Résumé
Purpose@#To evaluate the effectiveness of an instrument devised for slit-lamp examination of donor corneas suspended in preservation medium. @*Methods@#The study examined two donor corneas received at Yeouido St. Mary's Hospital in February 2023 and March 2023. The instrument has three main components: a plastic holder to hold the preservation medium bottle, a cube with a mirror for reflecting the slit beam, and a stand to attach the device to the slit-lamp. Using the instrument, the donor corneas were examined via slit-lamp: microscopy with the endothelium facing upward and downward. Specular microscopy and anterior segment optical coherence tomography (OCT) were also performed on the preserved donor corneas. @*Results@#Slit-lamp examination of donor corneas in preservation medium using the instrument showed overall corneal buttoning and optical sections of the donor cornea. Using specular reflection and retroillumination, the endothelial layer was partially visible. However, specular microscopy and anterior segment OCT could not examine the donor cornea in preservation medium using the instrument. @*Conclusions@#The devised instrument facilitates slit-lamp examination of donor corneas in preservation medium, enabling a qualitative assessment of donor corneas before corneal transplantation surgery.
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Purpose@#This study investigated the causative microorganisms, antibiotic susceptibility, and risk factors of infectious keratitis over the past 10 years. @*Methods@#Data from patients with infectious keratitis who underwent microbial culture tests from 2012 to 2021, obtained from anonymized data systems, were analyzed. Microbial culture results and antibiotic susceptibility profiles were examined. A retrospective analysis of the medical records of patients with infectious keratitis during the same period was conducted to investigate the clinical characteristics and risk factors. @*Results@#Data from 1,837 cases of infectious keratitis were extracted from anonymized records. The culture positive rate among patients was 46.0% (1,137/2,474), with coagulase-negative Staphylococcus (CoNS) being the most common causative organism (27.8%). Increased resistance to cefazolin and cefotaxime was observed in gram-negative bacteria, while there were no significant temporal changes in quinolone resistance in gram-positive or negative bacteria. A retrospective medical record analysis of 288 cases revealed that older patients, as well as those with an initial corrected visual acuity < 0.1, a history of ocular surgery, pre-existing ocular conditions, prior steroid eye drops, or glaucoma eye drops, had significantly higher rates of culture positivity. Multivariate analysis identified risk factors for severe keratitis requiring surgical intervention as a symptom-to-presentation period of 7 days or longer (p = 0.048) and pre-existing ocular conditions (p = 0.040). @*Conclusions@#CoNS was the most common microorganism causing infectious keratitis over the past decade. There has been an increase in resistance to cephalosporin antibiotics among gram-negative bacteria. Patients with pre-existing ocular conditions may require surgical intervention, so infectious keratitis in these patients requires greater attention.
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Purpose@#We evaluated a novel surgical technique for managing the intraocular lens (IOL) through in situ scleral fixation and its outcomes.Case summary: This retrospective case series included three eyes of three patients treated with the in situ scleral fixation technique for IOL. Our method involves suturing the haptics of an already intraocularly injected IOL in situ using a Siepser sliding knot suture, while the other haptic is tied externally. Notably, no intraoperative or postoperative complications, such as cystoid macula edema, were observed. @*Conclusions@#This novel technique is a user-friendly and effective approach to improve IOL-capsular bag stability, requiring minimal intraocular intervention or preoperative preparation compared to conventional IOL scleral fixation methods. Furthermore, it is particularly effective for addressing concerns related to IOL-capsular bag stability following IOL insertion, as it eliminates the possibility of performing the typical IOL scleral fixation due to the absence of preoperative preparation and evaluation.
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Purpose@#In the present study, we introduce human lacrimal gland imaging using an ultrasound biomicroscopy (UBM) with a soft cover and show their findings @*Methods@#The representative UBM findings of palpebral lobes in seven subjects (four with non-Sjögren dry eye syndrome, one with Sjögren syndrome, and two healthy subjects) were described in this study. To prolapse the palpebral lobe, the examiner pulled the temporal part of the upper eyelid in the superotemporal direction and directed the subject to look in the inferonasal direction. We scanned the palpebral lobes longitudinally and transversely using UBM. We used an Aviso UBM with a 50 MHz linear probe and ClearScan. @*Results@#In UBM of two healthy subjects, the echogenicity of the lacrimal gland was lower than that of the sclera and homogeneous. But the parenchyma of a patient with Sjögren dry eye syndrome was quite inhomogeneous compared to the healthy subjects. In two patients with dry eye syndrome, we were able to observe some lobules in the parenchyma. We could find excretory ducts running parallel at the surface of the longitudinal section in some subjects. In the longitudinal UBM scan of a subject, we observed a tubular structure at a depth of 1,500 μm that was considered a blood vessel. It ran from the superonasal to the inferotemporal direction. In a subject, we observed a large cyst beneath the conjunctiva. @*Conclusions@#Lacrimal gland imaging using UBM has both advantages of optical coherence tomography and sonography, and could be useful for evaluating dry eye syndrome.
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Purpose@#To analyze trends in corneal transplantation surgery and determine the number of domestic and imported corneal grafts used in South Korea.Method: The total number of keratoplasties and number of each individual surgical procedure conducted in 2010 and 2020 were identified using Health Insurance Review and Assessment Service data. The number of keratoplasties using domestic corneas in 2010 and 2020 was determined from the annual report of the Korean Network for Organ Sharing (KONOS). The number of keratoplasties using imported corneas was calculated by subtracting the number of keratoplasties using domestic corneas from the total number of keratoplasties. @*Results@#In 2010, 802 keratoplasties were performed in Korea, of which 299 (37.3%) used imported corneas; 715 (89.2%) were penetrating keratoplasties and 87 (10.8%) were anterior lamellar keratoplasties. In 2020, 911 keratoplasties were done in Korea and 564 (61.9%) used imported corneas; 541 (59.4%) were penetrating keratoplasties, 60 (6.6%) were anterior lamellar keratoplasties, and 310 (34.0%) were endothelial keratoplasties. From 2010 to 2020, the number of penetrating keratoplasties in Korea decreased, while the numbers of endothelial keratoplasties and keratoplasties using imported corneas increased. @*Conclusions@#There was a 30% decrease in the number of penetrating keratoplasties from 2010 to 2020, and a 30% increase in the numbers of endothelial keratoplasties and keratoplasties using imported corneas. The proportions of endothelial keratoplasties and imported corneas have increased steadily in Korea over the last 10 years.
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Purpose@#To introduce an intuitive method for measuring conjunctival microvascular blood flow velocity by imaging bulbar conjunctival microvessels using a slit-lamp biomicroscope equipped with a zoom lens and an ultra-high-speed camera. @*Methods@#After obtaining consent from 10 patients (1 male, 9 females) who visited Yeouido St. Mary’s Hospital from August 21, 2020, to June 12, 2021, the patients were examined under a slit lamp microscope equipped with an ultra-high-speed camera and zoom lens. The blood flow in the conjunctival microvessels was photographed. The captured images were analyzed with ImageJ software to measure the blood flow velocity in the conjunctival microvessels, and we investigated whether the blood flow velocity correlated with the vessel diameter and age. @*Results@#The median age of the subjects was 49.0 years. The mean conjunctival blood flow velocity in 53 microvessels was 0.786 ± 0.468 mm/s. The median conjunctival microvascular diameter was 7.06 μm (interquartile range 5.84 to 9.23 μm). The conjunctival microvascular diameter and blood flow velocity were not significantly correlated (Spearman’s p = 0.177), and the subjects’ age and conjunctival microvascular blood flow velocity were also not correlated (Spearman’s p = 0.669). @*Conclusions@#In this study, the blood flow velocity in the bulbar conjunctival microvessels could be measured easily by means of image analysis using a slit-lamp microscope equipped with an ultra-high-speed camera with a zoom lens.
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Purpose@#To assess the refractive changes and stability after cataract surgery with insertion of three different intraocular lenses in axial myopes. @*Methods@#A retrospective analysis was performed with 44 eyes of normal axial length (22.0 mm < axial length ≤ 24.5 mm) and 49 eyes of long axial length (24.5 mm < axial length) in patients who underwent phacoemulsification and posterior chamber lens insertion. Automated keratometry examination and refraction were performed using an autorefractor keratometer; A-scan ultrasound was used to calculate target refraction. One-piece intraocular lenses (IOLs) and three-piece IOLs were inserted. At 2 and 12 months postoperatively, refraction differences relative to the target refraction (calculated using the SRK-T formula) were analyzed. The refractive changes between 2 and 12 months postoperatively were compared according to the IOL. @*Results@#Myopic shift from the target refraction was observed with eyes of long axial length, compared with eyes of normal axial length, at 2 and 12 months postoperatively (p = 0.003, p = 0.013). For refractive stability according to IOL, there was no significant difference in eyes with normal axial length; in eyes with long axial length, three-piece IOLs showed significant refractive stability (p < 0.05). @*Conclusions@#In eyes with long axial length, there was a significant difference in postoperative refractive stability according to the inserted IOL; three-piece IOLs showed significant refractive stability compared with one-piece IOLs.
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Purpose@#To report two cases of keratoconjunctivitis induced by gingko nut contact.Case summary: These cases report two old patients with severe keratoconjunctivitis who had recently touched ginkgo nuts and then the periorbital area and eyes. In both patients, slit lamp examination found severe chemosis and corneal edema with moderate Descemet membrane folding. Specular microscopy showed diffuse damage of endothelial cells in acute stage of the disease. The patients were treated with oral and topical steroid and antihistamine over two weeks and showed slow recovery. @*Conclusions@#Contact with ginkgo nut can induce severe keratoconjunctivitis to the periorbital area. Special caution is recommended when after contacting ginkgo nuts.
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Purpose@#We report seven cases of first occurrence of dendritic keratitis associated with contact lens wear without previous keratitis history, based on a literature review. Those cases were finally diagnosed and treated as herpes virus keratitis. @*Methods@#Among patients who visited the ophthalmology outpatient clinic over two years, patients with dendritic corneal lesions associated with contact lens wear were included. Authors performed the diagnosis, treatment and the clinical follow up. @*Results@#Seven Patients with dendritic corneal lesions after wearing contact lens were diagnosed by history taking, clinical findings and molecular biological methods and were observed over the course of treatment. @*Conclusions@#For patients with dendritic keratitis after wearing contact lenses, there is a possibility of herpes keratitis rather than the common lesions associated with non-infectious corneal infiltration or keratitis caused by bacteria and fungus. It is necessary to observe those eyes thoroughly in respect to the exact past history taking, diagnosis by molecular-biological method as well as clinical features and the response to empirical antiviral agents.
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Purpose@#To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. @*Conclusions@#Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.
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Purpose@#To report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK.Case summary: A 47-year-old female underwent primary DMEK in her left eye with a diagnosis of Fuchs’ endothelial dystrophy. At 6 weeks later, corneal stromal edema with epithelial and subepithelial bullae was first observed. From that point on, the condition of the cornea and the visual acuity continued to degrade. After 7 months, a second DMEK procedure (i.e., a repeat DMEK) for graft failure was performed successfully without any complications. Since the second procedure, the cornea has been clear, and the best-corrected visual acuity has remained at 0.6 for 8 months. @*Conclusions@#To manage graft failure after primary DMEK, we performed a second DMEK procedure. The removal of the previous graft was easy, and there were no complications. Thus, repeat DMEK may be a feasible procedure.
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Purpose@#To compare the stability of intraocular lens (IOL) insertion methods of sutured haptics in the bag with scleral fixation to those of in the bag insertion and scleral sulcus fixation. @*Methods@#In group of only phacodonesis, two IOL insertion methods, in the bag insertion and sutured haptics in the bag with scleral fixation were compared. In group of phacodonesis with less than 90° zonulysis, two IOL insertion methods, sutured haptics in the bag with scleral fixation and scleral sulcus fixation were compared. Postoperative 2 months and 12 months refraction were compared with target refraction and the refractive change between postoperative 2 and 12 months were compared in each group. The change of anterior chamber depth (ACD) at postoperative 2 and 12 months were compared with preoperative ACD, and the change of ACD between postoperative 2 and 12 months were compared in each group. @*Results@#In group of only phacodonesis, the typical in the bag insertion group showed significant ACD change between postoperative 2 and 12 months (p = 0.010), but the group of sutured haptics in the bag with scleral fixation didn’t show the significant ACD change (p = 0.515). In group of phacodonesis with less than 90° zonulysis, the sulcus scleral fixation method showed significant ACD change and significant refractive change (p = 0.015, p = 0.004), but the group of sutured haptics in the bag with scleral fixation method didn’t show the significant ACD nor refractive change (p = 0.713, p = 0.106) between postoperative 2 and 12 months. @*Conclusions@#In eyes with zonular instability, sutured haptics in the bag with scleral fixation method can promote the postoperative stability of IOL.
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Purpose@#To report two cases of keratoconjunctivitis induced by gingko nut contact.Case summary: These cases report two old patients with severe keratoconjunctivitis who had recently touched ginkgo nuts and then the periorbital area and eyes. In both patients, slit lamp examination found severe chemosis and corneal edema with moderate Descemet membrane folding. Specular microscopy showed diffuse damage of endothelial cells in acute stage of the disease. The patients were treated with oral and topical steroid and antihistamine over two weeks and showed slow recovery. @*Conclusions@#Contact with ginkgo nut can induce severe keratoconjunctivitis to the periorbital area. Special caution is recommended when after contacting ginkgo nuts.
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Purpose@#We report seven cases of first occurrence of dendritic keratitis associated with contact lens wear without previous keratitis history, based on a literature review. Those cases were finally diagnosed and treated as herpes virus keratitis. @*Methods@#Among patients who visited the ophthalmology outpatient clinic over two years, patients with dendritic corneal lesions associated with contact lens wear were included. Authors performed the diagnosis, treatment and the clinical follow up. @*Results@#Seven Patients with dendritic corneal lesions after wearing contact lens were diagnosed by history taking, clinical findings and molecular biological methods and were observed over the course of treatment. @*Conclusions@#For patients with dendritic keratitis after wearing contact lenses, there is a possibility of herpes keratitis rather than the common lesions associated with non-infectious corneal infiltration or keratitis caused by bacteria and fungus. It is necessary to observe those eyes thoroughly in respect to the exact past history taking, diagnosis by molecular-biological method as well as clinical features and the response to empirical antiviral agents.
Résumé
Purpose@#To report a case of a successful secondary Descemet membrane endothelial keratoplasty in failed penetrating keratoplasty. Case summary: A 46-year-old male with keratoconus in both of his eyes underwent penetrating keratoplasty in his right eye 30 years ago and in his left eye 14 years ago. From one and a half year ago, the patient’s visual acuity decreased in his left eye due to graft failure. For treatment, secondary Descemet membrane endothelial keratoplasty was performed. Partial detachment of Descemet membrane was observed at 13 days after the operation, and an additional air injection was performed. At 8 months after the operation, the patient’s uncorrected visual acuity improved to 0.5 and the cornea maintained its clearance without rejection. @*Conclusions@#Secondary Descemet membrane endothelial keratoplasty was successfully performed in a patient with failed penetrating keratoplasty.
Résumé
Purpose@#To report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) for graft failure after primary DMEK.Case summary: A 47-year-old female underwent primary DMEK in her left eye with a diagnosis of Fuchs’ endothelial dystrophy. At 6 weeks later, corneal stromal edema with epithelial and subepithelial bullae was first observed. From that point on, the condition of the cornea and the visual acuity continued to degrade. After 7 months, a second DMEK procedure (i.e., a repeat DMEK) for graft failure was performed successfully without any complications. Since the second procedure, the cornea has been clear, and the best-corrected visual acuity has remained at 0.6 for 8 months. @*Conclusions@#To manage graft failure after primary DMEK, we performed a second DMEK procedure. The removal of the previous graft was easy, and there were no complications. Thus, repeat DMEK may be a feasible procedure.
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Purpose@#To compare the stability of intraocular lens (IOL) insertion methods of sutured haptics in the bag with scleral fixation to those of in the bag insertion and scleral sulcus fixation. @*Methods@#In group of only phacodonesis, two IOL insertion methods, in the bag insertion and sutured haptics in the bag with scleral fixation were compared. In group of phacodonesis with less than 90° zonulysis, two IOL insertion methods, sutured haptics in the bag with scleral fixation and scleral sulcus fixation were compared. Postoperative 2 months and 12 months refraction were compared with target refraction and the refractive change between postoperative 2 and 12 months were compared in each group. The change of anterior chamber depth (ACD) at postoperative 2 and 12 months were compared with preoperative ACD, and the change of ACD between postoperative 2 and 12 months were compared in each group. @*Results@#In group of only phacodonesis, the typical in the bag insertion group showed significant ACD change between postoperative 2 and 12 months (p = 0.010), but the group of sutured haptics in the bag with scleral fixation didn’t show the significant ACD change (p = 0.515). In group of phacodonesis with less than 90° zonulysis, the sulcus scleral fixation method showed significant ACD change and significant refractive change (p = 0.015, p = 0.004), but the group of sutured haptics in the bag with scleral fixation method didn’t show the significant ACD nor refractive change (p = 0.713, p = 0.106) between postoperative 2 and 12 months. @*Conclusions@#In eyes with zonular instability, sutured haptics in the bag with scleral fixation method can promote the postoperative stability of IOL.
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Purpose@#We report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) to treat graft failure after Descemet stripping endothelial keratoplasty (DSEK).Case summary: A 66-year-old female underwent DSEK of her right eye to treat pseudophakic bullous keratopathy that developed after cataract surgery and intraocular lens exchange. After 5 years, she complained of decreased vision; graft failure was observed. Secondary DMEK was performed; no additional air injection was needed. The corrected visual acuity was 0.2, 3 months after surgery, and the cornea became clear. @*Conclusions@#Visual recovery can be achieved by performing secondary DMEK after primary DSEK graft failure.
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Purpose@#We report a case of secondary Descemet membrane endothelial keratoplasty (DMEK) to treat graft failure after Descemet stripping endothelial keratoplasty (DSEK).Case summary: A 66-year-old female underwent DSEK of her right eye to treat pseudophakic bullous keratopathy that developed after cataract surgery and intraocular lens exchange. After 5 years, she complained of decreased vision; graft failure was observed. Secondary DMEK was performed; no additional air injection was needed. The corrected visual acuity was 0.2, 3 months after surgery, and the cornea became clear. @*Conclusions@#Visual recovery can be achieved by performing secondary DMEK after primary DSEK graft failure.
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PURPOSE: We report a case of herpes simplex keratitis after Descemet membrane endothelial keratoplasty (DMEK). CASE SUMMARY: A 67-year-old male underwent DMEK in his left eye due to pseudophakic bullous keratopathy. One week after DMEK, re-bubbling was performed due to partial detachment of Descemet's membrane at the corneal periphery. After re-bubbling, the cornea remained clear and the patient's visual acuity gradually improved. Two months after DMEK, the patient presented with mild discomfort and decreased visual acuity. The cornea showed an irregular, narrow dendrite with an epithelial defect and surrounding opacity. After confirming that Descemet's membrane was attached, the patient was started on oral valacyclovir for suspected herpes keratitis. Herpes simplex virus type 1 was eventually identified by polymerase chain reaction. The corneal lesion resolved after three weeks of antiviral treatment. CONCLUSIONS: Similar to penetrating keratoplasty, DMEK can trigger outbreaks of herpes simplex keratitis. Herpes simplex keratitis should remain on the clinician's differential diagnosis for patients who present with a corneal epithelial irregularity and decreased visual acuity following DMEK.