Visual outcomes of the second eye in keratoconic patients who have a corneal graft in the first eye: analysis at 12 years.

PURPOSE: To analyze demographic, clinical, and keratometric outcomes of the second eye in keratoconic patients when the first eye has already been grafted, initially and finally at 12 years. METHODS: Retrospective analysis of initial and 12 years visual and keratometric outcomes of the second eye in keratoconic patients when the first one has already been grafted. RESULTS: A total of 107 patients were included: 66 patients were analyzed at the beginning of the follow-up and at 12 years. There were no statistically significant differences with regard to the correction method from the beginning to the end of the follow-up; 3% of patients underwent crosslinking and 4.5% an intracorneal ring segments implantation. There was no significant progress in corneal opacities (1.5% vs 3.0% at 12 years) or visual comfort (90.9% vs 87.9%). The mean values of best-corrected visual acuity (BCVA) (0.69 vs 0.71 at 12 years, on a decimal scale), cylinder (-2.64 D vs -3.13 D), spherical equivalent, and keratometry (46.34 D vs. 46.49 D) had not significantly changed during the follow-up period. During the follow-up, 41 patients (38.3%) received a penetrating or lamellar keratoplasty on the contralateral eye (63% in the 5 years after the first corneal graft). At the time of the keratoplasty procedure, corneal opacities were seen in 7 patients (17.1%), mean BCVA was 0.26 ± 0.16, spherical equivalent mean was -3.70 D, mean cylinder was 3.89 D, mean keratometry values were 52.65 ± 6.80 D, and mean pachymetry value was 335.50 µm. CONCLUSIONS: This study suggests that the period of risk of keratoplasty in the second eye is significant in the first 5 years following the first keratoplasty. New therapeutic treatments have been made available, allowing for stabilization of the keratoconus decreasing the impact of transplantation.

Screening for diabetic retinopathy by ophthalmologists and endocrinologists with pupillary dilation and a nonmydriatic digital camera.

PURPOSE: To assess the effects of pupillary dilation on image quality and certitude of screening diabetic retinopathy by trained endocrinologists using a digital nonmydriatic camera. DESIGN: Prospective, comparative, observational case series. METHODS: One hundred fifty patients with diabetes attending a hospital-based photographic screening clinic had five-field (45 degree) digital retinal imaging and mosaic construction, first through dark-adapted pupils, then after a single application of tropicamide 1%. The 600 sets of images (150 patients, 300 eyes, before and after dilation) were graded independently and in a blinded manner by two endocrinologists and two ophthalmologists, with the consensual opinion on dilated images of the latter serving as the gold standard. The criteria of evaluation were assessment of image quality and certitude of detecting and grading retinopathy. RESULTS: Of 300 eyes, pharmacological mydriasis improved image quality, with an increase in the number of eyes with five good images from seven to 160 and good-quality mosaics from 99 to 233. Dilation allowed better identification of maculopathy in the second eye because there was a decrease in ungradeable central images from 127 to 15 eyes. Dilation increased the number of eyes having retinopathy detected with certainty from 153 to 252 and graded with certainty from 173 to 277. No adverse effects were recorded. CONCLUSIONS: Single application of tropicamide 1% significantly improves image quality and certitude of screening diabetic retinopathy with nonmydriatic camera by endocrinologists.