Apical Scarring Research Articles

Incidental Apical Pleuroparenchymal Scarring on Computed Tomography: Diagnostic Yield, Progression, Morphologic Features and Clinical Significance.

Apical pleuroparenchymal scarring (APPS) is commonly seen on chest computed tomography (CT), though the imaging and clinical features, to the best of our knowledge, have never been studied. The purpose was to understand APPS's typical morphologic appearance and associated clinical features. A random generator selected 1000 adult patients from all 21516 chest CTs performed at urban outpatient centers from January 1, 2016 to December 31, 2016. Patients with obscuring apical diseases were excluded to eliminate confounding factors. After exclusions, 780 patients (median age: 64y; interquartile range: 56 to 72y; 55% males) were included for analysis. Two radiologists evaluated the lung apices of each CT for the extent of abnormality in the axial plane (mild: <5mm, moderate: 5 to 10mm, severe: >10mm), craniocaudal plane (extension halfway to the aortic arch, more than halfway, vs below the arch), the predominant pattern (nodular vs reticular and symmetry), and progression. Cohen kappa coefficient was used to assess radiologists' agreement in scoring. Ordinal logistic regression was used to determine associations of clinical and imaging variables with APPS. APPS was present on 65% (507/780) of chest CTs (54% mild axial; 80% mild craniocaudal). The predominant pattern was nodular and symmetric. Greater age, female sex, lower body mass index, greater height, and white race were associated with more extensive APPS. APPS was not found to be associated with lung cancer in this cohort. Classifying APPS by the extent of disease in the axial or craniocaudal planes, in addition to the predominant pattern, enabled statistically significant associations to be determined, which may aid in understanding the pathophysiology of apical scarring and potential associated risks.

Bilateral keratoconus hydrops in a patient with Down Syndrome: a case report

Background: Keratoconus has been reported in as many as 8% to 36% of people with Down syndrome. Corneal hydrops, a complication of advanced keratoconus, is characterized by the sudden onset of severe stromal and epithelial edema resulting from descemet membrane rupture. According to previous studies, acute corneal hydrops occurs in between 0.2% and 2.8% of keratoconus patients, while the incidence of corneal hydrops in Down syndrome patients with keratoconus is unclear. This study aims to evaluate the bilateral keratoconus hydrops in a patient with Down Syndrome. Case Presentation: We reported a case of bilateral corneal hydrops in a Down syndrome patient aged 28. Upon arrival, his bilateral visual acuity was fixed to follow the object. Slit-lamp examination revealed bilateral corneal edema and apical corneal scarring, and grade 4 plus keratoconus were seen on the Scheimpflug camera system. The patient receives medical treatment to lessen the patient's symptoms while they wait for a cornea donor to do a transplant. Conclusion: Patients with Down syndrome could experience bilateral corneal hydrops. Strong symptom communication, quick referral, and good cooperation during eye examinations are needed for early detection of this eye condition.

Abstract 15675: Mid-Ventricular Hypertrophic Cardiomyopathy Presenting With Minoca

Background: Mid-ventricular hypertrophic obstructive cardiomyopathy (HOCM) is an uncommon form of cardiomyopathy that is linked to an apical aneurysm, increasing the risk of sudden death. Cases: We described four patients who presented with chest pain or SOB. Troponin elevation, acute myocardial infarction on cardiac MRI and absence of obstructive coronary disease confirmed the diagnosis of MINOCA. Echo revealed a pressure gradient between the apical and basal chambers of the left ventricle. Cardiac MRI showed mid-ventricular HOCM and mid-cavity obliteration with akinetic apical chamber LGE revealed areas of sub-endocardial or transmural myocardial infarction at the level of obstruction and at the apical segments distal to the obstruction. The presence of myocardial edema on tissue mapping in the same area suggested acute myocardial injury (Figure). Discussion: The pathogenesis of development of apical myocardial scarring and aneurysm formation in mid-ventricular HOCM remains unknown. Other variant of hypertrophic cardiomyopathy shows mid-myocardial foci of scar inside the hypertrophied segments, indicating fibrosis. Whereas in our patients, the LGE revealed a sub-endocardial or transmural infarct (myocardial infarction pattern) - an uncommon pattern in other hypertrophic cardiomyopathy variants. This pattern and elevation of troponin during the acute phase of illness supports the hypothesis that apical aneurysm is due to apical myocardial ischemia in mid-ventricular HOCM. Tissue characterization and pattern of scar by cardiac MRI in these patients could be useful in understanding the pathophysiology of this type of HOCM.

An association between bilateral keratoconus in a patient with spondyloocular syndrome and xylosyltransferase II gene mutation

Spondyloocular syndrome (SOS) is a rare autosomal-recessive disorder. Since 2015, SOS has been linked to mutations in xylosyltransferase II (XYLT2) locus. Phenotypic features could affect multiple systems, such as sight, hearing, or bones. Herein, we report a case of SOS with multiple bone fractures without trauma, bilateral cataracts, and sensorineural hearing loss. Mutations in XYLT2 gene were detected, and the diagnosis of SOS was made. At the age of 8, the patient presented with progressive vision loss. Slit-lamp examination revealed inferior steepening, apical scarring, and thinning of the cornea. Due to keratoconus suspicion, a corneal tomography was done, confirming the diagnosis of keratoconus. We present the first case of bilateral keratoconus in a patient with SOS.

Solitary pulmonary nodule malignancy predictive models applicable to routine clinical practice: a systematic review

BackgroundSolitary pulmonary nodule (SPN) is a common finding in routine clinical practice when performing chest imaging tests. The vast majority of these nodules are benign, and only a small proportion are malignant. The application of predictive models of nodule malignancy in routine clinical practice would help to achieve better diagnostic management of SPN. The present systematic review was carried out with the purpose of critically assessing studies aimed at developing predictive models of solitary pulmonary nodule (SPN) malignancy from SPN incidentally detected in routine clinical practice.MethodsWe performed a search of available scientific literature until October 2020 in Pubmed, SCOPUS and Cochrane Central databases. The inclusion criteria were observational studies carried out in low-risk population from 35 years old onwards aimed at constructing predictive models of malignancy of pulmonary solitary nodule detected incidentally in routine clinical practice. Studies had to be published in peer-reviewed journals, either in Spanish, Portuguese or English. Exclusion criteria were non-human studies, or predictive models based in high-risk populations, or models based on computational approaches. Exclusion criteria were non-human studies, or predictive models based in high-risk populations, or models based on computational approaches (such as radiomics). We used The Transparent Reporting of a multivariable Prediction model for Individual Prognosis Or Diagnosis (TRIPOD) statement, to describe the type of predictive model included in each study, and The Prediction model Risk Of Bias ASsessment Tool (PROBAST) to evaluate the quality of the selected articles.ResultsA total of 186 references were retrieved, and after applying the exclusion/inclusion criteria, 15 articles remained for the final review. All studies analysed clinical and radiological variables. The most frequent independent predictors of SPN malignancy were, in order of frequency, age, diameter, spiculated edge, calcification and smoking history. Variables such as race, SPN growth rate, emphysema, fibrosis, apical scarring and exposure to asbestos, uranium and radon were not analysed by the majority of the studies. All studies were classified as high risk of bias due to inadequate study designs, selection bias, insufficient population follow-up and lack of external validation, compromising their applicability for clinical practice.ConclusionsThe studies included have been shown to have methodological weaknesses compromising the clinical applicability of the evaluated SPN malignancy predictive models and their potential influence on clinical decision-making for the SPN diagnostic management.Systematic review registrationPROSPERO CRD42020161559

A Case Report on Diagnostic Approach of a Complex Clinical Scenario: Differentiation Between Coronary Artery Disease and Apical Hypertrophic Cardiomyopathy as a Cause of Recurrent Debilitating Angina

Apical hypertrophic cardiomyopathy (ApHCM) is a clinical challenge when presenting with symptoms of angina plus shortness of breath. An appropriate diagnosis of concurrent coronary artery disease (CAD) is needed for proper diagnosis, risk stratification, and management. We present a case of a 64-year-old gentleman with a history of ApHCM and CAD with previous percutaneous intervention presenting with recurrent angina. A repeat coronary angiography showed no new obstructive lesions. A stress cardiac magnetic resonance imaging was performed, which showed perfusion defect in the apex with apical scarring likely secondary to microvascular disease. The patient was managed medically with the improvement of symptoms. Diagnosis and management of CAD in patients with ApHCM are challenging. Multiple diagnostic modalities may be required for delineating the underlying pathology. Patients should be managed initially with medications. If symptoms are not controlled with medical management, a heart team approach with referral to an advanced center experienced in apical myectomy should be considered.

Central versus paracentral cone location and outcomes of accelerated cross-linking in keratoconus patients.

To compare outcomes 1 year after accelerated cross-linking (CXL) between keratoconus eyes with central cones to those with paracentral cones. In this post hoc analysis of data from a prospective multicentre study, consecutive progressive keratoconus eyes treated with accelerated CXL were included. Preoperative and 1 year post CXL manifest refraction, corneal cylinder, maximal keratometry (Kmax), central corneal thickness and coma were assessed. Central and paracentral coneswere defined as cones within the central 3 mm and those between 3 and 5 mm, respectively. Eyes with apical scarring and peripheral cones (>5 mm) were excluded. The primary outcome measures were changes in best spectacle-corrected visual acuity (BSCVA) and Kmax. Overall, 314 eyes (n = 314) with a mean age of 27.5 ± 7.7 years were included. At baseline, the central cone group was younger (p < 0.001), had lower corneal astigmatism (p = 0.03) and coma (p = 0.02). At 1 year post CXL, after adjusting for baseline characteristics (age, BSCVA, corneal astigmatism, Kmax and coma), the central cone group showed a greater reduction in myopia (mean difference 1.27 ± 0.60D, p = 0.04) and more improvement in BSCVA (mean difference 0.08 ± 0.02 logMAR, p < 0.001) compared to the paracentral group. There was no significant difference in progression rates between the central and paracentral groups (ΔKmax > 2D, 6.7% vs. 6.5%, respectively, p = 0.83). This large-scale study of keratoconus eyes 1 year after accelerated CXL indicates that compared to those with paracentral cones, central cones have on average almost one additional line improvement in BCSVA and 1.27 D more reduction in myopia.

The Correlation between Corneal Findings and Disease Severity in Keratoconus per Scheimpflug Corneal Tomography.

Purpose This study aims to correlate the clinical signs of keratoconus (KC) which include superficial apical scarring, Fleischer rings, and Vogt striae with best spectacle-corrected visual acuity (BSCVA) and corneal tomography findings. Patients and methods. A retrospective observational study. 72 consecutive KC patients seen by the senior author over the course of one year were included in this case series. Eyes with pellucid marginal degeneration, postrefractive ectasia, history of a corneal graft, prior corneal collagen cross-linking, intracorneal ring segments or hydrops were excluded from analysis. Subsequently, the final analysis included only treatment-naïve KC eyes with varying degrees of disease severity. Results BSCVA with manifest refraction was 0.5 logMAR higher in eyes with apical scarring (p < 0.001). Eyes with apical scarring had worse vision than eyes with Fleischer rings alone (0.43 logMAR higher in the former, p < 0.001). Eyes with apical scarring had worse vision than eyes with Fleischer rings alone (0.43 logMAR higher in the former, K2 = 64.56 ± 12.89 D versus 49.07 ± 6.61 D, p < 0.001). Eyes with apical scarring had worse vision than eyes with Fleischer rings alone (0.43 logMAR higher in the former, K2 = 64.56 ± 12.89 D versus 49.07 ± 6.61 D, p < 0.001). Eyes with apical scarring had worse vision than eyes with Fleischer rings alone (0.43 logMAR higher in the former, K2 = 64.56 ± 12.89 D versus 49.07 ± 6.61 D, p < 0.001). Eyes with apical scarring had worse vision than eyes with Fleischer rings alone (0.43 logMAR higher in the former, p < 0.001). Eyes with apical scarring had worse vision than eyes with Fleischer rings alone (0.43 logMAR higher in the former, p < 0.001). Eyes with apical scarring had worse vision than eyes with Fleischer rings alone (0.43 logMAR higher in the former, p < 0.001). Eyes with apical scarring had worse vision than eyes with Fleischer rings alone (0.43 logMAR higher in the former, Conclusion The presence of apical scarring and Fleischer rings on biomicroscopy can aid the clinician in making the distinction between severe or long-standing disease (respectively). Apical scarring is a sign of advanced disease and is associated with worse BSCVA and tomography findings. Fleischer rings are markers of intermediate disease and their presence correlates with disease duration.

Accelerated Corneal Cross-Linking: Efficacy, Risk of Progression, and Characteristics Affecting Outcomes. A Large, Single-Center Prospective Study

We examined the efficacy and preoperative characteristics that affect outcomes of accelerated (9 mW/cm2 for 10minutes) corneal cross-linking (CXL). Prospective single-center observational cohort study. We enrolled 612 eyes of 391 subjects with progressive keratoconus (n= 589), pellucid marginal degeneration (n= 11), and laser insitu keratomileusis-induced ectasia (n= 12). We evaluated best spectacle-corrected visual acuity (BSCVA), topography, refraction, endothelial cell density, corneal thickness, haze, intraocular pressure, and visual function before and 12months after the CXL procedure. We tabulated the proportion of those with progression of maximum keratometry (Kmax). We included participant's race, age, sex, and the presence of preoperative apical scarring and environmental allergies in a multivariable linear regression model to determine the effect of these characteristics on outcomes. At 1 year there was no significant change in mean Kmax (n= 569). Progression of Kmax was higher in subgroups with a baseline Kmax >58 diopters (n= 191) and those 14-18 years of age (n= 53). Preoperative BSCVA, Kmax, refraction, corneal cylinder, coma, central corneal thickness, and vision function were statistically and clinically significant predictors of outcomes (P< .001). Preoperative apical scarring led to worsening haze (P= .0001), more astigmatism (P= .002), more central corneal thinning (P= .002), and was protective to the endothelium (P= .008). Race, age, and sex affected some outcomes. Mean Kmax was stable at 1 year after accelerated CXL. Younger patients and those with a higher preoperative Kmax need to be monitored closely for progression. Preoperative BSCVA, topography, refraction, CCT, and apical scarring were significant predictors of outcomes.

Corneal elevation changes after forced eyelid closure in healthy participants and in patients with keratoconus

BackgroundTo assess pointwise corneal elevation changes after forced eyelid closure test (FECT) in the eyes of healthy subjects and in eyes with keratoconus.MethodsTwenty‐nine subjects with keratoconus and 31 healthy volunteers were evaluated. Patients with keratoconus who had corneal hydrops, apical scarring, corneal thickness ≤ 400 μm, ocular surface disease, contact lens wear on the examination day and a history of corneal cross‐linking were excluded. Exclusion criteria for healthy participants were spherical error > +3.00 D and < −3.00 D, corneal astigmatism > 1.50 D, corneal curvature > 47 D, ocular allergy, clinical findings and family history of keratoconus. Pentacam was performed before and after 20-seconds of FECT and raw data were extracted from the built‐in software. Pointwise anterior and posterior elevation changes in the central 8-mm cornea were assessed using paired samples t‐test and heat maps were constructed to reflect mean changes and statistically significant data points. Statistical significance was assumed at p < 0.01.ResultsAge and gender were similar between healthy subjects (24.5 ± 1.6-years, 46.4 per cent female) and subjects with keratoconus (28.6 ± 9.2-years, 46.4 per cent female, p = 0.19, 0.61, respectively). Healthy eyes displayed posterior depression clustering in the inferotemporal and inferonasal areas (mean change: −4.5 ± 7.8 μm and −5.2 ± 9.8 μm, respectively, all p < 0.01). In contrast, keratoconus eyes exhibited a wider area of posterior elevation clustering in the inferior cornea (mean change: 8.1 ± 14.5 μm, all p < 0.01) with a small extension in the inferotemporal cornea (mean change: 12.1 ± 22.3 μm, all p < 0.01).ConclusionFECT elicits corneal elevation changes mainly in the inferior cornea with the change being more pronounced and wider in eyes with keratoconus.

Contact Lenses for Keratoconus- Current Practice.

Background:Keratoconus is a chronic, bilateral, usuallly asymmetrical, non-inflammatory, ectatic disorder, being characterized by progressive steepening, thinning and apical scarring of the cornea. Initially, the patient is asymptomatic, but the visual acuity gradually decreases, resulting in significant vision loss due to the development of irregular astigmatism, myopia, corneal thinning and scarring. The classic treatment of visual rehabilitation in keratoconus is based on spectacles and contact lenses (CLs).Objective:To summarize the types of CLs used in the treatment of keratoconus. This is literature review of several important published articles focusing on the visual rehabilitation in keratoconus with CLs.Method:Gas permeable (GP) CLs have been found to achieve better best corrected visual acuity than spectacles, eliminating 3rd-order coma root-mean-square (RMS) error, 3rd-order RMS, and higher-order RMS. However, they have implicated in reduction of corneal basal epithelial cell and anterior stromal keratocyte densities. Soft CLs seem to provide greater comfort and lower cost, but the low oxygen permeability (if the lens is not a silicone hydrogel), and the inability to mask moderate to severe irregular astigmatism are the main disadvantages of them. On the other hand, scleral CLs ensure stable platforms, which eliminate high-order aberrations and provide good centration and visual acuity. Their main disadvantages include the difficulties in application and removal of these lenses along with corneal flattening and swelling.Result:The modern hybrid CLs are indicated in cases of poor centration, poor stability or intolerance with GP lenses. Finally, piggyback CL systems effectively ameliorate visual acuity, but they have been related to corneal neovascularization and giant papillary conjunctivitis.Conclusion:CLs seem to rehabilitate visual performance, diminishing the power of the cylinder and the high-order aberrations. The final choice of CLs is based on their special features, the subsequent corneal changes and the patient’s needs.

Morphometric characterisation of pterygium associated with corneal stromal scarring using high-resolution anterior segment optical coherence tomography

AimsTo investigate the role of high-resolution anterior segment optical coherence tomography (HR-ASOCT) in the assessment of pterygia.MethodsSingle centre cross-sectional study. Patients with primary pterygium and/or pingueculae were included. Clinical assessment...

Syncope in a 62-year-old man with sarcoidosis

A 62-year-old man presented with dyspnea on exertion and near-syncope for 1 month. His past medical history included pulmonary sarcoidosis. Although no biopsy was performed, diffuse hilar lymphadenopathy and apical scarring were noted on chest computerized tomography. These findings were consistent with sarcoidosis. The patient had 2 syncopal episodes 2 and 3 months before presentation without any prodrome. Cardiac magnetic resonance imaging showed normal right and left ventricular function, no late enhancement of gadolinium, and no signs of inflammation. He was not taking any cardioactive medications. The patient’s ECG is shown in Figure 1.

The Genetic Background of Keratoconus: A Review on Keratoconus Genes

Keratoconus is a chronic, bilateral, usually asymmetrical, non-inflammatory, ectatic disorder, being characterized by progressive steepening, thinning and apical scarring of the cornea. It affects approximately 1 in every 2000 individuals, but its incidence seems to be increased with the clinical use of corneal topography. Keratoconus is considered as a multifactorial disease, caused by the interaction between several genes, microRNAs and environmental factors, including eye rubbing, atopy, sun exposure, geographic location and race. Although the disease is usually sporadic, a genetic predisposition and raised incidence in familial and monozygotic twins have been described. Given that the diagnosis of the disease is based on a anterior eye assessment, the identification of certain genes could be an additional diagnostic tool. Furthermore, it may pave the way for the gene therapy of the disease.

Descemet Stripping Endothelial Keratoplasty for the Treatment of Combined Fuchs Corneal Endothelial Dystrophy and Keratoconus

To report the first case series of patients with Fuchs corneal endothelial dystrophy (FCD) and keratoconus (KCN) who underwent Descemet stripping endothelial keratoplasty (DSEK). This is a retrospective case series of 6 eyes of 4 patients with combined FCD and KCN who underwent DSEK at 3 different centers. Clinical information collected included corneal topography measurements, central corneal thickness, and endothelial cell count. Visual outcomes and change in keratometric measurements were evaluated. The follow-up for patients ranged from 10 to 72 months. The best-corrected visual acuity was 20/40 or better in all 6 eyes. The mean keratometric measurements decreased in all cases (range of 0.5-5.8 diopters); however, topography still demonstrated an inferior steepening in each case. Patients with FCD and KCN have been previously reported as being managed with penetrating keratoplasty. We present 6 eyes of 4 patients who were managed with DSEK for the FCD. Topographically, the characteristic inferior steepening of KCN did not change; however, all patients with DSEK had flatter postoperative keratometric measurements with improved visual acuity. If a DSEK is performed for FCD before apical corneal scarring from KCN, a good visual outcome may be achieved.

P53 Fast Track TB Radiology: A Bit of a Bonsai or a Tree in Bud?

Background Prompt diagnosis is central to effective tuberculosis(TB) management. To minimise clinician related delay, we developed a pathway where imaging suggestive of active TB is flagged for review by specialist radiologists and the TB service at a weekly meeting. If required, the patient is then fast-tracked for clinical assessment by the TB team. Methods Prospective study of patients referred to our radiology service June 2011–February 2012 with imaging flagged as suspicious of TB. Case management, diagnosis and final outcome were recorded. Results 68 subjects, median age 45 years (range 1–91), were studied. Of the flagged images, 38 were chest radiographs, 28 CT chest +/– abdomen, 1 CT head and 1 MRI spine. 32 (47%) were reported to be highly suspicious for TB. The remaining 36 (53%) had changes such as apical scarring, pleural effusion and/or mediastinal lymphadenopathy where TB was part of the differential diagnosis. 19 (28%) of the radiological referrals were from Primary Care & 12 (18%) Accident & Emergency (A & E). 59 of 68 (87%) were seen in a TB clinic at a median time from date of imaging to appointment of 13 days (range 1 –100). 18 (31%) had a final diagnosis of active TB. 3 were already on TB treatment, and the remaining 15 started a median 24 days from the time of imaging. Apart from TB, common final diagnoses included bacterial or NTM infection, bronchiectasis and sarcoidosis. 4/19 (21%) of GP and 3/12 (25%) A & E referrals had active TB. Patients not seen in a TB clinic were referred to other clinical services (4 cases – all with significant pathology) or no action taken following specialist review of their imaging (5). Conclusion The fast track service has a high yield for TB and other significant pathologies. Almost half of the reviews arose following Primary Care or A & E imaging. Prompt specialist imaging review is associated with rapid and appropriate triage to TB and other services. Further work will compare this approach to standard care pathways.

Myocardial Infarction With Intracardiac Thrombosis as the Presentation of Acute Promyelocytic Leukemia

A 29-year-old woman presented in February 2010 with acute-onset severe chest pain. This radiated to the left shoulder and was associated with breathlessness. She was afebrile, her saturations were 100% on air, and her clinical examination was entirely normal. An electrocardiogram showed diffuse 2- to 3-mm ST-segment elevation. At presentation, troponin I was elevated at 2.4 ng/mL (normal <0.1 ng/mL). Full blood count, chest radiograph, arterial blood gas, and bedside echocardiogram were unremarkable. She was diagnosed with myopericarditis and discharged from the accident and emergency department with nonsteroidal anti-inflammatories. Two days later, she returned with worsening chest pain and was admitted for investigation. She had a full blood count, and urea and electrolytes were within the normal range. Troponin I was significantly elevated at 15.2 ng/mL, C-reactive protein was >160 mg/L (normal 20 000 μg/L (normal 0 to 500 μg/L). Her electrocardiogram showed further widespread ST elevation, and repeat bedside echocardiogram demonstrated a mass at the left ventricular apex, with apical hypokinesis (Figure 1 and online-only Data Supplement Movie I). A cardiac magnetic resonance scan revealed apical scarring consistent with a small myocardial infarct, with adherent apical thrombus in both the left and right ventricles (Figures 2 and 3 and online-only Data Supplement Movies II and III). Figure 1. A, Electrocardiogram showing diffuse ST-segment elevation. B, Transthoracic echocardiogram: apical 4-chamber view in systole showing …

Transcatheter and Transapical Aortic Valve Replacement

Minimally invasive valve replacement is limited to bioprosthetic aortic and pulmonary valves for use in very specific populations of patients. Replacement via trans-catheter and transapical techniques should be used only in patients in whom traditional surgical replacement is deemed an unacceptable risk. Nursing management will focus heavily on care for comorbid conditions because of the high-risk nature of the patients in whom these valves will initially be implanted.

Radial Keratotomy for the Optical Rehabilitation of Mild to Moderate Keratoconus: More than 5 Years’ Experience

Purpose To present the authors’ long-term experience of radial keratotomy (RK) for the optical rehabilitation of patients with mild to moderate keratoconus – central corneal thickness of greater than 400 μm and without apical scarring. Methods In this observational, noncomparative series of cases, all consecutive patients with mild or moderate keratoconus, treated by RK between 1990 and 2002, with at least 1 year follow-up were included. A total of 170 eyes of 96 patients were investigated. Mean follow-up was 42.08 ± 28.14 months. Visual acuity, refraction, corneal curvature, central corneal thickness, and complications were evaluated. Results In all of the control visits, mean uncorrected and best spectacle corrected visual acuities were better than preoperative values (p&lt;0.0001). Preoperative myopic spherical refraction decreased significantly (p&lt;0.0001), and remained relatively unchanged throughout the follow-up (p=0.43). A small but statistically significant decrease from baseline was observed in astigmatism (p=0.038), which almost disappeared 1 year after the surgery (p=0.47). The surgery produced a statistically significant flattening of the corneal curvature (p&lt;0.0001). Central corneal thickness did not change significantly (p&gt;0.05) in either control visit. In 33 eyes (19.4%), re-deepening of the incisions was required. In 3 eyes (1.8%) penetrating keratoplasty was performed, due to disease progression in 2 eyes (1.2%) and acute traumatic hydrops in 1 eye (0.6%). In 4 eyes (2.2%) microperforation, in 2 eyes (1.2%) macroperforation, in 1 eye (0.6%) infectious keratitis, and in 1 eye (0.6%) hyperopic shift occurred. Conclusions RK surgery was found to be a reasonable option for the rehabilitation of a selected group of keratoconus patients in the early or moderate stages.

Radial keratotomy for the optical rehabilitation of mild to moderate keratoconus: More than 5 years experience.

To present the authors long-term experience of radial keratotomy (RK) for the optical rehabilitation of patients with mild to moderate keratoconus central corneal thickness of greater than 400 m and without apical scarring. In this observational, noncomparative series of cases, all consecutive patients with mild or moderate keratoconus, treated by RK between 1990 and 2002, with at least 1 year follow-up were included. A total of 170 eyes of 96 patients were investigated. Mean follow-up was 42.08 28.14 months. Visual acuity, refraction, corneal curvature, central corneal thickness, and complications were evaluated. In all of the control visits, mean uncorrected and best spectacle corrected visual acuities were better than preoperative values (p<0.0001). Preoperative myopic spherical refraction decreased significantly (p<0.0001), and remained relatively unchanged throughout the follow-up (p=0.43). A small but statistically significant decrease from baseline was ob-served in astigmatism (p=0.038), which almost disappeared 1 year after the surgery (p=0.47). The surgery produced a statistically significant flattening of the corneal curvature (p<0.0001). Central corneal thickness did not change significantly (p>0.05) in either control visit. In 33 eyes (19.4%), re-deepening of the incisions was required. In 3 eyes (1.8%) penetrating keratoplasty was performed, due to disease progression in 2 eyes (1.2%) and acute traumatic hydrops in 1 eye (0.6%). In 4 eyes (2.2%) microperforation, in 2 eyes (1.2%) macroperforation, in 1 eye (0.6%) infectious keratitis, and in 1 eye (0.6%) hyperopic shift occurred. RK surgery was found to be a reasonable option for the rehabilitation of a selected group of keratoconus patients in the early or moderate stages.