Current Issue : October - December Volume : 2012 Issue Number : 4 Articles : 5 Articles
Purpose. Keratolimbal allograft (KLAL) is a treatment for limbal stem cell deficiency. One disadvantage is systemic\nimmunosuppression to avoid rejection. Our purpose was to examine the adverse effects of systemic immunosuppression in\nKLAL. Methods. A retrospective case review of 16 patients with KLAL who received systemic immunosuppression consisting of\na corticosteroid, an antimetabolite, and/or a calcineurin inhibitor was performed. Patients were monitored for signs, symptoms,\nor laboratory evidence of toxicity. Results. Twelve of 16 patients (75%) experienced an adverse effect. The average age of those with\nadverse effects was 50.0 years (SD 17.8) and those without was 23.6 years (SD: 14.3), which was statistically significant (unpaired\nt-test P = 0.022). Ten of 11 patients (91%) had resolution during mean followup of 16.4 months. No serious adverse effects\noccurred. The most common included anemia, hyperglycemia, elevated creatinine, and elevated liver function tests. Prednisone\nand tacrolimus were responsible for the most adverse effects. More patients with comorbidities experienced adverse effects\n(83%) than those without comorbidities (25%). Conclusions. KLAL requires prolonged systemic immunosuppression. Our data\ndemonstrated that systemic immunosuppression did not result in serious adverse effects in our population and is relatively safe\nwith monitoring for toxicity. In addition, we demonstrated that adverse effects occurred more frequently in older patients and\nthose with comorbidities...
This paper documents a rare nonprogressive developmental disorderââ?¬â?bilateral circumscribed posterior keratoconusââ?¬â?in a 60-\r\nyear-old man referred for a cataract surgery. For the first time ultrasound biomicroscopy was used to visualise the local anterior\r\nbulging of the posterior corneal surface with concomitant thinning of the stroma. The amount of localized posterior depression,\r\ncorneal thickness and the refractive power of both the posterior and anterior corneal curvature were measured using slit-scanning\r\ntopography analysis (Orbscan)....
Diabetic macular edema is a main reason for visual loss in diabetic patients. Until recent years, macular laser photocoagulation\r\nwas the only available therapy. The awareness that inflammation is an important factor in the pathogenetic process of DME gave\r\nreason for intravitreal treatment with corticosteroids. The introduction of anti-VEGF drugs brought a revolutionary change in the\r\ntreatment of DME. This paper will review the important clinical trials with an emphasis on combination therapies....
Purpose. To evaluate the outcome of combined vitrectomy with phacoemulsification without postoperative face-down positioning\r\nfor idiopathic macular holes (MHs). Design. Retrospective, observational case series. Participants. Forty-two eyes of 42 patients\r\nwith MH.Methods.We studied 42 eyes of 42 cases followed up for 6 months postoperatively.MH closure rate and preoperative and\r\npostoperative visual acuity (VA) were evaluated. Main Outcome Measures. MH closure rate and VA were evaluated after combined\r\nvitrectomy with phacoemulsification without postoperative face-down positioning. Results. Of the 42 holes, 40 (95.2%) were initially\r\nclosed, and the final closure rate was 100%. Compared with preoperative VA, the mean VA was significantly improved at 1\r\nmonth and the improvement was maintained for at least 6 months postoperatively. Conclusions. Combined vitrectomy with phacoemulsification\r\nwithout postoperative face-down positioning produced favorable anatomic and functional results for MH repair.\r\nImprovement in VA can be expected for up to at least 6 months postoperatively...
Purpose. To report the 12-month follow-up after big-bubble deep anterior lamellar keratoplasty (DALK) assisted by femtosecond\r\nlaser that we have called IntraBubble. Methods. A 60 kHz IntraLase femtosecond laser (Abbott Medical Optics) firstly created\r\na 30? angled intrastromal channel to insert the air injection cannula, 50 �µ above the thinnest corneal site measured by Sirius\r\nScheimpflug camera (CSO, Firenze, Italy), then performed a full lamellar cut 100 �µ above the thinnest corneal point, and from the\r\nsame corneal depth, created a mushroom incision. The lamella was removed, and the smooth cannula of Fogla was inserted into\r\nthe stromal channel and air was injected to achieve a big bubble. The follow up is 12 months, and sutures were removed by the\r\n10th postoperative month in all patients. Best Corrected Visual Acuity (BCVA), spherical equivalent and, by Sirius Scheimpflug\r\ncamera (CSO, Firenze, Italy) keratometric astigmatism were evaluated. Results. All procedures were completed as DALK except\r\n2 converted to PK because an inadvertent intraoperative macroperforation occurred. Mean postoperative BCVA was 0.8, mean\r\nspherical equivalent was -3.5�±1.7D, and mean keratometric astigmatism was 4.8�±3.1D. Conclusion. The femtosecond laser could\r\nstandardize the big-bubble technique in DALK, reducing the risk of intraoperative complications and allowing good refractive\r\noutcomes....
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