Descemet stripping automated endothelial keratoplasty with the EndoGlide Ultrathin graft insertion device.

Endothelial keratoplasty has largely replaced penetrating keratoplasty as the preferred technique to selectively replace diseased corneal endothelium. Descemet's stripping automated endothelial keratoplasty (DSAEK) is the most common type of endothelial keratoplasty performed worldwide. One of the challenges in DSAEK is the insertion of the donor lenticule into the eye using a method so as to minimize endothelial cell loss. Various techniques have been suggested such as forceps insertion and graft insertion devices. With the trend towards using thinner DSAEK tissue and Descemet membrane endothelial keratoplasty, there are increasing challenges in inserting and manipulating even more delicate tissue. The EndoGlide Ultrathin has several new features that will enable easier insertion of thinner DSAEK tissue. This paper presents the features and surgical technique of the EndoGlide Ultrathin during DSAEK.

Ocular surface stem cell transplantation rejection: incidence, characteristics, and outcomes.

PURPOSE: To describe the incidence, characteristics, risk factors, treatment, and outcomes of ocular surface stem cell transplantation (OSST) rejection. METHODS: A chart review of patients who had OSST at a single institution between 1998 and 2010 was performed. Data were collected on patient demographics, type of OSST procedure, duration of immunosuppression, and rejection characteristics. Main outcome measures were ocular surface stability and improvement in best-corrected visual acuity. RESULTS: Two hundred twenty-two eyes of 158 patients were included with mean follow-up of 62.7 months (range, 12.0-158.3 months). The most common indications for OSST were aniridia (46.4%), chemical/thermal injury (22.1%), and Stevens-Johnson syndrome (12.2%). The most common procedures performed were keratolimbal allograft (KLAL) alone (80.6%) and combined living-related conjunctival allograft (lr-CLAL)-KLAL (11.3%). Mean time on immunosuppression was 44.3 months (range, 7.6-138.2 months). Severe rejection occurred in 43 eyes (19.4%) with mean time to rejection being 15.2 months (range, 0.2-93.1 months). Low-grade rejection occurred in 26 eyes (11.7%) with mean time to rejection being 26.2 months (range, 1.3-64.9 months). At the final follow-up, 36.6% of eyes in the rejection group achieved a stable ocular surface compared with 71.9% of eyes in the nonrejection group (P < 0.0001). Risk factors associated with increased risk of rejection were younger age (P < 0.0001), KLAL alone (P = 0.049), and noncompliance with immunosuppression (P = 0.047). CONCLUSIONS: Ocular surface outcomes for patients with OSST rejection are poor, with the majority of patients having failed ocular surfaces despite treatment with increased immunosuppression and repeat OSST. It is critical for success that OSST patients are closely monitored for rejection and for compliance with immunosuppression.

Traumatic wound rupture after Boston type 1 keratoprosthesis implantation.

OBJECTIVE: To describe the incidence, characteristics, causes, treatment, and outcomes of traumatic wound rupture in patients with Boston type 1 keratoprosthesis (KPro). DESIGN: Retrospective case series. PARTICIPANTS: We studied 136 eyes of 122 patients who underwent KPro implantation at a single institute between November 2004 and May 2011. METHODS: A chart review was performed to determine the incidence, characteristics, causes, treatments, and outcomes of traumatic wound rupture. RESULTS: The 4 eyes of 4 patients that sustained traumatic wound rupture resulted in an incidence of traumatic wound rupture of 2.9% (4/136). This complication occurred, on average, at 4.2 months (range, 1-9 months) after the KPro was implanted. All ruptures occurred at the graft-host junction. The 2 eyes that had complete keratoprosthesis extrusion experienced decreased vision postrupture, from hand motions to no light perception, and 20/300 to count-fingers vision, respectively. One eye that had 4 clock hours of superior wound rupture recovered vision postrupture from light perception to 20/40. One eye that had 2 clock hours of superior wound rupture maintained a stable vision of 20/125 after repair. CONCLUSIONS: The incidence of traumatic wound rupture after keratoprosthesis is comparable to that after penetrating keratoplasty. Patients should be aware that traumatic rupture is a lifelong concern and should use protective measures to prevent this complication from occurring.