[Patient-reported Outcomes after Laser In Situ Keratomileusis Surgery].

PURPOSE: To evaluate patient-reported quality of vision before and after laser in situ keratomileusis (LASIK) surgery. SUBJECTS AND METHODS: This study involved 140 patients who underwent LASIK surgery at Baptist Eye Clinic, Kyoto, Japan. Each patient was asked to respond to the Refractive Status and Vision Profile (RSVP) questionnaire prior to surgery and at 6-months and 5.5-years postoperative. In each patient, we defined the eye with better uncorrected visual acuity (VA) or with less refractive error as the better eye, and the other eye as the worse eye. RESULTS: Even in the worse eyes, the percentage of eyes with an uncorrected VA of decimal 0.5 or greater was 93.5% at 6-months and 88.6% at 5.5-ears postoperative. The mean preoperative total RSVP score was 37.1, yet that score significantly improved at 6-months postoperative (p< 0 .001) and remained the same throughout the 5.5-year follow-up period. CCONCLUSION The patient-reported quality of vi-ion post LASIK surgery was improved and remained improved throughout the 5.5-year follow-up period.

Comparative Study of Seven-year Outcomes Following Laser In Situ Keratomileusis with those of Trans-epithelial Photorefractive Keratectomy.

Purpose: To compare the long-term outcomes of laser-assisted in situ keratomileusis (LASIK) and trans-epithelial photorefractive keratectomy (tPRK). Methods: In this retrospective study, 23 eyes of LASIK patients were compared with 23 eyes of patients who underwent tPRK; none of who underwent retreatment. The cases were matched for refractive power and patient age. In all patients, visual acuity (VA), refractive power and corneal topography were evaluated between 6-months and 7-years postoperative. Results: At 7-years postoperative, uncorrected VA was 20/20 or better in 71.9% of the LASIK-treated eyes and in 68.7% of the tPRK-treated eyes. From 6-months to 7-years postoperative, both the LASIK- and tPRK-treated eyes developed a slight myopia (-0.18 D and -0.36 D, p=0.24), and a difference in corneal power change was observed between the LASIK (0.23 D steeper) and tPRK (0.57 D steeper) (p=0.05) eyes. Conclusion: At 7-years postoperative, a good surgical outcome was found in both the LASIK- and tPRK-treated eyes, yet myopic regression was more pronounced in the tPRK-treated eyes than in the LASIK-treated eyes.

Donor Corneal Endothelial Cell Maturity and Its Impact on Graft Survival in Glaucoma Patients Undergoing Corneal Transplantation.

PURPOSE: To examine corneal graft survival via corneal endothelial cell density (ECD) and corneal endothelial cell loss (ECL) at 5 years post-transplantation in the eyes of patients with and without a history of undergoing glaucoma surgery according to the maturity of the donor corneal endothelial cells. DESIGN: Prospective cohort study. METHODS: This prospective cohort study included 17 patients with glaucoma and 51 patients without glaucoma who underwent Descemet's stripping automated endothelial keratoplasty or penetrating keratoplasty at the Baptist Eye Institute, Kyoto, Japan, between October 2014 and October 2016. Human corneal endothelial cells were cultured from residual peripheral donor cornea tissue, and the maturity of the cells was evaluated by cell surface markers (ie, CD166+, CD44-/dull, CD24-, and CD105-) using fluorescence-activated cell sorting. Kaplan-Meier analysis or the chi-square test was used to assess the rate of successful corneal graft survival post-transplantation. RESULTS: At 36 months postoperatively, the mean ECD and ECL in the glaucoma-bleb eyes were 1197 ± 352 cells/mm2 and 55.5% ± 13.9% in the high-maturity group and 853 ± 430 cells/mm2 and 67.7% ± 18.1% in the low-maturity group, respectively. Kaplan-Meier analysis revealed that at 5 years postoperatively, the overall rate of survival was 45%, that is, 100% in the high-maturity group and 25% in the low-maturity group (P < .05). CONCLUSIONS: The findings in this prospective cohort study revealed that the use of donor corneal grafts containing mature-differentiated corneal endothelial cells could maintain the survival of the transplanted graft for a long-term period, even in patients with a history of undergoing glaucoma surgery.

A case of lattice corneal dystrophy type 1 with bilateral Mooren's ulcer.

Purpose: To report a rare case of lattice corneal dystrophy type 1 (LCD1) with bilateral Mooren's ulcer. Observations: This case involved a 62-year-old male patient with LCD1 who presented with the primary complaint of experiencing pain and photophobia in both eyes for 2 months prior to his initial visit. Upon examination, a peripheral corneal ulcer was observed in both eyes covering more than 3 of the 4 quadrants, accompanied with ciliary injection and severe corneal infiltration. He was diagnosed with Mooren's ulcer, and treatment with 0.1% betamethasone and 0.5% levofloxacin eye drops and systemic cyclosporine and betamethasone was initiated. At 1-month post treatment initiation, a remaining ulceration ridge was observed on the corneal surface in his left eye, which was subsequently resected. Complete epithelialization was achieved at 1-month postoperative in the left eye and after 6-months of conservative topical treatment in the right eye. At 8-9 years post onset of Mooren's ulcer, the patient underwent penetrating keratoplasty in both eyes while undergoing treatment with oral cyclosporine administration for severe corneal opacity due to progression of lattice dystrophy. Post treatment, there has been no recurrence of ulcerations, even though more that 10 years has passed since the onset of Mooren's ulcer. Conclusions and importance: To the best of our knowledge, this is the first reported case of LCD1 with bilateral Mooren's ulcer, and in this rare case, the patient was successfully treated with a combination of steroid, cyclosporine, and peripheral superficial keratectomy, and a good visual outcome was achieved after penetrating keratoplasty (PK) under the use of systemic cyclosporine.

Two presentations of upper lid migration of rigid gas-permeable contact lenses.

OBJECTIVE: To report two differing forms of upper lid migration of rigid gas-permeable contact lens and review the literature on embedded contact lenses. METHODS: Two case reports and review of the literature. RESULTS: Case 1 was a 36-year-old woman, who presented with a 1-year history of a left upper lid mass. Eversion of the upper lid revealed a tarsoconjunctival mass with an overlying scar. Excision revealed a migrated contact lens within a cyst of conjunctival epithelium. She recalled she had lost the lens 1 year before noticing the mass. Case 2 was a 42-year-old woman, who had a 10-month history of mucopurulent discharge from the right eye. Double eversion of the upper lid revealed an embedded contact lens with pus. Excision demonstrated a lens surrounded by inflamed granulation tissue. She recalled having lost the lens after sleeping overnight with the lens in place approximately 1 year before the development of the mucopurulent discharge. CONCLUSIONS: These cases highlight the importance of acquiring a detailed history of contact lens loss in patients presenting with upper eyelid masses. Furthermore, the history of lens loss may be remote from commencement of symptoms, which may vary significantly between patients.

Risk factors for intraocular pressure elevation during the early period post cataract surgery.

PURPOSE: To assess the risk factors for intraocular pressure (IOP) elevation during the early period post cataract surgery. STUDY DESIGN: Retrospective study. METHODS: This study involved 1587 eyes that underwent cataract surgery at the Baptist Eye Institute, Kyoto, Japan between April 2020 and May 2021. In all subjects, risk factors for early postoperative IOP elevation (i.e., an increase of IOP of 10 mmHg or more at 1-day postoperative compared with that at baseline, or a postoperative IOP of 28 mmHg or more) were analyzed by multivariate logistic regression analysis. RESULTS: Of the 1587 treated eyes in this study, 100 (6.3%) experienced early-postoperative IOP elevation. Of those 100 eyes, 78.0% were men, 27.0% had an axial length (AL) of ≥ 26.5 mm, 23.0% had a history of glaucoma treatment, 11.0% had poor mydriasis and 10.0% had intraoperative floppy iris syndrome (IFIS). Multivariate analysis findings revealed that male [odds ratio (OR) 4.36; 95% confidence interval (CI) 2.63-7.23; P < 0.001], AL of ≥ 26.5 mm (3.11; 1.83-5.30; P < 0.001), a history of glaucoma treatment (2.83; 1.63-4.91; P < 0.001), poorly mydriasis (2.63; 1.16-6.01; P = 0.02), IFIS (4.37; 1.78-10.74; P = 0.001) and baseline high IOP (1.09; 1.01-1.18; P = 0.03) were associated with increased IOP during the early period post cataract surgery. CONCLUSIONS: The findings in this study reveal that male sex, high myopia, a history of glaucoma treatment, poor mydriasis, IFIS and baseline high IOP are risk factors for IOP elevation during the early period post cataract surgery.

Comparison of penetrating keratoplasty outcomes with or without microwave thermokeratoplasty.

Microwave thermokeratoplasty (MTK) is a surgical procedure for the correction of pathologic corneal steepening. The purpose of this study was to examine the postoperative outcomes of eyes with advanced keratoconus that underwent femtosecond-laser zig-zag penetrating keratoplasty (z-PK) following MTK for reshaping of the central cornea. This study involved 32 eyes of 32 consecutive advanced keratoconus patients; i.e., 25 eyes of 25 patients who underwent MTK prior to z-PK (MTK + z-PK group), and 7 eyes of 7 patients who underwent z-PK alone (z-PK group). In all treated eyes, visual acuity (VA) and corneal topography were measured before surgery and at 6-months postoperative. At 6-months postoperative, the mean uncorrected distance VA (logarithm of the minimum angle of resolution) and surface regularity index (SRI) of the MTK + z-PK group was 0.62 ± 0.39 (mean ± standard deviation) and 1.26 ± 0.45, respectively, while that in the z-PK group was 1.02 ± 0.18 and 7.64 ± 3.22, respectively. Both variables were significantly better in the MTK + z-PK group than in the z-PK group (P < 0.05). The findings in this study reveal that MTK prior to z-PKP is effective for improving UDVA and reducing the irregularity of corneal topography in patients with advanced keratoconus.

Surgical outcomes of re-excimer laser phototherapeutic keratectomy (re-PTK).

To assess the surgical outcomes of re-excimer laser phototherapeutic keratectomy (re-PTK) for recurrent disease after initial PTK. Retrospective cohort study with historical comparison group. This study involved 56 patients who underwent re-PTK (mean follow-up period: 47.9 ± 36.2 months) at the Baptist Eye Institute, Kyoto, Japan. In all subjects, corrected-distance visual acuity (CDVA) before and after re-PTK was compared. Postoperative recurrence of corneal lesion with a decrease of CDVA of two lines or more was compared with postoperative best CDVA deemed as a significant relapse. The Kaplan-Meier method was used to compare the recurrence rate post-re-PTK with that after the initial PTK. The disease classification in the 78 eyes was heterozygous-type GCD (hetero-GCD, n = 47 eyes), homozygous-type GCD (homo-GCD, n = 13 eyes), band keratopathy (n = 7 eyes), lattice corneal dystrophy (n = 6 eyes), and other (n = 5 eyes). After re-PTK, homo-GCD recurred statistically significantly earlier than hetero-GCD (P = 0.0042). No significant difference was found in the recurrence rate for all diseases between post-re-PTK and post initial PTK (P > 0.05). Surgical outcomes after re-PTK were nearly equal to those after initial-PTK.

Long-term course of contrast sensitivity in eyes after laser-assisted in-situ keratomileusis for myopia.

PURPOSE: To evaluate the long-term contrast sensitivity (CS) after laser in-situ keratomileusis (LASIK) for myopia. METHODS: This retrospective, single-center, cohort study involved 190 eyes of 95 patients who underwent bilateral LASIK between January 2001 and October 2007. This study includes patients who underwent CS and higher-order aberration (HOA) measurements in a five-year postoperative period. For all enrolled patients, visual acuity, refractive error (RE) in diopters (D), CS at 3-, 6-, 12-, and 18-cycles per degree (cpd), and HOA in a 4 mm area of the dilated pupil were measured before surgery and 6 months, 1 year, and 5 years after it. RESULTS: The mean RE measured before the surgery and after 6 months, 1 year, and 5 years after was -6.08 ± 2.50D, -0.26 ± 0.65D, -0.28 ± 0.65D, and -0.48 ± 0.80D, respectively. There were no clinically significant changes between preoperative results and the measures taken 6 months, 1 year, and 5 years after surgery. The slight increase in HOA had little effect on CS over the mid to long-term postoperative period. CONCLUSION: Our findings show that CS does not clinically change post LASIK. Although we were unable to identify the specific mechanism, we theorize that after LASIK there is a possibility for the compensation of HOA.

Patient-reported vision-related quality of life after laser in situ keratomileusis, surface ablation, and phakic intraocular lens: The 5.5-year follow-up study.

To evaluate the long-term efficacy of refractive surgery of all cases in a single center via the use of a patient-reported outcome (PRO) refractive status questionnaire using descriptive statistics. This study was prospective, single-center, cohort study that involved 1422 patients who underwent refractive surgery (laser in situ keratomileusis, surface ablation, and phakic intraocular lens) at Baptist Eye Institute, Kyoto, Japan. The patients were asked to answer the Refractive Status and Vision Profile (RSVP) questionnaire before the surgery after 6 months (n = 1133 patients) and after 5.5 years (n = 232 patients). During the same period, examination by slit-lamp biomicroscopy and visual acuity tests were performed. Moreover, the patients were asked to rate their satisfaction with the surgery 6 months and 5.5 years after it. We examined overall RSVP scale (S), 8 RSVP subscales, rate of satisfaction with surgical outcome, slit-lamp biomicroscopy findings, and refractive error. The mean preoperative S was 36, yet that score significantly improved to 19 at 6 postoperative months postoperatively (P < .01), and basically remained the same (i.e., 20) throughout the 5.5-year postoperative period. During the 5-year follow-up period, mean refractive error became slightly myopic (0.3 D). No change in the rate of satisfaction was observed at both 6 months and 5.5 years postoperative period. The findings of this study help to clarify long-term PRO quality of vision (QOV) postrefractive surgery in a single center, and show that minor change in refractive error during 5 years postoperative period had no influence on the mean RSVP scores among outpatients. Nearly all patients reported short-term improvement of QOV, which continued throughout the long-term follow-up period.

Myopia progression over a 4-year period after laser-assisted refractive surgery in patients in their 20s and 30s.

PURPOSE: To investigate the increase in refractive error (RE) and axial length (AL) in myopia patients in their 20s and 30s after laser-assisted in situ keratomileusis (LASIK) or epipolis-LASIK (epi-LASIK). STUDY DESIGN: Retrospective cohort study. METHODS: This retrospective study involved 280 eyes of 140 myopia patients who underwent LASIK or epi-LASIK at the Baptist Eye Institute, Kyoto, Japan and who were followed for more than 5 years postoperatively. The patients were divided into 2 groups according to age: group A (age range, 20-29 years) and group B (age range, 30-39 years). In all patients, the RE and AL were measured at 1, 2, 3, 4, and 5 years postoperatively, and the 2 groups were compared in terms of each surgical method. RESULTS: The patients' mean age at surgery was 30.6 ± 4.9 years. No significant difference was found between the 2 groups in terms of the preoperative mean spherical equivalent (SE) or AL. In the LASIK group, the mean changes in SE during the 4 years of study in groups A and B were + 0.054 ± 0.256 D and + 0.052 ± 0.327 D, respectively (P = .93, NS), and the postoperative increases in AL were 0.059 ± 0.134 mm and 0.027 ± 0.133 mm, respectively (P = .08, NS). In the epi-LASIK group, the mean change in SE during the 4 years of study in groups A and B were -0.438 ± 0.207 D and -0.259 ± 0.454 D, respectively (P = .41, NS), and the postoperative increases in AL were 0.124 ± 0.141 mm and 0.094 ± 0.166 mm, respectively (P = .46, NS). CONCLUSION: Our findings showed no significant difference in myopia progression in patients in their 20s and 30s during a 4-year period after either LASIK or epi-LASIK.

Anterior and posterior ratio of corneal surface areas: A novel index for detecting early stage keratoconus.

PURPOSE: To evaluate the diagnostic ability of the ratio of anterior and posterior corneal surface areas (As/Ps) comparing with other keratoconus screening indices in distinguishing forme fruste keratoconus (FFKC) from normal eyes. METHODS: In this comparative study, 13 eyes of 13 patients with FFKC, 29 eyes of 29 patients with keratoconus (KC) and 88 eyes of 88 patients with normal subjects were involved. The As/Ps measured by the anterior segment optical coherence tomography (AS-OCT) and other indices measured by AS-OCT and rotating Scheimpflug-based corneal tomography were evaluated. The area under receiver-operating-characteristics (AU-ROC) was calculated to assess the diagnostic ability in discriminating FFKC from normal eyes. RESULTS: The As/Ps, the Belin/Ambrosio display enhanced ectasia total derivation value (BAD-D) and posterior and anterior elevation values showed the AU-ROC 0.9 or more in differentiating FFKC from normal eyes (0.980, 0.951, 0.924 and 0.903, respectively). The sensitivity and specificity were 0.92 and 0.96 for the As/Ps, 1.00 and 0.90 for BAD-D, 0.85 and 0.86 for posterior elevation value, and 0.85 and 0.96 for anterior elevation value, respectively. CONCLUSIONS: Among the several indices for keratoconus screening which we evaluated, the As/Ps obtained by AS-OCT had the large AU-ROC with high sensitivity and specificity in detecting FFKC, which was comparable with BAD-D obtained by rotating Scheimpflug-based corneal tomography. The As/Ps may provide information for improving the diagnostic accuracy of KC, even in the initial stage of the disease.

Five-year follow-up outcomes after Descemet's stripping automated endothelial keratoplasty: a retrospective study.

OBJECTIVE: To assess graft survival and endothelial cell density (ECD) over a 5-year follow-up period after Descemet's stripping automated endothelial keratoplasty (DSAEK). METHODS AND ANALYSIS: This retrospective study involved 130 eyes of 130 consecutive patients with Fuchs endothelial corneal dystrophy (FECD), non-FECD bullous keratopathy (BK) (non-FECD) or BK post-trabeculectomy or tube-shunt surgery (glaucoma with bleb) who underwent DSAEK between August 2007 and January 2012 and were followed for more than 5 years postoperatively. Patients with previous keratoplasty, graft suture failure, primary graft failure, postoperative endophthalmitis and ocular infection were excluded. Graft survival and ECD was then examined in all patients who underwent DSAEK and completed the postoperative follow-up period. The association between clinical factors and 5-year graft survival after DSAEK was analysed with multivariate logistic regression analysis. RESULTS: The overall graft survival rate at 5 years postoperatively was 85%, yet significantly poorer in the glaucoma with bleb eyes (47%) than in the FECD (100%) or non-FECD (90%) eyes (p<0.01, log-rank test). In the FECD, non-FECD and glaucoma with bleb eyes, the mean ECD at 5 years postoperatively was 1054 cells/mm2, 1137 cells/mm2 and 756 cells/mm2, respectively. Multivariate logistic regression analysis showed history of trabeculectomy or tube-shunt surgery and postoperative allograft rejection to be negative factors for graft survival at 5 years after DSAEK (OR 0.01, 95% CI 0.00 to 0.10 and OR 0.02, 95% CI 0.00 to 0.33, respectively). CONCLUSION: Our findings show that at 5 years postoperatively, the surgical outcome after DSAEK was poorer in eyes after trabeculectomy or tube-shunt surgery. TRIAL REGISTRATION NUMBER: UMIN000024891.

Long-Term Maintenance of Corneal Endothelial Cell Density After Corneal Transplantation.

PURPOSE: To investigate the key factors associated with eyes with an endothelial cell density (ECD) of ≥2000 cells/mm at 5 years after corneal transplantation. METHODS: This retrospective cohort study included 174 eyes that underwent penetrating keratoplasty by 1 corneal specialist surgeon at the Baptist Eye Institute, Kyoto, Japan, from 1998 through 2011 and that were carefully followed for over 5 years postoperative. In all operated eyes, corneal ECD was measured at 1, 2, 3, 4, and 5 years postoperative. Multivariate analysis with adjustment for preoperative donor ECD was performed between eyes with an ECD of ≥2000 cells/mm and those with an ECD of <2000 cells/mm at 5 years postoperative. RESULTS: Of the 174 eligible eyes, 16 eyes (9.2%) had an ECD of ≥2000 cells/mm at 5 years postoperative, and the annual rate of endothelial cell loss (mean ± SD) was 2.3% ± 3.7%. Multivariate analysis findings revealed that the donor-associated and surgery-related factors were not significant factors. Only the recipient diagnosis of bullous keratopathy was significantly associated with an ECD of <2000 cells/mm at 5 years postoperative. Of those 16 eyes, 6 (37.5%) had a recipient diagnosis of bullous keratopathy. CONCLUSIONS: None of the donor- and surgery-related factors, previously recognized as associated with a lower endothelial cell loss after penetrating keratoplasty, were found to be significant in this study, thus suggesting that there are still unknown factors associated with maintaining a higher ECD over the long-term postoperative period.

[Magnetic resonance imaging findings on the eyelids of Japanese cadavers for anatomical studies and a comparative examination of their histological pictures].

OBJECTIVE: To clarify ambiguous areas in interpreting MR images of Japanese eyelids, a histological examination was conducted on cadavers after the MRI for a comparative evaluation. SUBJECTS AND METHODS: Orbital sections including the unilateral upper and lower palpebrae of two Japanese cadavers (an 87-year-old woman and a 49-year-old man) were examined. Following MRI, the specimens of the same cadavers were examined histologically for a comparative evaluation. RESULTS: In both cadavers, a high signal intensity area with a hazy appearance unlike the orbital fat--fibroadipose tissue rich with connective tissue--was recognized between the orbicularis muscle and orbital septum. The same high signal intensity area that appeared to encase the posterior section of the descending orbital fat was also composed of fibroadipose tissue. Because of the presence of this intervening fibroadipose tissue, the posterior surface of the orbicularis muscle and the orbital septum could not come into contact with each other. CONCLUSION: Although limited to only two subjects, the current observation proved that fibroadipose tissue exists not only in the superficial layer of the orbital fat but that it further descends to surround the lowest portion of the orbital fat. As already reported, it was mainly the fibroadipose tissue, but not the orbital fat, that descends into the palpebral space.

Multiple Linear Regression Analysis of the Impact of Corneal Epithelial Thickness on Refractive Error Post Corneal Refractive Surgery.

PURPOSE: To evaluate the influence of corneal epithelial thickness (CET) on the deviation from the targeted refraction (refractive error [RE]) post corneal refractive surgery. DESIGN: Retrospective, single-center, cross-sectional study. METHODS: This study involved 211 eyes of 211 patients who previously underwent laser-assisted in situ keratomileusis (LASIK) or epipolis LASIK for the correction of myopia and myopic astigmatism from August 2000 to May 2014 at the Baptist Eye Institute, Kyoto, Japan, and who subsequently underwent examination of CET via optical coherence tomography imaging of 17 zones (central: n = 1 zone, paracentral: n = 8 zones, and midperipheral: n = 8 zones) within a 6.0-mm-diameter area of the central cornea from April 2014 to February 2015. The relationship between CET and RE was evaluated using Spearman coefficient in 5 parameters: CET in the (1) central, (2) paracentral, and (3) midperipheral zones, and the difference between the (4) central and paracentral zones and the (5) central and midperipheral zones. The influence of CET on RE was evaluated in the CET parameter that showed a significant correlation with RE using multiple liner regression analysis. RESULTS: The correlation coefficient with RE was (1) -0.238 (P < .01), (2) -0.172 (P < .05), (3) -0.002 (P = .98), (4) -0.186 (P < .01), and (5) -0.266 (P < .01), respectively. Multiple liner regression analysis revealed that the difference of mean CET between the central and midperipheral zones had a significant influence on RE (ß coefficient = -0.028, P < .01). CONCLUSIONS: The difference between CET at the central and midperipheral zones may play a role in the final RE post corneal refractive surgery.

Endothelial cell loss and graft survival after penetrating keratoplasty for laser iridotomy-induced bullous keratopathy.

PURPOSE: To assess corneal endothelial cell loss after penetrating keratoplasty (PK) treatment for laser iridotomy (LI)-induced bullous keratopathy (BK). METHODS: A retrospective study conducted on consecutive patients who underwent PK between March 2000 and December 2011. Patients who had undergone more than 24 months of follow-up were included. Patients who underwent PK were subcategorized into two groups based on their diagnosis of BK prior to PK; PK was performed to treat either LI-BK or non LI-BK. The cell density of the central corneal endothelium and the graft survival were evaluated during follow-up. RESULTS: Corneal endothelial cell density decreased in a similar fashion in both the LI-BK and non LI-BK patients, though the cell density decreased significantly faster in the LI-BK group than in the non LI-BK group throughout the 108 months of the study (p = 0.026). The mean cell loss at 36 months for the LI-BK group was 57.7% vs. 63.2% for the non LI-BK, 76.9% vs. 70.1% at 72 months, and 85.6% vs. 72.0% at 108 months. No eye among 21 eyes in the LI-BK group (0%) had failed grafts, whereas 4 of 25 eyes in the non LI-BK group (16.0%) had failed grafts at 60 months (p = 0.114). CONCLUSIONS: The outcome of PK for BK secondary to LI was no worse than the outcome of PK for other types of BK. However, our long-term follow-up after PK showed that cell density decreased faster in the LI-BK group than in the non LI-BK, suggesting that cell loss might be involved in the existence of LI prior to PK.

Topical non-steroidal anti-inflammatory drugs for the treatment of cystoid macular edema post Descemet's stripping automated endothelial keratoplasty.

PURPOSE: To investigate the effectiveness of topical non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of cystoid macular edema (CME) post Descemet's stripping automated endothelial keratoplasty (DSAEK). STUDY DESIGN: Retrospective observational study METHODS: In this study of 334 patients who underwent DSAEK at the Baptist Eye Institute, Kyoto, Japan between July 2011 and December 2015, 18 patients with postoperative CME (determined by optical coherence tomography) treated with topical NSAIDs after the onset of CME were included. RESULTS: At CME onset, 17 of the 18 patients were treated with bromfenac eye drops and 1 was treated with nepafenac eye drops. Post initiation of treatment with topical NSAIDs, CME in 17 (94.4%) of the 18 patients improved at 1 month and all cases completely recovered within 3 months. At 12-months post initiation of treatment, 61.1% (n = 11) of patients achieved a visual acuity (VA) of 20/40 or better, and there was no significant difference of VA between the patients with or without an episode of postoperative CME (P = 0.55). CONCLUSION: The administration of topical NSAID eye drops was found to be effective in treating patients with CME post DSAEK.