Clinical presentation, risk factors and treatment outcomes of first allograft rejection after penetrating keratoplasty in early and late postoperative period.

PURPOSE: Corneal graft rejection is the most common reason for the failure of an allograft corneal transplant. We undertook this study to identify and compare risk factors and treatment outcomes for early and late corneal graft rejections after optical penetrating keratoplasty. METHODS: A retrospective case file analysis of 880 primary penetrating keratoplasties was performed at a tertiary ophthalmic care centre. Patients were divided into early rejectors (rejection episode within 6 months postoperatively) and late rejectors (rejection episode after 6 months postoperatively). Main parameters evaluated were demographics, preoperative diagnosis and clinical signs, donor tissue details, surgical technique, details of rejection episode, treatment, and outcome information. RESULTS: A total of 156 patients with rejection episodes were identified. Of these, 42 (26.9%) patients experienced early rejection episodes and 114 (73.1%) patients experienced late rejection episodes. Preoperative donor and recipient characteristics, surgical technique, and clinical presentation of graft rejection were found to be similar between both groups after a Bonferroni correction was applied (P>0.005). Treatment outcomes of graft rejections were not significantly different (P=0.46) between early and late rejectors, with 83% of patients responding to rejection treatment (80% early rejectors; 85% late rejectors). CONCLUSION: Patients with early and late graft rejection have similar characteristics and both groups respond to treatment equally.

Trypan blue dye for anterior segment surgeries.

Use of vital dyes in ophthalmic surgery has gained increased importance in the past few years. Trypan blue (TB) has been a popular choice among anterior segment surgeons mainly due to its safety, ease of availability, and remarkable ability to enable an easy surgery in difficult situations mostly related to visibility of the targeted tissue. It is being used in cataract surgery since nearly a decade and its utilization has been extended to other anterior segment surgeries like trabeculectomy and corneal transplantation. This review will discuss the techniques and outcome of TB dye-assisted anterior segment surgeries.

Microbiological and clinical profiles of patients with microbial keratitis residing in nursing homes.

AIM: To study the microbiological and clinical profile of patients with microbial keratitis living in nursing homes. METHODS: A retrospective analysis of hospital records from 1996 to 2006 of patients who had microbial keratitis, and were living in nursing homes, was undertaken. The main parameters evaluated were clinical and microbiological profile and final visual outcome. RESULTS: Of 66 patients included in this study, 39 were female and 27 were male, with mean age of 81(SD 11) (range 46-97) years. The major ocular and systemic factors associated with the occurrence of microbial keratitis were the presence of dry eyes (26%) and rheumatoid arthritis (81%), respectively. A positive bacterial culture was obtained in 54 (82%) cases with Staphylococcus being the most prevalent isolate (48%). Seven patients had positive culture for herpes virus. Surgical intervention had to be performed in 31(47%) of cases mainly in the form of botox injection for induction of ptosis (n = 9, 27%), keratoplasty (n = 8, 24%), tarsorrhaphy (n = 5, 15%) or glue (n = 3, 9%). The mean pre-treatment and post-treatment visual acuity was counting fingers and 6/60 respectively. CONCLUSIONS: Microbial keratitis in patients living in nursing homes is usually caused by Staphylococcus and is associated with dry eyes and ocular surface disease. Surgical intervention is required in majority of cases with poor visual outcome.

Automated vitrector-assisted iridectomy and phacoemulsification in eyes with coexisting cataract and adherent leucomas.

PURPOSE: To describe a surgical technique as an alternative to allograft corneal transplantation for management of cases with cataract and corneal opacity. METHODS: Seven eyes of seven patients with adherent leucomas and cataract underwent phacoemulsification with intraocular lens (IOL) implantation. An automated vitrector was used to release the adherent leucoma and create an optical iridectomy at the start of surgery. Phacoemulsification with IOL implantation was performed in all eyes. The release of the iris adherence along with creation of an optical iridectomy improved visualization during phacoemulsification. RESULTS: Phacoemulsification and IOL implantation could be performed successfully in all seven eyes. The median best-corrected visual acuity (BCVA) improved from 1/60 (range: (light perception) 6/36) preoperatively to 6/18 (range: 6/36-6/12) at last follow-up (average: 41 days). CONCLUSIONS: This surgical technique is a viable option in cases with partial corneal opacification with coexisting cataract.

Comparative evaluation of 'flap on' and 'flap off' techniques of Epi-LASIK in low-to-moderate myopia.

PURPOSE: Comparative evaluation of 'flap on' and 'flap off' techniques of Epi-LASIK in low-to-moderate myopia. METHODS: Sixteen eyes of eight consecutive patients with myopia < or = 6 D were selected for this prospective, randomized, comparative, interventional case series. Epi-LASIK surgery was performed in all eyes. In one eye of each patient, the epithelial flap was retained after excimer laser ablation (flap on). In the fellow eye, the epithelial flap was discarded (flap off) after ablation. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), spherical equivalent (SEQ), postoperative pain score, time to epithelization, and corneal haze were recorded on postoperative visits. RESULTS: The mean preoperative SEQ in the two groups was -3.61+/-1.32 D (flap on) and -3.49+/-1.86 D (flap off; P=0.752). The mean follow-up period was 8.5+/-4.9 months. The mean pain score was comparable on all postoperative days except the second postoperative day when the group with flap off had a lesser mean pain score (P=0.053).Time for epithelial healing was 3.63+/-0.52 days in cases with flap off and 4.13+/-0.64 days in cases with flap on (P=0.113). Eyes with flap off had a better UCVA on the first postoperative day (0.19+/-0.11 logMAR) compared with eyes with flap on (0.41+/-0.28 logMAR; P=0.032). There was no significant difference in UCVA, BSCVA, SEQ, contrast sensitivity, corneal haze, and higher order aberrations at any other postoperative visit. CONCLUSIONS: There is no difference between flap on and flap off techniques of Epi-LASIK with regards to overall outcome of surgery.

Resuturing following penetrating keratoplasty: a retrospective analysis.

AIM: To examine the clinical profile of cases requiring resuturing following penetrating keratoplasty (PKP) at a tertiary care eye hospital. METHODS: The medical records of 947 consecutive patients who had undergone PKP between 1998 and 2006 were reviewed retrospectively and cases that were resutured during this period were analysed. The main parameters studied were indications for PKP, suturing techniques, causes of resuturing, visual acuity outcome and post-resuturing complications. RESULTS: The incidence of resuturing was 5.4% (51 eyes). The number of cases requiring resuturing was higher in corneal grafts performed for microbial keratitis (12%) than those for keratoconus (10%) and corneal endothelial decompensation (2.5%; p = 0.08). Wound dehiscence was the leading cause for resuturing (43%), followed by loose or broken sutures (37.3%). The most common complications after resuturing were occurrence of microbial keratitis (7.8%) and graft failure (5.9%). DISCUSSION: Resuturing may have to be performed more commonly for corneal transplantation surgery done for microbial keratitis and keratoconus. The major indications for resuturing are wound dehiscence and loose/broken sutures.

"Tuck In" Lamellar Keratoplasty (TILK) for corneal ectasias involving corneal periphery.

AIMS: Evaluation of a new surgical technique for the management of corneal ectasia with peripheral corneal involvement. METHODS: Twelve eyes of 12 patients with corneal ectasias and peripheral corneal thinning requiring surgical intervention, including eight patients with combined keratoconus and PMD and four patients of keratoglobus, were enrolled for the study in a tertiary care hospital. All patients were contact lens intolerant and had a best corrected visual acuity (BCVA) /=20/60, and all patients had BCVA >/=20/80. The mean keratometry decreased from 57.54 (SD 6.89) D preoperatively to 46.36 (2.39) D (p = 0.003), and the mean spherical equivalent (SEQ) refractive error decreased from -7.8 (4.6) D preoperatively to 1.23 (1.88) D (p = 0.007). A significant decrease was also seen in mean refractive astigmatism which decreased from 5.93 (3.06) D preoperatively to 3.23 (1.14) D (p = 0.037). CONCLUSION: Our technique of TILK is an effective surgical modality for the management of ectatic corneal dystrophies with peripheral corneal thinning.