The purpose of the study is to report the visual, refractive, and wound healing pattern outcomes of femtosecond assisted deep anterior lamellar keratoplasty (DALK) compared to the conventional manual technique. DALK was performed on 50 eyes of 47 advanced keratoconus patients. The patients were divided into two groups, 25 eyes each, depending on whether femtosecond assisted or manual DALK technique was performed for the side cut of the procedure only. Patients were followed up at 1 month, 6 months, and 1 year for visual acuity, clinical refraction, corneal cylinder, date of suture removal, and side cut corneal healing pattern according to new grading classification of the side cut scar (Grade 0 = transparent scar, 1 = faint healing opacity, 2 = evident healing opacity, 3 = significant opacity with some cosmetic imbalance, and 4 = highly significant opacity with very significant cosmetic imbalance). Outcomes are reported at one year. In conclusion, femtosecond assisted and manual DALK show comparable visual and refractive outcomes but femtosecond assisted DALK shows more evident corneal wound healing patterns at the side cut. This observation may indicate that an activated cornea wound healing might allow earlier suture removal when femtosecond technology is used to perform the side cut for DALK.

Purpose: To evaluate the morphological changes of the ciliary body after diode laser trans-scleral cyclo-photocoagulation using ultrasound bio-microscopy in refractory glaucoma. Settings: This prospective, interventional, non-comparative, non-randomized, longitudinal study was performed on 40 eyes with refractory glaucoma, during the period between February 2016 and March 2018. Methods: All patients were treated with single session diode laser trans-scleral cyclo-photocoagulation. The intraocular pressure was obtained over a period of 3 months after the operation and morphological changes of the ciliary body were observed using ultrasound bio-microscopy. Results: Trans-scleral cyclo-photocoagulation has achieved a reasonable success in reducing intraocular pressure to less than 22 mm Hg without increasing the number of glaucoma medication. The overall success rate was 40%, as the intraocular pressure decreased from a baseline mean value of 54.70 ± 12.27 to 42.45 ± 9.85 mm Hg 1 week after operation, 33.50 ± 8.00 mm Hg after 1 month, and 25.60 ± 6.62 after 3 months of operation. Ultrasound bio-microscopy detected reduction in the length and width of ciliary processes in addition to the ciliary muscle thickness of the treated quadrants. Intraocular pressure was more correlated to the width of the ciliary processes. Conclusion: Trans-scleral cyclo-photocoagulation is a rapid and effective procedure in treatment of refractory glaucoma with intraocular pressure reduction. Ultrasound bio-microscopy is a promising twin tool for cyclo-destructive procedures to detect ciliary body changes and can be used as a guide for re-treatment procedures.

Optical coherence tomography has emerged over the years with the ability to detect changes in the optic nerve head, retinal nerve fiber layer, and currently the ganglion cell layer much earlier than the defects manifest functionally. Thus, optical coherence tomography acts as an important diagnostic aid to diagnose and monitor the progression of this sight threatening disease called glaucoma.