Long-term ocular surface stability in conjunctivolimbal autograft and ocular surface safety in the donor eyes.

PURPOSE: The current study is aimed to present the long-term results of the patients who underwent conjunctivolimbal autograft (CLAU) as the primary operation in unilateral limbal stem cell deficiency and the ocular surface safety of the donor eyes. The patients were followed up for five years or longer. METHODS: The records of all patients who underwent CLAU as the primary operation were retrospectively analyzed. Additional ocular surface operations, ocular surface stability, best-corrected visual acuity (BCVA), and ocular surface status of the donor eyes were investigated. RESULTS: The mean age of the patients at the time of transplantation was 35.07 ± 12.9 (12-60). Twenty-nine eyes of 29 patients were followed up for an average of 97.82 ± 34.45 (60-186) months. Additional ocular surface operation was required in 27.58% (8/29) of the eyes in order to achieve a stable ocular surface. Ocular surface stability was achieved in 82.75% (24/29) of the eyes at the end of the follow-up period. BCVA increased from 1.78 ± 0.82 to 0.91 ± 0.92 logMAR at the last visit (p < 0.001). Corneal ectasia and vascularization developed in one donor eye in the fifth postoperative year. CONCLUSIONS: CLAU tissues provide ocular surface stability with a successful vision result in the long term. CLAU theoretically carries risks including limbal stem cell deficiency in the donor eye. In the long-term follow-up of donor eyes after CLAU, ectasia and limbal stem cell deficiency were observed in one eye.

Optical Coherence Tomography Angiography Findings in Primary Open-Angle and Pseudoexfoliation Glaucoma.

Objectives: To compare the optical disc and macular vascular density values of patients with glaucoma and healthy individuals by using optical coherence tomography angiography and evaluate the relationship between structural and functional test results and vascular density. Materials and Methods: The study included 128 eyes in total: 31 with pseudoexfoliation glaucoma (PEG), 55 with primary open-angle glaucoma (POAG) and similar visual field defects, and 42 healthy eyes. Whole image peripapillary vessel density (wpVD), intradisc vessel density (idVD), peripapillary vessel density (pVD), whole image macular vessel density (wmVD), and parafoveal vessel density (pfVD) values were compared between the groups. Correlations between visual field findings, retinal nerve fiber layer (RNFL) and optic nerve head measurements and peripapillary and macular vascular density were analyzed. Results: In the PEG and POAG groups, wpVD, idVD, wmVD, and pfVD values were significantly lower in than the control group. In the PEG group, wpVD was found to be significantly lower than the POAG group (p<0.001). There was no significant difference between the PEG and POAG groups in wmVD and pfVD except for nasal pfVD. There were strong positive correlations between RNFL thickness and pVD in the glaucoma groups (p<0.001). Significant correlations were found between visual field mean deviation and pattern standard deviation values and peripapillary and macular vessel density values in the glaucoma groups. Conclusion: Vascular density values were lower in glaucoma patients compared to normal individuals, and there is a strong correlation between structural and functional tests and vessel density values. The lower vascular density in the PEG group compared to the POAG group indicates that vascular damage may be more common in PEG patients.

Treatment of persistent epithelial defects with single-dose autologous serum eye drops.

PURPOSE: We aimed to investigate the efficacy and safety of single-dose autologous serum eye drops (ASEDs) for treatment of persistent corneal epithelial defects (PEDs). METHODS: About 34 eyes of 26 patients treated from March 2016 to May 2020 with a single dose of ASEDs for PEDs that did not respond to conventional treatment were retrospectively evaluated. Patient demographics, predisposing factors, size, and duration of the PED, duration of treatment, and dosage of ASEDs, PED healing time, success rate of the ASED treatment, and follow-up time after the onset of ASED treatment were recorded. Autologous serum eye drops (20%) were prepared by diluting the serum with preservative-free artificial tears in single-dose vials. Vials were stored at -20°C and used daily after dissolving. RESULTS: The mean patient age was 47.0 ± 18.5 years, and 13 (50%) of the patients were male. The most common indication for ASEDs was PED after keratoplasty. The mean duration of ASED treatment was 8.5 ± 6.3 months, and mean follow-up time was 22.8 ± 12.2 months. Autologous serum eye drop treatment was effective in 25 (73.5%) eyes and partially effective in 5 (14.7%) eyes. None of the eyes displayed complications related to the treatment. CONCLUSION: In patients with PED for whom conservative treatment is insufficient, ASEDs prepared by dilution with preservative-free artificial tears in single-dose vials and administered based on the daily use principle appear to be effective and safe.

Donor Cornea Use in Scleral Surface Reconstruction

Objectives: To investigate the indications for and results of treating scleral surface problems with donor corneal grafts that are not used in keratoplasty surgery or are left over from keratoplasty. Materials and Methods: The records of 16 patients in whom corneal tissue was used to repair a scleral tissue defect or cover an exposed glaucoma drainage implant were evaluated retrospectively. Partial-thickness grafts were prepared using a combined microkeratome system with artificial anterior chamber in 10 eyes and by manual dissection in 3 eyes. Full-thickness grafts were used in 3 eyes. Results: There were 8 female and 8 male patients aged 5-79 years (mean: 39.37±24.68). Indications for the use of corneal tissue on the scleral surface were limbal dermoid excision (n=2), pterygium surgery (n=1), intraocular lens removal and scleral fixation intraocular lens (SFIOL) implantation (n=1), exposed SFIOL suture coverage (n=1), trauma (n=2), scleral tissue loss due to repeated glaucoma surgeries (n=5), and exposed glaucoma drainage implant (n=4). The patients were followed for 6-42 months (mean: 14.37±9.14). None of the patients had graft infection, thinning, immunological graft rejection, or vision loss during follow-up. Tectonic lamellar grafts did not adversely affect final visual acuity in any case. At final examination, a good combination of graft and recipient tissue, a smooth ocular surface, and a cosmetic appearance were achieved in all eyes. Conclusion: Donor corneas that are not suitable for corneal transplantation or left over from the cornea transplant can be used in patients with scleral tissue loss due to various pathologies and in the treatment of glaucoma drainage implant erosion. In these cases, the use of corneal grafts provides a good ocular surface restoration and cosmetic appearance. The effectiveness and safety of this method should be investigated with large patient series and long follow-up times.

Corneal Pathology and Cataract: Combined Surgery or Sequential Surgery?

Objectives: To compare our combined surgery (CS) and sequential surgery (SS) results. Materials and Methods: The files of 44 patients who underwent CS (penetrating keratoplasty [PK], cataract extraction, and intraocular lens [IOL] implantation) and 126 patients who underwent SS (cataract extraction and IOL implantation in a second session after PK) between January 2009 and December 2018 were evaluated retrospectively. One eye of the patients who were followed up for at least 1 year was included in the study. The two groups were compared in terms of indications, corrected distance visual acuity (CDVA), refractive results, complications, and graft survival. Results: In the CS and SS groups, the median age was 63 (30-79) and 43 (18-73) years (p<0.001) and the median follow-up time was 51 (13-152) and 64.5 (13-154) months (p=0.011), respectively. The most common PK indications were traumatic corneal scar (20.5%) and endothelial dystrophy (15.9%) in the CS group versus keratoconus (24.6%) and stroma dystrophy (17.5%) in the SS group. In the CS and SS groups, 50% vs 69% of patients had CDVA ≥0.4 (p=0.04); 45.5% vs 25.4% had CDVA (0.1-0.3) (p=0.04); and 54.5% vs 73% had spherical equivalent ≤±2.0 D (p=0.02). The most common postoperative complications were glaucoma (20.5% vs 15.9%, p=0.48) and allograft reaction (9.1% vs 23%, p=0.04). Graft survival rates were 95.2% vs 86.5% (p=0.10) at 1 year and 75.9% vs 68.9% (p=0.47) at 5 years, respectively. Conclusion: Over long-term follow-up, the groups were similar in terms of graft survival. For this reason, each patient must be evaluated separately whether to perform a combined or sequential surgery. Given the lower refractive error and higher expectation of final visual acuity, SS can be more advantageous especially in young patients.

Anterior Segment Surgeries Under Topical Fresh Frozen Plasma Treatment in Ligneous Conjunctivitis.

PURPOSE: To evaluate the efficacy of topical fresh frozen plasma (FFP) therapy on clinical symptoms, findings, and prognosis after anterior segment surgeries in patients with ligneous conjunctivitis (LC). METHODS: Retrospective case note review. RESULTS: Eleven eyes of 7 cases whose remission was not achieved after medical treatment such as topical corticosteroids, cyclosporine A, and heparin were included in the study. The median age of admission was 19 (1-49) years, median duration of FFP treatment was 48 (15-79) months, median follow-up period was 62 (16-114) months, and median age at symptom onset was 12 (4-252) months. Diagnosis was made according to clinical presentations, plasminogen activities, and response to treatment. Topical FFP that was prepared in our clinic was used in all cases. Surgeries (membrane excision, eyelid surgery, deep anterior lamellar keratoplasty, and cataract surgery) were performed after at least 1 month of FFP treatment. Prosthetic contact lens was applied to one eye. During the follow-up period, recurrences requiring membrane excision and side effects from topical FFP were not observed. CONCLUSIONS: LC is a rare membranous conjunctivitis that proceeds with remissions and recurrences. When it was shown that the etiology of LC is plasminogen deficiency, FFP became the only treatment option targeting the etiology. In this study, we observed that the topical FFP is an effective treatment method that prevents recurrence and ensures regression of membranes and safer anterior segment surgeries in LC.

Anterior segment parameters in Behçet's patients with ocular involvement.

PURPOSE: To evaluate anterior segment findings in Behçet's disease patients within the ocular involvement inactive period. METHODS: One hundred twenty patients with Behçet uveitis in the inactive period (Behçet's disease group) and 121-age and sex matched healthy subjects (control group) were examined. Anterior segment parameters were assessed by Scheimpflug camera. RESULTS: In Behçet's disease group, the mean age was 39.89 ± 10.16 years, and 55.8% of patients were male; in the control group, the mean age was 38.69 ± 14.08 years, and 56.2% of control subjects were male. Pachymetric measurements of corneal apex (523.84 ± 30.36 µ vs 540.73 ± 27.85 µ, p < 0.001) thinnest point (518.70 ± 30.75 µ vs 537 ± 28.66 µ, p < 0.001), mean corneal volume (57.90 ± 3.39 mm3 vs 59.57 ± 3.37 mm3, p < 0.001) were significantly lower and anterior elevation [5.0 (1.0-34.0) vs 2.0 (1.0-7.0) diopter(D), p < 0.001], posterior elevation [11.0 (1.0-66.0) vs 4.0 (0-22.0) D, p < 0.001)] and corneal astigmatism [1.1 (0-7.1) vs 0.7 (0.1-5.7) D, p = 0.005] were significantly higher in the Behçet's disease group than in control group. No significant difference was found in other anterior segment parameters between the Behçet's disease group and control group. Concurrent keratoconus was detected in two cases (1.7%). A statistically significant correlation was found between the corneal measurements and frequency of uveitis attacks. CONCLUSION: The chronic inflammatory process associated with various proinflammatory cytokines, which play a role in the pathogenesis of keratoconus, may also contribute to a decrease in corneal thickness and corneal volume in Behçet's patients with ocular involvement.

Corneal Collagen Cross-Linking With Photoactivated Chromophore for Infectious Keratitis After Penetrating Keratoplasty.

PURPOSE: To evaluate the efficacy and safety of corneal collagen cross-linking with photoactivated chromophore (PACK-CXL) plus medical treatment in comparison with the non-CXL group in the management of graft infections after penetrating keratoplasty. METHODS: Forty eyes of 40 patients, 18 eyes in the PACK-CXL group and 22 eyes in the non-CXL group, with graft infections were retrospectively reviewed. Patients with microbial keratitis who were resistant to medical treatment for at least 1 week were treated with PACK-CXL in conjunction with medical treatment. The non-CXL group received only medical treatment. RESULTS: The median (interquartile range) size of the infiltrate was 11 (3-12.7) versus 7.5 (3.5-12.7) mm (P = 0.37), the epithelization time was 3 (2.7-5) versus 6 (3-11.2) days (P = 0.06), the complete healing time was 23.5 (17.7-33.5) versus 34 (27.7-41.2) days (P = 0.02), and the best-corrected distance visual acuity was 2.5 (0.5-3) versus 2.0 (0.9-3) logarithm of the minimum angle of resolution (P = 0.79) at presentation and 1 (0.3-3) versus 3 (1-3) logarithm of the minimum angle of resolution (P = 0.19) at the final visit for the PACK-CXL and non-CXL groups, respectively. Resolution of infiltrates was observed in 83.3% and 68.2% of cases in the PACK-CXL and non-CXL groups, respectively (P = 0.28). Graft failure was observed in 5 (27.8%) and 12 (54.5%) patients in the PACK-CXL and non-CXL groups, respectively (P = 0.08). CONCLUSIONS: PACK-CXL appears to be a promising adjuvant procedure in the management of resistant graft infections by reducing both the duration required for complete healing and rates of graft failure.

Candida parapsilosis Infection After Crescentic Lamellar Wedge Resection in Pellucid Marginal Degeneration.

Infectious keratitis after corneal lamellar surgery is a rare complication. In this report, we present unexpected complications after crescentic lamellar wedge resection (CLWR) and their treatment in a patient with pellucid marginal degeneration. A 42-year-old male patient developed fungal keratitis due to Candida parapsilosis in the late postoperative period after CLWR. Infection was controlled with medical treatment. However, recurrent intraocular infections and cataract formation occurred, probably due to capsular damage and inoculation of microorganisms into the crystalline lens during antifungal drug injection. Lensectomy was performed due to cataract progression and recurrence of the infection when treatment was discontinued. Amphotericin B was administered to the anterior chamber at the end of the operation. Four months later, an intraocular lens was implanted and corneal cross-linking treatment was performed. At the last visit, visual acuity reached 9/10. This case shows that good visual acuity can be achieved with appropriate treatment of fungal keratitis and all associated complications after CLWR.