1/234. Epikeratoplasty for traumatic corneal ectasia. PURPOSE: To evaluate the efficacy of epikeratoplasty in a case of traumatic corneal ectasia. METHOD: Epikeratoplasty using a manually dissected donor lenticule was used to treat traumatic corneal ectasia after an iron nail injury. RESULT: No intra- or postoperative complication was encountered. At the end of 6 months' follow-up, the patient's best corrected visual acuity was 6/12. CONCLUSION: Epikeratoplasty is a useful technique to treat traumatic corneal ectasia. ( info) |
| An unusual case of spontaneous corneal perforation of acute hydrops in the left eye of a 21-year-old man is presented. The patient had a history of atopic diseases. To evaluate the status of the other eye, corneal topographic analysis was performed. This confirmed a subclinical keratoconus in the fellow eye and the association with atopy, eye rubbing, and rapid progression of the ectasia leading to perforation. ( info) |
3/234. Discordance for keratoconus in two pairs of monozygotic twins. PURPOSE: We present two pairs of monozygotic twins discordant for keratoconus. methods: Two pairs of twins, each with one twin with keratoconus, and available family members were examined clinically and with computer-assisted videokeratography. polymerase chain reaction-based zygosity assays using between nine and 11 unique, anonymous DNA markers were performed on blood obtained from the twins and surviving parents to assess the probability of genetic monozygosity. RESULTS: dna probes showed a >99% probability that each of the two sets of twins was monozygotic. One twin from each pair had clinically diagnosed keratoconus. The remaining twins were normal by clinical examination and corneal topography. Clinical results for all family members examined were normal except that five of 13 from one family and one of six from the other family demonstrated "suspicious" corneal topography. CONCLUSION: Recent advances in knowledge and understanding of the twinning process suggest that monozygotic twins discordant for keratoconus does not preclude the possibility of a significant genetic component. ( info) |
| keratoconus is a progressive non-inflammatory corneal ectasia. alopecia areata is complete loss of hair patches on the hairy areas of the body in association with some ocular manifestations such as cataract, or disorders of the conjunctiva, iris, lens, choroid and retina pigment epithelium. A ten-year-old patient with atopic keratoconjunctivitis, keratoconus and alopecia areata is presented. This patient has also been receiving treatment for Hashimoto thyroiditis (chronic lymphocytic thyroiditis) for more than three years. The possible association of keratoconus with multisystem autoimmune disease is discussed. ( info) |
5/234. Bilateral circumscribed posterior keratoconus. BACKGROUND: Posterior keratoconus is a rare corneal disorder characterized by a diffuse or localized protrusion of the posterior corneal surface into a thinning stroma. It is believed to be a congenital, nonprogressive condition. CASE REPORT: A case of bilateral circumscribed posterior keratoconus is presented. Diagnostic ocular signs include localized protrusion of the posterior corneal surface, normal anterior corneal surface, stromal thinning, and endothelial changes. However, anterior corneal contour reveals progressive steepening in this case. CONCLUSION: Posterior keratoconus is an unusual corneal anomaly with subtle clinical features. Recognition of these signs is essential in the diagnostic and management processes. ( info) |
6/234. Epithelial ingrowth in a corneal graft treated by laser in situ keratomileusis: light and electron microscopy. PURPOSE: To demonstrate progressive epithelial ingrowth histopathologically in a human cornea after laser in situ keratomileusis (LASIK) and review its pathophysiology. SETTING: Department of ophthalmology, Medical College of virginia Campus, virginia Commonwealth University, and the veterans Affairs Medical Center, Richmond, virginia, USA. methods: Tissue from a corneal transplant specimen was examined 6 weeks after LASIK by light and transmission electron microscopy. RESULTS: Epithelial ingrowth in the flap interface with connection to the surface corneal epithelium was evident on light microscopy. In areas without epithelial ingrowth, the flap interface was imperceptible. Electron microscopy revealed minimal disruption of the stromal collagenous lamellae. CONCLUSION: Progressive epithelial ingrowth occurred with a continuous sheet of epithelium to the flap edge. Location of epithelial ingrowth and cytokine epithelial-stromal interaction appear to be important factors in this complication. Histopathological changes in the cornea after LASIK are difficult to detect in areas with normal wound healing. ( info) |
7/234. Denovo development of corneal guttae and Fuchs' dystrophy in corneal grafts. PURPOSE: To describe two cases of de novo development of corneal guttae and Fuchs' dystrophy in donor tissue following penetrating keratoplasty (PK) for unrelated conditions. methods: Two patients underwent PK for keratoconus and a disciform scar secondary to herpes simplex virus. They were followed clinically for a period of 16 and 11 years, respectively. Specular microscopy was used in one patient. RESULTS: Corneal guttae were first noted 10 years and 4 years following transplantation in the first and second patient, respectively. In both cases, the corneal guttae gradually increased in number, involving the central and temporal portions of the corneal graft There were no corneal guttae present in the host corneal rim or contralateral cornea of either patient. CONCLUSIONS: These cases provide evidence to suggest that some corneas may be genetically predetermined to develop corneal guttae and Fuchs' dystrophy many years before any changes can be clinically detected. ( info) |
8/234. keratoconus with good unaided visual acuities: two case reports. BACKGROUND: Ophthalmic evaluation of patients with keratoconus (KC) often reveals highly myopic and irregular astigmatic refractive corrections. Irregular corneal astigmatism and central corneal scarring in patients with KC often result in a loss of best-corrected spectacle acuity. Rigid gaspermeable contact lenses generally optimize visual acuities for patients with KC. case reports: Two cases are discussed of patients who manifested clinically diagnosed KC but unusually good unaided Snellen visual acuities (20/25 or better) in both eyes. CONCLUSION: Good unaided visual acuities are not necessarily inconsistent with the diagnosis of KC. ( info) |
9/234. Circumscribed posterior keratoconus: case report. BACKGROUND: Posterior keratoconus has only a few scattered case reports in the literature. Posterior keratoconus is characterized by a posterior stroma thinning and a depression of the posterior corneal surface. The effect on acuity is variable and may be related to other ocular and systemic conditions. CASE REPORT: An African-American woman came to us with posterior concavity (corneal thinning), with stromal scarring in both eyes and an epithelial iron ring present in the left eye. The endothelia layer appeared intact in both eyes. corneal topography of the right eye demonstrated a central flattened zone with peripheral steepening, while the left eye an inferior nasal steepened zone was present. The patient was also diagnosed with myopic degeneration (O.D. > O.S.) as well as cataracts. CONCLUSIONS: Posterior keratoconus generally has a minimal effect on visual performance and requires no specific treatment. In cases in which visual defect is severe and is attributable to the posterior keratoconus--and not other ocular conditions, such as cataracts--penetrating keratoplasty should be considered. ( info) |
| PURPOSE: To assess whether photorefractive keratectomy (PRK) controlled by videokeratography can successfully treat refractive errors in eyes with corneal irregularities and improve spectacle-corrected visual acuity. methods: In a prospective clinical study, PRK was performed in 10 eyes of 10 patients. Reason for surgery was irregular astigmatism after penetrating keratoplasty, corneal irregularity after corneal scarring, corneal astigmatism in keratoconus, and decentration after myopic and hyperopic PRK. Excimer ablation was controlled by preoperative videokeratography (Orbscan II, Orbtek) using the MEL-70 system from Aesculap Meditec. Follow-up was 6 months. RESULTS: Concerning manifest refraction, the sphere was reduced on average from 1.92 to 0.57 D, 6 months postoperatively. Cylinder changed from -1.95 D on average to -0.30 D at 6 months postoperatively. There was improvement of uncorrected visual acuity of 2 or more lines in 5 eyes and no change in 5 eyes 6 months postoperatively. Spectacle-corrected visual acuity improved in 2 eyes by 2 to 3 lines, in 9 eyes by 1 to 3 lines, and showed no change in 1 eye. CONCLUSION: Videokeratography-controlled PRK improved refractive errors in irregular corneas with improvement of spectacle-corrected visual acuity. ( info) |