1,721,051 research outputs found
Angiographic Evaluation of Inflammation in Atopic Keratoconjunctivitis
No full textPurpose: Grading of disease activity in patients with atopic keratoconjunctivitis (AKC) is limited by intra- and inter-observer variability. The aim of this study was to identify angiographic parameters to help evaluate inflammation and disease activity. Methods: In 12 patients (4 with active, 2 with inactive AKC, and 6 controls), disease activity were assessed using a validated biomicroscopic grading scale. Imaging of upper tarsal conjunctiva was undertaken using color photography, fluorescein (FA) and indocyanine green angiography (ICGA). Results: Extravascular ICG leakage only occurred in patients with active disease (mean 84.6 ± 28.8 s) except in one patient with inactive disease but only after 6 min. Transepithelial leakage of fluorescein occurred in all patients with active AKC (mean 63.5 ± 17.8 s) but not in patients with inactive disease or controls. Conclusions: Conjunctival transepithelial leakage of fluorescein and extravascular interstitial accumulation of ICG may be useful markers of disease activity patients in AKC
Corneal Indocyanine Green Angiography to Guide Medical and Surgical Management of Corneal Neovascularization
No full textPurpose: To illustrate the role of corneal angiography in the clinical assessment and surgical treatment of patients with complex corneal neovascularization (CoNV). Methods: A case series of 3 patients with CoNV is presented whose management was guided by indocyanine green (ICG) and fluorescein corneal angiography. In the first case, there was recurrent lipid exudation into an intrastromal cleft from CoNV; in the second, there was progressive exudation from CoNV at the graft-host interface; in the third, CoNV was associated with rejection after deep anterior lamellar keratoplasty. Results: In the first case, angiography helped to identify and treat the feeder vessels and stop further leakage. In the second case, it was possible using angiography to differentiate CoNV arising from iris and limbal vasculature enabling angiographic-guided fine-needle diathermy with cessation of exudation. In the third case, angiography revealed the location of CoNV in the host-graft interface after deep anterior lamellar keratoplasty, rather than within the corneal stroma. Conclusions: Corneal angiography is a useful diagnostic tool to guide medical and surgical management of CoNV by enabling the localization of vessel depth and topography
Spontaneous descemet membrane tear after uneventful big-bubble deep anterior lamellar keratoplasty
No full textPurpose: To report a case of delayed spontaneous Descemet membrane (DM) tear after big-bubble Deep Anterior Lamellar Keratoplasty (DALK). Methods: Uneventful big-bubble DALK was performed on a 29-year-old patient with advanced keratoconus. No injury to DM was noted intraoperatively and in the first postoperative week. On examination after 1 month, the patient presented with tear and partial detachment of Descemet membrane (DMD). Results: Circumscribed eccentric stromal edema, but not DMD, partially resolved after a 3-month observational period. Conclusions: A tear to DM and consecutive DMD may occur spontaneously after big-bubble DALK. Sutural traction and regressing corneal stromal edema may be etiologic factors
A serious adverse surgical event: Management of suspected HSV-1 keratitis in a donor cornea
No full textPurpose: To describe the management of a serious adverse event in a patient undergoing penetrating keratoplasty (PK). Case report: A 68-year-old man underwent PK for an aphakic bullous keratopathy following previous complicated cataract surgery. He had no past history of herpetic disease. Storage of the corneoscleral disc in the transport bottle precluded microscopic examination. After placement of the trephined donor cornea on the open eye of the recipient, a large dendritiform geographic ulcer was noted on the donor cornea. A replacement cornea was used after changing potentially contaminated instruments. Intravenous antiviral treatment was commenced intraoperatively to reduce the risk of infection to the central nervous system. Postoperatively, oral and topical antiviral treatment was commenced and 6 months following surgery the patient developed a geographic corneal ulcer at the graft host interface. Conclusion: Containers to transport corneoscleral discs should enable microscopic examination by the surgeon prior to use. High dose systemic antivirals may reduce the risk of herpetic disease involving the posterior segment of the eye and neuroretina in the aphakic eye and spread to the central nervous system
Intraoperative management of macroperforations of Descemet’s membrane in deep anterior lamellar keratoplasty
No full textBackground: To describe a surgical approach for the completion of pre-descemetic deep anterior lamellar keratoplasty (pdDALK) in the presence of a macroperforation of Descemet’s membrane (DM). Methods: Using case notes, we recorded the details of the intra- and perioperative course of patients who underwent successful pdDALK in the presence of macroperforation. A literature search of pdDALK techniques available to the corneal surgeon in a similar scenario was undertaken. Results: In two very different scenarios with intra- or preoperative perforation of DM, a centripetal layered lamellar dissection was performed and allowed completion of pdDALK with a residual recipient central stromal thickness of 36 and 115 μm and good visual outcome. Conclusion: Despite very different scenarios, a centripetal layered lamellar dissection offers an approach for the completion of pdDALK in the presence of a macroperforation
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