Factors associated with keratoconus in Israel-A cross-sectional population-based study.

PURPOSE: To identify potential factors associated with keratoconus. METHODS: This cross-sectional study included data from Israel's largest healthcare provider for the years 2005-2020. Keratoconus patients and age-matched controls were identified. Demographic factors and comorbid conditions, including smoking, diabetes mellitus, asthma, myalgia, mental retardation, Down syndrome, atopic dermatitis and allergy/allergic rhinitis, were compared between the two cohorts. The independent risk factors associated with keratoconus were determined using a multivariable conditional logistic regression model. RESULTS: Overall, 145 508 subjects were reviewed of which 13 228 were keratoconus patients. A ten-fold group (n = 132 280) of age-matched control subjects served as controls for comparisons. In multivariable analysis, several factors were found to be significantly associated with keratoconus. Male gender (OR = 1.27, p < 0.001), Arab ethnicity (OR = 1.50, p < 0.001), diabetes (OR = 1.19, p < 0.001), asthma (OR = 1.50, p < 0.001), myalgia (OR = 1.09, p = 0.02), mental retardation (OR = 2.63, p < 0.001), atopic dermatitis (OR = 1.35, p < 0.001) and allergic rhinitis (OR = 1.21, p < 0.001) were significantly associated with keratoconus. Smoking was significantly protective of keratoconus (OR = 0.66, p < 0.001). CONCLUSIONS: This population-based study reports male gender, Arab ethnicity, diabetes, asthma, myalgia, mental retardation/Down syndrome, atopic dermatitis and allergic rhinitis as factors associated with keratoconus while smoking demonstrates a protective effect. The results of this study could guide enhanced screening strategies and early interventions, particularly for high-risk groups.

Early postoperative complications of deep lamellar endothelial keratoplasty.

PURPOSE: To report and discuss the early postoperative complications of deep lamellar endothelial keratoplasty (DLEK). METHODS: The records of the first 44 patients who underwent DLEK by 1 surgeon were reviewed. Complications occurring between the first day and eighth week after surgery were recorded. RESULTS: In 6 patients (13.6%), the donor disc was floating in the anterior chamber on the first postoperative day and was repositioned with a 30-gauge needle. Fluid was present between the cornea and the disc in 8 patients (18.2%); in 6 of them, the fluid absorbed spontaneously. In 2 patients, the fluid was aspirated 1 month after surgery, but fibrosis developed in the interface. Two patients (4.5%) had persistent corneal edema. In 1 of them, the edema resolved after 2 months, but the other needed penetrating keratoplasty. One patient (2.3%) developed endothelial graft rejection when steroid treatment was discontinued because of exacerbation of preexisting glaucoma. Ten patients (22.7%) had elevated intraocular pressure (IOP) before surgery. The pressure was controlled with topical medication after surgery in 7 patients, 1 patient (mentioned above) suffered graft rejection, 1 patient underwent repeat trabeculectomy, and 1 patient needed insertion of a glaucoma valve. Three patients (6.8%) who did not have glaucoma before surgery developed elevated IOP postoperatively, which was controlled with topical medication. CONCLUSION: Non-adhesion of the disc and elevated IOP were the most common complications after DLEK. The mechanical preparation of a thinner donor disc and more experience may lead to fewer postoperative complications and their more efficient management.

Five-millimeter-incision deep lamellar endothelial keratoplasty: one-year results.

PURPOSE: To evaluate visual acuity, topography, and endothelial cell density 1 year after deep lamellar endothelial keratoplasty (DLEK) for endothelial dysfunction. METHODS: This is a prospective, comparative, interventional case series. Thirty-five eyes of 35 patients who had undergone DLEK with a 5-mm incision and had a minimum of 1-year follow-up were included. Main outcome measures were best spectacle-corrected visual acuity (BSCVA), uncorrected visual acuity (UCVA), astigmatism, topographic regularity and symmetry, and endothelial cell density. RESULTS: : One year postoperatively, BSCVA was 0.33 +/- 0.12 (mean, 20/60; range, 20/40-20/400) compared with 0.15 +/- 0.15 preoperatively (mean, 20/200; range, 20/70-20/800). Six patients did not reach an acceptable visual acuity and were not included in the mean BSCVA, 2 had a primary failure, and the others had preexisting glaucoma or macular disease. Spherical equivalent was -0.04 +/- 1.2 D, refractive astigmatism was 1.76 +/- 1.69 D, surface regularity index was 0.97 +/- 0.54, and surface asymmetry index was 1.25 +/- 0.78 1 year after surgery. Mean endothelial cell count from the donor was 2904 +/- 559 (range, 4694-2111) and 1 year after surgery was 1595 +/- 662 (range, 702-3040), equating to 45% cell loss (range, 15%-77%). CONCLUSIONS: DLEK is a newer method to replace the endothelium in patients with Fuchs dystrophy. Results showed minimal astigmatism, good topographic parameters, and acceptable visual acuity. Endothelial cell loss at 1 year was significant.

Intralesional cryosurgery enhances the involution of recalcitrant auricular keloids: a new clinical approach supported by experimental studies.

To explain the mechanism of action of a novel intralesional cryoprobe, thermal behavior measurements, and histological studies were performed in swine muscle specimens after intralesional cryosurgery ex vivo. Slow cooling (20 degrees C/min) and thawing (25 degrees C/min) rates, end temperature of -30 degrees C, produced 8 mm wide diffuse coagulative-type necrosis and a 3 mm-wide transition zone around the cryoprobe. In contrast, contact cryosurgery showed fast cooling and thawing rates (80 degrees C/min) and an end temperature of -100 degrees C. Efficacy and safety of the intralesional cryoprobe was further assessed in ten recalcitrant auricular keloids in nine Caucasian patients. There was a 67.4 +/- 23 percent reduction of scar volume at the end of the 18-month follow-up period after a single intralesional treatment (p < 0.005). Significant reduction of hardness, elevation, and redness as well as itching, pain, and tenderness was documented. The histomorphometric analysis, including spectral and fractal analysis, as well as assessment of the fast Fourier transform algorithm, showed parallel alignment and reorganization of the collagen fibers in the treated scar similar to that in the normal dermis. A long hold time in the deep scar core caused minimal damage to the superficial tissue, including melanocytes. There was no evidence of permanent hypopigmentation, active bleeding, infection, or recurrence. The major advantages of the intralesional cryoprobe, including the marked efficacy of a single treatment, may have a major importance in the clinical application of cryosurgery in the treatment of keloids and of other lesions localized deep in the skin.

Intraoperative complications of phacoemulsification in eyes with and without pseudoexfoliation.

PURPOSE: To determine the intraoperative complications in a large series of phacoemulsification procedures, including patients with and without pseudoexfoliation, excluding those with marked phacodonesis or lens subluxation. SETTING: Department of Ophthalmology, Carmel Medical Centre, Haifa, Israel. METHODS: This institutional case-control study included 1501 consecutive phacoemulsification procedures: 137 eyes with pseudoexfoliation and 1364 eyes without this condition. Baseline demographics and clinical factors were collected from the medical files. A comparative analysis of the incidence of intraoperative complications in eyes with or without pseudoexfoliation was calculated. Univariate analysis and multiple logistic regression were used to identify ocular factors that predicted intraoperative complications. RESULTS: There was no significant difference (P>.05) in the rate of intraoperative complications between the pseudoexfoliation (5.8%) and control (4.0%) groups. There were no significant differences in the incidence of capsular breaks, vitreous loss, and zonular ruptures without vitreous loss in the 2 groups. Pseudoexfoliation did not confer a statistically higher risk for intraoperative complications (odds ratio 1.62, 95% confidence interval 0.74-3.55). CONCLUSION: Phacoemulsification by experienced surgeons is safe in eyes with pseudoexfoliation without marked phacodonesis or lens subluxation.

Long-term intraocular pressure control after clear corneal phacoemulsification in glaucoma patients.

PURPOSE: To evaluate long-term IOP control after sutureless clear corneal phacoemulsification in eyes with preoperatively controlled glaucoma. SETTING: Institutional study. METHODS: The charts of 345 patients who had uneventful sutureless clear corneal phacoemulsification with acrylic foldable lens (IOL) implantation were retrospectively reviewed. Included were 58 patients with medically controlled open-angle glaucoma and 287 normal controls. Follow-up was 1 to 2 years. Outcome measures were postoperative IOP and number of glaucoma medications. RESULTS: Postoperatively, there was an insignificant decrease in IOP in the glaucoma group; the mean decrease was 1.5 mm Hg +/- 4.4 (SD) at 12 months and 1.9 +/- 4.9 mm Hg at 24 months. The mean number of medications decreased significantly at 12 months (0.53 +/- 0.86) and at 24 months (0.38 +/- 0.9) (P=.04). The control group also had a significant decrease in IOP, with a mean decrease of 0.72 +/- 3.7 mm Hg at 12 months (P=.01) and 1.33 +/- 3.2 mm Hg at 24 months (P<.0001). The decrease in IOP was more pronounced in eyes with a higher preoperative IOP in both the glaucoma and control groups. CONCLUSIONS: These findings suggest that sutureless clear corneal phacoemulsification with foldable acrylic IOL implantation is a relatively simple and efficient surgical option in patients with cataract and well-controlled glaucoma. The approach combines long-term IOP control with fewer medications and leads to rapid visual rehabilitation.

Iris prolapse at the surgical site: a late complication of nonpenetrating deep sclerectomy.

To investigate the occurrence and management of late-onset iris prolapse through the surgical wound after nonpenetrating deep sclerectomy. Two cases of iris prolapse that presented 8 and 10 months, respectively, after surgery for glaucoma were reviewed. One of the cases was associated with mild trauma. The postoperative follow-up was 5 and 24 months, respectively. The iris tissue bulge did not progress and there were no other complications. The visual acuity was not affected and the intraocular pressure was controlled with medical therapy. These cases demonstrate that the eye is weaker than normal at the surgical site after nonpenetrating deep sclerectomy, allowing iris protrusion. Iris prolapse should be added to the list of late postoperative complications of nonpenetrating deep sclerectomy.