Search

We report a case of herpetic perforated peripheral corneal ulcer in a patient with cutaneous porphyria and hepatitis C. The patient underwent peripheral lamellar keratoplasty. Antiherpetic antibodies were found at a significantly higher level in the aqueous humor than in the serum. Outcome was favorable with antiviral treatment. We discuss the causal role of the hepatitis C virus, porphyria and herpes simplex.

We report a case of acute angle-closure glaucoma in a patient treated with bronchodilator nebulization. An 82-year-old man with chronic obstructive bronchopathy was treated for acute respiratory decompensation with salbutamol and ipratropium bromide aerosols. Twenty-four hours after beginning the treatment, the patient developed acute angle-closure glaucoma which resolved rapidly with appropriate treatment. The case emphasizes the importance of precautionary measures (waterproof glasses and inhalation masks). In addition patients with a high risk of angle-closure glaucoma should be detected prior to prescribing bronchodilating aerosols.

Purpose: To study the refractive and topographic modifications induced by penetrating keratoplasty suture removal., Methods: We retrospectively studied 50 corneas from 50 patients who had undergone penetrating keratoplasty. All of the eyes were examined before and after all sutures were removed at 10.8+/-4.7 months and 20.3+/-7.9 months after keratoplasty. Subjective refraction, best spectacle-corrected visual acuity (LogMAR units), and corneal topography (EyeSys 2000R device) were recorded., Results: Suture removal decreased the subjective cylinder by an average of 0.91+/-2.32 D (p = 0.004) and modified the corneal topographic pattern (p = 0.03) and shape (p < 0.001) distribution. The change in subjective cylinder correlated with the variation of the steepest meridian power (r(s) = 0.46; p < 0.001). It correlated with the change in topographic pattern (r(s) = 0.59; p < 0.001). The subjective spherical equivalent increased (hyperopization) by an average of 0.61+/-2.24 D (p = 0.01). After suture removal, the prolate shape was less frequent, and the oblate shape was more frequent than before suture removal. Best spectacle-corrected visual acuity increased by an average of 0.8+/-2.0 lines (p = 0.004). The change in subjective cylinder correlated with the change in visual acuity (r(s) = 0.36; p = 0.006)., Conclusion: Suture removal modifies the corneal topographic pattern and shape. It decreases the subjective cylinder and induces an hyperopization. Visual-acuity improvement after suture removal mainly is explained by the decrease in astigmatism. Suture removal seems particularly helpful in corneas with a bow-tie pattern.

Purpose: To compare the accuracy and reproducibility of the Eye Sys videokeratoscope algorithms for analyzing idiopathic and surgery-induced astigmatism analysis., Methods: Refractive astigmatism, videokeratoscopy (axial, tangential and refractive power), autorefractometry, autokeratometry, and keratometry were recorded in 20 patients with idiopathic astigmatism, 40 patients who had undergone cataract surgery and 40 patients who had undergone penetrating keratoplasty. For each eye, 2 successive videokeratoscopy were recorded., Results: Both cylinder and axis provided by the tangential algorithm are significantly less reproducible than the cylinder and axis provided by the axial and refractive algorithms (P < 0.001). Cylinders provided by the axial and refractive algorithms showed a stronger correlation with subjective cylinder (rs > 0.89; p < 0.001) than the cylinder provided by the tangential algorithm (rs = 0.66; p < 0.001). Both keratometric axis and autokeratometric axis showed the strongest correlation with subjective axis (rs > 0.92; p < 0.001). The accuracy and reproducibility were higher for the topographic "bow tie" patterns than for the other topographic patterns., Conclusion: The axial and refractive algorithms of the Eye Sys videokeratoscope are more accurate and reproducible than the tangential algorithm for analyzing idiopathic or surgery-induced astigmatism.

Purpose: To investigate the effect of sodium hyaluronate on reepithelialization time after penetrating keratoplaty., Methods: We prospectly studied 56 consecutive penetrating keratoplasties. One group of patients (n = 22) received dexamethasone ointment at the end of surgery. The second group (n = 34) received sodium hyaluronate and topical dexamethasone. Postoperative reepithelialization time and graft central thickness were recorded., Results: There was no statistical difference between both groups for epithelialization (4.6 + 3.2 days in the hyaluronate group and 4.4 + 2.3 days in the dexamathasone group) and for graft thickness at day one (710 + 85 microns for the former group and 713 + 84 microns for the latter group) and at day of reepithelialization (663 + 80 microns for the former group and 703 + 99 microns for the latter group). The epithelium aspect was different at the first postoperative day between both groups., Conclusion: The use of sodium hyaluronate at the end of penetrating keratoplasty improves the graft epithelium aspect at the first postoperative day, but it does not influence reepithelialization time. Further studies are needed to investigate the mechanism of sodium hyaluronate effect on corneal epithelium.

Background: The aim of this study was identification of predictive factors for postoperative visual acuity in patients with a clear organ-cultured graft and to analyze the change in visual acuity between 12 and 24 months after transplantation., Methods: The study design was a prospective cohort study. A total of 342 consecutive penetrating keratoplasties using donor organ-cultured grafts, performed in 324 patients, were included. Visual acuity, graft thickness, and graft endothelial cell density were recorded in patients with clear transplants., Results: At 24 months postoperatively, 25 (18.7%) of 134 patients had 20/200 or worse visual acuity and 66 (49.3%) had 20/40 or better visual acuity. Graft thickness took 1 month to decrease to normal values. A temporary graft thinning occurred at 6 months postoperatively, followed by recovery of normal graft thickness by 18 months. The average postoperative endothelial cell density was 1,533+/-598 cells/mm2 during the second year. The 24-month LogMAR (logarithm of minimal angle of resolution) visual acuity correlated with preoperative LogMAR visual acuity (beta=0.26, P=0.005), postoperative lens status (beta=-0.34, P=0.008), preoperative intraocular pressure (beta=0.50, P=0.020), and postoperative astigmatism (beta=0.17, P=0.040). Visual acuity (P=0.022) significantly improved between 12 and 24 months. Preoperative diagnosis (P < 0.0001) and postoperative lens status (P < 0.0001) significantly influenced the change in LogMAR visual acuity between 12 and 24 months., Conclusions: Donor variables do not influence the visual acuity results of penetrating keratoplasty using organ-cultured donor tissue, whereas they have a strong influence on graft survival and graft endothelial cell density. Visual acuity improves during the first 2 years after transplantation. After keratoplasty, organ-cultured corneal grafts undergo dramatic modifications of their thickness and probably of their transparency.

Infectious crystalline keratopathy is an exceptional but serious complication of penetrating keratoplasty. Streptococcus viridans and a steroid treatment are very often found. The treatment is always lengthy and difficult. The high number of bacteria and the steroid treatment, necessary to prevent rejection, worsen the infection. We report a case of Streptococcus crystalline keratopathy that evolved, despite the treatment, simultaneously toward abscess and acute rejection. Topical cyclosporin treatment was used to maintain an immunosuppression without worsening the infection.

Purpose: To report the results of arcuate keratotomy performed with the Hanna arcitome in patients with postkeratoplasty astigmatism., Setting: Department of Ophthalmology, Saint-Antoine Hospital, Paris VI University, Paris, France., Methods: This retrospective study comprised 22 eyes (22 patients) with postkeratoplasty astigmatism. Paired symmetrical arcuate keratotomy was performed with the Hanna arcitome. Outcome measures included refraction, videokeratography, and keratometry., Results: At 6.6 months +/- 8.9 (SD) after surgery, the mean increase in best spectacle-corrected visual acuity (BSCVA) was 2.1 +/- 2.4 lines. Thirteen eyes gained 2 lines or more of BSCVA, and 15 gained 3 lines or more of uncorrected visual acuity. Two patients had a decrease in BSCVA: 1 had lens opacification unrelated to arcuate keratotomy and 1, increased corneal irregularity. Mean refractive astigmatism was 6.94 +/- 2.11 diopters (D) preoperatively and 3.85 +/- 1.95 D postoperatively (P < .01). Mean change in keratometric astigmatism was -51 +/- 36%. Astigmatism decreased in 21 eyes as measured by manifest refraction, keratometry, and videokeratography; it increased in 1 cornea with a microperforation., Conclusions: The results of arcuate keratotomy performed with the Hanna arcitome were comparable to those with freehand relaxing incisions. The instrument made safer and more uniform arcuate incisions than a freehand technique.

Purpose: To identify the correlation between videokeratography, autorefractometry, autokeratometry, and keratometry measurements and the subjective manifest refraction and spectacle-corrected visual acuity after penetrating keratoplasty., Methods: We studied 100 eyes from 100 patients that had undergone penetrating keratoplasty. All eyes were examined by videokeratography (EyeSys 2000) (axial, tangential, and refractive power maps), autorefractometry, autokeratometry, and keratometry. Measurements were made at an an average of 19 +/- 9 months after surgery. Postoperative refractive astigmatism, spherical equivalent refraction, and spectacle-corrected visual acuity were studied by regression analysis., Results: Both the total topographic cylinder measured by the refractive power map and topographic cylinder measured by the axial power map showed the strongest correlation with the manifest refractive cylinder (rs = +0.89, P < .001). The axis of astigmatism determined by keratometry and autokeratometry showed the strongest correlation with the subjective manifest refraction axis (rs = +0.87, P < .001). The total topographic cylinder showed the strongest correlation with the spectacle-corrected visual acuity (rs = +0.38, P = .001); however the topographic indices of predicted corneal acuity, corneal acuity, corneal uniformity index, asphericity, and refractive power symmetry did not correlate with spectacle-corrected visual acuity., Conclusion: Measurement of astigmatism after penetrating keratoplasty can be made more accurate by using videokeratographic measurements to supplement retinoscopic and manifest refraction. Other useful methods for predicting the axis of refractive astigmatism include keratometry, autokeratometry, and autorefractometry. In this study, indices designed to measure corneal surface irregularity failed to predict visual acuity after penetrating keratoplasty.

Purpose: To try to facilitate evaluation of corneal stroma during organ culture by means of light microscopy., Methods: Corneal stroma of 53 consecutive organ-cultured corneas was studied by means of light microscopy during endothelial quality control. Out of 9 corneas with bad stromal evaluation, 2 were studied by means of transmission electron microscopy, and 7 were grafted. From the remaining 44 corneas with a normal light microscopic appearance, 35 were grafted., Results: Stromal abnormalities consisted of bright visible structures with a cell-like shape corresponding to keratocyte injuries (i.e. cellular edema, light and dark vacuoles, cell membrane disruption and, finally, internal cytolysis) as observed by TEM. At 3 months postoperatively no clinical differences between the two groups of transplants were observed., Conclusion: Corneal stroma can be evaluated qualitatively and easily by means of light microscopy during organ culture. Further studies are needed to investigate whether the presence of lysed keratocytes in the graft's stroma actually influences the outcome of transplantation.

Purpose: To evaluate the clinical results of the triple procedure performed using phacoemulsification., Methods: We prospectively studied 23 consecutive triple procedures carried out during a 3-year period. The average follow-up was 18 months. The main indications for grafting were Fuchs' endothelial dystrophy (30%) and infectious keratitis (26%)., Results: A capsulorrhexis was performed in 70% of the cases whereas a "can opener" was performed in the remaining 30%. A divide and conquer phacoemulsification method was used in 43% of the cases. Hydrodissection was used for lens removing in 27% of the cases. The posterior lens capsule was inadvertently broken and a flexible anterior chamber lens was inserted in one case. Twenty-two posterior chamber lenses were inserted in the capsular bag (16) or in the sulcus (6). The estimated 1-year graft survival was 76.8% overall, and 92.9% when high-risk recipients were excluded. Causes of graft failure were immune rejection (n = 4), persistent epithelial defect (n = 1) and uncontrolled glaucoma (n = 1). The average endothelial density during the second year was 1,401 cell/mm2. Average corrected visual acuity was 20/45 at 12 months. Average astigmatism was 3.9 D. No retinal complication was observed., Conclusions: In-the-bag placement of posterior chamber lens is a safe and useful technique during the triple procedure. Phacoemulsification may be useful when the nucleus is hard and voluminous.

Purpose: To study the factors which induce post keratoplasty astigmatism. To assess the reliability of different methods in the astigmatism measurement and to study the visual acuity predicting factors., Methods: We retrospectively studied the corneal topography in 60 eyes with penetrating keratoplasty after suture removal, using the CAS* (Eye Sys). The diagnosis was keratoconus in 65% of the cases and bullous keratopathy in 15% of the cases. The graft was secured with a single running suture in 38.3% of the cases, interrupted sutures in 23.3% of the cases, or a combination of both running and interrupted sutures in remaining 28.3%., Results: The suture method, diagnosis and surgeon did not influence subjective refraction nor visual acuity. The topographic pattern correlated with subjective cylinder (rs = 0.52 p = 0.02). The refractive power cylinder ("Holladay diagnostic summary") correlated well with subjective cylinder (rs = 0.81 p < 0.001) and visual acuity (rs = -0.63; p < 0.001). The Javal keratometry remains the best method to measure astigmatism axis (rs = 0.58; p < 0.001)., Conclusions: The Holladay diagnostic summary (refractive power) is a useful tool for evaluating qualitative outcome of corneal transplantation.