Manual Preparation of Donor Lenticule Using Artificial Anterior Chamber for Descemet's Membrane Stripping Endothelial Keratoplasty

PURPOSE: To report a patient with a pseudophakic bullous keratopathy (PBK) who underwent Descemet's membrane stripping endothelial keratoplasty (DSEK) with manual preparation of the donor corneal graft.CASE SUMMARY: A 61-year-old female presented with visual disturbance in her right eye. Five months prior, she was treated with phacoemulsification and intraocular lens exchange surgery of the right eye, and a very severe corneal edema was revealed by slit-lamp examination. We diagnosed PBK and planned DSEK with manual preparation of a donor corneal graft because of the non-availability of a microkeratome or a femtosecond laser. After making the corneal graft using an artificial anterior chamber, crescent knife and cornea dissector, the keratoplasty proceeded using the graft. Three months after surgery, her graft was well-maintained on the right eye. The patient's visual acuity was 0.3, and the corneal endothelial cell count was 1,844/mm².CONCLUSIONS: Manual preparation of the donor corneal graft for DSEK is suitable as a second choice treatment method when the availability of surgical devices is limited.

Non-glaucomatous Retinal Nerve Fiber Layer Defect Associated with Paravascular Inner Retinal Defect

PURPOSE: To report a case of non-glaucomatous retinal nerve fiber layer (RNFL) defect associated with paravascular inner retinal defect (PIRD) in a patient with idiopathic epiretinal membrane (ERM).CASE SUMMARY: A 70-year-old male who was diagnosed with ERM in his right eye and pseudoexfoliative glaucoma in his left eye visited our clinic. His intraocular pressure was 14 mmHg in both eyes while using topical hypotensive medications in both eyes. His right eye showed no glaucomatous change of the optic disc head, and also no glaucomatous visual field defect on standard automated perimetry. Red-free fundus photography and swept-source optical coherence tomography showed an ERM and wedge-shaped RNFL defect starting from the PIRD, not the optic disc head. He was diagnosed with non-glaucomatous RNFL defect in the right eye and was told to stop using topical hypotensive medication for the right eye. After 2 years of discontinuing the medication, the IOP was within the normal range, the RNFL defect showed no progression, and the visual field remained stationary.CONCLUSIONS: A non-glaucomatous RNFL defect can develop in association with PIRD in patients with idiopathic ERM. Examinations for PIRD as well as evaluation of the optic disc head are therefore necessary in patients with ERM and RNFL defect.

Clinical Features and Surgical Outcomes of Primary Rhegmatogenous Retinal Detachment according to Age

PURPOSE: To investigate the clinical features and surgical outcomes of rhegmatogenous retinal detachment (RRD) requiring surgery according to age. METHODS: Medical records of patients who underwent surgery for primary RRD between January 2008 and March 2016 were reviewed retrospectively. Patients were classified into two groups according to age at diagnosis: the under-40 group and the over-40 group. The two groups were compared in terms of demographic features, ocular manifestation, operating methods, primary anatomical success rate, and visual outcome. RESULTS: One hundred and forty-four eyes from 144 patients were included. Mean subject age was 48.6 ± 16.9 years old. The under-40 group involved 42 eyes from 42 patients, and the over-40 group included 102 eyes from 102 patients. Symptom duration was shorter in the under-40 group compared to the over-40 group (7.6 ± 10.7 days vs. 14.5 ± 24.4 days; p = 0.029). Proliferative vitreoretinopathy (PVR) occurred more frequently in the under-40 group (40.0% vs. 17.4%, p = 0.007) than in the over-40 group. The anatomical success rate of primary surgery was significantly different between the two groups; 78.6% in the under-40 group and 91.2% in the over-40 group (p = 0.038). Preoperative PVR increased the rate of anatomical failure (40.0% vs. 6.2%, p < 0.001). The visual outcomes were not significantly different between the two groups. CONCLUSIONS: RRD is combined with PVR more frequently in young patients than in old patients, which increases the failure rate of primary re-attachment surgery.