Second-generation corneal deformation signal waveform analysis in normal, forme fruste keratoconic, and manifest keratoconic corneas after statistical correction for potentially confounding factors.

PURPOSE: To evaluate the difference in corneal biomechanical waveform parameters between manifest keratoconus, forme fruste keratoconus, and healthy eyes with a second-generation biomechanical waveform analyzer (Ocular Response Analyzer 2). SETTING: Jules Stein Eye Institute, University of California, Los Angeles, California, USA. DESIGN: Retrospective chart review. METHODS: The biomechanical waveform analyzer was used to obtain corneal hysteresis (CH), corneal resistance factor (CRF), and 37 biomechanical waveform parameters in manifest keratoconus eyes, forme fruste keratoconus eyes, and healthy eyes. Useful distinguishing parameters were found using t tests and a multivariable logistic regression model with stepwise variable selection. Potential confounders were controlled for. RESULTS: The study included 68 manifest keratoconus eyes, 64 forme fruste keratoconus eyes, and 249 healthy eyes. There was a statistical difference in the mean CRF between the normal group (10.2 mm Hg ± 1.7 [SD]) and keratoconus group (6.3 ± 1.9 mm Hg) (P = .003), and between the normal group and the forme fruste keratoconus group (7.8 ± 1.4 mm Hg) (P < .0001). There was no statistical difference in the mean CH between the normal group and the keratoconus group or the forme fruste keratoconus group. The CRF, height of peak 1 (P1) (P = .001), downslope of P1 (dslope1) (P = .027), upslope of peak 2 (P2) (P = .004), and downslope of P2 (P = .006) distinguished the normal group from the keratoconus groups. The CRF, downslope of P2 derived from upper 50% of applanation peak (P = .035), dslope1 (P = .014), and upslope of P1 (P = .008) distinguished the normal group from the forme fruste keratoconus group. CONCLUSION: Differences in multiple biomechanical waveform parameters can differentiate between healthy and diseased conditions and might improve early diagnosis of keratoconus and forme fruste keratoconus. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Comparison of ACIOL Retention With IOL Exchange in Patients Undergoing Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: To investigate clinical outcomes in the management of anterior chamber intraocular lenses (ACIOLs) in patients requiring Descemet stripping automated endothelial keratoplasty (DSAEK) for pseudophakic corneal edema. METHODS: This is a retrospective review of DSAEK procedures performed at a single center between May 1, 2006, and August 1, 2014. RESULTS: Forty-three eyes (41 patients) with pseudophakic corneal edema and an ACIOL were identified. In 26 eyes (60.5%), the ACIOL was retained [intraocular lens retention (IOLR) group], and in 17 eyes (39.5%), intraocular lens exchange [(IOLX) group] was concurrent with DSAEK. No significant difference was noted between the IOLR and IOLX groups for the following: the incidence of primary graft failure (7.7% vs. 5.9%; P = 1.0); the incidence (3.8% vs. 0.0%; P = 1.0) or rate (0.036 per eye-year vs. 0 per eye-year; P = 0.28) of secondary graft failure; or the incidence (7.7% vs. 11.8%; P = 1.0) or rate (0.056 per eye-year vs. 0.073 per eye-year; P = 0.69) of endothelial rejection. However, the incidence (23.1% vs. 58.8%; P = 0.026) and rate (0.291 per eye-year vs. 0.475 per eye-year; P = 0.033) of increased intraocular pressure were significantly higher in the IOLX group. There were more complications in the IOLX group, although the difference was not significant (7.7% vs. 29.4%; P = 0.093). CONCLUSIONS: There is no significant difference in the incidence of primary graft failure or in the rate of secondary graft failure or endothelial rejection in eyes with ACIOL retention or exchange. However, as IOLX is associated with intraoperative and postoperative complications and an increased rate of postoperative intraocular pressure elevation, we recommend performing DSAEK with retention of well-positioned ACIOLs in these eyes.

Combined astigmatic keratotomy and conductive keratoplasty to correct high corneal astigmatism.

PURPOSE: To determine the safety, efficacy, and predictability of combined astigmatic keratotomy (AK) and conductive keratoplasty (CK) for treating high corneal astigmatism. SETTING: University of California-Los Angeles, Los Angeles, California, USA. DESIGN: Retrospective case series. METHODS: From January 1, 2004, to December 31, 2009, AK and CK were performed in eyes with corneal astigmatism of 5.0 diopters (D) or more after keratoplasty or trauma. The uncorrected (UDVA) and corrected (CDVA) distance visual acuities, spherical equivalent (SE), defocus equivalent, mean astigmatism, efficacy index, and complications were evaluated. RESULTS: In 11 eyes of 11 patients, the mean UDVA improved from 1.54 logMAR ± 0.50 (SD) preoperatively to 0.69 ± 0.62 logMAR 3 months postoperatively (P < .001) and the mean CDVA from 0.55 ± 0.62 logMAR to 0.12 ± 0.11 logMAR (P = .028). The mean SE and mean defocus equivalent decreased from -1.25 ± 5.06 D to 3.13 ± 3.06 D (P = .15) and from 7.98 ± 4.41 D to 6.97 ± 3.73 D (P = .45), respectively; these changes were not statistically significant. The mean absolute astigmatism decreased from 10.25 ± 4.71 D to 4.31 ± 2.34 D (P < .001). The mean absolute orthogonal and mean oblique astigmatism showed a statistically significant decrease. The efficacy index was 0.82. One case of wound gape after AK required suturing. No infectious keratitis, corneal perforation, or graft rejection occurred. CONCLUSIONS: Results indicate that combined AK and CK is safe and effective for correcting high corneal astigmatism after surgery or trauma.

Compressive optic neuropathy secondary to a lateral rectus muscle dermoid cyst.

A 48-year-old man presented 2 weeks after sudden OS vision loss. On examination, the patient had decreased OS visual acuity, an ipsilateral afferent pupil defect, and proptosis. MRI of the orbit with and without gadolinium showed a large, enhancing heterogeneous mass extending to the orbital apex. Uncomplicated resection was performed and pathology was consistent with a dermoid cyst. Postoperatively, the patient had improved visual acuity and minimal lateral rectus dysfunction. There are only 4 reported cases of dermoid cysts located within the lateral rectus muscle, albeit this is the first case describing a compressive optic neuropathy in the setting of an orbital dermoid cyst.

Clostridium perfringens endophthalmitis after penetrating keratoplasty with contaminated corneal allografts: a case series.

PURPOSE: To report the postoperative clinical course of 3 patients who underwent corneal transplantation with corneal allografts contaminated with Clostridium perfringens and to evaluate the risk factors for anaerobic contamination in 2 donors. METHODS: Patient records and adverse reaction reports from a single eye bank related to cases of posttransplant C. perfringens endophthalmitis were reviewed. Records regarding the mated corneas, donor autopsy reports, and other pertinent data were also reviewed. RESULTS: Three adverse reactions associated with transplantation of corneal allografts contaminated with C. perfringens were reported. Two cases were from mated corneas. Both patients developed fulminant endophthalmitis after undergoing uncomplicated penetrating keratoplasty and required subsequent enucleation. Another isolated case (with no adverse reaction in the mate cornea) developed hypopyon postoperatively that resolved with intravitreal and topical antibiotics. Possible risk factors for anaerobic tissue contamination in the donors included illicit drug use in the first donor and exposure to sewage at the time of death in the second donor. CONCLUSIONS: Clostridial endophthalmitis is an aggressive rapidly progressive infection with potentially poor visual outcomes that can be transmitted from infected corneal allografts. Further investigation is needed to clarify the role of anaerobic donor rim cultures and the donor risk factors associated with recovering corneal allograft tissue contaminated with C. perfringens.