Visual acuity and endothelial cell density with respect to the graft thickness in Descemet's stripping automated endothelial keratoplasty:one year results

AIM: To evaluate the visual acuity and endothelial cell density according to thethickness in Descemet's stripping automated endothelial keratoplasty (DSAEK) one year after surgery.METHODS: DSAEK patients' data were reviewed. Thirty-seven eyes of 37 patients who underwent DSAEK for pseudophakic bullous keratopathy (PBK) were included in this study. Graft thickness was measured with optical coherence tomography (OCT) 12mo after DSAEK. Eyes were divided into 3 groups based on the graft thickness:thick (>200 μm), medium-thick (150-200 μm) and thin (<150 μm). Best corrected visual acuity (BCVA), endothelial cells density (ECD) and complications were assessed and comparisons were done between groups.RESULTS:There was no significant difference in age, sex, preoperative BCVA, or follow-up period between DSAEK groups. At postoperative 12mo, mean BCVA was 0.28±0.10 in thick graft group, 0.52±0.08 in medium-thick graft group, and 0.72±0.06 in thin graft group. Thin grafts showed better postoperative BCVA as compared with the medium-thick and thick grafts (P=0.001). Thick graft group had 1637.44±88.19-mm², medium thick graft had 1764.50±34.28-mm² and thin graft group had 1845.30±65.62-mm² ECD at 12mo after the surgery. Thin graft group had better ECD at 12mo after surgery (P=0.001).CONCLUSION: Thin grafts after DSAEK ensure better visual rehabilitation. Eyes with thin grafts had significantly lesser loss of ECD compared to eyes with medium-thick and thick grafts one year after surgery.     

Complications and management in Descemet's stripping endothelial keratoplasty: Analysis of consecutive 430 cases

Purpose:

To analyze the complications and their managements in Descemet''s stripping endothelial keratoplasty (DSEK) in consecutive 430 cases by single surgeon in a tertiary eye hospital.

Materials and Methods:

430 eyes of 366 patients with endothelial dysfunctions scheduled for DSEK, were analyzed retrospectively. In all cases donor dissection was performed manually, and ‘Taco’ insertion and unfolding technique was used. Intra-operative and postoperative complications with their managements and outcomes were reviewed retrospectively. Periodic endothelial cell density was analyzed for each patient till the last visit. Follow-up period was between 3 to 60 months (mean 18.7 months).

Results:

13 (3.0%) eyes had operative complications during donor dissection and 16 (3.7%) had during recipient procedure. In 7 (1.6%) eyes, donor lenticule was replaced with a new one during the surgery. In early postoperative period, 21 (4.9%) eyes had donor dislocation and 12 (2.8%) eyes had air-induced pupillary block; and they were managed immediately. 2 cases had primary graft failure and in 1 case had postoperative bacterial endophthalmitis requiring evisceration. In late postoperative period, 48 (11.3%) eyes had secondary glaucoma and 14 (3.3%) eyes had late secondary graft failure. Endothelial rejection occurred in 5 (1.2%) cases. Mean endothelial cell loss was 19.7% after 3 months and 54.2% after 5 years. Total graft failure in this series was 31 (7.2%) and in 17 cases re-DSEK was performed successfully.

Conclusions:

Both operative and postoperative complications do occur in DSEK. Most of these complications can be managed by medical or appropriate surgical means. Some of the complications can be avoided and reduced with experience.     

No-Touch Technique and a New Donor Adjuster for Descemet's Stripping Automated Endothelial Keratoplasty

Purpose

One difficulty with Descemet''s stripping automated endothelial keratoplasty (DSAEK) is air management during surgery and donor endothelial lamella centering. We evaluated the no-touch technique for donor centering and the use of a newly developed DSAEK donor adjuster.

Methods

We evaluated the records of 12 consecutive patients (mean age 75.3 years) with bullous keratopathy who had undergone DSAEK. In all cases, the no-touch technique was attempted first. When the no-touch technique failed, a DSAEK donor adjuster with a 30-gauge cannula resembling a curved reverse Sinskey hook was used for donor centering. The adjuster allows air injection during donor centering.

Results

The no-touch technique using simple corneal surface massage to center the graft was successful in 4 cases (33.3%), while 4 cases required ocular tilting (33.3%) in addition to corneal surface massage. The no-touch technique was ineffective in 4 cases (33.3%), but the donor adjuster was used successfully and easily for these patients. Comparing the endothelial cell loss rate between the no-touch technique group and the donor adjuster group, there was no significant difference at 6 months.

Conclusions

The no-touch technique was useful for better control of DSAEK donor centering in most cases. When the no-touch technique was ineffective, the DSAEK donor adjuster was uniformly successful.Key Words: Descemet''s stripping automated endothelial keratoplasty, No-touch technique, Donor adjuster     

A Comparison of Posterior Lamellar Keratoplasty Modalities: DLEK vs. DSEK

Purpose

To compare clinical outcomes after deep lamellar endothelial keratoplasty (DLEK) with Descemet stripping endothelial keratoplasty (DSEK) performed as initial cases by a single surgeon.

Methods

Sixteen patients with corneal endothelial were enrolled. Eight patients (8 eyes) underwent DLEK and 8 patients (8 eyes) DSEK. We measured uncorrected visual acuity, best corrected visual acuity (BCVA), manifest refraction, corneal endothelial count, interface opacity via Schiempflug imaging, and contrast sensitivity, as well as tracked postoperative complications over the first postoperative year.

Results

Primary graft failure occurred in two DLEK cases and one DSEK case, all of which were excluded for further analysis. The average 12-month postoperative BCVA was 20/70 in the DLEK group and 20/50 in the DSEK group, with the difference not statistically significant. No significant differences were identified between the 2 groups in terms of mean spherical equivalent and refractive astigmatism, although individuals in the DSEK group tended toward hyperopia. The average endothelial cell count at postoperative month 12 was 1849±494 in the DLEK group and 1643±417 cells/mm² in the DSEK group, representing cell losses of 26.2% and 31.9%, respectively. No significant differences in endothelial cell count or endothelial cell loss were observed between groups. Early postoperative donor disc dislocation occurred in two eyes after DLEK and one eye after DSEK. Interface opacities and contrast sensitivities were similarly not significantly different between groups.

Conclusions

No significant differences in any assessed clinical outcome were observed between individuals undergoing DLEK and DSEK, when performed as initial cases by a single surgeon.     

Tissue quality of eye-bank–prepared precut corneas for Descemet’s stripping automated endothelial keratoplasty

Objective

To evaluate endothelial cell density (ECD) of eye-bank–prepared tissue for use in Descemet’s stripping automated endothelial keratoplasty (DSAEK).

Design

Prospective case series of consecutive corneal tissue prepared for DSAEK surgery.

Participants

Sixty-seven sequential corneal-scleral tissue specimens representing 48 human donors processed for use in DSAEK surgery by the Regional Tissue Bank (Halifax, Nova Scotia).

Methods

Corneal-scleral donor tissue was obtained by in situ recovery. ECD was recorded using the EB-3000 XYZ (HAI Laboratories Inc, Lexington, MA) specular microscope within 24 hours of preservation. Before the tissue was dissected, the corneal thickness was measured using the DGH-550 PACHETTE 2 (DGH Technology, Exton, PA) ultrasound pachymeter. The dissection was performed using a 300-μm Moria ALTK model microkeratome (Moria Inc). The posterior bed thickness was measured, and the anterior flap was replaced. Endothelial cell count density was obtained after re-preservation.

Results

Complete measurements were obtained for 42 of 67 corneas. In 25 corneas it was not possible to obtain a postdissection ECD measurement. The mean ECD before dissection was 2806 ± 317 cells/mm². The mean ECD after dissection was 2772 ± 318 cells/mm². There was an average loss of 34 cells/mm² (95% CI –110 to 40 cells/mm², p = 0.3).

Conclusions

This case series confirms that ECD is preserved when DSAEK tissue is prepared in advance of surgery by trained eye-bank technicians in a low-volume Canadian eye bank. It was difficult to obtain clear images of the endothelial cell layer postdissection, possibly because of tissue swelling or distortion. Sixty-six of 67 corneas included in the study were used for surgery.     

Five-year endothelial cell count post penetrating keratoplasty using internationally-transported corneal donor tissue

Aim

To study the five-year endothelial cell loss in patients having undergone penetrating keratoplasty (PKP) and who received corneal donor tissue from international eye banks.

Donor and tissue profile of a community eye bank in Eastern India

Purpose:

The purpose of this study is to analyze the donor and tissue profile of a community eye bank in Eastern India.

Materials and Methods:

Eye bank records were analyzed for the period July 2007-June 2011. Variables analyzed included donor demographics (age, gender, and ethnicity), donor cause of death, consent for recovery, death-to-preservation interval, preservation-to-utilization interval, endothelial cell density (ECD), corneal suitability for transplantation, and corneal tissue utilization.

Results:

During this study period, 743 corneal tissues were retrieved from 373 donors (male:female = 263:110). The mean age of donors was 52 ± 21 years (range: 3-95 years). The most common donor age group was 41-50 and 71-80 years. Most of the donors belonged to one religious faith (99%). The most common causes of death were cardiorespiratory failure (34%) followed by road traffic accident (30%). Majority donors were motivated (n = 320; 86%), and remaining (n = 53; 14%) were voluntary. Most of the consents were given by sons or daughters of the deceased (45%) followed by siblings (18%). Mean death-to-preservation interval was 3.9 ± 1.9 h. Mean preservation-to-utilization interval was 56.0 ± 24.4 h. The mean ECD of donor corneal tissue was 2857 ± 551 cells/mm² and the median value was 2898 cells/mm². Of harvested corneas 556 (75%) corneal tissues were utilized. The most common causes of nonutilization were septicemia in donor (n = 56; 30%) and poor quality of tissue (n = 55; 30%).

Conclusions:

Although, there is significant corneal tissue utilization, there is a need for increased awareness among people in order to augment voluntary donations.     

Clinical outcomes after Descemet’s stripping endothelial keratoplasty using donor corneas from children younger than 3 years

Importance

There is limited literature on paediatric donors in endothelial keratoplasty.

Background

This study investigated the efficacy of and appropriate paediatric donor age for Descemet’s stripping endothelial keratoplasty (DSEK).

Design

Retrospective and observational case series.

Participants

Thirty‐eight consecutive patients underwent DSEK with paediatric donor corneas.

Methods

The age of the donors ranged from 32 weeks gestation (premature neonate) to 3 years old. All donor consents were obtained from the parents. The causes of donor death included traffic accident, congenital heart disease and neonatal respiratory distress syndrome.

Main Outcome Measures

The outcome measures included best‐corrected visual acuity, endothelial cell loss and complications.

Results

Best‐corrected visual acuity at last follow‐up was >20/40 in 28 of 38 eyes (73.7%). The mean preoperative endothelial cell density of donor corneas was 4682 ± 520 cells/mm². The mean endothelial cell density of grafts was 3977 ± 556 cells/mm² at 18 months postoperatively. Three lenticules from premature neonate donors exhibited severe contraction postoperatively. The edge of six lenticules from donors <1‐year‐old exhibited contraction in the early postoperative period and gradually flattened spontaneously. Graft detachment occurred in one patient.

Conclusions and Relevance

DSEK with paediatric donor corneas can achieve good clinical outcomes. The corneal lenticules from 1‐ to 3‐year‐ old donors are suitable for DSEK while those from donors <1‐year‐old are less suitable due to the possibility of severe postoperative graft contraction.     

Influence of disc area on retinal nerve fiber layer thickness measurement by spectral domain optical coherence tomography

Background:

To examine the effect of optic disc area on peripapillary RNFLT (retinal nerve fiber layer thickness) measurement at circle diameter of 3.4 mm around optic nerve head using spectral OCT/SLO (Optical coherence tomography/scanning laser ophthalmoscope).

Materials and Methods:

In this prospective, cross sectional study, one hundred and two eyes of 102 normal subjects underwent RNFLT and disc area measurement using spectral OCT/SLO. Based on disc area, subjects were divided into three groups i.e., <3 mm² (32 eyes), 3-4 mm² (36 eyes) and >4 mm² (34 eyes). The effect of disc area on RNFLT parameters was analyzed using linear regression analysis.

Results:

The mean and quadrant RNFLT did not show significant correlation with disc area in subjects with disc area of <4 mm², however in eyes with disc area >4 mm², average RNFLT, superior and temporal quadrant RNFLT showed negative correlation with disc area, which was statistically significant (P = 0.004, P = 0.005 and P = 0.002, respectively)

Conclusion:

In healthy eyes of disc area <4 mm², disc size does not appear to affect peripapillary RNFLT measurement by spectral OCT/SLO. Average, superior and temporal quadrant RNFLT measurements were inversely proportional to disc area in eyes with disc area >4 mm². Hence, RNFLT measurement by OCT in eyes with optic disc area of >4 mm² should be interpreted carefully.     

Corneal changes after a single session of selective laser trabeculoplasty for open-angle glaucoma

Purpose

To investigate the changes in endothelial cell count, central corneal thickness (CCT), and refractive error after a session of selective laser trabeculoplasty (SLT) for open angle glaucoma (OAG).

Methods

This prospective cohort study recruited 111 eyes of 66 consecutive subjects with OAG. Subjects received SLT to 360° of the trabecular meshwork. Endothelial cell count, CCT, and spherical equivalent were measured at baseline before SLT as well as at 1 week and 1 month post SLT. A repeated measure nested ANOVA with Tukey''s multiple comparison test was performed to compare the outcome measures before and after SLT.

Results

In 111 eyes of 66 subjects, the mean number of laser applications per treatment was 166.9±41.4 with a mean energy level of 1.0±0.07 mJ. The mean endothelial cell count decreased significantly from 2465.0±334.0 cells/mm² at baseline to 2355.0±387.0 cells/mm² at 1 week (P=0.0004) but increased to baseline levels at 1 month post SLT (2424.0±379.4 cells/mm², P=0.3). The CCT, which decreased from a baseline of 549.4±37.6 to 543.9±40.2 μm at 1 week post SLT (P=0.02), also returned to the baseline level by 1 month (P=0.2). The spherical equivalent was static from baseline. A positive correlation was found between total laser energy and CCT at 1 month post treatment (r=0.3, P=0.005).

Conclusion

The transient reductions in endothelial cell count and CCT following SLT returned to baseline levels 1 month after the procedure. Patients undergoing SLT should be aware of the risk of potential corneal changes.     

Corneal endothelium after deep anterior lamellar keratoplasty and penetrating keratoplasty for keratoconus: a four-year comparative study

Purpose:

To compare the status of corneal endothelium and central corneal thickness within the first four postoperative years after deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in patients with keratoconus.

Materials and Methods:

Thirty-nine eyes (Group A) which had PK and 44 eyes (Group B) which had DALK for the treatment of keratoconus were included in this retrospective study. The endothelial cell density (ECD), the mean endothelial cell area and the coefficient of variation of cell area were assessed with a non-contact specular microscope, and the central corneal thickness (CCT) was measured with an ultrasound pachymeter.

Results:

Mean ECD loss rate at two years was 36.24% in Group A and 18.12% in Group B (P<0.001). Mean ECD loss rate at four years was 47.82% in Group A and 21.62% in Group B (P<0.001). Mean annual ECD loss rate was calculated 14.12% per year in Group A and 5.78% per year in Group B. In the PK group, increase in mean CCT was 15.60% in two years and 15.03% in four years, while in the DALK group, mean CCT increased by 8.05% in two years and 9.31% in four years.

Conclusions:

As the majority of ectatic disorders such as keratoconus occur in young people, long-term endothelial cell survival following treatment with keratoplasty is essential for the long-term visual ability. Our finding that corneal endothelial cell loss in the DALK group occurs at a slower rate than in the PK group suggests DALK as a safer alternative to PK in these selected patients.     

The grave necessity to make eye bank specular microscopy mandatory in all eye banks in the subcontinent to improve utilization of scarce donor corneas

Context:

Donor tissue scarcity, Eye Bank Specular Microscopy as yet not made mandatory and tissue utilization often based on clinical judgment only.

Aims:

Prospectively analyze alteration in clinical grading of donor corneas and hence utilization, based on Eye Bank Specular Microscopy (EBSM) and to infer if EBSM should be mandatory in all eye banks.

Materials and Methods:

200 consecutive otherwise ‘suitable for surgery’ donor eyes were graded clinically. On quantitative and qualitative analysis of endothelial cells by EBSM, final grading was adjusted. Impact on subsequent utilization for various surgeries was analyzed with regard to Age of Donor, Death to Enucleation Time, Death to Preservation Time and Lens Status of Donor Eye.

Results:

76 eyes (38%) (P < 0.05) had significant change in grading. 12/59 (20.30%) tissues from donors <=40 years showed Cell Density (CD) between 1801-2500. 19/76 (25%) tissues from donor >60 years showed CD >= 2500. From donor >=81 years, 2/13 (15.3%) eyes showed CD between 2501-3000 and 1 (7.6%) eye showed CD > 3000. Owing to better grading after EBSM, 13/14 (92.85%) tissues with DTET >6 hours and 5/5 (100%) tissues with DTPT > 16 hours were transplanted. Out of 45 (22.5%) pseudo-phakic tissues, 21 (46.67%) tissues were used for Therapeutic/Tectonic Penetrating Keratoplasty (PKP) while 24 (53.33%) tissues were used for Optical PKP.

Conclusions:

EBSM significantly alters final grading of tissues and its subsequent utilization. Acquiring huge importance in areas where adequate supply of corneas is lacking, EBSM becomes an indispensable tool for optimizing availability of qualified tissues for surgery. EBSM should be made a mandatory analysis.     

Descemet’s stripping automated endothelial keratoplasty and penetrating keratoplasty for Fuchs’ endothelial dystrophy

Purpose: To compare the outcome of Descemet’s stripping endothelial keratoplasty (DSAEK) to that of penetrating keratoplasty (PK) in patients with Fuchs’ endothelial dystrophy. Methods: The first 20 patients who underwent DSAEK at the Department of Ophthalmology, Aarhus University Hospital were compared to 20 patients treated with classic PK. Best‐corrected visual acuity, subjective spectacle refraction and corneal thickness were registered before surgery and 1, 3, 6 and 12 months after DSAEK surgery; they were also measured before surgery and 12 months and 2–3 years after PK. Endothelial cell density was measured 12 months after surgery in both groups. Results: Two primary graft failures were observed in the DSAEK group; no failures were seen in the PK group. Best spectacle‐corrected visual acuity (BSCVA) at 12 months after surgery was significantly better in the DSAEK group (0.56 ± 0.04) than in the PK group (0.33 ± 0.06). At this time, 70% of the DSAEK‐treated eyes but only 25% of PK‐treated eyes had obtained a BSCVA of 0.5 or better. Two to three years after surgery, BSCVA was 0.5 or better in 55% of PK‐treated eyes. Refractive ametropia and astigmatism were significantly smaller in DSAEK‐treated eyes than in PK‐treated eyes, even after suture removal and arcuate keratotomy. Endothelial cell density (cells/mm²) after 1 year was lower in DSAEK‐treated (1.338 ± 113) than in PK‐treated eyes (1.610 ± 124), but the difference was not statistically significant. Conclusion: DSAEK seems to be superior to PK in treating Fuchs’ endothelial keratoplasty, although primary graft failure may be more common. Visual recovery is faster, and major ametropia and astigmatism is not induced. Long‐term follow‐up studies are essential to assess whether this conclusion also holds true more than 1 year after surgery.     

Foldable iris-fixated phakic intraocular lens implantation for the correction of myopia: two years of follow-up

Purpose:

To evaluate the safety, efficacy and potential risks of Artiflex foldable iris-fixated phakic intraocular lens (pIOL) implantation for the management of myopia.

Materials and Methods:

Seventy-eight eyes of 40 consecutive patients with a mean spherical refraction of –11.70 ± 3.77 diopters (D; range –5.50 to –17.5 D) were included in this prospective, noncomparative, interventional case series. Main parameters assessed were uncorrected visual acuity (UCVA), best-spectacle corrected visual acuity (BSCVA), corneal topography (Orbscan II, BauchandLomb, Rochester, NY, USA), manifest and cycloplegic refractive errors, endothelial cell density (ECD) and applanation tonometry.

Results:

After 2 years, BSCVA was 20/40 or better in 82% of the eyes and UCVA was 20/40 or better in 84% of the eyes. After 1 month, 1 year, and 2 years, 51.3% (37 of 72 eyes), 58.9% (46 of 78 eyes) and 76.0% (38 of 50 eyes) of eyes gained 1 line or more of BSCVA, respectively. Compared to preoperative values, the mean endothelial cell loss was 2.6% at 1 month, 4.9% at 1 year and 7.4% at 2 years. Pigmented or non-pigmented precipitates were observed in17 eyes (21.7%) which were treated with topical corticosteroids. At the second postoperative year, pigmented precipitates persisted in nine eyes. However, this was not associated with a loss of BSCVA.

Conclusion:

The implantation of Artiflex pIOL is an effective surgical option for the management of high myopia. The most common complication observed within 2 years of follow-up was accumulation of pigmented precipitates with no effect on the final BSCVA.     

Clinical measurement and categorization of optic disc in glaucoma patients

Background:

Assessment of optic disc size is an important component of optic nerve head examination. Agreement between different methods of disc size measurements is not very good.

Purpose:

To assess the agreement between the disc size assessed by Heidelberg retina tomograph (HRT) and stereobiomicroscopy with a 90 diopter (D) lens. To report the clinical (measured by biomicroscopy) disc diameters of small, average and large optic discs categorized by HRT disc areas.

Setting and Design:

Observational study of subjects examined in the glaucoma clinic of a tertiary eye institute.

Materials and Methods:

Seventy-five eyes of 75 glaucoma subjects were studied. Disc diameter was measured using stereobiomicroscopy and HRT. The agreement between the two sets of measurements was assessed by intraclass correlation coefficient (ICC). Discs were classified into small (<1.6 mm²), average (1.6-2.6 mm²) and large (>2.6 mm²) depending on cutoffs provided by the manufacturers of HRT. The means (95% CI) of the corresponding vertical disc diameter in these groups were assessed.

Statistical Analysis:

ICC, Bland and Altman plots.

Results:

ICC for measurements of clinical and HRT horizontal disc diameter was 0.518 and for vertical disc diameter measurement was 0.487. The mean difference between the clinical and HRT measurements as analyzed by the Bland and Altman plot was 0.17 (95% CI, 0.13- 0.47) for horizontal and 0.22 (95% CI, 0.11- 0.54) for vertical disc diameter. Of the 75 eyes, 3 eyes had small discs, 54 average and 18 large discs. The mean clinical vertical disc diameter for small discs was 1.55 mm (95% CI, 1.2-1.7), for average discs was 1.91 mm (95% CI, 1.87-1.96) and for large discs was 2.15 mm (95% CI, 2.03–2.27).

Conclusion:

The agreement between clinical and HRT disc diameter measurements is moderate. Disc diameter measurement on stereobiomicroscopy can be used to categorize discs into small, average and large discs.     

Outcome of different techniques of pterygium excision with conjunctival autografting in pediatric population: Our experience in central India

Aim:

To analyze surgical outcome of pterygium excision with conjunctival autografting in pediatric population ≤16 years.

Settings and Design:

Retrospective case series.

Materials and Methods:

A case sheet review of 145 patients (167 eyes) aged ≤16 years consecutively presented with pterygium from April 2008 to August 2014 in the single center was done. Twenty-six eyes of 25 children who underwent pterygium excision with conjunctival autograft were analyzed. Different techniques used to secure conjunctival autograft in a position were multiple interrupted 8-0 vicryl sutures, single 8-0 vicryl suture in the center of graft and sutureless glue free. Outcome measures were a failure of surgery and recurrence.

Results:

Of the total 167 eyes, 26 eyes of 25 children, mean age 13.07 ± 3.08 years (range 7–16 years) were managed surgically with pterygium excision and conjunctival autograft. The rest of the patients were managed conservatively. In 18 eyes, the graft was secured with multiple sutures, in 6 eyes with a single suture, whereas in 2 eyes, sutureless glue-free graft opposition was done. Mean follow-up was 8.03 months. No case of graft retraction, graft dehiscence or graft displacement was found. Recurrence occurred in 6 eyes and managed surgically.

Conclusions:

Occurrence of pterygium is not uncommon in the pediatric population. A single suture or sutureless glue-free technique may be good alternative for securing conjunctival autograft after pterygium excision in children.     

A new surgical technique using steel suture for trans-scleral fixation of posterior chamber intraocular lenses

Background:

A new emerging complication of trans-scleral fixation of posterior chamber (PC) intraocular lens (IOL) with polypropylene suture is high rates of spontaneous dislocation of the IOL due to disintegration or breakage of suture.

Materials:

We report a new surgical technique of trans-scleral fixation of posterior chamber intraocular lens (SF PCIOL) with steel suture to eliminate the complication of dislocation of IOL fixed with polypropylene suture in one adult and a child.

Results:

We successfully achieved stable fixation and good centration of IOL after SF PCIOL with steel suture in these patient having inadequate posterior capsular support. Both eyes achieved best corrected visual acuity 20/40 at 18 months follow-up.

Conclusions:

Steel suture is a viable option for trans-scleral fixation of posterior chamber intraocular lens.     

Outcomes of keratoplasty in a cohort of Indian patients with xeroderma pigmentosum

Purpose:To evaluate the outcomes of keratoplasty for xeroderma pigmentosum (XP) performed at a tertiary eye care center.Methods:A retrospective review of medical records of those patients who were clinically diagnosed to have XP (54 eyes of 36 patients) and underwent keratoplasty; either deep anterior lamellar keratoplasty (DALK, four eyes), endothelial keratoplasty (EK, eight eyes), or penetrating keratoplasty (PK, 42 eyes) from 1994 to 2018.Results:The median age at surgery was 20.6 years (interquartile range [IQR], 14.6–27.6 years) and 20 (55.6%) were males. Graft failure occurred in 15 eyes (35.7%) in the PK group and two eyes (50%) in the DALK group; none failed in the EK group. The probability of graft survival in the PK group was 97.2% ± 2.7% at 1 year, 74.0% ± 8.0% at 2 years, and 54.8% ± 11.7% at 5 years. In the PK group, 13 eyes needed antiglaucoma medications, 11 eyes developed graft infiltrate, and 13 eyes needed secondary interventions (cataract surgery, excision biopsy, and tarsorrhaphy). In the EK group, three eyes needed secondary interventions (excision biopsy). Median postoperative endothelial cell density at the last follow-up in the PK group was 1214 cells/mm² (IQR, 623–2277 cells/mm²).Conclusion:Despite the complexities of the ocular surface and adnexal issues in XP, keratoplasty had reasonably good outcomes. More than half of the PK grafts survived 5 years with no failures in the EK group. Regular follow-up and timely management of suture-related infections raised intraocular pressure, and suspicious ocular surface lesions, in addition to solar protection, are important for the success of keratoplasty in these eyes.     

Optic disc topography in normal Indian eyes using spectral domain optical coherence tomography

Purpose:

The aim was to study optic nerve head (ONH) parameters in normal Indian eyes using spectral domain optical coherence tomography (OCT)/scanning laser ophthamoscope (SLO).

Materials and Methods:

One hundred and fifty-seven eyes of 157 normal subjects of various age groups underwent ONH imaging with spectral OCT/SLO and the parameters obtained were correlated with disc size. The effect of age, gender, and refractive error on various ONH parameters were also studied.

Results:

The mean optic disc area was 3.36 ± 0.64 mm² (range, 2.13–5.08 mm²), mean rim area was 2.49 ± 0.58 mm² (range, 1.20–3.62 mm²), and mean cup area was 1.10 ± 0.75 mm² (range, 0–3.07 mm²). The disc area showed significant positive correlation with the rim area, cup area, horizontal cup disc ratio, vertical cup disc ratio, cup disc area ratio, mean cup depth, and maximum cup depth (P < 0.001). Neither gender nor refractive error showed any significant difference in various ONH parameters. ONH parameters did not show significant change with age except for rim area which declined with the advancing age (r = –0.25, P < 0.001).

Conclusions:

The quantitative measurement of ONH topography obtained with this study provides a normative database for an Indian population with spectral OCT/SLO. As optic disc area influences ONH topography, disc size should to be considered when evaluating optic disc for progressive optic neuropathies such as glaucoma.     

Toxic Anterior Segment Syndrome following a Triple Descemet's Stripping Automated Endothelial Keratoplasty Procedure

Purpose

To present a unique case of a 58-year-old female with toxic anterior segment syndrome (TASS), following a triple procedure: Descemet''s stripping automated endothelial keratoplasty (DSAEK), phacoemulsification and posterior chamber intraocular lens implantation.

Methods

The patient was treated with topical dexamethasone sodium phosphate 0.1% and topical atropine sulfate 1%. Due to a slow improvement in her clinical status, oral prednisone 1 mg/kg/day was added.

Results

The anterior chamber reaction improved gradually, with tapering down of topical and oral treatment, until a complete resolution of the anterior chamber reaction was observed.

Conclusions

Taking into account the estimated volume of DSAEK triple procedures performed worldwide, we would expect an annual incidence of several TASS cases, following triple DSAEK procedures. However, we were unable to find any such previous reports in the literature. This fact raises questions regarding the cause of reduced TASS incidence following triple DSAEK procedures.Key words: Toxic anterior segment syndrome, Triple procedure, Descemet''s stripping automated endothelial keratoplasty