Rij, G. van

Refractive, topographic, and visual outcomes of same-day corneal cross-linking with ferrara intracorneal ring segments in patients with progressive keratoconus (Article)

2011-12-01T00:00:00Z

PURPOSE:: To report refractive, topographic, and visual outcomes 12 months after same-day treatment with corneal cross-linking (CXL) and Ferrara intracorneal ring segments (ICRS) in eyes with progressive keratoconus (KC) and contact lens intolerance. METHODS:: This was a case series of 7 eyes (7 patients) with progressive mild to moderate keratoconus and contact lens intolerance undergoing implantation of Ferrara ICRS immediately followed by corneal cross-linking. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), refractive error, pachymetry, and keratometry were evaluated at 3, 6, and 12 months of follow-up. RESULTS:: Mean follow-up was 11.7 ± 3.6 months (range, 5-17 months). Mean preoperative UCVA and BSCVA were 0.10 ± 0.07 (range, 0.05-0.2) and 0.56 ± 0.08 (range, 0.5-0.7), respectively. One year after the treatment, mean UCVA and BSCVA measured 0.60 ± 0.24 (range, 0.32-0.9) and 0.82 ± 0.25 (range, 0.5-1.2), respectively. The mean spherical equivalent decreased significantly (P < 0.05) with 3.5 diopters (D). Mean K values (average keratometry of the cornea) decreased from 46.81 ± 2.13 D (range, 44-51 D) to 43.97 ± 2.22 D (range, 42-47.5 D) 1 year after the treatment. The average preoperative thinnest pachymetry measured 462 ± 46 μm (range, 410 ± 546 μm) and did not change significantly after the treatment. In patient 1, the inferior ICRS was removed 5 months postoperatively because of implant migration. CONCLUSIONS:: The combined treatment of corneal cross-linking and Ferrara ICRS is a safe procedure that may be considered in patients with progressive mild to moderate KC and contact lens intolerance. Copyright

A posterior khodadoust line in a graft rejection episode after descemet stripping automated endothelial keratoplasty (Article)

2011-02-01T00:00:00Z

Purpose: To describe the presence of an endothelial rejection line in immunological graft rejection after Descemet stripping automated endothelial keratoplasty (DSAEK). Methods: Case report. Results: A 77-year-old woman underwent DSAEK procedure of the left eye because of visual limiting bullous keratopathy. One week postoperatively, the donor lamella was partially detached and an additional air bubble was injected into the anterior chamber. Thereafter, complete adherence of the lamella was seen. Four months after surgery, vision deteriorated, and a transient immunological graft rejection episode with endothelial rejection line was seen. Conclusions: In contrast to other reports, an endothelial rejection line (Khodadoust line) can be seen during the endothelial rejection episode after DSAEK.

Long-term follow-up of hydrogel intracorneal lenses in 2 aphakic eyes (Article)

2010-12-01T00:00:00Z

We report the outcome of hydrogel intracorneal lens implantation in 2 patients. The lenses were implanted at approximately 50% depth in the cornea to correct high hyperopic refractive errors of 10.5 diopters (D) and 14.0 D, respectively. Both patients were contact lens intolerant and not suitable for intraocular lens implantation. Surgery was performed in 1988, and the patients were followed until early 2010. The patients showed good tolerance for the intracorneal lenses, but both developed opacities around the implant, leading to reduced visual acuity in 1 patient. Long-term patient monitoring is essential since corneal opacities can develop after many years. Removing the implant is not necessary as the lens can easily be rinsed by lifting the corneal cap. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned.

Zicht op het venster (Farewell Lecture)

2010-11-19T00:00:00Z

Afscheidsrede Prof. dr. G. van Rij hoogleraar Oogheelkunde Erasmus Universiteit Rotterdam Uitgesproken 19 november 2010

A genome-wide association study identifies a susceptibility locus for refractive errors and myopia at 15q14 (Letter To Editor)

2010-09-01T00:00:00Z

Refractive errors are the most common ocular disorders worldwide and may lead to blindness. Although this trait is highly heritable, identification of susceptibility genes has been challenging. We conducted a genome-wide association study for refractive error in 5,328 individuals from a Dutch population-based study with replication in four independent cohorts (combined 10,280 individuals in the replication stage). We identified a significant association at chromosome 15q14 (rs634990, P = 2.21 × 10−14). The odds ratio of myopia compared to hyperopia for the minor allele (minor allele frequency = 0.47) was 1.41 (95% CI 1.16–1.70) for individuals heterozygous for the allele and 1.83 (95% CI 1.42–2.36) for individuals homozygous for the allele. The associated locus is near two genes that are expressed in the retina, GJD2 and ACTC1, and appears to harbor regulatory elements which may influence transcription of these genes. Our data suggest that common variants at 15q14 influence susceptibility for refractive errors in the general population.

A genome-wide association study identifies a susceptibility locus for refractive errors and myopia at 15q14 (Letter To Editor)

2010-09-01T00:00:00Z

Introduction of epithelial cells in the flap-graft interface during descemet stripping automated endothelial keratoplasty (Article)

2009-07-01T00:00:00Z

Preliminary results of femtosecond laser-assisted descemet stripping endothelial keratoplasty (Article)

2008-10-01T00:00:00Z

Objective: To evaluate the preliminary visual results of femtosecond laser-assisted Descemet stripping endothelial keratoplasty (FS-DSEK). Methods: We prospectively analyzed results of 20 consecutive patients with Fuchs endothelial dystrophy or aphakic/ pseudophakic bullous keratopathy who underwent FS-DSEK. Best spectacle-corrected visual acuity (BSCVA), refraction, corneal topography, and endothelial cell density were measured preoperatively and 3 and 6 months after FS-DSEK. Corneal thickness was measured using an optical coherence tomography technique. Results: The average BSCVA of 11 eyes with normal visual potential significantly improved from 20/110±4 lines to 20/57±1 line at 6 months (P<.007). At 6 months, the mean (SD) hyperopic shift was 2.24 (2.3) diopters (D). Preoperative and 6 months postoperative refractive astigmatism were -0.75 (0.9) D and -1.58 (1.1) D (P=.01), but the topographic astigmatism did not change postoperatively (P=.95). Mean (SD) endothelial cell density at 6 months was 1368 (425) cells/mm2. There was a persistent deswelling of the graft up to 3 months postoperatively. Complications included graft dislocations requiring repositioning (20%), pupillary block glaucoma (5%), epithelial ingrowth (5%), and primary graft failure (5%). Conclusions: Femtosecond laser-assisted Descemet stripping endothelial keratoplasty was effective in treating endothelial failure with minimal induced refractive astigmatism, limited improvement of BSCVA, and induction of a hyperopic shift. Endothelial cell count and dislocation rate were significant, which may be related to the surgical technique.

Long-term Follow-up of Endothelial Cell Change after Artisan Phakic Intraocular Lens Implantation (Article)

2008-04-01T00:00:00Z

Objective: To report endothelial cell densities (ECDs) and their correlation to anterior chamber depth (ACD) after implantation of the Artisan intraocular phakic lens. Design: Prospective observational case series. Participants: Three hundred eighteen eyes of 173 myopic patients treated with the Artisan iris-fixated phakic intraocular lens (IOL). Methods: Eyes with an ACD ranging between 2.89 and 4.5 mm were implanted with the Artisan phakic IOL. Endothelial cell density measurements were performed preoperatively and at each follow-up examination using a noncontact specular microscope. Main Outcome Measures: Endothelial cell density (cells per square millimeter). Results: Follow-up ranged between 1 (82 eyes) and 7 years (13 eyes) (mean, 35.3±20.7 [standard deviation] months per eye). After 3 years, there was a significant loss in ECD (P≤0.03). At 5 years, mean observed endothelial cell loss was 8.3% (5.3% corrected for a natural endothelial cell loss of 0.6% a year). Endothelial cell density loss remained progressive throughout our follow-up period. After 3 years, a significant negative correlation between ACD and endothelial cell loss was revealed (P≤0.03). Patient age, gender, refractive error, incision size, and side of the eye were not correlated to ECD loss. All corneas remained clear throughout the study. Conclusion: After 3 years, a significant ECD loss was revealed. This ECD loss was significantly negatively correlated to the ACD. We therefore suggest that eyes just meeting the minimum ECD requirement have greater ACDs to compensate for possible greater endothelial cell loss and that patients with shallow anterior chambers have higher ECDs. Artisan phakic lens implantation in young eyes narrowly meeting the minimum criteria of endothelial cell density (2000 cells/mm2) and ACD (2.6 mm) should perhaps be reevaluated, due to longer exposure to higher rates of endothelial cell loss.

Acute angle closure glaucoma after oculoplastic surgery (Article)

2008-01-01T00:00:00Z

Purpose: To describe two patients with acute angle closure glaucoma after oculoplastic surgery. Design: Interventional case reports. Methods: Review of clinical findings and treatment. Results: A 61-year-old female developed a painful eye with decreased visual acuity a few days after bilateral blepharoplasty. A 69-year-old male developed a painful red eye with decreased visual acuity a few days after ptosis correction. In both cases the intraocular pressure increased to more than 50 mmHg. Both patients were diagnosed with acute angle closure glaucoma and treated appropriately. Conclusions: Acute angle closure glaucoma is a possible complication of oculoplastic surgery. Copyright

Triple procedure; analysis of outcome, refraction, and intraocular lens power calculation (Article)

1997-01-01T00:00:00Z

AIMS: A total of 97 triple procedures performed over a 6 year period were studied retrospectively to determine the best approach to calculate intraocular lens power. METHODS: The cases were divided into two diagnostic categories. RESULTS: After 1 year best corrected visual acuity was 20/40 or better in 37.5% of the cases of the 'modified group'. This group consists of patients with the diagnosis Fuchs' dystrophy, non-guttate endothelial dystrophy, and Reis-Buckler dystrophy. Analysis of visual acuity was made using logMAR. A final postoperative refraction within 2 dioptres of predicted refraction was achieved in 76.5% of patients in the modified group. CONCLUSION: In future, in the absence of a keratometry, a keratometry value of 7.49 mm will be used for calculation of the power of the implant as analysed in this study.