ABSTRACT
We report a case of a 43-year-old woman who underwent double lung transplantation from a donor with severe airway burns following a house fire. The recipient's lung function and quality of life remain excellent 24 months following transplantation. This case is the first to report successful long-term outcomes in transplantation of lungs affected by smoke inhalation.
Subject(s)
Burns , Lung Transplantation , Smoke Inhalation Injury , Adult , Female , Humans , Lung , Quality of Life , Smoke Inhalation Injury/complications , Smoke Inhalation Injury/surgerySubject(s)
Choroid/pathology , Dermatitis/complications , Retina/pathology , Skin/pathology , Tattooing/adverse effects , Uveomeningoencephalitic Syndrome/complications , Adult , Biopsy , Dermatitis/diagnosis , Female , Humans , Tomography, Optical Coherence , Uveomeningoencephalitic Syndrome/diagnosis , Visual AcuityABSTRACT
PURPOSE: To evaluate Descemet membrane endothelial keratoplasty (DMEK) in the setting of failed penetrating keratoplasty (PKP) and to identify factors associated with DMEK success and failure after PKP. METHODS: A retrospective chart review of patients who underwent DMEK for failed PKP at Toronto Western Hospital, Canada, between 2014 and 2017 was performed. Demographic characteristics, number of previous transplants, intraoperative and postoperative complications, best spectacle-corrected visual acuity (BSCVA), and endothelial cell density were analyzed. RESULTS: Twenty-eight eyes were included in the study. Rebubbling intervention was performed in 12 eyes (43%) within the first postoperative weeks. Five eyes (18%) developed graft rejection episodes. Twelve eyes (43%) had to be regrafted after DMEK surgery and were deemed failures (because of persistent Descemet membrane detachment, rejection episode that led to secondary failure, and infection). BSCVA before DMEK was significantly worse in the eyes that failed than those that did not [1.97 ± 0.85 and 1.2 ± 0.56 logMAR, respectively, (P = 0.01)]. Rebubbling was required in 75% of eyes in the failure group compared with 19% in the success group (P = 0.002). Six of the 16 eyes (37.5%) in the success group underwent femtosecond laser-enabled DMEK, whereas this technique was not used in any of the eyes in the failure group (P = 0.017). CONCLUSIONS: DMEK is a viable option for cases of failed PKP. DMEK failure after PKP might be associated with lower visual acuity before DMEK surgery, higher number of rebubble interventions, and manual descemetorhexis rather than femtosecond laser-enabled DMEK.
Subject(s)
Descemet Stripping Endothelial Keratoplasty/methods , Graft Rejection/surgery , Keratoplasty, Penetrating , Adult , Aged , Aged, 80 and over , Endothelium, Corneal/pathology , Female , Fuchs' Endothelial Dystrophy/surgery , Graft Rejection/etiology , Humans , Male , Middle Aged , Reoperation , Retrospective Studies , Supine Position , Treatment Failure , Visual Acuity/physiology , Young AdultABSTRACT
PURPOSE: Fixation examination with the MP-1 microperimeter (Nidek Technologies Srl., Vigonza, PD, Italy) determines the preferred retinal loci and fixation stability in patients with central vision loss. It is typically done for periods of 15 to 30 s as per the manual's recommendations, which are arbitrary. In this study, we examined (1) whether fixation stability depends on the duration of recording and (2) whether fixation stability changes over time. METHODS: Raw eye-position data from 76 patients with bilateral central vision loss (mean age = 80 ± 9.6 yrs) who had fixation examination recordings with the MP-1of at least 15 s were used. Bivariate contour ellipse areas (BCEAs) were calculated and compared for intervals of 0 to 5 s, 0 to 10 s, and 0 to 15 s and for three consecutive 5-s intervals (0-5 s, 5-10 s, and 10-15 s). Ellipse's centroid location, axes extent, and tilt angle were also evaluated for each of these intervals. RESULTS: BCEA worsened significantly with increasing the time of fixation recording (P < .001). Compared to the BCEA during the first 5 s of examination recording, median BCEA increased by a factor of 1.4 for the first 10 s and of 1.6 for the first 15 s of recording. However, the bivariate ellipses for the three consecutive 5-s intervals were the same in terms of area, centroid location, and axes extent, but differed significantly in tilt angle (P = .005). Fixation stability (BCEAs) results were also confirmed with an additional analysis performed on shorter sampling intervals. CONCLUSIONS: Fixation stability deteriorates with increasing duration of the fixation recording, but when fixation is evaluated in shorter consecutive 5-s intervals, only a difference in ellipse's tilt angle is found. These results suggest that the current recommendations for fixation stability recording with the MP-1 can be shortened to a less demanding duration.
