Faculty Bibliography

PURPOSE/OBJECTIVE:To evaluate staged combined treatment for keratoconus with intrastromal corneal ring segment (ICRS) implantation followed by corneal collagen crosslinking (CXL) with riboflavin-ultraviolet-A (UVA) and then toric implantable collagen copolymer phakic intraocular lens (pIOL) implantation. SETTING/METHODS:Large private ophthalmic hospital system. DESIGN/METHODS:Case series. METHODS:Eyes with progressive keratoconus had ICRS implantation, then CXL, and then pIOL implantation (minimum 6 months between procedures). RESULTS:The study enrolled 14 eyes (9 patients). After the combined treatments, the mean decimal uncorrected distance visual acuity (UDVA) and mean decimal corrected distance visual acuity (CDVA) were significantly improved from 0.01 and 0.14, respectively, preoperatively to 0.44 and 0.57, respectively (P<.0001). The mean manifest refraction spherical equivalent decreased from -16.40 diopters (D) ± 3.56 (SD) (range -11.50 to -22.50 D) to -0.80 ± 1.02 D (range -2.00 to +2.00 D) after the combined treatments (P<.0001). The mean refractive astigmatism decreased from -4.73 ± 1.32 D (range -3.00 to -7.00 D) to -0.96 ± 0.35 D (range -0.50 to -1.50 D) (P<.0001). The mean steep and mean flat keratometry values reduced from 60.57 D and 56.16 D, respectively, to 54.48 D and 53.57 D (P<.0001), respectively. No intraoperative or postoperative complications occurred. CONCLUSIONS:A combined 3-stage-approach keratoconus treatment comprising ICRS implantation followed by CXL and then toric pIOL implantation was effective in improving functional vision and reducing disease progression. Longer term studies are required for further evaluation and comparison with other methods.

BACKGROUND:One of the most common facial anomalies is the presence of a prominent ear. Numerous surgical techniques have been introduced in the literature for correction of this anomaly, which include suturing and sculpturing the ear cartilage. However, each has different complications. The modified Chongchet technique is one of the less invasive methods and can correct the above abnormality with satisfying results. METHODS:From July 2001 to March 2011, 19 cases of prominent ear were corrected using the modified Chongchet technique. The mean follow-up period was approximately 4.5 years. We employed an anterior approach and partial-thickness scaphal cartilage scoring in these cases. RESULTS:We observed no recurrences and no sharp cartilage protrusions following the surgeries. Additionally, all patients expressed satisfaction with the results.  CONCLUSION/CONCLUSIONS:We propose that the modified Chongchet approach is less aggressive and has improved surgical outcomes. One of the adverse effects of this procedure is unpredictable warping of the cartilage, which may result in asymmetry.

PURPOSE/OBJECTIVE:To highlight two cases of keratoconus with significant variations of corneal curvature during pregnancy that reversed several months after delivery. METHODS:Case reports and literature review. RESULTS:Two women experienced a significant decrease of corrected distance visual acuity during pregnancy. Evaluation of corneal topography by Scheimpflug imaging revealed transitory variations of the keratometric values in both patients during the gestational period. These topographical alterations were evident not only during pregnancy, but also in the postpartum period, with stabilization of corneal topography several months after delivery. CONCLUSIONS:These clinical cases indicate that hormonal changes occurring regularly during gestation may have a severe impact on the progression of keratoconus. However, these changes are transient and fully reversible. Therefore, physicians should be reluctant to perform cross-linking during or directly after pregnancy and should wait until the corneal curvature has been stabilized.

Nevus of Ota is a unilateral, asymptomatic cutaneous and mucosal hyperpigmentation of the face that is congenital or may appear during childhood. We present a case of symptomatic acquired nevus of Ota in an adult, associated with intense pruritus, not described in the literature so far. A 32-year-old woman presented with brownish mottled macules which appeared on her face progressively over 8 days, following the distribution of the first and second divisions of the left trigeminal nerve and partially covering the iris and sclera of the left eye. She reported an intense pruritus in this area. We performed a biopsy on the left forehead, which confirmed the diagnosis of nevus of Ota. Specific stains and immunohistochemistry revealed increased numbers of mast cells. Ophthalmological tests showed acute acquired melanocytosis of the left iris and sclera. The origin of the nevus is still unclear. Several hypotheses suggest a reactivation of melanocytes during their migration from the neural crest. The pruritus reported in our patient may be explained by the increased quantity of mast cells observed in the lesion and/or neuronal stimulation of the ophthalmic and maxillary divisions of the fifth cranial nerve.

PURPOSE/OBJECTIVE:To report the effect of intravitreal ranibizumab therapy for serous and vascular pigment epithelial detachments (PED) associated with choroidal neovascularisation (CNV) secondary to age-related macular degeneration (AMD). METHODS:In a prospective study, best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) data were collected for 62 eyes of 62 patients, with serous or vascular PED associated with CNV secondary to AMD. Intravitreal ranibizumab 0.5 mg was administered with a loading phase of three consecutive monthly injections, followed by monthly review with further treatment, as indicated according to the retreatment criteria of the PrONTO study. The change in visual acuity and PED height from baseline to month 12 after the first injection was determined. RESULTS:Sixty-one eyes of 61 patients (one of the patients developed retinal pigment epithelial tear and was excluded from the study) were assessed at the 12-month follow-up examination. There were two types of PED, including vascular PED in 32 patients (Group A) and serous PED (Group B) in 29 patients. The mean improvement of mean BCVA from baseline to 12 months was 0.09 logMAR (Logarithm of the Minimum Angle of Resolution) in Group A and 0.13 logMAR in Group B. Both groups showed significant improvement of the mean BCVA 12 months after the first injection compared with the baseline value (P < 0.05). In relation to the PED height, the mean decrease of mean PED height from baseline to 12 months was 135 μm in Group A and 180 μm in Group B. Both groups showed significant reduction of the PED height during the follow-up period (P < 0.01). The PED anatomical response to ranibizumab was not correlated with the BCVA improvement in any of the groups. Apart from one patient who developed pigment epithelial tear no other complications were documented. CONCLUSION/CONCLUSIONS:Ranibizumab is an effective and safe treatment for improving vision in patients with serous and vascular PED, although the anatomical response of the PED to ranibizumab may not correlate directly with the visual outcome.