All the methods allow non-contact biometry, but the results might differ due to measuring principles inherent to the system, experience of the examiner and compliance of the patient. Partial coherence interferometry with the AC-Master offers the advantage of measurement exactly along the optical axis with the highest reproducibility and patient compliance.
Aims: The use of the chemotherapeutic cytosine arabinoside (Ara-C) causes an ocular toxic reaction, characterized by aspecific keratopathy. We examined the pathway of the damaged cells by in vivo confocal microscopy. Methods: Prospective study of 11 patients with acute myeloic leukemia treated with high-dose Ara-C. Ten eyes developed fluorescein-negative punctate keratopathy, and were examined by slit lamp and in vivo confocal biomicroscopy at days 1, 3–4 and 9–14 after the beginning of ocular symptoms. Results: In vivo confocal microscopy revealed disseminated highly reflective granular irregular intraepithelial elements in the central cornea, which affected about 3% of epithelial cells. At day 1 of symptoms, these elements were present only in the basal epithelial layer (median 275.5/mm2), at days 3–4 they were mainly found in the basal (187.5/mm2) but also in the apical layers (96/mm2), at days 9–14 they mainly presented in more superficial layers (115/mm2 apically vs. 15.5/mm2 in the basal layers). Discussion: The intraepithelial distribution of cells with a granular cytosolic signal evolved over time, reflecting the migration of the necrotic basal cells to the wing cell layer and finally to apical epithelial layers. The desquamation of the necrotic cells is related to the resolution of symptoms, according to the period of the epithelial cell turnover. By confocal microscopy, we could follow the intraepithelial route of cells damaged by Ara-C in vivo.
Purpose: Transient ocular hypotony commonly occurs after 23-gauge (23G) vitrectomy. To assess possible causes, we visualized the sclerotomy site and pars plana by anterior segment optical coherence tomography (AS-OCT). Procedures: We prospectively analyzed the intraocular pressure (IOP) and findings related to clinical hypotony, assessed by AS-OCT, in 13 consecutive eyes of 13 patients receiving 23G vitrectomy. Five patients receiving a 20G vitrectomy served as controls. Results: The mean IOP after 23G vitrectomy was 11 mm Hg (range: 5–32 mm Hg; 13 eyes) at postoperative day 1. In contrast to controls, AS-OCT showed a scleral gap at the incision site in 22/39 sclerotomies (10/13 eyes), and subclinical choroidal detachment in 9/13 eyes. Conclusions: A scleral gap and choroidal detachment at the incision site are frequent findings following 23G vitrectomy. These subclinical features may account for postoperative hypotony as they are absent in 20G vitrectomy and scleral sutures. Hypotony following 23G vitrectomy is a self-limiting phenomenon and usually does not require therapeutic intervention.
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