Purpose. To evaluate the visual, refractive, and topographic outcomes after simultaneous topography-guided transepithelial photorefractive keratectomy (transepithelial TG-PRK) using the Amaris Excimer laser platform and accelerated corneal cross-linking (CXL) in eyes with keratoconus.Materials and Methods. Patients with 2 years of follow-up were included in this retrospective case series. Manifest refraction (MR), uncorrected (UDVA) and corrected (CDVA) distance visual acuity, corneal topography, and pachymetry were evaluated at 1, 3, 6, 12, and 24 months after surgery. The root-mean-square of total higher-order aberrations (total HOA-RMS), coma (Coma-RMS), and spherical aberration (SA-RMS) were calculated for 4- and 6-mm diameters.Results. Forty-six eyes of 46 patients were included in the study. Stromal ablation was ≤50μin all patients. MR was −3.78±3.26 preoperatively and −1.39±1.82 postoperatively. Significant improvements were seen in the UDVA and Coma-RMS values at 1 month, CDVA and total HOA-RMS values at 3 months, and SA-RMS values at 1 year compared to preoperative levels. UDVA values further improved after 2 years, compared to the 1-year values. No patient lost two or more lines and keratoconus progression was not observed in any patient.Conclusion. Simultaneous transepithelial TG-PRK and accelerated CXL resulted in significant gains in CDVA without compromising CXL efficacy.

Ozkaya A, et al. Korean J Ophthalmol. 2017 Oct;31(5):424-430. https://doi.org/10.3341/kjo.2016.0125

Purpose: This study aimed to compare the outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) procedures in keratoconic eyes with a previous hydrops-related corneal scar. Methods: In this retrospective study, the medical records of patients who had hydrops-related corneal scarring and underwent keratoplasty surgery were reviewed. Patients treated with DALK were classified as group 1, and patients treated with PK as group 2. Preoperative and postoperative best-corrected visual acuity, central corneal thickness, keratometry (K), and refractive error values of each group were recorded and compared. Results: Seventy-eight eyes (41 in group 1 and 37 in group 2) were included in this study. The mean follow-up period of the patients was 37.7 ± 30.0 months in group 1 and 51.2 ± 29.4 months in group 2 (P = 0.06). The preoperative and postoperative best-corrected visual acuity and central corneal thickness values were statistically similar in both groups (each P value >0.05). Keratometry values (K1 and mean keratometry) were significantly steeper in group 1 (P ¹ = 0.02 and P ² = 0.03, respectively). Descemet membrane perforation was experienced in 7 (4 macroperforation and 3 microperforation; 15.6%) of 45 eyes that planned to perform DALK. These 4 eyes with macroperforation underwent PK and were excluded from the study. When all postoperative complications were assessed, although the total complication rate was 21% after DALK, it was 43% after PK (P = 0.04). Conclusions: DALK with a big-bubble technique is a feasible surgery in eyes with corneal scarring due to previous hydrops and is comparable with PK in terms of visual and refractive outcomes. This study suggests that DALK, which is safer than PK with less postoperative complication rates, should be the primary surgical option to avoid serious complications in keratoconic eyes with hydrops-related corneal scarring.

Purpose: To compare visual and refractive outcomes in aphakic patients who underwent scleral fixated intraocular lens (SF-IOL) implantation with Yamane and Z-suture techniques. Design: Retrospective study Methods: Patients who underwent SF-IOL implantation with Yamane and Z-suture techniques due to aphakia between 2021 and 2023 were analyzed. Preoperative and postoperative 6. month best corrected visual acuity (BCVA-LogMAR), preoperative and postoperative spherical error, cylindrical error and postoperative mean absolute error (MAE), corneal endothelial and topographic parameters, 3 mm-6 mm pupil diameter corneal higher-order aberrations (HOAs) were evaluated. Results: Seventy-seven eyes of 77 patients who underwent SF-IOL implantation with Yamane and Z-suture techniques were included in the study. Yamane technique was performed in 38 (49.4%) and Z-suture technique in 39 (50.6%) patients. Postoperative BCVA was 0.44 ± 0.40 in Yamane technique and 0.47 ± 0.44 in Z-suture technique ( p = 0.73). Postoperative MAE was 0.84 ± 0.70 D in Yamane technique, 1.02 ± 0.88D in Z-suture technique ( p = 0.33). Postoperative CCT-preoperative CCT (ΔCCT) was 3.76 ± 27.62 µm in Yamane technique and 3.02 ± 15.58 µm in Z-suture technique ( p = 0.88). A significant difference was found between Yamane and Z-suture techniques only in the ΔTrefoil value at 6-mm pupil diameter in corneal HOAs. ΔTrefoil was significantly lower in Yamane technique ( p = 0.04). Conclusion: Except ΔTrefoil value at 6-mm pupil diameter, although no significant difference was found, corneal endothelial and topographic parameters were less affected in Yamane technique compared to Z-suture technique.

Purpose: Posterior capsule rupture is defined as an intraoperative posterior capsule tear resulting in vitreous loss. This study aimed to analyze the clinical characteristics, preoperative risk factors, intraoperative management strategies, and postoperative complications associated with posterior capsule rupture during phacoemulsification surgery. Methods: This was a retrospective observational cohort study of the medical records for 25,224 phacoemulsification surgeries performed at our tertiary eye care center between 2017 and 2022. We collected and collated the demographic characteristics and clinical findings of the patients in our cohort. Intraoperative management strategies and postoperative outcomes over a 1-year followup period were also recorded. Results: Posterior capsule rupture occurred in 351 eyes (351 patients), giving an overall posterior capsule rupture rate of 1.3%. The mean patient age was 68.6 ± 10.8 years. Pseudoexfoliation syndrome, mature cataracts, brown cataracts, and surgery performed by a resident were identified as risk factors for posterior capsule rupture (p<0.05 for each; the risk ratios were 2.70, 2.15, 2.44, 1.34, respectively). The most common intraoperative complications were dislocated lens fragments in the vitreous (8%) and iris damage (7.1%). The mean best-corrected visual acuity improved from 1.31 ± 0.84 (logMAR) postoperatively to 0.51 ± 0.56 at the end of the 1-year follow-up period (p<0.001). Corneal edema (55.6%) and elevated intraocular pressure (33.3%) were the most common early postoperative complications. Persistently elevated intraocular pressure (11.1%) and cystoid macular edema (5.1%) were the most common late postoperative complications. Conclusion: Posterior capsule rupture is a common complication of phacoemulsification surgery that requires prolonged postoperative follow-up and a multidisciplinary approach. Despite the increased incidence of complications when rupture occurs, appropriate intraoperative and postoperative management can lead to satisfactory visual outcomes.