Search

We review the clinical, histopathological, and ultrastructural findings and DNA phenotyping of a patient with Avellino corneal dystrophy exacerbated by laser in situ keratomileusis. The findings are reported and interpreted in the context of a literature review. The case highlights the possible difficulty of recognizing subtle dystrophic findings, as well as the importance of avoiding refractive surgical intervention in patients with Avellino corneal dystrophy to avoid exacerbation of dystrophic deposits in the cornea and subsequent reduction in vision.

Purpose: To determine whether viscoelastic materials effectively protect the corneal endothelium from air bubbles. Setting: Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. Methods: Human eye-bank and rabbit eyes had a standardized phacoemulsification procedure with or without viscoelastic material (Healon® [sodium hyaluronate 1.0%], Healon GV® [sodium hyaluronate 1.4%], or Viscoat® [chondroitin sulfate 4.0%−sodium hyaluronate 3.0%]). The integrity of the endothelium was examined after the procedure with F-actin staining and scanning electron microscopy. Rabbit eyes with and without viscoelastic material (Healon or Viscoat) had a standardized irrigation/aspiration (I/A) procedure. The mucinous layer of the endothelium was examined after the procedure with transmission electron microscopy. Results: In the phacoemulsification experiment without viscoelastic material, with Healon, and with Healon GV, the endothelium of human and rabbit corneas had many areas of cell loss in a pattern consistent with air-bubble damage. With Viscoat, endothelial cells remained intact. In the I/A experiment, the mucinous layer of Viscoat-exposed rabbit endothelium appeared thinner. In the same experiments without viscoelastic material or with Healon, the mucinous layer of the endothelium appeared normal. Conclusions: Viscoat effectively protected the endothelium from air-bubble damage. Viscoat appears to protect the endothelium by acting as a physical barrier. Its adherence is probably related to the way it interacts with the mucinous layer of the endothelium.

Behçet's disease is 1 of the most common causes of uveitis in the Eastern world. Its common ocular complications are uveitis, cataract, and obliteration of retinal vessels. Phacoemulsification with intraocular lens (IOL) implantation in patients with Behçet's disease is known to be a safe procedure. We managed a patient with Behçet's disease who had aggravated uveitis and opacification of a hydrophilic acrylic IOL (ACRL-C160, Ophthalmed) 4 months after cataract surgery. Recalcitrant uveitis despite maximum tolerable medication and IOL opacification with vitreous opacity necessitated an IOL exchange and trans pars plana vitrectomy. After the procedure, the eye became quiescent. However, the visual acuity was 20/200 because of the obliteration of retinal vessels.

A 69-year-old man developed stromal edema and a pocket of fluid in the laser in situ keratomileusis (LASIK) interface wound in the left eye after acute endothelial cell loss from complicated trabeculectomy. He eventually required penetrating keratoplasty along with cataract surgery. Histologic examination of the corneal button showed an edematous 720 microm central residual stromal bed, a 54 microm empty space at the level of the central interface wound, and a 154 microm LASIK flap. The endothelial cell count was 0 to 2 cells per high-power field, corresponding to a cell density of 450 to 500 cells/mm(2). Four years after LASIK, the central interface wound was susceptible to forming a pocket of serous fluid after the corneal endothelial function was compromised.

Purpose To investigate the conditions under which bubbles form during phacoemulsification. Setting Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea. Methods In the first part of the study, the partial pressure of oxygen (pO 2 ) was used as a surrogate measure for the partial pressure of air. Irrigation solutions packaged in glass and plastic containers were studied. A directly vented glass bottle was also tested. The pO 2 of the various irrigation solutions was measured as the containers were emptied. In the second part, phacoemulsification procedures were performed in rabbit eyes with different power settings and different irrigation solutions. Intracameral bubble formation during the procedure was recorded. Following the phacoemulsification procedures, the corneas were stained for F-actin and examined for endothelial injury. Results The initial pO 2 in irrigation solutions packaged in glass bottles was about half that at atmospheric levels; in solutions packaged in plastic, it was at atmospheric levels. As irrigation solutions were drained from the container, the pO 2 of the solution tended to rise toward atmospheric levels. The rate of pO 2 increase was markedly reduced by using a directly vented glass bottle. In the phacoemulsification procedures, bubble formation was most likely to occur with higher pO 2 and higher power settings. Observation of bubbles by the surgeon was highly correlated with endothelial damage. Conclusions Keeping the pO 2 low reduced the risk of endothelial damage, especially at higher phacoemulsification powers. The packaging of irrigation solutions was the most important factor in controlling the initial pO 2 of the solution. The pO 2 can be minimized throughout a phacoemulsification procedure by using a directly vented glass bottle.