[Graft refractive surgery for post-DALK atigmatism in keratoconus]

Evaluate the effect of relaxing incision and adjustment sutures to correct astigmatism after deep anterior lamellar keratoplasty [DALK] in patients with keratoconus. This interventional case series included keratoconic eyes undergoing graft refractive surgery [GRS] for intolerable post-DALK astigmatism. The technique of graft refractive surgery for the 5 initial cases consisted of relaxing incisions at the steep meridian in the graft-host interface down to Descemet's membrane. The main outcomes were uncorrected and best-corrected visual acuity, and change in refractive and keratometric astigmatism using subtraction and vector analysis methods. Fourteen eyes of 14 keratoconic patients [12 male subjects] with history of DALK underwent GRS. Mean age of the patients was 29.36 +/- 6.2 years and mean follow-up period was 12.0 +/- 7.4 months after initial GRS. Mean preoperative BCVA was 0.29 +/- 0.1 logMAR which improved to 0.22 +/- 0.1 logMAR after the operation [P=0.007]. Average keratometric astigmatism was reduced by 3.8 D and 5.5 D as measured by subtraction and vector analysis methods, respectively. Relaxing incisions and suturing at the steep meridian followed by selective suture removal can effectively and predictably reduce post-DALK astigmatism in patients with keratoconus

Donor eye contamination before and after decontamination process in the eye bank of the I.R. of Iran

To evaluate bacterial and fungal contamination of donor corneas before and after decontamination at Eye Bank of 1.R. of Iran based on cultures. This descriptive study was performed on 131 donor eyes [whole globe or cut cornea] used for corneal transplantation at Labbafinejad hospital during a 6-month period. Microbiologic culture was performed at three stages: before enucleation at the forensic medicine unit, after decontamination process at the eye bank and before transplantation in the at operation room. Prevalence of contamination with 95% confidence interval [95% CI] at each stage of the study was calculated. Donor tissue included 60 [45.8%] whole globes and 71 [54.2%] preserved cut corneas. Cultures were positive in 92.2% [CI 95%; 89.8-98%] of specimens before enucleation, 7.6% [CI 95%, 2.1-12.1] after decontamination, and only in 3.1% [CI 95%: 0.1- 6%] before transplantation. There was no case of postkeratoplasty endophthalmitis. Staphylococcus epidermidis was the most frequent organism found before enucleation [32.1%] and after decontamination [3.05%]. There was no correlation between frequency of contamination and cause of death, preservation time, and death to enucleation time. Fungal contamination was found only in one specimen. The decontamination process of the eye bank of the I.R. of Iran seems to be effective. Endophthalmitis following penetrating keratoplasty is rare under standard operating room and eye bank methods. Staphylococcus epidermidis is the most frequent organism, cultured from eye bank specimens