Ocular surface rehabilitation Application of human amniotic membrane in high-risk penetrating keratoplasties

Human amniotic membrane is a versatile tool for management of ocular surface disorders. This study evaluates the effect of cryopreserved human amniotic membrane [hAM] on one-year survival of penetrating keratoplasties [PKP] in high-risk recipients. This is a retrospective noncomparative cohort study of 58 consecutive eyes undergoing PKP with concurrent placement of a self-retained cryopreserved hAM [PROKERA®] at a tertiary care center from January 2009 to July 2010. Mean patient age was 66.7 +/- 17.2 years and 30 [54%] were males. 51 eyes were pseudophakic and one aphakic. 27 eyes were glaucomatous; 24 had glaucoma drainage device and 2 had previous endocyclophotocoagulation. 12 patients had PKP for the first time and 46 had repeat PKP [average number of prior PKP = 1.63 +/- 1.1, range: 1-5]. Risk factors for graft failure included repeat PKP [79.3%], corneal neovascularization [51.7%], preexisting glaucoma [46.6%], and presence of anterior synechiae [37.9%]. Both First Transplant and Repeat Transplant groups had similar survival rates until 6 months after transplant [75% vs 74%, odds ratio = 1.06, p = 1.00]. At 12 months, First Transplant group showed a better survival rate [67% vs 43%, odds ratio = 2.60, p = 0.20]. Eyes with >3 risk factors had a higher graft failure rate [odds ratio = 5.81, p = 0.003]. Survey of the literature suggests that high-risk PKP with concurrent hAM placement demonstrate comparable graft survival. Presence of multiple risk factors is associated with poor survival

Prosthetic Replacement of the Ocular Surface Ecosystem [PROSE] scleral lens for Salzmann's nodular degeneration

To evaluate the use of Prosthetic Replacement of the Ocular Surface Ecosystem [PROSE] scleral lens treatment as an alternative to keratectomy in patients with symptomatic Salzmann's nodular degeneration [SND]. A retrospective chart review from July 2009 to May 2013 identified 9 SND patients who were referred for PROSE evaluation. Patients who did not complete PROSE fitting or had other corneal comorbidities affecting vision were excluded from the study, and 7 eyes of 4 patients were included. Three patients were pseudophakic and 1 patient was phakic, and the lens status of our cohort did not change during the study. Visual acuity improved from 0.19 +/- 0.084 logMAR [approximately 20/31] pre PROSE to 0.028 +/- 0.047 logMAR [approximately 20/21] post PROSE in patients with Salzmann's nodular degeneration [p = 0.002] OSDI scores improved from 46.9 +/- 26.6 pre PROSE to 21.5 +/- 18.7 post PROSE in the same cohort [p = 0.02]. The results of this study show that PROSE can provide improvements in visual acuity and function in patients with Salzmann's nodular degeneration and offer an alternative to superficial keratectomy

Descemet stripping with automated endothelial keratoplasty: a comparative study of outcome in patients with preexisting glaucoma

To compare postoperative complications after Descemet stripping with automated endothelial keratoplasty [DSAEK] in patients with and without glaucoma. For this retrospective study a series of 298 DSAEK cases performed at the Doheny Eye Institute were taken, we compared postoperative complications in eyes with glaucoma on medication [55] or with previous glaucoma surgeries [64] with a time-matched group of all other DSAEK cases [179, control]. With a mean follow-up of 1.85 +/- 1.12 years, the complication rates were 12.8%, 11.1%, and 26.8% for postoperative graft detachment, graft failure, and IOP elevation, respectively. Graft detachment was an independent risk factor for graft failure [odds ratio OR = 12.35, 95% confidence interval CI [5.46-27.90], P < 0.001]. Graft detachment was not associated with either history of glaucoma or glaucoma surgery [P > 0.05]. Glaucoma on medication had no increased risks of graft failure compared to normal eyes [P = 0.38]. However, increased risk of failure was seen in eyes with prior incisional glaucoma surgeries [OR = 4.26, 95% CI [1.87-9.71], P < 0.001]. Medically managed glaucoma has increased risks of postoperative IOP elevation [OR = 2.39, 95% CI [1.25-4.57], P = 0.013], whereas surgically managed glaucoma has no significant elevation [P = 0.23]. Elevation of IOP was not significantly correlated with graft failure [P = 0.21]. DSAEK is the preferred treatment for corneal endothelial dystrophy. We observed that having glaucoma or glaucoma surgery is not associated with graft detachment. A history of glaucoma surgery and postoperative graft detachment appeared to be important risk factors for graft failure. And more studies are indicated to study long-term IOP evolution in post-DSAEK patients and its association with graft survival