EVALUATING CONTRAST SENSITIVITY IN AGE-RELATED MACULAR DEGENERATION USING A NOVEL COMPUTER-BASED TEST, THE SPAETH/RICHMAN CONTRAST SENSITIVITY TEST.

BACKGROUND: Contrast sensitivity (CS) is a valuable measure of visual function in patients with age-related macular degeneration (AMD). The authors aimed to compare a novel computer-based test (the Spaeth/Richman Contrast Sensitivity test) with Pelli-Robson test for evaluating CS in patients with AMD. METHODS: In this prospective cross-sectional study, CS was evaluated in patients with various stages of AMD and healthy controls using Spaeth/Richman Contrast Sensitivity test and Pelli-Robson test. Spaeth/Richman Contrast Sensitivity test determined CS scores for 5 areas of vision for each eye (central, superonasal, superotemporal, inferonasal, and inferotemporal) and the total score. Test scores between the two methods were compared using mixed-effects linear regression. Spearman's rank correlation coefficient was used to determine correlations. Test-retest reliability was determined using the intraclass correlation coefficient. RESULTS: Of 35 participants with AMD (54 eyes) and 34 controls (66 eyes), 51% were female and 93% were of European descent. The mean Spaeth/Richman Contrast Sensitivity test score for the central area and each of the 4 peripheral quadrants was significantly lower for patients with AMD versus controls (P < 0.001 for all). The mean Pelli-Robson score was also significantly lower in patients with AMD versus controls (P < 0.001). The intraclass correlation coefficient for Spaeth/Richman Contrast Sensitivity test total score and Pelli-Robson score was 0.87 and 0.92, respectively. CONCLUSION: Spaeth/Richman Contrast Sensitivity test, a novel Internet-based method of testing CS, had significantly lower scores for patients with AMD compared with controls for central and peripheral vision. This test is a valuable tool for assessing CS in AMD.

Do intravitreal anti-VEGF injections have an effect on corneal endothelial remodeling in children with premature retinopathy?

PURPOSE: This study was carried out to investigate the effects of retinopathy of prematurity (ROP) and intravitreal antivascular endothelial growth factor (VEGF) injections on the corneal endothelium in the childhood period of patients who have had ROP. METHODS: The material of comparative case-control clinical study consisted of patients followed up with ROP between February 2013 and February 2023. The eyes in the study group were divided into two subgroups consisting of those who received intravitreal anti-VEGF injections (subgroup 1) and those who were followed up only (subgroup 2). Central corneal endothelial cell density (ECD), coefficient of variation (CV), central corneal thickness (CCT), and pleomorphism parameters in the childhood period were evaluated by corneal specular microscopy and compared with age-matched healthy control subjects. RESULTS: There were 84 eyes of 42 patients with ROP in the study group and 80 eyes of 40 healthy children in the control group. Mean CCT was significantly higher in subgroup 1 and the control group than in subgroup 2 (p = 0.037), and mean ECD was significantly higher in subgroup 2 than in subgroup 1 and the control group (p < 0.001). There was no significant difference between subgroup 1 and the control group in mean ECD and CCT values (p = 1.000 for both cases). CONCLUSIONS: Considering that ROP patients who received intravitreal anti-VEGF injections had more advanced-stage ROP than ROP patients who were followed up only, these findings suggest that intravitreal anti-VEGF applications in ROP cases may lead to corneal endothelial parameters similar to those of healthy eyes.

A Detailed Analysis of Individuals Having Graft Failure After Corneal Transplantation.

PURPOSE: To describe demographic and clinical characteristics of patients with graft failure after keratoplasty, determine the cause of graft failure and outcomes. METHODS: The charts of patients between 2008-2013 in the Cornea Service at Wills Eye Hospital with a history of a corneal transplant before the end of 2012 were retrospectively reviewed. Included were patients who had graft failure after corneal transplantation and had at least one year of follow-up after transplantation. Penetrating keratoplasty (PK) and Descemet's stripping endothelial keratoplasty (DSEK) patients were analyzed separately. RESULTS: A total of 186 eyes of 170 patients with graft failure after a PK (156) or DSEK (30) procedures were identified. The baseline characteristics included 100 female and 70 male patients with an age between 0 and 90 years (median 63 years). At the time of surgery, 38% had three or more systemic diseases and 68% were using three or more systemic medicines. Mean follow up time for PK was nearly four times of DSEK. Only 2 DSEK eyes (7%) underwent a 3rd DSEK graft, while 47 (30%) PK eyes underwent a 3rd PK and 15 (10%) PK eyes underwent more than three PK procedures. CONCLUSIONS: Most DSEK failures occurred in 1st year, while graft failure in PKs is scattered over years. Failure in DSEK is mostly due to graft or surgical risk factors but in PK mostly due to factors in the host. DSEK does not appear to be as affected by the patients' demographic and clinical characteristics as much as PK.

Optic disc and retinal vessel densities assessment by optical coherence tomography angiography in patients with keratoconus.

BACKGROUND: This study aimed to evaluate retinal and optic disc vascular changes in patients with keratoconus (KC) using optical coherence tomography angiography (OCTA). METHODS: Thirty-two eyes of 22 patients with KC and 24 eyes of 24 age- and sex-matched healthy controls were included in this study. Corneal topography and OCTA were performed. Quantitative vessel density of the macular superficial capillary plexus (SCP), macular deep capillary plexus (DCP), and radial peripapillary capillaries (RPC); choriocapillaris flow area; and choroidal thickness were compared between the KC and control groups. RESULTS: SCP and DCP vessel densities showed a significant reduction in the KC group compared to that in the control group (p < 0.001 and p < 0.001 in the whole image and parafovea, respectively). Choriocapillaris flow area was significantly higher in patients with KC than in the control group (p = 0.003). The foveal avascular zone area did not significantly differ between the two groups (p = 0.949). RPC inside disc vessel density was significantly decreased in the KC group compared to that in the control group (p < 0.001). CONCLUSION: This study revealed important macular, choroidal, and optic disc vessel densities changes in patients with KC. Macular whole vessel density and parafoveal vessel density of the SCP and DCP decreased, while choriocapillaris flow area increased in patients with KC.

Analysis of optical coherence tomography angiographic findings of prematurely born children and its relationship with macular edema of prematurity.

PURPOSE: To compare foveal avascular zone (FAZ) area, foveal vascular density (VD), and foveal thickness in pre- and full-term children and to evaluate their relationship with cystoid macular edema (CME) in the prematurity period using spectral domain optical coherence tomography angiography (SD-OCTA). METHODS: OCTA imaging was performed at 4-6 years of age in 90 eyes of 45 prematurely born children and 50 eyes of 25 term children. Subjects were divided into three groups: prematurely born with CME (group 1); prematurely born without CME (group 2); healthy, term children (group 3). Imaging results in the three groups were compared. RESULTS: FAZ area was significantly larger in group 3 than in groups 1 and 2 (P < 0.001 [ANOVA]). FAZ area was found to be correlated with birth weight (r = 0.511; P < 0.001) and gestational age (r = 0.532; P < 0.001). No significant relationship was found between history of CME and FAZ area. CONCLUSIONS: In our study cohort, FAZ area was smaller in prematurely born children and was correlated with older gestational age and higher birth weight. CME in the neonatal period did not seem to affect retinal microvascular development in premature infants.

Effect of macular edema in the premature period on refraction in infants screened and treated for retinopathy of prematurity.

BACKGROUND: To determine the effect of macular edema on refraction in infants with retinopathy of prematurity (ROP) at the ages of one, two and three years using Optical Coherence Tomography (OCT). METHODS: Optical coherence tomography (OCT) was performed to detect and categorize edema in 280 eyes of 280 premature infants. The cross-sectional spectral domain OCT imaging of the macular region was performed between weeks 36 and 42 to assess macular development. Refraction measurement was performed during follow-up at the ages of one, two and three years. Macular thickness, choroidal thickness, macular edema severity, and the spherical, cylindrical and spherical equivalent (SE) values were measured. RESULTS: A positive correlation was found between macular thickness in the premature period and the SE value at age one and a negative correlation at age three. No correlation was found between gestational age and the SE value, but there was a positive correlation between birth weight and the SE value at ages one and two. Although no correlation was determined between edema and gestational age or between edema and birth weight, the prevalence of macular edema in infants with ROP was significantly higher than that of infants without this disease. CONCLUSIONS: Macular edema during the premature period can have an impact on refraction at the ages one, two and three years by effecting the emmetropization process.

Evaluation of the Findings of Patients Who Underwent Sutureless Flanged Transconjunctival Intrascleral Intraocular Lens Implantation with or without Pars Plana Vitrectomy.

PURPOSE: To compare the visual outcomes and complications of patients who underwent flanged transconjunctival sutureless intrascleral intraocular lens (SIS IOL) implantation after anterior and pars plana vitrectomy. METHODS: All patients who underwent flanged transconjunctival SIS IOL fixation using a 27-gauge needle between September 2017 and November 2019 and were followed up for at least six months were evaluated. The cases in which anterior vitrectomy was performed were classified as Group 1, and those that underwent pars plana vitrectomy were classified as Group 2. The best-corrected visual acuity (BCVA), spherical equivalent values, corneal endothelial cell density, and intraocular pressures were compared between the two groups before and after the operation. Intraoperative and postoperative complications were assessed. RESULTS: The study included 108 eyes of 108 patients who were included in the study. Group 1 consisted of 48 patients and Group 2 comprised of 60 patients. When the findings between Groups 1 and 2 were compared in the postoperative period, there was no statistically significant difference in terms of the mean intraocular pressure increase, endothelial cell density, BCVA, and spherical equivalent value (P=0.818, 0.601, 0.368, and 0.675, respectively). When all the patients were considered as a single group, the mean spherical value at the sixth postoperative month was 0.3 ± 2.2 D (min-max, (-5.5)-(+6)), the mean cylindrical value was -1.7 ± 2.4 D (min-max, (-9.25)-(+4)), and the mean spherical equivalent value was -0.5 ± 2.3 D (min-max, (-6.5)-(+6)). CONCLUSION: The flanged transconjunctival SIS IOL fixation technique performed using a 27-gauge needle is safe and effective in the patient group with aphakia and lens/IOL dislocation or subluxation. However, in patients planned to undergo flanged transconjunctival SIS IOL implantation, pars plana vitrectomy seems to be a more suitable option than anterior vitrectomy to reduce complications.

The effect of electronic cigarette smoking on retinal microcirculation: Enlargement of the foveal avascular zone.

BACKGROUND: To evaluate retinal microcirculation in electronic cigarette (e-cigarette) smokers using optical coherence tomography angiography (OCTA). METHODS: OCTA measurements were performed on the left eyes of 21 e-cigarette smokers and 21 healthy controls. Superficial and deep foveal, perifoveal and parafoveal vessel densities, outer retina and choriocapillaris flow area, foveal avascular zone (FAZ), and central macular thickness were evaluated in both groups. RESULTS: The FAZ area was larger in e-cigarette smokers than the control group, and the difference was statistically significant (p = 0.003). The superficial foveal, superficial total, deep foveal and deep total vascular densities were significantly lower in the e-cigarette group compared to the control group (p = 0.011, p = 0.012, p = 0.022, and p = 0.041, respectively). Central macular thickness was lower in the e-cigarette smokers but the difference was not statistically significant (p = 0.678). CONCLUSIONS: E-cigarette smoking causes enlargement of the FAZ area and decreases vascular densities.

Impact of Cataract Surgery on Functional Balance Skills of Adults

Objectives: To investigate the impact of phacoemulsification surgery and intraocular lens implantation on the functional balance skills of adults. Materials and Methods: This prospective study included patients with cataract who were recommended phacoemulsification surgery and intraocular lens implantation between May and October 2016. The Berg Balance Scale and Tinetti Gait and Balance Test were performed by a physical therapy specialist before and 1 month after surgery. Patients were analyzed in terms of age, visual acuity, and balance. Balance scores before and after cataract surgery were compared. We also compared patients with high (≤2 LogMAR) and low (>2 LogMAR) visual acuity. P values below 0.05 were accepted as statistically significant. Results: Fifty-one patients (27 female and 24 male, mean age 66.96 years) were included in the study. One month after surgery, the patients' Berg Balance scores and Tinetti Gait and Balance scores were increased by 3.60±5.00% and 4.14±6.55%, respectively. Postoperative increase in visual acuity was significantly greater in the 16 patients with visual acuity less than 0.05 (>2 LogMAR) (p=0.036), but balance scores were not significantly different. Conclusion: Visual acuity is significantly improved one month after cataract surgery, which also leads to significant increases in low functional balance scores among patients with poorer vision. The rapid increase in vision after cataract surgery enhances balance skills, resulting in safer mobility and increased quality of life.

Evaluation of Metabolite Changes in the Occipital Cortex of Patients with Idiopathic Infantile Nystagmus or Bilateral Ametropic Amblyopia by Magnetic Resonance Spectroscopy.

PURPOSE: To evaluate the effects of idiopathic infantile nystagmus (IN) and bilateral ametropic amblyopia on metabolites in the occipital cortex by magnetic resonance spectroscopy. METHODS: The children included in this prospective study were divided into three groups. Group 1 consisted of 11 patients with idiopathic IN, group 2 consisted of 10 patients with bilateral ametropic amblyopia and group 3 consisted of nine normal children. A single-voxel magnetic resonance spectroscopy examination was performed by placing a region of interest on the occipital cortex of each participant. N-acetyl aspartate (NAA), creatine (Cr) and choline (Cho) concentrations were measured in the occipital cortex. This was followed by calculating and comparing the NAA/Cr and Cho/Cr ratios between the three groups. The Kruskal-Wallis test, Mann-Whitney U-test, and chi-square test were used for statistical analysis. RESULTS: There was no statistically significant difference in NAA/Cr ratios between patients with idiopathic IN and normal children, but there was a statistically significant difference between these groups when Cho/Cr ratios were compared; the ratio was higher in the idiopathic IN group. There were no statistically significant differences in NAA/Cr or Cho/Cr ratios between patients with bilateral ametropic amblyopia and normal children. CONCLUSIONS: Our findings suggest that the neurochemical profile of the occipital cortex is partially affected by idiopathic IN, but not by bilateral ametropic amblyopia.

Surgical Management of Double-Head Pterygium Using a Modified Split-Conjunctival Autograft Technique.

AIM: To describe a modified split-conjuctival autograft technique for double-head pterygium and evaluate the postoperative outcomes. METHODS: A retrospective analysis of all patients who underwent split-conjunctival autograft surgery for double-head pterygium from November 2012 to March 2014. Conjunctival autograft was split vertically, in order to obtain limbal sides of cojunctival autograft for both sides. No adjunctive agent was used. Records of included patients were reviewed and outcomes and recurrence rates were noted. RESULTS: Eight cases of double-head pterygia were noted in 158 total cases of pterygia evaluated (5%). The baseline characteristics included 2 female and 6 male with an age between 26 and 71 (average 42.63) years. All eyes had 12-month follow-ups in average (6-21 months). No intraoperative or postoperative complications were noted. No recurrence was observed. CONCLUSION: A modified, vertical-split conjunctival autograft without any adjunctive agents is a successful and safe technique in management of double-head pterygium.

Comparison of 3 different releasable suture techniques in trabeculectomy.

PURPOSE: The use of releasable sutures provides an effective and simple way of titrating intraocular pressure (IOP) postoperatively. The purpose of this study was to compare the surgical outcome of 3 releasable suture techniques for closing scleral flaps in patients undergoing primary trabeculectomy. METHODS: The Wills Eye Glaucoma Research Center retrospectively reviewed the charts of patients who underwent primary trabeculectomy by 3 surgeons using 3 different releasable suture techniques. Ninety eyes of 90 glaucoma patients were divided into 3 groups by releasable suture technique (n = 30 eyes for each group). Main outcome measures included best-corrected visual acuity (BCVA), intraocular pressure (IOP), rate of surgical success, use of supplemental medical therapy, need for additional glaucoma surgery, and complications during suture removal. RESULTS: The BCVA and IOP were similar among the groups for all follow-up visits. As a determinant of success rate of trabeculectomy, mean decrease of IOP after surgery was over 30% in all groups (p = 0.43). The number of postoperative antiglaucomatous medications, number of complications, and need for an additional glaucoma surgery were similar in all groups (p = 0.40, p = 0.87, and p = 0.47, respectively). The differences in suture-related complications, defined as suture break or need for laser suture lysis, were not significant among the groups (p = 0.09). CONCLUSIONS: We found that the 3 most common surgical techniques had similar mechanisms of action. All techniques were safe and effective, yielding similar outcomes. All 3 techniques can be used for closing scleral flaps in patients undergoing primary trabeculectomy.

Trabeculectomy in Patients With Glaucoma Over 80 Years of Age: Relatively Short-term Outcomes.

PURPOSE: To compare the surgical outcomes of trabeculectomy performed in elderly patients (above 80 y) with those of younger controls. MATERIALS AND METHODS: We retrospectively reviewed the charts of patients who underwent trabeculectomy from January 1, 2009 through April 30, 2011 at the Wills Eye Hospital. Patients over 80 years of age were compared with younger controls. Outcome measures included intraocular pressure (IOP), visual acuity, number of glaucoma medications, surgical complications, and surgical failure. Surgical failure was defined as when IOP>21 mm Hg or <20% reduction below baseline or IOP<5 mm Hg or reoperation for glaucoma, or loss of light perception. RESULTS: Eighty-six eyes of patients over 80 years of age (range, 81 to 94 y) were compared with 86 eyes of younger controls (range, 22 to 79 y). Mean follow-up time was 23.9±8.0 and 25.1±8.0 months for each group, respectively. After 1 year, the failure rate was 31.3% in the elderly group, compared with 29.5% in the control group (P=0.98). At last follow-up visit, the rate of failure between the groups was similar (P=0.35). Postoperative complications were similar between the groups (P=0.25). CONCLUSIONS: The surgical outcomes of trabeculectomy in patients older than 80 years were found to be similar to those of younger controls. Taking into consideration elderly glaucoma patients' general health condition and life expectancy, age alone may not be a barrier to performing glaucoma filtration surgery.

Demographics of Patients with Double-headed Pterygium and Surgical Outcomes.

OBJECTIVES: To analyze demographic and ophthalmologic characteristics of patients with double-headed pterygium in the Mediterranean region of Turkey and to evaluate their surgical outcomes. MATERIALS AND METHODS: Records of all patients who underwent surgery for pterygium in Antalya Atatürk State Hospital between November 2012 and March 2014 were retrospectively reviewed. Patients with pterygia on both sides of the cornea (nasal and temporal) were included in the study. Patients with less than six months of follow-up were excluded. Age, occupation and smoking status of patients, recurrence of pterygium and any existing complications in records were evaluated. Fibrovascular proliferation more than 0.5 mm over the cornea was accepted as recurrence. RESULTS: Eight (5%) of 158 patients who underwent pterygium surgery were diagnosed with double-headed pterygium. Six (75%) of the patients were male and two (25%) were female. Mean age was 42.63 (26-71) years. It was recorded that all patients had worked under the sun for at least 5 hours a day. No intra-operative or post-operative complications were found. Mean follow-up time after surgery was 12 (6-21) months and no recurrence was detected. CONCLUSION: Pterygium, especially double-headed pterygium is mostly seen in warm climates and individuals who work outdoors. Dividing the free conjunctival autograft into two and suturing in place of the excised pterygium on both sides of the cornea is a good choice in these patients.

Long-term results of keratoplasty in patients with herpes zoster ophthalmicus.

PURPOSE: To report the long-term results of keratoplasty in patients with herpes zoster ophthalmicus (HZO). METHODS: All 14 patients underwent keratoplasty for a corneal scar or a perforated corneal ulcer due to HZO at the Wills Eye Institute from January 1999 to August 2011. RESULTS: We performed 9 penetrating keratoplasties and 1 deep anterior lamellar keratoplasty for corneal scarring, and 4 tectonic penetrating keratoplasties for perforated corneal ulceration due to HZO. Eight of the 14 eyes had a temporary tarsorrhaphy concurrent with graft. Postoperative follow-up time ranged from 12 to 132 months (mean 64 ± 38). Postoperatively, the most common complications were dense superficial punctate keratopathy and severe dry eye because of neuropathic keratopathy in 8 eyes, graft rejection in 5 eyes, and secondary glaucoma in 4 eyes. All grafts were clear, and best spectacle-corrected visual acuity was 20/40 or better in 6 eyes (42.8%) and 20/100 or better in 9 eyes at their final evaluation (64.2%). CONCLUSIONS: Although the sample size is small, we demonstrate that very good visual results in long-term follow-up can be achieved when keratoplasty is performed in patients with herpes zoster virus keratopathy. We believe that longer quiescent waiting period between active herpes zoster ocular involvement and keratoplasty may promote better visual results.

Demographic patterns and treatment outcomes of patients with recurrent corneal erosions related to trauma and epithelial and bowman layer disorders.

PURPOSE: To evaluate demographics and outcomes of patients with recurrent corneal erosions related to trauma and epithelial and Bowman layer disorders. DESIGN: Retrospective case series. METHODS: setting: Wills Eye Institute, Philadelphia, Pennsylvania. study population: Two hundred seventy-two eyes (230 patients) presenting between 2008 and 2011 with recurrent corneal erosions related to trauma and epithelial and Bowman layer disorders. procedure: Conservative management, diamond burr polishing, excimer laser phototherapeutic keratectomy (PTK), and epithelial debridement alone. main outcome measure: Recurrence of erosions, more than 6 weeks after commencing treatment. RESULTS: Mean age was 46.5 ± 14.6 (2-85) years. Female subjects accounted for 53% of patients and 18.3% had bilateral involvement. Etiology included epithelial basement membrane dystrophy in 52.9% (144/272) and trauma in 25.7% (70/272). One hundred sixty-six eyes with more than a single visit were initially managed conservatively, 68 of 166 (40.9%) had diamond burr polishing, 7 of 166 (4.2%) had PTK, and 4 of 166 (2.4%) had epithelial debridement alone. Many eyes had >6 weeks follow-up: 120 of 166 (72.3%) after conservative management, 54 of 68 (79.4%) after diamond burr polishing, 7 of 7 (100%) after PTK, and 4 of 4 (100%) after epithelial debridement. Percentage of eyes with recurrence was 56.7% (68/120) after conservative management, 14.8% (8/54) after diamond burr polishing, and 28.6% (2/7) after PTK. Rate of recurrence (eye-years) was 0.74, 0.19, and 0.23 with conservative management, diamond burr polishing, and PTK, respectively. Mild haze was seen in 22.2% of eyes (12 eyes) after diamond burr polishing and 28.6% (2 eyes) after PTK. CONCLUSION: Recurrent corneal erosions are most commonly associated with epithelial basement membrane dystrophy. Patients are generally initially managed conservatively, with recurrence in more than half of eyes. Diamond burr polishing is the most common surgical intervention and is effective in a majority of eyes.

Long-term outcomes of penetrating keratoplasty and Descemet stripping endothelial keratoplasty for Fuchs endothelial dystrophy: fellow eye comparison.

PURPOSE: To compare the visual outcomes and complications after Descemet stripping endothelial keratoplasty (DSEK) and penetrating keratoplasty (PK) in the same set of patients. METHODS: Fifteen patients underwent PK in 1 eye and DSEK in the fellow eye for Fuchs endothelial dystrophy at the Wills Eye Institute from 1993 to 2011. RESULTS: Mean postoperative best-corrected visual acuity in the PK and DSEK groups (0.39 ± 0.39 and 0.23 ± 0.12 logarithm of the minimum angle of resolution, respectively) was statistically significantly better than mean preoperative best-corrected visual acuity (0.83 ± 0.36 and 0.76 ± 0.34 logarithm of the minimum angle of resolution, respectively) (P < 0.025 and P < 0.001, respectively). Mean manifest refraction cylinder was higher in the PK eyes than in the DSEK eyes at 1 year [3.58 ± 1.82 and 1.23 ± 1.63 diopter (D), respectively] and at 2 years of follow-up (3.57 ± 1.81 and 1.05 ± 1.18 D, respectively) (P < 0.001) but was not statistically different at the last visit (3.18 ± 2.67 and 1.5 ± 1.66 D, respectively) (P = 0.052). Mean postoperative follow-up was 101.9 ± 39.5 and 29.9 ± 19.9 months after PK and DSEK, respectively. Most common complications after PK were high astigmatism in 15 eyes, monocular diplopia in 7 eyes, posterior capsule opacity in 6 eyes, and secondary glaucoma and graft rejection episodes in 5 eyes each. After DSEK, secondary glaucoma in 3 eyes and graft rejection in 2 eyes were the most common complications. CONCLUSIONS: Final visual outcomes were not statistically different between the 2 procedures, but DSEK had early visual stabilization and PK had a more complicated course, with more astigmatism, rejections, suture-related infections, and graft failures.

Indications and outcomes of corneal transplantation in geriatric patients.

PURPOSE: To identify the most common corneal transplant procedures, indications, coexisting ocular diseases, and outcomes in elderly patients, and to compare younger geriatric patients with super-geriatric patients. DESIGN: Retrospective case series. METHODS: Data of all patients 65 years old and older who underwent corneal transplantation at Wills Eye Institute from April 2007 to January 2013, and were followed up for at least 1 year, were collected. Two hundred seventy-one eyes of 253 patients were divided into 2 groups according to the age of the patient. RESULTS: Group I (65-79 years old) included 181 eyes and Group II (80 years and older) included 90 eyes. The most common indication was Fuchs endothelial dystrophy, with 78 eyes (43%) in Group I and 34 eyes (38%) in Group II. In Group I, 93 Descemet stripping endothelial keratoplasty (DSEK) (51%), 84 penetrating keratoplasty (PK) (46%), and 4 keratoprosthesis procedures(2%) were performed; in Group II, 37 DSEK (41%), 51 PK (57%), and 2 keratoprosthesis procedures (2%) were performed. Graft survival rate at last visit was 90% for Group I and 88% for Group II. Rejection occurred in 18 Group I eyes (10%) and 7 Group II eyes (8%) (P = .562). CONCLUSION: Endothelial abnormalities were more common indications and keratoconus was a less common indication for surgery in the elderly. Fuchs dystrophy was the leading indication for surgery in both super-geriatric and younger geriatric patients. Graft survival rate was slightly higher in the younger geriatric age group but was not statistically significant. In the elderly, there is an increased prevalence of both glaucoma and retinal diseases that can affect the visual outcomes after corneal transplantation.

A cross-sectional and longitudinal study of Fuchs uveitis syndrome in Turkish patients.

PURPOSE: To describe Turkish patients with Fuchs uveitis syndrome (FUS). DESIGN: Retrospective observational case series. METHODS: We reviewed the records of 172 patients with FUS seen at Istanbul University, Istanbul Faculty of Medicine, Department of Ophthalmology, between January 1995 and July 2007. The main outcome measures were demographic features, clinical findings at presentation, laser flare photometry values, risk of new complications, and rate of decreased vision. RESULTS: The mean age was 29.5 + 8.4 years. Male-to-female ratio was 1:1.3. Nine patients (5.2%) had bilateral involvement. The diagnosis of FUS had been made in only 10 of 115 (8.7%) referrals. Clinical findings at presentation included diffuse keratic precipitates (medium-sized round in 74.6%, fine-stellate in 22.1%), anterior chamber cells (74%), diffuse iris atrophy without hypochromia (48.6%), heterochromia (39.8%), iris nodules (32%), cataract/pseudophakia (69.1%), vitreous cells (71.8%), elevated intraocular pressure (12.7%), and chorioretinal scars (7.7%). The mean flare was 8.4 + 3.1 photons/ms in eyes with FUS and 3.7 + 0.8 photons/ms in the fellow eyes (P < .001). Hyperfluorescence of the optic disc was the only fluorescein angiographic finding, detected in 7 of 32 eyes (22%). Kaplan-Meier analysis estimated risks of cataract formation and intraocular pressure elevation as 42% and 17%, respectively, at 4 years. The rate of decreased visual acuity by 2 lines or more was 0.06/eye-year. CONCLUSIONS: The referral patterns suggest that FUS is frequently misdiagnosed in Turkish patients. Diffuse medium-sized round keratic precipitates, low flare readings, iris stromal atrophy without hypochromia, and vitreous opacities in the absence of macular edema are more often helpful clues to the diagnosis than heterochromia.