Tenon Patch Graft With Vascularized Conjunctival Flap for Management of Corneal Perforation.

PURPOSE: Traumatic paracentral corneal perforations may lead to irregular astigmatism and opacification from lamellar grafts. We present an alternative surgical technique using a Tenon patch graft and a conjunctival flap. METHODS: A 42-year-old man presented with a 1-mm paracentral corneal perforation 6 weeks after penetrating trauma by a metallic foreign body. A region of Tenon fascia was excised and sutured to cover the perforation, and a conjunctival flap was then created and sutured over this Tenon graft. A bandage contact lens was placed postoperatively. Serial imaging was conducted to document healing including optical coherence tomography (OCT) and slit lamp photography. RESULTS: At postoperative day 1, uncorrected distance visual acuity (UDVA) was hand motion, the anterior chamber was formed, and OCT revealed Tenon fascia and conjunctiva covering the defect. By postoperative week 2, the leak resolved and UDVA was 20/30. At postoperative week 4, UDVA improved to 20/20, the Tenon graft was noted to be undergoing contraction, and a single feeder vessel remained prominent in the conjunctival flap. By postoperative month 4, UDVA was 20/25 and only mild paracentral cornea clouding was noted. Initial, focal steepening and thickening normalized by month 4 leaving mild, normal astigmatism. OCT revealed integration of the Tenon graft into the corneal stroma. CONCLUSIONS: For paracentral corneal perforations, a Tenon patch graft in conjunction with a conjunctival flap may aid healing with favorable postoperative refractive outcomes.

Comparison of Tri-folded and Scroll-based Graft Viability in Preloaded Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To compare corneal endothelial damage associated with 2 techniques for preloaded Descemet membrane endothelial keratoplasty (DMEK): a tri-folded graft stored in a plastic cartridge designed for DMEK and a scrolled graft stored in a modified Jones Tube, at the time of preparation and after shipping. METHODS: DMEK grafts were prepared at the Rocky Mountain Lions Eye Bank. The grafts were either tri-folded and loaded in a plastic cartridge or scrolled and loaded into a modified Jones Tube. In each group, the grafts were then either immediately removed from the cartridges or shipped for 48 hours. The grafts were then stained with Calcein AM and imaged using a fluorescent microscope. Endothelial cell loss (ECL) was determined using trainable segmentation in Fiji by 2 graders. At each time point, rates of ECL loss were compared across the 2 groups. To explore the role of donor characteristics, a multivariable regression model was produced to account for method (tri-folding vs. scroll), donor age, donor gender, death-to-preservation time, death-to-preparation time, and shipping. RESULTS: A total of 40 grafts were prepared, processed, imaged, and analyzed. No significant difference in cell loss was seen between groups at either time point alone. In the multivariate model, no significant increase in cell loss was associated with either tri-folding (3.7% less ECL; P = 0.051) or shipping (4.3% less ECL; P = 0.049). CONCLUSIONS: All techniques used resulted in clinically acceptable levels of ECL. Tri-folded tissue in a plastic cartridge did not result in ECL inferior to a scroll when prepared either immediately or preloaded for 48 hours.

Outcome and Prognostic Factors of Phacoemulsification Cataract Surgery in Vogt-Koyanagi-Harada Uveitis.

PURPOSE: To investigate visual outcome and prognostic factors following cataract surgery in patients with Vogt-Koyanagi-Harada (VKH) disease. DESIGN: Retrospective, interventional case series. METHODS: The history, clinical characteristics, best-corrected visual acuity (BCVA), full-field electroretinogram (ERG), intraocular inflammation, complications, and extraocular manifestations were analyzed retrospectively. RESULTS: One hundred and forty-eight male (214 eyes) and 138 female (194 eyes) VKH patients with complicated cataract were included. Surgery was performed on 352 eyes after complete control of intraocular inflammation for at least 3 months. In another set of 56 eyes, surgery was done 1 month after intraocular inflammation control. There was no difference in postoperative complications or BCVA between these 2 groups. The main complications after surgery were hyphema, ocular hypertension, and moderate anterior chamber reaction. Average preoperative visual acuity was 0.08. At last visit, BCVA was improved in 405 eyes (99.3%). The preoperative BCVA, treatment delay after disease onset, preoperative intraocular hypertension, and iris synechiae were associated with final visual outcome. Other parameters such as postoperative inflammation, IOL type, and presence of extraocular VKH features did not affect final BCVA. Poor visual acuity was caused by optic nerve atrophy, choroidoretinal neovascularization, and subretinal fibrosis. Poor postoperative BCVA was associated with an abnormal preoperative ERG profile. CONCLUSIONS: Phacoemulsification and IOL implantation in VKH patients can be safely and successfully performed in quiet eyes even after 1 month following the last signs of inflammation. Visual prognosis was associated with preoperative BCVA, treatment delay after disease onset, preoperative intraocular hypertension, iris synechiae, and presence of preoperative ERG abnormalities.

Viability of Descemet Membrane Endothelial Keratoplasty Grafts Folded in the Eye Bank.

PURPOSE: Preloaded, trifolded grafts in Descemet membrane endothelial keratoplasty require transfer of the trifolding process from the corneal transplant surgeon to the eye bank technician. We sought to assess whether trifolding may be safely conducted by an eye bank technician with cell loss comparable to standard peeling and lifting. METHODS: A total of 10 grafts were stained, peeled, and transferred directly onto a bed of Calcein-AM and Amvisc Plus by an eye bank technician. Five grafts were removed and stained as a scroll, and 5 grafts were trifolded with the endothelium in before transfer. Photographs were acquired with an inverted fluorescence microscope, and image segmentation was performed. A t test was conducted to compare differences in endothelial cell loss across groups. RESULTS: Mean cell loss in the scroll group was 18.5% [95% confidence interval (CI): 15.2%-21.9%] compared with 7.6% of the trifolded group (95% CI: 1.7%-13.5%). A 2-tailed t test indicated decreased cell loss in the trifolded group (P = 0.013). CONCLUSIONS: Despite additional manipulation of the graft, trifolding of Descemet membrane and endothelium may be performed by an eye bank technician without significantly increased cell loss relative to graft preparation as a scroll.

Smartphone-based Video of Demodex folliculorum In Biopsied Human Eyelash Follicles.

The ability of smartphone technology to document static microscopy images has been well documented and is gaining widespread use in ophthalmology, where slit-lamp biomicroscopy is frequently utilized. However, little has been described regarding the use of smartphone technology to relay video of tissue microscopy results to patients, particularly when a tissue sample integrates motility of organisms as a characteristic feature of the disease. Here, we describe the method to use smartphone video to document motility of Demodex folliculorum in human eyelashes, individual results of which can be shown to patients for education and counseling purposes. The use of smartphone video in documenting the motility of organisms may prove to be beneficial in a variety of medical fields; producers of electronic medical records, therefore, may find it helpful to integrate video drop box tools.