Cornea
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To describe the clinical course of a patient requiring ophthalmic care for entropion and fungal keratitis in the setting of undiagnosed enophthalmos after previous ventriculoperitoneal shunting consistent with silent brain syndrome. ⋯ In patients with silent brain syndrome, the lack of apposition between the eyelids and the globe results in entropion, trichiasis, lagophthalmos, and ocular irritation. This can complicate entropion repair and the severity of infectious keratitis. We also propose that the enlarged fornices seen in silent brain syndrome can also serve as a reservoir for infection, similar to the pathogenesis seen in the giant fornix syndrome.
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To evaluate an innovative technique for intrastromal air injection to achieve deep anterior lamellar keratoplasty (DALK) with bare Descemet membrane (DM). Thirty-four eyes with anterior corneal pathology, including 27 with keratoconus, underwent DALK. After 400 μm trephination with a suction trephine, ultrasound pachymetry was performed 0.8 mm internally from the trephination groove in the 11 to 1 o'clock position. ⋯ Microperforations occurred in 5 cases: 3 during manual layer-by-layer dissection after air injection failed to detach the DM, 1 during removal of the residual stroma after big-bubble formation, and 1 during the diamond knife incision. Two cases (5.9%) were converted to penetrating keratoplasty because of macroperforations. The technique was reproducible, safe, and highly effective in promoting DALK with bare DM.