DOCSLIB.ORG

Femtosecond Laser-Assisted Tuck-In Penetrating Keratoplasty for Advanced Keratoglobus with Endothelial Damage

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Femtosecond Laser-Assisted Tuck-In Penetrating Keratoplasty for Advanced Keratoglobus with Endothelial Damage CASE REPORT Femtosecond Laser-Assisted Tuck-In Penetrating Keratoplasty for Advanced Keratoglobus With Endothelial Damage Jorge L. Alió del Barrio, MD, PhD,*† Olena Al-Shymali, MD,*‡ and Jorge L. Alió, MD, PhD, FEBOphth*† thinning, especially peripherally, in which the normal stromal Purpose: To describe the outcomes of femtosecond laser-assisted thickness is frequently reduced to less than one-fifth.1 KTG tuck-in penetrating keratoplasty as a single-step surgical procedure often presents at birth and results in the globular protrusion of for visual and anatomical rehabilitation of patients with severe the cornea, leading to severe loss of vision as a result of extreme keratoglobus (KTG) and endothelial damage. myopia, irregular astigmatism, and scarring.2 Severe complica- Methods: tions frequently appear as acute corneal hydrops and corneal Two eyes of a 7-year-old patient with bilateral severe 1–3 KTG and previous corneal hydrops were operated. Assisted by the perforations occurring spontaneously or after minimal trauma. KTG has been described in both congenital and femtosecond laser, both donor and recipient corneas were prepared. 2 An 8.5-mm full-thickness donor tissue with a peripheral partial- acquired forms. The former has been associated with blue thickness rim of 1.25 mm was sutured into an 8.5-mm recipient bed sclera syndrome, osteogenesis imperfecta, Leber congenital amaurosis, and connective tissue disorders, such as Ehlers– with a previously dissected intralamellar peripheral pocket up to the 2,4,5 limbus. The graft was secured with 16 interrupted 10-0 nylon sutures Danlos or Marfan syndrome. Acquired KTG has been and the peripheral donor rim tucked into the host stromal pocket. associated with vernal keratoconjunctivitis and chronic mar- ginal blepharitis due to frequent eye rubbing, thyroid eye Results: Six months after surgery, both grafts remained healthy and disease, and idiopathic orbital inflammation.6 clear. One eye developed mild postoperative ocular hypertension. No KTG management is challenging and is not standardized. intraoperative or other postoperative complications were observed. Conservative therapies, such as spectacles and contact lenses for Corrected distance visual acuity was 20/50 in both eyes, with the correction of myopia and astigmatism, are not always complete functional rehabilitation of the patient. Restoration of the possible in noncollaborative children and may provoke a risk peripheral corneal thickness was observed in the pachymetric map. of corneal perforation through trauma. Corneal repair after Conclusions: perforation in such eyes is very complex and involves a high risk Femtosecond laser-assisted tuck-in penetrating of final eye loss requiring evisceration or enucleation.1 Thus, keratoplasty can provide excellent anatomical and functional reha- prevention is critical in patients with severe KTG. In the absence bilitation of patients with severe KTG and endothelial damage, of a definitive standard procedure, different lamellar keratoplasty through a single-step surgical procedure and a single donor cornea and epikeratoplasty techniques have been described to provide per eye. The femtosecond laser permits accurate dissection of these structural support to these extremely weakened corneas, already thin corneas without inadvertent perforation risk. although in cases of previous hydrops and endothelial damage, Key Words: keratoglobus, tuck-in penetrating keratoplasty, corneal a 2-step procedure with a second central corneal graft will be 7 transplant, femtosecond laser required. In such cases, standard penetrating keratoplasty (PKP) should be avoided because it is technically demanding, and it is (Cornea 2017;36:1145–1149) often unsuccessful because of the severe host peripheral stromal thinning and the high rejection risk of these almost limbus-to- limbus grafts in young recipients. eratoglobus (KTG) is a rare noninflammatory bilateral In this article, we report the case of a child with bilateral Kcorneoscleral ectasia characterized by generalized corneal advanced KTG and previous bilateral corneal hydrops in which successful visual and anatomical rehabilitation was Received for publication April 12, 2017; revision received May 11, 2017; achieved by femtosecond laser-assisted tuck-in PKP as accepted May 19, 2017. Published online ahead of print July 6, 2017. a single-step surgical procedure. From the *Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain; †Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain; and ‡Research and Development Department, Vissum Corporation, Alicante, Spain. MATERIALS AND METHODS The authors have no funding or conflicts of interest to disclose. Reprints: Jorge L. Alió, MD, PhD, FEBOphth, Avda de Denia s/n, Vissum, Case Report Instituto Oftalmologico de Alicante, 03016 Alicante, Spain (e-mail: [email protected]). A 7-year-old boy was referred to our clinic presenting Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. bilateral KTG with severe and recalcitrant pain and Cornea Volume 36, Number 9, September 2017 www.corneajrnl.com | 1145 Copyright Ó 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Alió del Barrio et al Cornea Volume 36, Number 9, September 2017 photophobia for the last 2 months. Slit-lamp examination and N400mm, S 402 mm, and I 302 mm. In an attempt to reattach visual function test were impossible to be performed because the DM, air was injected into the anterior chamber of the left of a complete lack of cooperation. Therefore, a full examina- eye (Fig. 1B). Bilateral tuck-in PKP under general anesthesia tion was performed under general anesthesia: the right eye was scheduled with a 1-month gap in between. showed severe 360-degree corneal thinning up to the limbus with severe stromal scarring of the temporal half of the cornea affecting the visual axis. An underlying severe Descemet Surgical Technique membrane (DM) tear was observed without acute stromal edema. The intraocular structures were intact; the intraocular Donor Tissue Preparation pressure (IOP) was 6 mm Hg; ultrasound pachymetry values The 60-kHz IntraLase iFS femtosecond laser (AMO were as follows: central (C) 370 mm, temporal (T) 358 mm, Inc, Irvine, CA) was used to create an 8.5-mm-diameter and nasal (N) 270 mm, superior (S) 260 mm, and inferior (I) 310-mm-deep anterior side cut continued with a 300-mm-deep 315 mm. Examination revealed that the left eye was similar to ring lamellar cut up to a diameter of 9.5 mm (8.4–9.5 mm). the right eye, but with a giant central DM tear, which appeared Then, after the ring lamellar cut, the cornea was peripherally detached and retracted within the central 6 mm of the cornea manually dissected using a crescent blade up to the limbus. (Fig. 1A–B), together with overlying moderate corneal edema. Afterward, an 11-mm trephine was used for full-thickness Severe scarring affected the whole stromal surface (Fig. 1A); trephination from the endothelial side, subsequently removing IOP: 5 mm Hg; ultrasound pachymetry: C 330 mm, T 350 mm, the loose superficial rim of the peripheral cornea, finally FIGURE 1. Left eye preoperative external anterior segment photo- graphs before (A) and after (B) in- tracameral air injection. Note the severe diffuse stromal scarring as a consequence of giant DM split and detachment; slit-lamp postoperative anterior segment images 6 months after transplantation in the right (C) and left eyes (D), presenting the latest a fixed pupil as a consequence of Urrets–Zavalia syndrome. Observe the complete transparency of both penetrating grafts and the peripheral partial-thickness donor rim tucked within the host cornea; topography sagittal curvature of the right (E) and left eyes (F) 6 months after surgery shows a high degree of regular astigmatism. 1146 | www.corneajrnl.com Copyright © 2017 Wolters Kluwer Health, Inc. All rights reserved. Copyright Ó 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited. Cornea Volume 36, Number 9, September 2017 Femtosecond Laser-Assisted Tuck-In PKP FIGURE 2. Femtosecond laser-as- sisted tuck-in PKP surgical diagram: (A) final appearance of the donor cornea; (B) final appearance of the peripheral recipient stromal pocket; (C) the thread passes through the central 8.5-mm portion of the donor cornea with partial-thickness bite and the anterior portion of the re- cipient’s stromal pocket; (D) the peripheral circumferential donor rim remains tucked into the recipient’s stromal pocket, enhancing the peripheral corneal thickness. obtaining a “top hat-shaped” donor cornea with a central with oral acetazolamide and complete topical hypotensive 8.5-mm full-thickness sector and a 1.25-mm peripheral therapy, but leaving thereafter mild ocular hypertension that partial-thickness rim (Fig. 2A). required long-term topical hypotensive treatment (Fig. 1D). No other postoperative complications or rejection signs were Recipient Preparation recorded. The patient experienced a great visual function The recipient cornea was prepared under sedation in the improvement and recovered a normal academic activity at same manner as the donor with the laser, except for an anterior school. The patient was able to cooperate well throughout the side-cut depth of 160 mm and a ring lamellar cut depth of postoperative ophthalmic examinations. At the sixth-month 150 mm (the recipient side-cut depth was estimated as half of follow-up visit, both corneal grafts were healthy:
Load more

Recommended publications
  • Case Report Descemet Stripping Endothelial Keratoplasty in a Patient with Keratoglobus and Chronic Hydrops Secondary to a Spontaneous Descemet Membrane Tear
    Hindawi Publishing Corporation Case Reports in Ophthalmological Medicine Volume 2013, Article ID 697403, 5 pages http://dx.doi.org/10.1155/2013/697403 Case Report Descemet Stripping Endothelial Keratoplasty in a Patient with Keratoglobus and Chronic Hydrops Secondary to a Spontaneous Descemet Membrane Tear Anton M. Kolomeyer1 and David S. Chu1,2 1 The Institute of Ophthalmology and Visual Science, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark,NJ07103,USA 2 Metropolitan Eye Research and Surgery Institute, 540 Bergen Boulevard, Suite D, Palisades Park, NJ 07650, USA Correspondence should be addressed to David S. Chu; [email protected] Received 4 March 2013; Accepted 7 April 2013 Academic Editors: S. M. Johnson and S. Machida Copyright © 2013 A. M. Kolomeyer and D. S. Chu. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Purpose. To report the use of Descemet stripping endothelial keratoplasty (DSEK) in a patient with keratoglobus and chronic hydrops. Case Report. We describe a case of a 28-year-old man with bilateral keratoglobus and chronic hydrops in the right eye secondary to spontaneous Descemet membrane tear. The patient presented with finger counting (CF) vision, itching, foreign body sensation, and severe photophobia in the right eye. Peripheral corneal thinning with central corneal protrusion and Descemet mem- brane tear spanning from 4 to 7 o’clock was noted on slit lamp examination. The right eye cornea was 15 mm in the horizontal diam- eter.
    [Show full text]
  • Corneal Ectasia
    Corneal Ectasia Secretary for Quality of Care Anne L. Coleman, MD, PhD Academy Staff Nicholas P. Emptage, MAE Nancy Collins, RN, MPH Doris Mizuiri Jessica Ravetto Flora C. Lum, MD Medical Editor: Susan Garratt Design: Socorro Soberano Approved by: Board of Trustees September 21, 2013 Copyright © 2013 American Academy of Ophthalmology® All rights reserved AMERICAN ACADEMY OF OPHTHALMOLOGY and PREFERRED PRACTICE PATTERN are registered trademarks of the American Academy of Ophthalmology. All other trademarks are the property of their respective owners. This document should be cited as follows: American Academy of Ophthalmology Cornea/External Disease Panel. Preferred Practice Pattern® Guidelines. Corneal Ectasia. San Francisco, CA: American Academy of Ophthalmology; 2013. Available at: www.aao.org/ppp. Preferred Practice Pattern® guidelines are developed by the Academy’s H. Dunbar Hoskins Jr., MD Center for Quality Eye Care without any external financial support. Authors and reviewers of the guidelines are volunteers and do not receive any financial compensation for their contributions to the documents. The guidelines are externally reviewed by experts and stakeholders before publication. Corneal Ectasia PPP CORNEA/EXTERNAL DISEASE PREFERRED PRACTICE PATTERN DEVELOPMENT PROCESS AND PARTICIPANTS The Cornea/External Disease Preferred Practice Pattern® Panel members wrote the Corneal Ectasia Preferred Practice Pattern® guidelines (“PPP”). The PPP Panel members discussed and reviewed successive drafts of the document, meeting in person twice and conducting other review by e-mail discussion, to develop a consensus over the final version of the document. Cornea/External Disease Preferred Practice Pattern Panel 2012–2013 Robert S. Feder, MD, Co-chair Stephen D. McLeod, MD, Co-chair Esen K.
    [Show full text]
  • Megalocornea Jeffrey Welder and Thomas a Oetting, MS, MD September 18, 2010
    Megalocornea Jeffrey Welder and Thomas A Oetting, MS, MD September 18, 2010 Chief Complaint: Visual disturbance when changing positions. History of Present Illness: A 60-year-old man with a history of simple megalocornea presented to the Iowa City Veterans Administration Healthcare System eye clinic reporting visual disturbance while changing head position for several months. He noticed that his vision worsened with his head bent down. He previously had cataract surgery with an iris-sutured IOL due to the large size of his eye, which did not allow for placement of an anterior chamber intraocular lens (ACIOL) or scleral-fixated lens. Past Medical History: Megalocornea Medications: None Family History: No known history of megalocornea Social History: None contributory Ocular Exam: • Visual Acuity (with correction): • OD 20/100 (cause unknown) • OS 20/20 (with upright head position) • IOP: 18mmHg OD, 17mmHg OS • External Exam: normal OU • Pupils: No anisocoria and no relative afferent pupillary defect • Motility: Full OU. • Slit lamp exam: megalocornea (>13 mm in diameter) and with anterior mosaic dystrophy. Iris-sutured posterior chamber IOLs (PCIOLs), stable OD, but pseudophacodonesis OS with loose inferior suture evident. • Dilated funduscopic exam: Normal OU Clinical Course: The patient’s iris-sutured IOL had become loose (tilted and de-centered) in his large anterior chamber, despite several sutures that had been placed in the past, resulting now in visual disturbance with movement. FDA and IRB approval was obtained to place an Artisan iris-clip IOL (Ophtec®). He was taken to the OR where his existing IOL was removed using Duet forceps and scissors. The Artisan IOL was placed using enclavation iris forceps.
    [Show full text]
  • Analysis of the Variety of Eye Impairments in Glaucoma Cases in Children and Adults
    https://doi.org/10.5272/jimab.2017234.1804 Journal of IMAB Journal of IMAB - Annual Proceeding (Scientific Papers). 2017 Oct-Dec;23(4) ISSN: 1312-773X https://www.journal-imab-bg.org Original article ANALYSIS OF THE VARIETY OF EYE IMPAIRMENTS IN GLAUCOMA CASES IN CHILDREN AND ADULTS Tsvetomir Dimitrov Clinical Department of Ophthalmology, First General Hospital for Active Treatment Sofia AD, Sofia, Bulgaria ABSTRACT: the causes for the occurrence of glaucoma remain Glaucoma is a disease, which results in definitive vi- unclarified. There are multiple theories for the occurrence sion reduction. The aim of this study is an analysis of the of the disease, which may be systematized in the follow- differences in eye impairments in connection with the pro- ing way: gression of glaucoma in different age groups (children and 1. The increased intraocular pressure (IOP) impairs adults). A documentary method of investigation of scien- the nerve cells of the retina and of optic nerve due to me- tific sources, based on clinical practice, is applied. The chanical compression. methodology of the study comprises investigation of causes 2. The increased intraocular pressure (IOP) com- and manifestations of the disease and its typology. The spe- presses the blood vessels, which feed the retina and optic cific variety in the manifestation of glaucoma is established nerve, and the compression causes changes related to the in children and adults. Excavation of the optic nerve oc- disturbed blood supply. curs in the adult persons, because the eyeball is already 3. The presence of low blood pressure and high IOP thickened, and collagen is dense.
    [Show full text]
  • Differences in Manifestations of Marfan Syndrome, Ehlers-Danlos Syndrome, and Loeys-Dietz Syndrome
    1/30/2019 Differences in manifestations of Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome Ann Cardiothorac Surg. 2017 Nov; 6(6): 582–594. PMCID: PMC5721110 doi: 10.21037/acs.2017.11.03: 10.21037/acs.2017.11.03 PMID: 29270370 Differences in manifestations of Marfan syndrome, Ehlers-Danlos syndrome, and Loeys-Dietz syndrome Josephina A. N. Meester,1 Aline Verstraeten,1 Dorien Schepers,1 Maaike Alaerts,1 Lut Van Laer,1 and Bart L. Loeys 1,2 1Center of Medical Genetics, Faculty of Medicine and Health Sciences, University of Antwerp and Antwerp University Hospital, Antwerp, Belgium; 2Department of Genetics, Radboud University Medical Center, Nijmegen, The Netherlands Corresponding author. Correspondence to: Bart L. Loeys. Center for Medical Genetics, University of Antwerp, Antwerp University Hospital, Prins Boudewijnlaan 43/6, 2650 Antwerp, Belgium. Email: [email protected]. Received 2017 Jul 1; Accepted 2017 Oct 9. Copyright 2017 Annals of Cardiothoracic Surgery. All rights reserved. Abstract Many different heritable connective tissue disorders (HCTD) have been described over the past decades. These syndromes often affect the connective tissue of various organ systems, including heart, blood vessels, skin, joints, bone, eyes, and lungs. The discovery of these HCTD was followed by the identification of mutations in a wide range of genes encoding structural proteins, modifying enzymes, or components of the TGFβ-signaling pathway. Three typical examples of HCTD are Marfan syndrome (MFS), Ehlers-Danlos syndrome (EDS), and Loeys-Dietz syndrome (LDS). These syndromes show some degree of phenotypical overlap of cardiovascular, skeletal, and cutaneous features. MFS is typically characterized by cardiovascular, ocular, and skeletal manifestations and is caused by heterozygous mutations in FBN1, coding for the extracellular matrix (ECM) protein fibrillin-1.
    [Show full text]
  • Contact Lens Options and Fitting Strategies for the Management of the Irregular Cornea
    6/23/2017 CONTACT LENS OPTIONS AND FITTING STRATEGIES FOR THE MANAGEMENT OF THE IRREGULAR CORNEA DAVID I. GEFFEN, OD, FAAO David I Geffen, OD, FAAO Consultant/Advisor/Speaker Accufocus Shire Alcon Tear Lab AMO Tear Science Annidis Bausch + Lomb TLC Vision Bruder Healthcare EyeBrain Optovue Revision Optics 1 6/23/2017 Irregular Cornea Contact Lens Options Standard Soft Lenses Custom Keratoconic Soft Lenses Corneal Gas Permeable Lenses Intra-Limbal Gas Permeable Lenses Piggyback and Recess Systems Scleral Gas Permeable Lenses Hybrid Lenses Types of Irregular Corneas DEGENERATIONS DYSTROPHIES • Keratoconus • Cogan’s dystrophy • Bowman’s dystrophy • Keratoglobus • Granular corneal dystrophy • Pellucid marginal degeneration • Lattice corneal dystrophy • Terrien’s marginal degeneration • Meesmann’s corneal dystrophy • Salzmann’s nodular degeneration CORNEAL SCARRING • Ehlers-Danlos syndrome • After infection AFTER SURGERY • After trauma • Cornea transplant (PK, PKP) • Radial keratotomy (RK) • Photorefractive keratectomy (PRK) • Phototherapeutic keratectomy (PTK) • Epikeratophakia • LASIK 2 6/23/2017 CL Options: Soft Lenses Advantages: . Comfort . Centration (draping) . Corneal Protection Limitations: . Vision (due to draping effect) . Dehydration . Hypoxia /microbial contamination CL Options: Custom Soft KC Lenses Hydrokone (Visionary Optics) NovaKone (Alden) Kerasoft (dist. By B&L) Soft K (Acculens & Advanced Vision, & SLIC Labs) Continental Kone (Continental) Keratoconus lens (Gelflex) Soflex (Marietta)
    [Show full text]
  • Molecular Genetics of Corneal Dystrophy
    Molecular Genetics of Corneal Dystrophy A THESIS SUBMITTED FOR THE M.D. TO THE UNIVERSITY OF LONDON MOHAMED EL-ASHRY, MB CHB FRCS (Ed) CLINICAL RESEARCH FELLOW DEPARTMENT OF MOLECULAR GENETICS INSTITUTE OF OPHTHALMOLOGY UNIVERSITY COLLEGE LONDON BATH STREET LONDON AND MOORFIELDS EYE HOSPITAL CITY ROAD LONDON 2001 ProQuest Number: 10013866 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. uest. ProQuest 10013866 Published by ProQuest LLC(2016). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. Microform Edition © ProQuest LLC. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 Abstract Abstract Comeal dystrophies are inherited disorders characterised by progressive accumulation of deposits in the cornea causing visual impairment. They occur in either an autosomal dominant or recessive form and are usually manifested in the first few decades of life. The present classification is solely based on the layer or layers of the cornea involved. This study aimed at better understanding of the underlying molecular basis of such disorders via linkage to specific chromosomal loci and then mutation screening of the disease genes by means of amplification of the genomic DNA using polymerase chain reaction and then sequencing and restriction enzyme digest analysis.
    [Show full text]
  • Blue Sclera with and Without Corneal Fragility (Brittle Cornea Syndrome) in a Consanguineous Family Harboring ZNF469 Mutation (P
    in situ where disc and retinal assessments are essential Ophthalmic examination revealed visual acuity of no and for preoperative evaluation if therapeutic IOL ex- light perception OU. Both eyes were phthisical, had blue change to transparent media is considered. sclera, and were soft to palpation. Moreover, the observed ability of occlusive IOLs to General assessment revealed a well-nourished alert boy transmit infrared light suggests the potential for devel- with normal vital signs and chestnut-colored hair. Height, opment of infrared light–based assessment tools such as weight, and head circumference were age appropriate. Skin Snellen charts for this patient group. was thin, velvety, and without abnormal elasticity. Subcu- taneous veins were easily appreciated. There were scat- Chetan K. Patel, BSc, FRCOphth tered small scars on all extremities and a large one at the Imran H. Yusuf, MBChB (Hons), MRes right elbow where a small surgical incision had been made. Victor Menezo, FRCOphth There was no joint hypermobility (Beighton score 2/9) or Author Affiliations: Oxford Eye Hospital, John Rad- scoliosis. Oral inspection revealed grossly normal denti- cliffe Hospital, Oxford, England. tion and a slightly arched palate. Extremity assessment re- Correspondence: Dr Patel, Oxford Eye Hospital, Ox- vealed bilateral valgus foot (talipes valgus) and hallux val- ford Radcliffe Hospitals National Health Service Trust, gus, which were confirmed by plain-film radiography. West Wing, John Radcliffe Hospital, Headley Way, Head- Skeletal plain-film radiography showed normal bone den- ington, Oxford OX3 9DY, England (ckpatel@btinternet sities without evidence for fractures. Complete blood cell .com). count and electrolyte levels were within normal limits.
    [Show full text]
  • Editorial Page on Keratoconus
    Acta Scientific Ophthalmology Volume 1 Issue 3 November 2018 Editorial Editorial Page on Keratoconus Gowhar Ahmad* Department of Ophthalmology, University of Jammu and Kashmir, India *Corresponding Author: Gowhar Ahmad, Department of ophthalmology, University of Jammu and Kashmir, India. Received: October 23, 2018; Published: October 25, 2018 keratoconus is a degenerative disease characterised by non- 13. Mar fans - 14. Mitral valves prolapse syndrome fraction so patient presents with frequent changes in refraction inflammatory corneal ectasia their is progressive changes in re 15. Achondroplasia condition is usually bilateral more common at puberty with male 16. Topic dermatitis preponderance condition has base and apex of cone base is re- 17. Aniridia ferred to plauciod cornea and apex is referred to nipple cornea keratoconus is a visual disturbing disease and not a visual threat- 18. Cong cataracts ening disease complicated cases of this disease entity present as 19. ROP keratoglobus glaucoma and hydrops typical characterises of kera- Recent modalities in the treatment of keratoconus are toconus are 1. Crossed corneal linkage 1. Foods and ruptures in de smets membrane of cornea 2. Hybrid contact lenses 2. Munson’s sign that is distortion of lower lid margin 3. Customised contact lens caused by bulged corea when patient looks in downward 4. Scleral contact lens phase 5. Scleral contact lens 3. Fleisher’s ring which is brownish ring of hemosiderin at 6. Pegy contact lens base of cone 7. Intrastromal corneal ring 4. Enlarged or visible corneal nerves 8. lamellar keratoplasty. 5. Vogt strea which are present in post stroma of cornea dis- appear on pressing the cornea Associated conditions with keratoconus are as follows Volume 1 Issue 3 November 2018 1.
    [Show full text]
  • Asteroides to Trimethoprim-Sulphamethoxazole.' Cular Invasion Or Lipid Infiltration
    928 Letters protrusion occurs above the area of thinning, Br J Ophthalmol: first published as 10.1136/bjo.80.10.928 on 1 October 1996. Downloaded from whereas in keratoconus the maximal protru- sion occurs in the thinned area. Also, the iron lines typical ofkeratoconus are absent here. In keratoglobus thinming and protrusion occur over the entire cornea rather than in one area as in this case. The unilateral presentation in this case is unusual, for PMD is considered a bilateral condition."2 Although bilateral conditions often present asymmetrically in degree or time, the left eye in this case shows no signs of corneal involvement 30 years after the first eye Figure 1 (A) Photograph of right eye showing became symptomatic and past the age that cornealprotrusion. (B) Slit-lamp photograph of PMD typically is diagnosed. Cases of unilat- same eye showing band ofclear corneal thinning Figure 1 Slit-lamp photograph, showing the 1-2 mm above limbus. eral PMD associated with other corneal thin- central corneal infiltrate (arrow). Two satellites ning disorders such as keratoconus in the can be discerned. The corresponding visual acuity opposite eye have been reported,34 but this is was 201200. the first case of isolated unilateral PMD in an elderly patient. BRET B WAGENHORST Columbia, SC 29209, USA Accepted for publication 24 May 1996 1 Krachmer JH. Pellucid marginal corneal degen- eration. Arch Ophthalmol 1978;%: 1217-21. 2 Krachmer JH, Feder RS, Belin MW. Kerato- conus and related noninflammatory corneal IW W;W' 'M- thinning disorders. Surv Ophthalmol 1984;28: 293-322. Figure 2 Light microscopy ofcorneal scraping 3 Lisch K.
    [Show full text]
  • Keratoglobus After Long Standing Keratoconus - a Rare Case
    Jemds.com Case Report Keratoglobus after Long Standing Keratoconus - A Rare Case Pravin K. Tidke1, Neha Bajpayee2 1, 2 Department of Ophthalmology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to Be University), Sawangi (Meghe), Wardha, Maharashtra, India. INTRODUCTION Keratoglobus can be congenital or acquired. Congenital form always is associated Corresponding Author: with connective tissue disorder like Ehlers Danlos syndrome type 4 and blue sclera Dr. Neha Bajpayee, S-16 Shalintai PG Girls Hostel, syndrome. Acquired form occurs in later stages of life and can be associated with Datta Meghe Institute of Medical keratoconjunctivitis, pellucid marginal degeneration, and is a severe form of Sciences (Deemed to Be University), keratoconus. Keratoglobus is a minimally progressive disorder and when presents Sawangi (Meghe), Wardha, with keratoconus, corneal thickness is compromised, thus, proper evaluation of Maharashtra, India. cornea is needed. Since prevalence of keratoglobus in Central India is 2.3 %, and E-mail: [email protected] association of this with keratoconus makes this case more unusual to study and report. DOI: 10.14260/jemds/2021/87 Keratoglobus is non-inflammatory and ectatic disorder of cornea which causes How to Cite This Article: corneal thinning from limbus to limbus and leads to globular protrusion of cornea.1 Tidke PK, Bajpayee N. Keratoglobus after In past keratoglobus was misdiagnosed as megalocornea or congenital glaucoma.2 long standing keratoconus- a rare case. J The
    [Show full text]
  • Contact Lens Fitting: a Guide and Methodology of Contact Lens Fitting
    Contact Lens Fitting: A Guide and Methodology of Contact Lens Fitting ISBN: 978-1-946628-15-2 01 Contact Lens Fitting: A Guide and Methodology of Contact Lens Fitting Aliki Kantzou* Saera University, Spain *Corresponding author Aliki Kantzou, Saera University, The School of Advanced Education, Research and Accreditation, Universidad Isabel I, Spain, Email: [email protected] Published By : Juniper publishers Inc. United States Date: June 23, 2018 Index 1. Abstract 2. Introduction 2.1. Theme 1. Contact Lenses Correct Refractive Errors a) Slit Lamp Examination b) Topography c) Contact Lens Fitting 2.2. Theme 2. Soft Spherical and Soft Toric Lenses A. Types of Soft Contact Lenses 2.3. Theme 3. Contact Lenses for Presbyopia a) Types of Presbyopia Contact Lenses for Far and Near Vision 2.4. Theme 4. Extended Wear Contact Lenses 2.5. Theme 5. Rigid Gas Permeable Contact Lenses 2.6. Theme 6. Scleral Contact Lenses 2.7. Theme 7. Hybrid Contact Lenses i. Hybrid Contact Lenses using New Technology 2.8. Theme 8. Cosmetic and Prosthetic Contact Lenses 2.9. Theme 9. Therapeutic Contact Lenses 2.10. Theme 10. Colored Contact Lenses 2.11. Theme 11. Contact Lens Fitting in Aphakic Patients 2.12. Theme 12. Contact Lens Fitting in Orthokeratology 2.13. Theme 13. Contact Lens Fitting in Children 2.14. Theme 14. Contact Lens Fitting in Patients with Corneal Ectasia a. Pellucid Marginal Degeneration b. Keratoglobus c. Keratoconus 2.15. Contact Lenses after Keratoplasty 2.16. Contact Lens Fitting after Refractive Laser Procedures 2.17. PROSE Contact Lenses 2.18. Contact Lenses and Scuba Diving 2.19.
    [Show full text]