Association Between Indication for Descemet Stripping Automated Endothelial Keratoplasty and Rural Residency.

PURPOSE: Residing in rural locations can be a barrier to health care access. This study investigated the impact of residing in rural and small town (RST) areas on Descemet stripping automated endothelial keratoplasty (DSAEK) indications and outcomes in Atlantic Canada. METHODS: A retrospective cohort analysis examined consecutive DSAEKs performed in Nova Scotia between 2017 and 2020. Patient rurality was determined by the Statistical Area Classification system developed by Statistics Canada. Univariate and multivariate logistic regression models were used to assess for factors associated with DSAEK indication, including repeat keratoplasty, RST residence status, and travel time. RESULTS: Of 271 DSAEKs during the study period, 87 (32.1%) were performed on the eyes of RST residents. The median postoperative follow-up time was 1.6 years. Undergoing DSAEK for a previous failed keratoplasty was not associated with a higher odds of RST residency (odds ratio [OR], 0.50; 95% confidence interval [CI], 0.19-1.16; P = 0.13) but was associated with travel time (OR, 0.78 for each increasing hour of travel; 95% CI, 0.61-0.99; P = 0.044). RST residency was not associated with the occurrence of graft failure (OR, 0.48; 95% CI, 0.17-1.17; P = 0.13). CONCLUSIONS: Residing in a rural area in Atlantic Canada was not associated with DSAEK graft failure. Repeat endothelial keratoplasty was associated with shorter travel time for corneal surgery but not rural residency status. Further research in this field could inform regional health strategies aimed at improving equity and accessibility to ophthalmology subspecialist care.

Internal Plugging of a Traumatic Posterior Perforation Site Using Donor Sclera, Human Amniotic Membrane, and Fibrin Glue: A Novel Surgical Technique.

Purpose: To describe a novel surgical approach to treat traumatic posterior perforating injuries. Methods: A case and its findings were analyzed. Results: A 21-year-old man presented with bilateral intraocular foreign bodies that were sustained while hammering a metal railway pin. In the left eye, the foreign body was embedded in the posterior scleral wall, resulting in a 2 mm × 6 mm posterior perforation and partial retinal detachment. Silicone oil tamponade could optimize the chances for retinal reattachment; however, there was concern that the silicone oil would migrate through the posterior defect and into the orbit. Therefore, the perforation site was filled using a 3-layer plug consisting of donor sclera, human amniotic membrane, and fibrin glue. The silicone oil was successfully maintained within the globe; however, the final visual acuity was limited due to proliferative vitreoretinopathy. Conclusions: The efficacy and safety of the 3-layer plug technique should be further validated in similar cases.

Graft dislocation following Descemet stripping automated endothelial keratoplasty: a comparative cohort analysis of Optisol GS and organ culture preserved corneas.

Previous studies have suggested risk factors for graft dislocation after Descemet stripping automated endothelial keratoplasty (DSAEK). We aimed to investigate the influence of eye bank storage solution as a risk factor for graft dislocation, as this could have significant implications for eye banking practices. This retrospective analysis compared cohorts from the QEII Health Sciences Center, Halifax, Canada (donor corneas preserved in Optisol GS) and the Royal Victorian Eye and Ear Hospital, Melbourne, Australia (donor corneas preserved in organ culture). Patient, surgical, and post-operative data were collected for consecutive DSAEK surgeries performed between 2012 and 2020. Risk factors were analyzed using univariate and multivariate logistic regression modeling. 654 DSAEK surgeries were performed during the study period: 271 in the Optisol GS storage cohort and 383 in the organ culture cohort. The most common indications were pseudophakic bullous keratopathy, Fuchs endothelial dystrophy, and failed previous DSAEK. The incidence of graft dislocation requiring surgical repositioning was 9.6% (n = 26) in the Optisol GS cohort and 12.0% (n = 46) in the organ culture cohort (OR, 0.50, 95% CI, 0.20-1.13). Development of graft dislocation was associated with intraoperative venting incisions (OR, 2.50, 95% CI, 1.12-5.51) and a post-operative wound leak (OR, 55.24, 95% CI, 10.20-514.85). The incidence of DSAEK dislocation was similar between study sites using Optisol GS and organ culture, suggesting changes in eye bank storage solution would not mitigate this post-operative complication. Intraoperative creation of venting incisions and post-operative wound leaks and were factors associated with graft dislocation.

Necrobiotic xanthogranuloma associated with necrotizing scleritis.

A 57-year-old man presented to the ophthalmology clinic with a red right eye. He denied pain, diplopia, tearing, and blurred vision. His medical history included asymptomatic annular plaques on the trunk and extremities for at least a decade. Ophthalmological examination revealed a necrotizing scleritis of the right eye. Examination of the skin demonstrated variable sized annular plaques with central atrophy, some with prominent indurated border and yellow discoloration. No periorbital lesions were present. The ocular lesion rapidly progressed and areas of scleral melting developed in the right eye, which eventually required a scleral patch graft. The left eye also developed necrotizing scleritis with areas of scleral melting. Two sets of skin biopsies were performed a few weeks apart. An initial set of skin punch biopsies revealed extensive palisading granulomatous inflammation throughout the dermis, extending into the subcutis. The accompanying perivascular mononuclear infiltrate contained the collections of plasma cells. Scattered multinucleated giant cells were noted. The possibility of necrobiosis lipoidica diabeticorum was suggested. Subsequent skin biopsies showed more prominent and extensive necrobiosis, raising the possibility of necrobiotic xanthogranuloma. Protein electrophoresis was performed, which revealed an IgG λ monoclonal protein.

Mutations in the UBIAD1 gene, encoding a potential prenyltransferase, are causal for Schnyder crystalline corneal dystrophy.

Schnyder crystalline corneal dystrophy (SCCD, MIM 121800) is a rare autosomal dominant disease characterized by progressive opacification of the cornea resulting from the local accumulation of lipids, and associated in some cases with systemic dyslipidemia. Although previous studies of the genetics of SCCD have localized the defective gene to a 1.58 Mbp interval on chromosome 1p, exhaustive sequencing of positional candidate genes has thus far failed to reveal causal mutations. We have ascertained a large multigenerational family in Nova Scotia affected with SCCD in which we have confirmed linkage to the same general area of chromosome 1. Intensive fine mapping in our family revealed a 1.3 Mbp candidate interval overlapping that previously reported. Sequencing of genes in our interval led to the identification of five putative causal mutations in gene UBIAD1, in our family as well as in four other small families of various geographic origins. UBIAD1 encodes a potential prenyltransferase, and is reported to interact physically with apolipoprotein E. UBIAD1 may play a direct role in intracellular cholesterol biochemistry, or may prenylate other proteins regulating cholesterol transport and storage.

Demographics of corneal transplantation in Canada in 2004.

BACKGROUND: Penetrating keratoplasty (PKP) is the most frequently performed transplant surgery, and one of the most successful, yet no national study on the demographics of corneal transplantation in Canada has been published to date. The objectives of this study were to determine demographics of Canadian corneal transplant surgeons, donor tissue availability and waitlist length for each province, and limiting factors for the number of PKPs performed in Canada. METHODS: An anonymous voluntary survey of all Canadian corneal transplant surgeons was conducted between June and September 2004, with a concurrent voluntary survey of all eye banks in Canada. RESULTS: In 2004, there were 76 corneal transplant surgeons distributed as follows: British Columbia 17.1%, Alberta 11.8%, Saskatchewan 3.9%, Manitoba 7.9%, Ontario 36.8%, Quebec 17.1% and the Atlantic provinces 5.3%. The response rate of the Canadian corneal transplant surgeon survey was 69.7%. On average, each respondent performed 1 (SD 1) PKP/week, 40 (33) PKPs/year, and had a waitlist of 50 (63) patients. The mean wait time from date of referral to initial consultation was 10 (SD 7) weeks and from time of diagnosis to PKP was 51 (32) weeks. The most significant contributing factor to PKP waitlist selected by respondents in all provinces except Ontario was donor tissue shortage (64.7%); Ontario respondents (81.0%) believed that insufficient operating room time was the main factor. Ontario was the only province where all corneal transplant surgeons scheduled PKP electively and where surplus corneal tissue was regularly exported. INTERPRETATION: Recommendations include standardizing the criteria for acceptable donor tissue across all eye banks in Canada to increase efficiency of distribution, introducing and properly implementing mandatory referral and request legislation to increase donor rates, and increasing availability of operating room time for corneal transplant surgeons, especially in Ontario.