Faculty Bibliography

PURPOSE: To present a case in which an RK4 lens was fitted for a patient who developed flap striae resulting from laser-assisted in situ keratomileusis (LASIK). METHODS: Case report. RESULTS: A 44-year-old man underwent uncomplicated LASIK procedure for bilateral myopia and astigmatism. Visually significant flap striae (OS>OD) were noted postoperatively. The flaps were relifted, refloated, and stretched twice in each eye. In addition, OD enhancement laser treatment was performed. Nevertheless, decreased best-corrected visual acuity (OS>OD) persisted. One month after LASIK, the patient was referred to our office for a second opinion and further evaluation. To avoid additional manipulation of the flaps, we used an RK4 lens fitting to achieve a final corrected visual acuity of 20/20 OU. CONCLUSIONS: Persistent, visually significant flap striae following flap, refloating, stretching, and smoothing techniques can make LASIK patients unhappy. An RK4 lens fitting is an alternative method for correcting postoperative irregular astigmatism and to achieve the best-corrected visual acuity

PURPOSE: We evaluated the performance of the RK4 (reverse-geometry) contact lens in patients with flat central and steep peripheral corneal topography after penetrating keratoplasty (PK). METHODS: A retrospective study was performed of post-PK patients fitted with RK4 lenses on the Cornea Service at Wills Eye Hospital, between March 2000 and February 2002. RESULTS: Fifteen eyes of 13 post-PK patients were fitted with RK4 lenses and monitored for more than two months (range, 2.1-23.5 months; mean, 8.1 +/- 7.0 months). The average number of lens refits per eye was 1.0 +/- 1.2 (range, 0-4). Ninety-three percent (14/15) of the eyes that were fitted achieved at least 20/30 visual acuity, and 53% (8/15) of eyes achieved 20/20 visual acuity. A comparison of prefitted and post-fitted corrected visual acuity demonstrated a statistically significant improvement (P < 0.01). RK4 lenses were successfully worn full time or part time in all cases. CONCLUSIONS: The RK4 lens can provide well-tolerated visual correction in cases with central flat, peripheral steep corneal contour following PK

This article presents the case of a 49-year-old man who did not have a history of wearing contact lenses and who developed a rapidly progressive course of Acanthamoeba keratitis. The patient developed stromal keratitis that did not respond to herpes simplex virus therapies. Within 1 week after presentation, the patient progressed from mild anterior stromal haze and edema to a ring infiltrate, epithelial loss, and significant corneal edema. Corneal scrapings demonstrated cysts consistent with Acanthanmoeba keratitis. The patient was admitted to the hospital and placed on intensive medical therapy. He responded to therapy, and at 5 months showed central scarring in a quiet eye. This article presents a case of Acanthamoeba keratitis in a non-contact lens wearer, who was diagnosed clinically and histopathologically within 1 week of onset of symptoms. His case was atypical given his lack of contact lens wear or antecedent trauma and rapid progression to a ring infiltrate, usually seen as late findings

PURPOSE: To assess the rates of simple and clinically significant recurrences of stromal dystrophies in corneal grafts. METHODS: We conducted a retrospective review of Wills Eye Hospital records from 1984 to 2001, identifying all patients with stromal corneal dystrophies who had penetrating keratoplasties. Kaplan-Meier curves and chi analysis were performed. RESULTS: The study population consisted of 35 eyes (21 patients) with lattice dystrophy, 17 eyes (10 patients) with corneal dystrophy of Bowman's membrane (CDB), 14 eyes (eight patients) with macular dystrophy, seven eyes (five patients) with granular dystrophy, and four eyes (four patients) diagnosed with Schnyder's crystalline dystrophy. There was a simple recurrence in 21 (60%) eyes (14 patients) with lattice and in 15 (88%) eyes (eight patients) with CDB. The median time to simple recurrence for the first eye transplanted of each patient was 8.4 years for lattice and 2.0 years for CDB. After 5 years of follow-up, there was a clinically significant recurrence, manifested by recurrent erosions or associated with decreased visual acuity, in the first eye transplanted of each patient, respectively, in six (17.1%) and seven (20%) eyes with lattice and in two (11.8%) and three (17.6%) eyes with CDB. CONCLUSION: Corneal dystrophy of Bowman's membrane has the highest rate of simple recurrence followed by granular and lattice dystrophies, respectively. However, the rate of clinically significant recurrence, both recurrent erosions and decreased visual acuity, in the first 5 years is similar in CDB and lattice dystrophies. Recurrence is infrequent in macular and Schnyder's crystalline dystrophy. As expected, in genetic diseases, the potential for recurrence exists and increases with follow-up time

OBJECTIVE: To analyze the possible causes of Descemet's membrane detachment (DMD) and the treatment and outcome of patients after cataract surgery. DESIGN: Retrospective noncomparative interventional case series. PARTICIPANTS: Fifteen eyes of 12 patients. METHODS: We reviewed clinical data on 15 eyes of 12 patients with nonscrolled DMD after cataract surgery who presented to the Cornea Service at Wills Eye Hospital from 1986 to 2001. Institutional review board/ethics committee approval was obtained. MAIN OUTCOME MEASURES: Visual acuity and reattachment of Descemet's membrane. RESULTS: Cataract procedures involved nine clear-corneal eyes, four limbal incisions, one trabeculectomy/combined phacoemulsification, and one extracapsular cataract extraction. From 1986 to 1990, we had 1 patient; from 1991 to 1995, no patients; and from 1996 to 2001, 11 patients (including all clear-corneal eyes). Of the 15 eyes, 8 resolved with medical treatment alone, with a mean time to resolution of 9.8 weeks. One patient was lost to follow-up while improving on medical treatment, and another required a penetrating keratoplasty (PK) after medical treatment failed. Five eyes received anterior-chamber SF(6) gas injection. Of these eyes, three DMDs resolved, one underwent repeated injection (not improving after 10 weeks), and another required a PK. CONCLUSIONS: Referrals for DMD seem to be increasing. This may be explained by the increase in clear-corneal cataract procedures. Medical treatment seems to be adequate in many cases and may be appropriate initial therapy. When needed, SF(6) gas injection may also be successful, but not in all cases

PURPOSE: This study was designed to identify factors that may help to determine the likelihood of a patient with keratoconus undergoing a penetrating keratoplasty (PK) after referral to a cornea service. METHODS: A retrospective chart review of 109 patients from a corneal referral practice was undertaken to identify clinical characteristics at presentation that were predictive of subsequent PK. RESULTS: Overall, during an average follow-up of 10.9 years, 39 (35.8%) did not have a PK for keratoconus in either eye, 34 (31.2%) had a PK in one eye, and 36 (33.0%) had a PK in both eyes. The presence of corneal scarring and steep keratometry values were significant risk factors for subsequent PK. CONCLUSION: In a corneal referral practice, 64.2% of patients go on to PK in one or both eyes during long-term follow-up. The presence of scarring and high keratometry values at initial presentation may help to predict the likelihood of requiring a PK and may aid in patient counseling