International Journal of Keratoconus and Ectatic Corneal Diseases

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2015 | September-December | Volume 4 | Issue 3

RESEARCH ARTICLE

Jérôme C Vryghem

Editorial

[Year:2015] [Month:September-December] [Volume:4] [Number:3] [Pages:1] [Pages No:0 - 0]

PDF  |  DOI: 10.5005/ijkecd-4-3-iv  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Josh Duncan, José AP Gomes

A new Tomographic Method of Staging/Classifying Keratoconus: The ABCD Grading System

[Year:2015] [Month:September-December] [Volume:4] [Number:3] [Pages:9] [Pages No:85 - 93]

PDF  |  DOI: 10.5005/jp-journals-10025-1105  |  Open Access |  How to cite  | 

Abstract

Purpose

To incorporate advanced corneal imaging into a new keratoconus classification system that utilizes posterior curvature, thinnest pachymetry, and best-corrected distance vision (CDVA) in addition to standard anterior parameters.

Materials and methods

A total of 672 eyes of 336 normal patients were imaged with the Oculus Pentacam HR. Anterior and posterior radius of curvature measurements were taken using a 3.0 mm zone centered on the thinnest area and corneal thickness was measured at the thinnest point. Mean and standard deviations were recorded and anterior data were compared to the existing Amsler-Krumeich (AK) classification.

Results

A total of 672 eyes of 336 patients were analyzed. Anterior and posterior values were 7.65 ± 0.236 mm / 6.26 ± 0.214 mm respectively and thinnest pachymetry values were 534.2 ± 30.36 um. Comparing anterior curvature values to AK staging yielded 2.63, 5.47, 6.44 standard deviations for stages 1, 2, and 3 respectively. Posterior staging uses the same standard deviation gates. Comparative pachymetric values yielded 4.42, and 7.72 standard deviations for stages 2 and 3 respectively.

Conclusion

A new keratoconus staging system incorporates posterior curvature, thinnest pachymetric values, and distance visual acuity in addition to the standard anterior curvature and consists of stages 0 to 4 (5 stages), closely matches the existing AK classification stages 1 to 4 on anterior curvature. The new classification system by incorporating curvature and thickness measurements based on the thinnest point, as opposed to apical, better reflects the anatomic changes in keratoconus.

How to cite this article

Belin MW, Duncan J, Ambrósio R Jr, Gomes JAP. A New Tomographic Method of Staging/Classifying Keratoconus: The ABCD Grading System. Int J Kerat Ect Cor Dis 2015;4(3):85-93.

RESEARCH ARTICLE

Jamyl Habib Castillo, Beatrice Tiosano, Rana Hanna, Eran Berkwitz

Collagen Cross-linking for the Treatment of Keratoconus in Pediatric Patients

[Year:2015] [Month:September-December] [Volume:4] [Number:3] [Pages:6] [Pages No:94 - 99]

PDF  |  DOI: 10.5005/jp-journals-10025-1106  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Hanna R, Berkwitz E, Castillo JH, Tiosano B. Collagen Cross-linking for the Treatment of Keratoconus in Pediatric Patients. Int J Kerat Ect Cor Dis 2015;4(3):94-99.

RESEARCH ARTICLE

Cheryl MacGregor, Rakesh Jayaswal, Nick Maycock

Collagen Cross-linking for Pellucid Marginal Degeneration

[Year:2015] [Month:September-December] [Volume:4] [Number:3] [Pages:3] [Pages No:100 - 102]

PDF  |  DOI: 10.5005/jp-journals-10025-1107  |  Open Access |  How to cite  | 

Abstract

How to cite this article

MacGregor C, Jayaswal R, Maycock N. Collagen Cross-linking for Pellucid Marginal Degeneration. Int J Kerat Ect Cor Dis 2015;4(3):100-102.

RESEARCH ARTICLE

Jorge L Alio, Pablo Sanz-Díez

Phakic Intraocular Lenses in Keratoconus

[Year:2015] [Month:September-December] [Volume:4] [Number:3] [Pages:4] [Pages No:103 - 106]

PDF  |  DOI: 10.5005/jp-journals-10025-1108  |  Open Access |  How to cite  | 

Abstract

Purpose

To discuss and summarize the indications, contraindications and results in refractive surgery for keratoconus.

Summary

Keratoconus is an ectatic corneal disease characterized by a progressive corneal thinning and irregular astigmatism that negatively impact in the visual function and the optical quality of the patients. The refractive surgery in keratoconus has been discussed by several authors. The two primary lines of action are phakic lens implantation and corneal tissue ablation using photorefractive keratectomy. The use of phakic intraocular lenses (IOLs) to correct myopia and compound myopic astigmatism associated with keratoconus is gaining popularity.

Recent findings

The use of phakic IOLs to correct myopia and compound myopic astigmatism associated with keratoconus is gaining popularity. According to a recent study by our group the safety of this procedure in visual terms is high (post-CDVA/ pre-CDVA = 1.19 ± 0.29). It is also an effective operation (post-UDVA/pre-CDVA = 0.90 ± 0.26).

How to cite this article

Alio JL, Sanz-Díez P. Phakic Intraocular Lenses in Keratoconus. Int J Kerat Ect Cor Dis 2015;4(3):103-106.

RESEARCH ARTICLE

Marco Abbondanza, Gabriele Abbondanza

Surgical Correction of an Inverse Astigmatic Keratotomy following Penetrating Keratoplasty in a Patient with Keratoconus

[Year:2015] [Month:September-December] [Volume:4] [Number:3] [Pages:3] [Pages No:107 - 109]

PDF  |  DOI: 10.5005/jp-journals-10025-1109  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Abbondanza M, Abbondanza G. Surgical Correction of an Inverse Astigmatic Keratotomy following Penetrating Keratoplasty in a Patient with Keratoconus. Int J Kerat Ect Cor Dis 2015;4(3):107-109.

RESEARCH ARTICLE

David S Rootman, Yakov Goldich, Uri Elbaz

Anterior Uveitis after Collagen Cross-linking for Keratoconus

[Year:2015] [Month:September-December] [Volume:4] [Number:3] [Pages:5] [Pages No:110 - 114]

PDF  |  DOI: 10.5005/jp-journals-10025-1110  |  Open Access |  How to cite  | 

Abstract

How to cite this article

Goldich Y, Elbaz U, Rootman DS. Anterior Uveitis after Collagen Cross-linking for Keratoconus. Int J Kerat Ect Cor Dis 2015;4(3):110-114.

RESEARCH ARTICLE

Ritu Arora, Sonal Dangda

Diffuse Sterile Corneal Infiltration: An Unusual Complication Post Collagen Cross-linkage

[Year:2015] [Month:September-December] [Volume:4] [Number:3] [Pages:5] [Pages No:115 - 119]

PDF  |  DOI: 10.5005/jp-journals-10025-1111  |  Open Access |  How to cite  | 

Abstract

Purpose

Presenting the course of visually disabling corneal infiltration post uneventful collagen cross-linking (CXL) in a 23 years old male with bilateral keratoconus.

Methods

A 23 years old male with bilateral keratoconus underwent cross-linking of left eye with indigenous 0.1% riboflavin dye and 370 nm ultraviolet A irradiation. This patient had an uneventful successful cross-linking performed in right eye 6 months prior with good recovery of vision to LogMAR (6/9 Snellen).

Results

Patient developed diminution of vision, along with redness of eye, photophobia and watering on 3rd day after uneventful cross-linkage. Examination revealed very poor vision; diffuse corneal clouding with multiple superficial stromal infiltrates and incomplete corneal epithelization. A provisional diagnosis of infective keratitis was made, in situ bandage contact lens (BCL) removed and subjected to culture. Intensive fortified topical antibiotics were initiated and steroids withheld. After complete corneal re-epithelization on 6th day, the infiltrations did not decrease in either intensity or number. Response to antibiotics being inadequate, an immune etiology was suspected and full strength topical steroids reinstituted which resulted in slow resolution of infiltration over a 10 weeks period. Last follow-up at 9 months post-CXL, revealed a diffuse stromal haze with unaided visual acuity of LogMAR 0.8 6/36 and best-corrected visual acuity (BCVA) of 0.3 (6/12) with use of a rigid gas permeable lens.

Conclusion

Sterile infiltration post-CXL requiring intense topical steroids is a rare complication of CXL and needs to be differentiated from infective keratitis.

How to cite this article

Bhattacharyya M, Singh K, Mutreja A, Dangda S, Arora R. Diffuse Sterile Corneal Infiltration: An Unusual Complication Post Collagen Cross-linkage. Int J Kerat Ect Cor Dis 2015;4(3):115-119.

RESEARCH ARTICLE

Nancy Al Raqqad, Naser Al Fgara

Management of Acanthamoeba and Candida Keratitis in a Young Female: Our Experience at Princess Haya Military Hospital

[Year:2015] [Month:September-December] [Volume:4] [Number:3] [Pages:3] [Pages No:120 - 122]

PDF  |  DOI: 10.5005/jp-journals-10025-1112  |  Open Access |  How to cite  | 

Abstract

Aim

We aim to share our experience in the management of a 19 years old female patient, who presented to Princess Haya Military Hospital in Aqaba, Jordan, with a very aggressive keratitis.

Patients and methods

A 19 years old female patient with 1 year history of keratitis that did not resolve despite several treatment strategies tried elsewhere, presented to the eye clinic in Aqaba.

Ocular examination showed signs of Acanthamoeba keratitis with perineuritis.

Corneal cultures were not informative. Corneal biopsy showed a mixed Candida and Acanthamoeba growth.

Results

The patient was started on topical and oral anti-amoebic and antifungal treatment (antiamoebic drops brought from UK). Improvement was drastic after 2 weeks of treatment. The patient maintained a chronic low infective state and scarring of the cornea. She received therapeutic and visual karatoplasty 3 months later.

Patient is now 12 months after her PKP. The cornea is clear and vision is 6/12 unaided.

Conclusion

Cases of mixed fungal and amoebic keratitis are very rare. Prompt treatment and diagnosis is essential for recovery. Controversy still exists on the use of steroids after corneal transplantation for treatment of chronic fungal keratitis. Management should be tailored to each individual case.

How to cite this article

Al Raqqad N, Al Fgara N. Management of Acanthamoeba and Candida Keratitis in a Young Female: Our Experience at Princess Haya Military Hospital. Int J Kerat Ect Cor Dis 2015;4(3):120-122.

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