Comparison of endothelial/Descemet's membrane complex thickness with endothelial cell density for the diagnosis of corneal transplant rejection.

PURPOSE: This study compared the effectiveness of endothelial/Descemet's membrane complex thickness obtained using high-definition anterior segment optical coherence tomography with endothelial cell density obtained using confocal microscopy as diagnostic tools in predicting corneal transplant rejection. METHODS: This observational, prospective, cross-sectional study evaluated penetrating keratoplasty grafts. Slit lamp examination organized the grafts into healthy or rejecting grafts. Grafts were scanned using both high-definition anterior segment optical coherence tomography and confocal microscopy. Central corneal thickness, endothelial/Descemet's membrane complex thickness, endothelial cell density, and coefficient of variation were each compared with the clinical status. Descemet's rejection index, defined by endothelial/Descemet's membrane complex thickness divided by central corneal thickness multiplied by 33, further compared endothelial/Descemet's membrane complex thickness with central corneal thickness. RESULTS: Endothelial/Descemet's membrane complex thickness, central corneal thickness, and Descemet's rejection index were all able to differentiate between clear and rejected corneal grafts (p < 0.0001, p = 0.001, and p = 0.012, respectively). Endothelial cell density and coefficient of variation did not correlate with the clinical status (p = 0.054 and p = 0.102, respectively). Endothelial/Descemet's membrane complex thickness had the largest area under the curve using receiver operating characteristic curves (p < 0.0001). Endothelial/Descemet's membrane complex thickness had a sensitivity of 86% and specificity of 81% with a cutoff value of >16.0 µm (p < 0.0001). The sensitivity and specificity of endothelial cell density were both 71% with a cutoff value of ⩽897 cells/mm2 (p = 0.053). There was a high correlation between endothelial/Descemet's membrane complex thickness and both Descemet's rejection index and central corneal thickness (p < 0.0001). CONCLUSION: Endothelial/Descemet's membrane complex thickness measured by high-definition anterior segment optical coherence tomography is a useful parameter for the diagnosis of corneal graft rejection. The diagnostic performance of endothelial/Descemet's membrane complex thickness was significantly better than that of endothelial cell density and central corneal thickness. Endothelial cell density and the coefficient of variation were unable to diagnose corneal graft rejection in our cross-sectional study.

In Vivo Characteristics of Corneal Endothelium/Descemet Membrane Complex for the Diagnosis of Corneal Graft Rejection.

PURPOSE: To evaluate the utility of endothelial/Descemet membrane complex (En/DM) characteristics in diagnosing corneal graft rejection. DESIGN: Diagnostic reliability study. METHODS: One hundred thirty-nine eyes (96 corneal grafts post penetrating keratoplasty or Descemet stripping automated endothelial keratoplasty: 40 clear, 23 actively rejecting, 24 rejected, and 9 nonimmunologic failed grafts; along with 43 age-matched control eyes) were imaged using high-definition optical coherence tomography. Images were used to describe En/DM and measure central corneal thickness (CCT) and central En/DM thickness (DMT). En/DM rejection index (DRI) was computed to detect the relative En/DM thickening to the entire cornea. RESULTS: In actively rejecting grafts, DMT and DRI were significantly greater than controls and clear grafts (28, 17, and 17 µm and 1.5, 1 and 1, respectively; P < .001). Rejected grafts had the highest DMT and DRI compared to all groups (59 µm and 2.1; P < .001). DMT and DRI showed excellent accuracy, significantly better than that of CCT, in differentiating actively rejecting from clear grafts (100% and 96% sensitivity; 92.5% and 92.5% specificity), actively rejecting from rejected grafts (88% and 83% sensitivity; 91% and 83% specificity), and nonimmunologic failed from rejected grafts (100% and 100% sensitivity; 88% and 100% specificity). DMT correlated significantly with rejection severity (P < .001). CONCLUSIONS: In corneal grafts, in vivo relative thickening of the En/DM is diagnostic of graft rejection as measured by DMT and DRI. These indices have excellent accuracy, sensitivity, and specificity in detecting graft immunologic status, superior to CCT. DMT is a quantitative index that correlates accurately with the severity of rejection.

Corneal Toxicity Associated With Aquarium Coral Palytoxin.

PURPOSE: To report a series of patients who developed corneal toxicity after exposure to aquarium coral palytoxin. DESIGN: Multicenter retrospective case series. METHODS: Retrospective review. RESULTS: Seven patients presented with corneal findings ranging from superficial punctate epitheliopathy to bilateral corneal melt with subsequent perforation. Among those with mild corneal findings, resolution was achieved with topical steroids and lubrication, whereas some patients who developed progressive corneal melt required therapeutic penetrating keratoplasty. The history in all patients revealed exposure to aquarium zoanthid corals shortly before disease onset. A review of the literature revealed that there are few prior reports of coral-associated corneal toxicity and that some species of coral secrete a substance known as palytoxin, a potent vasoconstrictor that inhibits the membranous sodium-potassium ATPase pump across cell types and can cause rapid death if inhaled or ingested. CONCLUSIONS: This is the largest case series to date demonstrating patients with aquarium coral palytoxin-associated corneal toxicity, and is the first to provide details of related histopathologic findings. Similar to other forms of toxic keratoconjunctivitis, a detailed history and careful clinical assessment are required, as well as timely removal of the offending agent from the patients' ocular milieu and environment. Mild ocular surface and corneal disease may be treated effectively with aggressive topical steroid therapy and lubrication. Given the potential severity of ocular as well as systemic adverse effects, there should be increased awareness of this entity among eye care professionals, aquarium enthusiasts, and the general public.

Visual outcomes and complications of epiretinal membrane removal secondary to rhegmatogenous retinal detachment.

PURPOSE: To examine visual outcomes after surgery for removal of epiretinal membrane after retinal detachment (RD) repair, and to identify possible complications. DESIGN: Retrospective case series. PARTICIPANTS: Seventy-five patients who underwent surgery for removal of an epiretinal membrane after RD repair. METHODS: Retrospective chart review of 75 patients who underwent surgery for removal of an epiretinal membrane after RD repair over a 10-year period. Follow-up ranged from 6 to 124 months (mean, 49). MAIN OUTCOME MEASURES: Measurement of final visual acuity (VA). RESULTS: After epiretinal membrane removal, VA increased 0.43 logarithms of the minimum angle of resolution (95% confidence interval, 0.27-0.58; t = 5.47, P = 0.000). Sixty-six patients (88%) had a VA at final follow-up greater than their preoperative VA. Forty-nine patients (70%) had a final VA equal to or greater than their best VA after RD repair. Final VA of 20/60 or better was achieved in 65.3% of eyes. Of the 43 eyes that were phakic at the beginning of the study, 34 (79.1%) underwent cataract extraction before final follow-up. Five eyes (6.7%) had a recurrent RD after membrane removal. Sixteen eyes (21.3%) developed a recurrent epiretinal membrane, 1 of which (1.3% of all eyes) was visually significant, requiring repeat surgery. CONCLUSIONS: Epiretinal membrane development is a known complication of RD repair. Visual acuity can be improved in these patients by removal of the epiretinal membrane, with excellent results. In this series, recurrent membrane formation is not visually significant. Careful follow-up is needed to detect recurrent RD.