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Purpose: To identify specific factors and outcomes associated with corneal edema and Haabs striae in primary congenital glaucoma (PCG)., Methods: The medical records of patients with PCG from 2011 to 2023 with >3 months' follow-up were reviewed retrospectively. Preoperative details and final outcomes were compared between eyes with and without corneal findings. The right eye of bilateral cases and the affected eye in unilateral cases were included., Results: A total of 58 patients (104 eyes, 69% male) underwent initial angle surgery at an average age of 297 ± 368 (median, 134) days. Corneal edema and Haabs striae were present preoperatively in 72 (69%) eyes of 41 patients and 68 (65%) eyes of 39 patients, respectively. Patients with corneal edema presented at a younger age (P < 0.0001) and with shorter axial length (P = 0.01) than those without edema. Univariate analysis showed that corneal edema was associated with worse visual acuity at final follow-up (OR = 4.4; 95% CI, 1.2-25.3). Patients with Haabs striae were older than those without striae (P = 0.04). After angle surgery, corneal edema was present at 1 month in 71% (95% CI, 52-84), at 2 months in 26% (95% CI, 12-42), at 3 months in 16% (95% CI, 6-30), and at 1 year in 3% (95% CI, 0-13). Corneal opacification did not resolve in 4 eyes of 3 patients after >4 years of follow-up., Conclusions: In our study cohort, corneal edema resolved in the majority of PCG cases within 2-3 months of initial angle surgery but was associated with younger age at presentation and worse visual acuity at final follow-up., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Congenital ectropion uveae (CEU) is a rare anomaly of the embryonic development of the anterior segment of the eye. We report the case of a 5-year-old child with an undiagnosed CEU who was treated urgently for an acute angle closure attack., Case Description: A 5-year-old child was referred urgently for evaluation of anisocoria with mydriasis of the right eye and severe headache. Brain imaging with contrast injection was initially performed in the pediatric emergency department and ruled out central nervous system pathology. The initial examination of the right eye revealed an intraocular pressure (IOP) of 37mmHg, corneal edema, congenital ectropion uveae, mydriasis with pupillary block, a closed angle on gonioscopy, and a clear lens. The examination of the left eye was unremarkable, with no visible CEU. The initial management consisted of medical treatment with topical glaucoma drops and miotics and acetazolamide at 10mg/kg/d. Re-evaluation under general anesthesia showed persistent mydriasis and no resolution of the pupillary block. Filtering surgery was performed in the absence of a complete response to medical treatment, allowing control of IOP without drops and complete regression of the corneal edema., Discussion: CEU is a rare malformation, and pressure complications represent an insignificant proportion of pediatric glaucoma cases. The acute presentation of acute angle closure in this potentially blinding short-term setting, however, makes detection and management difficult in very young children in a great deal of pain. Only one similar case has been reported in the pediatric literature., Conclusion: Acute angle closure complicating CEU is exceptional and difficult to diagnose in a pediatric context. Parents of children with this predisposing condition should be informed of the need to consult urgently when clinical signs of elevated intraocular pressure appear., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Background: Long-term comparative data of phacoemulsification combined with endoscopic cyclophotocoagulation (phaco-ECP) versus phacoemulsification (phaco) alone in dogs are rare., Objectives: To investigate the effects of ECP on postoperative intraocular pressure (IOP) and complications after phaco in dogs with normal IOP., Methods: Medical records of IOP, conjunctival hyperemia, corneal edema, aqueous flare, posterior synechia, intraocular fibrin, and posterior capsule opacification (PCO) formation in 15 canine eyes that underwent phaco-ECP and 36 eyes that underwent phaco alone were evaluated retrospectively. ECP was applied when either the iridocorneal angle or the ciliary cleft was narrow or closed., Results: The IOP of the phaco-ECP group persisted within the normal range postoperatively. The phaco-ECP group had a shorter period of dorzolamide use than did the phaco group. PCO was formed earlier in the phaco-ECP group than in the phaco group. The phaco-ECP group showed more severe corneal edema than the phaco group at every follow-up visit. Posterior synechia was more severe in the phaco-ECP group than in the phaco group from two weeks until the last follow-up., Conclusions: Although ECP might cause more postoperative complications such as corneal edema and posterior synechia, it could effectively reduce the incidence of IOP increase after phaco in dogs with a high risk of postoperative glaucoma., Competing Interests: The authors declare no conflicts of interest., (© 2023 The Korean Society of Veterinary Science.)

Bullous keratopathy (BK) is known to present with corneal edema and Descemet's folds, which can cause corneal astigmatism. However, no report quantitatively evaluated BK astigmatism by separating it into regular and irregular astigmatism. This study investigated the regular and irregular astigmatism of the anterior and posterior corneal surface with Fourier harmonic analysis and anterior segment optical coherence tomography. Preoperative data from 43 eyes of 41 BK patients who received corneal endothelial transplantation were compared with the data from 43 eyes of 43 subjects without corneal disease. Anterior and posterior cylinder power, central corneal thickness (CCT) and thinnest corneal thickness were significantly greater in BK. With Fourier harmonic analysis, BK eyes were found to have significantly larger anterior and posterior regular astigmatism, asymmetry component and higher-order irregularity. Asymmetry component and higher-order irregularity that accounted for the posterior irregular astigmatism increased as CCT increased in BK. Higher-order irregularity in the posterior cornea also positively correlated with worsening best corrected visual acuity. Subgroup analysis found significant correlations between CCT and posterior higher-order irregularity for intraocular surgery and laser iridotomy, but not Fuchs endothelial corneal dystrophy. This study has significance in that it revealed the characteristics of the corneal posterior irregular astigmatism of BK., (© 2022. The Author(s).)

Purpose: To assess risk factors contributing to corneal decompensation following glaucoma drainage device (GDD) implantation., Design: Retrospective case control study., Methods: Records of 1610 eyes that underwent GDD implantation between June 1, 2009, and April 1, 2020, at the Johns Hopkins Wilmer Eye Institute were reviewed. Seventy-nine eyes (5%) developed corneal decompensation, of which 46 underwent keratoplasty. These 79 cases were matched with 220 controls. Cox proportional hazard models with robust standard error estimates to account for clustering at the matched-pair level were used to assess risk factors for corneal decompensation. Kaplan-Meier survival analysis analyzed time to corneal decompensation., Results: The mean (SD) age of cases and controls was 68 (12.3) and 60.5 (15.9) years, respectively. The mean time from GDD implantation to corneal decompensation was 32 months, and the cumulative probability of developing decompensation at 3, 6, and 9 years was 4.7%, 9.2%, and 14.8%, respectively. Final visual outcomes in cases were worse, with a final mean ± SD visual acuity (logMAR) of 1.96±1.25 relative to a mean±SD visual acuity of 1.11±1.36 in controls (P < .001). In the multivariable model, significant risk factors for corneal decompensation were increased age (adjusted hazard ratio [AHR] 1.39, 95% CI 1.18, 1.63; P ≤ .001), history of Fuchs dystrophy or iridocorneal endothelial syndrome (AHR 9.18, 95% CI 5.35, 15.74; P ≤ .001), and postoperative complications such as hypotony (AHR 3.25, 95% CI 1.85, 5.72; P ≤ .001) and tube-cornea touch (AHR 6.37, 95% CI 3.77, 10.75; P ≤ .001)., Conclusions: The risk of postoperative corneal decompensation is persistent over time. Patients receiving GDDs, particularly those with advanced age, preexisting corneal pathology, and postoperative complications, should be counseled regarding their increased risk for corneal decompensation., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The cornea is an avascular, transparent tissue that is essential for visual function. Any disturbance to the corneal transparency will result in a severe vision loss. Due to the avascular nature, the cornea acquires most of the oxygen supply directly or indirectly from the atmosphere. Corneal tissue hypoxia has been noticed to influence the structure and function of the cornea for decades. The etiology of hypoxia of the cornea is distinct from the rest of the body, mainly due to the separation of cornea from the atmosphere, such as prolonged contact lens wearing or closed eyes. Corneal hypoxia can also be found in corneal inflammation and injury when a higher oxygen requirement exceeds the oxygen supply. Systemic hypoxic state during lung diseases or high altitude also leads to corneal hypoxia when a second oxygen consumption route from aqueous humor gets blocked. Hypoxia affects the cornea in multiple aspects, including disturbance of the epithelium barrier function, corneal edema due to endothelial dysfunction and metabolism changes in the stroma, and thinning of corneal stroma. Cornea has also evolved mechanisms to adapt to the hypoxic state initiated by the activation of hypoxia inducible factor (HIF). The aim of this review is to introduce the pathology of cornea under hypoxia and the mechanism of hypoxia adaptation, to discuss the current animal models used in this field, and future research directions., Competing Interests: None., (© 2021 The Authors. Animal Models and Experimental Medicine published by John Wiley & Sons Australia, Ltd on behalf of The Chinese Association for Laboratory Animal Sciences.)

Purpose: To examine the optical coherence tomography (OCT) and histologic features of Descemet membrane detachment (DMD) to ascertain the involvement of the pre-Descemet layer (PDL)., Design: Retrospective, observational case series., Methods: Clinical, histopathologic, and OCT features of a cohort of 41 cases with diagnosis of DMD from 4 centers were studied. OCT images were evaluated independently by 3 observers for number of detached layers (1 or 2), reflectivity, configuration (straight line or wavy), distance from posterior stroma, and presence or absence of a tear with any scrolling of the torn edges. Five had a histology specimen. The main outcome measure was the involvement of the PDL in DMD and its confirmation by histology., Results: Three types of DMD were identified: type 1, where the PDL and DM were detached together; type 2, where only the DM was detached; and mixed, where the PDL and DM were detached but also separated from each other. These were further found to be rhegmatogenous or nonrhegmatogenous depending on the presence of absence of a tear in DM or both layers. Histology confirmed involvement of PDL in all 5 cases and showed it to be infiltrated by cells in 3 of 5 cases., Conclusions: The PDL is involved in DMD. This fact significantly changes our understanding of DMD and could have implications for management. The detached PDL can be infiltrated with cells. A prospective study in relation to etiology and types of DMD is needed., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Purpose: To report an unusual case of a patient with keratoconus and acute hydrops complicated with corneal perforation and describe its management using a new surgical approach., Methods: A case report and new surgical approach description., Results: A 47-year-old female patient with a history of keratoconus and implantable contact lens surgery presented at our institute with symptoms of acute corneal hydrops in her right eye. On examination, best corrected visual acuity was of counting fingers in the involved eye. Slit-lamp examination revealed a small inferotemporal corneal perforation, surrounded by marked corneal edema and a positive Seidel test. Initial attempts of conservative treatment with cyanoacrylate tissue adhesive application and bandage soft contact lens placement were ineffective. We decided to proceed with an inferior, lamellar wedge resection of the diseased corneal tissue. One month postoperatively, the cornea remained clear, whereas best corrected visual acuity was 0.1., Conclusions: Lamellar wedge resection could represent an alternative surgical approach for keratoconic patients, with eccentric acute hydrops and subsequent corneal perforation that provides rapid visual rehabilitation.

Purpose: The aim of this study is to report our results of toric intraocular lens (IOL) implantation in patients with asymmetric astigmatism, its efficacy and safety in reducing the refractive cylinder., Methods: This is a retrospective cohort study. Patients with asymmetric astigmatism and non-progressive corneal ectasia, unable to fit hard contact lenses, with poor-corrected visual acuity or unsatisfactory spectacles-corrected visual acuity, underwent cataract surgery with toric IOL implantation. The choice of lens was individually after optical biometry examination. All surgeries were performed by a single surgeon, with a 2.75-mm clear cornea self-sealing incision at 130° axis, from December 2008 to December 2015., Results: We evaluated 88 eyes of 69 patients with asymmetric astigmatism: primary, secondary to leucoma, post-radial keratectomy, post-lamellar or penetrating keratoplasty, post-LASIK, post-PRK and due to pterygium. Snellen best-corrected spectacles visual acuity increased from 0.39 ± 0.23 preoperative to 0.80 ± 0.23 postoperative. The average refractive cylinder reduced from 2.32 ± 1.78 D preoperatively to 0.87 ± 1.09 D after surgery (P < .001). Sixty-three eyes out of 88 (71%) had residual refractive cylinder ≤ 1.0 D., Conclusion: The favorable efficacy on visual acuity outcomes we have found suggests that toric IOL can be used in cases of asymmetric astigmatism, in order to provide better-corrected vision, less spectacles dependence and an improved quality of vision overall, which is especially important in contact lenses intolerant patients.

Purpose: To describe a new surgical option for the treatment of acute corneal hydrops in keratoconus and to present the first results., Methods: This is a retrospective analysis of 3 patients who presented to our clinic with a massive corneal hydrops in acute keratoconus and were treated by mini-Descemet membrane endothelial keratoplasty (DMEK). According to the size and the shape of the gap in the patient's Descemet membrane (DM), 1 DMEK graft was trephined with a round 5-mm punch. The other grafts were trimmed with a razor blade to a width of about 3 mm and a length adjusted to the length of the defect of the recipients' DM. The graft was inserted with a regular intraocular lens shooter. Correct unfolding of the graft was controlled by using intraoperative optical coherence tomography. At the end of the surgery, the graft was attached to the posterior corneal surface by a small air bubble. Thereafter, the complete anterior chamber was filled with 20% SF6 gas., Results: All 3 patients (age 32 ± 3 years on average) showed a rapid increase in uncorrected visual acuity from the logarithm of the minimum angle of resolution (LogMAR) 1.66 (±0.46) before mini-DMEK to the LogMAR 1.2 (±0.3) within 6 to 8 weeks after mini-DMEK. The thickest corneal point within the edematous cornea decreased in all 3 patients (1088 ± 280 μm before surgery vs. 630 ± 38 μm 1 week after surgery). One mini-DMEK failed in a first attempt. In this patient, the recipient DM was under strong tension and showed a pronounced dehiscence. Therefore, a small part of the recipient's DM around the preexisting gap in DM was removed before a second mini-DMEK graft was placed successfully. The other 2 patients developed partial graft detachment within 1 to 2 weeks after surgery. However, the corneas of these patients were dehydrated to physiological levels after mini-DMEK, and despite partial detachment, there was no relapse of the hydrops., Conclusions: Mini-DMEK could be helpful in patients with larger defects and detachments of DM in very ectatic corneas in the acute phase of corneal hydrops in acute keratoconus. These patients may not be successfully treated by intracameral gas application alone or in combination with pre-Descemetal sutures. Further investigations are needed to identify factors helping to decide on the best surgical approach in hydrops in acute keratoconus.

Restoration of vision due to corneal blindness from corneal endothelial dysfunction can be achieved via a corneal transplantation. However, global shortage of donor tissues has driven the development cell-based therapeutics. With the capacity to propagate regulatory compliant human corneal endothelial cells (CEnCs), this study evaluated the functionality of propagated CEnCs delivered via tissue-engineered endothelial keratoplasty (TE-EK) or corneal endothelial cell injection (CE-CI) within a rabbit model of bullous keratopathy. For animals with TE-EK grafts, central corneal thickness (CCT) increased to >1000 μm post-operatively. Gradual thinning with improvements in corneal clarity was observed from week 1. CCT at week 3 was 484.3 ± 73.7 μm. In rabbits with CE-CI, corneal clarity was maintained throughout, and CCT at week 3 was 582.5 ± 171.5 μm. Control corneas remained significantly edematous throughout the study period compared to their respective experimental groups (p < 0.05). Characterization of excised corneas showed a monolayer with heterogeneously shaped CEnCs in both TE-EK and CE-CI groups. Immunohistochemistry demonstrated reactivity to anti-human specific nuclei antibody attributing corneal recovery to the functional human CEnCs. This study showed that regulatory compliant cell-based therapy for corneal endothelial dysfunction can be delivered by both TE-EK and CE-CI, and holds great promise as an alternative to traditional corneal transplantation.

Purpose: To describe a surgical technique to achieve the desired plane during deep anterior lamellar keratoplasty (DALK) in eyes with Descemet membrane (DM) tears due to previous hydrops., Methods: This was a prospective, consecutive, interventional case series of DALK in 12 keratoconic eyes with healed hydrops. Dissection of the peripheral cornea was performed by air injection and using the microbubble incision technique as a guide to the clear predescemetic stroma. The central posterior scar was then removed by peeling to bare DM., Results: DALK was successfully completed in all eyes, with DM tears ranging from a microperforation to approximately 4 mm. At 12 months, the mean logMAR best-corrected visual acuity was 0.38 ± 0.07, the mean keratometric astigmatism was 5.2 ± 1.9 diopters, and the mean endothelial cell density was 2364 ± 316.9 cells/mm., Conclusions: Peripheral pneumatic dissection and central scar peeling technique is a useful technique to complete DALK in eyes with scars due to previous hydrops.

Purpose: To determine the effects of the Ziemer LDV Z8 liquid interface femtosecond laser platform during capsulotomy under different energy settings in the presence of corneal edema., Methods: Cadaveric porcine eyes (n = 36) employed at less than 6 and greater than 24 post enucleation hours to simulate clear/edematous corneas, underwent capsulotomy with the Ziemer LDV Z8 femtosecond laser (5-mm diameter, energy 90%, 130%, or 150%). Lens capsules were removed for evaluation by scanning electron microscopy and rupture strengths determined by the single column universal testing system. Following ethical approval, 23 patients had lens capsules removed during routine cataract surgery following manual or Z8 capsulotomy and subjected to TUNEL assay., Results: There was no difference in edge morphology or rupture strength (120, 113, and 118 mN at increasing energy, P = 0.42) in the clear cornea. Only 50% of capsulotomies succeeded at 90% energy in an edematous cornea, improving with increased energy (75% completion at 130%, 100% at 150%). Rupture strength in edematous corneas was not significantly different at 112, 133, and 114 mN for 90%, 130%, and 150%, respectively (P = 0.3). In human samples, increased TUNEL-positive cells were seen at 130% energy, but not at 150% (0.0 manual vs. 0.2 [90%] vs. 2.1 [130%] vs. 0.6 [150%], P < 0.05)., Conclusions: Because of the low energy delivered by a femtosecond nanojoule platform, even incremental increases in energy appeared to have minimal effect on lens capsule morphology and strength and negligible influence on cell death. Furthermore, increasing energy appeared to enhance consistency and the ability to complete a capsulotomy in an edematous cornea.

Purpose: Acute angle closure attacks are frequently accompanied by corneal edema. However, little is known about corneal endothelial cell status at different stages of angle closure. Here, we compared endothelial cell density (ECD) in unoperated eyes with that in eyes with open angles (OAs) and various stages of angle closure disease., Materials and Methods: The study was conducted at Aravind Eye Hospitals in India. Masked examiners performed gonioscopy to classify each eye as follows: (1) OA, (2) primary angle closure suspect, or (3) primary angle closure (PAC)/primary angle closure glaucoma (PACG). Specular microscopy was performed and differences in ECD were analyzed using hierarchical models., Results: A total of 407 patients and 814 eyes were studied, including 127 (15.6%), 466 (57.3%), and 221 (27.1%) with PAC/PACG, primary angle closure suspect, and OA, respectively. Participants were predominantly female (69.8%) and the mean age was 49.2 (SD: 8.6) years. Lower ECD was observed with increasing age [β=-6.3 cells/mm; 95% confidence interval (CI), -9.3 to -3.3, per year; P<0.001], greater iridotrabecular contact [β=-15.6 cells/mm; 95% CI, -28.3 to -2.9, per quadrant of contact; P=0.016), and shallow (<2.5 mm) anterior chamber depth (β=-40 cells/mm; compared to deeper AC's (≥2.5 mm), 95% CI, 78.9-1.1; P=0.044). In age-adjusted analyses, angle closure suspects had lower ECD than OA eyes (β=-54.7 cells/mm; 95% CI, -47.8 to -85.3; P=0.018), although PAC/PACG eyes were not significantly different from OA eyes (β=-18.6 cells/mm; 95% CI, -85.9 to 2.5; P=0.058)., Conclusion: In untreated eyes, only mild, clinically insignificant decrement in ECD was noted with angle closure.

A 17-year-old boy presented with sudden loss of vision in the left eye (OS) for 3 days. He was diagnosed with acute hydrops following keratoconic progression in OS. The patient was initially started on topical medical therapy, including steroids and hypertonic eye drops; showing no signs of resolution. Hence, the patient was planned for full-thickness compressive corneal sutures. Four sutures were placed along the central oedematous area covering the area of ruptured Descemet's membrane. Signs of resolution were noticed by 1st week and there was complete resolution of oedema by 3rd post-op week. Sutures were removed by 7th postoperative week/45th day. The patient was doing fine with visual acuity of 6/60 in the last visit with no symptoms of discomfort and no signs of corneal vascularisation. Full-thickness corneal compressive sutures is an effective alternative in cases of acute hydrops if perfluoropropane gas is not available., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Keratoconus may progress to acute corneal hydrops even after cross-linking. In some cases, keratoconus progresses during pregnancy. In this report, we present a case of a patient with increased anterior stromal resistance after cross-linking that would favor nonprogression of keratoconus during pregnancy., Case Presentation: We report that cross-linking is likely to have had a protective effect in a white pregnant patient with acute corneal hydrops who showed rapid improvement, as documented by corneal topography. Improvement occurred within 8 days, whereas up to 250 days are reported in the literature. No keratoconus progression occurred in the 20-month follow-up period., Conclusions: Cross-linking failed to prevent the occurrence of acute corneal hydrops after rupture of Descemet's membrane but most likely helped to accelerate the resolution of the condition. Corneal hardening resulting from cross-linking may have also contributed to stabilizing keratoconus during pregnancy.

Purpose: Relatively little data exist regarding the outcomes of children with primary infantile glaucoma presenting with acute corneal hydrops. The aim of our study was to determine the surgical outcome of children of infantile glaucoma who presented with acute corneal hydrops., Methods: In total, 38 eyes of 31 consecutive children of infantile glaucoma presented with acute corneal hydrops who underwent primary combined trabeculotomy-trabeculectomy (CTT) by a single surgeon from January 1990 to December 2012 at the LV Prasad Eye Institute (LVPEI), a tertiary eye care centre in Southern India were enrolled in this retrospective study. Primary outcome measures were intraocular pressure (IOP) control (IOP ≤ 16 mmHg under anaesthesia or IOP ≤ 21 mmHg without anaesthesia) and clearance of corneal edema. Secondary outcome measures were visual acuity (VA), corneal diameter, bleb appearance, intraoperative and postoperative complications., Results: Mean age at presentation was 6.4 months (range, 2-11 months) and seven eyes (23%) had bilateral affliction. At presentation, all eyes (100%) had moderate to severe degree of corneal edema with a mean preoperative IOP of 25.6 ±5.1 mmHg. Postoperatively, the IOP reduced to 12.0 ± 3.8 mmHg (difference = -13.6, 95% CI = -15.7 to -11.5, t = -13.18, p<0.0001), and the percentage reduction in IOP was 53.05%. Preoperatively 83% of the eyes were on antiglaucoma medication, and postoperatively 2 eyes (5.3%) required 1 antiglaucoma medication for control of IOP. Preoperatively, corneal edema was present in all eyes and postoperatively it cleared in all of them. Significant myopic astigmatism was present in 28 eyes (74%), the commonest being compound myopic astigmatism (75%) followed by simple myopic astigmatism (21%). Normal VA (best-corrected VA; BCVA ≥ 20/60) was achieved in 44.4% of the eyes and 22.2% eyes had low vision (BCVA, <20/60 to 20/400). Complete success (IOP control and clearance of corneal oedema) was obtained in 94.7% eyes. There were no significant intraoperative or postoperative complications. Two thirds of the patients showed low, elevated functional filtering bleb. No patient had any bleb leak, blebitis or bleb related endophthalmitis. The median follow-up was 36 months (range 2-228 months)., Conclusions: Primary CTT is safe and effective in controlling IOP, resulting in complete clearance of corneal edema with modest visual improvement in children of infantile glaucoma presenting with acute corneal hydrops. The outcome of the study will have a positive impact on counseling the parents preoperatively.

Background: Tonometry in the anesthetized child, vital for evaluating known or suspected glaucoma, remains limited to tonometers capable of supine recording. The Icare PRO measures intraocular pressure (IOP) in the sitting or supine patient. The purpose of this study was to compare Icare PRO and Tono-Pen tonometry during examination under anesthesia in eyes of supine children with normal eyes and glaucoma and/or corneal pathology., Methods: In this prospective study of children undergoing examination under anesthesia, IOP was recorded in both eyes with Icare PRO and Tono-Pen immediately after mask anesthesia induction, with instrument order randomized., Results: A total of 100 eyes of 50 children (median age, 58 months) were included. IOP range was 6-50 mm Hg by Icare PRO and 6-53 mm Hg by Tono-Pen. Mean IOP measured by Tono-Pen (18.9 ± 7.5) was higher than that measured by Icare PRO (16.7 ± 7.1 mm Hg) by 2.2 mm Hg (P < 0.001). The presence of corneal edema was associated with IOP measurements higher by Tono-Pen than by Icare PRO (mean difference, 8.4 mm Hg). When eyes with corneal edema were excluded from analysis, there was no correlation between central corneal thickness and the difference in IOP between the two instruments., Conclusions: IOP in eyes of supine children under anesthesia measured approximately 2 mm Hg higher by Tono-Pen than Icare PRO and this difference was greater in eyes with frank corneal edema. Icare PRO may become a valuable tool for tonometry in supine infants and children, but a confirmatory test should be considered in eyes with corneal edema., (Copyright © 2015 American Association for Pediatric Ophthalmology and Strabismus. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of this study was to evaluate a novel surgical combination of Descemet stripping automated endothelial keratoplasty (DSAEK) and deep sclerectomy (DS) for the management of concomitant corneal endothelial decompensation and uncontrolled glaucoma., Methods: This retrospective case series noncomparative study included 9 eyes of 6 consecutive patients with coexistence of corneal edema resulting from Fuchs dystrophy or pseudoexfoliation keratopathy and medically uncompensated glaucoma; these patients underwent combined DSAEK and DS with mitomycin C and an absorbable collagen implant. Corneal graft clarity, endothelial cell density, visual acuity, intraocular pressure (IOP), and identification of complications were assessed over a 2-year follow-up., Results: All eyes obtained graft clarity throughout the follow-up, with a final average endothelial cell decrease of -36% from baseline, and showed improved vision and good IOP control without hypotensive therapy. Measured at 3 and 24 months postoperation, the mean visual acuity improvement was 154% and 372% and IOP decrease was 51.1% and 46.4%, respectively. Two anterior segment complications occurred in 2 (22%) patients' eyes. This consisted of a graft dislocation and a modest IOP elevation, treated successfully., Conclusions: Combined DSAEK and DS was longitudinally associated with good corneal graft survival and IOP control, with few complications. These findings suggest that this surgical approach is a viable option for patients with coexisting glaucoma and corneal endothelial dysfunction. Our study should stimulate a multicenter, randomized, controlled trial of our technique.

Acute corneal hydrops is a rare complication of advanced corneal ectasia. This case report describes the clinical course of a child with severe atopy and no previous ocular examination who developed bilateral, acute corneal hydrops, secondary to keratoconus, by 8 years of age. The report demonstrates the rapidity of progression in the pediatric phenotype of the disease. This case also provides an important clinical lesson in highlighting the necessity for children with atopy to be referred for comprehensive ophthalmic examination, even in the apparent absence of visual symptoms, to ensure the timely diagnosis and management of any atopy-associated ocular disease. Prompt referral is particularly essential for pediatric corneal ectasia, in which the rapidity of progression may preclude stabilizing treatments, such as corneal collagen cross-linking, and result in significant childhood visual impairment, as was the case for this child. This case demonstrates the potential for significant ocular involvement in atopic children and identifies scope to enhance current international clinical guidelines relating to the management of childhood atopy through the inclusion of ocular screening for associated disease., (Copyright © 2014 by the American Academy of Pediatrics.)

Purpose: To report our initial series of Descemet stripping automated endothelial keratoplasty (DSAEK) patients with 2 years of follow-up and to compare the complications and outcomes between normal and abnormal eyes., Methods: Records of all patients who underwent DSAEK between April 2007 and April 2009 were reviewed. Eyes were categorized as "normal" or "abnormal" for comparison. Two risk factors, anterior chamber compromise and glaucoma tube/bleb, were analyzed for association with tissue detachment., Results: Thirteen DSAEKs were performed on 13 "normal" eyes, and 18 DSAEKs were performed on 15 "abnormal" eyes. The lenticule detachment rates were 15.4% in the normal group and 41.2% in the abnormal group (P = 0.13). The difference in endothelial cell loss was not significant until 1.5 years postoperatively in favor of the abnormal group (P = 0.024). The mean starting vision was 20/115 for the normal group and 20/322 for the abnormal group (P = 0.06). At 2 years, the mean visual acuity was 20/47 for the normal group and 20/34 for the abnormal group (P = 0.44). Risk factor analyses indicated that glaucoma tubes/blebs were not related to lenticule detachment (P = 0.45), whereas anterior chamber compromise was related to lenticule detachment (P = 0.031)., Conclusions: Complication rates for abnormal eyes are higher than those for normal eyes, and risk factor analyses suggest that marked anterior chamber compromise is related to lenticule detachment. However, if DSAEK is successful for these compromised eyes, the visual outcomes compare favorably with normal eyes through 2 years of follow-up.

Purpose: To report a case of spontaneous bleb formation in a presumed pellucid marginal corneal degeneration with acute hydrops., Methods: A 51-year-old man reported sudden ocular pain with a lower conjunctival mass in his left eye. A clinical examination was performed to investigate this lesion., Results: The intraocular pressure in the left eye was markedly lower compared with that in the opposite eye. Slit-lamp examination of the left eye showed a conjunctival mass inferior to the corneoscleral limbus adjacent to corneal epithelial and stromal edema without perforation. Corneal topography showed the typical bow tie appearance of corneal steepening rotated 120 degrees clockwise. The right eye was totally normal. Fourier-domain optical coherence tomography with a corneal anterior module adaptor clearly showed a break in Descemet membrane and a ruptured corneal stromal cleft under the conjunctiva near the corneal limbus that resulted in spontaneous bleb formation. The cornea gradually healed after bandage treatment; the spontaneous bleb became smaller and the corneal stromal cleft and edema regressed at 3 months with corneal scarring. The intraocular pressure in the left eye recovered to the same level as that in the opposite eye in association with the decreased bleb size., Conclusions: This case indicated that spontaneous bleb formation in a pellucid marginal corneal degeneration should be included in the differential diagnosis of a conjunctival mass of unknown origin.

We report a case of unilateral Brown-McLean syndrome (peripheral corneal oedema) with bilateral keratoconus. A 30 years old lady presented with decreased vision in her right eye for the last 2 years. There was no history of surgery or trauma. Patient had no systemic illness. There was peripheral concentric corneal oedema extending 2.5-3.5 mm from the limbus involving right eye. On topography, we found bilateral keratoconus. To the best of our knowledge, this combination of Brown-McLean syndrome and keratoconus has not been reported before.

To evaluate the outcomes of repeat corneal transplantation, either penetrating keratoplasty (PKP) or Descemet's stripping automated endothelial keratoplasty (DSAEK), for penetrating keratoplasty grafts which failed due to corneal edema. The charts of 24 eyes with failed PKP grafts, due to corneal edema, which underwent a repeat corneal transplant (PKP in 17 eyes [Group 1] and DSAEK in seven eyes [Group 2]) between 2003 and 2007 were retrospectively reviewed. There was no statistically significant difference in the median postoperative visual acuity between the two groups at 1, 2, or 3 years. In Group 1, two (18%) eyes had a final visual acuity ≥ 20/40, in contrast to four (80%) eyes in Group 2, which was statistically significant (P = 0.038). Seven (41%) of the Group 1 eyes developed postoperative complications compared to only one (14%) eye in Group 2. Eleven (65%) of the Group 1 eyes and five (71%) of Group 2 eyes had clear grafts on the last examination. There was no statistically significant difference in the graft survival rate for Group 1 versus Group 2 at 3 years (57.9% vs 68.6%, P = 0.507). There was a trend towards better postoperative visual acuity, a lower postoperative complication rate, and a higher graft survival rate in eyes that underwent DSAEK rather than repeat PKP for graft failure secondary to corneal edema. Given this small, retrospective study, future studies comparing repeat PKP with DSAEK are warranted to determine which procedure allows for improved outcomes.

Purpose: To report spontaneous corneal clearing with improved visual acuity and central endothelial cell repopulation after Descemet's stripping without endothelial replacement., Design: Interventional case report., Methods: A 34-year-old woman with bilateral decreased vision secondary to corneal edema from endothelial dysfunction underwent Descemet's stripping endothelial keratoplasty (DSEK) in the right eye and Descemet's stripping only in the left eye. Histopathologic evaluation confirmed a dual diagnosis of Fuchs' endothelial dystrophy and posterior polymorphous membrane dystrophy from Descemet's membrane specimens removed from each eye. After primary graft failure with regraft in the right eye, the second posterior corneal lenticule detached and was removed and not replaced. The cornea cleared, and central endothelial cell repopulation was documented by confocal microscopy. Therefore, Descemet's stripping without endothelial replacement was performed in the left eye. The left cornea also cleared with central endothelial cell repopulation., Main Outcome Measures: Postoperative visual acuity and central endothelial cell repopulation., Results: Endothelial migration after Descemet's stripping alone in the left eye, with probable host endothelial cell repopulation in the right eye., Conclusions: Endothelial cell migration after Descemet's stripping procedure without insertion of endothelial graft can occur, resulting from host endothelial cell repopulation with corneal clearing and improved visual acuity., (Copyright © 2012 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

Purpose: To demonstrate the efficacy of a planned near-Descemet dissection deep anterior lamellar keratoplasty (nddDALK) in posthydrops corneal scarring., Methods: In a retrospective noncomparative case series, nddDALK was performed on 22 consecutive eyes of 22 patients with posthydrops scarring because of keratoconus. After a partial thickness corneal trephination, air was injected at superficial to midstromal depth, followed by an anterior keratectomy. Multiple episodes of stromal hydration with a blunt cannula followed by air injection were repeated to leave a thin stromal layer. A #69 Beaver blade (BD, Franklin Lakes, NJ) was used to remove the scar. The best spectacle-corrected visual acuity (BSCVA), spherical equivalent, and refractive cylinder were recorded 12, 24, and 36 months after surgery. Intraoperative and postoperative complications were noted., Results: Twelve months after surgery, the BSCVA was ≥ 20/40 in 68.1% of patients. The mean spherical equivalent was -3.53 ± 2.94 diopters (D), and the average refractive cylinder was 3.42 ± 1.7 D. Microperforations occurred in 6 patients, all of which were successfully tamponaded by an intracameral air injection alone., Conclusions: nddDALK gives good visual results and quality of vision. In developing countries, lamellar-grade donor corneas are almost the only option available. Apart from visual benefits, the procedure puts the patient at a minimal risk of immune rejection, which is a major complication of penetrating keratoplasty.

Purpose: To report a case of cytomegalovirus (CMV) endotheliitis after insertion of an intravitreal fluocinolone acetonide (Retisert) implant., Design: Interventional case report., Methods: Retrospective chart review., Results: A 40-year-old man received a Retisert implant in the left eye for recurrent Behçet uveitis. Although inflammation became quiescent within a month, corneal edema developed 4 months after insertion. Polymerase chain reaction analysis for aqueous humor detected 3.9 × 10(4) copies/mL of CMV DNA. After treatment with oral valganciclovir, CMV DNA nearly disappeared but visual outcome was poor due to corneal decompensation resulting from severe endothelial cell loss., Conclusions: After Retisert implant, clinicians should be attentive to the potential risk of CMV endotheliitis.

In children with congenital glaucoma the functional long-term result is often disappointing even if the intraocular pressure is well controlled. The reason for this discrepancy is attributed to amblyogenic factors responsible for interfering with normal visual development. These amblyogenic factors are corneal edema, irregular astigmatism and non-corrected ametropia as monocular causes. Binocular causes are anisometropia-induced suppression and strabismus. Full ametropic correction and a very early prophylaxis and treatment of amblyopia with a close follow-up are mandatory to reduce amblyogenic visual impairment in children with congenital glaucoma.

Purpose: To characterize the 3-D corneal shape deformation incurred by Fuchs corneal dystrophy and pseudophakic bullous keratopathy by using the integrated analysis of Orbscan (Bausch & Lomb Surgical, Rochester, NY) topographic maps of affected and normal corneas., Methods: One hundred thirty-seven patients with Fuchs dystrophy or pseudophakic keratopathy were divided into three groups according to the severity of the disease: mild (central corneal thickness [CCT], 500-710 μm; n = 46); moderate (710-775 μm; n = 45), and severe (775-1100 μm; n = 46). A control group included 411 normal subjects matched for age and refractive spherical equivalent (three control subjects for each subject with Fuchs or pseudophakic keratopathy). The four groups were compared by using 3-D corneal shape atlases illustrating mean anterior elevation, posterior elevation, and pachymetry., Results: Whereas the atlases showed little anterior surface deformation, the posterior surface presented a significant central bulging toward the anterior chamber. The thinnest point was displaced away from the center, toward the superior nasal midperiphery. The corneal periphery remained relatively unaffected by the disease, except in the final stage., Conclusions: 3-D atlases provided detailed new information on the 3-D corneal shape deformation incurred by Fuchs corneal dystrophy throughout disease progression.

Objective: To determine whether preoperative and/or postoperative central endothelial cell density (ECD) and its rate of decline postoperatively are predictive of graft failure caused by endothelial decompensation following penetrating keratoplasty to treat a moderate-risk condition, principally, Fuchs dystrophy or pseudophakic corneal edema., Methods: In a subset of Cornea Donor Study participants, a central reading center determined preoperative and postoperative ECD from available specular images for 17 grafts that failed because of endothelial decompensation and 483 grafts that did not fail., Results: Preoperative ECD was not predictive of graft failure caused by endothelial decompensation (P = .91). However, the 6-month ECD was predictive of subsequent failure (P < .001). Among those that had not failed within the first 6 months, the 5-year cumulative incidence (+/-95% confidence interval) of failure was 13% (+/-12%) for the 33 participants with a 6-month ECD of less than 1700 cells/mm(2) vs 2% (+/-3%) for the 137 participants with a 6-month ECD of 2500 cells/mm(2) or higher. After 5 years' follow-up, 40 of 277 participants (14%) with a clear graft had an ECD below 500 cells/mm(2)., Conclusions: Preoperative ECD is unrelated to graft failure from endothelial decompensation, whereas there is a strong correlation of ECD at 6 months with graft failure from endothelial decompensation. A graft can remain clear after 5 years even when the ECD is below 500 cells/mm(2).

Introduction: Mitochondrial encephalomyopathy is a set of rare diseases in which corneal involvement is exceptional., Case Report: A 34-year-old patient, a known carrier of Kearns-Sayre syndrome, was hospitalized for acute corneal decompensation, with a keratoconus-like hydrops stemming from an endothelial-Descemet membrane disruption. Under local hypotonic treatment, the favorable progression was fast with a decline in the edema and coaptation of the endothelial-Descemet membrane disruption., Conclusion: The possible physiopathologic mechanisms are debated; the preferred hypothesis was a dysfunction of endothelial cell pumps. We emphasize the extremely complex medical management of these fragile patients presenting mitochondrial encephalopathy. General corticotherapy is contraindicated and beta-blockers including in eye drops must be used extremely carefully because of cardiac abnormalities such as conduction disturbance and/or arrhythmia and dilated cardiomyopathies.

Superior keratoconus is a rare form of keratoconus, in which the corneal apex is atypically superior. We report a 32-year-old man who presented with corneal hydrops in his right eye. Ophthalmic examination revealed corneal edema with Descemet's break involving the superior part of his right cornea. Superior steepening in the left cornea demonstrated by corneal topography was consistent with subclinical keratoconus.

Purpose: To identify recipient factors that may be related to risk of corneal graft failure., Design: Multicenter, prospective, double-masked, controlled clinical trial., Participants: One thousand ninety subjects undergoing corneal transplantation for a moderate-risk condition (principally Fuchs' dystrophy or pseudophakic corneal edema)., Methods: Donor corneas were assigned using a random approach without respect to recipient factors, and surgeons were masked to information about the donor cornea, including donor age. Surgery and postoperative care were performed according to the surgeons' usual routines, and subjects were followed up for 5 years. Baseline factors were evaluated for their association with graft failure., Main Outcome Measures: Graft failure, defined as a regraft or a cloudy cornea that was sufficiently opaque to compromise vision for a minimum of 3 consecutive months., Results: Preoperative diagnosis of pseudophakic or aphakic corneal edema increased graft failure risk approximately 4-fold compared with Fuchs' dystrophy (27% vs. 7%). Prior glaucoma surgery with preoperative glaucoma medication use substantially increased the graft failure rate. Factors not strongly associated with graft failure included age, gender, diabetes, smoking, and graft size., Conclusions: The risk of graft failure is significantly increased in eyes with pseudophakic or aphakic corneal edema compared with Fuchs' dystrophy, independent of lens status, and in eyes with a history of glaucoma., Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.

Background: To develop a novel quantitative index for evaluation of corneal epithelial oedema, the pixel intensity of confocal microscopic images was measured derived from the basal cell layer (BCL) of the corneal epithelium in normal eyes, eyes before and after cataract surgery, and eyes affected by bullous keratopathy., Methods: Five eyes of five normal volunteers, 14 eyes of 11 cataract patients and 12 eyes of 12 bullous keratopathy patients were examined by confocal microscopy. The cataract patients underwent cataract surgery, and they were examined by confocal microscopy, corneal pachymetry, and anterior fluorometry both before and at various times after surgery. The pixel intensity of BCL images obtained by confocal microscopy was measured and expressed as the BCL index., Results: The coefficient of variation for repeated (five times) measurement of the BCL index in each of the five normal eyes was 3.4%. The BCL index was 54.8 5.3 (mean SD) before surgery, increased significantly to 65.2 10.0 on the day after surgery, and gradually decreased thereafter in the cataract patients. The time-course of the BCL index coincided well with that of corneal thickness and anterior fluorometry value. The BCL index in eyes affected by bullous keratopathy was significantly increased at 95.0 6.4., Conclusion: The BCL index was increased after cataract surgery and in eyes affected by bullous keratopathy, conditions associated with corneal epithelial oedema. This quantitative measure obtained by confocal microscopy may prove useful in the clinical evaluation of corneal epithelial oedema.

Purpose: Acanthamoeba and fungal keratitis are rare ocular infections. We report cases of combined Fusarium and Acanthamoeba keratitis and the clinical course of medical treatment., Methods: We reviewed the medical records of patients treated for culture-proven Acanthamoeba keratitis at a referral centre, during 2001-2006., Results: Eleven consecutive patients were treated for culture-proven Acanthamoeba keratitis during the 5 years, two of whom had combined fungal infections. A 29-year-old man presented with ground-glass corneal oedema and epitheliopathy caused by contact lens use. The other patient, a 7-year-old girl, had eye trauma that led to a feathery corneal infiltrate. Both cases were treated with topical 0.02% polyhexamethylene biguanide (PHMB), 0.1% propamidine, 1% clotrimazole and 5% natamycin. Therapeutic keratoplasty was not required in either case., Conclusions: Timely identification of the pathogen, with repeated culture and smear if necessary, as well as adequate dosage to prevent recurrence is highly recommended in order to preclude the need for therapeutic penetrating keratoplasty.

Purpose: To evaluate the anterior chamber (AC) inflammatory reaction by anterior segment high-speed optical coherence tomography (OCT)., Design: A prospective, nonrandomized, observational case series., Methods: Sixty-two eyes of 45 patients were studied for AC reaction clinically and by anterior segment OCT. Hyperreflective spots suggesting the presence of cells in the AC from the OCT images were counted manually and by a custom made automated software using MATLAB (Mathworks, Natick, Massachusetts, USA) and correlated with clinical grading of AC cells using Standardization of Uveitis Nomenclature criteria., Results: In manual method, mean hyperreflective spots were 3 +/- 1.8 in grade 1, 12 +/- 3.5 in grade 2, 33.8 +/- 10.2 in grade 3, and 61.4 +/- 9.6 in grade 4. Automated method showed mean 3 +/- 1.9 hyperreflective spots in grade 1, 12.4 +/- 3.6 in grade 2, 33.2 +/- 9.6 in grade 3, and 74.8 +/- 17 in grade 4. Significant difference seen in mean values between the manual and automated method in grade 4 (P = .009). AC cells were detected in 12 (19.3%) eyes with corneal edema with central corneal thickness ranging from 702 to 1020 microns (mean, 843 +/- 109 microns). Out of 62 eyes, grade 4 aqueous flare was detected by OCT imaging in 7 eyes and clinically in 5 eyes., Conclusion: Anterior segment OCT can be used as an imaging modality in detecting AC inflammatory reaction in uveitis and also in eyes with decreased corneal clarity and compromised AC visualization attributable to corneal edema. Automated method is sensitive in higher grades of uveitis.

Purpose: To determine the efficacy and postoperative complications of complex deep lamellar endothelial keratoplasty (DLEK) when used for the management of complex bullous keratopathy with severe vision loss., Methods: Twelve consecutive eyes with severe bullous keratopathy and other associated intraocular abnormalities underwent complex DLEK which was combined with other intraocular surgeries such as vitrectomy, intraocular lens removal, and secondary intraocular lens implantation. An air bubble was used in 9 eyes and an air and C3F8 gas bubble in 3 eyes for tissue support. Prospective data of best spectacle-corrected visual acuity, corneal astigmatism, and curvature were collected on all 12 eyes preoperatively and at 6, 9, and 12 months postoperatively. Average donor endothelial cell density was recorded preoperatively and at 9 months postoperatively., Results: Preoperatively, severe visual loss was recorded at hand motions (n = 3), count fingers (n = 7), and 20/400 (n = 2). Best spectacle-corrected visual acuity improved in 83% of eyes with vision of 20/67 or better in 42% (5/12) and 20/100 or better in 66% (8/12) of eyes at 12 months postoperatively. Vision was not improved in three eyes due to coexistent retinal disease. Four aphakic eyes underwent secondary intraocular lens implantation later at 4-6 months after DLEK, and best spectacle-corrected visual acuity was increased from count fingers to 20/200 or better. At 12 months postoperatively, average corneal astigmatism and curvature were 2.3 +/- 0.5 diopters and 44.0 +/- 0.9 diopters, respectively. Average central corneal thickness at 12 months postoperatively (541.3 +/- 26.7 microm) was significantly thinner than that before surgery (673.8 +/- 77.5 microm, P < 0.01). Preoperative average donor endothelial cell density was 2685.1 +/- 193.9 cells/mm. At 9 months postoperatively, average endothelial cell density was 1920.1 +/- 94.0 cells/mm (27.3% of endothelial cell loss) in eyes with primary surgery and 1866.3 +/- 92.8 cells/mm (33.9% of endothelial cell loss) in eyes with secondary surgery. Postoperative complications usually occurred within 3 months of surgery. After surgery, 3 eyes showed narrow gaps between the border of the graft and the host. Epithelial bullae in these areas recurred in 2 eyes but disappeared within 3 months. There was one graft dislocation in this series, no pupillary block cases, and no primary graft failures., Conclusions: In cases of complex bullous keratopathy with severe vision loss, DLEK combined with other intraocular surgeries is a feasible and effective procedure to significantly improve visual acuity to a functional level in most patients. DLEK can be used successfully in eyes with aphakia and other anterior segment abnormalities without a high risk of graft dislocation or failure. Mild postoperative complications usually occurred early after DLEK and did not affect visual outcomes and graft survival if managed appropriately.

Purpose: To describe a patient with cone dystrophy who presented with acute hydrops and perforation, leading to the diagnosis of keratoconus., Methods: Case report and literature review., Results: A 21 -year-old male patient with a history of cone dystrophy presented with a flat anterior chamber, diffuse corneal stromal edema with an intrastromal cleft, and ruptured Descemet membrane, findings consistent with acute hydrops with corneal perforation. After bandage contact lens placement and instillation of a cycloplegic agent, the anterior chamber reformed within 24 hours. Over the next week, conservative management with a bandage lens, pressure patching, topical fluoroquinolone antibiotic, and topical cycloplegic led to the reformation and maintenance of anterior chamber stability. Corneal topography of the unaffected eye showed global corneal thinning and steep sim K readings suspicious for early keratoconus., Conclusions: Although the association between keratoconus and cone dystrophy is extremely rare, our patient's vision-threatening complication of acute hydrops with corneal perforation highlights the importance of corneal evaluation including topography in cone dystrophy. Conservative management was successful in the restoration of anatomic integrity in this situation.

Purpose: To study the incidence, course, and common factors of patients with negative dysphotopsia and consider the possible role of the corneal incision in cases in which symptoms are transient., Setting: Private practice and the University of Cincinnati, College of Medicine, Cincinnati, Ohio, USA., Methods: Phacoemulsification with implantation of a single-piece acrylic intraocular lens (IOL) was performed in 250 consecutive routine cataract procedures. Patients were asked whether they noticed a temporal shadow on the day after surgery and were followed by serial evaluations for 3 years. Evaluations included subjective questionnaires and objective testing., Results: The incidence of negative dysphotopsia was 15.2% on the first postoperative day, decreasing to 3.2% after 1 year, then 2.4% after 2 and 3 years. Common findings included a shallow orbit, prominent globe, space greater than 0.45 mm between the iris and IOL by ultrasound biomicroscopy, and perimetric comet-shaped light in the area corresponding to the shadow. Slitlamp revealed a transparent peripheral capsule and a shadow sign in which a linear shadow on the iris became curvilinear as the light from the slit beam was projected through the incision toward the pupil., Conclusions: Two groups of patients experienced negative dysphotopsia that rapidly resolved or remained unchanged from the first postoperative day. It is hypothesized that the corneal edema associated with a beveled temporal incision contributes to transient negative dysphotopsia.

Purpose: To report a case of acute hydrops in pellucid marginal corneal degeneration (PMCD) documented with anterior segment optical segment tomography and successfully treated with sulphur hexafluoride (SF6) intracameral injection., Methods: A 47-year-old female patient presented with spontaneous onset of pain, redness and decreased vision in her left eye. Clinical evaluation revealed bilateral PMCD with evidence of acute hydrops in the left eye. Anterior segment Slit lamp Adapted Optical Coherence Tomography (SL-OCT) examination revealed intrastromal clefts with Descemet's membrane detachment in the left eye. She was managed with descemetopexy with 0.2ml injection of iso-expansile SF6 (18%) intracameral., Results: The patient showed excellent early resolution of the stromal edema with reattachment of the Descemet's membrane., Conclusion: Prompt intervention in acute hydrops in PMCD cases helps in achieving early good visual results and prevents potentially serious complications such as perforation. Newer imaging modalities like SL-OCT helps in better visualisation and also in monitoring the response to treatment.