DMEK Surgery at a Tertiary Hospital in Sweden. Results and Complication Risks.

Purpose: This study reports clinical outcomes up to 6 years after Descemet's membrane endothelial keratoplasty (DMEK) performed at the Department of Ophthalmology, Örebro University Hospital, Örebro, Sweden. Methods: The study has a cross-sectional and case series design. Inclusion criteria were all DMEK-operated eyes during 2013-2018 until repeat keratoplasty. Results: Altogether 162 eyes from 120 patients were enrolled. Among eyes without preoperative comorbidities, examined 1-6 years after DMEK, 85.8% achieved visual acuity of 0.1 logMAR or better. The median endothelial cell density (ECD) loss was 27% in a cohort of eyes examined 1-2 years post-DMEK, 31% at 2-3 years, 42% at 3-4 years, and > 60% at 4-6 years post-DMEK. ECD at the examination timepoint was correlated with donor ECD (as expected) and time since surgery. Conclusion: The results from DMEK surgeries in Örebro, Sweden, are promising. Further studies with even longer follow-up are needed to evaluate graft sustainability.

Early detection of type 2 diabetes mellitus and screening for retinopathy are associated with reduced prevalence and severity of retinopathy.

PURPOSE: To explore whether the prevalence and severity of retinopathy differ in diabetes cohorts diagnosed through screening as compared with conventional health care. METHODS: A total of 257 diabetes patients, 151 detected through screening and 106 through conventional clinical care, were included. Retinopathy was evaluated by fundus photography. The modified Airlie House adaptation of the Early Treatment Retinopathy Study protocol was used to grade the photographs. Averages of clinically collected fasting blood glucose (FBG), blood pressure and body mass index values were compiled from diabetes diagnosis until the eye examination. Blood chemistry, smoking habits and peripheral neuropathy were assessed at the time of the eye examination. RESULTS: Among the screening-detected patients, 22% had retinopathy as compared to 51% among those clinically detected (p < 0.0001). In a multivariate analysis, patients with retinopathy were more likely to have increased average FBG (OR 1.42, 95% CI 1.19-1.70 per mmol/l) and peripheral neuropathy (OR 2.75, 95% CI 1.40-5.43), but less likely to have screening-detected diabetes (OR 0.31, 95% CI 0.17-0.57). Similar results were found using increasing severity grade of retinopathy as outcome. The cumulative retinopathy prevalence for the screening-detected diabetes cohort as compared with the clinically diagnosed cohort was significantly lower from 10 years' follow-up and onwards (p = 0.0002). CONCLUSIONS: Among patients with screening-detected diabetes, the prevalence of retinopathy and increasing severity of retinopathy were significantly lower than among those who had their diabetes diagnosed through conventional care, even when other risk factors for retinopathy such as duration, hyperglycaemia and blood pressure were considered. Early detection of diabetes reduces prediagnostic time spent with hyperglycaemia. In combination with early and regular screening for retinopathy, more effective prevention against retinopathy can be provided.

Cosmic radiation increases the risk of nuclear cataract in airline pilots: a population-based case-control study.

BACKGROUND: Aviation involves exposure to ionizing radiation of cosmic origin. The association between lesions of the ocular lens and ionizing radiation is well-known. OBJECTIVE: To investigate whether employment as a commercial airline pilot and the resulting exposure to cosmic radiation is associated with lens opacification. METHODS: This is a population-based case-control study of 445 men. Lens opacification was classified into 4 types using the World Health Organization simplified grading system. These 4 types, serving as cases, included 71 persons with nuclear cataracts, 102 with cortical lens opacification, 69 with central optical zone involvement, and 32 with posterior subcapsular lens opacification. Control subjects are those with a different type of lens opacification or without lens opacification. Exposure was assessed based on employment time as pilots, annual number of hours flown on each aircraft type, time tables, flight profiles, and individual cumulative radiation doses (in millisieverts) calculated by a software program. Odds ratios were calculated using logistic regression. RESULTS: The odds ratio for nuclear cataract risk among cases and controls was 3.02 (95% confidence interval, 1.44-6.35) for pilots compared with nonpilots, adjusted for age, smoking status, and sunbathing habits. The odds ratio for nuclear cataract associated with estimation of cumulative radiation dose (in millisieverts) to the age of 40 years was 1.06 (95% confidence interval, 1.02-1.10), adjusted for age, smoking status, and sunbathing habits. CONCLUSION: The association between the cosmic radiation exposure of pilots and the risk of nuclear cataracts, adjusted for age, smoking status, and sunbathing habits, indicates that cosmic radiation may be a causative factor in nuclear cataracts among commercial airline pilots.

The prevalence of retinopathy in subjects with and without type 2 diabetes mellitus.

PURPOSE: To evaluate the prevalence of and risk factors for, retinopathy in a geographically defined population with type 2 diabetes mellitus compared with a control group of subjects without diabetes, matched by age, sex and residence in order to find the retinopathy attributable to type 2 diabetes. METHODS: The study populations are, on one hand, a prevalence cohort of subjects with type 2 diabetes resident in the community of Laxå, Sweden, and on the other a control group, matched by age, gender and residence with those with a diagnosis of type 2 diabetes mellitus. Retinopathy was graded from fundus photographs using a modification of the Early Treatment Retinopathy Study (ETDRS) adaptation of the modified Airlie House classification of diabetic retinopathy (DR). RESULTS: Any retinopathy was found in 34.6% in the type 2 diabetes cohort and in 8.8% in the control group without diabetes. Among the diabetic patients, any retinopathy was significantly associated with duration of diabetes (p = 0.0001), HbA1c (p = 0.0056), systolic blood pressure (p = 0.0091) and lower serum cholesterol (p = 0.0197) in multivariate logistic regression analyses. Having retinopathy in the control group was associated only with systolic blood pressure (p = 0.0014) in logistic regression analysis. CONCLUSIONS: The prevalence of retinopathy among patients with type 2 diabetes in Laxå, Sweden, was similar or somewhat lower compared with other studies in the Nordic countries. The prevalence of retinopathy in a control group without diabetes equalled numbers from population studies worldwide. Our study indicates that the retinopathy that can be attributed to hyperglycaemia in the diabetic state is less common than is usually accounted for. A considerable fraction of retinopathy in subjects with diabetes may instead be due to other factors such as hypertension and should thus be treated correspondingly.

The prevalence of cataract in a population with and without type 2 diabetes mellitus.

PURPOSE: To evaluate the prevalence and risk factors of lens opacities in a geographically defined population of subjects with type 2 diabetes mellitus compared with a control population. METHODS: Subjects in the community of Laxå with a diagnosis of type 2 diabetes mellitus (n = 275) and a control group (n = 256) participated in the study. Lens opacities were graded with Lens Opacities Classification System II in all participants. Lens Opacities Classification System score ≥ 2 was considered as significant lens opacity. Anthropometric and blood chemistry data were collected for all participants in connection with the eye examination. For the diabetic population, yearly updated information on glucose control, blood pressure and body mass index was available through medical records from diabetes diagnosis until the time of the eye examination. RESULTS: The prevalence of significant cortical, posterior subcapsular and nuclear cataract was 65.5%, 42.5% and 48.0%, respectively, in the type 2 diabetes population in Laxå. In logistic regression analyses, all types of lens opacities were strongly associated with age (p < 0.0001). Cortical lens opacity was also associated with a diagnosis of diabetes (p < 0.0001), posterior subcapsular lens opacity with HbA1c (p < 0.0001) and nuclear lens opacity with female gender and higher heart rate (both p = 0.0004). In the diabetic population, all types of cataract were likewise strongly associated with age (p < 0.0001), posterior subcapsular cataract with HbA1c (p = 0.0032), nuclear cataract with female gender (p = 0.0002) and higher heart rate (p = 0.0008). CONCLUSIONS: Our study shows that cortical cataract is associated with diabetes mellitus, not necessarily defined by glucose control, whereas posterior subcapsular cataract is associated with glucose levels. Nuclear cataract is not associated with diabetes mellitus, but is more frequent in women and is also associated with higher heart rate.

Making the transition from PK to DSEK: experiences during the learning curve.

PURPOSE: To report our experiences during the transition from penetrating keratoplasty to Descemet's stripping with endothelial keratoplasty (DSEK). METHODS: All patients undergoing DSEK during the period of April 2008 to April 2009 were included in this study. RESULTS: All grafts were attached and clear at both the 6- and 12 -month follow-up examinations. Mean best-corrected visual acuity was 0.6 at 6 months and 0.7 at 12 months for patients without other ocular comorbidity. CONCLUSION: With adequate attention to detail, DSEK seems to be a safe and successful treatment for corneal endothelial disease, also during the surgeon's learning curve.

[Two serious eye injuries after tampering with fireworks]. / Viti til varnadar. Tvo alvarleg augnslys vegna fikts vid flugelda.

In this article we describe two separate cases of serious eye injuries that were the result of two teenagers´ attempts to make home-made explosives out of fireworks. They had tampered with the same brand of fireworks, Víti, that appears to be popular for this purpose and instructions are available on the internet. One boy got an intraocular glass splinter and underwent vitrectomy for removal. The other boy suffered burns on his corneas that were treated with amniotic membranes. In both cases the outcome was better than expected at first. The objective of this article is to draw attention to the danger of tampering with fireworks and the necessity of preventive measures to minimize the risk of serious eye injuries.

Visual acuity in a population with regular screening for type 2 diabetes mellitus and eye disease.

PURPOSE: Regular screening for both diabetes mellitus and diabetic eye disease should be the gold standard in preventing diabetic blindness. In the community of Laxå, County of Orebro, Sweden, such screening has been carried out since 1983. We evaluate visual impairment and blindness in this population. METHODS: All persons in the community of Laxå with a diagnosis of type 2 diabetes mellitus (n = 276) participated in the study. An age- and gender-matched control group (n = 259) was assembled. Best corrected visual acuity (BCVA) was tested in all participants, and a detailed eye examination performed by an ophthalmologist. RESULTS: No significant statistical differences were seen between the diabetes and control groups regarding visual acuity (VA). In all, 2.9% of the diabetes patients and 1.2% of the controls had BCVA < or = 0.1. Only one person in the diabetes group was blind as a result of diabetic retinopathy. In both groups the leading cause of blindness was age-related macular degeneration. In a logistic regression analysis we found that in both the diabetes and the control populations, increasing age was related to worsening BCVA (odds ratio [OR] 1.13, 95% confidence interval [CI] 1.10-1.16 versus OR 1.16, 95% CI 1.13-1.19), as was female gender in the diabetes group only (OR 2.73, 95% CI 1.69-4.40). CONCLUSIONS: In a population that is carefully screened for diabetes mellitus and provided with regular screening for diabetic retinopathy, the loss of vision from diabetic retinopathy is uncommon.