Orbital Dynamics and Efficacy of Retrobulbar Anesthesia With and Without Hyaluronidase in Vitreoretinal Surgery.

Purpose: To compare retrobulbar anesthesia injection (RAI) with hyaluronidase and without hyaluronidase in vitreoretinal surgery using clinical efficacy measures and orbital manometry (OM). Methods: This prospective randomized double-masked study enrolled patients who had surgery using an 8 mL RAI with or without hyaluronidase. Outcome measures were clinical block effectiveness (akinesia, pain scores, need for supplemental anesthetic or sedative medications) and orbital dynamics assessed by OM before and up to 5 minutes after RAI. Results: Twenty-two patients received RAI with hyaluronidase (Group H+), and 25 received RAI without hyaluronidase (Group H-). Baseline characteristics were well matched. No differences in clinical efficacy were found. OM showed no difference in preinjection orbital tension (4 ± 2 mm Hg in both groups) or calculated orbital compliance (0.6 ± 0.3 mL/mm Hg, Group H+; 0.5 ± 0.2 mL/mm Hg, Group H-) (P = .13). After RAI, the peak orbital tension was 23 ± 15 mm Hg in Group H+ and 24 ± 9 mm Hg in Group H- (P = .67); it declined more rapidly in Group H+. Orbital tension at 5 minutes was 6 ± 3 mm Hg in Group H+ and 11 ± 5 mm Hg in Group H- (P = .0008). Conclusions: OM showed faster resolution of post-RAI orbital tension elevation with hyaluronidase; however, there were no clinically evident differences between groups. Thus, 8 mL RAI with or without hyaluronidase is safe and can achieve excellent clinical results. Our data do not support the routine use of hyaluronidase with RAI.

Comparison of Visual Acuity Outcomes Between Nanothin Descemet Stripping Automated Endothelial Keratoplasty and Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To compare the visual outcomes and complications between nanothin Descemet stripping automated endothelial keratoplasty (NT-DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). METHODS: A prospective comparative case series of 28 consecutive cases of NT-DSAEK (less than or equal to 50 µm) and DMEK was undertaken. Inclusion criteria were a diagnosis of Fuchs dystrophy, presence of pseudophakia, or planned combined cataract surgery/endothelial keratoplasty, with a minimum of 6-month follow-up. Exclusion criteria were any concurrent ocular comorbidities. Primary outcomes measures were best spectacle-corrected visual acuity (BSCVA) and complications. RESULTS: Mean thickness of NT-DSAEK grafts was 41.0 ± 7.5 µm (range 26-50 µm). At 1 month postoperatively, the DMEK group had significantly better mean BSCVA of 0.18 ± 0.20 logarithm of the minimum angle of resolution (logMAR) (20/33) compared with 0.28 ± 0.16 logMAR (20/40) for NT-NSAEK (P = 0.049). At 3, 6, and 12 months postoperatively, mean BSCVA was comparable between both groups [3 months: NT-DSAEK 0.17 ± 0.12 logMAR (20/30) versus DMEK 0.13 ± 0.17 (20/27), P = 0.31; 6 months: NT-DSAEK 0.11 ± 0.10 logMAR (20/26) versus DMEK 0.09 ± 0.10 (20/25), P = 0.63; 12 months: NT-DSAEK 0.07 ± 0.09 logMAR (20/24) versus DMEK 0.07 ± 0.11 logMAR (20/24), P = 0.95]. Other than 1 NT-DSAEK graft that was successfully rebubbled, no other complications were encountered in either group. CONCLUSIONS: Compared with DMEK, NT-DSAEK provides comparable visual outcomes and complications rates.

Tomographic changes in eyes with hyperopic shift after triple Descemet membrane endothelial keratoplasty.

PURPOSE: To describe the tomographic changes in eyes with a hyperopic shift after triple Descemet membrane endothelial keratoplasty (DMEK). SETTING: Private cornea practice, Blue Ash, Ohio, USA. DESIGN: Retrospective case series. METHODS: Patients who had previous triple DMEK with preoperative and postoperative Scheimpflug corneal tomography (Pentacam) measurements and corresponding manifest refraction measurements were reviewed. Eyes with and without a hyperopic postoperative shift were compared at either the 1-month or 3- to 6-month follow-ups. Assessed parameters included demographics, cataract testing, visual acuity, manifest refraction, and Scheimpflug tomography data. RESULTS: Sixty-two eyes of 47 patients (21 men, 26 women) with Fuchs endothelial corneal dystrophy were included. Preoperative posterior flat keratometry (K), posterior steep K, posterior average K, central pachymetry, and asphericity (Q value) of the posterior cornea were significantly different when comparing the hyperopic and non-hyperopic group. At the postoperative 1-month and 3- to 6-month follow-ups, there was a significant between-group difference in change in postoperative anterior K (average), posterior K (average), central pachymetry, and posterior Q values compared with preoperative values. The combined preoperative criteria of posterior flat K (≥-5.25), central pachymetry (≥670 µm), and posterior Q value (≥0.5) had a sensitivity of 58% (11/19 correctly identified hyperopic shifts) and specificity of 81% (8/43 incorrectly identified). CONCLUSIONS: Eyes with a hyperopic surprise after triple DMEK demonstrated a significant change in posterior and anterior corneal curvature compared with eyes without a hyperopic surprise. This might be secondary to corneal edema because these eyes also demonstrated greater preoperative corneal pachymetry.