Descemet stripping endothelial keratoplasty: six-month results of the first 100 consecutive surgeries performed solo by a surgeon using 1 technique with 100% follow-up.

PURPOSE: To determine the outcomes and complication rates achieved by a novice cornea surgeon when performing Descemet stripping automated endothelial keratoplasty (DSAEK) while precisely following a previously described forceps insertion technique. METHODS: Prospective, noncomparative interventional case series including 100 eyes of 74 patients with endothelial decompensation. An institutional review board approved, prospective, DSAEK series was initiated. Cases included all initial patients with endothelial failure operated on by a single surgeon after his cornea fellowship training. The surgeon strictly adhered to a previously published 5-mm incision, folded forceps graft insertion technique. Patients were followed at 1 day, 1 week, and 1, 3, and 6 months. Postoperative complications (including graft dislocation, primary graft failure, and pupillary block), best spectacle-corrected visual acuity (BSCVA) and specular microscopy of central endothelial cell density at 6 months postoperatively were the main outcome measures. RESULTS: One hundred consecutive eyes were enrolled in the study, and 100% follow-up at 6 months was achieved. Postoperative complications included 2 graft dislocations (2%), and both grafts were attached successfully and cleared; 2 episodes of cystoid macular edema (2%) occurred, and 1 eye (1%) developed areas of anterior iris synechiae to the graft. There were no pupillary block episodes or primary graft failures. In eyes without comorbidity (n=57), the mean BSCVA improved from 20/48 preoperation to 20/29 at 6 months after operation (P<0.001). No eyes lost vision. Mean central endothelial cell density decreased from 2769 cells per square millimeter preoperatively to 2308 cells per square millimeter postoperatively at 6 months. This represented a mean cell loss of 16%. CONCLUSIONS: This study demonstrates that with meticulous attention to a standardized forceps insertion technique, excellent outcomes with low rates of complications, improved BSCVA, and low endothelial cell loss can be achieved with DSAEK surgery.

Ocular neuromyotonia after gamma knife stereotactic radiation therapy.

Three patients who underwent multiple intracranial operations for recurrent nonsecreting pituitary adenomas followed by gamma knife stereotactic radiosurgery developed diplopia at 1, 5, and 6 years after the treatments. Examination disclosed features of ocular neuromyotonia, a phenomenon attributed to radiation damage to ocular motor cranial nerves. Amply reported after external beam radiotherapy, neuromyotonia has not been described after radiosurgery previously. These patients are, however, exceptional in that all had undergone multiple sellar region operations or received high doses of radiotherapy, or both.

The effect of lubricating eye drops on optical coherence tomography imaging of the retina.

INTRODUCTION: The goal of this study was to examine the potential value of corneal lubrication in improving the quality of optical coherence tomography (OCT) imaging of the retina. MATERIALS AND METHODS: This study is a consecutive series of 13 eyes of 11 patients in whom repeated attempts at OCT imaging failed to yield a good quality study despite the absence of significant media opacity or inadequate pupil dilation. Immediately following several poor quality scans, each eye received lubricating eye drops. The quality of images before and after the administration of drops was assessed. RESULTS: A statistically significant improvement in OCT image quality was observed following the administration of eye drops in each case. The change in mean signal strength (SS) was from 4.35 to 6.26 (p=0.0002). The proportion of scans with erroneous edge detection decreased from 41 to 13 percent. DISCUSSION: Lubricating drops appear to improve the quality and feasibility of OCT imaging in selected cases.

Long-term survival of central visual field in end-stage glaucoma.

PURPOSE: To evaluate the long-term survival of visual field and visual acuity in treated glaucoma patients with end-stage glaucomatous visual field loss defined by a field constricted to a 10-degree radius or less. DESIGN: Retrospective chart review. PARTICIPANTS: Sixty-four patients with end-stage glaucoma. METHODS: Serial 10-2 Humphrey visual fields with size III stimulus were analyzed. The following data were recorded for each visual field: mean deviation (MD), pattern standard deviation, the largest horizontal and vertical diameters measured in degrees including only locations with thresholds of 10 decibels or more, and the number of points on the pattern deviation plot with a probability value of more than 5%. MAIN OUTCOME MEASURE: Change in visual acuity and visual field. RESULTS: Eighty-four eyes of 64 patients satisfied inclusion criteria with an average follow-up of 8.34+/-3.1 years. Seventy-eight percent of patients were black. During the study period, 14 eyes lost more than 3 lines of visual acuity. Of these 14, 8 eyes progressed to a visual acuity of 20/200 or worse. Seven eyes lost 3 decibels or more from the MD that could be reproduced over 2 visual fields. CONCLUSIONS: In this predominantly black population, most treated patients with end-stage glaucoma did not demonstrate a decline in visual acuity or progressive loss of the central visual field during long-term follow-up.