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.

Infectious keratitis after overnight orthokeratology in Canada.

PURPOSE: To report 3 cases of infectious keratitis related to overnight orthokeratology use. METHODS: Retrospective case observation. RESULTS: All 3 patients were using overnight orthokeratology lenses when they presented with unilateral corneal ulcers. The organisms isolated were Acanthamoeba, Pseudomonas aeruginosa, and Serratia marcescens. The clinical presentation and treatment of each case is presented. CONCLUSIONS: Overnight orthokeratology use may be associated with infectious keratitis despite the use of more oxygen-permeable materials and improved lens design. Patient education with informed consent, appropriate lens care, and meticulous follow-up is important. Because this complication is potentially sight threatening, orthokeratology requires further analysis and evaluation to establish its safety. The cases here are the first few reported cases in North America.