Technique for Ensuring Type I Bubble Formation for Pre-Descemet Endothelial Keratoplasty Preparation.

PURPOSE: To describe a technique that ensures the production of a type 1 bubble when preparing pre-Descemet endothelial keratoplasty (PDEK) grafts with a high rate of predictability. METHODS: Donor corneas were placed on a support disc, and a blunt instrument was used to score 360 degrees of the peripheral Descemet membrane and endothelium just inside the trabecular meshwork. Air was injected in several short bursts and several stages with a 30-gauge needle on a 3-mL syringe 2.0 mm away from the limbus to create a type 1 big bubble. The technique was tested by 2 operators (M.S. and A.S.-J.) in 26 human donor corneas, including 12 for possible transplantation, over a 9-month period. Anterior segment optical coherence tomograph (AS-OCT) was performed in 1 case proving a type 1 bubble. RESULTS: A type 1 big bubble was successfully created in 24 of 26 attempted cases (92.3%). The technique was used successfully to obtain PDEK tissue for transplant in 9 eyes. One case was not technically acceptable because of diffuse cell loss (>10%); however, the bubble preparation itself was successful. One case had a mixed bubble because of incomplete scoring, resulting in a Descemet membrane endothelial keratoplasty graft used for transplant. One case failed to form any bubble likely because the scoring was too central. Of a total of 26 cases, 14 cases were for practice. CONCLUSIONS: The Soper technique significantly improved the success rate of creating a type 1 bubble for PDEK preparation.

Ocular adverse events of systemic inhibitors of the epidermal growth factor receptor: report of 5 cases.

PURPOSE: To describe the ocular effects associated with the administration of the systemic epidermal growth factor receptor (EGFR) inhibitors panitumumab and erlotinib. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Ten eyes of 5 patients in treatment with systemic EGFR inhibitors, 4 patients with erlotinib for end-stage lung carcinoma, and 1 patient with panitumumab for end-stage colorectal cancer. METHODS: Data collected from charts included gender, age at presentation, systemic disease, and clinical presentation in each eye. MAIN OUTCOME MEASURES: Demographics on presentation and clinical findings. RESULTS: Multiple epithelial defects were observed in all 10 eyes, corneal melting and thinning were observed in 3 eyes of 2 patients, 2 eyes of 1 patient presented with lower lid ectropion, and 2 eyes of 2 patients presented with corneal perforation, both requiring a penetrating keratoplasty. CONCLUSIONS: Severe ocular side effects, including corneal perforation, may be associated with the use of the EGFR inhibitors panitumumab and erlotinib.