Early Endophthalmitis Rates and Risk Factors After Corneal Transplant Surgeries in Medicare Beneficiaries From 2016 to 2019

PURPOSE

The aims of this study were to determine rates of early postkeratoplasty endophthalmitis and identify sociodemographic and medical risk factors in the Medicare population.

METHODS

Using a retrospective cohort design, patients aged 65 years and older undergoing penetrating keratoplasty (PK), endothelial keratoplasty (EK), and anterior lamellar keratoplasty (ALK) from 2016 to 2019 among 100% Medicare Fee-or-Service database were included. Rates of early endophthalmitis within 42 days of keratoplasty were determined using the International Classification of Diseases, 10th Revision-Clinical Modification diagnostic codes. Patient and physician characteristics were compared using x2 tests, and a multivariable logistic regression model was used to evaluate factors associated with endophthalmitis.

RESULTS

The overall early endophthalmitis rate after keratoplasty was 0.39% (n = 216/54,822) with a median time to diagnosis of 14 (interquartile range: 5-25) days. Rates by keratoplasty types were 1.31% for cataract surgery combined with PK, 1.13% for PK, and 0.22% for EK. On multivariable analysis, the odds of endophthalmitis were higher for PK [odds ratio (OR): 5.46, 95% confidence interval (CI), 3.98-7.49] and ALK (OR: 5.45, 95% CI, 2.59-11.49) relative to EK. Patients with a Charlson Comorbidity Index (CCI) ≥3 had higher odds of endophthalmitis (OR: 1.82; 95% CI, 1.28-2.58) relative to patients with a CCI of 0. Practices located in the Midwest (OR: 0.59, 95% CI, 0.36-0.96), West (OR 0.57; 95% CI, 0.35-0.93), and Northeast (OR: 0.59 95% CI, 0.35-0.99) had lower odds of reporting endophthalmitis when compared to the South.

CONCLUSIONS

Patients undergoing PK and ALK and those with a CCI ≥3 had higher odds of endophthalmitis relative to EK and patients without comorbidities, respectively. Practices in the West, Midwest, and Northeast had lower odds of endophthalmitis relative to the South.

Risk of Keratitis and Keratopathy in Hidradenitis Suppurativa Patients: A Global Federated Health Network Analysis

BACKGROUND/AIM

Hidradenitis suppurativa (HS) is linked to immune dysregulation and systemic inflammation. While previous studies indicate a higher prevalence of ocular manifestations in HS, the specific risk of keratopathy and keratitis remains unclear. The primary aim of this study was to assess the risk of keratitis and keratopathy in individuals with HS.

PATIENTS AND METHODS

In this retrospective cohort study conducted with data from the TriNetX database, 53,716 patients with HS were matched to an equivalent number of non-HS controls using propensity score matching. The study covered the period from January 1st, 2005, to December 31st, 2017. Hazard ratios and their respective 95% confidence intervals (CIs), were computed to evaluate the occurrences of keratitis and keratopathy over a 5-year duration in patients with HS, compared to non-HS controls.

RESULTS

HS was associated with a 1.52 times higher risk of keratitis over a 5-year period (95%CI=1.24-1.86) and a 1.47 times higher risk of keratopathy (95%CI=1.18-1.84). These risks remained consistent in sensitivity analyses. The elevated risk of keratitis was observed across both sexes. However, the risk of keratopathy was significantly higher in women with HS (HR=1.61, 95%CI=1.24-2.10) and individuals aged 18-64 years (HR=1.32, 95%CI=1.04-1.68).

CONCLUSION

HS was linked to an elevated risk of both keratitis and keratopathy over a 5-year period. Ophthalmologic manifestations are recommended to be considered in HS standard care.

Glaucoma after penetrating keratoplasty and keratoprosthesis

PURPOSE

To compare visual and glaucoma outcomes in patients with known glaucoma after a penetrating keratoplasty (PKP) or a Boston Keratoprosthesis Type 1 (KPro) as a second corneal replacement procedure.

DESIGN

Retrospective interventional case series.

PARTICIPANTS

Charts of 141 eyes that underwent either a PKP or KPro at the Centre hospitalier de l'Université de Montréal after one failed PKP from 2008 to 2020 were reviewed. Forty-six eyes with preoperative glaucoma were included.

METHODS

Data collected included demographics, indication for the initial surgery, best corrected visual acuity (BCVA), concurrent ocular disorders, number of glaucoma medications, need for glaucoma surgery, cup-to-disc ratios (CDRs), mean RNFL thickness, and visual field (VF) characteristics. Primary outcomes were glaucoma progression trends. Secondary outcomes were visual outcomes and need for additional procedures.

RESULTS

Mean follow-up was 4.7 years for the PKP and 7.3 for the KPro group (P<0.007). 30.6% of PKP compared to 70.5% of KPro patients were diagnosed with glaucoma preoperatively. Glaucoma worsened similarly in both groups; this is based on an analysis of the number of glaucoma medications, CDR, need for glaucoma surgery, and characteristic VF changes. Patients in the PKP group required significantly more regrafts than patients in the KPro group (31.8 vs. 8.3%; P=0.045).

CONCLUSIONS

A preoperative diagnosis of glaucoma does not preclude KPro implantation. In glaucomatous eyes, the disease progressed similarly in both groups. Since both procedures increase the risk of worsening glaucoma, close follow-up is recommended. KPro may decrease the need for further corneal transplantation surgery.

Trends in keratoplasty from central and Northern India. Part I: Indications for keratoplasty

PURPOSE

To report the indications for keratoplasty and analyze trends in two decades in India.

METHODS

This was a retrospective review of eye bank registries of six tertiary eye care centers located in central and northern India from 2005 to 2021. The patterns of corneal pathology and changes in trends were analyzed.

RESULTS

Between 2005 and 2021, 13223 corneal grafts were performed in the six collaborating tertiary eye care centers. The most common indication for keratoplasty in both decades was corneal ulcer (41.1%), followed by corneal scar (25.5%), failed graft (12.0%), post-cataract surgery corneal edema (11.7%), corneal dystrophies (3.1%), corneal ectasia (1.8%), corneal trauma (0.3%), congenital corneal opacity (0.3%), and others (4.1%). An increasing trend was seen in corneal ulcers, failed grafts, and keratoconus. A reducing trend was seen in corneal scar and aphakic bullous keratopathy. There was no change in pseudophakic bullous keratopathy and Fuchs endothelial corneal dystrophy.

CONCLUSION

Corneal ulcers, corneal scars, failed grafts, and post-cataract surgery corneal edema remained the foremost indications for keratoplasty in two decades in India. An increasing trend was seen in corneal ulcers and failed grafts which are of concern as these indications carry a poorer outcome. Capacity building in lamellar keratoplasty techniques is the need of the hour as pseudophakic bullous keratopathy was an important indication, and an increasing trend was noticed in keratoconus.

[Long-term visual outcomes of Boston type I keratoprosthesis in Canada]

BACKGROUND/PURPOSE

To evaluate long-term visual outcomes of Boston type I keratoprosthesis (KPro) surgery and identify risk factors for visual failure.

METHODS

Single surgeon retrospective cohort study including 85 eyes of 74 patients who underwent KPro implantation to treat severe ocular surface disease, including limbal stem cell deficiency, postinfectious keratitis, aniridia and chemical burns. Procedures were performed at the Centre hospitalier de l'Université de Montréal from October 2008 to May 2012. All patients with at least 5 years of follow-up were included in the analysis, including eyes with repeated KPro. Main outcome measures were visual acuity (VA), visual failure, defined as a sustained VA worse than the preoperative VA, postoperative complications, and device retention.

RESULTS

Mean follow-up was 7.2±1.3 years (±SD). Mean VA was 2.1±0.7 (logarithm of minimal angle resolution) preoperatively and 1.9±1.2 at last follow-up. In total, 2.4% of patients had VA better than 20/200 preoperatively vs. 36.5% at last follow-up. Maintenance of improved postoperative VA was seen in 61.8% of eyes at 7 years. Preoperative factors associated with visual failure were known history of glaucoma (HR=2.7 [1.2 to 5.9], P=0.02) and Stevens-Johnson syndrome (HR=7.3 [2.5 to 21.4], P<0.01). Cumulative 8-year complication rates were 38.8% retroprosthetic membrane formation, 25.9% hypotony, 23.5% new onset glaucoma, 17.6% retinal detachment, 8.2% device extrusion and 5.9% endophthalmitis. The majority (91.8%) of eyes retained the device 8 years after implantation.

CONCLUSION

Nearly two-thirds of patients exhibited improved VA 7 years after KPro implantation. Preoperative risk factors for visual failure were known glaucoma and Stevens-Johnson syndrome.

Pediatric Corneal Transplantation in Uyo, Nigeria: Early Experiences

ABSTRACT

The burden of avoidable blindness from corneal disease is significantly higher where access to specialist eye care, the cost of treatment and the treatment infrastructure including eye banking, are beyond the reach of the impoverished masses. Corneal transplantation in children is challenging: it is more technically complex; patients often require multiple examinations under general anaesthesia to optimize treatment outcomes. There is also the increased risk of several complications including graft dehiscence, infection, rejection, and inappropriate patient or caregiver care. However, when successful, it restores vision. We present a report of our initial experience with penetrating keratoplasty in 2 children with blinding corneal disease in Uyo, Nigeria. Corneal transplantation history was retrieved and data (including data on age, sex, aetiology of corneal disease, indications for corneal transplantation, pre-operative and post-operative visual acuity and intraocular pressure measurements) was extracted for this report. Both patients had standard penetrating keratoplasty performed by one surgeon, under general anaesthesia. Case one was a 10-year-old male presenting with profound visual impairment from congenital hereditary endothelial dystrophy. His best corrected post-operative visual acuity was 6/24. Case two was a 3-year-old male with vision loss due to a corneal leucoma following treated herpes simplex keratitis. Post-operatively, his best corrected visual acuity improved to 6/12. Corneal graft tissue remained clear at more than 3 years of follow-up. Although amblyopia was a notable co-morbidity, corneal transplantation significantly improved their vision. Corneal banking services are advocated for in resource-limited settings where the magnitude of corneal blindness is greatest.

Keratoplasty in the United States: Trends and Indications From 2015 to 2020

PURPOSE

The aim of this study was to report trends in keratoplasty techniques and indications in the United States from 2015 to 2020.

METHODS

This retrospective review of annual reports from the Eye Bank Association of America assessed domestic corneal graft distribution and surgical indication data for various types of keratoplasty. Trends in procedure volume and indications from 2015 to 2020 were analyzed using the Cochran-Armitage test.

RESULTS

The total number of corneal transplants increased from 47,903 in 2015 to 49,143 in 2019, with a decline to 42,257 in 2020, most likely due to COVID-19. Penetrating keratoplasty (PK) volume decreased from 2015 to 2020 (19,160-15,402, 40% to 36.4%, P < 0.001), continuing a trend from the previous decade. Descemet membrane endothelial keratoplasty as a percentage of all keratoplasty procedures increased (9.8%-27.8%, P < 0.001), whereas Descemet stripping automated endothelial keratoplasty (47%-33.9%, P < 0.001) and anterior lamellar keratoplasty (ALK) decreased (2.3%-1.2%, P < 0.001).From 2017 to 2020, repeat corneal transplant was the most common specific indication for PK while ectasias/thinnings decreased in prevalence (15.6%-11.5%, P < 0.001). Ectasias/thinnings and endothelial dystrophy remained the leading indications for ALK and endothelial keratoplasty, respectively.

CONCLUSIONS

From 2015 to 2020, keratoplasty trends in the United States showed a continuation of the decrease in PK and increase in Descemet membrane endothelial keratoplasty observed in the previous decade. The most common domestic indications from 2017 to 2020 have been repeat corneal graft, endothelial dystrophy, and ectasias/thinnings for PK, EK, and ALK, respectively.

Incidence and risk factors for glaucoma development and progression after corneal transplantation

OBJECTIVE

To assess the cumulative incidence and risk factors for glaucoma development and progression within 1-2 years following corneal transplant surgery.

DESIGN

Retrospective cohort study.

METHODS

Patients undergoing penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), Descemet stripping endothelial keratoplasty (DSEK), Descemet membrane endothelial keratoplasty (DMEK), Boston keratoprosthesis type I (KPro) implantation, or endothelial keratoplasty (DSEK or DMEK) under previous PK (EK under previous PK) at one academic institution with at least 1 year of follow-up were included. Primary outcome measures were cumulative incidence of glaucoma development and progression after corneal transplant, in patients without and with preoperative glaucoma, respectively. Risk factors for glaucoma development and progression were also assessed.

RESULTS

Four hundred and thirty-one eyes of 431 patients undergoing PK (113), DALK (17), DSEK (71), DMEK (168), KPro (35) and EK under previous PK (27) with a mean follow-up of 22.9 months were analyzed. The 1-year cumulative incidence for glaucoma development and progression was 28.0% and 17.8% in patients without and with preoperative glaucoma, respectively. In a Cox proportional hazards analysis, DSEK surgery, KPro implantation, average intraocular pressure (IOP) through follow-up and postoperative IOP spikes of ≥30 mmHg were each independently associated with glaucoma development or progression (p < 0.04 for all).

CONCLUSIONS

A significant proportion of patients developed glaucoma or exhibited glaucoma progression within 1 year after corneal transplantation. Patient selection for DSEK may partly explain the higher risk for glaucoma in these patients. Postoperative IOP spikes should be minimized and may indicate the need for co-management with a glaucoma specialist.

Current social determinants of health and social risk factors in conditions of the cornea: a scoping review

PURPOSE OF REVIEW

To achieve health equity in eye health and vision care, social determinants of health (SDoH) and the associated social risk factors must be addressed. To address SDoH and social risk factors in ophthalmology, they must first be identified. The purpose of this review was to determine the SDoH and social risk factors in conditions of the cornea that have most recently been explored.

RECENT FINDINGS

This review identified social risk factors associated with all five domains of SDoH, as outlined by Healthy People 2030. The neighborhood and built environment was the domain identified the most for both exploration and observation. The social and community context domain was the least explored, and healthcare access and quality and social and community context domains were the least observed. The cornea condition explored the most in relation to SDoH was dry eye syndrome.

SUMMARY

The findings from this review can inform clinicians on the social risk factors that could be screened for in eye care facilities, so patients can be connected with services to minimize the impact of social risk factors on cornea conditions. Furthermore, the findings have identified cornea conditions and domains of SDoH that are understudied which can be an area for future studies by vision researchers.

Epidemiology of Contact Lens-Related Emergency Department Visits: Data From Nationwide Emergency Department Sample

PURPOSE

The purpose of this retrospective longitudinal cohort study was to determine the epidemiology of contact lens-related visits to the emergency department at a national level and identify high-risk groups.

METHODS

National emergency department (ED) sample, a representative sample of all US EDs, was used to determine the incidence and characteristics of keratitis in contact lens users presenting to the ED from 2006 to 2017. ICD-9-CM and ICD-10-CM codes for corneal disorder due to contact lens use (371.82 and H1882) were used to identify the patients.

RESULTS

A total of 149,716 ED visits were recorded with a diagnosis of corneal disorder due to contact lens use. Incidence of ED visits with contact lens-related corneal disorder declined steadily from 2010 to 2016. In total, 67% of the patients were female, 68.9% were adults aged 19 to 44 years, and 56.3% had a private insurance provider. The most common diagnosis at the time of discharge was "eye discharge" or "redness" (10.9%), followed by "corneal ulcer" (3.6%). Patients of highest income quartiles were more likely to present to the ED with contact lens-related corneal disorders (adjusted odds ratio, 1.21, 95% confidence interval 1.15-1.27) compared with low-income quartile. Among those who were discharged from the ED, the average charge per patient was $1051.4 (SD = 795.4).

CONCLUSIONS

Women, young adults, and patients belonging to higher socioeconomic status were found to have higher prevalence of contact lens-related corneal ED visits. Identification of high-risk groups will help in the prevention of further corneal complications and the associated vision loss.

Eye banking and keratoplasty trend analysis during the COVID-19 pandemic: A South Indian observational study

Purpose

To analyze the impact on eye donation and corneal transplantation during the COVID-19 pandemic in a tertiary eye hospital in south India.

Methods

A retrospective analysis of the donor and recipient records during the study period from January 2020 to May 2021 was conducted and tabulated in Microsoft Excel 2013. Demographic details of the donor, utility rate, cause of death, culture characteristics, storage methods, wet lab usage, and the surgical donor outcomes were evaluated. Additionally, the postoperative workup of the recipients, diagnosis, graft infection and rejection episodes, development of COVID-19 postoperatively, and outcome in terms of visual acuity at one, three, and six months were also noted.

Results

A total of 466 eyes from 249 donors were received during the study period. The mean age of the donor population was 62.43 years (20.9). The corneal transplantation utility rate was 36.4% (n = 170). Fifty-one percent of the total transplant surgeries were for therapeutic purposes. This was followed by penetrating optical keratoplasty (34%), Descemet's stripping endothelial keratoplasty (9%), and patch grafts (3%). Seventeen (10%) graft rejection episodes were noted and nine (53%) had complete resolution after medical treatment.

Conclusion

Proper preventive measures are key to carrying out safe and efficient eye banking activities even during a deadly pandemic, as COVID-19 transmission via transplantation is rare.

Trends in Early Graft Failure Leading to Regrafting After Endothelial Keratoplasty in the United States

PURPOSE

The purpose of this study was to report trends in the prevalence of early graft failure after endothelial keratoplasty in the United States.

METHODS

Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) graft volumes were collected from records maintained by 6 major eye banks in the United States from January 1, 2013, to December 31, 2018. The prevalence and presumed cause of early graft failures (defined as a graft with persistent edema or regrafted within 8 weeks after keratoplasty) each year were sourced from surgeon-reported adverse events. Failed graft cases from the 3 eye banks were compared with nonfailures at the donor and recipient levels to perform subset analysis of factors associated with early graft failure.

RESULTS

A total of 51,887 endothelial keratoplasty tissues were distributed during the study period; 72% were DSAEK grafts. The total number of early graft failures reported was 168 of 14,284 (1.18%) for DMEK and 322 of 37,603 (0.86%) for DSAEK. Early DMEK failures decreased from 2013 (7.69%) to 2018 (0.68%). In generalized linear mixed model analyses adjusting for donor tissue characteristics, recipient age, and diagnosis, an association of borderline significance was found between higher donor age and early failure [odds ratio (95% confidence interval): 1.03 (1.00-1.05); unit change of 1 yr] and DSAEK [odds ratio 1.02 (1.00-1.04); unit of change 1 yr] cases.

CONCLUSIONS

The proportion of early graft failures in DMEK decreased over time and was comparable with failure rates in DSAEK at the end of the study period. The surgical learning curve might have played a role.

Changing Trends in Corneal Transplantation in Aotearoa/New Zealand, 1991 to 2020: Effects of Population Growth, Cataract Surgery, Endothelial Keratoplasty, and Corneal Cross-Linking for Keratoconus

PURPOSE

The purpose of this study was to identify trends in the primary indication for keratoplasty in New Zealand/Aotearoa (NZ) after significant population growth, increase in the number of cataract surgeries per population, widespread adoption of endothelial keratoplasty, and introduction of corneal cross-linking for keratoconus.

METHODS

Statistical analysis of the New Zealand National Eye Bank's prospective database of all keratoplasties was performed between January 1991 and January 2020. Indications for keratoplasty were isolated for the primary diagnosis.

RESULTS

In total, 6840 corneas were transplanted with mean 236 ± 57.5 transplants/year, increasing from 2.55 to 6.06 per 100,000 NZ population/year. Over the past decade, the number of transplant recipients aged 60 years or older has increased and recipients aged 20 to 39 years have plateaued. In 2019, for the first time, regraft became the most common indication (30.9%), followed by keratoconus (27.9%) and corneal dystrophy (18.8%), with a steady decline in bullous keratopathy. Proportions of the keratoplasty technique changed dramatically: penetrating keratoplasty fell from 91.4% in 2006 to 55.0% in 2019, Descemet's stripping endothelial keratoplasty increased from 0% to 29.5%, anterior lamellar keratoplasty increased from 2.5% to 5.7%, and Descemet membrane endothelial keratoplasty increased from 0% to 9.1%.

CONCLUSIONS

Keratoplasty trends in Aotearoa/NZ have changed considerably because of the evolution of phacoemulsification and keratoplasty techniques. Unlike proportions observed overseas, NZ still performs penetrating keratoplasties in over half of all transplants. Corneal cross-linking may be having an early effect of reducing keratoplasty rates for keratoconus.

Retroprosthetic Membrane Formation in Boston Keratoprosthesis Type 1: Incidence, Predisposing Factors, Complications, and Treatment

PURPOSE

The purpose of this study was to evaluate the incidence, rate of formation, and risk factors of retroprosthetic membrane (RPM) after Boston type 1 keratoprosthesis (BKPro) as well as identify secondary complications linked to its formation and describe its treatment.

METHODS

This was a retrospective cohort study. One hundred thirty-three eyes of 115 patients who underwent BKPro implantation at the Centre Hospitalier de l'Université de Montréal from 2008 to 2017 were included with at least 1-year follow-up. Charts were reviewed, and data were collected, including incidence of RPM formation, preoperative and intraoperative risk factors, postoperative complications, and treatment modalities.

RESULTS

The mean follow-up was 5.5 years, and 39% (n = 52) of eyes developed RPM. No etiologies were found to be significantly associated with RPM development. Simultaneous lensectomy and simultaneous intraocular lens extraction were respectively positively and negatively correlated with RPM development [odds ratio (OR): 0.3590, 95% CI: 0.1629-0.7570, P = 0.0097; OR = 2.646, 95% CI: 1.273-5.585, P = 0.0086, respectively]. As for postoperative complications, the strongest correlation was between RPM and retinal detachment (OR = 6.16, 95% CI: 2.14-16.14; P = 0.0004). RPM development was also positively associated with the development of hypotony and corneal melt. Nd:YAG membranectomy was the most common treatment, performed in 83% of eyes with RPM (n = 24), with 58% resolution.

CONCLUSIONS

More than one third of patients who undergo BKPro will develop RPM, requiring close monitoring for retinal detachment. Simultaneous intraocular lens extraction seems protective, whereas simultaneous lens extraction increases the rate of RPM formation significantly. Nd:YAG membranectomy can be used as an initial noninvasive approach.

Increase in infected corneal ulcerations in dogs during the northern Colorado's 2020 wildfire season

OBJECTIVE

In the fall of 2020, Colorado experienced the two largest wildfires in state history. The smoke blanketed the college town of Fort Collins, Colorado, the location of the Veterinary Teaching Hospital at Colorado State University (CSU-VTH). The objective for this cross-sectional observational study was to evaluate how these wildfires and the corresponding elevated air quality index (AQI)) was associated with infected corneal ulcerations in dogs when compared to the two previous years.

ANIMALS

Seventeen dogs were included in this study.

PROCEDURES

Medical records from dogs presented to the CSU-VTH ophthalmology service with infected corneal ulcerations in August, September, and October of 2020, 2019, and 2018 were evaluated. Only corneal ulcerations with growth on their microbial cultures were included in this study.

RESULTS

The study revealed a significant increase in prevalence of infected corneal ulcerations in dogs presented to the CSU-VTH during the three wildfire months of 2020 that is, 3.5% (9/255) when compared with the two previous years, 2019: 1.0% (4/383, p = 0.04), and 2018: 0.9% (4/457) (p = .01). The AQI (mean ± standard error) was also significantly elevated for dogs that presented with infected corneal ulcerations in 2020 (70.2 ± 5.8) compared with 2019 (19.7 ± 8.7) and 2018 (45.6 ± 8.7) (p < .01).

CONCLUSIONS AND CLINICAL RELEVANCE

Elevation of AQI from wildfires seems to be correlated with an increased prevalence of infected corneal ulceration in dogs. As the duration and frequency of wildfires continues to rise globally, the effects of these wildfires on animal health should be investigated further.

Limbal Stem Cell Deficiency: Demographics and Clinical Characteristics of a Large Retrospective Series at a Single Tertiary Referral Center

PURPOSE

The aim of this study was to characterize a large cohort of patients presenting to a single referral center for limbal stem cell deficiency (LSCD).

METHODS

A retrospective chart review of all patients with a clinical diagnosis of LSCD from 2002 to 2015 was performed. Demographics, etiology, previous ocular surgeries, visual acuity, and treatment were assessed.

RESULTS

Seven hundred thirty-eight eyes of 434 patients (51.4% male subjects) were diagnosed with LSCD. The mean presenting age was 42.9 years, 70% presented with bilateral disease, and overall vision was poor. The most common etiologies were congenital aniridia (30.9%), chemical or thermal injuries (20.6%), contact lens (16.8%), Stevens-Johnson syndrome (SJS, 10.4%), and iatrogenic (7.3%). Congenital aniridia had a significantly increased association with glaucoma or ocular hypertension (P < 0.0001). Chemical or thermal injuries (P = 0.0007), SJS (P < 0.0001), and mucous membrane pemphigoid (P < 0.0001) had a significantly increased association with eyelid pathology. The mean logMAR best corrected visual acuity (analysis excluded eyes with light perception and no light perception) at presentation was 1.145 (∼20/280). Keratoplasty performed (before presentation at our center) without first addressing the LSCD was seen in 80 eyes; all keratoplasties failed due to recurrence of the LSCD.

CONCLUSIONS

Patients presenting with LSCD were on average middle aged without sex predominance. LSCD was most commonly bilateral, comprised a wide range of etiologies, and decreased vision substantially. Ocular comorbidities may need to be treated before treating the LSCD surgically. Finally, not addressing the LSCD (primary issue) first can result in keratoplasty failure.

Ophthalmic Assessment in Patients With Darier Disease

PURPOSE

To assess the prevalence of ophthalmic findings in patients with Darier disease, an autosomal dominant genetic skin disorder, in an effort to evaluate the need for eye examinations in the management of the disease.

DESIGN

Prospective observational case series.

METHODS

Thirty-six individuals with Darier disease were evaluated by both ocular assessment questionnaire and a comprehensive ophthalmic examination (visual acuity, refraction, external examination, and slit-lamp examination) with emphasis on the eyelids, conjunctiva, and cornea. In addition, questionnaire-based medical interview and skin examination were conducted.

RESULTS

According to the medical questionnaire, 39% of patients reported eye problems, 36% dry eye, and 42% eye fatigue after prolonged reading. Ocular examination revealed Darier disease lesions on the eyelids in 55% of the patients, blepharitis in 44%, conjunctival hyperemia in 28%, and short tear film break-up time in 83%. There was no significant relationship between any of these ophthalmic findings and systemic retinoid therapy, sex, or age.

CONCLUSIONS

The high prevalence of blepharitis and dry eye highlights the importance of ophthalmologic evaluation of patients with Darier disease.

Associations Between Regional Environment and Cornea-Related Morphology of the Eye in Young Adults: A Large-Scale Multicenter Cross-Sectional Study

Purpose

To investigate environmental factors associated with corneal morphologic changes.

Methods

A cross-sectional study was conducted, which enrolled adults of the Han ethnicity aged 18 to 44 years from 20 cities. The cornea-related morphology was measured using an ocular anterior segment analysis system. The geographic indexes of each city and meteorological indexes of daily city-level data from the past 40 years (1980-2019) were obtained. Correlation analyses at the city level and multilevel model analyses at the eye level were performed.

Results

In total, 114,067 eyes were used for analysis. In the correlation analyses at the city level, the corneal thickness was positively correlated with the mean values of precipitation (highest r [correlation coefficient]: >0.700), temperature, and relative humidity (RH), as well as the amount of annual variation in precipitation (r: 0.548 to 0.721), and negatively correlated with the mean daily difference in the temperature (DIF T), duration of sunshine, and variance in RH (r: -0.694 to 0.495). In contrast, the anterior chamber (AC) volume was negatively correlated with the mean values of precipitation, temperature, RH, and the amount of annual variation in precipitation (r: -0.672 to -0.448), and positively associated with the mean DIF T (r = 0.570) and variance in temperature (r = 0.507). In total 19,988 eyes were analyzed at the eye level. After adjusting for age, precipitation was the major explanatory factor among the environmental factors for the variability in corneal thickness and AC volume.

Conclusions

Individuals who were raised in warm and wet environments had thicker corneas and smaller AC volumes than those from cold and dry ambient environments. Our findings demonstrate the role of local environmental factors in corneal-related morphology.

Ocular surface manifestation of COVID-19 and tear film analysis

To evaluate the ocular manifestation in patients hospitalized with coronavirus disease 2019 (COVID-19) and to search for the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in tears. This study was conducted in 29 hospitalized patients who were admitted to the COVID center at the Policlinic Hospital of the University of Messina, Italy. All patients underwent an ophthalmologic assessment comprising a Standardized Patient Evaluation of Eye Dryness (SPEED) questionnaire, anterior segment, and the ocular surface examination of both eyes using a portable slit lamp. The Schirmer I test was performed, and the filter paper strip was used to search for the presence of SARS-CoV-2 on the ocular surface by real-time quantitative polymerase chain reaction (RT-qPCR). A total of 10 patients reported ocular symptoms; in particular, four reported eye burning, three reported foreign body sensation, and three reported tearing. Moreover, seven patients presented conjunctival hyperemia and/or chemosis, eleven patients presented blepharitis signs such as lid margin hyperemia and/or telangiectasia, crusted eyelashes, and meibomian orifices alterations. Tear analysis did not reveal the presence of SARS-CoV-2. Ocular symptoms are common in patients with COVID-19; although, tear analysis did not reveal the presence of SARS-CoV-2.

Survey report on keratoplasty in China: A 5-year review from 2014 to 2018

To provide the general information on corneal transplantation (CT) in China, China Cornea Society designed a questionnaire on CT from 2014 to 2018 and entrusted it to 31 committee members for implementation of the survey nationwide. This article presents the results of the survey and compares the indicators used in the survey and those in the annual statistical report released by the Eye Bank Association of America (EBAA). The number of corneal transplantations completed by the 64 hospitals from 2014 to 2018 was respectively 5377, 6394, 7595, 8270 and 8980, totally 36,616 (22,959 male and 13,657 female). The five largest hospitals by the number of corneal transplantations completed 15,994 surgeries in total, accounting for 43.68% of all the surgeries performed in the 64 hospitals. The most common indication for corneal transplantations was corneal leukoma (7683, 20.98%), followed by bacterial keratitis (4209, 11.49%), corneal dystrophies (4189, 11.44%), keratoconus (3578, 9.77%) and corneal perforation (2839, 7.75%). The main surgical techniques were penetrating keratoplasty (PK) (19,896, 54.34%), anterior lamellar keratoplasty (ALK) (13,869, 37.88%). The proportion of PK decreased from 57.97% in 2014 to 52.88% in 2018 while the proportion of ALK increased from 36.04% in 2014 to 37.92% in 2018. The geographical distribution of keratoplasties performed in China is unbalanced. PK and ALK were the main techniques of CT and corneal leukoma, bacterial keratitis and corneal dystrophies were the main indications for CT in China.

Risk factors for early flap misalignment following microkeratome-assisted laser in situ keratomileusis: A retrospective large database analysis

PURPOSE

To determine factors associated with early flap misalignment following microkeratome-assisted laser in situ keratomileusis.

MATERIALS AND METHODS

This retrospective study included the right eyes of consecutive patients who underwent laser in situ keratomileusis procedure between 2005 and 2016 at Care-Vision Laser Centers, Tel-Aviv, Israel. Patients were divided into two groups according to whether or not they subsequently developed early flap misalignment.

RESULTS

A total of 14,582 eyes (mean age of patients: 32.4 ± 10.3 years) were included. Post-laser in situ keratomileusis early flap misalignment developed in 158 eyes (1.1%). Misalignment was more frequent during the spring (32.3% vs 22.8%, p = 0.003) and in a higher operating room temperature (23.34 ± 1.06 vs 22.98 ± 1.26, p < 0.001). In addition, in the misalignment group, there was a higher rate with the of use of the a Moria M2 microkeratome (rather than sub-Bowman's keratomileusis microkeratome) head (55.2% vs 40.5%, respectively, p < 0.001). In a multivariable analysis adjusted for surgeon and year of surgery, high operating room temperature (odds ratio = 1.22, p = 0.006), treatment zone of 9.0 mm (as opposed to smaller treatment zones, odds ratio = 1.54, p = 0.04), and springtime (odds ratio = 1.58, p = 0.02) were associated with flap misalignment. There was a significant difference in misalignment rates between surgeons (p = 0.02).

CONCLUSION

This study found that larger treatment zones, higher operating room temperature, operating during the spring, and the use of Moria M2 microkeratome were associated with increased flap misalignment rates. The association with operating room temperature and seasonal variation is of interest and merits further research.

Effect of Demographic Variables on the Regional Corneal Pachymetry

PURPOSE

The measurement of corneal thickness by corneal pachymetry provides valuable information in the setting of corneal disease; however, spectral-domain optical coherence tomography (SD-OCT)-based assessment of different corneal sectors has been scarce in Pakistan.

DESIGN

We aimed to obtain a whole-corneal thickness map using SD-OCT and to evaluate its correlation with age, sex, and axial length.

METHODS

Our study included 214 subjects with healthy corneas; each eye was scanned with an SD-OCT covering a 9-mm diameter, and reproducibility was evaluated in a subset of 50 participants by means of an identical scan protocol repeated by 2 different OCT operators.

RESULTS

Our analysis revealed corneal thickness to be thinnest inferotemporally whereas thickest in the superior and superonasal quadrants. No statistically significant differences could be detected between male and female participants with respect to corneal thickness, age, intraocular pressure, axial length, and refractive errors. However, we identified a significant negative correlation between age and corneal thickness in all corneal sections, excluding the inner and middle superior, inner superonasal, and inner and middle superotemporal quadrants. Conversely, the correlation between axial length and corneal thickness was found to be positive in the central region (P = 0.03, R = 0.149), the outer inferotemporal quadrant (P = 0.012, R = 0.171), throughout the temporal quadrant (P = 0.024, R = 0.154 for inner; P = 0.025, R = 0.153 for middle; P = 0.006, R = 0.186 for outer), and in the inner superotemporal quadrant (P = 0.018, R = 0.162).

CONCLUSIONS

Different corneal sectors may interact heterogeneously with patient-related characteristics. This may provide incentive to evaluate whole-corneal thickness as a distinct parameter for clinical identification of disease processes.

Postoperative Corneal Complications in Small Incision Lenticule Extraction: Long-Term Study

PURPOSE

To investigate the incidence and clinical results of corneal complications after small incision lenticule extraction (SMILE).

METHODS

A retrospective cohort study including 3,223 patients (6,373 eyes) who were treated for myopia or myopic astigmatism was conducted. Postoperative corneal complications were recorded. Postoperative follow-up visits were scheduled on days 1 and 7 and months 1, 3, 6, and 12.

RESULTS

Of the 6,373 cases, 432 eyes (6.8%) developed at least one corneal complication postoperatively. These included punctate epithelial erosions (3.26%), diffuse lamellar keratitis (DLK) (2.17%), corneal infiltrates (0.39%), interface debris/secretion (0.30%), interface haze (0.17%), interface foreign body (0.24%), corneal striae (0.14%), corneal edema (0.09%), and epithelial ingrowth (0.02%). Of cases with corneal complications, 308 (71.3%) had an uncorrected distance visual acuity (UDVA) of better than 20/25 and 49 (11.3%) eyes lost two or more lines of corrected distance visual acuity (CDVA) on the first day after surgery. By 3 months, only 2 eyes (0.9%) had lost two or more lines of CDVA. At 6 months, 1 eye (1.0%) did not achieve a UDVA of 20/25 as a result of stage 3 DLK, but achieved 20/20 by 1 year. The postoperative spherical equivalent in cases without complications was lower than that in cases with complications at 1 day and 1 and 3 months (P = .001, .011, and .001, respectively), but there was no statistical difference at 6 and 12 months.

CONCLUSIONS

In this large cohort study, a variety of corneal complications were noted after SMILE. Although some of these complications may temporarily affect visual recovery, most resolve with appropriate treatment. [J Refract Surg. 2019;35(3):146-152.].

Corneal Infections Associated with Sleeping in Contact Lenses - Six Cases, United States, 2016-2018

Contact lenses, when worn and cared for properly, are a safe and effective form of vision correction used by an estimated 45 million Americans. However, contact lens wearers are at risk for contact lens–related eye infections, especially when wearers do not practice proper contact lens wear and care habits. These infections, affecting the cornea and known as microbial keratitis (Figure), can lead to serious adverse health outcomes. Because contact lenses are regulated by the Food and Drug Administration (FDA) as medical devices, contact lens–related corneal infections should be reported to FDA as an adverse event. To illustrate their serious health implications, six cases of contact lens–related corneal infection, in which sleeping in lenses was reported as the main risk factor, are presented. Consequences of infection reported among the identified cases included the need for frequent administration of antibiotic eye drops, multiple follow-up medical appointments, and permanent eye damage. Health education measures directed toward contact lens wearers should emphasize raising awareness of the risks of sleeping in contact lenses as well as adherence to all recommendations for the wear and care of contact lenses. Additional measures are needed to educate eye care professionals about the need to report contact lens–related corneal infections to MedWatch, the FDA Safety Information and Adverse Event Reporting program (https://www.fda.gov/MedWatch/).

Risk Factors for Epithelial Ingrowth Following Microkeratome-Assisted LASIK

PURPOSE

To analyze the incidence and risk factors associated with epithelial ingrowth following uncomplicated microkeratome-assisted LASIK.

METHODS

All patients who underwent microkeratome-assisted LASIK between January 2006 and December 2014 in a single surgical center were reviewed. Epithelial ingrowth cases were identified and associated factors were assessed.

RESULTS

Overall, 149 (0.49%) of 30,574 cases developed epithelial ingrowth. The epithelial ingrowth group was older compared to controls (35.3 ± 12.3 vs 31.7 ± 10.3 years, P = .001) and had a higher percentage of moderate to high hyperopia (13.7% vs 5.3%, P < .001), early postoperative flap slippage requiring flap repositioning (9.4% versus 2.8%, P < .001), or flap lifting for enhancement (48.6% vs 4.3%, P < .001), were treated with a smaller optic zone (6 mm) (37.7% vs 15.2%, P < .001), with a Moria M2 microkeratome (Moria SA, Antony, France) (70.1% vs 55.5%, P = .02), by low volume surgeons (n < 1,000) (5.8% vs 1.3%, P < .001), in a lower operating room temperature (22.3 ± 1.8 vs 22.8 ± 1.6, P = .005), and with a greater maximum ablation depth (67.3 ± 29.7 vs 57.3 ± 30.3, P < .001). There was a high incidence of epithelial ingrowth in the enhancement group compared to primary LASIK (4.8% vs 0.2%, P < .001). The time between treatments (primary and enhanced LASIK) was significantly greater in the epithelial ingrowth group (mean: 1,110 ± 870 vs 626 ± 662 days, P < .001). There was a significant rise in epithelial ingrowth rates as time between primary and enhancement LASIK increased, peaking at 4 to 5 years (P < .001). In multivariate analysis, flap lifting for enhancement (odds ratio [OR] = 19.5, P < .001), 6-mm optic zone (OR = 2.2, P < .001), moderate to severe hyperopia (OR = 2.4, P = .005), greater ablation depth (OR = 1.005, P < .001), and low volume surgeon (OR = 3.9, P = .01) were associated with epithelial ingrowth (total R² = 15.4).

CONCLUSIONS

The potential risk factors described above may forewarn surgeons as to which individuals merit closer observation for this complication. [J Refract Surg. 2018;34(2):100-105.].

A Prospective Longitudinal Study to Investigate Corneal Hysteresis as a Risk Factor for Predicting Development of Glaucoma

PURPOSE

To investigate the role of corneal hysteresis (CH) as a risk factor for development of glaucoma.

DESIGN

Prospective observational cohort study.

METHODS

Two hundred and eighty-seven eyes of 199 patients suspected of having glaucoma were followed for an average of 3.9 ± 1.8 years. All eyes had normal visual fields at baseline. Development of glaucoma was defined as occurrence of 3 consecutive abnormal standard automated perimetry tests during follow-up, defined as pattern standard deviation (PSD) < 5%, and/or Glaucoma Hemifield Test outside normal limits. Measurements of CH were acquired at baseline using the Ocular Response Analyzer (ORA). Univariable and multivariable Cox regression models were used to investigate baseline factors associated with development of visual field loss over time.

RESULTS

Fifty-four (19%) eyes developed repeatable visual field defects during follow-up. Measurements of CH at baseline were significantly lower in patients who developed glaucoma vs those who did not (9.5 ± 1.5 mm Hg vs 10.2 ± 2.0 mm Hg; P = .012). Each 1-mm Hg lower CH was associated with an increase of 21% in the risk of developing glaucoma during follow-up (95% confidence interval [CI]: 1.04-1.41; P = .013). In a multivariable model adjusting for age, intraocular pressure, central corneal thickness, PSD, and treatment, CH was still predictive of development of glaucoma (hazard ratio = 1.20; 95% CI: 1.01-1.42; P = .040).

CONCLUSION

Baseline lower CH measurements were significantly associated with increased risk of developing glaucomatous visual field defects over time. The prospective longitudinal design of this study supports a role of CH as a risk factor for developing glaucoma.

Refractive state and optical compositions of preterm children with and without retinopathy of prematurity in the first 6 years of life

This study aimed to investigate the refractive state and optical compositions of preterm children with and without mild retinopathy of prematurity (ROP) and explore the influence of prematurity and mild ROP on the development of refractive state and optical compositions.Preterm children who received fundus screening were recruited, and divided into ROP group and non-ROP group. Term children matched in age were also recruited as controls. Several correspondence indicators were measured before and after ciliary muscle paralysis with 1% cyclopentanone.A total of 250 eyes from 126 patients were included for analysis. The incidence of myopia was the highest in ROP group. The incidence of hyperopia was the highest in control group. The incidence of astigmatism was the highest in ROP group. The corneal astigmatism and mean astigmatism in ROP group and non-ROP group were significantly higher than in control group. Corneal refraction in ROP was markedly higher than in non-ROP group and control group; corneal curvature in ROP group increased significantly as compared with non-ROP group and control group (P < .05). The axial eye length in ROP group and non-ROP group reduced significantly as compared with control group (P < .05). Gestational age had negative relationships with corneal astigmatism (P = .019) and astigmatism (P = .001) and positive relationship with axial eye length (P = .005). Birth weight had negative relationships with corneal astigmatism (P = .001), astigmatism (P < .001), corneal refraction (P = .001), and corneal curvature (P = .001) and positive relationships with axial eye length (P = .001) and spherical equivalent refraction (P = .039). The incidence of myopia increased and that of hyperopia reduced in children over age. In children aged 3 to 4 years, the anterior chamber depth, lens thickness, vitreous thickness, and axial eye length significantly increased as compared with those aged 5 years (P < .05); the vitreous thickness and axial eye length in children aged 5 years increased significantly as compared with those aged 6 years (P < .05).This study shows that preterm children with and without mild ROP are more likely to develop myopia and astigmatism, and low birth weight, prematurity, and ROP may simultaneously affect the development of optical compositions, leading to myopia and astigmatism.

Corneal confocal microscopy best identifies the development and progression of neuropathy in patients with type 1 diabetes

A sub-set of 38 individuals with type 1 diabetes that fulfilled a strict criterion of "normal" classification for all 7 measures of neuropathy at baseline, were identified and followed. Corneal nerve morphology, as captured with corneal confocal microscopy demonstrated the greatest, and most sustained degeneration over a 4 year period.

Comparative evaluation of visual outcomes and corneal asphericity after laser-assisted in situ keratomileusis with the six-dimension Amaris excimer laser system

Purpose

To compare the visual and refractive outcomes after laser-assisted in situ keratomileusis (LASIK) surgery for correction of myopia or myopic astigmatism using a six-dimensional Amaris excimer laser.

Methods

In this retrospective cohort study, we enrolled 47 eyes of 28 patients (age: 19–36 years) with myopia or myopic astigmatism. We used the Custom Ablation Manager protocol and performed ablations with the SCHWIND AMARIS system. LASIK flaps were cut with an iFS Advanced Femtosecond Laser. Mean static (SCC) and dynamic cyclotorsion (DCC) were evaluated. Visual and refractive outcomes were evaluated during 6 months’ follow-up. Corneal asphericity (Q-value) was analyzed at 4 months postoperatively.

Results

The spherical equivalent (SE) reduction was statistically significant reduce 1 day after refractive surgery (P < 0.001), with no additional significant changes during follow-up (P = 0.854). SCC registration rates were 81% in the Aberration-Free mode (AF) and 90% in the Corneal Wavefront mode (CW). SCC measurements were within ± 5 degrees in 57% (AF) and 68% (CW) of eyes. Mean DCC was within ± 1 degree in 96% (AF) or 95% (CW) of cases. At 6 months, the uncorrected distance visual acuity was 20/25 or better in all eyes. At last follow-up, both steep and flat keratometry values had significantly flattened in both groups (P < 0.001). Corneal asphericity also increased significantly during the postoperative period for an 8-mm corneal diameter (P < 0.001).

Conclusions

LASIK for myopia or myopic compound astigmatism correction using the six-dimensional AMARIS 750S excimer laser is safe, effective, and predictable. Postoperative corneal asphericity can be analyzed by linear regression to predict the changes in postoperative corneal asphericity with this approach.

Ophthalmologic findings in contact sport disciplines

BACKGROUND

The aim of the study was to investigate the prevalence and the incidence of ocular complications in contact sport disciplines in a large population of professional and amateur athletes over a period of 3 years.

METHODS

We performed a retrospective review of 694 medical records from athletes examinated from 2008 to 2011. The following data were collected during the routine visit for agonistic sports eligibility: medical history, age, weight, years of sport practice, approximate number of matches, head and eyes injuries during and beyond of the match and a through ocular history. All athletes underwent a detailed ophthalmological evaluation. The follow-up of each athlete was carried out during the following routine visit for agonistic sports eligibility.

RESULTS

Most common disorders observed were: peripheral retinal degeneration, blepharitis, conjunctival and corneal diseases with a prevalence of 7%, 4%, 7% and 4% respectively. It was observed a positive correlation between peripheral retinal degeneration and age in amateur male boxers. Moreover, we noticed an incidence of 6% of laser therapeutic treatments as a result of retinal holes or degenerations, during the follow-up.

CONCLUSIONS

Contact sport disciplines did not result in higher prevalence of severe ocular lesion. Both conjuntival diseases and peripheral retinal degenerations represented the ophthalmologic disorders with the higher prevalence in our sample. In particular, peripheral retinal degeneration is remarkable because of the increased risk of retinal detachment. Dyschromatopsie, even if quite rare, should be considered when analysing the reception of shots, since gloves in most cases are either red or blue.

Contact Lens-induced Limbal Stem Cell Deficiency

Limbal stem cell deficiency (LSCD) is a pathologic condition caused by the dysfunction and/or destruction of stem cell precursors of the corneal epithelium, typified clinically by corneal conjunctivalization. The purpose of this review is to critically discuss a less well-known cause of limbal stem cell disease: contact lens (CL) wear. A literature search was conducted to include original articles containing patients with CL-induced LSCD. This review describes epidemiology, diagnostic strategies, pathogenesis, differential diagnosis, and treatment modalities for this condition.

[Clinical analysis of 30 cases of children blepharitis]

OBJECTIVE

To study the clinical features and treatment of children blepharitis.

METHODS

Retrospective case series.

PARTICIPANTS

30 children patients less than 15 years old with blepharitis.

RESULTS

The clinical features , past diagnosis, treatment and therapeutic effect of 30 cases of children blepharitis recorded between Janurary 2010 to June 2013 were analyzed.

RESULTS

Of all the patients, 9 were male, and 21 were female. 15 cases (50%) were diagnosed as keratitis, among which 13 cases (43.3%) were diagnosed as virus keratitis. The main complications were keratopathy, accounting for 80%. Of all the 30 children blepharitis cases, 5 (16.7%) cases were cured; 21 (70%) cases got better; 2 cases (6.7%) recurred. Of 24 keratopaty associated with blepharitis cases, 17 cases (70.8%) were cured; 5 (20.8%) cases got better; 2 (8.3%) cases recurred.

CONCLUSIONS

Blepharitis is the common ocular surface disease, clinicians often ignore the eyelid to misdiagnosis.Children blepharitis usually affects cornea and results in keratopathy associated with blepharitis. Cure rate of Chlidren blepharitis is low. It becauses cure not only needs drug therapy but also demands patients adjust their habits and high obedience with doctors. (Chin J Ophthalmol, 2015, 51: 291-294).

Blepharokeratoconjunctivitis in childhood: corneal involvement and visual outcome

PURPOSE

The main objective of this study is to describe the prevalence, degree and risk of corneal involvement, and visual impact in a pediatric population with blepharokeratoconjunctivitis (BKC).

METHODS

Retrospective, observational, case-control study. Clinical records of patients ≤16 years old with BKC seen between 2006 and 2012 were reviewed. The prevalence and relative risk of corneal involvement was evaluated between patients with and without corneal affection through a univariate and multivariate analysis with logistic regression. Visual acuity at presentation and at last follow-up visit was also analyzed.

RESULTS

One hundred and fourteen children with BKC, with a male-to-female ratio of 1 : 1 and a mean age at diagnosis of 9.13 years. The mean follow-up time was 26.4 (±25) months. Corneal involvement was present in 39.5% of patients, varying from superficial punctate keratitis to perforation. Corneal changes were not seen in children under 4 years old. The risk of corneal affection was greater in patients with photophobia, hordeolum, female gender and asymmetric disease (OR of 2.69, 11.6, 2.35 and 2.77, respectively). The mean best-corrected visual acuity at presentation was 0.20 (corneal affected group), compared to 0.11 (unaffected group; P=0.02).

CONCLUSIONS

Our study showed an older age at time of diagnosis and a worse visual outcome in patients with BKC and corneal disease compared with previous reports. Early diagnosis and detection of risk factors for corneal involvement, as well as adequate treatment, is mandatory to prevent serious long-term visual repercussions in children with BKC.

The prevalence of adenoviral conjunctivitis at the Clinical Hospital of the State University of Campinas, Brazil

OBJECTIVES

Viral conjunctivitis is a common, highly contagious disease that is often caused by an adenovirus. The aim of this study was to evaluate the prevalence of adenoviral conjunctivitis by analyzing data from a prospective clinical study of 122 consecutively enrolled patients who were treated at the Clinical Hospital of the State University of Campinas (UNICAMP) after a clinical diagnosis of infectious conjunctivitis between November 2011 and June 2012.

METHODS

Polymerase chain reaction was used to evaluate all cases of clinically diagnosed infectious conjunctivitis and based on the laboratory findings, the prevalence of adenoviral infections was determined. The incidence of subepithelial corneal infiltrates was also investigated.

RESULTS

Of the 122 patients with acute infectious conjunctivitis included, 72 had positive polymerase chain reaction results for adenoviruses and 17 patients developed subepithelial corneal infiltrates (13.93%).

CONCLUSIONS

The polymerase chain reaction revealed that the prevalence of adenoviral conjunctivitis was 59% in all patients who presented with a clinical diagnosis of infectious conjunctivitis from November 2011 to June 2012. The prevalence of adenoviral conjunctivitis in the study population was similar to its prevalence in other regions of the world.

Transplant rejection following endothelial keratoplasty and penetrating keratoplasty in the United Kingdom: incidence and survival

PURPOSE

To investigate the incidence and outcome of cornea transplant rejection following endothelial keratoplasty (EK) and penetrating keratoplasty (PK) for Fuchs endothelial dystrophy (FED) and pseudophakic bullous keratopathy (PBK).

DESIGN

Multicenter cohort study.

METHODS

Patients registered on the United Kingdom Transplant Registry (UKTR) who had an EK or PK for FED or PBK between April 1, 2005 and March 31, 2011 were included. Data were collected from UKTR forms at 1 and 2 years. Postoperative steroid use varies between surgeons and cannot be captured in this reporting system. Rejection events were identified as those recorded as endothelial rejection.

RESULTS

A total of 3486 corneal transplants were undertaken: 1973 for FED, 1513 for PBK. For FED, 2-year rejection-free survival was 93% (95% confidence interval [CI] 90%-94%) for PK and 94% (95% CI 92%-96%) for EK (P = .3). In transplants that had a rejection episode, 50% of PKs (17) and 60% of EKs (15) subsequently failed. For PBK, 2-year rejection-free survival for PK was 88% (95% CI 86%-90%) and 90% (95% CI 86%-92%) for EK (P = .6). In transplants that had a rejection episode, 85% of PKs (41) and 76% of EKs (22) subsequently failed. Inflammation (ie, conjunctival injection, presence of keratic precipitates and intraocular signs) at the time of surgery for patients with FED was significant for developing rejection: 3.5 times greater compared with those with no inflammation (P = .02).

CONCLUSIONS

There is no significant difference in rejection-free survival between EK and PK for FED or PBK. The presence of inflammation is an important risk factor, and attention to its control before and following surgery is important.

Prevalence of Preoperative Corneal Astigmatism in Patients Undergoing Cataract Surgery at Mettapracharak Hospital, Thailand

OBJECTIVE

To describe and analyze the demography and distribution of preoperative corneal astigmatism in patients undergoing cataract surgery at Mettapracharak Hospital.

MATERIAL AND METHOD

The medical records of consecutive patients who had cataract surgery between October 1, 2010 and September 30, 2011 at Mettapracharak Hospital were retrospectively reviewed and analyzed. Patient demographic and keratometric data were collected and analyzed.

RESULTS

The present study evaluated the keratometric data in 2,688 eyes of 2,671 patients who had cataract surgery with the mean age of 66.23±10.79 years. The mean corneal astigmatism was 1.09 D (range 0.00-8.50 D). Corneal astigmatism was higher than 1.00 D in 36.6%, between 0.51 D and 1.00 D in 37.9% and 0.50 D or less in 25.5% of eyes. The mean steep keratometry and flat keratometry values were 44.89±1.52 D and 43.81±1.57 D respectively. The magnitude of corneal astigmatism was positively correlated with age (p<0. 001) and there was a tendency for corneal astigmatism to increase with age above 50 years. Female had significantly steeper corneas than male. Corneal astigmatism was mainly against-the-rule (the steepest meridian at 180±30 degrees). The type of corneal astigmatism was strongly correlated with age. Against-the-rule astigmatism increased with older age. While aging decreased with-the-rule astigmatism.

CONCLUSION

The present report showed the pattern of corneal astigmatism before cataract surgery in Thai governmental hospital, approximately one third of cataract patients had more than 1.00 D of astigmatism. This finding provide the important normative reference and help ophthalmologists to plan and manage the cost-effective correction of preexisting corneal astigmatism in cataract patients to achieve the best visual outcome.

A multi-center, cross-sectional study on the burden of infectious keratitis in China

OBJECTIVE

To understand the prevalence and demographic characteristics of infectious keratitis and infectious corneal blindness.

METHODS

A multi-center, population-based cross-sectional study was conducted from January 1 to August 31, 2010. A total of 191,242 individuals of all age groups from 10 geographically representative provinces were sampled using stratified, multi-stage, random and systematic sampling procedures. A majority, 168,673 (88.2%), of those sampled participated in the study. The examination protocol included a structured interview, visual acuity testing, an external eye examination, and an anterior segment examination using a slit lamp. The causes and sequelae of corneal disease were identified using uniform customized protocols. Blindness in one eye caused by infectious keratitis was defined as infectious corneal blindness.

RESULTS

The prevalence of past and active infectious keratitis was 0.192% (95% confidence interval [CI], 0.171-0.213%), and the prevalence of viral, bacterial, and fungal keratitis was 0.11%, 0.075%, and 0.007%, respectively. There were 138 cases of infectious corneal blindness in at least one eye in the study population (prevalence of 0.082% [95%CI, 0.068%-0.095%]). Statistical analysis suggested that ocular trauma, alcoholic consumption, low socioeconomic levels, advanced age, and poor education were risk factors for infectious corneal blindness.

CONCLUSIONS

Infectious keratitis is the leading cause of corneal blindness in China. Eye care strategies should focus on the prevention and rehabilitation of infectious corneal blindness.

[Corneal transplantations in the Czech Republic in 2012]

OBJECTIVE

To determine the frequency of corneal transplantations in the Czech Republic in 2012, the percentage representations of the different types of surgeries and main indications for corneal transplantation.

METHODOLOGY

All clinics performing the corneal transplantations were asked to complete a questionnaire about the number of corneal transplants, types of surgeries and indications for such procedures. The obtained data were compared with the annual report of corneal banks for the year 2012.

RESULTS

Data for 465 transplantations were analyzed, it represents 92, 8 % of all corneas issued by the corneal tissue banks. The most common indication for corneal transplantation (regardless of type) was bullous keratopathy (40 % of cases), then keratoconus and other ectatic diseases (19,1 %) and endothelial dystrophy (16,1 %). The most common type of translation was penetrating keratoplasty (50,75 %), then posterior lamellar keratoplasty (44, 95 %) and anterior lamellar keratoplasty (4,3 %).

CONCLUSION

Acquired data confirm increasing proportion of lamellar transplantations among all corneal keratoplasties, especially posterior lamellar keratoplasty. This approach probably affects indications, for which keratoplasties are made. Keratoplasties are indicated significantly due to endothelial corneal dystrophies such as bullous keratopathy and other endothelial dystrophies. Keratoconus represents approximately 20 % of indications to corneal transplantation.

Clinical results of 40 years of paediatric keratoplasty in a single university eye clinic

PURPOSE

  To evaluate indications for paediatric keratoplasty in recipients aged ≤16 years and assess long-term clinical outcome.

METHOD

  Recipients were identified from records of the Danish Cornea Bank. Data were collected from patient journals, clinical follow-up examinations and questionnaires and stratified into pre-, peri- and postoperative variables. Diagnoses were classified into acquired traumatic, acquired nontraumatic and congenital groups. Recipients were divided into groups of <8 and ≥8 years. Data were analyzed using relative percentages and Kaplan-Meier survival plots.

RESULTS

  Thirty-three out of sixty identified recipients (73 keratoplasties in 63 eyes) were invited. Twenty-four accepted, seven still attended follow-up in our clinic. Follow-up data reached 95% of the eligible recipients (median follow-up 11 years). Twenty-three per cent were <8 years and 77%≤8 years. Diagnoses were mainly acquired nontraumatic (69%), acquired traumatic (12%) and congenital (7%). Indications were primarily optical (52%) or tectonic (41%). Graft survival was best in the acquired nontraumatic group (except regrafts) (median survival 15-20 years) and poorest in the regraft subgroup as well as the acquired traumatic and congenital groups (median survival 1-2 years). Graft failure was higher in the youngest with predisposing risk factors and in combined procedures. In terms of indications, visual improvement and eye preservation was achieved in 70%.

CONCLUSION

  Paediatric keratoplasty was successful regarding indication. Graft survival was best in the acquired nontraumatic group and poorest in the congenital group. Vascularization and/or combined risk factors, additional surgeries and young recipient age influenced negatively on graft survival.

Age distribution of various corneal diseases in China by histopathological examination of 3112 surgical specimens

PURPOSE

To analyze the age distribution of corneal disease in China by histopathological examination.

METHODS

A retrospective histopathological analysis of the prevalence and age distribution of corneal disease was performed on corneal specimens from 3112 patients who underwent corneal surgery between 2001 and 2012 in the Henan Eye Institute.

RESULTS

Infectious keratitis (2212 specimens, 71.08%) was the most common corneal disease. The distribution of age groups was significantly higher after age 30 (16.29%), reaching a peak by age 40 (22.04%) and remaining high until age 59 (21.05%, P < 0.01). The highest age-specific percentage of corneal infection was between the ages of 50 and 59 (83.21%, P < 0.01). Noninfectious corneal diseases occurred mainly in the age range of 10 to 19 years (42.47%) and 20 to 29 years (40.78%). Between the ages of 10 and 19, the leading pathologic diagnosis was keratoconus, accounting for 21.29% of cases. In patients aged 80 and older, the most common noninfectious corneal diseases were Terrien-marginal degeneration (8.33%) and Mooren's ulcer (4.17%). The highest incidence of corneal tumor was seen between the ages of 0 and 9 years (65.83%) and age 80 and older (45.86%; P < 0.01).

CONCLUSIONS

The age distribution of corneal diseases in the Chinese population is distinct from other countries. The corneal diseases tend to increase in prevalence in middle age, especially for infectious corneal disease. The prevalence of corneal tumor is high in early and late life. Corneal degenerative disease occurs predominately in seniors.

[Grading for corneal endothelial damage]

While corneal endothelial damage in its most advanced stage results in bullous keratopathy where corneal transplantation is needed, there is no severity grading for corneal endothelial damage. The Japanese Corneal Society formed a working group to establish a severity grading for corneal endothelial damage. The following are the proposed severity grading criteria. Normal: Corneal endothelial cell (CEC) density is 2000 cells/mm2 or more. Grade 1: CEC density between 1000 and 2000 cells/ mm2. The corneal endothelium is below the normal physiological condition. Grade 2: CEC density between 500 and 1000 cells/ mm2. The transparency of the corneal endothelium is endangered. Even slight damage can induce bullous keratopathy. Grade 3: CEC density below 500 cells/mm2 but no corneal edema is observed. Grade 4: Bullous keratopathy. The cornea is opaque with edema.

Demographic patterns and treatment outcomes of patients with recurrent corneal erosions related to trauma and epithelial and bowman layer disorders

PURPOSE

To evaluate demographics and outcomes of patients with recurrent corneal erosions related to trauma and epithelial and Bowman layer disorders.

DESIGN

Retrospective case series.

METHODS

setting: Wills Eye Institute, Philadelphia, Pennsylvania. study population: Two hundred seventy-two eyes (230 patients) presenting between 2008 and 2011 with recurrent corneal erosions related to trauma and epithelial and Bowman layer disorders. procedure: Conservative management, diamond burr polishing, excimer laser phototherapeutic keratectomy (PTK), and epithelial debridement alone. main outcome measure: Recurrence of erosions, more than 6 weeks after commencing treatment.

RESULTS

Mean age was 46.5 ± 14.6 (2-85) years. Female subjects accounted for 53% of patients and 18.3% had bilateral involvement. Etiology included epithelial basement membrane dystrophy in 52.9% (144/272) and trauma in 25.7% (70/272). One hundred sixty-six eyes with more than a single visit were initially managed conservatively, 68 of 166 (40.9%) had diamond burr polishing, 7 of 166 (4.2%) had PTK, and 4 of 166 (2.4%) had epithelial debridement alone. Many eyes had >6 weeks follow-up: 120 of 166 (72.3%) after conservative management, 54 of 68 (79.4%) after diamond burr polishing, 7 of 7 (100%) after PTK, and 4 of 4 (100%) after epithelial debridement. Percentage of eyes with recurrence was 56.7% (68/120) after conservative management, 14.8% (8/54) after diamond burr polishing, and 28.6% (2/7) after PTK. Rate of recurrence (eye-years) was 0.74, 0.19, and 0.23 with conservative management, diamond burr polishing, and PTK, respectively. Mild haze was seen in 22.2% of eyes (12 eyes) after diamond burr polishing and 28.6% (2 eyes) after PTK.

CONCLUSION

Recurrent corneal erosions are most commonly associated with epithelial basement membrane dystrophy. Patients are generally initially managed conservatively, with recurrence in more than half of eyes. Diamond burr polishing is the most common surgical intervention and is effective in a majority of eyes.

Genetic background and climatic droplet keratopathy incidence in a Mapuche population from Argentina

Purpose

To determine whether the incidence of and susceptibility to climatic droplet keratopathy (CDK), an acquired, often bilateral degenerative corneal disease, is influenced by the genetic background of the individuals who exhibit the disorder.

Methods

To determine whether the disease expression was influenced by the genetic ancestry of CDK cases in native Mapuche of the northwest area of Patagonia in Argentina, we examined mitochondrial DNA and Y-chromosome variation in 53 unrelated individuals. Twenty-nine of them were part of the CDK (patient) population, while 24 were part of the control group. The analysis revealed the maternal and paternal lineages that were present in the two study groups.

Results

This analysis demonstrated that nearly all persons had a Native American mtDNA background, whereas 50% of the CDK group and 37% of the control group had Native American paternal ancestry, respectively. There was no significant difference in the frequencies of mtDNA haplogroups between the CDK patient and control groups. Although the Y-chromosome data revealed differences in specific haplogroup frequencies between these two groups, there was no statistically significant relationship between individual paternal genetic backgrounds and the incidence or stage of disease.

Conclusions

These results indicate a lack of correlation between genetic ancestry as represented by haploid genetic systems and the incidence of CDK in Mapuche populations. In addition, the mtDNA appears to play less of a role in CDK expression than for other complex diseases linked to bioenergetic processes. However, further analysis of the mtDNA genome sequence and other genes involved in corneal function may reveal the more precise role that mitochondria play in the expression of CDK.

The 7-year cumulative incidence of cornea guttata and morphological changes in the corneal endothelium in the Reykjavik Eye Study

PURPOSE

To examine the corneal endothelium and establish the 7-year cumulative incidence of cornea guttata (CG).

METHODS

Population-based prospective cohort study with 573 participants (third wave of the Reykjavik Eye Study (RES) in 2008). Four hundred and thirty-seven subjects had either right or left eyes available for analysis after excluding confounding eye conditions. The baseline for eyes at risk for developing CG is the second wave of the RES in 2001. Participants underwent specular microscopy and a standardized eye examination.

RESULTS

The cumulative 7-year incidence of CG in either eye was estimated as a 95% confidence interval for the expected value for both genders combined (15-23%), for males (8-18%) and for females (19-29%). In right eye only, the 7-year cumulative incidence for both genders combined was estimated to be 6-11%. For genders combined and for males only, the data indicated no correlation between 7-year cumulated incidence and age at baseline. In women, however, the change of 7-year incidence for CG in at least one eye appeared to be correlated to age at baseline. Reduction of endothelial cell density for corneas with CG at baseline was found [CI (0.95)-132 ± 94].

CONCLUSION

The cumulative 7-year incidence of primary central CG for a middle-aged and older Caucasian population without history of potentially confounding eye disease has been established. Women tend to have higher incidence if onset occurs at middle age. If CG is present, the cell density and the cell size variation decrease within a 7-year period.