Body Weight as an Indicator of Vulnerability to Domestic Cat Predation for Juveniles of Three Species of Cottontail Rabbits (Sylvilagus spp.) in Colorado, USA: Implications for Release Criteria.

Cottontail rabbits (Sylvilagus spp.) are frequently admitted to wildlife rehabilitation facilities due to predation by domestic cats (Felis catus). Our retrospective study (2015-19) of three species (Sylvilagus audubonii, Sylvilagus floridanus, and Sylvilagus nuttallii) indicated that once juveniles reached a weight over 220 g, they were unlikely to present due to domestic cat interactions. This information should be incorporated into release criteria for these species.

Clostridial Enterotoxemia and Coccidiosis in Weanling Cottontail Rabbits ( Sylvilagus audubonii, Sylvilagus floridanus, Sylvilagus nuttallii) from Colorado, USA.

Wild cottontail rabbits ( Sylvilagus spp.), especially young individuals, are one of the most frequent wildlife species presented for rehabilitation at wildlife rehabilitation centers. These species are challenging to rehabilitate, with gastrointestinal (GI) disease being a major cause of morbidity and mortality during the weaning stage. Two organisms, Clostridium spiroforme and Eimeria spp., are frequently associated with GI disease in young domestic rabbits ( Oryctolagus cuniculus) and can result in high rates of morbidity and mortality in this species. Here we present evidence that these two pathogens also play an important role in GI disease in young cottontail rabbits ( Sylvilagus audubonii, Sylvilagus floridanus, Sylvilagus nuttallii) undergoing rehabilitation.

The Effectiveness of a Peer-Staffed Crisis Respite Program as an Alternative to Hospitalization.

OBJECTIVE: This study assessed whether peer-staffed crisis respite centers implemented in New York City in 2013 as an alternative to hospitalization reduced emergency department (ED) visits, hospitalizations, and Medicaid expenditures for individuals enrolled in Medicaid. METHODS: This study used Medicaid claims and enrollment data for January 2009 through April 2016 to estimate impacts on ED visits, hospitalizations, and total Medicaid expenditures by using a difference-in-differences model with a matched comparison group. The study sample included 401 respite center clients and 1,796 members of the comparison group. RESULTS: In the month of crisis respite use and the 11 subsequent months, Medicaid expenditures were on average $2,138 lower per Medicaid-enrolled month and there were 2.9 fewer hospitalizations for crisis respite clients than would have been expected in the absence of the intervention (p<.01). CONCLUSIONS: Peer-staffed crisis respite services resulted in lowered rates of Medicaid-funded hospitalizations and health expenditures for participants compared with a comparison group. The findings suggest that peer-staffed crisis respites can achieve system-level impacts.

Descemet Membrane Endothelial Keratoplasty (DMEK) Tissue Preparation: A Donor Diabetes Mellitus Categorical Risk Stratification Scale for Assessing Tissue Suitability and Reducing Tissue Loss.

PURPOSE: This study assessed a novel diabetes mellitus (DM) rating scale in relation to its utility in reducing Descemet membrane endothelial keratoplasty (DMEK) tissue preparation failure. METHODS: A 5-point DM rating scale was defined, in which 1 demonstrated relatively good health associated with DM and 5 represented comorbidities associated with DM. A chart review from consecutive donors who had at least 1 tissue prepared for DMEK was performed. Using the donor profile, the first tissue processed from each donor was categorized according to the DM severity and if the tissue passed or failed the DMEK preparation. Failure rates per rating group were evaluated using logistic regression and odds of preparation failure. RESULTS: A total of 125 tissues prepared for DMEK were categorized based on the defined DM rating scale. Of these, 9 tissues were rated 1 (11.1% failure), 25 were rated 2 (0% failure), 31 were rated 3 (6.5% failure), 24 were rated 4 (16.7% failure), and 36 were rated 5 (30.6% failure). The odds ratios were significant for tissues rated as 5 and 3 (P < 0.05). No other rating categories were found to influence the odds of failure. A χ test comparing categories of low risk (1-3) and high risk (4-5) was also performed (P = 0.001). CONCLUSIONS: The DM rating scale does seem to stratify the risk of preparation failure associated with the severity of DM and associated comorbidities. Inclusion of some diabetic donors for the preparation of DMEK grafts may be warranted given proper screening of the donor history and application of the rating scale.

Surgical hospitalist: can this be a program for your group?

A shortage of general surgeons is creating issues for the coverage of many emergency departments. This article outlines a new way of thinking about how to diagnosis and treat this problem. Learn the basics behind the possible creation of a surgical hospitalist program from assessing the need; reviewing physician issues; computing the financial analysis; understanding the political and bureaucratic issues; and, finally, recruiting to fill the positions.

Endothelial keratoplasty: the relationship between donor tissue storage time and donor endothelial survival.

PURPOSE: To evaluate the relationship between storage time in Optisol GS (Bausch & Lomb, St. Louis, MO) and postoperative cell loss after Descemet's stripping automated endothelial keratoplasty (DSAEK) surgery. DESIGN: Retrospective analysis of a noncomparative, interventional case series. PARTICIPANTS: Three hundred sixty-two eyes of 265 patients undergoing DSAEK surgery for Fuchs' endothelial dystrophy. METHODS: Storage times (death to surgery) of donor tissue were recorded for 362 eyes undergoing DSAEK surgery. Donor cell loss at 6, 12, and 24 months was recorded. Analysis of storage times with endothelial cell loss was performed using a Pearson correlation coefficient and an independent samples Student t test. MAIN OUTCOME MEASURES: Percentage of donor endothelial cell loss as measured by specular microscopy of central endothelial cell density (ECD). RESULTS: The mean storage time was 98.95 ± 33 hours (range, 20.65-186.02 hours). The mean percent endothelial cell loss from before to after surgery was 29 ± 16% at 6 months (n = 362), 31 ± 16% at 12 months (n = 263), and 32 ± 20% at 24 months (n = 98). Storage time did not correlate significantly with endothelial cell loss at any postoperative time point (6 months: r = -0.047, P = 0.373; 12 months: r = -0.023, P = 0.709; 24 months: r = -0.14, P = 0.169). The mean cell loss for corneas stored 0 to 4 days (n = 55) was 32 ± 17% at 2 years and the mean cell loss for corneas stored for more than 4 days (n = 43) was 30 ± 18% at 2 years (P = 0.57). At the extremes of storage time, 10 corneas stored for the shortest time (1.5 days) had a 1-year cell loss of 33% and 10 corneas stored for the longest time (7 days) had a 1-year cell loss of 30% (P = 0.45). CONCLUSIONS: No correlation was found between the characteristic of storage time and the decline of ECD. Surgeons should not make special requests to the eye bank for short storage times with the hope of improving donor endothelial survival. The upper limit of donor storage time as it relates to acceptable postoperative endothelial cell loss is not known.

Endothelial cell damage in descemet stripping automated endothelial keratoplasty with the underfold technique: 6- and 12-month results.

PURPOSE: To evaluate the endothelial cell loss at 6 and 12 months after Descemet stripping automated endothelial keratoplasty (DSAEK) using a modified 40/60 underfolding technique and to compare this to the literature on other commonly used implantation techniques, such as the conventional 60/40-fold, gliding, and hitch suture techniques. METHODS: Endothelial cell density was measured prospectively, and cell loss was calculated at 6 and 12 months after endothelial keratoplasty using a recently described underfolding implantation technique. RESULTS: In this study, 305 eyes undergoing DSAEK were evaluated. Average endothelial cell loss was 26% at 6 months and 27% at 12 months, all statistically significant reductions from preoperative values (P < 0.01). The decrease in cell count from 6 months to 12 months was not statistically significant. CONCLUSIONS: This study demonstrates reduction in endothelial cell loss after DSAEK using the underfold technique when compared with previous reports on conventional folding techniques and similarity to previous reports on glide techniques at 6 and 12 months postoperatively (26% vs. 34% vs. 23% at 6 months). This offers an easy modification to a commonly used existing technique and improves endothelial cell survival after DSAEK.

Descemet stripping automated endothelial keratoplasty in eyes with previous trabeculectomy and tube shunt procedures: intraoperative and early postoperative complications.

PURPOSE: To evaluate the intraoperative and early postoperative outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) in patients with previous glaucoma filtering surgeries. METHODS: A retrospective review of all DSAEK surgeries performed at one center comparing complications of DSAEK in eyes with previous glaucoma filtering procedures (study eyes) with a time-matched group of all other DSAEK cases (control eyes). RESULTS: There were 28 study eyes, 19 with previous trabeculectomies and 9 with previous glaucoma drainage devices (GDDs) and 431 control eyes. Study group intraoperative complications included 1 compromised bleb and 1 loss of donor tissue because of traumatic manipulation. One intraoperative complication, a perforation of the donor tissue, occurred in the control group. Venting stab incisions were used more often in study eyes (n = 5; 18%) than in control eyes (n = 12; 4.4%) (P = 0.002). GDD tubes were trimmed in 2 eyes (22%). No intraoperative manipulations were used to occlude the glaucoma filters or tubes. Postoperative complications in the study group included 1 dislocation (3.6%) and 1 decentered graft (3.6%) and 1 eye with loss of pressure control (3.6%), whereas in the control group, there were 10 dislocations (2.3%) and 1 decentered graft (0.2%) (P = 0.267 for dislocations and P = 0.118 for decentered grafts). One episode of pupillary block (0.2%) occurred in the control group, and none occurred in the study group. No primary graft failures occurred in either group. CONCLUSIONS: DSAEK surgeries in eyes with previous glaucoma filtering procedures were performed without primary graft failure and with reasonably low dislocation (3.6%) and graft decentration (3.6%) rates. Although the intraoperative complication rate for the study group (7.1%) was higher than the rate for the control group (0.23%), excellent early postoperative outcomes can be achieved when DSAEK is performed in eyes with previous trabeculectomies and GDDs.

NIP45 controls the magnitude of the type 2 T helper cell response.

Nuclear factor of activated T cell (NFAT) transcription factors are key regulators of gene transcription within immune cells. The NFAT-interacting protein, (NIP45), augments NFAT-driven IL-4 expression by a mechanism that relies on arginine methylation. To establish the function of NIP45 in vivo, we generated mice with a targeted deletion of the gene encoding this cofactor. NIP45-deficient T helper cells displayed profound defects in the expression of NFAT-regulated cytokine genes, including IL-4. Whereas NIP45 deficiency does not interfere with T helper cell NFAT activation or lineage-specific transcription-factor expression, NIP45 acts as an enhancer for the assembly of protein arginine methyltransferase 1 and the protein arginine methyltransferase 1-linked histone 4 arginine 3 methylation with the IL-4 promoter. Our study reveals an essential role for NIP45 in promoting robust cytokine expression in vivo, which is required for the efficient handling of parasites. We propose that NIP45 acts as a molecular rheostat serving to amplify the type-2 immune response.

Complications and clinical outcomes of descemet stripping automated endothelial keratoplasty with intraocular lens exchange.

PURPOSE: To evaluate complications and clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with intraocular lens (IOL) exchange compared with DSAEK alone. DESIGN: Retrospective, interventional case series. METHODS: DSAEK was performed in 19 eyes in which the anterior chamber IOL was exchanged for a posterior chamber IOL (study group) and in 188 eyes in which the posterior chamber IOL was left in place (comparison group). The complications of graft dislocations, primary graft failure episodes, and pupillary block were recorded for all eyes. Six-month best spectacle-corrected visual acuity and mean central endothelial cell density were measured prospectively and then compared with preoperative values for all eyes. RESULTS: Dislocations occurred in 0 (0%) of 19 eyes in the study group and in 5 (3%) of 188 eyes in the comparison group (P = .47), with 0 primary graft failures and 0 pupillary block episodes in either group. Preoperative mean best spectacle-corrected visual acuity for those eyes without any underlying ocular comorbidities was 20/205 and 20/100 in the study and comparison groups, respectively (P = .18). Mean best spectacle-corrected visual acuity at 6 months improved to 20/48 in the study group and to 20/34 in the comparison group, a statistically significant difference (P = .01). Mean donor cell loss at 6 months was 33% in the study group and 26% in the comparison group (P = .18). CONCLUSIONS: Concurrent IOL exchange with DSAEK surgery does not increase the dislocation, primary graft failure, or pupillary block rates in the immediate postoperative period. Donor endothelial cell loss in DSAEK was not increased significantly by IOL exchange. Visual acuity was slightly worse after combined surgery than after DSAEK alone.

Endothelial keratoplasty: endothelial cell loss after deep lamellar endothelial keratoplasty with retention of an open-loop anterior chamber intraocular lens.

PURPOSE: To prospectively assess the impact of a retained open-loop anterior chamber intraocular lens (ACIOLs) on endothelial cell loss after deep lamellar endothelial keratoplasty (DLEK). METHODS: Prospectively gathered central endothelial cell densities of eyes with open-loop ACIOLs after DLEK were examined at 6 months, 1 year, and 2 years. RESULTS: Nine eyes with an open-loop ACIOL were examined. Mean endothelial cell loss was 37% at 6 months (n = 9, P = 0.001), 36% at 1 year (n = 6, P = 0.001), and 41%, at 2 years (n = 5, P = 0.002) after surgery. CONCLUSION: Postoperative endothelial cell loss over the first 2 years in this small series of patients undergoing DLEK with retention of an open-loop ACIOL may be greater in the first 6-12 months but similar at 2 years when compared with that found in the literature for the DLEK procedure.

Descemet's stripping automated endothelial keratoplasty (DSAEK) using corneal donor tissue not acceptable for use in penetrating keratoplasty as a result of anterior stromal scars, pterygia, and previous corneal refractive surgical procedures.

PURPOSE: The purpose of this study was to evaluate outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) using anterior stromal flawed (ASF) donor corneas that were unsuitable for use in full-thickness penetrating keratoplasty as a result of stromal scars, pterygia, or previous corneal refractive surgery and to compare results with DSAEK using standard tissue. METHODS: We conducted a review of our initial 42 (19 with 6-month follow up) consecutive DSAEK surgeries using ASF tissue compared with 357 (199 with 6-month follow up) time-matched controls using standard tissue. Intraoperative and perioperative complications, including dislocations and primary graft failures, were compared. Six-month best spectacle-corrected vision, incidence of rejection episodes, postoperative refractive astigmatism, keratometric values, pre- and postoperative topography-derived surface asymmetry index, and surface regularity index were compared. RESULTS: One surgeon-cut ASF tissue was perforated before surgery and was discarded. No surgeon-cut standard tissue was perforated. No intraoperative complications and no episodes of primary graft failure or pupillary block glaucoma occurred in either group. One (2.4%) postoperative graft dislocation and one (5.2%) graft rejection episode occurred in the study group. There were 10 (2.8%) dislocations and 8 (2.2%) graft rejection in the controls. A statistically similar significant improvement in best spectacle-corrected vision occurred in both groups. Corneal topography, pachymetry, and manifest astigmatism were not significantly different between groups. CONCLUSION: Postoperative results of DSAEK using donor tissue excluded from use in penetrating keratoplasty as a result of stromal flaws are equivalent to results using standard donor tissue. Central corneal thickness measurements should be performed before cutting to avoid tissue perforation. The use of ASF tissue for DSAEK will expand the cornea donor pool.

Long-term anterior and posterior topographic analysis of the cornea after deep lamellar endothelial keratoplasty.

PURPOSE: To analyze the 2-year topographic response of the cornea to deep lamellar endothelial keratoplasty (DLEK). METHODS: The Orbscan topographies of 24 eyes that underwent DLEK for corneal decompensation were retrospectively analyzed. Twelve eyes received a large-incision DLEK technique and 12 eyes received a small-incision DLEK. All the preoperative and postoperative corneal raw data were imported into a custom software program, which computed the average composite corneal maps and difference maps for both study groups to evaluate the corneal response to the surgery. The software delineated 2 concentric zones of the cornea to characterize the regional response after the surgery: the central and peripheral regions. RESULTS: At 2 years after surgery, no significant changes (<0.41 diopters; analysis of variance, P > 0.05) in the central topography configuration were measured in comparison with the preoperative state after DLEK procedures. On the other hand, a significant increase (P < 0.01) in the mean tangential curvature and astigmatic power of the anterior corneal periphery was measured after surgery, with higher changes after large-incision DLEK. No significant differences in the average curvature profile of the posterior corneal interface were measured after DLEK procedures (<0.40, P > 0.05) in comparison with the preoperative state. CONCLUSIONS: DLEK provides stable central corneal topography, with minimal changes in curvature and astigmatic power in the years after surgery. Moreover, the donor posterior cornea shows to maintain its vitality and integrity in the long-term postoperative period, with curvature values similar to the original posterior corneal interface.

Endothelial keratoplasty: vision, endothelial survival, and complications in a comparative case series of fellows vs attending surgeons.

PURPOSE: To compare a 6-month postoperative vision, endothelial cell loss, and immediate postoperative complications in Descemet stripping automated endothelial keratoplasty (DSAEK) cases performed by an experienced corneal surgeon and his inexperienced fellows using an established technique. DESIGN: Retrospective analysis of prospectively gathered data in 327 consecutive DSAEK cases. METHODS: DSAEK cases performed by fellows vs attending surgeons during a concurrent period were compared for 6-month postoperative best spectacle-corrected visual acuity (BSCVA), endothelial cell loss, and immediate postoperative complications. This series represents the initial consecutive cases performed by 3 cornea fellows using a technique identical to that used by the attending. RESULTS: After DSAEK, average BSCVA improved from 20/80 to 20/37 in the attending cases and 20/74 to 20/36 in the fellow cases. There was no statistical difference in endothelial cell loss between groups (32% vs 35%). The dislocation rate was 2% in the attending group and 1% in the fellow group. There were no primary graft failures or cases of pupillary block in either group. CONCLUSIONS: This study demonstrates no difference in vision or endothelial cell loss after DSAEK when performed by an experienced corneal surgeon or inexperienced fellows. Postoperative complications also were similar. Results and complications of DSAEK performed by supervised novice fellows can equal those of an experienced DSAEK surgeon.

Endothelial keratoplasty for Fuchs' dystrophy with cataract: complications and clinical results with the new triple procedure.

PURPOSE: To report the immediate postoperative complications and the 6- and 12-month clinical results in a large series of cases undergoing the new triple-procedure Descemet's stripping automated endothelial keratoplasty (DSAEK) and concurrent cataract surgery. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: Three hundred fifteen eyes of 233 patients with Fuchs' corneal dystrophy were evaluated for the complications of dislocation and iatrogenic primary graft failure (IPGF). Two hundred three eyes of 149 patients had 6-month postoperative data available for other outcome analysis. METHODS: A standardized technique of DSAEK with extensive use of cohesive viscoelastic was performed in all 315 eyes with Fuchs' dystrophy, and 225 of those eyes had cataract surgery concurrently. Of the 203 eyes with 6-month data, concurrent phacoemulsification with intraocular lens placement (triple procedure) was performed in 149 of those eyes. MAIN OUTCOME MEASURES: The complications of graft dislocation and IPGF were recorded for all eyes. Six- and 12-month postoperative best spectacle-corrected visual acuity (BSCVA), refractive spherical equivalent (SE), and central donor endothelial cell density (ECD) were measured prospectively and then compared with preoperative values for the triple-procedure eyes. RESULTS: There were 4 dislocations (4%) among the 90 straight DSAEK cases and 4 dislocations (1.8%) among the 225 triple-procedure cases (P = 0.327). There was not a single case of IPGF in any of the 315 DSAEK cases. After the triple procedure, the BSCVA in eyes without comorbidity (n = 122) improved with 93% at 20/40 or better at 6 months and 97% at 20/40 or better at 12 months. Refractive SE at 6 months averaged 0.11+/-1.08 diopters (D), with 73% of eyes within 1 D of emmetropia and 95% within 2 D of emmetropia. The postoperative mean ECD was 1955 cells/mm(2) at 6 months (n = 125) and 1979 cells/mm(2) at 12 months (n = 89) and represented a 32% cell loss from that before surgery (P<0.001) for both postoperative time points. CONCLUSIONS: The new triple-procedure DSAEK combined with cataract surgery provides rapid visual recovery and allows selection of an appropriate intraocular lens. Dislocations are rare (1.8%) and primary graft failure did not occur.

Endothelial keratoplasty: the influence of insertion techniques and incision size on donor endothelial survival.

PURPOSE: To determine the acute endothelial cell damage from trephination and tissue insertion in endothelial keratoplasty (EK) surgery. The influence of insertion technique (forceps insertion vs "pull-through" insertion) of donor tissue and incision size (3 vs 5 mm length) was assessed. METHODS: Forty precut 8.-mm-diameter donor posterior buttons were used in this study. Thirty-five buttons were inserted through a limbal incision of either 3 or 5 mm length into the anterior chamber of cadaver eyes and then removed through an open sky technique without further trauma. Five buttons that were trephined but not inserted served as a control group. Vital dye staining and computer digitized planimetry were used to analyze the tissue and quantify the total damaged area over the entire endothelial surface. Five buttons for each of 7 insertion techniques were used. The 8 tissue groups evaluated were as follows: group 1: control group of trephination only, with no insertion; group 2: forceps with folded tissue through 5-mm incision; group 3: suture pull through of nonfolded tissue through a 5-mm incision; group 4: forceps pull through of Busin glide folded tissue through a 5-mm incision; group 5: forceps with folded tissue through a 3-mm incision; group 6: suture pull through with folded tissue through a 3-mm incision; group 7: suture pull through with nonfolded tissue through a 3-mm incision; and group 8: forceps pull through of Busin glide folded tissue through a 3-mm incision. RESULTS: The control group demonstrated 9% +/- 2% peripheral cell damage from simple trephination of the tissue but without insertion. In the 5-mm incision surgeries, forceps insertion (group 2) caused 18% +/- 3% loss, suture pull-through insertion (group 3) caused 18% +/- 2% loss, and Busin glide pull through (group 4) caused 20% +/- 5% loss. There were no significant differences in damage between any of the 5-mm incision group techniques (P > 0.99). In the 3-mm incision surgeries, forceps insertion (group 5) caused a 30% +/- 3% loss, pull through with folded tissue (group 6) caused 30% +/- 5% loss, pull through with nonfolded tissue (group 7) caused 56% +/- 4% loss, and Busin glide pull through (group 8) caused a 28%+/- 5% loss. There was no difference in damage among the 3-mm groups (P > 0.96), with the exception of group 7 where pulling the unfolded tissue through a 3-mm incision was significantly worse than all other techniques (P < 0.001). There was significantly greater cell area damage in the 3-mm groups (36%) than in the 5-mm groups (19%) (P <0.001). Large patterns of striae with cell loss were seen in the 3-mm groups emanating from the peripheral traction site, regardless of whether the traction to pull the tissue through the incision and into the chamber was generated by a suture or cross-chamber forceps. Direct forceps insertion caused circular patterns of injury at the tip compression site regardless of incision size, but this damage was multiplied and exacerbated by insertion through a smaller incision. CONCLUSIONS: Smaller size (3 mm) incisions for EK surgery result in greater acute endothelial area damage than larger size (5 mm) incisions. Pull-through insertion techniques through a 5-mm incision seem equivalent in the amount of induced area damage to that of forceps insertion. Compressive injury from the incision appeared less when the tissue was folded than when not folded. Insertion with any technique through a 3-mm incision resulted in larger areas of endothelial damage. All these iatrogenic death zones outside the central endothelial area would be missed clinically by standard early specular microscopy after EK surgery.

Precut tissue for Descemet's stripping automated endothelial keratoplasty: vision, astigmatism, and endothelial survival.

PURPOSE: To report 6 and 12 month results using precut tissue for Descemet's stripping automated endothelial keratoplasty (DSAEK) and correlate donor characteristics with clinical outcomes. DESIGN: Prospective, noncomparative, interventional case series. PARTICIPANTS: We reviewed 100 donor corneas precut for 100 eyes of 90 DSAEK patients. METHODS: Our first 100 consecutive cases of DSAEK with precut tissue were entered into a prospective protocol. Donor characteristics and the visual, refractive, topographic, and specular microscopy results at 6 and 12 months were analyzed. Correlation analysis comparing donor characteristics with clinical outcomes was performed. MAIN OUTCOME MEASURES: Six- and 12-month postoperative best spectacle-corrected visual acuity (BSCVA), refractive astigmatism, topographic keratometry (K), and specular endothelial cell densities (ECD) were measured prospectively and then compared with preoperative values. Donor characteristics analyzed included death to preservation time, death to surgery time, precutting resection to surgery time, and graft thickness. RESULTS: Six months after DSAEK surgery, BSCVA improved from 20/83 to 20/38. (P<0.01). In eyes with no known comorbidity (n = 60), 92% had a vision of >/=20/40 at 6 months and 20% obtained > or =20/20. Astigmatism changed an average of 0.09 diopters (D) and K changed by +0.09 D, both of which were not significant and were stable to 12 months. The postoperative mean ECD (n = 65) was 1918 cells/mm(2) at 6 months, and represented a 31% cell loss from preoperatively (P<0.001). The mean ECD (n = 61) was 1990 cells/mm(2) at 12 months, and represented a 29% cell loss from preoperatively (P<0.001) with no significant change from 6 to 12 months (P = 0.172). Improvement of visual acuity from preoperative to postoperative in eyes without comorbidity was not correlated with any donor characteristic. Greater endothelial cell loss correlated with higher preoperative ECD levels (P<0.001) and with a trend toward longer precut resection to surgery times at both 6 months (P = 0.049) and 12 months (P = 0.051). CONCLUSIONS: Precut tissue by Eye Banks for use in DSAEK surgery provides an improvement in vision with no significant change in astigmatism. Donor endothelial cell loss from 6 to 12 months is stable and is comparable with reports involving tissue that is cut intraoperatively. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosures may be found after the references.

Endothelial keratoplasty: the influence of preoperative donor endothelial cell densities on dislocation, primary graft failure, and 1-year cell counts.

PURPOSE: The purpose of this study was to determine if an association exists between preoperative donor central endothelial cell density (ECD) and the complications of donor dislocation, iatrogenic primary graft failure (IPGF), and endothelial survival at 1 year after endothelial keratoplasty (EK) surgery. METHODS: A prospective, nonrandomized, interventional case study was conducted evaluating 629 consecutive EK procedures. The preoperative donor ECD was recorded for each case. The mean preoperative ECD of the group of EK cases with postoperative donor dislocation was compared with the mean ECD of the group of EK cases that did not suffer donor dislocation. The subset of eyes that underwent Descemet stripping automated endothelial keratoplasty (DSAEK) was also evaluated for dislocation, IPGF, and ECD at 1 year. RESULTS: There were 31 eyes that suffered a dislocation in the overall group of 629 eyes (4.9% dislocation rate). The mean preoperative ECD of the donor tissue in this dislocation group was 2769 cells per square millimeter (range = 2147-3454 cells/mm). The mean preoperative ECD of the donor tissue in the group that did not dislocate (n = 598) was 2818 cells per square millimeter (range = 2110-4209 cells/mm). There was no significant difference in preoperative ECD between these groups (P = 0.428). There was a subset of 350 cases of DSAEK, of which 9 cases dislocated (2.6% dislocation rate). The mean preoperative ECD of the donor tissue in this dislocation group was 2604 cells per square millimeter (range = 2323-3175 cells/mm), with 5 of the 9 dislocation donors with a preoperative ECD above 2500 cells per square millimeter. The mean preoperative ECD of the donor tissue in the group that did not dislocate (n = 341) was 2825 cells per square millimeter (range = 2110-4209 cells/mm). There was no significant difference in preoperative ECD between these groups (P = 0.069). There was no significant correlation between preoperative ECD and the ECD at 1 year after DSAEK (n = 90; Pearson correlation = 0.184; P = 0.082). There were no IPGFs in the entire series of 350 consecutive DSAEK cases, and therefore, no statistical analysis is possible for IPGF. CONCLUSIONS: Preoperative donor ECD was not associated with donor dislocation for any form of EK surgery. Tissue with donor cell counts below 2500 cells per square millimeter can attach, and tissue with donor cell counts above 2500 cells per square millimeter can detach. Higher preoperative donor ECD was not correlated with higher ECD at 1 year postoperatively. Surgeons' requests for donor tissue with an ECD above 2500 cells per square millimeter for DSAEK surgery for the purpose of avoiding dislocations, IPGF, or improving 1-year ECD are not supported by this data.