Eyeworld

EW CORNEA 82 eyes with corneal perforations, lenticule transplantation seemed safe and effective as an adjuvant for the closure of corneal perforations. The investigators maintained that lenticules have a potential clinical application, as relatively simple and inexpensive temporary measures, to improve the corneal condition until further definitive interventions could be carried out. The study ap- plied lenticules with central corneal thickness of at least 100 µm using interrupted stitches and a single lay- er of overlying amniotic membrane. The corneal perforations were sealed in all seven patients, with no evi- dence of infection, relapse, or reper- foration detected in the 12 months following transplantation. 4 "Corneal lenticule transplanta- tion could be the method of choice for deep defects. In the future, these lenticules could be considered for treatment of other conditions like hyperopia and keratoconus," Dr. Studeny said. EW September 2018 Repurposing continued from page 81 in the area of about 10 square acres of the volcanic activity. No laze patients Dr. Senft has yet to see any patient from the airborne volcanic pollutant that results from the volcanic erup- tion hitting ocean waves—known as laze—which forms glass particles that can be very irritating. "I haven't seen anyone who has had that because it is too far away, only in the immediate vicinity of where the lava hits the ocean, where new land is forming and the steam is coming off the water area," Dr. Senft said. The two serious cases she treat- ed were from the affected area and offered no other explanation for their conditions. The recent cases were beyond the common cases she has treated stemming from volcanic smog, which is sulfur dioxide that pro- duces swelling, redness, and mild irritation on the surface of the eye, similar to allergic conjunctivitis symptoms. That clinical challenge has affected island residents since 1983, when there was a major erup- tion of Kilauea. "These cases were a punctate keratitis, it looked like a toxic chem- ical had gone in," Dr. Senft said. "Like if someone were to get into some type of industrial accident and spill battery acid in their eye, it looked like that." Local authorities have advised residents to stay indoors and use air conditioning or air purifiers on days of heavy volcanic activity. "In Hawaii, not a lot of people have air conditioning," Dr. Senft said. "It is usually windows open and trade winds, so this is a new thing for people." However, her use of air purifiers appeared to effectively counteract the volcanic air pollution, as well as working in an air conditioned environment. Suspected causes Dr. Senft thinks the accumulation of volcanic air pollution in the tear film was causing the problems she has seen. Other ophthalmologists in Ha- waii have told her they haven't seen such serious cases. But that would be expected since their areas are not receiving winds from the areas of the active volcano. "We're the ones who are getting the bad air and also the South Point area," Dr. Senft said. "They may occasionally get a Kailua-Kona wind that blows something over their way, but it's diluted by the time it gets over there compared to what we have here." Not much has been written about how to treat patients in the area of an active volcano because it is unusual, she said. "It was striking that both of these people who had this had it just in the interpalpebral fissure area," Dr. Senft said. The striking difference from similar serious cases was that pa- tients with a chemical irritation usu- ally have the entire cornea involved. "This was unique to the inter- palpebral fissure zone," Dr. Senft said. "It is only the part that was exposed. That's what made it so impressive." EW Editors' note: Dr. Senft has no financial interests related to her comments. Contact information Senft: senft808@gmail.com Volcanic continued from page 80 One week after transplantation of lenticule and amniotic membrane Outcome after corneal tissue lenticules from ReLEx SMILE for the treatment of corneal ulcer Source: Pavel Studeny, MD References 1. Pradhan KR, et al. Femtosecond laser-as- sisted keyhole endokeratophakia: correction of hyperopia by implantation of an allogeneic lenticule obtained by SMILE from a myopic donor. J Refract Surg. 2013;29:777–82. 2. Lim CH, et al. LASIK following small incision lenticule extraction (SMILE) lenticule re-implantation: a feasibility study of a novel method for treatment of presbyopia. PLoS One. 2013;8:e83046. 3. Mohamed-Noriega K, et al. Cornea lenticule viability and structural integrity after refractive lenticule extraction (ReLEx) and cryopreserva- tion. Mol Vis. 2011;17:3437–49. 4. Abd Elaziz MS, et al. Stromal lenticule transplantation for management of corneal perforations; one year results. Graefes Arch Clin Exp Ophthalmol. 2017;255:1179–1184. Editors' note: Dr. Studeny has no finan- cial interests related to his comments. Contact information Studeny: studenypavel@seznam.cz

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