Corneal Decompensation in Uveitis Patients: Incidence, Etiology, and Outcome

Long-Term Outcomes of Scleral-Sutured Fixated Secondary Intraocular Lenses in Patients With Uveitis

OBJECTIVE

This study examined the long-term outcomes of scleral-sutured fixated intraocular lenses (SSIOLs) in patients with uveitis.

PATIENTS AND METHODS

Retrospective, consecutive review of uveitis patients with SSIOL fixation from January 2017 to December 2020. SSIOL techniques included four-point fixation with the Akreos A060 (Bausch + Lomb) or enVista MX60 (Bausch + Lomb) lens, or Hoffman's pockets rescue.

RESULTS

Thirteen eyes of 13 patients received an SSIOL (9 AO60, 2 MX60, 2 Hoffman's pockets). Diagnoses included pan- (9), anterior (2), and posterior uveitis (2). Average LogMAR best-corrected visual acuity pre- and postoperatively was 1.01 (Snellen ∼20/200) and 0.50 (Snellen ∼20/60), respectively (P = 0.003). No patients had postoperative SSIOL dislocation or conjunctival suture erosion. Six patients (46%) had uveitis flares postoperatively. Average follow-up was 50.2 months (range = 36.8 to 67.5).

CONCLUSION

This series demonstrates a 0% dislocation and suture exposure rate. Risks of uveitis flares postoperatively are high despite aggressive perioperative control but are manageable with current treatments; therefore, patients must be continually monitored. [Ophthalmic Surg Lasers Imaging Retina 2024;55:XX-XX.].

Risk Factors for Corneal Endothelial Decompensation after Penetrating Keratoplasty: A Population-Based Cohort Study

(1) Background: Endothelial decompensation is a common complication after penetrating keratopathy (PK), while the risk factors for endothelial decompensation after PK have not been fully elucidated. Consequently, we aim to investigate the possible risk factors for endothelial decompensation after PK. (2) Methods: This retrospective study was conducted using the National Health Insurance Research Database (NHIRD) of Taiwan. The main outcome was the development of endothelial decompensation after PK surgery. The effects of potential risk factors were compared between the patients with endothelial decompensation and the patients without endothelial decompensation via Cox proportional hazard regression, which produced the adjusted hazard ratio (aHR) and a 95% confidence interval (CI). (3) Results: Overall, 54 patients developed endothelial decompensation after PK surgery, with a ratio of 16.12 percent. The pre-existing type 2 diabetes mellitus (T2DM) (aHR: 1.924, 95% CI: 1.257-2.533, p = 0.0095) and history of cataract surgery (aHR: 1.687, 95% CI: 1.328-2.440, p = 0.0026) were correlated with the development of endothelial decompensation. In the subgroup analysis, the correlation between a history of cataract surgery and post-PK endothelial decompensation was more prominent in patients older than 60 years compared to their younger counterparts (p = 0.0038). (4) Conclusions: Pre-existing T2DM and a history of cataract surgery are associated with a higher incidence of post-PK endothelial decompensation.

Descemet membrane endothelial keratoplasty in complex eyes

PURPOSE OF REVIEW

To review the current literature on Descemet membrane endothelial keratoplasty (DMEK) in complex eyes.

RECENT FINDINGS

DMEK surgery has become a standardized procedure in Fuchs endothelial dystrophy and simple bullous keratopathy. But eyes with more complex disease present unique intraoperative and postoperative challenges to the DMEK surgeon. Poor visualization during surgery, complex anterior segment anatomy, altered anterior chamber dynamics, glaucoma shunts, and congenital or iatrogenic missing or altered iris and lens make DMEK surgery extremely difficult to accomplish.

SUMMARY

DMEK is feasible in complex eyes, including advanced bullous keratopathy, eyes with history of glaucoma or vitreoretinal surgery, previous penetrating keratoplasty, uveitis, pediatric, and congenital anterior segment disorders. The tools and methods reported in the literature to accomplish DMEK in complex eyes vary widely with no particular consensus or standardization of techniques. The outcomes noted for some of these conditions demonstrate the difficulty of the surgery and the uncertainty of long-term graft survival in complex eyes. Both surgical standardization and randomized prospective data will better help elucidate DMEK's role in the corneal rehabilitation of complex eyes.

Corneal Endothelial Transplantation in Uveitis: Incidence and Risk Factors

PURPOSE

To estimate the incidence of corneal endothelial transplantation (CET) and identify risk factors among patients with noninfectious ocular inflammation.

DESIGN

Retrospective cohort study.

METHODS

Adult patients attending United States tertiary uveitis care facilities diagnosed with noninfectious ocular inflammation were identified from the Systemic Immunosuppressive Therapy for Eye Diseases Cohort Study. Time-to-event analysis was used to estimate the incidence of CET, including penetrating keratoplasty, Descemet stripping endothelial keratoplasty, or Descemet membrane endothelial keratoplasty procedures. The incidence of CET was calculated. Potential risk factors for CET were also evaluated using Cox regression, accounting for correlation between eyes of the same patient.

RESULTS

Overall, 14,264 eyes met eligibility criteria for this analysis, with a median follow-up of 1.8 eye-years. The Kaplan-Meier estimated incidence of CET within 10 years was 1.10% (95% CI, 0.68%-1.53%). Risk factors for CET included age >60 years vs <40 years (adjusted hazard ratio [aHR], 16.5; 95% CI, 4.70-57.9), anterior uveitis and scleritis vs other types (aHR, 2.97; 95% CI, 1.46-6.05; and aHR, 4.14; 95% CI,1.28-13.4, respectively), topical corticosteroid treatment (aHR, 2.84; 95% CI, 1.32-6.13), cataract surgery (aHR, 4.44; 95% CI, 1.73-11.4), tube shunt surgery (aHR, 11.9; 95% CI, 5.30-26.8), band keratopathy (aHR, 5.12; 95% CI, 2.34-11.2), and hypotony (aHR, 7.38; 95% CI, 3.14-17.4). Duration of uveitis, trabeculectomy, peripheral anterior synechia, and ocular hypertension had no significant association after multivariate adjustment.

CONCLUSIONS

In patients with ocular inflammation, CET occurred infrequently. Tube shunt surgery, hypotony, band keratopathy, cataract surgery, and anterior segment inflammation were associated with increased risk of undergoing CET; these factors likely are associated with endothelial cell damage.

[Specular microscopy findings in active uveitis]

PURPOSE

To study the effect of ocular inflammation in active uveitis on the corneal endothelium.

MATERIALS AND METHODS

This is a prospective cross-sectional study involving 63 eyes of 38 patients with active newly-diagnosed uveitis. Eighty-four eyes of 42 non-uveitic subjects served as a control group. All patients underwent detailed ophthalmic examination, laser flare photometry, and non-contact specular microscopy. Eyes with uveitis had a follow-up visit at one month after initiation of treatment, including laser flare photometry and specular microscopy.

RESULTS

The mean age of the active uveitis patients was 33 (range: 9-67 years) with 21 men (55%) and 17 women (45%). For the uveitis patients at baseline, the mean flare value was 32ph/ms (range: 15-100ph/ms) with flare photometry value ≥50ph/ms in 13 eyes (21%) and<50ph/ms in 50 eyes (79%). At baseline, cell density (CD) of the uveitis patients was similar to CD in control eyes (p꞊0.16). The percent of hexagonality was significantly lower (p<0.0001), and the coefficient of variance (CV) (p<0.0001) and central corneal thickness (CCT) (p<0.0001) were significantly higher than in the control group. After one month, there was a significant decrease in flare photometry values (p<0.0001), with a mean flare value of 14.5ph/ms (range: 4-60ph/ms). In the active uveitis group, the overall results of specular microscopy did not significantly vary between the initial examination and the 1-month examination. For eyes with flare photometry value ≥50ph/ms at baseline, CD and hexagonal cell count significantly increased on the 1-month examination (p꞊0.01 and p꞊0.02 respectively), while CV and CCT decreased significantly at the one-month follow-up visit (p꞊0.007/p꞊0.03 respectively). For eyes with flare photometry value at baseline <50ph/ms, there was no significant differences in specular microscopy results between the initial examination and the 1-month examination.

CONCLUSIONS

In eyes with newly-diagnosed uveitis and active anterior chamber inflammation, specular microscopy shows transient qualitative abnormalities of the corneal endothelium that depend on the severity of the anterior chamber inflammation as measured by the laser flare meter.