Argon laser iridotomy-induced bullous keratopathy a growing problem in Japan

AIMS

To describe the long-term risk of bullous keratopathy following argon laser iridotomy (ALI) in Japan and to compare it with other centres in the world.

METHODS

We retrospectively reviewed the case records of all patients with ALI-induced bullous keratopathy that underwent penetrating keratoplasty at Kyoto Prefectural University of Medicine (KPUM) from January 2001 to December 2004. The results were compared with the other representative centres in Singapore and the UK.

RESULTS

Thirty-nine eyes of 33 patients were included in the study. The mean age of patients was 73.3+/-6.9 years (range, 58 to 87 years). Patients developed bullous keratopathy at a mean duration of 6.9+/-4.9 years (range, 0.2 to 16 years) after the laser iridotomy procedure. The majority of eyes that developed bullous keratopathy (59.0%) occurred following prophylactic ALI. KPUM had the highest percentage of ALI-induced bullous keratopathy cases that underwent penetrating keratoplasties, as compared with other centres in Singapore and the UK (20.0%, 1.8% and 0%, respectively).

CONCLUSION

Bullous keratopathy may arise many years following ALI, and is a growing problem in Asian countries. This condition is a major cause of ocular morbidity in Japan, which has seen a worrying increase in the number of cases in recent years.

Organ failure in Syria: initiating a national deceased donation program

In the absence of formal registry data, the volume and causes of organ failure in Syria are difficult to establish with certainty. However, we evaluated in this study the extent of organ failure by collecting data from health care authorities in different medical institutions who are involved in caring for patients with organ failure. Subsequently, we assessed the problem of the widening gap between organ supply and demand in our country and we highlighted the obstacles to initiating a national deceased donation program as a viable option to address the challenge of organ shortage. The estimated prevalence of corneal blindness in Syria is 2.3 per one thousand population. The estimated incidence of viral-induced cirrhosis is 49 - 67 per one million population (pmp); these include both HCV and HBV, which constitute the leading causes of liver failure. We estimated the incidence of end-stage renal disease (ESRD) to be from 80 - 100 pmp. Obstacles to initiating a national deceased donation program include lack of awareness of the public at large and health care professionals to the importance of organ donation and transplantation. Other obstacles include lack of adequate resources in terms of finance, personnel and services and the unavailability of a national center for organ transplantation that influences public attitude, sets national guidelines and supervises all activities related to organ donation and transplantation.

Indications for Penetrating Keratoplasty in Iran

PURPOSE

To determine the indications for penetrating keratoplasty (PK) in Iran.

METHODS

: All eye bank records of patients who had undergone PK between 1994 and 2004 at ophthalmic centers throughout the country were reviewed.

RESULTS

During this 11-year period, a total of 19,668 cases were operated on. The most common indication for PK was keratoconus (n = 6787, 34.51%), followed by corneal opacity and scar (n = 3674, 18.68%), pseudophakic bullous keratopathy (n = 1808, 9.19%), corneal dystrophies (n = 1272, 6.47%), aphakic bullous keratopathy (n = 1198, 6.09%), and regraft (n = 1038, 5.28%). There was an increasing trend in rates of keratoconus and pseudophakic bullous keratopathy and a decreasing trend in aphakic bullous keratopathy over this period (P < 0.001). No significant change of trend was noted in the corneal opacity and scar, regraft, and corneal dystrophy groups.

CONCLUSIONS

Keratoconus is the most common indication for PK in Iran.

National Survey on Bullous Keratopathy in Japan

PURPOSE

To present the results of a national survey on bullous keratopathy (BK) in Japan.

METHODS

A cross-sectional national survey was conducted for 963 eyes with BK seen between 1999 and 2001 by members of the Japan Cornea Society. Demographic characteristics, type of surgery, complications, and postoperative outcome were analyzed.

RESULTS

BK accounted for 24.2% (963 eyes) of total keratoplasties performed during the period. Graft clarity was maintained in 77.4% of cases, and immunologic rejection and elevated intraocular pressure was noted in 10.8% and 15.3%, respectively. Cataract surgery was the most common cause of BK (n = 428, 44.4%), and phacoemulsification and aspiration were performed in approximately 40% of cases. BK secondary to laser iridotomy (LI) was the second most common cause of BK (n = 225, 23.4%). LI was performed as a prophylactic measure in approximately one half of these cases. BK developed with a mean duration of 6.8 years after LI. Fuchs dystrophy was the cause of BK in 18 eyes (1.9%).

CONCLUSIONS

The causes of BK in Japan are considerably different from those in other Western countries. LI-related BKs showed a remarkably high number, whereas Fuchs dystrophy was observed only rarely.

Veränderungen der Indikationen für die perforierende Keratoplastik über 20 Jahre, 1985 - 2004

BACKGROUND

The aim of the study was to determine the changing indications for penetrating keratoplasty (PK) over the 20 years from 1.1.1985 through 31.12.2004 at our Ophthalmology Department as well as to identify additional surgical interventions.

PATIENTS AND METHODS

Medical records of all 268 patients (290 eyes) who underwent PK at our Ophthalmology Department Teaching Hospital Maribor over the 20-year period (1985-2004) were reviewed retrospectively. All PK were divided into two groups: the first group comprised 121 eyes operated in the first 10 years (1985-1994) and the second one comprised those operated in the last 10 years (1995-2004).

RESULTS

During the period of 20 years (1984-2004), the most common indication for PK was aphakic/pseudophakic bullous keratopathy (23.1 %). Keratoconus was the second most common indication for PK (21.7 %), followed by corneal scars (21.4 %). In the first 10 years of the study (1985 to 1994) the most common indications were corneal scars (28.9 %), keratoconus (22.3 %) and corneal dystrophy (19.8 %). Over the second 10 years (1995 to 2004) the three most common indications were bullous keratopathy (29 %), keratoconus (21.3 %) and corneal scars (16.9 %). There was a dramatic increase in the number of PK for failed corneal transplants, from 3.3 % in the first to 12.4 % in the second period (+ 275.8 %) and for bullous keratopathy (+ 94.6 %) as well as a decrease for corneal scarring (-41.5 %) and corneal dystrophy (-40.4 %). Additional surgical interventions increased from 21.5 % in the first 10 years to 28.4 % (+ 32.1 %) in the second 10 years.

CONCLUSIONS

Bullous keratopathy was the leading indication for PK during the last 10 years (1994-2005). Keratoconus was the second leading indication in both 10 year periods. Regrafting showed a significant increasing trend in the last 10 years.

Congenital eye diseases at Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria

BACKGROUND

Congenital eye disorders, though rare are important causes of childhood blindness. It can occur in isolation or in combination, or as part of a syndrome. This retrospective study was aimed at documenting the causes of congenital eye diseases at Olabisi Onabanjo University Teaching Hospital (OOUTH), Sagamu, Nigeria.

METHOD

A review of the case notes of patients presenting at the eye clinic with congenital eye diseases between January 1994 and December 2004 was carried out.

RESULT

The most common congenital disorders are cataract 50 (47.6%), congenital glaucoma 15 (14.3%), Dacryostenosis 11 (10.5%), and corneal opacity 6 (5.7%) which are causes of preventable blindness. Less common congenital disorders are microcornea (1%), aniridia (1%), retinal atrophy (1%), and congenital anomaly of the optic disc (1%), which are congenital causes of irreversible childhood blindness.

CONCLUSION

We conclude that screening programmes should be instituted at the maternity centers before babies are discharged for early detection of congenital eye diseases and treatment of those that can cause preventable blindness. Also we recommend that Government should strengthen our welfare system by providing adequate measures for rehabilitation and care of those with irreversible blindness.

Impact of impaired vision and eye disease on quality of life in Andhra Pradesh

PURPOSE

To determine the impact of visual impairment and eye diseases on quality of life (QOL) in an older population of Andhra Pradesh in southern India.

METHODS

The World Health Organization (WHO) QOL (WHOQOL) instrument was adapted as a health-related quality of life (HRQOL) instrument for administration to adults participating in the Andhra Pradesh Eye Disease Study. Participants aged 40 years and older (n = 3702), 99.4% of the 3723 eligible, who underwent interview and detailed dilated ocular eye evaluation by trained professionals were included in this study. Psychometric properties of the HRQOL instrument were evaluated among visually impaired people. Relationships among overall QOL scores and presenting visual acuity in the better eye, specific eye diseases, and demographic variables were examined.

RESULTS

Internal consistency was high for the entire questionnaire (alpha = 0.94). Each item of the QOL scale had an adequate item-total correlation (range, 0.25-0.77) greater than 0.2. After adjusting for demographic variables and ocular disease, Subjects with blindness had significantly lower QOL scores. Subjects with glaucoma or corneal disease independent of visual acuity had lower scores than subjects without those eye diseases. Subjects with cataract or retinal disease had significantly lower scores than those without cataract or retinal disease in the model without visual acuity but not when visual acuity was added to the model.

CONCLUSIONS

Decreased QOL was associated with the presence of glaucoma or corneal disease independent of visual acuity and with cataract or retinal disease as a function of visual acuity. Visual impairment from uncorrected refractive errors was not associated with decreased QOL.

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.

[Diabetic complications within ocular surface]

Authors present one of the ocular diabetic complications--diabetic keratoepitheliopathy. The aim of this article is to summarize the knowledge about diabetic keratoepitheliopathy, its causes, manifestations and treatment options. Diabetes mellitus is associated with structural and functional disturbances in eyelids, conjunctiva and cornea. There are also changes in tear film present. Diabetic neuropathy resulting from the biochemical poor control of diabetes is the probable basic cause of the pathology. Mechanisms responsible for these changes are still not well understood. The corneal and conjunctival complications may occur spontaneously. But more often they arise from undue stress of intraocular surgery procedures. The incidence of diabetic keratoepitheliopathy in diabetic patients is high. However, it is rarely diagnosed. Effectiveness of symptomatic treatment with use of common medications is not satisfactory and it needs further investigation.

Study of the factors associated with the presence of white dots in the corneas of regular soft contact lens users from an Asian country

PURPOSE

: To investigate factors associated with the presence of microdot deposits or white dots (WDs) on confocal microscopy in regular soft contact lens (SCL) users.

METHODS

: This cross-sectional observational study investigated changes in the cornea in regular SCL users by using an in vivo slit-scanning microscope (ConfoScan 3). Images were analyzed by noting the presence of highly reflective WDs. Factors associated with WDs were analyzed by using an unpaired t test with Welch correction.

RESULTS

: There were 56 SCL wearers. Of these, a group of 10 had WDs (GWD) in various parts of the cornea. They had worn SCLs for 7 to 20 years and had a mean total duration of SCL wear of 13.6 +/- 4.4 years. Their mean age was 35.8 +/- 10.4 years. They were compared with a group of SCL wearers with no evidence of WDs (GNWD). The mean age of GNWD was 29.1 +/- 7.2 years, with a mean duration of SCL use of 8.17 +/- 5.1 years. The two groups were compared in terms of age, total duration of SCL wear (years), duration in hours per week, SCL water content (%), mean cell density in the endothelium and stroma, endothelial cell coefficient of cell size variation, and percentage of hexagonal cells. Only the duration of SCL wear was significantly associated with the presence of WDs (p=0.0042). WDs were most commonly found in the posterior stroma (n = 9). Two patients had WDs in the epithelium, with one of these having WDs in the endothelium. All patients except one with a hazy left eye scan had WDs bilaterally and symmetrically.

CONCLUSIONS

: Confocal microscopy allows visualization of WDs in the corneas of Asian regular SCL users. Patients with WDs have a longer history of SCL wear. WDs may represent an early stage of corneal disease or degeneration associated with alterations in cell behavior.

Principais indicações de transplante penetrante de córnea em um serviço de referência no interior de São Paulo (Sorocaba - SP, Brasil)

PURPOSE

To identify the main indications for corneal transplantation, analyze the results and provide demographic and epidemiological profile of patients referred to the Corneal Transplantation Project.

METHODS

A retrospective analysis, from June to December 2003, of patients referred to the Corneal Transplantation Project.

RESULTS

Total of 171 patients. One hundred and two (59.6%) patients were male and 69 (40.3%) female; mean age was 37 years. One hundred and six (49%) patients had indication for corneal transplantation. The origins of patients were: São Paulo (68%), Minas Gerais (6%), Paraná (6%), Rio de Janeiro (5%), Maranhão (3%) and others (12%). The main indications: keratoconus 65%, pseudophakic bullous keratopathy 21%, corneal scarring 10%, Fuchs dystrophy 1.9%, lattice dystrophy 0.9% and Stevens-Johnson syndrome 0.9%.

CONCLUSION

Many patients referred to corneal transplantation had no indication for such procedure. This fact demonstrates the poor knowledge of general ophthalmologists about the real indications of penetrating keratoplasty. Keratoconus was the major indication followed by pseudophakic bullous keratopathy.

Trends of penetrating keratoplasty in the United States from 1980 to 2004

PURPOSE

To examine the changing trends in penetrating keratoplasties (PKs) performed in the United States.

DESIGN

Retrospective review.

METHODS

Review of Eye Bank Association of America (EBAA) data on corneal tissue distribution in the United States from 1980 to 2004. Data analysis was retrospective. United States population census data were obtained and used for population-adjusted calculations. A series of Poisson regression models were calculated looking at the temporal trends over time.

MAIN OUTCOME MEASURES

The estimated yearly percent change and P values were calculated using Poisson regression models.

RESULTS

The total number of corneas distributed for PKs from EBAA member eye banks have steadily increased since 1980. In 1990, the international and domestic distribution data were separated. The total number of PKs performed from EBAA-supplied tissue has continued to rise since 1990; however, the total number of PKs performed in the United States has steadily declined and when population-adjusted rates are examined, the rate of decline is more dramatic.

CONCLUSION

Although both absolute numbers and age-adjusted numbers of PKs have declined recently, the population-adjusted rates have dropped more significantly.

Changing pattern of childhood blindness in Maharashtra, India

AIM

To determine the causes of severe visual impairment and blindness in children in schools for the blind in Maharashtra, India.

METHODS

Children aged <16 years with a visual acuity of <6/60 in the better eye, attending 35 schools for the blind were examined between 2002 and 2005, and causes were classified using the World Health Organization's system.

RESULTS

1985 students were examined, 1778 of whom fulfilled the eligibility criteria. The major causes of visual loss were congenital anomalies (microphthalmos or anophthalmos; 735, 41.3%), corneal conditions (mainly scarring; 395, 22.2%), cataract or aphakia (n = 107, 6%), and retinal disorders (mainly dystrophies; n = 199, 11.2%). More than one third of children (34.5%) were blind from conditions which could have been prevented or treated, 139 of whom were referred for surgery. Low vision devices improved near-acuity in 79 (4.4%) children, and 72 (4%) benefited from refraction. No variation in causes by sex or region was observed.

CONCLUSIONS

Congenital anomalies accounted for 41% of blindness, which is higher than in a similar study conducted 10 years ago. Corneal scarring seems to be declining in importance, low vision and optical services need to be improved, and research is needed to determine the aetiology of congenital anomalies.

The CORTES Study

PURPOSE

To describe the corneal transplantation activity in Italy, to assess the long-term graft survival, and to begin to outline the potential risk factors for graft outcome.

METHODS

We followed a consecutive series of penetrating (PK) and lamellar (LK) keratoplasties performed with corneas procured and distributed by the Veneto Eye Bank Foundation, which provides about one third of the corneas grafted in Italy each year.

RESULTS

Data on 4415 PKs and 489 LKs performed in 174 clinical centers are reported. Keratoconus was the major transplant indication (47% and 66%, respectively, for the 2 groups), followed by regraft (14%) and bullous keratopathy (14%) in the PK group and keratitis (8%) and refractive reasons (4%) for the LKs. In the 2 groups, graft survival, after 1 year, was estimated to be 95% and 93%, respectively, showing a decrease of the survival rate during the second and third years of study. Graft survival in patients with keratoconus indication was 98% in the PK group and 95% in the LK group for the whole period of observation, whereas the patients with other indications reported a survival rate ranging from 92% after 1 year to 52% after 3 years (PK) and from 89% to 85% (LK).

CONCLUSIONS

CORTES is the most extensive survey on corneal transplantation in Italy that involves a large cohort of patients and a significant number of surgeons with corneal tissues processed and distributed by a single eye bank. In the first 3 years, a picture of the epidemiology of the corneal transplant has been defined. The graft survival rates were comparable to those reported by other studies for the same follow-up period. However, the follow-up of a sample of this cohort for a further 3 years will allow us to precisely estimate the long-term graft survival and to better evaluate the risk factors related to graft failure.

Polymorphisms in the CC-chemokine receptor-2 (CCR2) and -5 (CCR5) genes and risk of coronary heart disease among US women

OBJECTIVE

Genetic variation in CC-chemokine receptor-2 (CCR2) and -5 (CCR5), and their common haplotypes, acting through inflammatory responses, may affect atherosclerosis and risk of coronary heart disease (CHD).

METHOD AND RESULTS

We examined seven common variants in the CCR2 and CCR5 loci and risk of CHD among women in the Nurses' Health Study. During 8 years of follow-up, we documented 248 incident cases of nonfatal myocardial infarction and fatal CHD, and matched controls 2:1 based on age and smoking. The distribution of alleles was similar between cases and controls. The haplotype-specific odds ratios (ORs) were not statistically significant nor was the globally-adjusted p-value (p=0.61). However, there was a statistically significant association for CCR5-Delta32 and A58755G (rs2856758) between cases and controls comparing age of onset <55 and >or=55 years. For Delta32, the OR for having the variant was 0.12 (0.02-0.76) for age <55, and 1.14 (0.69-1.88) for age >or=55 years (p, interaction=0.04). The CCR5-Delta32 was in linkage disequilibrium with 58755G, and a similar association was observed for having the 58755G.

CONCLUSIONS

In this population, CCR2-CCR5 haplotypes were not associated with risk of CHD. However, our data suggest a strong inverse association for certain CCR5 variants and early age of CHD onset.

Prevalence and risk factors for cornea guttata in the Reykjavik Eye Study

PURPOSE

To establish the age- and gender-specific prevalence of cornea guttata (CG) in citizens of Reykjavik, Iceland, 55 years and older.

DESIGN

Cross-sectional, random, population-based study.

PARTICIPANTS

The 774 participants were those participating in the second examination of the Reykjavik Eye Study. At baseline, we had a response rate of 75.8%, and at the 5-year follow-up, 88% of the survivors participated.

METHODS

We used slit-lamp and non-contact specular microscopy and endothelial specular photography as well as computer-assisted morphometry. We used a standardized grading system for CG.

MAIN OUTCOME MEASURES

Diagnosis of primary central CG.

RESULTS

The prevalence of CG is 11% for females and 7% for males both for right eyes and left eyes. Higher weight and higher body mass index are found to be associated with decreased risk of CG. Having smoked more than 20 pack-years increased the risk of CG more than 2-fold (P<0.02).

CONCLUSIONS

Cornea guttata seem to be found more commonly in women than in men. Smoking for more than 20 pack-years increases the risk of developing CG more than 2-fold.

Climatic droplet keratopathy in the Argentine Patagonia

PURPOSE

To present the findings of climatic droplet keratopathy (CDK) that affects people of a rural area of the Argentine Patagonia.

DESIGN

Observational case series.

METHODS

Five hundred seventy-seven individuals who live in settlements and villages in an inland area of the northwest Patagonia region in Argentina received a complete eye examination.

RESULTS

The mean age was 36.02 years (r = 1.5 months to 89 years); 55.63% of the patients were female. The mean age of the 7.62% of the patients who had typical CDK was 65.31 years (r = 42 to 89 years); 86.36% of the patients were male. Of 66 eyes in 35 patients with CDK, 35 eyes had peripheral haziness (grade 1); 23 eyes had a band-shaped haziness (grade 2), and 8 eyes had the aggregate of yellow subepithelial droplets (grade 3). Pinguecula, pterygium, cataract, and pseudoexfoliation were frequent findings among patients with CDK.

CONCLUSION

CDK is not infrequent among male adults in this area of the Argentine Patagonia and may be severely handicapping.

Corneo-conjunctival carcinoma in Uganda

AIMS

Since 1990, the incidence of conjunctival neoplasia has more than tripled in Uganda. It is known to be associated with exposure to solar ultraviolet radiation and to infection with the human immunodeficiency virus-1 (HIV). However, little is known about the most effective treatments. In this study, we report surgical outcomes among people with corneo-conjunctival squamous neoplasia in Uganda and investigate the role of HIV infection and other factors in the aetiology of the tumour.

METHODS

Country-wide enrolment of participants; removal and histology of suspect lesions; HIV counselling and testing; home visiting of participants to determine outcomes.

RESULTS

In 67 months between 1995 and 2001, 476 participants were enrolled (262 female, 214 male, median age 32 years). A total of 463 (97%) had eye-conserving removal of the lesion and 13 had other surgery. For 414, the histology was squamous neoplasia (184 invasive carcinoma, 230 intraepithelial). The prevalence of HIV infection in cases was 64%. In all, 96% were followed up for a median period of 32 months (range 0-81) after eye-conserving surgery during which time 13 (3.2%) had a recurrence.

CONCLUSIONS

Surgery resulted in a low recurrence rate during the follow-up period and had minimal complications. The prevalence of HIV among cases was higher than expected on the basis of data from the general population, although about a third of cases were HIV-negative and had normal CD4 counts. No new cofactors were identified.

Vision-limiting complications in open-globe injuries

BACKGROUND

To correlate vision-limiting complications of open-globe trauma with anatomical zone and mechanism of injury.

METHODS

Retrospective review of 235 patients with open-globe injuries at the Massachusetts Eye and Ear Infirmary. Vision-limiting complications were assessed at 2 to 3 months after the injury.

RESULTS

Traumatic cataracts and corneal scarring were the most prevalent vision-limiting complications in patients with zone I (cornea-only) lacerations. The most common vision-limiting factors in eyes with zones II and III lacerations (involving sclera) were cataracts and retinal detachments. In patients with penetrating injuries, predominant vision-limiting findings were traumatic cataracts and corneal scarring. In patients with blunt-force ruptures, leading causes were traumatic cataracts and retinal detachments. There were increased rates of phthisis and enucleation surgery in patients with ruptures and zones II and III injuries. In cases of penetrating and zone I injuries, significantly more patients achieved visual acuities better than 20/50 when compared with eyes that had ruptures or zones II and III injuries.

INTERPRETATION

Traumatic cataracts were the most common vision-limiting factor in all subcategories of open-globe injuries. Injuries in zones II and III and blunt-force ruptures were associated with increased rates of retinal detachments, phthisis, and enucleation, contributing to the poorer visual prognosis in these patients.

Trends in the indications for penetrating keratoplasty, 1980-2001

PURPOSE

To study the leading indications and changing trends for penetrating keratoplasty (PK) over the past 3 decades.

METHODS

This is a retrospective review of 696 cases of PK. The indications for PKs performed at the Duke University Eye Center during the years 1980-1981, 1990- 1991, and 2000-2001 were tabulated to determine trends over the past 3 decades. The main outcome measures were indications for PK.

RESULTS

During this study, 696 PKs were performed. The leading indications for PK and their respective frequencies during 1980-1981, 1990-1991, and 2000-2001 were failed grafts (10.8%, 19.0%, 27.0%, respectively), pseudophakic bullous keratopathy (PBK)/aphakic bullous keratopathy (ABK) (19.4%, 20.6%, 16.7%, respectively), Fuchs dystrophy (15.6%, 13.0%, 23.8%, respectively), keratoconus (13.4%, 8.2%, 11.8%, respectively), and corneal scar (7.0%, 8.9%, 10.7%, respectively). The number of PKs for failed grafts and Fuchs dystrophy increased over time.

CONCLUSIONS

In this study, failed graft has gradually become the leading indication for PK, whereas most other studies have reported PBK as the leading indication. Unlike many other studies, Fuchs dystrophy was a common indication for PK.

Indications of Penetrating Keratoplasty in Northern India

PURPOSE

To identify the indications for penetrating keratoplasty in northern India.

METHODS

All the eye bank records of penetrating keratoplasties performed during the period from June 1997 to November 2003 at Rajendra Prasad Center for Ophthalmic Sciences were reviewed.

RESULTS

During this period, 2022 penetrating keratoplasties were performed. The leading indications for penetrating keratoplasty were corneal scarring (38.03%) followed by acute infectious keratitis (28.38%), regrafting (11.5%), aphakic bullous keratopathy (7.27%), pseudophakic bullous keratopathy (6.18%), and corneal dystrophy (3.85%). Healed infectious keratitis (19.83%) was the most common subcategory among the eyes with corneal scarring followed by traumatic corneal scars (16.71%). Healed (19.83%) and active keratitis (28.38%) together accounted for the majority of keratoplasties (48.21%). In cataract-related corneal edema (13.45%), aphakic bullous keratopathy (7.27%) was almost as frequent as compared with pseudophakic bullous keratopathy (6.18%).

CONCLUSIONS

Corneal infections either active or healed are the most common indication for keratoplasty in northern India.

Incidence and outcomes of uveitis in juvenile rheumatoid arthritis, a synthesis of the literature

BACKGROUND

Juvenile rheumatoid arthritis (JRA) is the most common systemic cause of pediatric uveitis in Europe and North America. Uveitis is commonly perceived as a frequent sequela of JRA and JRA-associated uveitis is commonly considered to have a complicated course with frequent adverse visual outcomes.

METHODS

We performed a systematic literature search for series of consecutive patients with JRA (as defined by the American College of Rheumatology criteria) reporting on the frequency of uveitis and/or complications of uveitis, published between January 1980 and December 2004. The main outcome measures were: the cumulative incidence of uveitis in JRA, the cumulative incidence of adverse visual outcome and that of complications in JRA-associated uveitis. Additionally, the influence of gender, presence of antinuclear antibody (ANA) and disease onset subtype to the likelihood of developing uveitis were examined.

RESULTS

Analysis of pooled data from the 26 eligible series suggested a cumulative incidence of uveitis in JRA of 8.3% [95% confidence intervals (CI), 7.5-9.1%]. The cumulative incidence of uveitis varied according to geographic location, being highest in Scandinavia, then the US, then Asia and lowest in India. JRA-associated uveitis was more common in pauciarticular than polyarticular onset patients [odds ratio (OR) = 3.2, 95% CI, 2.33-4.36] and in ANA-positive than ANA-negative patients (OR = 3.18, 95% CI, 2.22-4.54). Female gender was only a weak risk factor for the development of uveitis in JRA patients (OR = 1.69, 95% CI 1.09-2.62) and was not statistically significant after considering disease onset subtypes. In JRA-associated uveitis the cumulative incidence of cumulative incidence of adverse outcome (visual acuity < 20/40 OU) was 9.2% (95% CI: 4.7-15.8) of cataracts 20.5% (95% CI: 15.5-26.3), of glaucoma 18.9% (95% CI: 14.4-24.2) and of band keratopathy 15.7% (95% CI: 10.9-21.7).

CONCLUSION

The cumulative incidence of uveitis in JRA varies according to geographic location, presence of ANA, type of JRA onset and gender. Uveitis, adverse visual outcome, and complications in JRA are less frequent than commonly accepted.

Incidence of Corneal Epithelial Defects With the Standard and Zero-Compression Hansatome Microkeratomes

PURPOSE

To evaluate the incidence of epithelial defects in patients who have had laser in situ keratomileusis (LASIK) surgery with the standard compression Hansatome microkeratome head in comparison to the modified (zero-compression) Hansatome microkeratome head (Bausch & Lomb, Rochester, NY).

METHODS

This study was a retrospective review of 404 consecutive patients who had LASIK surgery on both eyes between January 2002 and June 2002. The standard compression microkeratome head was used in 216 (53%) cases and the zero-compression microkeratome head was used in 188 (47%) cases. Epithelial defects were categorized as loose epithelium, or a break in the epithelium, within the area of the flap. An adverse outcome for a patient was defined as having an epithelial defect in at least one eye. Odds ratios were estimated using logistic regression.

RESULTS

When the standard compression microkeratome head was used, 19 (8.8%) patients had an epithelial defect in at least 1 eye. When the zero-compression microkeratome head was used, 5 (2.7%) patients had an epithelial defect in at least 1 eye. Logistic regression comparing the risk of epithelial defect in either eye with the standard compression head versus the zero-compression head resulted in an age-adjusted odds ratio of 0.2 (95% confidence interval, 0.07 to 0.58, P < .05).

CONCLUSIONS

These findings provide evidence that LASIK surgery with a zero-compression head reduces the risk of epithelial defect compared to the standard compression head of the Hansatome microkeratome.