ABSTRACT
PURPOSE OF REVIEW: Endothelial keratoplasty has evolved tremendously since its inception. Thick Descemet stripping automated endothelial keratoplasty (DSAEK) grafts have made sway for slimmer ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK). This review discusses the recent literature comparing outcomes of UT-DSAEK, DSAEK, and Descemet membrane endothelial keratoplasty (DMEK). RECENT FINDINGS: DMEK provides quick visual recovery and has remarkably low incidence of graft rejection. However, the learning curve is long compared to DSAEK. UT-DSAEK utilizes donor grafts less than 100-µm thick. Recent studies comparing DMEK and UT-DSAEK have shown DMEK has better visual outcomes with similar rejection rates. SUMMARY: UT-DSAEK remains an excellent surgical option for endothelial keratoplasty in eyes with complex anterior segment anatomy. The visual outcomes after UT-DSAEK have been shown to be superior when compared with DSAEK. Recent studies show that DMEK provides better visual outcomes compared with UT-DSAEK.
Subject(s)
Corneal Diseases/surgery , Descemet Stripping Endothelial Keratoplasty/methods , Corneal Diseases/physiopathology , Descemet Membrane/pathology , Endothelium, Corneal/pathology , Humans , Visual Acuity/physiologyABSTRACT
PURPOSE: To analyze the risk factors, clinical characteristics, management, and treatment outcomes of culture-proven cases of Moraxella keratitis at our center. DESIGN: Retrospective observational case series. METHODS: Thirty-nine culture-proven cases of Moraxella keratitis (39 eyes) diagnosed and treated between January 2003 and April 2018 at the University of Pittsburgh Medical Center were identified and retrospectively reviewed for ocular and systemic risk factors, treatment modalities, and outcomes, as well as for antimicrobial sensitivity and resistance data. RESULTS: The mean age of the 39 patients was 63.0 (range 4-95 years) with median follow-up time of 170 days. Thirty-four of 39 patients (87.2%) had an ocular risk factor, the most common of which were blepharitis in 12 (30.8%), dry eyes in 12 (30.8%), and history of ocular surgery in 9 (23.1%). History of diabetes mellitus was found in 8 patients (20.5%). Thirty-six of 39 patients (92.3%) received a fluoroquinolone (92.3%) and 30 of 39 (76.7%) received topical fortified antibiotics. Resistance to fluoroquinolones, gentamicin, and tobramycin was seen in 1 patient each, respectively. Four patients (10.3%) required tarsorrhaphy, 6 patients (15.4%) required penetrating keratoplasty, and 1 patient required enucleation. Of the 35 patients for whom visual acuity information was available, 19 (54.3%) were count fingers or worse at most recent follow-up. CONCLUSIONS: Ocular risk factors, especially poor ocular surface, were identified in the vast majority of patients with Moraxella keratitis. Moraxella isolates in our study were susceptible to fluoroquinolones and aminoglycosides. Many patients required surgical intervention and the final visual acuity was often poor.
Subject(s)
Eye Infections, Bacterial , Keratitis , Moraxella/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Eye Enucleation , Eye Infections, Bacterial/etiology , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/therapy , Female , Humans , Keratitis/etiology , Keratitis/microbiology , Keratitis/therapy , Keratoplasty, Penetrating , Male , Middle Aged , Retrospective Studies , Risk Factors , Visual Acuity , Young AdultABSTRACT
PURPOSE OF REVIEW: Cytomegalovirus (CMV) keratitis, albeit an uncommon manifestation of this ubiquitous pathogen, can lead to devastating ocular morbidity. Timely diagnosis and appropriate treatment are also unfortunately uncommon. The purpose of this review is to discuss recently published literature regarding the epidemiology, pathophysiology, diagnosis, and therapy of CMV keratitis. RECENT FINDINGS: Classic clinical presentations of CMV keratitis are known; however, current investigations further elucidate characteristics of typical versus atypical disease. Ongoing research stems beyond utilizing PCR analysis towards targeted diagnostic studies with advanced imaging modalities as well as modern genotyping techniques. Strong clinical acumen combined with appropriate handling of these modern technologies are proving invaluable for rapid diagnosis and treatment of this virulent pathogen. SUMMARY: The current recommended treatment for CMV keratitis is systemic ganciclovir. Astute clinicians must consider this diagnosis in any patient with keratitis, anterior uveitis, and intraocular hypertension. Novel diagnostic techniques should be combined with clinical exam findings to accurately and efficiently diagnose, treat, and monitor progression.
