Uneventful Anterior Migration of Intravitreal Ozurdex Implant in a Patient with Iris-Sutured Intraocular Lens and Descemet Stripping Automated Endothelial Keratoplasty

Purpose

We report here the case of a patient with anterior segment migration of intravitreal dexamethasone implant as well as its management and outcome.

Methods

The patient had the following sequence of events: complicated cataract surgery, iris-sutured intraocular lens implant, followed by cystoid macular edema treated with intravitreal Avastin, retinal vein occlusion treated with intravitreal dexamethasone implant, corneal decompensation treated with Descemet stripping automated endothelial keratoplasty (DSAEK), and finally recurrence of macular edema treated with repeated intravitreal dexamethasone implant.

Results

Dexamethasone implant had completely dissolved from the eye 12 weeks after insertion without any complication.

Conclusion

A conservative approach with regular monitoring in the situation of a quiet anterior segment without any corneal decompensation can provide enough time for the implant to dissolve without causing any complication to the involved eye, avoiding any additional surgical intervention, as presented in this case report. Despite the fact that the implant was left for natural dissolution, there were no adverse effects related to the graft or the eye.

Optical Biometry Derived Axial Length Measurements Following Intravitreal Anti-Vascular Endothelial Growth Factor Treatment for Macular Edema

PURPOSE

To evaluate axial length (AL) alterations in patients with macular disease over the course of intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment.

METHODS

In this prospective, comparative study, 33 patients with macular edema underwent unilaterally intravitreal anti-VEGF therapy and were followed for two months; the contralateral eyes were considered as controls. Central retinal thickness (CRT) was measured with spectral-domain optical coherence tomography and AL with an IOL-Master optical biometer.

RESULTS

CRT of the treated eyes decreased by 35.33 ± 65.59 μm (range, -222.00-67 μm), while AL increased by 0.008 ± 0.062 mm (range, -0.11-0.18 mm). CRT of the control group decreased by 9.82 ± 65.40 μm (range, -203-182 μm), and AL increased by 0.011 ± 0.129 mm (range, -0.20-0.67 mm). No significant correlation was detected between CRT and AL parameters (rhos=0.026, P=0.882).

CONCLUSIONS

Anti-VEGF administration has no significant impact on optical biometry-derived AL measurements.

Corneal Stromal Demarcation Line Depth Following Standard and a Modified High Intensity Corneal Cross-linking Protocol

PURPOSE

To compare the corneal stromal demarcation line depth using anterior segment optical coherence tomography (AS-OCT) after corneal cross-linking (CXL) using two different treatment protocols: the standard Dresden protocol (30 minutes with 3 mW/cm(2)) and a modified high intensity protocol (7 minutes with 18 mW/cm(2)), corresponding to a total surface dose of 5.4 and 7.5 J/cm(2), respectively.

METHODS

This prospective, comparative, interventional case series included 29 keratoconic patients (32 eyes). All patients underwent CXL using the same high intensity ultraviolet-A (UV-A) irradiation device (CCL-365; Peschke Meditrade GmbH, Huenenberg, Switzerland). Sixteen eyes were treated for 30 minutes with 3 mW/cm(2) according to the standard Dresden protocol, whereas 16 eyes were treated with a novel modified high intensity CXL protocol for 7 minutes with 18 mW/cm(2) of UV-A irradiation intensity. One month postoperatively, corneal stromal demarcation line depth was measured by two independent observers using AS-OCT.

RESULTS

There was no significant difference in corneal stromal demarcation line depth between observer measurements for both groups (P = .645, Dresden protocol group; P = .715, high intensity group). Mean corneal stromal demarcation line depth was 341.81 ± 47.02 µm for the Dresden protocol group and 313.37 ± 48.85 µm for the high intensity protocol group. There was no statistically significant difference (P = .104) in the corneal stromal demarcation line depth between the two groups. Mean endothelial cell density did not change significantly in either group (P = .090, Dresden protocol group; P = .103, high intensity group). No intraoperative or postoperative complications were noted.

CONCLUSIONS

Corneal stromal demarcation line depth using UV-A irradiance with 3 mW/cm(2) for 30 minutes and 18 mW/cm(2) for 7 minutes was similar. It seems that the current modified accelerated CXL protocol provided the same treatment depth as the standard Dresden protocol.

Safety of high-intensity corneal collagen crosslinking

PURPOSE

To evaluate the safety of a new high-intensity corneal collagen crosslinking (CXL) treatment protocol for keratoconus.

SETTING

Vardinoyiannion Eye Institute of Crete, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece.

DESIGN

Prospective interventional case series.

METHODS

Patients with progressive keratoconus had CXL using a new treatment protocol with 9 mW/cm(2) irradiance for duration of 10 minutes. The rate of reepithelialization, endothelial cell density (ECD), corrected distance visual acuity (CDVA), and steep and flat keratometry (K) values were evaluated preoperatively and 3 months postoperatively.

RESULTS

Nine patients (10 eyes) were enrolled. No intraoperative or early postoperative complications were observed in any patient. The ECD did not change significantly 3 months postoperatively (P=.169). The CDVA improved from 0.19 logMAR ± 0.20 (SD) preoperatively to 0.10 ± 0.16 logMAR 3 months postoperatively; however, the improvement did not attain significance (P=.141). No eye lost lines of CDVA. The mean steep K readings decreased significantly from 48.04 ± 2.57 diopters (D) preoperatively to 46.51 ± 2.81 D 3 months postoperatively (P=.047); the mean flat K readings did not change significantly postoperatively (P=.285).

CONCLUSIONS

Corneal collagen crosslinking at 9 mW/cm(2) irradiance for 10 minutes did not cause significant changes in ECD or intraoperative or early postoperative complications. None patient lost a line of CDVA 3 months after the procedure.

FINANCIAL DISCLOSURE

No author has a financial or proprietary interest in any material or method mentioned.

Evaluation of corneal stromal demarcation line depth following standard and a modified-accelerated collagen cross-linking protocol

PURPOSE

To compare the corneal stromal demarcation line depth using anterior segment optical coherence tomography (AS-OCT) after corneal collagen cross-linking (CXL) using 2 different treatment protocols: the standard Dresden protocol (30 minutes with 3 mW/cm(2)) and a modified-accelerated protocol (14 minutes with 9 mW/cm(2)).

DESIGN

Prospective, comparative study.

METHODS

Forty-three keratoconic patients (52 eyes) were enrolled. All patients underwent CXL using the same high-intensity ultraviolet-A (UV-A) irradiation device. Twenty-six eyes were treated for 30 minutes with 3 mW/cm(2) according to the standard Dresden protocol (Group 1), while 26 eyes were treated with a novel modified-accelerated CXL protocol for 14 minutes with 9 mW/cm(2) of UV-A irradiation intensity (Group 2). One month postoperatively, corneal stromal demarcation line depth was measured by 2 independent observers using AS-OCT.

RESULTS

Corneal stromal demarcation line depth was assessed with no significant difference between observer measurements for both groups (P = .676 for Group 1 and P = .566 for Group 2). Mean corneal stromal demarcation line depth was 337.00 ± 46.46 μm for Group 1 and 322.91 ± 48.28 μm for Group 2. There was no statistically significant difference (P = .243) in the corneal stromal demarcation line depth between the 2 groups.

CONCLUSIONS

Corneal stromal demarcation line depth using UV-A with 3 mW/cm(2) for 30 minutes and 9 mW/cm(2) for 14 minutes was similar. A modified-accelerated protocol of 14 minutes of CXL provided the same treatment depth as the classic Dresden protocol.

Diffuse lamellar keratitis in the femtosecond-assisted LASIK flap tunnel

Here we report a case of a 29-year-old myopic female who underwent femtosecond laser-assisted in situ keratomileusis (LASIK) and, on the first postoperative day slit-lamp examination revealed a dense, white, granular reaction with the presence of some blood droplets (stage I diffuse lamellar keratitis [DLK]) in her left eye, specifically localized into the femtosecond LASIK flap tunnel (not extended to the flap interface). The patient received intensive treatment with topical corticosteroids and 5 days later the granular reaction had completely resolved. A new site of DLK, ie, the flap tunnel, in femtosecond-assisted LASIK is presented. DLK into the flap tunnel could be managed with corticosteroids if detected early, without affecting the flap interface.

Anterior segment optical coherence tomography for demonstrating posterior capsular rent in posterior polar cataract

AIMS/PURPOSE

To report the preoperative use of anterior segment optical coherence tomography (AS-OCT) for the determination of pre-existing posterior capsule defect in patients with posterior polar cataract.

METHODS

Three patients presented with posterior polar cataract and were evaluated preoperatively using AS-OCT, revealing in one patient intact posterior capsule and in the other two a pre-existing posterior capsule defect not detectable by slit-lamp evaluation. All patients underwent phacoemulsification and intraocular lens implantation.

RESULTS

Intraoperatively, AS-OCT findings were confirmed after cataract surgery in all patients. No intra- or late postoperative complications were noted.

CONCLUSION

AS-OCT could be an additional useful imaging modality in these patients, essential for surgical planning and patient consultation.

Correlation of the corneal collagen cross-linking demarcation line using confocal microscopy and anterior segment optical coherence tomography in keratoconic patients

PURPOSE

To evaluate and compare the depth of the corneal stromal demarcation line after corneal collagen cross-linking (CXL) using 2 different methods: confocal microscopy and anterior segment optical coherence tomography (AS OCT).

DESIGN

Prospective, comparative, interventional case series.

METHODS

Seventeen patients (18 eyes) with progressive keratoconus were enrolled. All patients underwent uneventful CXL treatment according to the Dresden protocol. One month after surgery, corneal stromal demarcation line depth was measured in all patients by 2 independent observers using confocal microscopy and AS OCT.

RESULTS

Mean corneal stromal demarcation line depth measured using confocal microscopy by the first observer was 306.22 ± 51.54 μm (range, 245 to 417 μm) and that measured by the second observer was 303.5 ± 46.98 μm (range, 240 to 390 μm). The same measurements using AS OCT were 300.67 ± 41.56 μm (range, 240 to 385 μm) and 295.72 ± 41.01 μm (range, 228 to 380 μm) for the first and second observer, respectively. Pairwise comparisons did not reveal any statistically significant difference between confocal microscopy and AS OCT measurements for both observers (P = .3219 for the first observer and P = .1731 for the second observer).

CONCLUSIONS

Both confocal microscopy and AS OCT have similar results in evaluating the depth of the corneal stromal demarcation line after CXL.