Fuchs Dystrophy Research Articles

Region of Interest Densitometry Analysis of Descemet Membrane Endothelial Keratoplasty Dehiscence on Anterior Segment Optical Coherence Tomography.

PurposeTo evaluate a region of interest (ROI) method of analyzing anterior segment optical coherence tomography (AS-OCT) corneal densitometry (CD) in the setting of Descemet membrane endothelial keratoplasty (DMEK) dehiscence.MethodsRetrospective chart review of eyes that underwent (1) DMEK for Fuchs dystrophy (2) between 2018 to 2020 with (3) a partial DMEK dehiscence on AS-OCT, (4) involvement of only one side of the graft, (5) high-quality corneal AS-OCT scan, and (6) location of dehiscence within the central 5.5 mm of the cornea. Image analysis of the ROIs with ImageJ compared the total edematous area, mean stromal CD, and ratio of anterior-to-posterior (A/P) stromal CD for regions of DMEK dehiscence compared to the contralateral side with an attached DMEK graft. Control regions (with no dehiscence) and postdehiscence resolution images were also analyzed.ResultsSeventy sectors of the 21 images from 21 eyes with DMEK dehiscence were included. Compared to the contralateral side, regions of DMEK dehiscence had larger total areas (P < 0.0001), lower mean stromal CD (P = 0.0003), and higher A/P stromal CD (P < 0.0001). All control regions and postdehiscence resolution images did not show any significant differences compared to the contralateral sides.ConclusionsThis technique to analyze multiple ROIs on AS-OCT can be useful to evaluate CD of specific regions of corneal pathology. Lower mean stromal CD and higher A/P stromal CD may specify corneal edema.Translational RelevanceAnalyzing CD via multiple specific ROIs may be more suitable than measuring the CD of the full cornea and has broader applications extending to other corneal pathologies.

Descemet membrane endothelial keratoplasty in a patient with iris-fixated intraocular lens and prior radial keratotomy: a case report

BackgroundAnterior segment surgeries such as cataract surgery, intraocular lens (IOL) repositioning, and radial keratotomy (RK) may hasten endothelial dysfunction, particularly in the context of pre-existing Fuchs dystrophy, necessitating future corneal transplantation.Case presentationA 68-year-old woman with a history of RK with associated irregular astigmatism in both eyes and iris-fixated intraocular lens (IF-IOL) in the left eye presented with six months of decreased vision in the left eye. She was found to have Fuchs dystrophy and underwent DMEK surgery. She had an uncomplicated postoperative course, with uncorrected visual acuity improving to 20/20 three months after surgery.ConclusionTo our knowledge, this is the first reported case of a highly successful DMEK surgery in a patient with prior RK and IF-IOL.

Chirurgie de cataracte seule chez le patient porteur d’une dystrophie endothéliale de Fuchs

While endothelial keratoplasty has become the standard treatment for Fuchs dystrophy, the strategy for first-line surgery in patients with associated cataract is still debated. The purpose of this study was to evaluate the surgical outcomes of eyes with Fuchs endothelial corneal dystrophy (FECD) undergoing phacoemulsification alone, to ascertain preoperative factors that predict the need for endothelial keratoplasty (EK). Single-center retrospective study. Cataract surgery alone was performed in 64 eyes of 50 patients with FECD. This decision was made if the patient did not have morning blur, the central corneal thickness (CCT) was below 630 microns, and endothelial cells were visible in the periphery. Mean follow-up was 21 months (range 5-55 months). The mean preoperative CCT was 571±43μm. 6 months after surgery, it was 584±52μm (P=0.12). During follow-up, 14 eyes (22%) required an EK because of poor visual outcome after cataract surgery alone. Mean pre-operative CCT of these eyes (595±23μm) was significantly higher than eyes that did not require EK during follow-up (564±45μm, P=0.022). Over 570 microns, 34% of eyes required an endothelial keratoplasty after the cataract surgery alone. CCT below 630μm associated with the absence of morning blur are preoperative criteria allowing 78.1% eyes with FECD to obtain good visual outcomes after cataract surgery alone. In these eyes, EK can therefore be avoided while ensuring good results.

Postoperative supine position after primary Descemet-stripping automated endothelial keratoplasty reduces graft detachment rate

ObjectiveTo characterize the association between prolonged supine postoperative positioning of patients undergoing Descemet-stripping automated endothelial keratoplasty (DSAEK) and graft dislocation rate. MethodsIn this retrospective cohort study, medical records of patients who underwent uncomplicated DSAEK surgery at Yitzhak Shamir Medical Center between 2010 and 2019 were reviewed. Nursing documentation of patients’ adherence to supine positioning during the postoperative hospitalization period was collected. A patient was considered compliant if he or she was documented as cooperative with supine positioning throughout the first 24 hours. ResultsA total of 170 eyes of 138 patients were found eligible. Main indications for surgery were pseudophakic bullous keratopathy (50.6%), previous graft failure (25.9%), and Fuch's endothelial dystrophy (FED; 20.6%). Twelve surgeries were combined with cataract extraction. Postoperative graft detachment occurred in 26 eyes (15.3%) after an average period of 1 day (range, 0–20 days). Compliance with supine positioning was documented in 84.1% (n = 143 patients). Noncompliance rates during the first 24 hours in the detached and nondetached groups were 26.9% (n = 7) and 14.4% (n = 20), respectively; after adjustment for possible confounders, the odds ratio (OR) was 1.44 (p = 0.249). Graft dislocation was observed in 13.3% (19 of 143) and 25.9% (7 of 27) of cooperative and noncooperative patients, respectively (p = 0.17). Subanalysis of 120 eyes with either BPK or FED for which it was the first transplantation demonstrated a protective effect of supine positioning (OR 3.42, confidence interval 1.095–10.700; p = 0.034). Findings for both groups remained unchanged in multivariate analysis. ConclusionsWe found a statistically significant protective effect of 24 hours of postoperative supine positioning against graft detachment after DSAEK in eyes with no prior transplantations.

Impact of Pre- and Intraoperative Factors on Endothelial Cell Density in the Early and Late Stage after Penetrating Keratoplasty.

This retrospective investigated the impact of donor age, recipient age, donor endothelial cell density, vis-à-tergo, and additional intraoperative lens exchange (triple-procedure) on overall early and late phase postoperative endothelial cell density (ECD) following penetrating keratoplasty (PKP) in various diagnosis groups. In 590 cases with diagnosed keratoconus (KC), Fuchs dystrophy (FD) and herpes simplex virus infection (HSV) who underwent PKP or triple surgery, the ECD in cells/mm2 was analysed, both preoperatively, with all-sutures-in (early postoperative stage), and after last suture removal. The factors were tested by Mann-Whitney U-test, correlation analysis and linear regression analysis. Correlation analysis demonstrated a weak negative correlation between the patient's ECD and donor age (early postoperative stage: r = - 0.25, p < 0.001; after last suture removal: r = - 0.16; p = 0.003). Regression analysis revealed that donor age did not impact postoperative patient ECD. There was a weak negative correlation between postoperative ECD and recipient age (early postoperative stage: r = - 0.31, p < 0.001; after last suture removal: r = - 0.34, p < 0.001). Regression analysis confirmed the negative impact of recipient age on patient ECD (early postoperative stage: β = - 13.2, p = 0.001; after last suture removal: β = - 4.6, p < 0.001). Correlation analysis determined a weak positive correlation between postoperative ECD and donor endothelial cell density (early postoperative stage: r = 0.37, p < 0.001; after last suture removal: r = 0.32, p < 0.001). Regression analysis also determined that donor endothelial cell density had a positive impact on postoperative ECD following last suture removal (β = 0.4, p < 0.001). Vis-à-tergo and additional lens exchange (triple procedure) had no significant effect on postoperative ECD (p > 0.05). This was also confirmed by the results of the regression analysis after last suture removal. Recipient age and donor endothelial cell density have a significant impact on postoperative ECD following PKP. Not all of the statistical tests proved donor age to be a significant influencing factor. Vis-à-tergo and additional lens exchange (triple procedure) had no significant effect on postoperative ECD following PKP.

Anterior Chamber Characteristics, Endothelial Parameters, and Corneal Densitometry After Descemet Stripping Automated Endothelial Keratoplasty in Patients With Fuchs Dystrophy.

PurposeTo compare anterior segment parameters in patients with Fuchs endothelial dystrophy (FED) who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) in one eye and no corneal surgery in the fellow eye.MethodsThis prospective study was conducted on 28 eyes of 14 patients with FED who underwent DSAEK in one eye at least one year prior (DSAEK group) and no corneal surgery in the fellow eye (control group). Each eye was analyzed with the anterior segment optical coherence tomography, specular microscopy, and Scheimpflug imaging systems. Data were compared between the two groups.ResultsThe mean age of the patients was 76.9 7.0 years. There were no statistically significant differences in the mean central corneal thickness (CCT), central anterior chamber depth, anterior chamber angle parameters, cylinder and keratometry values between two groups (all P-values 0.05). The paracentral corneal thickness, corneal volume, endothelial cell density, and hexagonal cell ratio measurements were statistically significantly higher in the DSAEK group than the control (all P-values < 0.05), and anterior chamber volume in the DSAEK group was significantly less than the control (P = 0.046). While posterior and total corneal densitometry values in the DSAEK group were statistically significantly lower than the control (P < 0.001 and P = 0.011, respectively), there were no statistically significant differences in the anterior or middle corneal densities (P = 0.108 and P = 0.134, respectively).ConclusionWe found that total corneal densitometry value decreased in DSAEK group. Although DSAEK surgery did not affect the anterior chamber angle parameters, it reduced the anterior chamber volume and increased the corneal volume and paracentral corneal thickness due to the addition of the DSAEK graft.

Randomized, Double-Masked, Pilot Study of Netarsudil 0.02% Ophthalmic Solution for Treatment of Corneal Edema in Fuchs Dystrophy

To evaluate off-label use of netarsudil 0.02% for treatment of corneal edema associated with Fuchs dystrophy. Prospective, randomized clinical trial. Twenty-nine subjects with symptomatic Fuchs dystrophy were enrolled and randomized to use netarsudil or placebo eye drops once daily for 3 months. The primary outcomes were the change in central corneal thickness between baseline and 1 month and between baseline and 3 months. Secondary outcomes included change in scotopic corrected distance visual acuity (CDVA) at 3 months and change in scores on a visual disability questionnaire validated for use with Fuchs dystrophy. Compared with use of placebo, use of netarsudil produced significant reduction in central corneal thickness at 1 month (mean difference, -20 µm; 95% confidence interval, -32 to -9 µm) and 3 months (mean difference, -26 µm; 95% confidence interval, -39 to -12 µm) and significant improvement in scotopic CDVA at 3 months (mean difference +1.6 lines; 95% confidence interval, 0.2-3.0 lines). Scores on the visual disability questionnaire did not change significantly in either arm or differ significantly between arms. One subject assigned to netarsudil had baseline epithelial bullae and withdrew from the study because of disabling glare. Use of netarsudil was associated with reduction of corneal edema and improvement in scotopic CDVA in Fuchs dystrophy patients. Further study is needed to more fully assess patient satisfaction and visual acuity under various lighting conditions and to compare use of netarsudil with other treatment options such as endothelial keratoplasty.

Predicting Edema Resolution After Descemet Membrane Endothelial Keratoplasty for Fuchs Dystrophy Using Scheimpflug Tomography

Predicting the extent of corneal edema resolution after Descemet membrane endothelial keratoplasty (DMEK) may help in preoperative decision-making by identifying patients who may benefit from restoring endothelial function. To develop and validate a predictive model for edema resolution after DMEK using Scheimpflug tomographic imaging. Two prospective studies recruited participants with advanced Fuchs dystrophy at a university-based tertiary referral center between July 1, 2017, and August 31, 2019. Analyses were designed in November 2019 and completed on June 30, 2020. Development of a predictive model using linear least absolute shrinkage and selection operator regression was conducted in a derivation cohort (100 eyes). Overall performance, discrimination, and calibration were tested in the separate validation cohort (32 eyes). Preoperative Scheimpflug parameters and patient-reported visual disability were considered as potential predictors of edema resolution: (1) tomographic features (irregularity of lines of equal corneal thickness, displacement of the thinnest point of corneal thickness from the inferior-temporal quadrant, and absolute amount of focal posterior corneal depression), (2) standardized anterior and posterior corneal backscatter, (3) preoperative central corneal thickness, and (4) Fuchs dystrophy-specific visual disability. Decrease in central corneal thickness after DMEK indicative of edema resolution. Of the 88 patients included in the analysis, 54 were women (61%); median age was 68 years (interquartile range [IQR], 59-76 years). A median of 13 months after DMEK (IQR, 9-16 months), median corneal thickness was 77 μm lower (IQR, 51-94 μm) in the derivation cohort and 75 μm lower in the validation cohort (IQR, 54-96 μm) than before surgery. Per 10-μm edema resolution, eyes gained 0.66 Early Treatment Diabetic Retinopathy Study letters (95% CI, 0.09-1.23) in best-corrected visual acuity. Three tomographic features were present in 68 of 100 eyes (68%) in the derivation cohort and in 18 of 32 eyes (56%) in the validation cohort before DMEK and in only 1 of 132 eyes (1%) after DMEK. To predict edema resolution after DMEK based on preoperative assessment, 5 variables were selected by the statistical learning algorithm: nonparallel isopachs, focal posterior depression, anterior and posterior corneal backscatter, and central corneal thickness. In the separate validation cohort, the model showed high overall performance, discrimination, and calibration. These post hoc analyses of prospective cohorts support a model for use in the prediction of edema resolution after DMEK using Scheimpflug measurement to identify patients benefitting most from DMEK.

Comparaison de l’acuité visuelle, des complications et de la satisfaction des patients entre la chirurgie de kératoplastie ambulatoire ou en hospitalisation

Our objective in this work was to compare visual acuity, complication rate, rate of unplanned visits in the month following the procedure, and patient satisfaction between patients who received a corneal transplant as an outpatient or inpatient. Our work focused on 19 patients (6 inpatients and 13 outpatients), who had undergone unilateral keratoplasty between May 2018 and December 2018. The indications for corneal transplant were keratoconus, Fuchs dystrophy and graft rejection. All patients who were followed for at least one month had an improvement in their VA. There were on average as many postoperative consultations in the inpatient group as in the outpatient group. Complications occurred in 77% of inpatients versus 40% of outpatients. The rate of consultations in the month following the operation was similar in both groups. Patients were satisfied with outpatient management. No similar studies have been conducted to our knowledge. This preliminary work is limited by the small number of patients and questionnaires received and the length of follow-up. The criteria for outpatient care are very important to limit complications. For corneal transplantation, hospitalisation is most often performed with an average stay of 2to 5days. Outpatient management seems, according to our preliminary work, to be able to be extended into more centres without changing the postoperative follow-up or increasing the rate of complications, allowing lower cost and patient satisfaction. The previous lack of this type of study, as well as the encouraging results of this work, open the way to larger scale prospective comparative as well as medico-economic studies.

Review on the Use of Topical Ocular Hypertonic Saline in Corneal Edema.

To review the effectiveness of topical ocular hypertonic saline in corneal edema. Online literature search of published articles on the effectiveness of topical hypertonic saline in corneal edema, bullous keratopathy (BK), and other associated corneal conditions in humans was performed on April 16, 2020. A total of 16 articles were reviewed after curation by the authors for relevance, with 4 randomized control trials, 6 prospective studies, 4 retrospective studies, and 2 case reports. Efficacy of hypertonic saline eye drops varied widely, depending on the specific corneal disorder being treated. Six of the studies involved BK (edema involves epithelium), 2 in corneal edema limited to the stroma, 5 in Fuchs dystrophy, 3 in filamentary keratitis (the presence of filaments attached to corneal epithelium), 2 in recurrent corneal erosion, and 1 in jellyfish stings. There was limited efficacy for hypertonic saline in BK, whereas clinical improvement was noted in most studies for corneal edema without epithelial involvement, especially if associated with Fuchs dystrophy or corneal hydrops in keratoconus. Hypertonic saline also seems to be beneficial for other corneal disorders, such as filamentary keratitis and jellyfish stings, but not in recurrent corneal erosion. Adverse effects from topical hypertonic saline include a mild stinging or burning sensation, with no serious complications having been reported. Topical ocular hypertonic saline seems to be a safe and effective treatment in the management of less severe forms of corneal edema and other corneal disorders such as filamentary keratitis.

Corneal dystrophies: A decade of experience in a reference center in Bogotá, Colombia

Purpose: To describe sociodemographic findings, frequency, and clinical characteristics of patients with corneal dystrophy who consulted an ophthalmologic national reference center in Bogotá-Colombia in 10 years.Methods: Observational, descriptive case series study was carried out. The information was obtained from reviewing medical records of patients who consulted the cornea service at an ophthalmologic national reference center in Bogotá-Colombia between 2008 and 2018. The diagnosis of corneal dystrophy was done according to the International Committee for Corneal Dystrophies classification, as well as the currently accepted specific name of the dystrophy. The type of dystrophy, clinical, diagnostic findings, sociodemographic characteristics, and type of treatment were evaluated.Results: A total of 151 eyes of 79 patients were analyzed; 68.3% of subjects were female. The mean age was 57.6 ± 18.9 years, with a range between 2 and 95 years. The median best-corrected visual acuity (BCVA) in all the groups at diagnosis was 0.30 LogMAR (interquartile range 0.5) or 20/40 Snellen. Lattice dystrophy type 1 and its variants had the worse BCVA. Fuchs' dystrophy (FD) was the most frequently identified. Regarding treatment, 80.1% (n = 121) did not require any, and 11.9% (n = 18) had a corneal transplant. Thirteen underwent penetrating keratoplasty. Of those, two had a clinical diagnosis of TGFB1 dystrophy, three of stromal dystrophy, and eight of endothelial dystrophy. DSAEK was performed in 5 eyes four had endothelial dystrophy and one had unclassified dystrophy.Conclusions: Adults and females were the most affected groups. FD was the most frequent and unclassified dystrophies were the second most frequently diagnosed. This highlights the importance of complementary studies such as optical coherence tomography of the anterior segment and genetic markers which are not currently universally available in our healthcare system.Ethical considerations: This study was approved by the Institutional Ethics Committee and was conducted in accordance with the principles of the Declaration of Helsinki.

Editorial introductions

Current Opinion in Ophthalmology was launched in 1990. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of Ophthalmology is divided into nine sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Editor and Section Editor for this issue. EDITOR Allen C. HoAllen C. HoDr Allen C. Ho is an Attending Surgeon of the Retina Service and Director of Retina Research of Wills Eye Hospital, USA. He is Professor of Ophthalmology at Thomas Jefferson University School of Medicine, USA. Dr Ho is a founding member of Mid Atlantic Retina. He is author of multiple textbooks including Age Related Macular Degeneration Diagnosis and Treatment, The Wills Eye Hospital Color Atlas and Synopsis of Retinal Disease and is Editor-in-Chief of Current Opinion in Ophthalmology and Chief Medical Editor of Retina Today, a global publication that features new therapies for retinal disease. He is a member of the Scientific Editorial Boards of Retina Cases and Brief Reports, Ophthalmic Surgery, Lasers and Imaging, Retinal Physician, and Ocular Surgery News. Dr Ho has been an invited lecturer at numerous national and international ophthalmic meetings around the world. He is a recipient of multiple clinical research grants investigating new treatments for macular diseases sponsored by the National Eye Institute and received the American Academy of Ophthalmology's Achievement Award and Senior Achievement Award and the American Society of Retina Specialists Crystal Apple Award. Dr Ho is Principal Investigator at Wills Eye Institute of several collaborative clinical trials evaluating new treatments for age-related macular degeneration, surgical retina and diabetic retinopathy. He maintains special interests in macular diseases, diabetic retinopathy, surgical retinal diseases and clinical trials investigating new treatments for vitreoretinal diseases SECTION EDITOR Natalie A. AfshariNatalie A. AfshariNatalie A. Afshari is Stuart I. Brown MD Chair in Ophthalmology in Memory of Donald P. Shiley, Chief of Cornea and Refractive Surgery, Vice Chair of Education, and Professor of Ophthalmology at the Shiley Eye Institute, University of California, San Diego. Prior to this, she was Professor of Ophthalmology and Director of Centers of Excellence at the Duke University Eye Center. She received her medical degree from Stanford University and her residency training at Harvard University, Massachusetts Eye and Ear Infirmary. She then completed a two-year fellowship in cornea and refractive surgery at Harvard University. Dr Afshari is the recipient of the Senior Achievement Award and the Secretariat Award by the American Academy of Ophthalmology and has been named a Gold Fellow of the Association for Research in Vision and Ophthalmology. She has received the inaugural Top Ten Women in Medicine award by Triangle News, Women Who Mean Business award by San Diego Business Journal, and the Teacher of the Year award at the Duke University Eye Center. She has also been recognized in the Best Doctors in America in each listing for the past decade, and was named in the U.S. News & World Report's Top Doctors List. Dr Afshari is the co-editor of a new two-volume cornea book called “Principles and Practice of Cornea”. She is also on the editorial boards of Investigative Ophthalmology and Visual Science and American Journal of Ophthalmology. She has previously served on the EyeNet editorial board, BCSC Cornea text book committee, and the American Academy of Ophthalmology council representing the American Society of Cataract and Refractive Surgery. She was co-chair of the cornea program committee for the Association for Research in Vision and Ophthalmology and co-director of Cornea Subspecialty Day for the American Academy of Ophthalmology. She is currently the chair of the American Society of Cataract and Refractive Surgery FDA Committee. Her NIH research grant is on the study of Fuchs dystrophy, and she investigates the intricacies of endothelial keratoplasty and regeneration of cornea. When not researching or practicing, Dr Afshari donates her time and surgical expertise as an international volunteer. She has traveled to West Africa, Central America, and Mexico to help patients who might otherwise go untreated.

Random Survival Forests Analysis of Intraoperative Complications as Predictors of Descemet Stripping Automated Endothelial Keratoplasty Graft Failure in the Cornea Preservation Time Study

A new analytic method can evaluate factors of interest associated with graft failure after Descemet stripping automated endothelial keratoplasty (DSAEK) or more generally in any ophthalmic surgical setting with a time-to-event outcome. To reanalyze types of intraoperative complications associated with DSAEK graft failure in the Cornea Preservation Time Study using random survival forests. This cohort study, initially conceived in April 2019, used a prediction model to conduct a post hoc secondary analysis of data collected in a multicenter, double-masked, randomized clinical trial. Forty US clinical sites with 70 surgeons participated, with donor corneas provided by 23 US eye banks. The study included 1090 participants, representing 1330 eyes, undergoing DSAEK for Fuchs dystrophy (1255 eyes [94.4%]) or pseudophakic or aphakic corneal edema (75 eyes [5.6%]). Enrollment occurred between April 16, 2012, and February 20, 2014, and follow-up ended June 5, 2017. Statistical analysis was performed from July 10, 2019, to May 29, 2020. Descemet stripping automated endothelial keratoplasty with random assignment of a donor cornea with preservation time of 7 days or less or 8 to 14 days. Ranked variable importance for intraoperative complications among 50 donor, recipient, and eye bank variables and restricted mean survival time through 47 months (1434 days) after DSAEK were examined. Random survival forests, a nonparametric method (with less restrictive model assumptions) that is far more flexible in its ability to model nonlinear effects and interactions, was used to analyze the data. This study included 1090 participants (663 women [60.8%]; median age, 70 years [range, 42-90 years]), representing 1330 eyes. Random survival forests ranked a DSAEK intraoperative complication as the third most predictive factor of graft failure, after surgeon and eye bank, in the final model with 5 predictors. In the first 47 months after DSAEK, the estimated mean difference in restricted mean survival time for grafts that experienced a DSAEK intraoperative complication vs those that did not was -227 days (99% CI, -352 to -70 days) based on the final RSF model. These findings, while post hoc, support the hypothesis that random survival forests allow for an improved analytic approach for identifying factors predictive of graft failure and for obtaining adjusted graft survival estimates. Random survival forests offer the opportunity to guide the development of future population-based cohort ophthalmic surgical studies, establishing definitive factors for procedural success.

Descemet Stripping Automated Endothelial Keratoplasty

The purpose is to determine if the preoperative central endothelial cell density (ECD) in triple (phacoemulsification plus intraocular lens implantation plus DSAEK) and non-triple Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) procedures have a relationship with the 5-year postoperative ECD or percent Endothelial Cell Loss (ECL).Out of 986 consecutive DSAEK surgeries for Fuchs dystrophy, 241 eyes had 5-year ECD measurements available. Endothelial cell densities were then evaluated against preoperative ECDs to obtain measures of ECL. Triple and non-triple procedures were isolated and compared independently.One hundred eighty two eyes had undergone a triple procedure and 59 had not. The mean ECD at 5 years was 1560 ± 648 cells/mm2 for triples and 1483 ± 621 cells/mm2 for non-triples (P = .42). Endothelial Cell loss was 44.4% ± 21.7% and 44.4% ± 22.0%, respectively for eyes that underwent a triple or non-triple (P = .99). There was a moderate, but significant correlation between preoperative ECD and the ECD at 5 years after DSAEK for both triples (r = 0.39, P < .001), and non-triples (r = 0.32, P = .01), respectively.In Descemets stripping automated endothelial keratoplasty grafts, higher preoperative donor ECD was correlated with higher ECD at 5 years postoperatively but was unaffected by a concurrent cataract surgery in the triple procedure.

Hyperopic shifts and anterior curvature flattening after Descemet-stripping endothelial keratoplasty and cataract surgery in 2 patients with a history of myopic LASIK

Two patients with a history of myopic laser in-situ keratomileusis (LASIK) experienced larger-than-expected hyperopic results after cataract surgery and Descemet-stripping endothelial keratoplasty (DSEK) for Fuchs endothelial corneal dystrophy. Although an anticipated hyperopic shift from DSEK-related posterior curvature steeping was taken into account during IOL power calculations, the refractive outcome was still more hyperopic than expected. Postoperative analysis revealed significant and unexpected flattening of the anterior corneal curvature that is not common after standard DSEK. Central anterior stromal ablation from myopic LASIK might make the cornea more prone to swelling and anterior steepening as Fuchs dystrophy progresses, increasing corneal power. A subsequent reduction in swelling might then cause central flattening and contribute to hyperopic errors after combined cataract–endothelial keratoplasty surgery.

Factors influence bullous keratopathy post cataract surgery at National Eye Center of Cicendo Eye Hospital (PMN RSMC), West Java, Indonesia

Background: Bullous keratopathy is one of the leading causes of vision loss following cataract surgery. Several factors have been elucidated regarding the influence of bulosa keratopathy post cataract surgery. This study aims to evaluate pre-, intra-, and postoperative predisposition factors for bullous keratopathy following cataract surgery.Methods: A retrospective descriptive study was done using data extracted from medical records. Patients diagnosed with bullous keratopathy after cataract surgery who underwent further examination procedures for at least 3 months were included. Patients with a history of glaucoma, Fuch's dystrophy, or other intraocular procedures were excluded. Data were analyzed by SPSS version 20 for Windows.Results: Fourteen cases were included in this study. Most cases were female (78.57%) aged ≥60 years old (64.29%). There were postoperative changes in visual acuity and corneal status in most patients without any change in intraocular pressure. The majority of patients underwent manual small incision cataract surgery with posterior chamber intraocular lens implantation. Intraoperative complications were vitreous prolapse and Descemet membrane stripping, while postoperative complications were uveitis and lens adhesion.Conclusion: Bullous keratopathy after cataract surgery was more common in elderly females. There were notable changes in visual acuity and corneal status postoperatively. Further large-scale analytic study is warranted to confirm the predictive factors and causality.

Peripheral-to-central ratio of Guttae: validity and reliability of an objective method to characterize severity of Fuchs endothelial corneal dystrophy.

Common methods of measuring severity of Fuchs endothelial corneal dystrophy (FECD) are limited in objectivity, reliability, or start with a variable baseline that prevents distinguishing healthy from affected eyes. The aim of this study was to describe a method of grading FECD that overcomes these limitations. Fifteen patients with Fuchs endothelial corneal dystrophy were included in the study. Guttae were imaged with a slit lamp beam 8mm tall; the bottom 4mm half of each image was divided into two equally-sized sections. Guttae were counted by four independent graders blinded to disease severity scores. The peripheral:central guttae ratio was compared to modified Krachmer clinical severity scores. The peripheral:central guttae ratio was compared between mild (severity 0.5-3) versus moderate-to-severe (severity 4-5) disease. Receiver operating characteristics defined optimal ratio cutoffs for mild versus moderate-to-severe disease. Increased peripheral guttae and peripheral:central guttae ratio correlated with Krachmer severity (p = 0.021 and p = 0.009, respectively). The difference between mild and moderate-to-severe cases for the peripheral:central guttae ratio was significant (p < 0.001). Inter-rater reliability of total guttae count was high (coefficient = 0.82, p < 0.001). A peripheral:central guttae ratio of 0.16 was the ideal cut-off point (area under the curve = 0.79, sensitivity = 0.78, and specificity = 0.80). In this pilot study, the peripheral:central ratio of guttae correlates with subjective clinical severity of Fuchs dystrophy. It starts at a common baseline, has good inter-rater reliability, does not require dilation, and can be conducted with a smartphone and slit-lamp.

Influence of graft thickness and regularity on vision recovery after endothelial keratoplasty

AimTo assess the influence of graft thickness and regularity on visual recovery and postoperative wavefront aberrations after endothelial keratoplasty (EK).Methods150 EKs performed in eyes with corneal endothelial disorders and no...

Rezidivierendes DMEK-Versagen

Wir berichten über einen Fuchs-Endotheldystrophie-Patienten mit drei „Descemet Membrane Endothelial Keratoplasty“ (DMEK) bei rezidierendem Transplantatversagen mit Intraokulardruckerhöhung und cystoides Makulaödem. Bei der dritten DMEK wurde Herpes im Vorderkammeraspirat nachgewiesen und eine adäquate Therapie eingeleitet. Bei der 6 Monaten-Kontrolle blieb die Hornhaut klar, der Visus betrug 0,8, der Intraokulardruck lag im Normbereich und das Makulaödem bildete sich zurück. Entweder wurde eine latente Herpes simplex Virus(HSV)-Infektion des Patienten reaktiviert oder eine befallene Spender-Lamelle transplantiert mit Spender-zu-Wirt-zu-Spender „Ping-Pong“ Übertragung.

Four-Year Survival of Descemet Membrane Endothelial Keratoplasty in Patients With Previous Glaucoma Surgery

To evaluate 4-year outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with previous glaucoma surgery. Retrospective, comparative case series. Patients with previous trabeculectomy or glaucoma drainage device (GDD) implantation who later underwent DMEK (study group) were matched for follow-up duration with Fuchs dystrophy DMEK patients (control group). The minimum follow-up was 18months. Primary outcomes included graft survival and rejection rates, and secondary outcomes included rates of detachment/rebubble, endothelial cell loss, best spectacle-corrected visual acuity, intraocular pressure, and glaucoma medications/surgeries. Subgroup analysis compared eyes with and without a GDD. Ninety-four eyes of 91 patients were included. There were 51 eyes of 49 patients in the study group (GDD= 32 eyes, no GDD= 19 eyes) and 43 eyes of 42 patients in the control group. The mean follow-up was 37.9 ± 15.2 and 33.8 ± 13.5months, respectively (P= .322). Graft survival probability of the study group at 12, 24, 36, and 48months was 75%, 60%, 43%, and 27%, respectively, compared with a consistent 88% in the control group (P < .001). Survival curves of study subgroups (GDD and no GDD) were significantly lower than the control group (P < .001). Rejection rates in the study and control groups were 19.6% and 2.3%, respectively (P= .010). Endothelial cell loss in the study group was 12%-22% higher than the control group at 12, 24, 36, and 48months (P= .049, P= .027, P= .200, and P= .004). In eyes with previous glaucoma surgery, DMEK has good early outcomes, but longer-term rejection and failure rates are high. Physicians and patients should be cognizant of the high likelihood of graft failure in this setting.