A Clinical Case of Fitting Scleral Lens for Correction of Pellucid Marginal Degeneration

Background. Pellucid Marginal Degeneration (PMD) is a rare bilateral degenerative corneal disease. It causes corneal ectasia with bilateral, clear, inferior (typically 4 o’clock to 8 o’clock), peripheral corneal thinning. It usually affects about 80% of corneal stroma, which leads to the corneal ectasia above the thinning area as well as provokes the irregular astigmatism and visual impairment that are difficult to correct. Purpose. To study the possibilities of correction and social rehabilitation in a patient with PMD wearing scleral lenses. Materials and methods. The study included a patient with PMD, signs of corneal dysfunction and narrow-angle subcompensated glaucoma in the right eye, and PMD of the cornea resulted in a corneal leukoma – terminal glaucoma in the left eye. In addition to standard ophthalmic methods, we performed corneal topography and optical coherence tomography (OCT). For intraocular pressure measurement, ICARE IOP tonometer was used in several areas of the intact peripheral cornea. Results. Prior to lens fitting, UCVA in the right eye amounted to 0.06. Scleral lens helped achieve a high visual acuity of 0.9–1.0. The lens was well-tolerated by the patient. Conclusion. Scleral lenses may be a good choice for patients with irregular cornea caused by corneal dystrophy. Not only they are easy to use and have a good visual effect, but they also help patients with social rehabilitation.

Autologous Corneal Transplant from an Enucleated Fellow Eye for Choroidal Melanoma: A Case Report

Background: To report a case of autologous corneal transplant in a patient with corneal leukoma and choroidal melanoma in the fellow eye. Case Presentation: A 56-year-old woman was complaining about decrease in vision in her left eye. The patient was on the waiting list for a corneal transplant on her right eye due to corneal leucoma after a previous herpes infection. The patient was diagnosed with choroidal melanoma in her left eye. Due to the tumor size (longitudinal diameter >10 mm; anterior-posterior diameter >16 mm) the patient decided to undergo enucleation, after being informed about different treatment options (brachytherapy and enucleation). The patient showed her willingness to use the cornea of the left eye as a transplant for her right eye. After discussion with the ethical committee and its approval, and signing informed consent, the patient underwent enucleation of her left eye. The sample was examined by a pathologist and found to be free of melanoma cells in the corneolimbal tissue. Afterwards, trepanation of the donor cornea button was performed and transplanted to the left eye. Conclusion: Autologous corneal transplantation is a safe and feasible procedure in selected cases.

Correction of High Astigmatism after Penetrating Keratoplasty with Toric Multifocal Intraocular Lens Implantation

After penetrating keratoplasty (PK), high astigmatism is often induced, being frequently about 4–6 dpt. According to the entity and typology of astigmatism, different methods of correction can be used. Selective suture removal, relaxing incisions, wedge resections, compression sutures, photorefractive keratectomy, and laser-assisted in situ keratomileusis can reduce corneal astigmatism and ametropia, but meanwhile they can cause a reduction in the corneal integrity and cause an over- or undercorrection. In case of moderate-to-high regular astigmatisms, the authors propose a toric multifocal intraocular lens (IOL) implantation to preserve the corneal integrity (especially in PK after herpetic corneal leukoma keratitis). We evaluated a 45-year-old patient who at the age of 30 was subjected to PK in his left eye due to corneal leukoma herpetic keratitis, which led to high astigmatism (7.50 dpt cyl. 5°). The patient was subjected to phacoemulsification and customized toric multifocal IOL implantation in his left eye. The correction of PK-induced residual astigmatism with a toric IOL implantation is an excellent choice but has to be evaluated in relation to patient age, corneal integrity, longevity graft, and surgical risk. It seems to be a well-tolerated therapeutic choice and with good results.