakic eye with comparable good acuity. These findings may explain the subjective experience of epikeratophakia patients. ( info) |
13/31. epikeratophakia following rotational autokeratoplasty in a child. A 3-year-old child with posttraumatic aphakia and a corneal scar was treated with a rotational penetrating ipsilateral autokeratoplasty followed by epikeratophakia 2 months later. His final best corrected visual acuity was 20/30, with 1.37D of corneal astigmatism. There were no significant operative or postoperative complications. ( info) |
14/31. Cyclic esotropia in a patient with unilateral traumatic aphakia: case report. Cyclic esotropia is a rare and poorly understood condition normally treated by correcting the deviation measured on the squinting day. Control in some patients with this condition can be gained by correcting their refractive errors, thereby improving acuity. We report on an adult patient who developed cyclic esotropia after unilateral traumatic aphakia with failed contact lens wear whose squint was corrected by secondary intraocular lens implantation. This may be explained by the reduction in the degree of aneisokonia which subsequently improved steropsis. ( info) |
15/31. Refractive changes from use of silicone oil in vitreous surgery. When silicone oil fills the vitreous cavity of the phakic eye or the entire aphakic eye, the refractive correction can be expected to change by 5-9 diopters and sometimes as much as 14 diopters. Aphakic eyes become less hyperopic when filled with silicone oil, whereas phakic eyes become more hyperopic when the vitreous cavity is filled with silicone oil. Previously emmetropic aphakic eyes that are filled with silicone oil have only 4-6 diopters of hyperopia, whereas the same eyes have 10-12 diopters of hyperopia before insertion or after removal of silicone oil. Phakic eyes develop 5-7 diopters of hyperopia when the vitreous cavity is filled with silicone oil, and this puts them in the same range as the silicone oil filled aphakic eyes. High myopia, incomplete silicone oil filling, and several other factors influence the final optical outcome. The vitreoretinal surgeon must anticipate significant changes in refractive error when silicone is introduced into an eye or removed from the eye. Careful retinoscopy and refraction is essential for obtaining optimal vision in these patients. ( info) |
16/31. Interface opacities in epikeratophakia. Although small, peripheral, cystic, or putty-gray infiltrates were observed along the suture tracks in 20 of 100 pediatric patients after epikeratophakia at louisiana State University Medical Center, new orleans, they progressed to clinically significant opacities in only three. In one, the interface material was curetted and the lenticule was reattached. The removed material was identified histologically as epithelial cells in varying states of degeneration. In a second case, the graft became hazy and the opacity involved most of the interface. The lenticule was removed, and epikeratophakia was again performed. On the posterior surface of the removed lenticule was a multilayered epithelium that had infiltrated into adjacent stromal lamellae. In the third case, a clear cyst resolved without intervention over a five-year period. These cases illustrate the importance of meticulous removal of all surface epithelium and the necessity for copious irrigation of epithelial debris intraoperatively. Epithelial ingrowth should not be confused with bacterial infection. Such opacities can be treated by curettage or aspiration of the invading material or removal of the epikeratophakia lenticule if spontaneous resolution does not occur. ( info) |
17/31. Aphakic correction in ectopia lentis. ectopia lentis may cause a reduction in visual acuity, which varies with the type and degree of dislocation and the presence of other ocular abnormalities. retinoscopy may reveal a significant refractive error, usually myopia and astigmatism. Occasionally, an accurate refraction may be difficult because of tilting or dislocation of the lens. If aphakic refraction improves visual acuity, an aphakic correction should be considered. ( info) |
18/31. A case of spontaneous dislocated lenses. There are a great number of causes of dislocated lenses. One such cause is the spontaneous dislocation of a mature or hypermature cataractous lens. The case of an 80-year-old black female with spontaneously dislocated lenses is reported. Because the woman was not aphakic from surgery, but rather from spontaneous dislocation of her lenses, she was not eligible for eyeglasses from medicare. ( info) |
19/31. Persistent corneal edema in aphakic eyes from daily-wear and extended-wear contact lenses. corneal edema developed in seven aphakic eyes of six patients (three men and three women ranging in age from 60 to 88 years) who used daily- or extended-wear hydrophilic and silicone contact lenses. This edema, which developed suddenly, persisted despite discontinuation of contact lens wear and treatment with topical corticosteroids. The onset of the edema occurred in two patterns. In three eyes, edema occurred soon (30 minutes to 30 days) after the contact lens was first worn and persisted during follow-up periods averaging 15 months. In the other four eyes, the edema developed late, after 20 to 66 months. In three of these eyes, edema resolved after follow-up periods averaging seven months. In the fourth eye, it was still present after 18 months. Of the affected eyes in which peripheral endothelial cell densities could be measured, all but one had fewer than 800 cells/mm2. Central cell densities in the five uninvolved fellow eyes averaged 1,964 cells/mm2. Marked polymegathism and cornea guttata were present in all affected and fellow eyes. We believe this condition is a complication of aphakic contact lens wear, distinct from contact-lens-intolerance syndrome and aphakic bullous keratopathy. ( info) |
20/31. argon laser treatment of the ciliary processes in aphakic glaucoma with flat anterior chamber. We treated three patients (a 72-year-old man, a 68-year-old woman, and a 60-year-old man) with aphakic glaucoma with flat anterior chamber by administering laser burns to the ciliary processes (11 ciliary processes in one case, 27 in the second, and three in the third). There was some improvement in all three cases; in one case the intraocular pressure decreased from more than 50 mm Hg to less than 20 mm Hg. In each case the anterior chamber deepened immediately without administration of cycloplegics. ( info) |