Long-term follow-up of deep anterior lamellar keratoplasty after Descemet stripping automated endothelial keratoplasty.

AIMS: To describe the long-term outcomes of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DSAEK) in cases of infection and residual stromal opacity. METHODS: Ten eyes of nine consecutive patients undergoing DALK after DSAEK at a single tertiary referral center (SNEC) from 2011 to 2016 were analyzed for best spectacle-corrected visual acuity (BSCVA), refraction, spherical equivalent (SE) and cylinder, as well as graft diameters, survival, and complications. RESULTS: The mean pre-DSAEK BSCVA was 1.73 ± 0.76 LogMAR. At a mean follow-up of 9.8 ± 7.1 months, visual acuity had improved significantly (p = 0.028) to 1.09 ± 0.55 LogMAR after DSAEK. DALK was performed at 10.3 ± 7.2 months after DSAEK because of residual stromal scarring in nine and a corneal infection in one case. At the last follow-up visit (19.4 ± 13.9 months) after DALK, BSCVA had improved to 0.38 ± 0.6 LogMAR, significantly better than after DSAEK alone (p = 0.015) and before DSAEK (p = 0.018). Spherical equivalent (- 4.8 ± 3.5 D) and cylinder (- 2.5 ± 2.0 D) did not show significant changes compared to after DSAEK (SE p = 0.17; cylinder p = 0.19) or 3 months after DALK (SE p = 0.17; cylinder p = 0.46). One endothelial graft failed 3 months after DALK. Kaplan-Meier estimated average survival for all cases was 45.3 (95% CI 36.6-54.0) months. The cumulative survival probability for the entire cohort was 90% at 1, 2, and 4 years of follow-up. CONCLUSIONS: DALK surgery after DSAEK can improve vision in cases of residual host scarring and treat host corneal infection, while avoiding open-sky surgery and sparing a healthy endothelial graft.

Atypical multiple evanescent white dot syndrome presenting with peripheral retinal lesions.

Multiple evanescent white dot syndrome (MEWDS) is a rare inflammatory eye condition. We report an atypical case of MEWDS in a man in his 30s who presented with blurred vision (visual acuity 6/9), floaters and photopsia in his left eye. Funduscopy examination showed mild peripheral nasal vascular sheathing with subtle grey-white dots highlighted on fundus autofluorescence. As far as the authors are aware, this is the first case presentation whereby areas affected by MEWDS started in the peripheral retina and migrated centrally. Fluorescein angiography showed hyperfluorescent areas in wreath-like patterns nasally. Optical coherence tomography showed disruption of the ellipsoid zone and hyperreflective projections into the outer nuclear layer. The size of the involved area increased over 3 weeks and subsequently resolved over 4 months. Simultaneously, the patient's symptoms also resolved, without treatment. This case highlights the importance of multimodal imaging, especially ultrawidefield imaging in diagnosing MEWDS.

Cicatricial Conjunctivitis and Concurrent Clinical Features: A Case Study.

Purpose: We report a case of cicatricial conjunctivitis to illustrate the clinical approach for management of such a case. This is a 52-year-old Chinese man who presented with bilateral red eyes associated with itching for a year. He had a history of chronic itchy rash in the chest and the arms. Otherwise there was no history of autoimmune disease, asthma, sinusitis, or drug allergy. On examination, he had diffuse hyperemia over both conjunctivae, with symblepharon involving the inferior bulbar and palpebral conjunctivae, associated with cicatrization of the caruncles, and obliteration of inferior lacrimal puncta. There were mild subtarsal papillary reaction with Meibomian gland dysfunction and presence of inferior mis-directed eyelashes. The corneas showed multiple foci of superficial epitheliopathy. A clinical diagnosis of chronic cicatricial conjunctivitis was made, with differential diagnosis of chronic atopic allergic conjunctivitis. Conjunctival biopsy was performed from the inferior conjunctival adhesions and it showed patchy chronic stromal inflammation with focal lymphoplasmacytic sub-epithelial infiltrates and loss of goblet cells. The stroma shows marked fibrosis, with no evidence of mast cells or eosinophils. In particular, there were no deposits of IgA, IgM, C3, and fibrinogen in the basement membrane. The patient was treated with topical loteprednol, glucocorticoids and artificial tears, and his symptoms improved after treatment. Conclusion: We present a man with cicatricial conjunctivitis with chronic subconjunctival inflammation and fibrosis but no immune deposits in the conjunctival basement membrane on histology, to illustrate the clinical approach and diagnostic challenges in managing such a case.

Prevalence of pseudoexfoliation syndrome and pseudoexfoliation glaucoma in Upper Egypt.

BACKGROUND: Pseudoexfoliation (PXF) is a recognized risk factor for developing cataract, glaucoma and lens dislocation. PXF is also associated with increased risk of complications during cataract surgery due to poor mydriasis and zonular weakness. The aim of this study is to report the prevalence of pseudoexfoliation among Upper Egyptians attending the ophthalmology clinic of Assiut University Hospital. METHODOLOGY: A retrospective, chart review study conducted in the period from February 2002 to August 2009. A total of 7738 patients aged 40 years or older attending the general ophthalmic clinics were included in this study. A detailed evaluation including ophthalmic and general history, slit lamp biomicroscopy, intraocular pressure measurement, gonioscopy and dilated eye examination were performed. Patients with pseudoexfoliative material on the anterior lens surface and / or the pupillary margin in either or both eyes were labeled as having PXF. RESULTS: Out of the 7738 patients included, three hundred twenty (4.14%) subjects had PXF. Mean age of PXF group was 68.15 years (SD 8.16, range 40-92 years). PXF was bilateral in 82.2% of cases. It was significantly associated with cataract, glaucoma and hearing loss. Of the PXF patients, 65% had cataract, 30.3% had glaucoma and 8.1% had hearing loss. CONCLUSION: Pseudoexfoliation appears to be a common disorder in older individuals in Upper Egypt.

Redeployment of ophthalmologists in the United Kingdom during the Coronavirus Disease Pandemic.

BACKGROUND: During the current coronavirus (COVID-19) pandemic, some ophthalmologists across the United Kingdom (UK) have been redeployed to areas of need across the National Health Service (NHS). This survey was performed to assess aspects of this process including training & education, tasks expected, availability of personal protection equipment (PPE) used and the overall anxiety of ophthalmologists around their redeployment. METHOD: Online anonymous survey around the existing guidance on safe redeployment of secondary care NHS staff and PPE use by NHS England and Public Health England respectively. The survey was open to all ophthalmologists across the UK irrespective of their redeployment status. FINDINGS: 145 surveys were completed and returned during a 2-week period between 17th April 2020 and 1st May 2020, when 52% of ophthalmologists were redeployed. The majority of this group consisted of ophthalmologists in training (79%). 81% of those redeployed were assigned to areas of the hospital where patients with confirmed Coronavirus disease were being treated as inpatients. There was a statistically significant improvement in anxiety level following redeployment which was mainly attributed to the support received by staff within the redeployed area. 71% of the redeployed group were found to have sufficient PPE was provided for the area they worked in. INTERPRETATION: This is the first national survey performed on redeployment of ophthalmologists in the UK. The study showed that ophthalmologists across all grades were able to contribute in most aspects of patient care. Anxiety of redeployment was reduced by prior training and good support in the redeployment area.