Outcome of optical penetrating keratoplasties at a tertiary care eye institute in Western India.

Aim: To study the indications, risk factors, postoperative course, and long-term survival of corneal transplants done for optical purposes. Design: Retrospective case series. Materials and Methods: Data were obtained by reviewing the records of 181 patients operated at our institute (H.V. Desai Eye Hospital) between October 2005 and October 2007 for optical penetrating keratoplasty. Patients with less than one year of follow up, pediatric cases, therapeutic, tectonic, and lamellar keratoplasties were excluded. Kaplan Meier survival analysis was used to calculate median survival time of grafts and to see correlation between nine variables viz. age, gender, corneal vascularization, previous failed grafts, previous Herpes Simplex keratitis, post-perforation corneal scars, donor tissue quality, graft size, type of surgery and follow-up. These variables were also used for univariate and multivariate analysis using Cox Proportional Hazard Regression Modeling. Results: Median survival of the cohort was 27 months (95% confidence interval: 20.47-33.52). One- and two-year survival rates were 65% and 52.5%, respectively. Median survival was significantly lower in poor prognosis cases (14 months) than good prognosis cases (27 months, P = 0.0405). Graft survival was lower in vascularized corneas (18.55 months, P = 0.030) and in post-perforation corneal scars (17.96 months, P = 0.09, borderline significance). Multivariate analysis showed that the same factors were predictive of graft failure. Conclusion: Long-term survival of grafts at our center is different from centers in western world. More high-risk cases, paucity of excellent quality donor corneas, and differences in patient profile could be the contributory factors.

Longevity and failure analysis of fixed restorations serviced in Korea / 대한치과보철학회지

STATEMENT OF PROBLEM: Every effort has been continually made to obtain objectivity in measuring the longevity of fixed restorations, such as by establishing unified judgement standard for deciding success and adopting statistical method that analyzes the data of successful and failed cases at the same time. In Korea, however, desired level of development has not to be made in this field yet. PURPOSE: This study, adopting California Dental Association (CDA) quality evaluation system, established objective standard for deciding success, and inferred the longevity of fixed restorations and their failure analysis through adopting Kaplan-Meier survival analysis. Material and method. In order to assess the longevity of fixed restorations serviced in Korea and causes of failure, a total of 1109 individuals (aged 15-74, 716 women and 393 men loaded with 2551 unit fixed restorations, and 1934 abutments) who lived in Kyung-In Province were examined and the findings were as follows: RESULTS: 1. Length of service of fixed restorations serviced in Korea was 6.86+/-0.15 yr (mean), 5.5 yr (median), and the rate of success was 65.82% in 5 year survival, and 21.15% in 10 year survival. 2. When there was patient's need for replacing old prosthetics, longevity of fixed restorations was 7.51+/-0.27 yr (mean), 7 yr (median), and the rate of success was 61.08% in 5 year survival, and 17.57% in 10 year survival. 3. Longevity of fixed restorations was longest in the over-sixty age group(9.21+/- 0.66) and that of the teen age group(3.39+/-0.28) was shortest (p0.05). 9. Longevity of fixed restorations made of non precious metal was longest (9.60+/-0.40 yr), semi precious and precious trailing behind(p0.05). 11. Longevity of fixed restorations was longest in the centric interference group(9.35+/-0.62) (p<0.05) among different types of occlusal interference. CONCLUSION: We found that longevity of fixed restorations serviced in Korea is affected by age, gender and type of material, and that most frequent cause of failure is defective margin. In order to assess the accurate longevity of fixed restorations, unified research design, overcoming inter-observer difference and establishing the objective research items are needed. Furthermore, it is thought that prospective approach through thorough study and regular follow-ups is needed just from the start of research. Nationwide detailed studies on length of service of fixed restorations manufactured in Korea are hoped to be conducted hereafter.

Comparison of Short-term Surgical Outcomes of Ahmed Glaucoma Valve Implant between 96 mm2 and 184 mm2 of the Surface Area

PURPOSE: To compare the short-term surgical outcomes of Ahmed glaucoma valve implant with a surface area between 96 mm2 and 184 mm2. METHODS: The outcomes of thirteen eyes of 13 patients with refractory glaucoma who had undergone 96 mm2-sized Ahmed glaucoma valve implantation were compared with those of 13 eyes of 13 patients with 184 mm2-sized Ahmed glaucoma valve implantation. RESULTS: Average age and preoperative intraocular pressure (IOP) were statistically indistinguishable between the two groups (p=0.54 and 0.40, respectively). Average follow-up period and final IOP were also statistically similar (p=0.15 and 1.00, respectively). Comparing the overall IOPs and the numbers of antiglaucoma medications, the IOP of postoperative day 1 with the 184 mm2-group was only relatively lower (p=0.07). The 2-year success rates were 18.0% for the 96 mm2-group and 69.2% for the 184 mm2-group (Ed-there is no respective comparison here) with Kaplan-Meier survival analysis (p=0.0018). The rates of complications and re-operation were similar between the two groups. CONCLUSIONS: The average postoperative IOPs were not statistically different between the two groups. However, the success rate was better in the 184 mm2-group than in the 96 mm2-group.

Clinical Experience with the Ahmed Glaucoma Valve

The purpose of this study is to assess clinical outcomes of the patients who underwent Ahmed glaucoma valve implantation. Twelve eyes of 11 patients underwent Ahmed valve implantation for intractable glaucoma unresponsive to conventional management from March 1997 to April 1998 at department of ophthalmology of Kangbuk Samsung Hospital and had minimum follow-up of three months. Success(survival)was defined as an intraocular pressure(IOP)between 6 and 21 mmHg and with no additional glaucoma surgery, phthisis, implant removal, or loss of light perception. The mean follow-up period was 8 months(range, 3-17 months). There were 7 neovascular glaucomas, 3 secondary angle close glaucomas and 2 juvenile open angle glaucomas. The postoperative 1 year cumulative survival rate (Kaplan-Meier survival analysis)was 83. 3%. High survival rate was shown in secondary angle close glaucoma and JOAG(100%). The survival rate was not affected by sex, age, preoperative IOP, preoperative diagnosis, or number of preoperative glaucoma medications. There was failure in 2 eyes. One eye had qualified success by secondary Ahmed valve implantation. In the other eye, the tube in anterior chamber was too short and was plugged by blood clot and inflammatory membrane. This patient could not be reoperated due to poor general condition. Complications were hyphema and hypotony, and they were well controlled. Ahmed valve implantation in patients with intractable glaucoma may offer a better chance of surgical success.