Graft-size selection and anisometropia reduction in penetrating keratoplasty (PKP).

PURPOSE: To compare the amount of myopia induced by same-size donor-to-host penetrating keratoplasty with that of the amount of myopia induced by over-sized donor-to-host penetrating keratoplasty. SETTING: Tertiary referral academic center. DESIGN: Retrospective cohort study. METHODS: Charts from patients who underwent penetrating keratoplasty by the same technique at Bascom Palmer Eye Institute between Nov 1, 2002, and January 1, 2006, were reviewed. The patients underwent optical penetrating keratoplasty using 12 interrupted 10-0 nylon sutures and a 12-bite continuous 10-0 nylon suture by a single surgeon (R.K.F.). The surgical technique used would be considered standard of care at most institutions. The Institutional Review Board, University of Miami Human Subjects Research Office, approved the study protocol. The donor graft was over-sized by 0.25mm in eyes when the intended final refractive target was greater than -1.00 diopters spherical equivalent (SE). The same-size donor graft was used when the intended final refractive target was less than -1.00 diopters SE. The selection of donor graft size was entirely based upon clinical parameters, meaning that the intended final refractive target was determined per each patient's fellow eye refraction, with the intention of reducing anisometropia. All patients received postoperative refraction and corneal topography. These measurements were performed at 6-8 weeks when the initial removal of sutures commenced, then at 6 months, then after completion of selective suture removal, then again at 12 months. RESULTS: At 12 months, the over-sized group resulted in -1.35 diopters (SD = 2.25) SE of refraction, and the same-size group resulted in -0.14 diopters (SD = 2.42) SE. This approached statistical significance (p = 0.052) in comparison to -1.00 diopters spherical equivalent. CONCLUSIONS: Using a donor graft that is over-sized by 0.25mm results in refraction of -1.00 diopters SE or more of myopia. Using a same-size donor-graft results in refraction of less than -1.00 diopters SE. Therefore, careful graft-size selection can result in a more favorable clinical outcome-namely, reduction in anisometropia-in patients undergoing penetrating keratoplasty.

Interventions and Outcomes in Patients with Infectious Pseudomonas scleritis: A 10-Year Perspective.

Purpose: To identify interventional factors associated with improved visual results and faster time to resolution for patients with Pseudomonas scleritis. Methods: Retrospective study analyzing inciting factors, therapeutic modalities, and outcomes of patients with Pseudomonas scleritis. Results: A total of 24 patients were analyzed; 22 were treated as outpatients. All had resolution of infection and 58% (n = 14) maintained ≥20/200 vision. Medical therapy included topical and oral antibiotics; seven received additional subconjunctival injections; two were admitted for IV antibiotics. Patients presenting with ≥20/200 vision were more likely to maintain this level of vision (n = 8, 80%) compared to those presenting with severe vision loss (n = 5, 36%) (p = 0.04). A similar proportion of patients who received (n = 8, 61%) and did not receive (n = 5, 39%) oral steroids achieved 20/200 vision or better once infection resolved, p = 1.0. Conclusions: Pseudomonas scleritis can be successfully managed in the outpatient setting. Oral steroids do not appear harmful in the treatment of this disease.

Lamellar keratoplasty with corneoscleral graft for limbal dermoids.

To assess the postoperative outcomes of limbal dermoid excision with corneoscleral graft transplantation. The charts of 8 consecutive patients (mean age: 13.0y) who had undergone limbal dermoid excision with lamellar corneoscleral graft transplantation by a single surgeon were retrospectively reviewed. Mean dermoid size was 7.75 mm (6.0-12.0 mm). Mean visual acuities (in logMAR units) before and after surgery were 1.8 and 1.7, respectively (P=0.29). Spherical equivalents were 1.3 diopter (D) before surgery and 0.7 D after surgery (P=0.40). The mean astigmatism measurements before and after surgery were 2.4 D and 1.5 D, respectively (P=0.17). Vector analysis revealed a mild change in astigmatism with a mean "d" of 3.2 (0.56-6.89). No intra- or post-operative complications occurred. Lamellar keratoplasty for limbal dermoids is safe and offers good cosmesis and tectonic stability. A significant decrease in the amount of astigmatism is not expected following surgery.

Endophthalmitis: Then and Now.

PURPOSE: To report historically evolving strategies (then and now) in prevention and management of endophthalmitis. DESIGN: A perspective on relevant topics in the prophylaxis and management of endophthalmitis. METHODS: This is an author-selected review of studies leading to changes in strategies for endophthalmitis management over the last 100 years. RESULTS: The current perspective discusses the trends and strategies over the past century. Historically, 3 endophthalmitis time-periods have existed and include the pre-antimicrobial era, the predominantly systemic antimicrobial era, and the current intravitreal antimicrobial era. The management of endophthalmitis from different etiologies, including endogenous, postinjection, post-cataract surgery, and other anterior segment-related (eg, post-penetrating keratoplasty), bleb-associated, glaucoma drainage device-associated, and open globe injury-associated, are discussed. Specific etiologies may predict most common microbial causes and may guide differing management strategies. Pars plana vitrectomy offers theoretical advantages but is generally reserved for patients with more advanced disease. CONCLUSIONS: Despite advances over the past 100 years, endophthalmitis is an important sight-threatening complication. Timely management with the appropriate use of antimicrobial agents may optimize visual outcomes.

Contact-Lens-Associated Purpureocillium Keratitis: Risk Factors, Microbiologic Characteristics, Clinical Course, and Outcomes.

PURPOSE: To study the risk factors, microbiologic characteristics, clinical course, and outcomes of patients with Purpureocillium keratitis at a tertiary eye care center in south Florida. MATERIALS AND METHODS: All medical records during a seven-year period starting January 1, 2007, were reviewed. Twenty-eight culture-proven Purpureocillium keratitis cases with complete medical records presenting to our institution were included in this retrospective, observational case series. Data collected included predisposing factors, therapeutic interventions, treatment duration, and visual outcomes. RESULTS: Twenty patients (71.4%) had a history of soft contact lens use, with only two for therapeutic use. Other identified risk factors were trauma and immunosuppression. Fifteen patients (53.6%) received topical corticosteroid treatment prior to the diagnosis of fungal keratitis. Thirteen patients (46.4%) were on Natamycin treatment prior to Purpureocillium identification. As a group, the average best-corrected visual acuity (BCVA) at presentation was 1.1 logMAR; upon the final evaluation, it was 1.0 logMAR. The BCVA on last evaluation for the eight patients presenting to our institution within two weeks of onset of symptoms was 0.3 log MAR, and all patients in this group responded to medical management. The final BCVA for 20 patients presenting two weeks after onset of symptoms was 1.2 logMAR. There was a significant difference in the final BCVA between Group 1 and Group 2 (p = 0.004), but no difference in steroid use or previous treatments. Previous steroid use tended to extend time to presentation and was significantly associated with a worse final visual outcome (1.2 versus 0.6 logMAR; p = 0.0474). Previous Natamycin use was significantly associated with a worse final visual outcome (1.4 versus 0.6 logMAR; p = 0.014). CONCLUSION: Purpureocillium keratitis can have devastating consequences to visual function and even lead to enucleation. Physicians should make every effort to arrive at an earlier microbiological diagnosis, as this is associated with better outcomes and less need for surgical intervention. The first line use of voriconazole is recommended, and steroid use should be avoided, as their previous use is associated with worse visual outcomes.

Infectious Pseudomonas and Bipolaris scleritis following history of pterygium surgery.

We report an interesting case of infectious scleritis from coinfection of Pseudomonas aeruginosa and Bipolaris with no corneal infiltrate. A healthy 60-year-old man with a history of infectious scleritis following pterygium excision presented with purulent material growing P. aeruginosa and 1+ colonies of Bipolaris species of fungus. Broad spectrum treatment was initiated with hourly topical moxifloxacin, fortified tobramycin, and natamycin along with a subconjunctival injection of voriconazole and topical cyclosporine, with PO ketoconazole. After 10 weeks of aggressive empiric treatment, the patient's symptoms had resolved, and his vision returned to baseline although a scleral patch graft was utilized to stabilize scleral thinning.

Endophthalmitis caused by Enterococcus faecalis: clinical features, antibiotic sensitivities, and outcomes.

PURPOSE: To report the clinical features, antibiotic sensitivities, and visual acuity outcomes of endophthalmitis caused by Enterococcus faecalis. STUDY DESIGN: Retrospective, observational case series. METHODS: A consecutive case series of patients with culture-positive endophthalmitis caused by E. faecalis between January 1, 2002, and December 31, 2012, at an academic referral center. RESULTS: Of 14 patients identified, clinical settings included bleb association (n = 8), occurrence after cataract surgery (n = 4), and occurrence after penetrating keratoplasty (n = 2). All isolates were vancomycin sensitive. When comparing isolates in the current study with isolates from 1990 through 2001, the minimal inhibitory concentration required to inhibit 90% of isolates increased for ciprofloxacin (4 µg/mL from 1 µg/mL), erythromycin (256 µg/mL from 4 µg/mL), and penicillin (8 µg/mL from 4 µg/mL), indicating higher levels of resistance. The minimal inhibitory concentration required to inhibit 90% of isolates remained the same for vancomycin (2 µg/mL) and linezolid (2 µg/mL). Presenting visual acuity ranged from hand movements to no light perception. Initial treatment strategies were vitreous tap and intravitreal antibiotic injection (n = 12) and pars plana vitrectomy with intravitreal antibiotic injection (n = 2). Visual acuity outcomes were 20/400 or worse in 13 (93%) of 14 patients. CONCLUSIONS: Although all isolates were sensitive to vancomycin and linezolid, higher minimal inhibitory concentration required to inhibit 90% of isolates in the current study, compared with isolates from 1990 through 2001, occurred with ciprofloxacin, erythromycin, and penicillin. Despite prompt treatment, most patients had poor outcomes.

Delayed-onset endophthalmitis associated with corneal suture infections.

BACKGROUND: The purpose of the current study was to report the microbiology, risk factors, and treatment outcomes in patients with delayed-onset endophthalmitis associated with corneal suture infections. For this retrospective consecutive case series, a search of the ocular microbiology department database was performed to identify all patients with positive corneal and intraocular cultures (anterior chamber and/or vitreous) between 01 January 1995 and 01 January 2010. A subset of patients with a history of corneal suture infections and delayed-onset endophthalmitis was identified. RESULTS: Over the 15-year period of the study, 68 patients were identified to have both positive corneal and intraocular cultures. Among them, six patients were identified to have a culture-proven, delayed-onset endophthalmitis that developed from a culture-positive corneal suture infection. All of the patients in the current study were using topical corticosteroids at the time of diagnosis. In four of six patients, there was documented manipulation of a suture before the development of endophthalmitis. Streptoccocus was identified as the causative organism in five of six patients in the current study. All of the Streptoccocus isolates were sensitive to vancomycin. The single case of Serratia marcescens endophthalmitis was sensitive to amikacin, ceftazidime, ciprofloxacin, gentamicin, and tobramycin. Treatment modalities varied and were guided by the attending ophthalmologist depending upon clinical presentation. One patient with severe Streptococcus pyogenes keratitis and endophthalmitis underwent a primary enucleation after developing a wound dehiscence. Of the remaining five patients, all received topical and intravitreal antibiotics. Therapeutic penetrating keratoplasty was performed in three patients. Pars plana vitrectomy was performed in two patients. Visual acuity outcomes ranged from 20/150 to no light perception. CONCLUSIONS: In the current study, Streptococcus was isolated in nearly all patients with delayed-onset endophthalmitis associated with corneal suture infections. Topical steroid use and suture manipulation were identified as associated factors for developing endophthalmitis. Visual acuity outcomes were poor despite the prompt recognition of endophthalmitis and appropriate antibiotic therapy.

Epidemiology and visual outcomes in patients with infectious scleritis.

PURPOSE: To describe the epidemiology of patients with infectious scleritis and identify factors associated with poor visual prognosis. METHODS: Retrospective review of inciting factors, causative organisms, and visual outcomes of patients with infectious scleritis. RESULTS: Fifty-five patients (56 eyes) with confirmed infectious scleritis were included. The median time from inciting event to scleritis symptoms was 1.9 months. Eyes with a history of pterygium surgery had a longer time from surgery to development of scleritis (median 49 months, range 0-183) compared to those with a history of glaucoma, cataract, and retina surgery (median 1.0-1.6 months; P = 0.001). Fungal, nocardial, and mycobacterial infections (median 17-45 days) had a longer interval between symptoms and diagnosis than eyes with non-acid-fast gram-positive and gram-negative bacteria (median 7 days; P = 0.04). Patients were followed for a median of 11.1 months (0.5-47 months). Approximately 50% of eyes lost functional vision (worse than 20/200). Presenting VA of worse than 20/200 and concomitant keratitis or endophthalmitis were associated with poorer VA outcomes. CONCLUSIONS: Infectious scleritis can occur days to years after ocular surgery, with infection occurring after a longer interval in eyes with a history of pterygium surgery. Approximately 50% of eyes lost functional VA after infection with poor presenting VA being the strongest predictor for subsequent severe vision loss.

Infectious keratitis progressing to endophthalmitis: a 15-year study of microbiology, associated factors, and clinical outcomes.

PURPOSE: To describe the incidence, microbiology, associated factors, and clinical outcomes of patients with infectious keratitis progressing to endophthalmitis. DESIGN: Nonrandomized, retrospective, consecutive case series. PARTICIPANTS: All patients treated for culture-proven keratitis and endophthalmitis between January 1, 1995 and December 31, 2009, at the Bascom Palmer Eye Institute. METHODS: Ocular microbiology and medical records were reviewed on all patients with positive corneal and intraocular cultures over the period of the study. Univariate analysis was performed to obtain P values described in the study. MAIN OUTCOME MEASURES: Microbial isolates, treatment strategies, and visual acuity (VA) outcomes. RESULTS: A total of 9934 corneal cultures were performed for suspected infectious keratitis. Only 49 eyes (0.5%) progressed to culture-proven endophthalmitis. Fungi (n = 26) were the most common responsible organism followed by gram-positive bacteria (n = 13) and gram-negative bacteria (n = 10). Topical steroid use (37/49 [76%]) was the most common associated factor identified in the current study, followed by previous surgery (30/49 [61%]), corneal perforation (17/49 [35%]), dry eye (15/49 [31%]), relative immune compromise (10/49 [20%]), organic matter trauma (9/49 [18%]), and contact lens wear (3/49 [6%]). There were 27 patients in whom a primary infectious keratitis developed into endophthalmitis, and 22 patients in whom an infectious keratitis adjacent to a previous surgical wound progressed into endophthalmitis. Patients in the primary keratitis group were more likely to be male (22/27 [81%] vs 8/22 [36%]; P = 0.001), have history of organic matter trauma (8/27 [30%] vs 1/22 [5%]); P = 0.030), and have fungal etiology (21/27 [78%] vs 5/22 [23%]; P<0.001). Patients in the surgical wound-associated group were more likely to use topical steroids (20/22 [91%] vs 17/27 [63%]; P = 0.024). A VA of ≥ 20/50 was achieved in 7 of 49 patients (14%), but was <5/200 in 34 of 49 (69%) at last follow-up. Enucleation or evisceration was performed in 15 of 49 patients (31%). CONCLUSIONS: Progression of infectious keratitis to endophthalmitis is relatively uncommon. The current study suggests that patients at higher risk for progression to endophthalmitis include patients using topical corticosteroids, patients with fungal keratitis, patients with corneal perforation, and patients with infectious keratitis developing adjacent to a previous surgical wound. Patients with sequential keratitis and endophthalmitis have generally poor visual outcomes. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Corneoscleral block excision grafts: indications, techniques, and outcomes.

PURPOSE: The purpose of this article is to discuss the indications, techniques, and outcomes for corneoscleral grafts in sight-threatening ocular disease. METHODS: We conducted a single-center review of 12 medical records of patients who underwent corneoscleral grafts by a single surgeon (R.K.F.) from 1983 through 2004. RESULTS: The 4 primary indications for undergoing a corneoscleral graft included infection, anterior chamber cyst, epithelial downgrowth, and invasive squamous cell carcinoma. The surgical technique involved en bloc excision of the lesion followed by placement of cadaveric corneoscleral tissue to reapproximate the original structures in the region. The surgical technique was modified to suit the individual indication and degree of involvement. Visual acuity, recurrence, complications, and time to rehabilitation are discussed. Histopathologic evaluation for each case was performed. Best-corrected visual acuity improved in 3 of 12 eyes. Vision of 20/50 or better was maintained in 5 of 12 eyes, and a visual acuity between 20/60 and 20/300 was achieved in 5 of 12 eyes. One patient with epithelial downgrowth had progression to phthisis bulbi, and 1 patient with squamous cell carcinoma experienced recurrence of the primary disease process resulting in enucleation. CONCLUSIONS: Patients undergoing placement of large corneoscleral grafts have a guarded prognosis; however, this extensive, technically difficult, surgical intervention may allow patients to preserve and/or improve their visual function.

In vivo morphologic characteristics of Salzmann nodular degeneration with ultra-high-resolution optical coherence tomography.

PURPOSE: To examine the in vivo morphologic properties of Salzmann nodular degeneration with ultra-high-resolution optical coherence tomography (OCT). DESIGN: Interventional case series. SETTING: Single-center academic practice. STUDY POPULATION: Nineteen eyes of 12 patients with Salzmann nodular degeneration were recruited to participate in the study. OBSERVATIONAL PROCEDURE: Subjects were imaged using novel, custom-built ultra-high-resolution OCT. Images were used to describe in vivo characteristics of subepithelial nodules. Morphometric measurements were made with custom-built software. Ultra-high-resolution OCT findings were compared with histopathologic findings in 3 patients. MAIN OUTCOME MEASURES: Identifiable in vivo morphologic characteristics of Salzmann nodular degeneration with ultra-high-resolution OCT. RESULTS: Ultra-high-resolution OCT images demonstrate intraepithelial fibrous nodules with epithelial thinning and corneal surface elevation. The Bowman layer could be differentiated in 9 of 12 patients. The difference between the mean thickness of epithelium above the nodule and the thickness of normal epithelium was statistically significant (P < .0001). The correlation between thickness of the epithelium and thickness of the nodule was statistically significant (r = -0.48; P < .0001). The correlation between thickness of the nodule and total surface thickness (thickness of the epithelium + thickness of the nodule) was statistically significant (r = 0.98; P < .0001). Ultra-high-resolution OCT findings were consistent with histopathologic results. CONCLUSIONS: Ultra-high-resolution OCT can be used to noninvasively image the cornea in Salzmann nodular degeneration. This new imaging technique helps us to demonstrate different in vivo morphologic characteristics of Salzmann nodular degeneration.

Epithelial ingrowth after Descemet stripping automated endothelial keratoplasty: description of cases and assessment with anterior segment optical coherence tomography.

PURPOSE: To describe 5 cases of epithelial ingrowth after Descemet stripping automated endothelial keratoplasty (DSAEK) and the use of anterior segment optical coherence tomography (AS-OCT) to describe the areas of ingrowth. METHODS: Five cases with epithelial ingrowth after DSAEK were examined with commercially available AS-OCT and/or a novel custom-built ultrahigh resolution (UHR) AS-OCT. Argon laser photocoagulation was also used to confirm epithelial ingrowth on the iris surface. Pathological evidence of epithelial ingrowth was noted in an eye that underwent corneoscleral grafting for extensive ingrowth through a fistulous tract. RESULTS: Epithelial ingrowth was solely in the graft-host interface in 1 case and in both the interface and retrocorneal and iris surfaces in 4 cases. Argon laser photocoagulation on the iris confirmed epithelial ingrowth in 4 cases. The areas of epithelial ingrowth were imaged in 1 case with the Visante AS-OCT and in 3 cases with an UHR-OCT. In 1 case, block excision with corneoscleral grafting was required. CONCLUSIONS: Epithelial ingrowth can occur after DSAEK. This series reports 5 cases of epithelial ingrowth into the interface and/or the retrocorneal surface after DSAEK. Imaging with AS-OCT, specifically the UHR-OCT, and argon laser photocoagulation can help confirm the diagnosis. UHR-OCT imaging of the interface and retrocorneal surfaces can provide clues to the origin of epithelial ingrowth. Four cases were observed. One case underwent corneoscleral grafting with histological confirmation of epithelial ingrowth.

Subconjunctival mycetoma after sub-Tenon's corticosteroid injection.

PURPOSE: To describe a case of a subconjunctival mycetoma that developed after a patient received a sub-Tenon's injection of triamcinolone acetonide. METHODS: Case report. RESULTS: A 76-year-old white male presented with a subconjunctival mass in the area of a previous posterior sub-Tenon's corticosteroid injection for wet age-related macular degeneration. Microbiologic and pathologic analysis of the mass revealed the causative organism to be the pigmented fungus Exophiala jeanselmei. CONCLUSION: This is the first published case of an Exophiala-associated subconjunctival mycetoma.

Postkeratoplasty corneal wavefront analysis of selective suture removal.

PURPOSE: To analyze the corneal wavefront higher order aberrations (HOAs) after penetrating keratoplasty and selective suture removal. METHODS: All patients undergoing penetrating keratoplasty by the same surgeon (R.K.F.) using identical suturing technique were retrospectively identified. Corneal HOAs were calculated at the week 6, week 10, 6-month, and final postoperative visits and compared with simulated corneal astigmatism, surface regularity index, surface asymmetry index, and best-corrected visual acuity. RESULTS: Ninety-two eyes were identified. Total corneal HOAs declined from the week 6 visit to the final visit (week 6: 0.65, final: 0.50, P = 0.041). Final visit linear regression demonstrated correlations of surface asymmetry index and surface regularity index with total corneal HOAs (R = 0.51 and R = 0.45, respectively). No relationship for simulated corneal astigmatism or vision was found with total corneal HOAs (R = 0.003 and 0.30, respectively). CONCLUSIONS: Total corneal HOAs are increased in the early postkeratoplasty course, possibly representing the optical consequences of surface irregularity. Because simulated keratometry provides no information in regard to corneal HOAs, measuring HOAs may be indicated in select cases. Total corneal HOAs perhaps provide a clinical representation of irregular astigmatism. The visual significance of these total corneal HOAs was not evident.

Insurgence of Fusarium keratitis associated with contact lens wear.

OBJECTIVE: To describe the clinical presentation and course of patients who developed keratitis due to Fusarium while wearing nontherapeutic soft contact lenses. METHODS: A retrospective review of microbiologic records from January 1, 2004, through April 15, 2006, was performed, identifying all patients with corneal ulceration and a culture positive for Fusarium species. Medical records of 34 patients were reviewed for clinical characteristics, treatment regimens, and microbiologic features. RESULTS: The most common antimicrobial medications administered prior to Fusarium diagnosis were antibacterials in 31 of 34 patients. No distinct preponderance of any one brand of either contact lens or solution was identified. The microbiologic corneal cultures found Fusarium oxysporum in 20 cases, Fusarium solani in 3 cases, Fusarium species not further identifiable in 10 cases, and no growth in 1 case. Patients with a delayed onset of treatment had a tendency for prolonged treatment until cure. CONCLUSIONS: Fusarium has previously been an unusual organism in the etiology of infectious keratitis in the setting of nontherapeutic soft contact lens wear. A delay in proper diagnosis and intervention may contribute to a prolonged treatment course. The microbial spectrum of contact lens-related keratitis may be evolving with higher participation of Fusarium species compared with prior reports.

Anterior chamber and sutured posterior chamber intraocular lenses in eyes with poor capsular support.

PURPOSE: To compare the clinical outcomes and complications of patients who had surgical placement of anterior chamber (AC IOLs) and sutured posterior chamber intraocular lenses (PC IOLs) after cataract surgery resulting in poor capsular support. SETTING: Department of Ophthalmology, Bascom Palmer Eye Institute, Miami, Florida. METHODS: A retrospective interventional comparative case series of 181 eyes of 181 patients that had implantation of an intraocular lens with inadequate capsular support was conducted. A chart review of all patients that had implantation of AC IOLs or sutured PC IOLs at a tertiary care eye hospital between 1995 and 2001 was conducted. RESULTS: Outcome measures included final best-corrected visual acuity, spherical equivalent, and postoperative complications (pseudophakic bullous keratopathy, elevated intraocular pressure [IOP] inflammation, retinal detachment, suture erosion, cystoid macular edema). Of 702 charts reviewed, 181 were found to fit inclusion and exclusion criteria. The postoperative complication risk ratio was 0.80 (95% confidence interval [CI]: 0.52-1.23) for AC IOLs compared with PC IOLs. The most common complication experienced by patients having implantation of either lens type was elevated IOP (AC IOL: 38%; PC IOL: 42%). The incidence of other complications was similar between the groups. Best-corrected visual acuity was similar; however, final spherical equivalent trended toward more myopic values in the PC IOL group (-0.82 +/- 1.67 for AC IOL versus -1.32 +/- 2.12 for PC IOL). CONCLUSIONS: The findings suggest that no significant differences in outcome exist when comparing AC IOLs to sutured PC IOLs in complicated cataract extraction with poor capsular support. Recent advances in AC IOL design have yielded lenses that provide a safe, effective alternative to sutured PC IOLs.

Mutations in PIP5K3 are associated with François-Neetens mouchetée fleck corneal dystrophy.

François-Neetens fleck corneal dystrophy (CFD) is a rare, autosomal dominant corneal dystrophy characterized by numerous small white flecks scattered in all layers of the stroma. Linkage analysis localized CFD to a 24-cM (18-Mb) interval of chromosome 2q35 flanked by D2S2289 and D2S126 and containing PIP5K3. PIP5K3 is a member of the phosphoinositide 3-kinase family and regulates the sorting and traffic of peripheral endosomes that contain lysosomally directed fluid phase cargo, by controlling the morphogenesis and function of multivesicular bodies. Sequencing analysis disclosed missense, frameshift, and/or protein-truncating mutations in 8 of 10 families with CFD that were studied, including 2256delA, 2274delCT, 2709C-->T (R851X), 3120C-->T (Q988X), IVS19-1G-->C, 3246G-->T (E1030X), 3270C-->T (R1038X), and 3466A-->G (K1103R). The histological and clinical characteristics of patients with CFD are consistent with biochemical studies of PIP5K3 that indicate a role in endosomal sorting.

Surgical technique for control of postkeratoplasty myopia, astigmatism, and anisometropia.

PURPOSE: We previously demonstrated that selective suture removal reduces keratoplasty astigmatism; however, a myopic shift was induced with the increasing number of interrupted sutures removed. This study is an attempt to determine the effects of a modified surgical technique on postkeratoplasty myopia, astigmatism, and anisometropia. DESIGN: A cohort study compared with historical controls. METHOD: Optical penetrating keratoplasties were performed on 92 eyes of 84 patients. The study group consisted of 92 consecutive penetrating keratoplasties performed using 12 interrupted 10-0 nylon sutures and a tight 12-bite continuous suture and an average K reading of 46.00 diopters for eyes undergoing combined and intraocular lens exchange procedures. All patients had refraction, keratometry, and videokeratoscopy postoperatively starting at 6 weeks and at the completion of selective suture removal. RESULTS: Before suture removal, the average spherical equivalent was -0.160 +/- 3.59 diopters; it was -1.58 +/- 3.66 diopters at the completion of suture removal at 1 year and -1.44 +/- 3.72 at the last follow-up visit, averaging 20.7 months. Final refractive, keratometric, and videokeratoscopy astigmatism was 2.81 +/- 1.82, 4.19 +/- 2.94, and 3.58 +/- 2.03 diopters, respectively. Anisometropia, using the spherical equivalent of the operated and fellow eyes, was 2.49 +/- 2.25 diopters at completion of the study. A best-corrected visual acuity of 20/50 or better was achieved in 59% of patients. CONCLUSIONS: Low myopic spherical equivalent and anisometropia were achieved using a K reading of 46 diopters for calculation of intraocular lens power. The use of tighter continuous sutures and selective removal of fewer interrupted sutures only served to increase final astigmatism, with no significant effect on the final spherical equivalent.