Rate of Rejection After Descemet Stripping Automated Endothelial Keratoplasty in Fuchs Dystrophy: Three-Year Follow-up.

PURPOSE: To evaluate the rate of rejection after Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with Fuchs endothelial dystrophy (ED) and to analyze potential risk factors for rejection. METHODS: An observational retrospective chart review of 400 patients with Fuchs ED was performed. The primary outcome was the rate of endothelial graft rejection. Secondary outcomes included graft clarity after rejection, medications at the time of rejection, and preoperative graft thickness. RESULTS: A total of 400 consecutive eyes with at least 1 year of follow-up were evaluated with an average follow-up of 38 months (range 12-95 months). The cumulative rate of rejection at 1 year was 1%; 2 years, 2.9%; and 3 years, 4.8%. The greatest number of rejection episodes occurred between postoperative months 19 and 30 (N = 7). There was a statistically significant association of developing a rejection episode when a patient was off of topical steroids (P = 0.001, odds ratio = 6.25, 95% confidence interval = 2.03-19.3) or had a donor graft thickness greater than 145 µm (P = 0.011, odds ratio = 5.03, 95% confidence interval, 1.28-23.1). CONCLUSIONS: Corneal graft rejection is an uncommon but important complication after DSAEK. This study reports a lower rejection rate in Fuchs ED than that reported in previous studies. Risk factors for developing a rejection episode include discontinuation of topical steroids and a graft thickness greater than 145 µm. Maintaining patients on indefinite topical corticosteroid therapy and using thinner donor tissue will likely result in an even lower rate of rejection.

Mitomycin C-associated scleral stromalysis after pterygium surgery.

PURPOSE: To describe complications after use of mitomycin C (MMC) as a surgical adjuvant in pterygium surgery. METHODS: This is a retrospective chart review of patients presenting to a tertiary referral center over a 7-year period with a diagnosis of scleral stromalysis after previous pterygium removal. RESULTS: Sixteen eyes of 15 patients were identified with scleral stromalysis after pterygium surgery with the use of adjuvant MMC. Three eyes were excluded because of insufficient chart information or previous beta-irradiation treatment. Twelve of 13 eyes underwent surgical treatment for primary pterygium, and 1 eye was treated for recurrent pterygium. Time from initial pterygium surgery to presentation ranged from 1 month to 10 years. Dosage and routes of MMC administration included 0.02% intraoperative application to either the bare sclera or Tenon capsule with a range of 30 seconds to 3 minutes or topical administration 4 times daily for 2 weeks. In some cases, the dose and route of MMC administration were unknown. Four of 13 patients (31%) required a scleral patch graft with 1 patient (8%) requiring multiple patch grafts. CONCLUSIONS: Use of MMC in various forms and concentrations can cause devastating complications including scleral stromalysis. Scleral stromalysis may present anywhere from months to years after application. We suggest that MMC should be used with extreme caution when used as a surgical adjuvant for pterygium surgery. Patients must be urged to continue long-term follow-up after MMC use because of the potential for future anterior segment complications.

Needle contamination in the setting of intravitreal injections.

BACKGROUND/PURPOSE: To evaluate the risk of intravitreal needle contamination through speaking versus breathing in an office setting. METHODS: This was a prospective sampling assay. Participants held a sterile 30-gauge half-inch needle 25 cm from their mouth for 30 seconds under 2 conditions: (1) while speaking and (2) while breathing silently. Needles were then cultured and assayed after 6 days of incubation. Absolute colony-forming units were compared between conditions and against control sterile needles and oral swab cultures. RESULTS: Ten physicians were sampled with 15 samples per physician. Participants grew an average of 0.21 colonies (median = 1 CFU) from their talking samples and 0.07 colonies (median = 1 CFU) from their silent breathing samples. Oral swab plates grew an average of 373.4 colonies. None of the control needle plates grew colony-forming units. A nominal regression analysis showed no significant difference between talking and silent samples (P = 0.457). CONCLUSION: No significant difference in needle contamination was found between talking and breathing. Compared with oral swab plates, a significant difference exists between the amount of flora colonizing the oropharynx and that which was found on the needle cultures (P < 0.0001). These findings suggest that speaking versus remaining silent makes no difference in regard to needle contamination with oral flora during intravitreal injection.