Endothelial keratoplasty in children.

PURPOSE OF REVIEW: Descemet stripping endothelial keratoplasty has superseded penetrating keratoplasty (PKP) in adults as the procedure of choice for treating endothelial dysfunction, but endothelial keratoplasty despite the multitude of advantages has undergone a much slower adoption in pediatric patients. This review focuses on the recent advances made in the field of pediatric endothelial keratoplasty and the associated surgical challenges. RECENT FINDINGS: Pediatric endothelial keratoplasty does not require as many sutures as PKP, and the wound size is smaller and more stable. Endothelial keratoplasty grafts clear faster, possibly allowing for a more effective management of amblyopia. Visual outcomes appear to be comparable with PKP but with a lower complication rate. SUMMARY: As corneal surgeons grow more and more familiar with the nuances of pediatric endothelial keratoplasty, our understanding of this procedure will become more complete. The limited data available suggest that endothelial keratoplasty is a suitable surgical alternative to PKP in children.

Automated detection of premature ventricular contraction in ECG signals using enhanced template matching algorithm.

Nowadays, with the increasing number of people who suffer from cardiovascular diseases such as irregular heartbeats (arrhythmia), there is a vital need to pay more attention to healthcare conditions. Therefore, the production of smart biomedical garments becomes of great necessity. The first step of manufacturing such smart garments is to build an electrocardiogram (ECG) analysis system. In this paper, the premature ventricular contraction (PVC), which is a serious life-threatening cardiovascular condition, is recognised. In addition, an improved template matching technique is developed, implemented, and evaluated to identify the irregularity of PVC beats in the QRS complex and T wave. The improvement in this technique is that a PVC recogniser is established by analysing the maximum and minimum correlation coefficient values instead of the maximum values only. Moreover, a sufficient number of features are relied upon for the accurate detection of PVC beats. The template matching algorithm is evaluated on the MIT-BIH arrhythmia, St. Petersburg Institute of Cardiological Technics (INCART), QT, MIT-BIH Supraventricular Arrhythmia, and Fantasia databases. The results show a valuable accuracy enhancement when compared with those of other recent approaches.

Long-term Outcomes on de novo Ocular Hypertensive Response to Topical Corticosteroids After Corneal Transplantation.

PURPOSE: To determine incidence, demographics, management, and outcomes of topical steroid-induced ocular hypertension after penetrating keratoplasty (PKP) and to establish effects on intraocular pressure (IOP) and graft rejection when alternate corticosteroids are used. METHODS: A single-center, retrospective review of 568 consecutive PKPs performed between 1997 and 2010 was conducted. Data were collected on demographics, best-corrected visual acuity, surgical indications, lens status, IOP, postoperative management, and incidence of rejection. RESULTS: Eighty eyes (14.1%) of 74 patients were included. The most common indication was keratoconus (28.8%). Twenty-seven eyes (33.8%) were phakic, 46 (57.4%) had a posterior chamber intraocular lens, and 7 (8.8%) had an anterior chamber intraocular lens. Mean postoperative IOP increase was only significant in the anterior chamber intraocular lens group (18.7 mm Hg, SD 10.4; P = 0.02). The average time for developing hypertension was 9.8 months (SD 14.8) postoperatively, with an average IOP increase of 13.3 mm Hg (SD 5.9). Prednisolone acetate 1% was switched to rimexolone 1% in 64 eyes (80%) and to fluorometholone 0.1% in 16 eyes (20%), which alone achieved IOP normalization in 26 eyes (32.5%) (P < 0.01). Fifty-four eyes (67.5%) required additional antiglaucoma medication. An average IOP reduction of 12.3 mm Hg (SD 6.9) was achieved at an average of 2.3 months (SD 5.2) after the switch. Seventeen eyes (21%) developed glaucoma and 13 eyes (16.3%) developed graft rejection after switching formulations, with no statistically significant differences between rimexolone and fluorometholone (P > 0.05). CONCLUSIONS: The use of alternate topical corticosteroids may be considered in cases of steroid-induced ocular hypertension after PKP because they offer good antiinflammatory prophylaxis with reduced hypertensive response.

Axis alignment and rotational stability after implantation of the toric implantable collamer lens for myopic astigmatism.

PURPOSE: To assess axis alignment and stability of the Toric Implantable Collamer Lens (TICL; STAAR Surgical Co) over time. METHODS: Thirty-five consecutive eyes of 19 patients received the TICL for treatment of myopic astigmatism. Manifest refraction spherical equivalent (MRSE) and manifest refractive cylinder were measured preoperatively and at 3 months postoperatively. The axis alignment of the TICL was measured using the internal OPD map obtained with the OPD-Scan II (NIDEK Co Ltd). RESULTS: Mean refractive cylinder was reduced from 2.80+/-1.45 diopters (D) preoperatively to 0.63+/-0.75 D at 3 months postoperatively; MRSE was -7.61+/-4.02 D preoperatively and -0.14+/-0.38 D at 3 months. Mean absolute value of the measured axis misalignment from baseline (day 1) to 1 month was 2.90+/-2.11 degrees and from 1 month to 3 months was 4.6+/-11.2 degrees. Mean absolute value of the measured changes in axis misalignment from baseline to 3 months was 2.68+/-2.11 degrees (after excluding one eye that required repositioning due to TICL rotation). At 3 months postoperatively, 96.8% (30/31) eyes had

Descemet's stripping automated endothelial keratoplasty for congenital hereditary endothelial dystrophy.

Congenital hereditary endothelial dystrophy (CHED), presents in infancy or early childhood with bilateral clouding of corneas. This condition has previously been managed surgically with penetrating keratoplasty (PKP). Performing PKP in pediatric patients has its own set of difficulties. More recently, there has been growing interest in treating this condition with Descemet's stripping automated endothelial keratoplasty (DSAEK). The purpose of this study is to report our experience of successfully performing DSAEK in a child with CHED.

The use of fibrin glue to seal Descemet membrane microperforations occurring during deep anterior lamellar keratoplasty.

PURPOSE: To report the use of fibrin glue to seal microperforations in Descemet membrane (DM) during deep anterior lamellar keratoplasty (DALK). METHODS: Two patients with keratoconus underwent DALK complicated by DM microperforation. Fibrin glue was successfully used to seal the microperforation in both cases. RESULTS: DM remained attached postoperatively in both cases, with no opacification, increased inflammation, or vascularization of the corneal stroma. CONCLUSIONS: The use of fibrin glue for managing microperforations in DALK may be a viable option.

Predescemetic dissection for healed hydrops--judicious use of air and fluid.

PURPOSE: To demonstrate the efficacy of a planned near-Descemet dissection deep anterior lamellar keratoplasty (nddDALK) in posthydrops corneal scarring. METHODS: In a retrospective noncomparative case series, nddDALK was performed on 22 consecutive eyes of 22 patients with posthydrops scarring because of keratoconus. After a partial thickness corneal trephination, air was injected at superficial to midstromal depth, followed by an anterior keratectomy. Multiple episodes of stromal hydration with a blunt cannula followed by air injection were repeated to leave a thin stromal layer. A #69 Beaver blade (BD, Franklin Lakes, NJ) was used to remove the scar. The best spectacle-corrected visual acuity (BSCVA), spherical equivalent, and refractive cylinder were recorded 12, 24, and 36 months after surgery. Intraoperative and postoperative complications were noted. RESULTS: Twelve months after surgery, the BSCVA was ≥ 20/40 in 68.1% of patients. The mean spherical equivalent was -3.53 ± 2.94 diopters (D), and the average refractive cylinder was 3.42 ± 1.7 D. Microperforations occurred in 6 patients, all of which were successfully tamponaded by an intracameral air injection alone. CONCLUSIONS: nddDALK gives good visual results and quality of vision. In developing countries, lamellar-grade donor corneas are almost the only option available. Apart from visual benefits, the procedure puts the patient at a minimal risk of immune rejection, which is a major complication of penetrating keratoplasty.

Corneal collagen crosslinking in the treatment of infectious keratitis.

PURPOSE: To report the use of corneal collagen crosslinking in the treatment of infective keratitis not responding to antimicrobial therapy. METHODS: Two retrospective case reports of infective keratitis treated with corneal collagen crosslinking. RESULTS: In both cases, corneal collagen crosslinking caused a rapid resolution of the infective keratitis, leaving residual stromal scarring. Due to the density of scarring, one case required subsequent penetrating keratoplasty for visual rehabilitation. CONCLUSION: Corneal collagen crosslinking is a promising new technique for the management of infective keratitis not responding to antimicrobial therapy. Further elucidation of its safety and role in management of infectious keratitis is needed by way of future studies.