ABSTRACT Purpose: This study aimed to compare the clinical outcomes following deep anterior lamellar keratoplasty and penetrating keratoplasty in contralateral eyes of the same patients. Methods: In this retrospective, comparative case series, clinical outcome data included best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, endothelial cell density, endothelial cell loss, central corneal thickness, and intraocular pressure, which were evaluated at 6, 12, 24, and 36 months after deep anterior lamellar keratoplasty and penetrating keratoplasty. Additionally, complications were assessed. Results: Fifty-two eyes (26 patients) were included, of which 19 patients had keratoconus, 6 had stromal dystrophy, and 1 had post-laser-assisted in situ keratomileusis ectasia. The mean follow-up was 44.1 ± 10.5 months in the deep anterior lamellar keratoplasty Group and 47.9 ± 11.9 months in the penetrating keratoplasty Group. No significant differences were observed in the mean best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, and central corneal thickness between the deep anterior lamellar keratoplasty and penetrating keratoplasty Groups during follow-up. The endothelial cell density was significantly higher in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.022 and 0.013, respectively). Endothelial cell loss was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.025 and 0.001, respectively). Intraocular pressure was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Grroup at 6 months postoperatively (p=0.015). Microperforation occurred in 4 eyes (15%) during deep anterior lamellar keratoplasty surgery; however, penetrating keratoplasty was not required. No endothelial rejection occurred in the penetrating keratoplasty Group during follow-up. Conclusions: Over the 3-year follow-up, endothelial cell loss and intraocular pressure in the deep anterior lamellar keratoplasty Group were significantly lower than those in the penetrating keratoplasty Group, while visual and refractive results were similar.
RESUMO Objetivo: Este estudo teve como objetivo comparar os resultados clínicos após ceratoplastia lamelar anterior profunda e ceratoplastia penetrante nos olhos contralaterais dos mesmos pacientes. Métodos: Nesta série de casos comparativa e retrospectiva, avaliaram-se os seguintes dados de resultados clínicos: melhor acuidade visual corrigida, equivalente esférico refrativo, astigmatismo refrativo, densidade de células endoteliais, perda de células endoteliais, espessura central da córnea e pressão intraocular. Esses dados foram avaliados aos 6, 12, 24 e 36 meses após ceratoplastia lamelar anterior profunda e ceratoplastia penetrante. Também foram avaliadas as complicações. Resultados: Foram incluídos 52 olhos (26 pacientes), sendo que 19 pacientes apresentavam ceratocone, 6 apresentavam distrofia estromal e 1 apresentava ectasia após ceratomileuse in situ assistida por laser. O tempo médio de acompanhamento foi de 44,1 ± 10,5 meses no grupo da ceratoplastia lamelar anterior profunda e 47,9 ± 11,9 meses no grupo da ceratoplastia penetrante. Nenhuma diferença significativa foi observada nas médias da melhor acuidade visual corrigida, equivalente esférico refrativo, astigmatismo refrativo e espessura central da córnea entre os grupos da ceratoplastia lamelar anterior profunda e da ceratoplastia penetrante durante o acompanhamento. A densidade de células endoteliais foi significativamente maior no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 24 e 36 meses de pós-operatório (p=0,022 e 0,013, respectivamente). A perda de células endoteliais foi significativamente menor no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 24 e 36 meses de pós-operatório (p=0,025 e 0,001, respectivamente). A pressão intraocular foi significativamente menor no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante aos 6 meses de pós-operatório (p=0,015). Ocorreu microperfuração em 4 olhos (15%) durante a cirurgia de ceratoplastia lamelar anterior profunda; entretanto, a ceratoplastia penetrante não foi necessária. Não ocorreu nenhuma rejeição endotelial no grupo da ceratoplastia penetrante durante o período de acompanhamento. Conclusões: Durante o acompanhamento de 3 anos, a perda de células endoteliais e a pressão intraocular foram significativamente menores no grupo da ceratoplastia lamelar anterior profunda que no grupo da ceratoplastia penetrante, mas os resultados visuais e refrativos foram semelhantes.
PURPOSE: This study aimed to compare the clinical outcomes following deep anterior lamellar keratoplasty and penetrating keratoplasty in contralateral eyes of the same patients. METHODS: In this retrospective, comparative case series, clinical outcome data included best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, endothelial cell density, endothelial cell loss, central corneal thickness, and intraocular pressure, which were evaluated at 6, 12, 24, and 36 months after deep anterior lamellar keratoplasty and penetrating keratoplasty. Additionally, complications were assessed. RESULTS: Fifty-two eyes (26 patients) were included, of which 19 patients had keratoconus, 6 had stromal dystrophy, and 1 had post-laser-assisted in situ keratomileusis ectasia. The mean follow-up was 44.1 ± 10.5 months in the deep anterior lamellar keratoplasty Group and 47.9 ± 11.9 months in the penetrating keratoplasty Group. No significant differences were observed in the mean best-corrected visual acuity, refractive spherical equivalent, refractive astigmatism, and central corneal thickness between the deep anterior lamellar keratoplasty and penetrating keratoplasty Groups during follow-up. The endothelial cell density was significantly higher in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.022 and 0.013, respectively). Endothelial cell loss was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Group at 24 and 36 months postoperatively (p=0.025 and 0.001, respectively). Intraocular pressure was significantly lower in the deep anterior lamellar keratoplasty Group than in the penetrating keratoplasty Grroup at 6 months postoperatively (p=0.015). Microperforation occurred in 4 eyes (15%) during deep anterior lamellar keratoplasty surgery; however, penetrating keratoplasty was not required. No endothelial rejection occurred in the penetrating keratoplasty Group during follow-up. CONCLUSIONS: Over the 3-year follow-up, endothelial cell loss and intraocular pressure in the deep anterior lamellar keratoplasty Group were significantly lower than those in the penetrating keratoplasty Group, while visual and refractive results were similar.
ABSTRACT Purpose: To evaluate the clinical course and management of infectious interface keratitis after Descemet membrane endothelial keratoplasty. Methods: A total of 352 cases that had undergone Descemet membrane endothelial keratoplasty were retrospectively reviewed. Patients with infectious interface keratitis during follow-up were analyzed. The microbiological analyses, time to infection onset, clinical findings, follow-up duration, treatment, and post-treatment corrected distance visual acuity were recorded. Results: IIK was detected in eight eyes of eight cases. Three fungal and three bacterial pathogens were identified in all cases. All patients received medical treatment according to culture sensitivity. Antifungal treatment was initiated in two cases with no growth on culture, with a preliminary diagnosis of fungal interface keratitis. Intrastromal antifungal injections were performed in all patients with fungal infections. The median time to infection onset was 164 days (range: 2-282 days). The postoperative infectious interface keratitis developed in the early period in two cases. The mean follow-up duration was 13.4 ± 6.2 months (range: 6-26 months). Re-Descemet membrane endothelial keratoplasty was performed in two patients (25%) and therapeutic penetrating keratoplasty in four patients (50%) who did not recover with medical treatment. The final corrected distance visual acuity was 20/40 or better in five patients (62.5%). Conclusion: The diagnosis and treatment of infectious interface keratitis following Descemet membrane endothelial keratoplasty are challenging. Early surgical intervention should be preferred in the absence of response to medical treatment. Better graft survival and visual acuity can be achieved with therapeutic penetrating keratoplasty and re-Descemet membrane endothelial keratoplasty in patients with infectious interface keratitis.
RESUMO Objetivo: Avaliar o curso clínico e o manejo da ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet. Métodos: Um total de 352 casos submetidos a ceratoplastia endotelial da membrana de Descemet foram revisados retrospectivamente. Pacientes com ceratite infecciosa de interface foram analisados durante o acompanhamento. As análises microbiológicas, o tempo até o início da infecção, os achados clínicos, a duração do acompanhamento, o tratamento e a acuidade visual para longe corrigida pós-tratamento foram registrados. Resultados: Ceratite infecciosa de interface foi detectada em 8 olhos de 8 casos. Três patógenos fúngicos e três bacterianos foram identificados em todos os casos e receberam tratamento médico de acordo com a sensibilidade da cultura. O tratamento antifúngico foi iniciado em dois casos sem crescimento em cultura, com diagnóstico preliminar de ceratite infecciosa fúngica. Injeções antifúngicas intraestromais foram usadas em todos os casos com infecções fúngicas. O tempo médio para o início da infecção foi de 164 dias (variação: 2-282 dias). A ceratite infecciosa de interface pós-operatória desenvolveu-se no período inicial em dois casos. A duração média do acompanhamento foi de 13,4 ± 6,2 meses (variação: 6-26 meses). A ceratoplastia endotelial de membrana de Descemet foi realizada em dois casos (25%) e ceratoplastia penetrante terapêutica em quatro casos (50%) que não se recuperaram com tratamento médico. A acuidade visual para longe corrigida final foi de 20/40 ou melhor em 5/8 (62,5%) dos pacientes. Conclusões: O diagnóstico e o tratamento da ceratite infecciosa de interface após ceratoplastia endotelial da membrana de Descemet são difíceis. A intervenção cirúrgica precoce deve ser o procedimento preferido se não houver resposta ao tratamento médico. Melhor sobrevida do enxerto e melhor acuidade visual podem ser alcançadas com ceratoplastia penetrante terapêutica e ceratoplastia endotelial da membrana de Descemet em pacientes com ceratite infecciosa de interface
PURPOSE: The aim of this study was to analyze the trends in the major indications and types of keratoplasty over a 15-year period and to determine the effect of the coronavirus disease-2019 (COVID-19) pandemic on the selection of corneal transplant recipients at a tertiary referral center in Turkey. METHODS: We retrospectively reviewed the data of patients who underwent keratoplasty at the center from January 2006 to March 2021. The keratoplasty indications and types of surgery were evaluated after classification into three groups (period I - January 2006-December 2012; period II - January 2013-March 2020; COVID-19 period - April 2020-March 2021). RESULTS: A total of 5016 corneal transplants were performed in 3862 patients. Lamellar keratoplasty (LK) techniques were found to demonstrate a statistically significantly increasing trend compared to penetrating keratoplasty in the period between 2006 and 2021 (χ2 = 240.55, P < 0.001). The top 4 indications over the 15-year period were aphakic/pseudophakic bullous keratopathy (BK) (1105, 22%), keratoconus (1085, 21.6%), regraft (1084, 21.6%), and keratitis (645, 12.8%). The most common keratoplasty indication during the COVID-19 period was regraft (27, 54.0%), followed by BK (13, 26.0%) and corneal perforation (5, 10%). CONCLUSION: BK was the most common keratoplasty indication at our clinic during the 15-year period. LK rates have been found to increase in recent years, although still not reaching the rates of developed countries. There was a marked decrease in the number of keratoplasties during the COVID-19 pandemic and patients requiring urgent keratoplasty or those who suffered from a painful eye were prioritized.
PURPOSE: To evaluate the clinical course and management of infectious interface keratitis after Descemet membrane endothelial keratoplasty. METHODS: A total of 352 cases that had undergone Descemet membrane endothelial keratoplasty were retrospectively reviewed. Patients with infectious interface keratitis during follow-up were analyzed. The microbiological analyses, time to infection onset, clinical findings, follow-up duration, treatment, and post-treatment corrected distance visual acuity were recorded. RESULTS: IIK was detected in eight eyes of eight cases. Three fungal and three bacterial pathogens were identified in all cases. All patients received medical treatment according to culture sensitivity. Antifungal treatment was initiated in two cases with no growth on culture, with a preliminary diagnosis of fungal interface keratitis. Intrastromal antifungal injections were performed in all patients with fungal infections. The median time to infection onset was 164 days (range: 2-282 days). The postoperative infectious interface keratitis developed in the early period in two cases. The mean follow-up duration was 13.4 ± 6.2 months (range: 6-26 months). Re-Descemet membrane endothelial keratoplasty was performed in two patients (25%) and therapeutic penetrating keratoplasty in four patients (50%) who did not recover with medical treatment. The final corrected distance visual acuity was 20/40 or better in five patients (62.5%). CONCLUSION: The diagnosis and treatment of infectious interface keratitis following Descemet membrane endothelial keratoplasty are challenging. Early surgical intervention should be preferred in the absence of response to medical treatment. Better graft survival and visual acuity can be achieved with therapeutic penetrating keratoplasty and re-Descemet membrane endothelial keratoplasty in patients with infectious interface keratitis.
Corneal Ulcer , Descemet Stripping Endothelial Keratoplasty , Eye Infections, Fungal , Keratitis , Humans , Descemet Membrane/surgery , Descemet Stripping Endothelial Keratoplasty/adverse effects , Antifungal Agents/therapeutic use , Retrospective Studies , Keratitis/etiology , Keratitis/microbiology , Keratoplasty, Penetrating/adverse effects , Eye Infections, Fungal/etiology , Eye Infections, Fungal/microbiology , Corneal Ulcer/drug therapy
Split cornea transplantation can reduce the shortage of donor corneas. Therefore, this study aimed to evaluate the effect of split graft storage time on the outcomes of split corneal transplantation through Descemet membrane endothelial keratoplasty (DMEK) and deep anterior lamellar keratoplasty (DALK) surgeries. Split corneal transplantation was performed in 80 eyes using 41 donor corneas. The mean before and after splitting storage times and total storage times were recorded. Donor corneal buttons and split grafts were stored in short-term solution at 4°C. In both surgeries (DMEK and DALK), donor corneas were divided into groups depending on their storage times. Mean postoperative 12th month best corrected visual acuity (BCVA), endothelial cell density (ECD), endothelial cell loss (ECL), central corneal thickness (CCT), refractive spherical equivalent (RSE), refractive astigmatism, and complication rates were compared among the groups. Correlation between storage times and 1-year BCVA, ECL, and complication rates were assessed. Clinical outcomes of the groups 1 year after the surgeries were also compared. DALK and DMEK were performed in 41 and 39 eyes, respectively. Storage times were not correlated with 1-year DMEK outcomes and only weakly correlated with post-DALK ECD, ECL, and RSE values. Except for CCT in those that underwent DALK, the outcomes of DMEK and DALK surgeries with stored and non-stored split grafts were not significantly different (P = .02). The storage times of donor corneas and split grafts do not have any impact on outcomes.
Corneal Transplantation , Humans , Retrospective Studies , Tissue Donors , Visual Acuity
OBJECTIVES: We evaluated the effects of various graft-marking techniques on surgical results in patients undergoing Descemet membrane endothelial keratoplasty. MATERIALS AND METHODS: In this single-center retrospective study, 65 eyes from 55 patients that had received various types of marking or no marking and that had been used for Descemet membrane endothelial keratoplasty endothelial graft preparation were included. Patients were divided into 3 groups according to the marking technique used: group I (F-marked graft; 17 eyes), group II (asymmetric triangle-marked graft; 12 eyes), and group III (unmarked graft; 36 eyes). The main outcome measurements were best-corrected visual acuity, endothelial cell density, central corneal thickness, postoperative complications, rebubbling, and secondary keratoplasty rates. RESULTS: In groups I, II, and III, rates of patients with 6-month best-corrected visual acuity ≥ 20/32 were 35.7%, 77.8%, and 71.9%, respectively (P = .04). The mean 6-month endothelial cell density decrease for each group was 43.3%, 48.8%, and 46.4%, respectively (P = .589), whereas the mean 6-month central corneal thickness decrease for each group was 7.7%, 15.8%, and 34.0%, respectively (P = .001). Rates of primary graft failure for groups I, II, and III were 35.3%, 8.3%, and 13.9%, respectively. Rebubbling was performed in 21.5% of eyes, and secondary keratoplasty was required in 29.2% of eyes. CONCLUSIONS: Although graft-marking techniques for Descemet membrane endothelial keratoplasty greatly facilitate graft positioning during surgery, both the potential toxic effects of alcohol on the endothelium when marking with gentian violet dye and the risk of graft detachment with asymmetric marking must be considered.
Corneal Diseases , Descemet Stripping Endothelial Keratoplasty , Corneal Diseases/surgery , Descemet Membrane/surgery , Descemet Stripping Endothelial Keratoplasty/adverse effects , Descemet Stripping Endothelial Keratoplasty/methods , Endothelium, Corneal/transplantation , Humans , Retrospective Studies , Treatment Outcome , Visual Acuity
OBJECTIVES: The aim of this study was to evaluate the demographic features of corneal donors and available data of corneas in our eye bank during a 14-year period. MATERIALS AND METHODS: The demographic features of the corneal donors, the causes of death, the death-to-excision interval, serology results, the mean endothelial cell density, and the reasons for discarding the corneas were retrospectively evaluated. RESULTS: During the study period, 6524 corneas were retrieved from 3326 donors (76.1% male, 23.9% female). Mean donor age was 43.7 ± 16.0 years (range, 4-75 years; median 45.0 years). The most common cause of death was cardiovascular disease (n = 1467; 44.1%). The most common reason for discarding corneas was positive serology (n = 509; 78.6%). The mean endothelial cell density was 3030.1 ± 484.3 cells/mm². There was a weak negative statistically significant correlation between age and endothelial cell density (Pearson correlation coefficient r = -0.187, P < .001). Multiorgan donations made up 1.5% of the whole group (n = 50). CONCLUSIONS: We believe that preoperative detailed evaluations of graft quality in addition to review of donor-related medical records and data from previous surgeries, after collecting them in a single system, will have a positive effect on postoperative corneal survival.
Eye Banks , Tissue Donors , Adolescent , Adult , Aged , Child , Child, Preschool , Corneal Transplantation , Female , Humans , Male , Middle Aged , Retrospective Studies , Tertiary Care Centers , Turkey/epidemiology , Young Adult
A 24-year-old female presented with bilateral vision loss following attempted suicide with pregabalin. Her best-corrected visual acuity (BCVA) was 20/40 in the right eye and 20/50 in the left eye. The bilateral visual disturbance was associated with serous macular detachment. Fundus examination of both eyes showed foveal serous retinal detachment, which was confirmed by optical coherence tomography. Topical nepafenac 0.1% eye drops were started as single drop every 8 hours for 4 weeks. One month later, the serous macular detachment had regressed and BCVA increased to 20/20 in both eyes. To the best of our knowledge, this is the first reported case of bilateral serous macular detachment presumably caused by pregabalin intoxication.
BACKGROUND: The purpose of this study is to investigate whether oral colchicine has an effect on peripapillary retinal nerve fiber layer (pRNFL) thickness of familial Mediterranean fever (FMF) patients. METHODS: We conducted a cross sectional study by comparing pRNFL thickness of FMF patients on colchicine (treated group), newly diagnosed colchicine naïve FMF patients (untreated group) and healthy controls. The study included 66 FMF patients and 32 healthy control subjects. Treated FMF patients were grouped according to colchicine use, duration of use and dosage. pRNFL thickness of the patients and controls were measured by using optical coherence tomography and the measurements were compared. RESULTS: No statistically significant difference was found between the pRNFL thickness in untreated group, treated group and the healthy control group (all p > 0.05). No statistically significant difference was found between pRNFL thickness in the healthy control group and FMF patients grouped according to duration or dosage of colchicine use (all p > 0.05). CONCLUSIONS: According to our study, FMF and oral colchicine use had no statistically significant effect on pRNFL thickness.
Colchicine/therapeutic use , Familial Mediterranean Fever/drug therapy , Nerve Fibers/drug effects , Retinal Ganglion Cells/drug effects , Tubulin Modulators/therapeutic use , Administration, Oral , Adult , Cross-Sectional Studies , Female , Humans , Intraocular Pressure , Male , Middle Aged , Nerve Fibers/pathology , Optic Disk , Retinal Ganglion Cells/pathology , Tomography, Optical Coherence
AIM: To compare visual, surgical and topographic outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) for keratoconus (KC). METHODS: In this multicenter, prospective, randomized clinical trial 76 eyes of 71 KC patients operated between January 2011 and July 2014 in 2 tertiary referral hospitals were included. Consecutive patients were alternately selected to receive one of the two surgical methods. Thirty eight eyes underwent DALK with the big-bubble technique and 38 eyes underwent PK. RESULTS: Mean best spectacle corrected visual acuity (BSCVA) at the first postoperative week (P=0.012) and the first postoperative month (P<0.001) was statistically significantly higher in DALK group. The mean BSCVA at 12mo was not significantly different for DALK (0.30±1.99 logMAR) versus PK (0.40±0.33 logMAR) (P=0.104). The 76.3% of the eyes had a BSCVA over 0.5 in DALK and 47.4% in PK group (P=0.009). The 7.9% of the eyes had a BSCVA of 1.0 in DALK and 5.3% in PK group (P=0.644). Mean spherical equivalent was -2.94 D in DALK and -3.09 D in PK group. Mean topographic astigmatism was 4.62 D and 4.18 D respectively. Regular topographic patterns were observed in 31 (81.6%) of DALK and 29 (76.3%) of PK (P=0.574). The most frequent topographic pattern was oblate asymmetric bow tie, seen in 39.5% in DALK and 23.7% in PK. CONCLUSION: Big bubble DALK provides an earlier visual improvement compare to PK. However, visual and topographic outcomes are similar to those in PK at 1y. Postoperative complications including rejection and intraocular pressure elevation are more frequent in PK. DALK is a safer alternative to PK for KC. However, intraoperative perforation of the Descemet's membrane is a significant complication.
OBJECTIVES: To evaluate changes of the cornea and anterior chamber after penetrating keratoplasty in eyes with keratoconus. METHODS: Medical records of 68 eyes of 68 patients with keratoconus who experienced penetrating keratoplasty at the Eye Clinic of Dr. Lütfi Kirdar Kartal Research and Training Hospital between 2010 and 2012 were studied. Records were retrospectively evaluated with regard to anterior chamber depth, iridocorneal angle, central corneal thickness, thinnest corneal thickness, maximum keratometric value, and mean keratometric value. Patients who developed complications and required additional surgery were excluded. RESULTS: A total of 68 eyes of 68 patients were included in this study. There were 40 (58.8%) male and 28 (41.2%) female patients. The mean age was 24.5±8.19 years (range: 11-42 years). The graft diameter was 7.5 mm and the recipient bed diameter was 7.0 mm in all patients. The preoperative anterior chamber depth decreased from 3.92±0.47 mm to 3.01±0.55 mm (23% decrease). No significant postoperative change was observed in the mean iridocorneal angle values. Keratometric values decreased by 30% and corneal thickness increased by 50% (P<0.001 for both). CONCLUSION: Anterior chamber depth decreased significantly, but no change was observed in iridocorneal angle after penetrating keratoplasty in patients with keratoconus. Also, a decrease in the keratometric values and an increase in corneal thickness were observed. Understanding, estimating, and managing changes in the anterior chamber after penetrating keratoplasty, which induces significant changes in anterior chamber morphology, might increase the success of surgery.
Anterior Chamber/pathology , Cornea/pathology , Corneal Diseases/etiology , Keratoconus/surgery , Keratoplasty, Penetrating/adverse effects , Adolescent , Adult , Child , Corneal Diseases/pathology , Corneal Topography , Female , Follow-Up Studies , Humans , Male , Refraction, Ocular/physiology , Retrospective Studies , Visual Acuity/physiology , Young Adult
Alexandrite laser is one of the most common methods of hair removal. Its utilization is gradually increasing due to easy accessibility and high effectiveness. However, the disuse of protective goggles during the application of this laser is a serious problem. In this case report, we presented a 35-year-old male patient who had foveal injury by alexandrite laser. The inflammatory process secondary to the foveal injury and subsequent macular edema were treated with Ozurdex because of its potent antiedematous effect.
BACKGROUND: We aimed to evaluate the risk factors, clinical features and outcomes of surgery for traumatic wound dehiscence (TWD) following penetrating keratoplasty (PK). METHODS: Twenty-six patients with TWD following PK were evaluated retrospectively in terms of factors related to the trauma, types of reconstructive surgery, final graft clarity, and visual acuity. RESULTS: There were 26 patients with a mean age of 40.7±19.6 years. In 12 (46.1%) patients, the better eye was affected by the trauma. The most frequent type of trauma was blunt trauma by various objects (9). In all cases, the dehiscence was at the graft host junction. The mean extent of detachment was 135.4°±57.6°. Crystalline or intraocular lens damage was present in 42.3% of cases. Median follow-up time after the reconstructive surgery was 36 months. The graft remained clear in 13 (50%) patients, whereas graft insufficiency/graft rejection developed in 13 (50%) patients. Final visual acuity was over 20/200 in 13 (50%) patients. CONCLUSION: TWD may occur at any time after PK, most frequently within the first postoperative year. Low visual acuity in the other eye seems to be a major risk factor. In patients without major complications such as posterior segment damage, visual outcomes and graft survival can be favorable.
Keratoplasty, Penetrating/adverse effects , Surgical Wound Dehiscence/epidemiology , Adolescent , Adult , Aged , Child , Child, Preschool , Female , Humans , Male , Middle Aged , Retrospective Studies , Risk Factors , Turkey/epidemiology , Young Adult
AIM: To report the long-term vision-threatening complications in patients who underwent phakic intraocular lens (pIOLs) implantation for high myopia. METHODS: This study was designed from a consecutive series of phakic intraocular lens complication and corrective surgeries. Sixteen eyes of 13 patients had implantation of phakic intraocular lens for correction high myopia and developed serious complications have been included in this study. The mean age of patients was 38.6±6.35y (range 32-50y) and the mean time of history of pIOL implantation for high myopia was 6±2y (range 2-10y). Before corrective surgery, best spectacle-corrective visual acuity (BSCVA) ranged from perception to 20/200 in the eyes in which severe complications occurred. RESULTS: Corneal decompensation occurred in 12 eyes of 9 high myopic patients after anterior chamber pIOL implantation. Rhegmatogenous retinal detachment (RRD) occurred in 4 eyes of 4 high myopic patients following anterior chamber and posterior chamber pIOL implantation. Patients with corneal decompensation, had combined procedures consisting of pIOL removal and penetrating keratoplasty (PKP). Removals of pIOL, phacoemulsification and pars plana vitrectomy (PPV) with silicone oil tamponade were performed in patients with RRD. After corrective surgeries, all patients but one (P+, patient 2, right eye) achieved moderate BSCVA ranged from 20/200 to 20/50 at the last visit. CONCLUSION: Phakic IOLs may be effective for the correction of high myopia. Although these IOLs may have severe complications and it affects safety and efficacy of this surgery. As seen here, corneal decompensation and rhegmatogenous retinal detachment are possible postoperative vision-threatening complications of phakic IOLs. Patients must be carefully examined before and after surgery for possible endothelial cell loss and vitreoretinal problems.
We report a case of group G Streptococcus endophthalmitis following an intravitreal ranibizumab injection for a choroidal neovascular membrane. Pars plana vitrectomy was applied for endophthalmitis and group G Streptococcus cultures were isolated in the vitreous samples taken from the patient. Twenty-four hours following pars plana vitrectomy the patient underwent myocardial infarction and cardiac arrest. To our knowledge this is the first reported case of group G Streptococcus endophthalmitis following an intravitreal injection.
AIM: To evaluate postoperative visual acuity and contrast sensitivity results following deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PK) in patients with keratoconus (KC). METHODS: All the patients' records with KC who had PK or DALK surgery between May 2010 and May 2011 were retrospectively reviewed. Sixty patients who underwent successful corneal transplantation for KC: 30 eyes underwent DALK and 30 eyes underwent PK were included in this study. Preoperative and postoperative mean logarithm of the minimum angle of resolution (logMAR) uncorrected visual acuity (UCVA), logMAR best spectacle-corrected visual acuity (BSCVA) and intraocular pressure (IOP) were evaluated. Contrast sensitivity tests (CS) were done preoperative and 2 months after all sutures had removed. All surgeries were performed under regional anesthesia (retrobulbar anesthesia) by 1 surgeon (B.K.) who was experienced in penetrating and lamellar keratoplasty techniques. RESULTS: The mean age of the DALK group was 29.67±4.95 (range 18-40) years and the PK group was 28.7±3.53 (range 18-39) years. Preoperatively there was no significant difference in the logMAR UCVA, logMAR BSCVA and IOP between the DALK (1.281±0.56; 0.97±0.85; 12.07±2.12mmHg) and PK (1.34±0.21; 0.98±0.21; 13±2.12mmHg) groups. One-year after surgery there was no significant difference in the mean logMAR UCVA and IOP between the DALK (0.46±0.37; 11.73±2.1mmHg) and PK (0.38±0.21; 12±2.12mmHg) groups. The mean contrast sensitivity was evaluated by CC-100 Topcon LCD at 1.5, 2.52, 4.23, 7.10 and 11.91 cycles per degree (cs/deg) spatial frequencies before and 2 months after the all sutures had removed. CONCLUSION: All patients with keratoconus in both DALK and PK groups performed good visual function postoperatively. The mean contrast sensitivity increased considerably at all spatial frequencies compared with preoperative levels in the DALK and PK groups. The mean post-operative evaluation of contrast sensitivity measurements was not significantly different between the two groups.
PURPOSE: To identify the incidence of and risk factors associated with the development of glaucoma after penetrating keratoplasty. METHODS: A retrospective study was carried out between September 1996 and January 2007 with 729 patients' 749 eyes, which underwent penetrating keratoplasty at the 1st Eye Clinic at Dr. Lütfi Kirdar Kartal Training and Research Hospital, Istanbul. Six attending surgeons performed all the surgeries at the same center. Age, sex, preoperative diagnosis, the presence of preoperative glaucoma, the status of the lenses, and additional surgery performed during keratoplasty, which may affect the postoperative intraocular pressure, were evaluated. RESULTS: The patients' ages ranged from 5 to 86 years (with a mean of 40.9 +/- 20.4 years). Two hundred seventy-seven (61.9%) of the patients were female and 452 (38.1%) were male. Intraocular pressure increases in the early postoperative period occurred in 41 (5.5%) eyes and chronically elevated intraocular pressure was found in 124 (16.6%) eyes. Preoperative diagnosis of inflammatory diseases such as graft thinning (relative risk [RR] = 4.96), traumatic scar formation (RR = 2.66), graft abscess (RR = 2.62), graft rejection (RR = 2.61), bullous keratopathy (RR = 2.59), and corneal abscess (RR = 1.52) were found to be risk factors for the development of glaucoma. Also, the following were significantly associated with an increased risk of glaucoma: peripheral anterior synechia (P = 0.019), preoperative glaucoma (P = 0.0001), and additional surgery combined with penetrating keratoplasty (P = 0.0001). The average period between surgery and the first intraocular pressure elevation was 5.0 +/- 6.5 months for all eyes. The mean intraocular pressure value of eyes that developed glaucoma after penetrating keratoplasty was 27.9 +/- 5.8 mmHg. CONCLUSIONS: Increased intraocular pressure after penetrating keratoplasty is a common clinical problem, and the risk factors are preoperative diagnosis of inflammatory diseases, peripheral anterior synechia, preoperative glaucoma, and additional surgery combined with penetrating keratoplasty.
Glaucoma/etiology , Intraocular Pressure , Keratoplasty, Penetrating , Postoperative Complications , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Glaucoma/epidemiology , Humans , Incidence , Male , Middle Aged , Retrospective Studies , Risk Factors , Tonometry, Ocular , Young Adult
A toric intraocular Collamer lens (ICL) was used to correct myopic astigmatism after penetrating keratoplasty. The patient's manifest refraction improved from -8.0 -1.75 x 170 preoperatively, with an uncorrected distance visual acuity (UDVA) of 0.15 and a corrected distance visual acuity (CDVA) of 0.4, to +0.75 -0.50 x 130 postoperatively, with a UDVA of 0.8 and a CDVA of 1.0. No serious complications or refractive changes occurred during the 1-year follow-up. Implantation of a myopic toric ICL in phakic eyes is an option to correct postkeratoplasty anisometropia and astigmatism.
Astigmatism/surgery , Keratoplasty, Penetrating/adverse effects , Lens Implantation, Intraocular , Myopia/surgery , Phakic Intraocular Lenses , Adult , Astigmatism/etiology , Astigmatism/physiopathology , Cell Count , Corneal Topography , Endothelium, Corneal/pathology , Humans , Male , Myopia/etiology , Myopia/physiopathology , Postoperative Complications , Visual Acuity/physiology
