Mean Best Spectacle-corrected Visual Acuity Research Articles

Effects of femtosecond laser-assisted minimally invasive lamellar keratoplasty (FL-MILK) on mild-to-moderate and advanced keratoconus.

To compare the outcomes of femtosecond laser-assisted minimally invasive lamellar keratoplasty (FL-MILK) for mild-to-moderate keratoconus (KC) and advanced KC. Prospective case series study. Sixty-three eyes of 56 patients with progressive KC underwent FL-MILK were divided into group 1 [mean keratometry (Kmean) ≤ 53D] and group 2 (Kmean > 53D). Best spectacle-corrected visual acuity (BSCVA), Kmean, maximum keratometry (Kmax), anterior central corneal elevation (ACE), stiffness parameter A1 (SP-A1) and deformation amplitude (DA) were evaluated preoperatively and up to 24months postoperatively. Mean BSCVA improved from 0.34 ± 0.13 logMAR preoperatively to 0.25 ± 0.13 logMAR at 24months postoperatively in group 1 (F = 10.10, P < .0001), and from 0.54 ± 0.31 logMAR to 0.40 ± 0.26 logMAR (F = 9.06, P = .0002) in group 2. Group 2 showed an average Kmax reduction of 10.9 D and an average Kmean reduction of 3.9 D at 24months postoperatively (both P < .0001), whereas no significant change was observed in group 1. Average ACE decreased from 19.2 ± 10.0 to 5.2 ± 8.4 at 24months postoperatively in group 1 (F = 28.5, P < .0001), and from 46.2 ± 16.3 to 19.1 ± 9.0 (F = 49.6, P < .0001) in group 2; SP-A1 increased from 53.8 ± 12.7mmHg/mm to 95.9 ± 20.2mmHg/mm in group 1 (F = 70.0, P < .0001), and from 38.6 ± 13.4mmHg/mm to 89.3 ± 18.2mmHg/mm (F = 96.9, P < .0001) in group 2; DA decreased from 1.30 ± 0.14mm to 1.17 ± 0.13mm in group 1 (F = 14.0, P < .0001), and from 1.40 ± 0.16mm to 1.18 ± 0.10mm (F = 27.6, P < .0001) in group 2. FL-MILK can stabilize progressive KC in mild-to-moderate cases and advanced cases at 24-month follow-up. Steeper corneas are more likely to undergo flattening after FL-MILK. Date of registration: July 16, 2017. The title of the trail: www. gov Trial registration number: NCT03229239. The name of the trial registry: ClinicalTrials.gov.

Relationship of Density, Depth, and Surface Irregularity of Superficial Corneal Opacification with Visual Acuity

Purpose To explore the relationship between the density, depth, and surface irregularity of superficial corneal opacities and vision. Methods This prospective imaging study included 19 patients with unilateral superficial corneal opacification due to scarring post-microbial keratitis. Each eye underwent an assessment of uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), contact lens corrected visual acuity (CLCVA), and Scheimpflug and anterior segment optical tomography imaging. Regression analysis was performed to detect the association between density, depth of scarring, and the surface irregularity in terms of higher order aberrations (HOA), and keratometry and UCVA, CLCVA, and the difference between BSCVA and CLCVA. Results The mean logMAR UCVA, BSCVA, and CLCVA were 0.76, 0.35, and 0.28, respectively. The corneal scars had a mean thickness of 158.7 ± 61 µ and density of 65.73 ± 24.46 GSU. Bivariate analysis model for UCVA showed an association with Z4 2 secondary astigmatism (p = 0.02), Z4 4 quadrafoil (p = 0.01), combined coma Z3 ± 1(p = 0.03), and combined HOA Z3–Z6 (p = 0.045), out of which Z4 4 Quadrafoil (p = 0.04) was most significant with multivariate analysis. Bivariate analysis for BCVA-CLVA showed association with Z3 1 coma horizontal (p = 0.04), Z3 3 oblique trefoil (p = 0.02), Z4 0 primary spherical aberration (p = 0.008), and Z5 − 5 (p = 0.007), out of which Z3 1 horizontal coma (p = 0.04) and Z4 0 spherical aberration (p = 0.009) were significant on multivariate analysis. Change in densitometry, corneal thickness, epithelial:stromal reflectivity ratio, scar depth, and keratometry did not show any significant association with UCVA, BSCVA-CLCVA, or CLCVA. Conclusion In superficial corneal stromal scarring, deranged surface irregularity parameters like higher-order aberrations affect the final visual acuity more than the depth or density of the opacity.

Cataract surgery outcomes in pediatric patients with systemic comorbidities.

The aim of the study was to evaluate the outcomes of cataract surgery in patients of the pediatric age group with systemic comorbidities. Medical records of 54 eyes (30 patients) of the pediatric age group with systemic comorbidities who had undergone cataract surgery in a tertiary-care center were reviewed. The following parameters were recorded: systemic comorbidity; toxoplasmosis, rubella, cytomegalovirus, herpes simplex, HIV (TORCH) profile, best spectacle-corrected visual acuity (BSCVA), strabismus, nystagmus, and cataract morphology. Thirty patients with a mean age of 55 months (9 months-14 years) were included. On average, every child was seen by three physicians, and the mean duration between the first visit to a physician and presentation to our center was 2.23 ± 0.67 years. The various causes for delay in referral include multiple referrals due to a lack of general anesthesia services in 78% of cases, a long waiting list at the referral hospital in 35% of cases, and a lack of awareness at the primary-care physician level in 50% of cases. The mean BSCVA at presentation was 1.4 logMAR (0.3 to 3 logMAR). The most common cataract morphology was that of zonular cataract (31.48%; 17/54). Strabismus and abnormal eye movements were observed in 27.7% (15/54) and 33.3% (18/54) of eyes, respectively. Various systemic associations were periventricular leukomalacia (12/30), Down's syndrome (6/30), seizure disorder (6/30), cardiac valvular anomalies (6/30), Marfan's syndrome (4/30), hypothyroidism (4/30), rubella (3/20), cytomegalovirus (3/20), cerebral palsy (2/30), nephrotic syndrome (2/30), Type 1 diabetes mellitus (1/30), microcephaly (1/30), cryptogenic West syndrome (1/30), congenital rubella syndrome (1/30), and Tourette syndrome (1/30). The mean postoperative corrected distance visual acuity (CDVA) at 2-year follow-up improved to 1.0 logMAR (0 to 3 logMAR). No postoperative complications were reported at the final follow-up. Around 70% of the parents reported improvement in their child's psychomotor skills. Intellectually impaired pediatric patients with cataract should be operated upon whenever there is a presence of infrastructure, and unnecessary delay in surgery should be avoided by referring the patient to higher centers. Even though objective improvement in visual acuity was suboptimal, there was definitely an improvement in the psychomotor skills of the patients.

Efficacy and safety of single-step transepithelial photorefractive keratectomy with the all-surface laser ablation SCHWIND platform without mitomycin-C for high myopia: A retrospective study of 69 eyes.

Studies suggest that transepithelial photorefractive keratectomy (TransPRK) with the all-surface laser ablation (ASLA)-SCHWIND platform is effective and safe for both low-moderate myopia and high myopia. In most studies, mitomycin-C is administered immediately after surgery to prevent corneal opacification (haze), which is a significant complication of photorefractive keratectomy in general. However, there is evidence that adjuvant mitomycin-C induces endothelial cytotoxicity. Moreover, a recent study showed that omitting adjuvant mitomycin-C did not increase haze in low-moderate myopia. The present case-series study examined the efficacy, safety, and haze rates of eyes with high myopia that underwent ASLA-SCHWIND TransPRK without adjuvant mitomycin-C. All consecutive eyes with high myopia (≤-6 D) that were treated in 2018-2020 with the SCHWIND Amaris 500E® TransPRK excimer laser without adjuvant mitomycin-C in a tertiary-care hospital (France) and were followed up for 6 months were identified. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and spherical equivalent (SE) were recorded before and after surgery. Postoperative haze was graded using the 4-grade Fantes scale. Efficacy rate (frequency of eyes with 6-month UCVA ≤0.1 logMAR), safety rate (frequency of eyes that lost <2 BSCVA lines), predictability (frequency of eyes with 6-month SE equal to target SE±0.5 D), efficacy index (mean UCVA at 6 months/preoperative BSCVA), and safety index (BSCVA at 6 months/preoperative BSCVA) were computed. Sixty-nine eyes (38 patients) were included. Mean preoperative and 6-month SE were -7.44 and -0.05 D, respectively. Mean 6-month UCVA and BSCVA were 0.00 and -0.02 logMAR, respectively. Efficacy rate and index were 95.7% and 1.08, respectively. Safety rate and index were 95.7% and 1.13, respectively. Predictability was 85.5%. Grade 3-4 haze never arose. At 6 months, the haze rate was zero. ASLA-SCHWIND TransPRK without mitomycin-C appears to be safe as well as effective and accurate for high myopia.

Epidemiology of Corneal Neovascularization and Its Impact on Visual Acuity and Sensitivity: A 14-Year Retrospective Study.

Purpose: To quantify the severity and location of corneal neovascularization (cNV) and its impact on the visual acuity and corneal sensitivity in a cohort of the patients referred to a specialist cornea clinic and also to describe the etiology of cNV in the cohort.Methods: We retrospectively evaluated the charts of 13,493 subjects referred to the San Raffaele Cornea Unit between January 2004 and December 2018 to search for cNV diagnosis. The corneal neovascularization severity was measured in the quadrants (range: 1–4) and location was defined as superficial, deep, or both. Best spectacle corrected visual acuity (BSCVA) was measured in logMar. We used the multiple regression analysis to identify the independent predictors of logMAR, after adjusting for age, gender, keratoconus, herpes keratitis, penetrating keratoplasty, trauma, and cataract surgery.Results: Corneal neovascularization was diagnosed in 10.4% of the patients analyzed. The most prevalent etiology of cNV in our population was non-infectious corneal dystrophies/degenerations followed by herpes simplex virus infection. cNV affected OD, OS, or both eyes in 35.6, 40.2, and 24.2 of cases, respectively. Mean BSCVA (SD) was 0.59 (0.76), 0.74 (0.94), and 1.24 (1.08) in cNV one, two, and three or four of the quadrant groups. Superficial, deep, or mixed cNV occurred in 1,029, 348, and 205 eyes. Severe cNV (three or four of the quadrants) was a significant predictor of low visual acuity (p < 0.001) and reduced corneal sensitivity (p < 0.05). cNV location and its severity were associated (p < 0.05). In addition, corneal anesthesia was associated with lower BSCVA (p < 0.001).Conclusion: Severe and deep cNV are associated with the reduced visual acuity and corneal sensitivity. Our data strongly support the relevance of appropriate follow-up as cNV is a major risk factor for graft rejection.

Long-term outcomes of Descemet stripping automated endothelial keratoplasty for bullous keratopathy after argon laser iridotomy.

To report the long-term outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) for bullous keratopathy secondary to argon laser iridotomy (BK-ALI). Retrospective chart review. Forty-five eyes from 41 consecutive patients with BK-ALI who underwent DSAEK from July 2007 to December 2013 were retrospectively analyzed. Best spectacle-corrected visual acuity (BCVA), endothelial cell density (ECD), and any complications were investigated over a 10-year postoperative period. The mean BCVA improved from 0.80 logMAR before DSAEK to 0.28 logMAR at 6months after DSAEK; the mean values showed an additional slight improvement between 6months and 10years after the surgery (P < .01). The mean ECD decreased from 2864 cells/mm2 at baseline to 2269 cells/mm2 (20.8% loss) at 6months post-DSAEK, and this decreasing trend continued throughout the 10years after DSAEK (P < .01). The mean ECD was 1148 cells/mm2 (59.9% loss) after 5years, and 568 cells/mm2 (80.2% loss) after 10years. No graft deaths were observed throughout the 10-year period (5-year follow-up rate 60.0%, 10-year follow-up rate 20.0%). The 10-year outcomes of DSAEK for BK-ALI were excellent with a high graft survival rate.

Stromal peeling for deep anterior lamellar keratoplasty in post-penetrating keratoplasty eyes

Background/aimsTo evaluate the clinical outcomes of deep anterior lamellar keratoplasty performed by stromal peeling in eyes that have previously undergone penetrating keratoplasty (PK) for keratoconus.MethodsStandardised stromal exchange included (1) 9...

Two-Years Corneal Collagen Cross-Linking Outcomes in Patients with Keratoconus

Aims: This study aimed to report refractive, topographic, and tomographic outcomes of 2-years corneal collagen cross-linking in patients with progressive keratoconus. Materials and Method: This prospective study was conducted on76 eyes of 40 patients with progressive keratoconus and a corneal thickness of at least 400?m. After the baseline examination, cross-linking was performed using riboflavin 0.1% and ultraviolet irradiation (370 nm, 3 mW/cm2) for 30 min. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction spherical equivalent (MRSE), cylinder, keratometric readings, and corneal thickness were evaluated at baseline, 6, 12, and 24 months after corneal collagen cross-linking. Results: Results showed that at a 24-month follow-up, mean BSCVA, and UCVA had significant improvements. Changes in MRSE and cylinder were not significant during the two years of follow-up. At a 2-years follow-up, the mean values of minimum keratometry, maximum keratometry, and average keratometry decreased significantly to0.75, 0.97, and 0.52 D, respectively, compared to their baseline values. Anterior best fit sphere (BFS) also had significant difference at 24-month follow-up compared to base line evaluation. The central corneal thickness decreased significantly up to38 ? after 2 years. Conclusion: Corneal collagen cross-linking is an effective treatment to stop the progression of keratoconusas shown by reduced keratometry and improved vision.

Descemet Membrane Endothelial Keratoplasty versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty: A Multicenter Randomized Controlled Clinical Trial

To compare best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), refractive astigmatism, and complications after Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK). Prospective, multicenter randomized controlled trial. Fifty-four pseudophakic eyes of 54 patients with corneal endothelial dysfunction resulting from Fuchs endothelial corneal dystrophy were enrolled in 6 corneal centers in The Netherlands. Participants were allocated to DMEK (n= 29) or UT-DSAEK (n= 25) using minimization randomization based on preoperative BSCVA, recipient central corneal thickness, gender, age, and institution. Donor corneas were prestripped and precut for DMEK and UT-DSAEK, respectively. Six corneal surgeons participated in this study. The primary outcome measure was BSCVA at 12 months after surgery. Central graft thickness of UT-DSAEK lamellae measured 101 μm (95% confidence interval [CI], 90-112 μm). Best spectacle-corrected visual acuity did not differ significantly between DMEK and UT-DSAEK groups at 3 months (0.15 logarithm of the minimum angle of resolution [logMAR] [95% CI 0.08-0.22 logMAR] vs. 0.22 logMAR [95% CI 0.16-0.27 logMAR]; P= 0.15), 6 months (0.11 logMAR [95% CI 0.05-0.17 logMAR] vs. 0.16 logMAR[95% CI 0.12-0.21 logMAR]; P= 0.20), and 12 months (0.08 logMAR [95% CI 0.03-0.14 logMAR] vs. 0.15 logMAR [95% CI 0.10-0.19 logMAR]; P= 0.06). Twelve months after surgery, the percentage of eyes reaching 20/25 Snellen BSCVA was higher in DMEK compared with UT-DSAEK (66% vs. 33%; P= 0.02). Endothelial cell density did not differ significantly 12 months after DMEK and UT-DSAEK (1870 cells/mm2 [95% CI 1670-2069 cells/mm2] vs. 1612 cells/mm2 [95% CI 1326-1898 cells/mm2]; P= 0.12). Both techniques induced a mild hyperopic shift (12 months:+0.22 diopter [D; 95% CI -0.23 to 0.68 D] for DMEK vs.+0.58 D [95% CI 0.13-1.03 D] for UT-DSAEK; P= 0.34). Descemet membrane endothelial keratoplasty and UT-DSAEK did not differ significantly in mean BSCVA, but the percentage of eyes achieving 20/25 Snellen vision was significantly higher with DMEK. Endothelial cell loss did not differ significantly between the treatment groups, and both techniques induced a minimal hyperopic shift.

Outcomes of big-bubble deep anterior lamellar keratoplasty for pediatric keratoconus.

To evaluate the outcomes and complications of deep anterior lamellar keratoplasty (DALK) performed for pediatric keratoconus. This retrospective study enrolled 44 consecutive eyes of 39 keratoconus-affected children (≤ 18years of age). All patients underwent big-bubble DALK from March 2004 to June 2016. The outcome measures included postoperative best spectacle-corrected visual acuity (BSCVA), manifest refraction, keratometry readings, and complications. The mean participant age was 16.8 ± 1.4years, and the mean follow-up period was 68.5 ± 39.9months. Successful big bubble was achieved in 33 eyes (75.0%), while the surgical technique was predescemetic DALK in 11 (25.0%). The mean BSCVA changed from 1.34 ± 0.49 LogMAR preoperatively to 0.24 ± 0.10 LogMAR postoperatively (P < 0.001). The mean keratometry decreased from 59.54 ± 5.17D preoperatively to 46.23 ± 2.17D postoperatively (P < 0.001). The complications encountered during the study period were intraoperative Descemet's membrane perforation (n = 5, 11.4%), the Urrets Zavalia syndrome (n = 1, 2.3%), graft epithelial problems (n = 3, 6.8%), subepithelial graft rejection (n = 5, 11.4%), high intraocular pressure (n = 8, 18.2%), and traumatic wound dehiscence (n = 2, 4.6%). Suture-related complications included premature loosening (n = 13, 29.6%), broken sutures (n = 12, 27.3%), suture-tract vascularization (n = 6, 13.6%), suture-associated abscesses (n = 5, 11.4%), and suture cheese wiring (n = 2, 4.6%). A clear graft was found in 40 eyes (90.9%) at the last follow-up examination. This study showed promising results with big-bubble DALK in keratoconus-affected children. A frequent and close follow-up with dedicated parental involvement is essential for the early recognition and management of postoperative complications.

Deep anterior lamellar keratoplasty in eyes previously treated with collagen crosslinking for keratoconus: 3-year results

To evaluate the 3-year results of deep anterior lamellar keratoplasty (DALK) using the big-bubble technique in keratoconus patients with previous corneal collagen crosslinking (CXL) treatment. Twenty eyes of 20 keratoconus patients who underwent DALK surgery using the big-bubble technique after CXL treatment between January 2011 and September 2015 were retrospectively reviewed. All patients completed 3years follow-up. Intraoperative and postoperative complications were recorded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), maximum keratometry, keratometric astigmatism and endothelial cell density (ECD) were analysed. The mean interval between CXL and DALK surgery was 47.5 ± 24.0months (mean ± SD). DALK was completed in all eyes. Big-bubble was successfully achieved in 16 eyes (80%), and manual dissection was performed in four eyes (20%). Microperforation occurred in three eyes (15%). Postoperatively, persistent epithelial defect occurred in three eyes (15%). The mean UCVA and mean BSCVA values were significantly improved preoperatively to all postoperative visits (p < 0.001). UCVA was 20/100 or lower in all eyes preoperatively and 20/100 or better in 18 eyes (80%) at 3years; BSCVA was 20/40 or better in all eyes (100%) and 20/20 or better in three eyes (15%), and keratometric astigmatism was lower than 4 dioptres in 14 eyes (70%) at 3years. The mean ECD loss was 6.3 ± 4.4% at 1year, 9.0 ± 6.3% at 2years and 11.2 ± 7.4% at 3years. Previous CXL treatment in keratoconus patients did not cause a negative impact on the visual, refractive and surgical outcomes of DALK surgery using the big-bubble technique. DALK surgery seems to be a safe and effective surgical approach in these patients.

Outcomes of difluprednate treatment for corneal graft rejection

ObjectiveTo evaluate outcomes of difluprednate treatment in penetrating keratoplasty (PK) graft rejection DesignRetrospective, interventional case series. ParticipantsPatients treated with difluprednate for acute endothelial rejection after PK. MethodsData were collected on resolution of rejection, treatment regimen used, best spectacle-corrected visual acuity (BSCVA), intraocular pressure (IOP), and side effects. Main outcome measure: rate of rejection resolution. Secondary outcome measures: BSCVA change and side-effect rates. ResultsThirty-three eyes of 33 patients aged 56.7 ± 17.9 years were included. Twenty-four grafts (72.7%) were high-risk grafts. Complete treatment success was achieved in 19 of 33 grafts (57.6%) over 1.8 ± 1.4 months. Non-high-risk grafts had 100% treatment success rate (9 of 9 grafts). All treatment failures occurred in high-risk grafts, which had a significantly lower treatment success rate of 41.7% (10 of 24 grafts) compared with non-high-risk grafts (p = 0.004). Mean BSCVA in the treatment-success group improved from 1.07 ± 0.74 logMAR at the time of rejection to 0.44 ± 0.33 logMAR after treatment (p = 0.003). High-dose difluprednate (every 1–3 hours while awake) was used in 93.9% of eyes. IOP elevation and toxic epitheliopathy were each seen in 21.2% of patients. IOP elevation was managed successfully with topical medication and/or difluprednate discontinuation. Epitheliopathy resolved in all cases after completion of difluprednate treatment, except for one case complicated by an infected ulcer. ConclusionsHigh-dose difluprednate was effective in treating PK graft rejection, especially in non-high-risk grafts. Adjunct treatment may be required in high-risk grafts. Monitoring for IOP elevation and for toxic epitheliopathy is recommended.

Effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty.

To investigate the effects of corneal thickness distribution and apex position on postoperative refractive status after full-bed deep anterior lamellar keratoplasty (FBDALK). This is a retrospective analysis of patients who were diagnosed with advanced keratoconus between 2011 and 2014 in our hospital. The base of the cone in all patients did not exceed the central cornea at a 6-mm range. The FBDALK was performed by a same surgeon. All patients had a complete corneal suture removal and the follow-up records were intact. Patients who had graft-bed misalignment or who were complicated with a cataract or glaucoma were excluded. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), and Pentacam examination data were recorded at two years postoperatively. The recorded data included the superior-inferior (S-I) and nasal-temporal (N-T) corneal thickness differences in 2, 4, 6, and 8 mm diameter concentric circles with the corneal apex as the center (S-I2 mm, S-I4 mm, S-I6 mm, S-I8 mm, N-T2 mm, N-T4 mm, N-T6 mm, and N-T8 mm), the linear, X-axis, and Y-axis distance between the corneal pupillary center and the cornea apex, total corneal astigmatism at a zone of 3 mm diameter from the corneal apex (TA3 mm), the astigmatic vector values J0 and J45, and the corneal total higher-order aberration for 3 and 6 mm pupil diameters (HOA3 mm and HOA6 mm). Statistical analysis was performed by SPSS 15.0. A total of 47 eyes of 46 patients met the criteria and were included in this study. The mean follow-up time was (28±7) months. The mean UCVA was 0.45±0.23 (logMAR) (MAR: minimum angle of resolution) and the mean BSCVA was 0.19±0.15 (logMAR), which were all significantly positively correlated with postoperative TA3 mm and HOA3 mm. The mean S-I corneal thickness differences were (44.62±37.74) μm, and the mean N-T was (38.57±32.29) μm. S-I2 mm was significantly positively correlated with J0 (r=0.31), J45 (r=0.42), HOA3 mm (r=0.37), and HOA6 mm (r=0.48). S-I4 mm and S-I8 mm were significantly positively correlated with HOA3 mm (r=0.30, r=0.40) and HOA6 mm (r=0.46, r=0.35). The X-axis distance between corneal pupillary center and corneal apex was significantly positively correlated with J45 (r=0.29). In patients with advanced keratoconus after FBDALK, the unevenly distributed thickness at corneal pupillary area and the misalignment of corneal apex and pupillary center might cause significant regular and irregular astigmatism, which affected the postoperative visual quality.

Retrospective Single-Center Registry Study on Graft Thickness 1 Year After Descemet Stripping Automated Endothelial Keratoplasty.

To compare the graft thickness of eye bank precut grafts with graft thickness measured 1 year after Descemet stripping automated endothelial keratoplasty (DSAEK) and to correlate the graft thickness of eye bank precut grafts with best spectacle-corrected visual acuity (BSCVA) and endothelial cell density (ECD) 1 year after DSAEK. This was a retrospective registry study of 183 eyes of 179 DSAEK patients. Grafts were cut in the eye bank after 1 day in dextran-containing medium, and thickness was measured by optical coherence tomography immediately after precutting. Examinations 1 year after DSAEK included optical coherence tomography for graft thickness, BSCVA, and specular microscopy. Patients were divided into 2 groups based on the median graft thickness. The correlations between original graft thickness and graft thickness measured 1 year later, BSCVA, and ECD were analyzed by linear regression analyses. Graft thickness decreased from 116 ± 36.8 μm before to 100 ± 36.8 μm 1 year after DSAEK (R =0.901, P <0.0001). Mean BSCVA 1 year after DSAEK was 0.24 logMAR in eyes without ocular comorbidity. BSCVA was 0.25 ± 0.16 (0.21-0.28) and 0.20 ± 0.11 (0.18-0.23) in eyes with a graft thickness above or below 111 μm, respectively (P = 0.04). ECD loss 1 year after surgery did not correlate with graft thickness (R = 0.0006, P <0.875). Graft thickness measured immediately after precutting correlates strongly with graft thickness measured 1 year after DSAEK. This study suggests that ultrathin grafts provide better visual acuity 1 year after DSAEK than regular grafts.

Long-Term Functional and Anatomical Outcome after Descemet Stripping Automated Endothelial Keratoplasty: A Prospective Single-Center Study.

Purpose To investigate the long-term anatomical and functional outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK). Methods Prospective follow-up of 114 eyes (95 subjects) after DSAEK for endothelial dysfunction. Measurements included best spectacle-corrected visual acuity (BSCVA), straylight, endothelial cell density (ECD), and graft thickness. Results The mean follow-up time was 5.1 ± 1.5 years. Four grafts ultimately failed (after 5 to 7 years). From baseline up to 1 year after DSAEK, mean BSCVA improved by 0.30 logMAR. This beneficial effect remained until the last follow-up (LFU). After DSAEK, straylight was reduced. ECD sharply dropped by 900 cells/mm2 (33%) immediately after surgery and, thereafter, steadily decreased at a rate of 11 cells/mm2 per month. No significant correlation was observed between graft thickness at 3 years and BSCVA. Conclusions We observed a low graft failure rate and a normalization of graft thickness. Postoperative straylight remained elevated relative to the normal population. The sharp initial and the subsequent more gradual ECD decline are consistent with other studies. A significant and prolonged functional gain can be achieved by posterior lamellar grafting for endothelial dysfunction.

Impact of donor graft quality on deep anterior lamellar Keratoplasty (DALK)

BackgroundTo evaluate main features of donor tissue that may influence clinical outcome or complication rate after deep anterior lamellar keratoplasty (DALK).MethodsDonor tissue parameters of 84 consecutive corneal donor grafts used for big-bubble DALK surgery between June 2011 and December 2014 in 84 eyes of 84 patients with disorders of anterior corneal stroma were correlated to clinical outcome parameters of recipient eyes 12 months after surgery and 3 months after total suture removal. Main donor tissue parameters included age), post-mortem time, overall preservation time, preservation time after split and prior to transplantation, and preservation technique. Clinical outcome parameters included best spectacle corrected visual acuity (BSCVA), central corneal thickness (CCT), endothelial cell density (ECD) and complication rates. Pearson’s correlation, linear regression analysis for clinical outcome parameter and logistic regression analysis for postsurgical complication rates were applied.ResultsCorneal donors were mean aged 67.4 ± 12.5 years with a post-mortem time of 20.7 ± 14.7 h and ECD of 2641.0 ± 362.8 cells/mm2. Overall preservation time was 16.3 ± 6.3 days. Recipients showed mean BSCVA 12 months postoperatively of 0.60 ± 0.36 logMAR, endothelial cell loss was 4 ± 16%, and central corneal thickness was 571.7 ± 54.2 μm. 3 months after total removal of sutures, BSCVA was 0.20 ± 0.10 logMAR, endothelial cell loss was 17 ± 24%, and central corneal thickness was 590.9 ± 55.5 μm. Loosening of sutures occurred in 20%, and Descemet detachment in 16%. None of the clinical outcome parameters or complication rate after DALK showed a significant association with donor tissue parameters.ConclusionsDonor corneas, independent of excision techniques or preservation method, with donor age ≤ 88 years, post-mortem time ≤ 63 h, overall preservation time ≤ 14 days for cold storaged donor tissue and ≤35 days for organ culture, and preservation time after split prior to grafting ≤96 h, seem to be applicable as safe donor tissue for DALK surgery.

Comparison of Oral Voriconazole Versus Oral Ketoconazole as an Adjunct to Topical Natamycin in Severe Fungal Keratitis: A Randomized Controlled Trial.

To compare the efficacy of oral voriconazole (VCZ) with oral ketoconazole (KCZ) as an adjunct to topical natamycin in severe fungal keratitis. Fifty eyes of 50 patients with proven severe fungal keratitis, (>5 mm size, involving >4 mm central cornea and >50% stromal depth), smear, and/or culture positive were randomized to receive either oral VCZ (n = 25) or oral KCZ (n = 25) 200 mg twice a day. Both groups received topical natamycin along with oral medication. The primary outcome measure was best spectacle-corrected visual acuity (BSCVA) at 3 months of follow-up. Secondary outcomes were the percentage of healed cases and scar size. The mean BSCVA after treatment was 1.3 ± 0.35 logarithm of minimum angle of resolution units in the VCZ group and 1.6 ± 0.39 logarithm of minimum angle of resolution units in the KCZ group [P = 0.004, 95% confidence interval (CI), -0.10 to 0.54]. The final mean scar size was smaller for oral VCZ than for oral KCZ (P = 0.04, 95% CI, -0.01 to 0.93 mm). The percentage of cases healed were 80% and 72% in VCZ and KCZ groups, respectively (P = 0.51, 95% CI, -0.15 to 0.31). The ratio of tear film to serum concentration of oral VCZ was better than oral KCZ at days 14 (P = 0.002) and 21 (P = 0.006). Although the duration and percentage of healing was similar in both groups, oral VCZ attained a significantly better tear film concentration with a smaller scar size and better BSCVA compared with oral KCZ. Thus, oral VCZ may be preferred over oral KCZ in severe fungal keratitis.

Comparison of visual and topographic outcomes of deep-anterior lamellar keratoplasty and penetrating keratoplasty in keratoconus.

To compare visual, surgical and topographic outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for keratoconus (KC). In this multicenter, prospective, randomized clinical trial 76 eyes of 71 KC patients operated between January 2011 and July 2014 in 2 tertiary referral hospitals were included. Consecutive patients were alternately selected to receive one of the two surgical methods. Thirty eight eyes underwent DALK with the big-bubble technique and 38 eyes underwent PK. Mean best spectacle corrected visual acuity (BSCVA) at the first postoperative week (P=0.012) and the first postoperative month (P<0.001) was statistically significantly higher in DALK group. The mean BSCVA at 12mo was not significantly different for DALK (0.30±1.99 logMAR) versus PK (0.40±0.33 logMAR) (P=0.104). The 76.3% of the eyes had a BSCVA over 0.5 in DALK and 47.4% in PK group (P=0.009). The 7.9% of the eyes had a BSCVA of 1.0 in DALK and 5.3% in PK group (P=0.644). Mean spherical equivalent was -2.94 D in DALK and -3.09 D in PK group. Mean topographic astigmatism was 4.62 D and 4.18 D respectively. Regular topographic patterns were observed in 31 (81.6%) of DALK and 29 (76.3%) of PK (P=0.574). The most frequent topographic pattern was oblate asymmetric bow tie, seen in 39.5% in DALK and 23.7% in PK. Big bubble DALK provides an earlier visual improvement compare to PK. However, visual and topographic outcomes are similar to those in PK at 1y. Postoperative complications including rejection and intraocular pressure elevation are more frequent in PK. DALK is a safer alternative to PK for KC. However, intraoperative perforation of the Descemet's membrane is a significant complication.

Aberrometric Outcomes of Intrastromal Corneal Ring Segment (KeraRing 355) Implantation Using PocketMaker Microkeratome in Patients with Keratoconus

Objective: To evaluate aberrometric changes in corneas with keratoconus implanted with intrastromal corneal ring segment (Keraring 355) during a 3-months follow-up. Design: Prospective, consecutive case series Methods: In this interventional study, 22 eyes of 21 keratoconic patients with mean age of 29 ± 6 years who underwent KeraRing 355 intrastromal corneal ring insertion using a Pocket Maker Microkeratome for channel creation and completed at least three months of follow-up were included. Uncorrected visual acuity (UCVA), best spectacle corrected visual acuity (BSCVA), refractive outcome, Orbscan finding and corneal aberrations were assessed. Results: Three months postoperately, Low order aberration (defocus and astigmatism) decreased significantly (P<0.001). No statistically significant changes were detected in total RMS, trefoil, secondary trefoil and coma. Moreover, a statistically significant increase in quatrefoil, secondary coma, spherical aberration and secondary spherical was found. In term of visual outcomes, the mean UCVA (in LogMAR value) improved significantly from 0.75 ± 0.33 to 0.31 ± 0.23 and the mean BSCVA improved (from 0.31 ± 0.16 to 0.19 ± 0.15) (P<0.05). The mean spherical refractive error improved (from -1.37 ± 1.36 to 0.01 ± 2.47) and the mean cylindrical refractive error decreased significantly (from -3.8 ± 1.03 to -2.1 ± 1.27 (P<0.001)). Also, the mean keratometry value decreased from 47.61 ± 2.03 to 42.50 ± 2.76. Conclusion: KeraRing 355 implantation provided significant improvement in low order aberrations but was not effective in high order aberrations (HOA) in low/moderate keratoconus patients. However, UCVA, BCVA, spherical and cylindrical refractive error and keratometry results improved significantly.

Deep Anterior Lamellar Keratoplasty After Descemet Stripping Automated Endothelial Keratoplasty

To report the indications and long-term outcomes of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DSAEK) in cases of visually significant stromal opacities. Retrospective, interventional, consecutive case series. Setting: Private hospital. Thirteen eyes that underwent DALK after DSAEK at our institution. Indications for DALK after DSAEKincluded both stromal opacities persisting after DSAEK and stromal opacities occurring secondarily in post-DSAEK corneas. DALK was always performed in a standardized fashion including exchange of a disc of full-thickness recipient cornea (up to the DSAEK stromal surface),7.0mm in diameter, with a donor lamella obtained by microkeratome-assisted dissection, punched to 7.0mm and sutured into place with a double running 10-0 nylon suture. Best spectacle-corrected visual acuity (BSCVA), manifest refraction, and endothelial cell density (ECD). Mean follow-up was 26 ± 18months (range= 6-60months). Indications for DSAEK were full-thickness graft failure (n= 8), DSAEK graft failure (n= 3), and pseudophakic bullous keratopathy (n= 2). Indications for subsequent DALK were persisting stromal opacity (n= 9) and stromal opacities newly occurred after DSAEK as a result of HSV keratitis (n= 2) or interface infection (n= 2). After complete suture removal, mean BSCVA was 20/28 (0.14 ± 0.8 logMAR) in eyes without ocular comorbidities affecting visual acuity (n= 7), while refractive astigmatism was within 4diopter (D) in all but 1 eye (average= 3.2 ± 1.4 D). No intraoperative complications were recorded. Performing DALK on DSAEK eliminates the need for open-sky surgery, achieving visual results comparable to those of penetrating keratoplasty, while sparing a healthy endothelial graft.