Trends in contact lens-related corneal ulcers at a tertiary referral center.

PURPOSE: To evaluate the changes and trends in the number and characteristics of contact lens-related ulcers (CLRUs) and to compare the results with those of previously published series at our institution. METHODS: Medical records of all patients diagnosed with presumed bacterial corneal ulcers seen at the Cornea Service, Wills Eye Institute, between January 1, 2004, and December 31, 2007, were retrospectively reviewed. RESULTS: Five hundred seven corneal ulcers were identified. Of these, 223 (43.9%) were contact lens (CL) related and 284 (56.1%) were not CL related. The proportion of CLRU showed a significant increase over time (P = 0.003), with significantly greater percentage of CLRU in 2006 and 2007 compared with 2004 (P = 0.004 and P = 0.005, respectively). One hundred thirty-one (58.7%) of the 223 CLRU patients were men. Many CLRUs were vision threatening, with 45.7% (92 of 201) more than 4 mm in size, 36.3% (81 of 223) associated with hypopyon, and 46.4% (103 of 222) central or paracentral in location. Pseudomonas aeruginosa was the most frequent agent isolated in CLRUs, found in 75 (63.0%) of 119 positive cultures. Soft daily-wear frequent replacement lenses were the most common lenses associated with corneal ulcers and were used in 68 (33.5%) of 203 cases. There was a history of overnight wear of CLs in more than half of the cases (121 of 223, 54.3%). Of these, 21 (9.4%) were not approved for overnight wear. CONCLUSIONS: There was a significant increase in the number of cases of presumed bacterial keratitis associated with soft CL wear over the study period from 2004 to 2007 at our institution. The significant increase in CLRU noted from 1996 to 1999 to 1999 to 2002 reported previously seems to have continued between 2004 and 2007.

Guttae in the donor after Descemet-stripping automated endothelial keratoplasty.

BACKGROUND: Descemet-stripping automated endothelial keratoplasty (DSAEK) has become the surgical technique of choice for endothelial disorders, supplanting penetrating keratoplasty (PK). Although case reports have described the presence of guttae after PK, there have been no published reports of guttae occurring in the graft after DSAEK. METHODS: Case report of DSAEK in an 82-year-old female with pseudophakic bullous keratopathy RESULTS: Routine follow-up demonstrated the presence of guttae in the graft as early as the first post-operative day, with stromal edema being observed by the second post-operative week. The patient has had a stable visual acuity and exam for 16 months since DSAEK, with moderate guttae and trace stromal edema. The initial procedure was unremarkable, although another bubble was placed on the first post-operative day because of a cleft between the host and graft. CONCLUSIONS: Guttae may occur in the donor cornea after DSAEK, as previously seen after PK. Potential causes include problems with tissue preparation and grading, tissue misidentification, or surgical manipulation. Methods of elucidating whether there is an underlying predisposition to guttae formation in certain grafts, continued vigilance to ensure the highest-quality donor tissue, and meticulous surgical technique will be necessary as the use of DSAEK continues to grow.

Quality of life in keratoconus patients after penetrating keratoplasty.

PURPOSE: To determine vision-related quality of life (QoL) measured with the National Eye Institute Visual Function Questionnaire (NEI-VFQ) in keratoconus (KCN) patients who have undergone penetrating keratoplasty (PK) in 1 or both eyes and to compare the results of our study to those of historical controls. DESIGN: Clinical-based, cross-sectional study. SETTING: Wills Eye Institute, Cornea Service, Thomas Jefferson University, Philadelphia, Pennsylvania. STUDY POPULATION: This study included 149 consecutive patients who had undergone PK for KCN. INTERVENTION: Between June 1, 2008 and December 31, 2008, the NEI-VFQ was administered to 149 patients. The relationship between demographic and clinical factors and NEI-VFQ subscale scores was evaluated. MAIN OUTCOME MEASURE: Vision-related quality of life. RESULTS: Eighty-three of 149 patients (55.7%) were male. Approximately half of the patients (76/149; 51.0%) had PK in both eyes. Visual acuity with current correction in the better eye was better than 20/40 in 80% of patients (119/149). Our sample had significantly lower (worse) NEI-VFQ scores compared to Collaborative Longitudinal Evaluation of Keratoconus (CLEK) historical control group for the subscales of role difficulties, dependency, driving, and peripheral vision. In general, scores of our sample were between scores of patients with age-related macular degeneration (AMD) category 3 and 4. Patients with visual acuity better than 20/40 (in the better eye) showed significantly higher scores in all subscales except color vision. There was a significant relationship between minimum time since the graft of 5 years or greater and NEI-VFQ overall score better than AMD category 3 (P = .004). CONCLUSION: Despite satisfactory results on visual outcome measures obtained after PK, vision-related QoL in KCN patients remains impaired.