SMILE After DALK to Reduce Residual Refraction: Two-Year Results

PurposeTo determine the two-year results of small incision lenticule extraction (SMILE) for correcting post-keratoplasty myopia and myopic astigmatism.MethodsIn this case-series study, 10 eyes of 10 patients with a 6-10-year history of successful deep lamellar keratoplasty (DALK) underwent SMILE using VisuMax laser platform. Ophthalmologic examinations and visual acuity and refraction measurement were done pre- and 1, 3, 6, 12, and 24 months postoperatively. Pentacam and Sirius imaging was done in the first and last follow-up session.ResultsThe mean age of the patients was 39.60±7.86 years. Six subjects were male. After two years, uncorrected distance visual acuity did not change in one eye and improved 1-6 lines in other eyes. Corrected distance visual acuity decreased in one eye, did not change in four eyes, and improved 1-8 lines in other eyes. The mean decrease of spherical equivalent, spherical error, and cylinder power was 1.92±1.96 diopter (D) (P=0.013), 0.70±3.05D (P=0.213), and 2.42±2.91D (P=0.024), respectively. The vector mean target induced astigmatism, surgical induced astigmatism, and difference vector was 1.30D@44˚, 1.11D@24˚, and 0.86D@73˚, respectively. Two years after surgery, vertical coma, horizontal coma, and spherical aberration increased by 0.44±0.51, 0.23±0.32, and 0.02±0.16µm respectively (all P>0.05) while trefoil reduced by 0.29±0.75µm (P=0.428).ConclusionSMILE is a successful procedure for reducing refraction and astigmatism after DALK in patients with moderate myopia and moderate to severe astigmatism and improves the visual acuity in these patients. Axis rotation during surgery may result in under-correction of astigmatism. Refinement of SMILE treatment nomogram for post-DALK cases seems necessary.

Pathogenesis of Fixed Dilated Pupil (Urrets-Zavalía Syndrome) after Deep Lamellar Keratoplasty in Keratoconus

ABSTRACT Purpose To present a case series of patients that developed Urrets-Zavalia syndrome (UZS) after deep anterior lamellar keratoplasty (DALK) for treating keratoconus and discuss the mechanisms for the syndrome. Materials and methods Retrospective chart analysis of patients who developed UZS after DALK at the Cornea Unit, Hospital São Geraldo, Federal University of Minas Gerais. Results We present a series of 3 patients with features consistent with UZS, after undergoing DALK. Elevated intraocular pressure (IOP) was noted in the early postoperative period in 2 cases, despite the fact that the other case reported eye pain, headache, and nausea at the night after the surgery with undocumented IOP. Although at different extents, the pupil remained atrophic and dilated in all 3 eyes, and 2 of them developed anterior subcapsular cataract. Conclusion Iris ischemia resulting from occlusion of iris root vessels due to elevated IOP higher than diastolic blood pressure causes UZS. Elevated IOP should be monitored, especially in young patients with low diastolic blood pressure, in order to avoid the occurrence of the syndrome. How to cite this article Reis JRC, Diniz-Filho A, Rocha FM, Torquetti L. Pathogenesis of Fixed Dilated Pupil (Urrets-Zavalía Syndrome) after Deep Lamellar Keratoplasty in Keratoconus. Int J Kerat Ect Cor Dis 2016;5(1):32-34.