The influence of obesity, diabetes mellitus and smoking on fuchs endothelial corneal dystrophy (FECD)

To detect environmental factors, which may be possible risk factors in the disease course of Fuchs' endothelial corneal dystrophy (FECD). Evaluation of patients with FECD registered in the FECD genetics database of the Center for Ophthalmology, University Hospital Cologne. For the evaluation, disease onset, central corneal thickness, best spectacle corrected visual acuity (BSCVA, logMAR), and modified Krachmer grading (grades 1-6) were correlated with the presence of diabetes mellitus (DM), body mass index (BMI), and smoking behavior. To put the age-related increase in Krachmer grading into perspective, a correction of grading were formed. Depending on the variables studied, differences between groups were examined by Mann-Whitney U test and chi-square test. The significance level was 5%. 403 patients with FECD were included in the analysis. The mean age of the patients was 70.0 ± 10.32 (range 28-96) years. The mean age at diagnosis of those patients was 63.1 ± 13.2 years. The female-to-male ratio was 1.46:1. Patients with a BMI > 30.0 kg/m2 developed FECD significantly earlier than patients with a BMI < 30 kg/m2, p = 0.001. Patients with DM showed significantly more often an Krachmer grade of 5, p = 0.015. Smoking had a negative effect on Krachmer grading (p = 0.024). Using the mediation analysis, the presence of DM correlated Krachmer Grade 5 (p = 0.015), and the presence of DM correlated with BMI > 30.0 kg/m2 (p = 0.012). In addition to smoking and DM our study shows for the first time that obesity may have a negative impact on the development of FECD. Whether dietary interventions and hormones can influence the development or progression of the disease needs to be investigated in future studies.

[Diagnostics, clinical aspects and genetics of congenital corneal opacities]

BACKGROUND

Congenital corneal opacities are comparatively rare diseases with high amblyogenic potential.

PURPOSE

The present work provides an overview of the diagnostics, clinical aspects and genetics of congenital corneal opacities.

METHODS

A literature search was carried out to compile an overview and illustration with own clinical case examples.

RESULTS

Differentiated diagnostics are of high importance in the treatment of patients with congenital corneal opacities. A close cooperation between the medical departments involved and also the parents is absolutely essential. The structured classification of congenital corneal opacities provides the basis for a targeted treatment.

DISCUSSION

The causes and the clinical symptoms of congenital corneal opacities are manifold. The correct diagnosis should be made early and in an interdisciplinary manner. Based on this, conservative and surgical treatment measures can be planned and an impending development of amblyopia can be specifically counteracted.

[Treatment of vascularized high-risk eyes with a Boston keratoprosthesis]

BACKGROUND

In severely compromised and vascularized high-risk eyes, the Boston keratoprosthesis procedure is often the last treatment option. The transparency of the optics is not impaired by endothelial immune reactions.

METHODS

This review article discusses relevant literature as well as our own data and experiences with the Boston keratoprosthesis in high-risk eyes. The relevant complications as well as the postoperative management are discussed.

RESULTS

In more than 60% of the high-risk eyes a long-term increase in visual acuity can be achieved. Keratoprosthesis retention rates show a variable span with reported mean 5‑year retention rates of 75%. The most common postoperative complications include the formation of a retroprosthetic membrane and keratolysis in up to 50% each. More than 70% of the eyes already suffer from (secondary) glaucoma preoperatively, so that glaucoma surgery is performed simultaneously in at least 20% of cases and in the postoperative course further antiglaucomatous surgery is necessary in up to 31%. Vitreoretinal complications include, in particular, sterile vitritis and infectious endophthalmitis but persistent hypotonia is also described in one third of patients.

CONCLUSION

The Boston keratoprosthesis is an alternative to conventional corneal replacement if the prognosis for allogeneic transplants is poor. Postoperative complications are common; therefore, postoperative management plays an important role. For vascularized high-risk eyes, however, it is often the only remaining option for visual rehabilitation.

[Boston type I keratoprosthesis implantation technique : Video article]

BACKGROUND

Keratoprosthetics refer to the replacement of human corneal tissue with an artificially produced exchange product. The most widely implanted keratoprosthesis worldwide is the Boston Type I Keratoprosthesis (BI-KPro, Massachusetts Eye and Ear Infirmary, Boston, MA, USA).

METHODS

This video article demonstrates the surgical technique of BI-KPro implantation as routinely performed at this institution. In addition, an overview of the surgical indications, patient consent, anesthesia and positioning, postoperative treatment and complications as well as the evidence of the technique is provided in the article based on experience with 31 BI-KPro implantations.

RESULTS

The indications for BI-KPro primarily include patients in a high-risk keratoplasty setting particularly after repeatedly failed keratoplasty. A thorough patient examination and assessment of the indications as well as detailed disclosure of information to the patient about the individual prognosis, the risk profile, the postoperative therapy and follow-up enable a positive postoperative result.

CONCLUSION

The BI-KPro provides an established and relatively standardized option for surgical treatment of eyes in a high-risk keratoplasty setting. Patients should be preoperatively informed with respect to the individual prognosis, complication profile and life-long follow-up.

[Canaloplasty : a new alternative in non-penetrating glaucoma surgery]

BACKGROUND

Canaloplasty provides a new option in non-penetrating glaucoma surgery. The aim of this study is to examine its early postsurgical safety and efficacy.

PATIENTS AND METHODS

This was a retrospective study of canaloplasties performed at our institution in 2009 (n=46, 13 of which were combined with cataract surgery). The mean follow-up was 6.0±3.4 months. The most important parameters examined were intraocular pressure (IOP), number of topical medications, postoperative complications, and required additional surgery.

RESULTS

Mean presurgical IOP: 18.2±5.8 mmHg on a mean of 2.3±1.2 applied topical medications. Mean postsurgical IOP: 12.3±5.1 mmHg at 3 months, 11.7±3.0 mmHg at 6 months, and 12.6±2.4 mmHg at 12 months. Number of postsurgical medications: 0.8±1.1 at 3 months, 1.2±1.3 at 6 months, and 1.0±1.1 at 12 months. The most frequent postoperative complications were transient hypotension (32.6%), bleb leakage (26.1%), and microhyphema (23.9%). Revision surgery was required in 8.7% of all patients.

CONCLUSIONS

Canaloplasty showed a good IOP-reducing effect. Complications occurred mostly temporarily and were of a controllable nature.