Faculty Bibliography

PURPOSE:To assess the progression of keratoconus in patients treated with collagen cross-linking with riboflavin and ultraviolet A (UVA) irradiation. METHODS:Thirty-eight eyes of 19 patients with progressive keratoconus were enrolled in a prospective comparative study. Average follow-up was 9 +/- 2 months (range: 5 to 12 months). The worse eye was treated with collagen cross-linking, and the fellow eye served as the control. Corneal epithelium was mechanically removed. Riboflavin 0.1% solution in dextran T-500 20% solution was applied every 2 to 3 minutes for 30 minutes throughout the irradiation. Ultraviolet A irradiation (370 nm) was performed using a commercially available UVA lamp for 30 minutes. RESULTS:The group treated with collagen crosslinking demonstrated a mean decrease (less myopic) in spherical equivalent refraction and cylinder of 1.03 +/- 2.22 diopters (D) (range: -5.25 to +3.75 D) and 1.04 +/- 1.44 D (range: -2.00 to +4.00 D), respectively (P < .01), and an increase in uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) of 0.06 +/- 0.05 (range: 0.00 to 0.20) and 0.10 +/- 0.14 (range: -0.10 to 0.34), respectively (P < .01). The maximal curvature decreased by 1.57 +/- 1.14 D (range: 0.00 to 3.90 D), and intraocular pressure increased by 2 +/- 2 mmHg (range: -1 to 6 mmHg), which was statistically significant. No statistical difference was noted regarding central corneal thickness (P = .06) and endothelial cell count (P = .07). The untreated group showed no statistical difference for any of the clinical parameters, apart from UCVA and BSCVA, which decreased by 0.08 +/- 0.12 (range: -0.40 to 0.10) and 0.06 +/- 0.09 (range: -0.20 to 0.10), respectively (P < .01). CONCLUSIONS:Riboflavin/UVA collagen cross-linking appears to be efficacious in inhibiting the progression of keratoconus by reducing the corneal curvature, spherical equivalent refraction, and refractive cylinder in eyes with progressive keratoconus at average 9-month follow-up.

AIM/OBJECTIVE:To study the efficacy of silicone gel applied to hypertrophic burn scars, in reducing scar interference with normal function and improving cosmesis. METHODS:A randomised, double-blind, placebo-controlled trial involving 38 people with hypertrophic burn scars. Each scar was divided into two segments; silicone gel sheet was applied randomly to one of the two and placebo to the other. Participants were seen again after 1 and 4 months. Their data and wound characteristics were collected using the Vancouver scar scale. RESULTS:The median age of participants was 22 years (1.5-60 years) and 16 were male; 4 did not attend follow-up and were excluded from the study. There were no significant differences in baseline characteristics. Although after 1 month all scar scale measures were lower in treated areas, only the vascularity scale was significantly different between the two areas. After 4 months, all scale measures were significantly lower in the silicone gel group than in the control group, except for the pain score. CONCLUSION/CONCLUSIONS:Silicone gel is an effective treatment for hypertrophic burn scars.

Elevation of the skin along with its deep fascia vascular network is a recent facility for flap design. The longitudinal trapezius fasciocutaneous flap was first introduced in 1996; at that time it did not receive much attention, although it has many significant benefits compared with other available procedures. Sixteen trapezius fasciocutaneous flaps were elevated in 15 patients for reconstruction of severe scarring of the neck and midface. All flaps were based on the deep branch of the transverse cervical artery and included the overlying fascia of the trapezius muscle. Delaying was applied for very long flaps. Two flaps developed minimal distal necrosis (<5 cm) due to longer pedicles (>10 cm below the muscle border). The results indicate that an extra-long back fascia flap based on the descending branch of the transverse cervical artery could be formed, which would be long enough to reconstruct the entire neck and safely transfer it to the midface. The vertical trapezius fasciocutaneous flap, with its abundant tissue, excellent blood supply, anatomic proximity, wide arc of rotation, and hidden donor site scar, provides a simple and reliable method for primary reconstruction of various midface and neck defects.

We report on two patients, each with an atrophic blind eye who underwent strabismus correction as an alternative treatment of artificial eye prosthesis intolerance. Both patients had acquired intolerance of their prostheses, which could not be adjusted by the ocularist. The intolerance was assumed to result from focal corneal pressure by the prosthesis, related to progressive exotropia and hypertropia. This led to irritation and pain in both patients, and to focal corneal staining in one. Both patients underwent retropositioning of the external and superior rectus muscles of the left eye. At 4 weeks and 13 months postoperatively, they were free of symptoms while wearing the original artificial eye prosthesis.

Iatrogenic keratectasia after laser in situ keratomileusis (LASIK) represents a serious complication of refractive laser surgery. We describe a woman who developed bilateral iatrogenic keratectasia during her first pregnancy 26 months after LASIK. Corneal collagen crosslinking (CCL) with riboflavin and ultraviolet-A was performed in March 2005 (right eye) and April 2005 (left eye). This treatment stopped the progression and even caused the keratometric steepness to regress over a postoperative follow-up of 22 months, as demonstrated by preoperative and postoperative corneal topographies and maximum K-readings. During the patient's second pregnancy, the keratectasia exacerbated. To our knowledge, this is the first case showing exacerbation of keratectasia despite CCL and, as the exacerbation occurred only during pregnancy, suggesting that hormonal changes might affect corneal biomechanical stability.