Cornea

You can leave the epithelium intact, say Dr Roberto Pinelli and Dr Tarek El Beltagi

Corneal crosslinking showed remarkable stability in a recent rabbit study, Dr Gregor Wollensak told delegates during the session on New Surgical Approaches to Keratoconus.

Patients with thicker corneas are less likely to progress to primary open angle glaucoma (POAG) from ocular hypertension (OHT), according to a study published in the June 2008 issue of Contact Lens and Anterior Eye.

A hydroxypropyl cellulose ophthalmic insert (Lacrisert, Aton Pharma) is a preservative-free product recommended for once-daily insertion in the inferior cul-de-sac. Its convenience, efficacy, and safety make it a valuable option for the management of dry eye disease.

In instances of repeated corneal transplantation, ulcers and persistent epithelial defects are relatively commonplace, according to a study published in the August 2008 issue of Graefe's Archive for Clinical and Experimental Ophthalmology.

The fourth-generation Crystalens HD (Bausch & Lomb) accommodating intraocular lens (IOL) has received FDA marketing approval, five years after the lens was initially launched on the market.

Corneas from donors up to the age of 75 are suitable for transplantation, according to a study published in the April 2008 issue of Ophthalmology.

Corneal grafts obtained from cancer patients may be associated with an increased risk of infection for the recipient, according to a study published in the February issue of Archives of Ophthalmology.

Sreening for early ectatic disease is essential in the evaluation of the refractive surgical candidate. There have, however, been many cases of severe post-LASIK ectasia without evidence of preoperative risk factors. Improving preoperative screening with better detection of subtle corneal topographic abnormalities may therefore help eliminate these rare but devastating cases.

New developments in diagnostic technology should enable better screening and follow-up of refractive surgery patients, said Dan Z. Reinstein, MD, delivering a keynote address during the refractive surgery subspecialty day preceding the annual meeting of the American Academy of Ophthalmology in November 2007.

The clinical assessment of an anterior chamber inflammatory reaction may be difficult to determine in eyes where corneal clarity is reduced by corneal oedema. Slit lamp examination is currently the gold standard method to assess inflammation1-3 but in conditions such as poor corneal clarity, the clinician routinely encounters difficulties.

A half-top-hat wound configuration is a valid option for penetrating keratoplasty (PK) as it offers better apposition of donor and recipient corneas, improved tectonic strength and the possibility of early suture removal.

Pigment-epithelium-derived factor (PEDF), which is known for its importance in the prevention of neovascularization of the retina, can be found in measurable amounts in the human tear fluid of healthy subjects. It may therefore be important in the regulation of corneal vascularization.

Using a decagonal transplant shape in perforating keratoplasties (pKPL) delivers promising results.

Levofloxacin ophthalmic solution 1.5% (Iquix) has been introduced for the treatment of corneal ulcers. It is the only newer-generation fluoroquinolone approved by the FDA for this indication.

Topography-guided LASIK, used with a comprehensive eye scanner (Pentacam, Oculus), has been very successful in minimizing severe corneal distortions and offers reliable registration in most cases.

...we have been able to develop some real staging-based guidelines for the therapeutic treatment of keratoconus and, in our opinion, corneal collagen cross-linking is mainly effective in the first and second stage of the disease

It has not yet been demonstrated whether riboflavin penetrates more or less with or without de-epithelialization

It was more than one hundred years ago when the world's first successful human corneal transplant was performed by Dr Eduard Zirm. Since then, corneal surgery has evolved dramatically through the refinement of techniques and instruments and the discovery and development of antibiotics and corticosteroids.

The simplest approach to caring for the corneal surface, which can be responsible for 50% of graft failures, is the application of non-preserved ointment for at least the first month after surgery.

It is fast becoming a more standard procedure for the surgical treatment of irregular astigmatism

Intracorneal rings (Intacs, Addition Technology) to correct keratoconus appear to yield better results when only one ring segment is implanted inferiorly rather than two segments implanted, one superiorly and one inferiorly, explains Joaquim N. Murta, MD, PhD.

The femtosecond laser has the potential to be the ultimate corneal incision device - the possibilities are nearly limitless

As always, there is a steep learning curve when dealing with new technologies but it is clear that outcomes with AlphaCor are continuing to improve

Keratoconus progression was halted in all 20 eyes treated at eight months postoperatively. In 75% of eyes we recorded a regression in pathology and an improvement in visual acuity was seen in 80% of eyes