5-year efficacy of all surface laser ablation with cross-linking(ASLA-XTRA)for the treatment of myopia

Background:The purpose of our study is to examine the long(5-year)efficacy of the all surface laser ablation(ASLA)combined with accelerated cross-linking(CXL)for the treatment of myopia without the use of mitomycin-C(MMC).Methods:This retrospective study consisted of 202 eyes of 118 myopic(SD:2.41,range:−1.50 to−12.75 D)patients(44 males,74 females).Mean age was 28.50 years(SD:6.45,range:18 to 51 years)that underwent ASLA with accelerated CXL for the treatment of their myopia.Results:The patients underwent routine postoperative assessment on the 1st,3rd,7th day and in the 1st,3rd,6th and 12th month,30th month(±6 months),4th and 5th year.The mean spherical equivalent(SEq)refractive error changed from−6.41±2.41 D preoperatively to−0.02±0.53 D at 5 years postoperatively.The haze score was 0.18,0.25 and 0.28 at 1,3 and 6 months postoperatively.At 12 months after the treatment,no eyes had significant corneal haze and in all the following postoperative time intervals the haze traces were gone.Conclusion:ASLA combined with accelerated CXL(ASLA-XTRA)appears to be safe,efficacious and offering very good refractive results.The potential additional benefits of this modality are the stabilizing effect of the refraction and its sterilization effect on the treated cornea without the potential side effects of MMC.

Treatment of anterior corneal scarring,following DSAEK graft failure,with combined graft exchange and phototherapeutic keratectomy

Background:To present a method,alternative to penetrating keratoplasty,for the restoration of impaired corneal clarity with anterior stromal scarring following long-standing corneal graft failure.Case presentation:A 48-year old female who had previously underwent Descemet stripping automated endothelial keratoplasty(DSAEK)for the treatment of pseudophakic bullous keratopathy,presented with longstanding corneal oedema and anterior corneal scarring.A significant improvement in corrected distance visual acuity was demonstrated,as corneal clarity was restored following graft exchange and phototherapeutic keratectomy(PTK).Conclusions:The combination of corneal graft exchange and phototherapeutic keratectomy may represent an effective therapeutic option for long-standing corneal oedema with concomitant anterior corneal scarring after failure of a DSAEK graft.

Surgical management of spontaneous,lateonset Descemet membrane detachment after penetrating keratoplasty for keratoconus:a case report

Background:To report a surgical method for treating corneal oedema in a case of late-onset Descemet membrane detachment after penetrating keratoplasty.Case presentation:A 55-year old patient presented with sudden visual loss in his left eye 28 years after penetrating keratoplasty for keratoconus.Slit-lamp biomicroscopy revealed a distortion of the corneal graft anatomy with protrusion of the graft and peripheral thinning and steepening in the residual host tissue,accompanied by corneal graft oedema.Anterior segment optical coherence tomography revealed detachment of Descemet membrane localized to the area of the graft oedema.We proceeded with a full-thickness,partially circumferential incision in the graft-host junction,followed by repositioning and re-suturing of the graft in place,and intracameral air injection in order to achieve reattachment of Descemet membrane.Conclusions:Corneal graft repositioning in combination with re-bubbling may represent an effective therapeutic option in keratoconic patients with peripheral thinning in the residual host corneal tissue and subsequent Descemet membrane detachment.