Descemet's membrane endothelial keratoplasty (DMEK): first UK prospective study of 1-year visual outcomes, graft survival and endothelial cell count.

AIM: To evaluate the clinical outcomes of Descemet's membrane endothelial keratoplasty (DMEK) in the treatment of patients with Fuchs' endothelial dystrophy. METHODS: This prospective study involved 16 consecutive patients who had DMEK done and who were evaluated over a year. Measurements included best corrected visual acuity (BCVA), endothelial cell count, and central corneal thickness. RESULTS: Two patients had failed grafts. Of the remaining 14 patients with successful grafts, after 12 months, 79% had BCVA of 6/6 or better, and all patients had a BCVA of 6/9 or better. Median endothelial cell count was 1567 cells per mm(2) (range=900-2359) representing a 40% reduction compared with preoperative counts. Median central corneal thickness was 498 µm (range 445-567 µm) compared with a median of 649 µm (range 548-740 µm) preoperatively. All patients attained total visual rehabilitation without further surgical intervention. CONCLUSIONS: In our experience, DMEK has the potential to become the primary procedure for treating Fuchs' endothelial dystrophy and endothelial disease as it produces rapid total visual rehabilitation with few complications, and an easy follow-up and management regimen. Donor preparation and graft insertion, however, remain important challenges.

Incidence and outcomes evaluation of endophthalmitis management after phacoemulsification and 3-piece silicone intraocular lens implantation over 6 years in a single eye unit.

PURPOSE: To evaluate the incidence and outcomes of management of endophthalmitis following phacoemulsification and 3-piece silicone intraocular lens (IOL) implantation in a single eye unit over a 6-year period. SETTING: Shrewsbury and Telford Hospital, NHS Trust, Shrewsbury, United Kingdom. METHODS: Forty-four cases of endophthalmitis following phacoemulsification and 3-piece silicone IOL implantation were identified between January 1, 1998, and December 31, 2003. All the data related to the endophthalmitis cases were prospectively collected. The total number of cataract surgeries was identified from the hospital information technology department through coding data. RESULTS: There were 44 cases of endophthalmitis following 12 362 phacoemulsification cataract extractions (incidence 0.36%). The incidence of endophthalmitis with a silicone polypropylene IOL (0.67%) was significantly higher (P<.0005) than with a silicone poly(methyl methacrylate) (PMMA) IOL (0.24%). Thirty-six patients (81.8%) had vitreous tap while 8 patients (18.2%) had vitrectomy. Twenty cases (45.5%) were culture positive. Visual acuity was 6/12 or better in 30 patients (68.8%). There was weak correlation between visual acuity at presentation and final visual outcome (Pearson correlation r = 0.33, P = .029). Final visual acuity was not significantly related to culture results (P = .85, Mann-Whitney U test) or type of presentation (P = .52, Mann-Whitney U test). CONCLUSIONS: In this first single-center study to report incidence of endophthalmitis following phacoemulsification and silicone IOL implantations alone, the incidence of endophthalmitis was significantly higher with silicone polypropylene IOLs than with silicone PMMA IOLs and the overall incidence of endophthalmitis following phacoemulsification surgery was higher than most of the published data.