Anterior Segment Reconstruction Research Articles

Editorial introductions.

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Jimmy K. LeeJimmy K. LeeDr Jimmy Lee specializes in laser vision correction surgery. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, all forms of corneal transplantation, and limbal stem cell transplantation. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianShahzad I. Mian, M.D., is a professor of ophthalmology and visual sciences in the University of Michigan Medical School. He also serves the Department as Vice Chair for Clinical Sciences and Learning. Dr. Mian earned his medical degree in 1996 from the Emory University School of Medicine. He then completed a residency at the Wills Eye Hospital of Thomas Jefferson University in Philadelphia. From 2000-02, he was a fellow in cornea and refractive surgery at Harvard Medical School, Massachusetts Eye and Ear Infirmary. He joined the U-M faculty in 2002 and was promoted to associate professor with tenure in 2010. He became professor of ophthalmology and visual sciences in 2016. His research focuses on eye banking, keratoplasty techniques, and ocular graft versus host disease. He served as director of the residency training program between 2004 and 2019 and previously served as fellowship director in the department. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. Dr. Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Center, and the Senior Achievement Award from the American Academy of Ophthalmology. He received the Straatsma Award for resident education from the Association of University Professors in Ophthalmology in 2017 and the Payton Award for Eye banking from the Eye Bank Association of America in 2019. He serves as the Senior Medical Director for Eversight Eye banks as well as on the Board of Directors. He also serves on the Board of Directors for the Cornea Society and the Eye Bank Association of America. He also serves on the Residency Review Committee for Ophthalmology.

Double-flanged knotless technique for iris prosthesis and IOL implantation associated with keratoplasty.

Anterior segment reconstruction and penetrating keratoplasty combined with iris prosthesis (IP) and intraocular lens (IOL) scleral fixation require prolonged open-sky surgery and complex suturing. Herein we present a novel double-flanged knotless surgical technique that minimizes the open sky duration and facilitates the fixation of the IP and IOL complex to the sclera. After corneal trephination and removal, a temporary keratoprosthesis is fixated. Three 5.0 polypropylene suture segments are introduced in the anterior chamber transconjunctivally and then externalized through keratoprosthesis. Each suture is threaded through the eyelets of the IP and then flanged. The temporary keratoprosthesis is removed, and the IP and IOL complex is positioned in the sulcus. A donor cornea button is sutured in place and the IP is centred on the optical axis by adjusting the polypropylene sutures. Finally, the suture ends are shortened, flanged, and buried under the conjunctiva. Surgery was performed on three eyes of three patients. No intraoperative complications occurred, while cystoid macular edema and ocular hypertension occurred in two patients during the follow-up period. The best corrected visual acuity was 6/20, 8/20, and 13/20. So far the IPs remained stable in the three eyes with a maximum follow-up of 18 months. This novel technique of penetrating keratoplasty combined with an intraocular lens (IOL) and iris prosthesis implantation makes it possible to reduce open sky surgery time, avoid complex suturing, and ensure optimal IOL visual axis alignment by adjusting suture tension.

Use of ultrasound biomicroscopy to predict the outcome of anterior segment reconstruction in congenital fibrovascular pupillary membrane with secondary glaucoma

AimsTo evaluate the efficacy and safety of anterior segment reconstruction (ASR) in congenital fibrovascular pupillary membrane-induced secondary glaucoma (CFPMSG) basing ultrasound biomicroscopy (UBM) classification.MethodsThis ambispective cohort study enrolled patients with...

Anterior segment reconstruction with artificial iris and Descemet membrane endothelial keratoplasty: a staged surgical approach

PurposeTo describe a surgical approach that involves anterior segment reconstruction with CustomFlex Artificial Iris (CAI; HumanOptics, Erlangen, Germany) followed by Descemet membrane endothelial keratoplasty (DMEK) in complex eyes with corneal...

Complete anterior segment reconstruction: Corneal transplantation and implantation of an iris prosthesis and IOL in a single surgery.

Purpose:Patients who have suffered an ocular trauma may present with varying degrees of injury to the anterior segment. In this retrospective interventional case series, we report the outcome of seven patients who underwent complete anterior segment reconstruction in a single surgery.Methods:All patients with posttraumatic corneal decompensation or scar, aphakia, and iris defect underwent human donor corneal graft transplantation and implantation of an intraocular lens combined with a flexible silicone iris prosthesis. Postoperative examinations included assessment of best corrected distance visual acuity, objective refraction, and intraocular pressure. Sensitivity to glare and subjective discontent with the eye’s appearance was rated on a scale from 1 to 10, with 1 standing for low and 10 for high severity.Results:Mean best corrected distance visual acuity (BCDVA) was 1.51 ± 0.26 logMAR preoperatively and 1.29 ± 0.36 logMAR postoperatively. Mean IOP was 15.71 ± 8.94 mmHg pre-surgery and 13.57 ± 6.52 mmHg post-surgery. The mean sensitivity to glare was reduced from 7.17 ± 2.91 to 3.80 ± 3.43 and subjective cosmetic disfigurement was reduced from 5.33 ± 3.35 to 1.80 ± 1.60.Conclusions:A single surgery technique for entire anterior segment reconstruction in trauma patients can effectively reduce glare and patient discontent with the eye’s appearance.

Thirty-three-gauge hypodermic needle-guided iris suturing technique.

The purpose of this study was to describe a new 33-gauge hypodermic needle-guided iris suturing technique for repair of iris defects and its adaptation for use to address a wide range of iris pathology in complex anterior segment reconstruction cases. This approach uses a 33-gauge hypodermic needle loaded with a 10-0 Prolene suture within its lumen, which is then used to directly introduce and manipulate the suture within the anterior chamber. Eliminating the need for a needle holder, this technique provides surgeons improved ergonomics and minimizes risk for trauma to adjacent tissues. Improving on and addressing limitations of the original sewing machine technique described by Safran in 1995, iris repair using this technique has been applied successfully in 15 patients to achieve satisfactory visual and cosmetic outcomes without complications. Multiple iris suturing strategies can be combined on a given case to attain complex repair with this new approach.

Outcomes of corneal transplantation using donor corneas retrieved from patients with chronic kidney disease

Purpose:To report the outcomes of corneal transplantation utilizing corneas retrieved from donors with chronic kidney disease (CKD).Methods:Outcomes of corneal transplantation (optical PK and EK) performed from Jan 2018 to Dec 2018 utilizing donor corneas retrieved from CKD patients was performed retrospectively.Results:Of the total of 233 donor corneas retrieved from CKD, 135 (57.9%) were utilized for transplantation after the routine screening protocol of the eye bank. Mean age of the donors was 56.2 ± 13.5 years. The mean endothelial cell density on specular microscopy of the donor corneas used for optical PK was 2685.7 ± 377.6 cells/mm2 (range, 2028–3448 cells/mm2) and for EK was 2731.7 ± 189.1 cells/mm2 (range, 2380–3194 cells/mm2). The overall primary graft failure rate was 5.1%. All grafts except 1, cleared in the PK group. In the EK group (6 DMEK and 16 DSAEK), 1 patient had a complete graft detachment and another 1 had a primary graft failure after DMEK.Conclusion:The donor corneas retrieved from chronic kidney disease patients are safe and suitable for optical keratoplasty provided they meet the criteria for transplantation.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Jimmy K. LeeJimmy K. LeeDr Jimmy K. Lee specializes in laser vision correction surgery. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, all forms of corneal transplantation, and limbal stem cell transplantation. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Mian is a Professor in ophthalmology and visual sciences at University of Michigan/Kellogg Eye Center and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. His practice is focused in cornea and refractive surgery and research interests include corneal transplantation techniques, ocular graft versus host disease, and eye banking. He is the Vice Chair for Clinical Sciences and Learning and has been director of the residency training program since 2004. In 2003 and 2012, he received the Bergstrom Faculty Teaching Award presented by ophthalmology residents. He received the Straatsma award for resident education in 2017. He serves on the Residency Review Committee for Ophthalmology, Accreditation Board for the Eye Bank Association of America, as the senior medical director of Eversight Michigan Eye bank, and is the past-president of the Program Director's Council of the Association of University Professor in Ophthalmology.

Graft Survival after Penetrating Keratoplasty in Cases of Trabeculectomy versus Ahmed Valve Implant.

Purpose To compare the corneal graft survival rates after penetrating keratoplasty (PKP) in cases of post-PKP glaucoma managed by either trabeculectomy with mitomycin C or Ahmed glaucoma valve (AGV). Methods This study was a retrospective interventional comparative study that included 40 eyes of 40 patients. The included patients had undergone previous PKP for anterior segment reconstruction after microbial or fungal keratitis, chemical burns, trauma, or perforated corneal ulcer. Post-PKP glaucoma was managed surgically by either trabeculectomy with mitomycin C (group 1) or Ahmed glaucoma valve (group 2). Results The first group (n=20) had undergone trabeculectomy with MMC, and the second group (n=20) had undergone AGV implantation. Regarding BCVA, there was no statistically significant difference between the 2 groups. Mean IOP was significantly lower in the AGV group at 6 months, 12 months, and 24 months (p=0.001). Mean IOP at 24 months dropped significantly from preglaucoma surgery levels in both groups (p=0.001). Rejection episodes occurred in 2 eyes (10%) of the trabeculectomy group versus 8 eyes (40%) in the AGV group (p=0.028). In the trabeculectomy group, corneal graft failure occurred in 1 (5%), 3 (15%), and 6 (30%) eyes at 6 months, 12 months, and 24 months, respectively. In the AGV group, corneal graft failure occurred in 2 (10%), 5 (25%), and 10 (50%) eyes at 6 months, 12 months, and 24 months, respectively. The mean time to failure in the trabeculectomy group was 12.33 ± 5.60 months versus 11.90 ± 5.70 months in the AGV group (p=0.027). Conclusion Managing postpenetrating keratoplasty glaucoma could be bothersome especially in complex cases. Ahmed glaucoma valve implant controls the intraocular pressure more effectively than trabeculectomy with mitomycin C. However, Ahmed glaucoma valve can result in higher rates of corneal graft failure in a shorter duration of time. This trial is registered with PACTR201712002861391 on 21 Dec 2017.

Visual acuity recovery due to anterior segment reconstruction after severe bilateral open globe injury – case report

Visual acuity recovery due to anterior segment reconstruction after severe bilateral open globe injury – case report

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Jimmy K. LeeJimmy K. LeeJimmy K. Lee, MD, is the Director of Refractive Surgery at Montefiore Medical Center in Bronx, NY, USA. He specializes in laser vision correction surgery, including LASIK, LASEK, PRK and PTK. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, and artificial cornea. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. He is the former Director of the cornea, refractive surgery, and external diseases service at the Yale Eye Center, USA. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Shahzad I. Mian is an Associate Professor of Ophthalmology and Visual Sciences at the University of Michigan Medical School, USA, and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. He has been Director of the residency training program since 2004, and serves as the Associate Chair for Education. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. His research focuses on the role of lasers in corneal transplantation, keratoplasty techniques and clinical studies in refractive surgery. Dr Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Institute and the 2009 Achievement Award from the American Academy of Ophthalmology. He serves as the Medical Director of the Michigan Eye bank, is on the board of directors for the Cornea Society and the Program Director's Council of the AUPO. Since 2011, Dr Mian has represented The Cornea Society as its Councilor for the American Academy of Ophthalmology. He has 50 publications in peer reviewed journals and over 20 book chapters.

Conservative Surgical Management of a Grade III Corneal Dermoid

To present a rare, unique, grade III corneal dermoid treated with conservative surgical management. An 8-month-old boy was admitted to our clinic with a lesion on the central cornea of the right eye and a corneal mass in the left eye. The mass had a skin-like surface and protruded to the outside of the palpebral fissure. MRI (magnetic resonance imaging) of the orbits showed a large cyst covering most of the cornea and the absence of the anterior chamber and lens. The dermoid was excised and sent for histopathological examination. The cornea was reconstructed using the partial thickness scleral graft. The histopathology report confirmed the diagnosis of a grade III corneal dermoid. On examination 1 year after the surgery, the orbital and globe volumes were the same, and the intraocular pressure was normal. This is likely the first report of an unusual case in which a grade III corneal dermoid with an anterior staphyloma was treated by anterior segment reconstruction using an autologous partial thickness scleral graft. We believe that this technique has the advantage that it stimulates orbital and facial development and has good cosmetic results.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Roy S. ChuckRoy S. ChuckRoy S. Chuck M.D., Ph.D. serves as Chairman and University Professor and holds the Paul Henkind Chair at the Albert Einstein College of Medicine, USA, and Montefiore Medical Center in New York City, USA. He previously held the Tom Clancy Professorship in Ophthalmology and was the Director of Refractive Surgery at the Wilmer Eye Institute of Johns Hopkins University, USA. A cornea and refractive surgery specialist, Dr Chuck has expertise in both the fields of complex corneal transplantation including ocular surface reconstruction, and laser techniques for refractive eye problems and has published, patented and lectured extensively throughout his career. Dr Chuck, a University of California, Berkeley, USA, trained engineer, graduated from the Columbia University College of Physicians and Surgeons, USA, where he received his M.D., Ph.D. degree. He then proceeded on to residency in the Department of Ophthalmology and Visual Sciences at the Washington University School of Medicine, USA, where he also served as faculty Chief Resident. He completed his fellowship training in cornea and refractive surgery at the Doheny Eye Institute of the University of Southern California, USA. Prior to joining Einstein, Dr Chuck served on the faculties of Ophthalmology and Engineering at Washington University, University of Southern California, University of California, Irvine and Johns Hopkins University. Jimmy K. LeeJimmy K. LeeJimmy K. Lee, M.D. is the Director of Refractive Surgery at Montefiore Medical Center in Bronx, NY, USA. He specializes in laser vision correction surgery, including LASIK, LASEK, PRK and PTK. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, and artificial cornea. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. He is the former Director of the Cornea, Refractive Surgery, and External Diseases service at the Yale Eye Center, USA. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, USA, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Shahzad I. Mian is an Associate Professor of Ophthalmology and Visual Sciences at the University of Michigan Medical School, USA, and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. He has been Director of the Residency training program since 2004, and serves as the Associate Chair for Education. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. His research focuses on the role of lasers in corneal transplantation, keratoplasty techniques and clinical studies in refractive surgery. Dr Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Institute, USA, and the 2009 Achievement Award from the American Academy of Ophthalmology. He serves as the medical director of the Michigan Eye bank, is on the board of directors for the Cornea Society and the Program Director's Council of the Association of University Professors of Ophthalmology (AUPO). Since 2011, Dr Mian has represented The Cornea Society as its Councilor for the American Academy of Ophthalmology. He has 50 publications in peer reviewed journals and over 20 book chapters.

Application of 23G minimally invasive vitreous cutting system in the first stage of anterior segment reconstruction on severe ocular injury

Application of 23G minimally invasive vitreous cutting system in the first stage of anterior segment reconstruction on severe ocular injury

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Roy S. ChuckRoy S. ChuckRoy S. Chuck M.D., Ph.D. serves as Chairman and University Professor and holds the Paul Henkind Chair at the Albert Einstein College of Medicine, USA, and Montefiore Medical Center in New York City, USA. He previously held the Tom Clancy Professorship in Ophthalmology and was the Director of Refractive Surgery at the Wilmer Eye Institute of Johns Hopkins University, USA. A cornea and refractive surgery specialist, Dr Chuck has expertise in both the fields of complex corneal transplantation including ocular surface reconstruction, and laser techniques for refractive eye problems and has published, patented and lectured extensively throughout his career. Dr Chuck, a University of California, Berkeley, USA, trained engineer, graduated from the Columbia University College of Physicians and Surgeons, USA, where he received his M.D., Ph.D. degree. He then proceeded on to residency in the Department of Ophthalmology and Visual Sciences at the Washington University School of Medicine, USA, where he also served as faculty Chief Resident. He completed his fellowship training in cornea and refractive surgery at the Doheny Eye Institute of the University of Southern California, USA. Prior to joining Einstein, Dr Chuck served on the faculties of Ophthalmology and Engineering at Washington University, University of Southern California, University of California, Irvine and Johns Hopkins University. Jimmy K. LeeJimmy K. LeeJimmy K. Lee, M.D. is the Director of Refractive Surgery at Montefiore Medical Center in Bronx, NY, USA. He specializes in laser vision correction surgery, including LASIK, LASEK, PRK and PTK. His surgical expertise also includes complex cataract surgery, anterior segment reconstruction, and artificial cornea. Dr Lee's research interests are new technologies in refractive surgery and improving surgical techniques for endothelial keratoplasty (DSAEK and DMEK). A member of the American Academy of Ophthalmology and American Society of Cataract and Refractive Surgery, he has extensively lectured nationally and internationally on these topics. He is the former Director of the Cornea, Refractive Surgery, and External Diseases service at the Yale Eye Center, USA. A Phi Beta Kappa graduate from Johns Hopkins University, USA, Dr Lee obtained his medical degree from Cornell University Medical College, USA. Following his residency at Albert Einstein Montefiore Hospital, USA, he completed a fellowship in cornea, external diseases, and refractive surgery at the Wilmer Eye Institute of The Johns Hopkins Hospital and is a Diplomate of the American Board of Ophthalmology. Shahzad I. MianShahzad I. MianDr Shahzad I. Mian is an Associate Professor of Ophthalmology and Visual Sciences at the University of Michigan Medical School, USA, and holds the Terry J. Bergstrom Collegiate Professorship for Resident Education. He has been Director of the Residency training program since 2004, and serves as the Associate Chair for Education. In 2003 and 2012, he received the Bergstrom Teaching Award presented by ophthalmology residents. His research focuses on the role of lasers in corneal transplantation, keratoplasty techniques and clinical studies in refractive surgery. Dr Mian received the 2007 Anthony Adamis Award for Outstanding Research from the U-M Kellogg Eye Institute, USA, and the 2009 Achievement Award from the American Academy of Ophthalmology. He serves as the medical director of the Michigan Eye bank, is on the board of directors for the Cornea Society and the Program Director's Council of the Association of University Professors of Ophthalmology Program Directors Council (AUPO). Since 2011, Dr Mian has represented The Cornea Society as its Councilor for the American Academy of Ophthalmology. He has 50 publications in peer reviewed journals and over 20 book chapters.

Combined endoscopic vitrectomy with pars plana tube shunt procedure

PurposeWe report a case series of patients with limited fundus view due to advanced and complex anterior segment disease that underwent combined endoscopic vitrectomy and pars plana tube shunt for...

Artificial iris devices: Benefits, limitations, and management of complications

To discuss limitations and benefits of a custom-made foldable artificial iris (Artificialiris) in the management of acquired iris defects. Hochkreuzklinik Eye Hospital, Bonn, and the Department of Ophthalmology, University of Cologne, Germany. Case series. We reviewed the clinical course and surgical management in eyes with sight-compromising complications after phakic anterior chamber implantation of synthetic iris devices between November 2011 and January 2012. Three eyes of 2 patients were reviewed. One patient developed cataract and corneal decompensation after anterior chamber artificial iris implantation in the left eye to treat post-uveitic mydriasis. Further treatment included artificial iris removal, cataract surgery, iridoplasty, and Descemet membrane endothelial keratoplasty (DMEK). By the 6-month follow-up, visual acuity had increased from 20/50 to 20/25. The second patient presented with bilateral secondary glaucoma, cataract, corneal edema, and iris atrophy after implantation of Newiris devices for cosmetic reasons. He consecutively had binocular explantation of the cosmetic devices, cataract surgery, artificial iris implantation, and DMEK in both eyes and Ahmed valve implantation in the right eye. During the 6-month follow-up, the intraocular pressure remained sufficiently adjusted in both eyes. Photophobia was eliminated, and visual acuity improved to 20/32 in the right eye and 20/20 in the left eye. In patients with major iris defects ineligible for pupilloplasties, the artificial iris allows functionally and esthetically satisfactory anterior segment reconstruction. To prevent secondary complications, the artificial iris should only be implanted in aphakic or pseudophakic eyes and placed in the posterior chamber.

Immediate Loading of Dental Implants in the Esthetic Region Using Computer-Guided Implant Treatment Software and Stereolithographic Models for a Patient with Eating Disorders

This manuscript describes the reconstruction of a maxillary anterior segment using immediate implant placement and immediate implant loading techniques, aided by computer-guided implant treatment software and stereolithographic models and surgical templates, in a patient with a history of eating disorder. Her medical and dental histories did not make her a candidate for the use of conventional 2-stage implant surgery and restorative procedures along with an interim removable prosthesis.

Diagnostics and Treatment of Polymicrobial Keratitis and Endophthalmitis?Case Report

Purpose: To describe a case of polymicrobial keratitis and endophthalmitis successfully treated with topical and systemic antibacterial and antifungal agents, collagen cross-linking (CXL) and penetrating keratoplasty. Methods: Case report Results: A 59-year-old woman presented with a corneal ulcer. Multiple samplings of the corneal lesion were used for microbiological investigations by standard protocol that repeatedly revealed coagulase-negative Staphylococcus sp. (CoNS); mycotic tests were negative. She was treated with topical and systemic antibiotics and an emergency therapeutic keratoplasty was performed. Four months later, she was readmitted for ulcerative keratitis and endophthalmitis. Laboratory work up on corneal corneal scraping and aqueous humor cultures showed a Fusarium species, CoNS and Bacillus species. She was treated with topical and systemic voriconazole, antibacterials, and the corneal cross-linking (CXL) procedure. Complete resolution of the infection was observed but a large vascular leucoma developed. A penetrating keratoplasty and anterior segment reconstruction surgery with very good results were performed seven months later. Conclusions: Voriconazole, antibacterial antibiotics and CXL were effective in the management of a severe polymicrobial corneal ulcer progressing to endophthalmitis with no side-effects observed.

Contribution of 3D anterior segment reconstruction by rotative UBM to the sizing of phakic IOL

AbstractPurpose Posterior phakic implantation is the recommended procedure for high ametropia correction but it is harmed by a difficult sizing inducing errors. We designed a 3D rotative UBM prototype in order to take into account the volume of the posterior chamber to improve the sizing.Methods 7 myopic eyes (mean MRSE: ‐10.8) of 4 patients underwent a phakic implantation by one surgeon with a “white to white”‐based sizing method. During the 3rd postoperative month, we evaluated several mesures that we assessed by anterior segment OCT (2D) and by our UBM prototype (3D), designed by the LaTIM ‐Inserm U1101 in association with Quantel Medical®. It contains a linear scanning probe of 50 MHz with a rotative motor (acquisition of 30 coaxial slides).Results 3D reconstruction gives us a representation of one eye on 360°. For each eye, we have compared data pre and postoperative implantation and our results reflect the conventional impact of implant.Conclusion Our rotative probe has allowed the first 3D reconstruction of the ocular anterior segment. This initial approach reports high anatomical variations and non uniformity of intraocular clearances, explaining potentially some unexpected IOL positioning. Our goal is to have an accurate visualization of relationship between phakic IOLs and intraocular surrounding structures. Perspectives could be the evaluation of the impact of accommodation on intraocular volumes in addition to preoperative simulations in 3 dimensions. Commercial interest