cellulase and Corneal-Diseases

Descemetocele is a severe complication of corneal ulceration associated with a high risk of perforation. We describe a modified air-assisted deep anterior lamellar keratoplasty (DALK) technique for the surgical management of small and large epithelialized descemetoceles.. Two representative cases are presented, one with a small (2 mm) and one with a large (4 mm) descemetocele. In both cases, the air-assisted lamellar dissection allowed a superficial keratectomy and access to the Descemet membrane. Viscoelastic was then directly injected through the stromal hole to separate the Descemet membrane from the posterior stroma, thereby allowing its complete removal.. DALK was successfully performed using this modified air-assisted DALK technique. Visual acuity improved from counting fingers and hand motion to 20/40 and was maintained for at least 1 year after surgery.. These cases demonstrate that the modified air-assisted DALK technique may be proposed for the management of small and large descemetoceles, allowing both tectonic and visual rehabilitation.

Topics: Adult; Bacterial Proteins; Cellulase; Corneal Diseases; Corneal Stroma; Corneal Transplantation; Corneal Ulcer; Descemet Membrane; Epithelium, Corneal; Herniorrhaphy; Humans; Male; Middle Aged

To describe a patient with a history of epithelial basement membrane dystrophy who developed symptomatic corneal verticillata after vandetanib therapy for anaplastic astrocytoma.. Retrospective interventional case report.. A 48-year-old female patient with a history of anaplastic astrocytoma status post resection, external beam radiation, and chemotherapy presented with glare symptoms, decreased contrast sensitivity, and increased lacrimation after approximately 12 months of therapy with the anti-epidermal growth factor receptor (EGFR) and anti-vascular endothelial growth factor receptor 2 protein tyrosine kinase inhibitor, vandetanib. Ophthalmic examination revealed diffuse corneal verticillata and fine subepithelial opacities. Schirmer 1 testing was normal bilaterally. Therapy with carboxymethylcellulose, 5% sodium chloride ointment, and a decrease in the dose of vandetanib led to an improvement in the patient's ophthalmic symptoms despite persistence of the corneal findings. The patient remained under surveillance for tumor recurrence.. Vandetanib (ZD6474), a protein tyrosine kinase inhibitor with dual anti-EGFR and anti-vascular endothelial growth factor receptor 2 action, may have contributed to the formation of corneal verticillata in our patient. Inhibition of EGFR, which is involved with corneal epithelial cell migration and wound healing, may play a role in the pathogenesis underlying corneal vortex keratopathy and ocular surface conditions with significant epithelial turnover.

Topics: Astrocytoma; Brain Neoplasms; Cellulase; Corneal Diseases; Corneal Opacity; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Therapy, Combination; ErbB Receptors; Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Ointments; Piperidines; Quinazolines; Retrospective Studies; Sodium Chloride; Vascular Endothelial Growth Factor Receptor-2