Long-term outcomes of therapeutic corneal transplants performed in a tertiary eye care hospital in South India

Purpose: This study aimed to review the demographics, clinical characteristics, and long?term outcomes of therapeutic penetrating keratoplasty (TPK) performed in a tertiary eye care hospital. Methods: Case records of 149 therapeutic transplants (135 patients) that were performed during the calendar year 2016 were retrospectively analyzed, and outcomes were measured until 3 years of follow?up. Information on demographics, presentation characteristics, keratoplasty indications, offending microbe, and secondary surgical interventions was studied. The final outcome was classified in terms of therapeutic, anatomical, and functional outcomes. Results: The median age of the recipients was 55 years with 61% men. The most common indications for TPK were perforated infectious ulcer (45.9%), nonhealing ulcers (29.9%), and graft infections (17.4%). Fungal etiology was noted in 61.2% and bacterial etiology in 17.4% of the eyes. Therapeutic success was achieved in 130 eyes (89%) at the end of 1 month. Anatomical success was achieved in 130 (98.5%) and 88 patients (86.3%) at the end of 1 and 6 months, respectively. At the 6?month time point, 78 patients (76.5%) attained functional success with vision better than light perception. Three?year follow?up data were available for 23.7% of recipients, of which only 12 patients (37.5%) retained a clear graft either after a primary therapeutic or secondary optical keratoplasty. Conclusion: Therapeutic keratoplasty is highly effective in eradicating infection and providing anatomical integrity. However, timely intervention can aid in achieving the best functional outcome.

Pre-operative optical coherence tomography predictors: Do they hold any relevance in the era of inverted internal limiting membrane flap in large macular holes?

Purpose: To study the relevance of preoperative OCT predictors in large macular holes (MH) treated using the inverted ILM peel technique. Methods: Prospective study of 95 patients undergoing vitrectomy for large MH between January 2019 and December 2020 was performed by dividing the patients into groups depending on various quantitative parameters and indices of MH such as base diameter (BD), hole form factor (HFF), macular hole index (MHI), diameter hole index (DHI), and tractional hole index (THI) by using parameters such as minimal hole diameter, hole height, nasal and temporal arm lengths. Depending upon the duration of symptoms, patients were divided into three groups: <3 months, 3–6 months, and >6 months. Anatomical success rate, type of closure, and postoperative vision gain were analyzed in relation to the abovementioned diameters, indices, and duration to see if any significance existed. Results: The mean age of patients included in the study was 60.48 ± 13.88 years, with female preponderance (males: females = 37:58). Change in logMAR was statistically significant individually with all studied parameters (P < 0.0001) without influence of size of hole and other indices. BD and DHI levels showed significant association with type of closure as indicated by P values of 0.017 and 0.048, respectively. Duration of symptoms showed no significance in terms of anatomical and functional success. Conclusion: OCT predictors of MH success seem to have lost relevance with inverted flap surgeries as 100% anatomical success is achieved with this technique, with 95.78% (91/95) achieving type 1 closure with statistically significant equivalent functional gain across the indices with no effect of duration of symptoms.

Prognostic Factors of Anatomical Success in Scleral Buckling for High Myopic Rhegmatogenous Retinal Detachment

PURPOSE: To assess the prognostic factors associated with anatomical success of scleral buckle (SB) for rhegmatogenous retinal detachment (RRD) in high myopia patients. METHODS: The medical records of RRD in highly myopic eyes treated with SB from January 2009 to December 2013 were reviewed retrospectively. Cases with history of intraocular surgery including phacoemulsification and vitrectomy were excluded. Correlations between anatomical success and the parameters of age, sex, preoperative visual acuity, axial length, presence of large tear, presence of horseshoe tear, the number of tears, involved fovea, and extent of detachment were analyzed. RESULTS: This study included 80 eyes of 80 patients. Average age and axial length were 32.3 ± 13.4 and 26.753 ± 0.961 mm, respectively. Sixty-nine eyes (86.3%) were reattached following primary surgery. Univariate analysis revealed that age (p = 0.011), presence of large tear (p = 0.002), and presence of horseshoe tear (p = 0.044) were correlated with anatomical success after SB. Based on multivariate logistic regression analysis, age was the sole independent prognostic factor (odds ratio = 1.086, 95% confidence interval = 1.022~1.154, p = 0.004). CONCLUSIONS: A younger age is associated with a higher rate of primary anatomical success of SB for RRD in highly myopic eyes. In young, highly myopic patients with RRD, SB should be considered as the primary procedure.

Factor Influencing Anatomical Failure of Simple Rhegmatogenous Retinal Detachment

PURPOSE: This study analyzes the factors influencing anatomical failure of the primary operation for simple rhegmatogenous retinal detachment. METHODS: The patients in this study were diagnosed with simple rhegmatogenous retinal detachment and operated on by a single physician. The success group comprised 251 eyes and the failure group comprised 29 eyes. The factors analyzed between the two groups were the type of primary procedure, the type of retinal defect; the numbers of retinal defects; the extent of retinal detachment; the duration of retinal detachment; the existence of peripheral degeneration; carrying out of subretinal fluid drainage; the type of tamponade material used and the position of retinal defects. RESULTS: The anatomical success rate of the primary operation for simple rhegmatogenous retinal detachment was 89.64%. Patient sex, the type of tamponade material used and the position of the retinal defect showed significant differences between the success and failure groups. There was a higher percentage of male patients in the failure group than in success group (p=0.034). Silicone oil used as the tamponade material resulted in a greater chance of failure than success (p=0.017). Analysis of the position of the retinal defect showed that, defects distributed in the inferior retina or through multiple area led to a greater likelihood of anatomical failure (p=0.036). CONCLUSIONS: Due ti the greater possibility of anatomical failure of the primary operation when retinal defects are distributed in the inferior retina or through multiple area, clinicians should consider intensive treatment for such cases.

Intraoperative Use of Perfluo rocarbon Liquids in the Management of Proliferative Vitreoretinopathy

Perfluorocarbon liquids have been shown to be a useful intraoperative adjunct in managing complicated retinal detachment. To prove the effectiveness of intraoperative use of perfluorocarbon liquid and the improvement of surgical and functional outcomes, we retrospcetively evaluated the clinical results of the patients[13 eyes]who had retinal detachment complicated with proliferative vitreoretinopathy [over PVR Grade C4, C4 :7 eyes, C5 :6 eyes]. We performed standard 3-port pars plana vitrectomy in all eyes included in this study.Perfluorodecalin[DK-line]was used as a shortterm vitreous substitute intraoperatively and removed before the end of the surgery. The mean follow-up period was 15 months.Anatomical success rate was 86%[6 eyes]in Grade C4, 67%[4 eyes]in Grade C5, Visual acuity was over 5/200 in one eye[8%]and there was improvement in 5 eyes[40%] although it was below 5/200. Consequently, we could easily manage the retinal detachment with PVR with help of intraoperative perfluorocarbon liquid and could improve the postoperative surgical and visual outcomes.

Clinical Study for Anatomical Reattachment and Visual Outcome in Rhegmatogenous Retinal Detachment Treated with Scleral Buckling

We analyzed a total of 41 eyes with rhegmatogenous retinal detachment treated with scleral buckling to evaluate factors elated to anatomical and functional success rate. 22 patients (55 %) were wemen. The most common age group was third decade(27.5%). Among the associated ocular findings, the most common finding was high-degree myopia (14 eyes, 34.1%) and the next was lattice degeneration. The most common postoperative complication was temporary elevation of intraocular pressure (14 eyes, 34.1 %). The overall anatomical success rate was 87.8 % and functional success rate was 68.3%. Important factors related to anatomical and functional success were duration of retinal detachment(less than 1 month), location of tears(at or anterior to the equator) and the difference of intraocular pressure between affected and unaffected eyes(less than 10 mmHg). The macular status was highly related to the functional success. The sex, age , preoperative visual acutiy, preoperative refractive error and surgical method had no statistically significant relationship with success rate.

Intraoperative Perfluorophenanthrene Use in Complicated Retinal Detachment

23 eyes of 23 patients who underwent conventional vitreoretinal surgery with high specific gravity perfluorocarbon liquid, perfluorophenanthrene, for complicated retinal detachment were evaluated retrospectively. Preoperative vitreoretinal findings showed grade C2 PVR in 4 eyes and C3 in 1 eye and C4 in 10 eyes and C5 in 8 eyes. As a result, 17 eyes(74%) showed anatomical success, completely reattached in 15 eyes, partially reattached in 2 eyes, and 12 eyes(52%) showed functional success (corrected visual acuity 5/200 or better). Follow-up period was over 6 months in all cases. Postoperative complications includes keratopathy in 6 eyes, hypotony in 5 eyes, cataract in 2 eyes, transient vitreous hemorrhage in 1 eye, acute increased IOP in 1 eye, posterior synechiae in 1 eye, cystoid macular edema in 1 eye, and pupillary membrane in 1 eye. Consequently, perfluorophenanthrene can be used beneficially in yield of surgical field and mechanical stabilization of retina in complicated retinal detachment surgery.

Effect of Encircling Silicone Sponge for Retinal Detachment

120 eyes of 119 patients with retinal detachment were treated with an encircling silicone sponge scleral buckling in the department of Ophthalmolgy, Severance Hospital, Yonsei University Medical Center from September 1, 1988, to January 31, 1991. Results were as follow 107 eyes among 120 eyes (89.2%) showed anatomical success, and 54 eyes of them (45%) showed functional success. As the preoperative factors, the case of over 20/70 vision (100%, p>0.05, 100%, p0.05, 57%, p0.05,61%, p0.05, 54%, p<0.05) showed favorable anatomical and functional success rate. The presence and degree of the proliferative vitreoretinaopathy affected the anatomical and functional success rate, but the age of patients did not affect the success of surgery.