Visual Recovery and Endothelial Cell Survival After Descemet Stripping Automated Endothelial Keratoplasty for Failed Penetrating Keratoplasty Grafts­A Cohort Study.

PURPOSE: To assess visual recovery and donor cell survival after Descemet stripping automated endothelial keratoplasty (DSAEK) for the repair of failed penetrating keratoplasty (PK) grafts. METHODS: Best spectacle-corrected Snellen visual acuity results after DSAEK were compared with best-ever documented visual acuity (BDVA) results obtained with the previous PK graft in a prospective cohort study. Donor cell survival after DSAEK for PK repair was compared with cell survival after DSAEK for Fuchs endothelial dystrophy and pseudophakic bullous keratopathy. Differences in the logMAR best spectacle-corrected Snellen visual acuity and endothelial cell loss rates were calculated. RESULTS: Twenty-eight eyes with DSAEK for PK repair were identified, 21 of which lacked vision-limiting comorbidities. The mean follow-up was 18.4 ± 10.6 months. At 3 months postoperatively, 10/21 eyes (48%) regained their BDVA. By 24 months, only 14% remained with 0.2 logMAR below their BDVA. Endothelial cell counts decreased significantly faster in patients with DSAEK for failed PK (P = 0.024) or pseudophakic bullous keratopathy (P = 0.018) than in patients with DSAEK for Fuchs endothelial dystrophy. CONCLUSIONS: DSAEK for the restoration of failed PK grafts promotes rapid visual recovery within the visual limits of the previous PK graft. Increased endothelial cell loss is noted relative to other DSAEK indications, which may result in earlier endothelial graft failure in renovated PK.

Changes in intraocular pressure after descemet stripping automated endothelial keratoplasty: a retrospective analysis.

PURPOSE: To analyze the occurrence of postoperative intraocular pressure (IOP) elevation and types of pressure-lowering treatment in patients after Descemet stripping automated endothelial keratoplasty (DSAEK) with and without previous diagnoses of glaucoma and/or pseudoexfoliation (PXF) syndrome. METHODS: This retrospective assessment considered 211 consecutive DSAEK cases (176 patients) performed by 1 surgeon between January 2007 and November 2010 with at least 1-year follow-up. Salient patient characteristics, IOP, and type of antiglaucoma treatment registered in postoperative visits up to 36 months were extracted from medical records. IOP elevation and its association with glaucoma, PXF, and combination of the 2 were assessed using multivariate ordinal logit models. RESULTS: Of 211 eyes, 97 eyes (45%) showed at least 1 increase in IOP >25 mm Hg after DSAEK. Of these 97 eyes, 17 eyes (17.5%) had a history of glaucoma alone, another 17 eyes (17.5%) had a history of glaucoma combined with PXF, 10 eyes (9.7%) had PXF alone, and 53 eyes (54.6%) were steroid responders only. To control IOP elevation, steroid reduction alone was performed in 6 eyes (6.2%) and IOP-lowering medication as the only measure was performed in 26 eyes (26.8%). In 46 eyes (47.4%), steroids were reduced in combination with IOP-lowering medication and 16 eyes (16.5%) required surgery. In 3 eyes (3.1%), no action was required. Presence of PXF (odds ratio, 1.71; 95% confidence interval, 0.62-2.81; P = 0.002) and PXF glaucoma (1.14; 95% confidence interval, 0.06-2.21; P = 0.038) required a more intensive IOP-lowering management than patients without PXF with IOP problems. CONCLUSIONS: Increased IOP is common after DSAEK, and a significant number of patients need IOP-lowering treatment. PXF syndrome and PXF glaucoma are risk factors for significant IOP elevation after DSAEK. In most cases, IOP remains controlled with conservative management, but some patients require glaucoma surgery.

Visual function in human ocular toxoplasmosis.

AIM: To assess functional impairment in terms of visual acuity reduction and visual field defects in inactive ocular toxoplasmosis. METHODS: 61 patients with known ocular toxoplasmosis in a quiescent state were included in this prospective, cross-sectional study. A complete ophthalmic examination, retinal photodocumentation and standard automated perimetry (Octopus perimeter, program G2) were performed. Visual acuity was classified on the basis of the World Health Organization definition of visual impairment and blindness: normal (> or =20/25), mild (20/25 to 20/60), moderate (20/60 to 20/400) and severe (<20/400). Visual field damage was correspondingly graded as mild (mean defect <4 dB), moderate (mean defect 4-12 dB) or severe (mean defect >12 dB). RESULTS: 8 (13%) patients presented with bilateral ocular toxoplasmosis. Thus, a total of 69 eyes was evaluated. Visual field damage was encountered in 65 (94%) eyes, whereas only 28 (41%) eyes had reduced visual acuity, showing perimetric findings to be more sensitive in detecting chorioretinal damage (p<0.001). Correlation with the clinical localisation of chorioretinal scars was better for visual field (in 70% of the instances) than for visual acuity (33%). Moderate to severe functional impairment was registered in 65.2% for visual field, and in 27.5% for visual acuity. CONCLUSION: In its quiescent stage, ocular toxoplasmosis was associated with permanent visual field defects in >94% of the eyes studied. Hence, standard automated perimetry may better reflect the functional damage encountered by ocular toxoplasmosis than visual acuity.

Reactivation of ocular toxoplasmosis during pregnancy.

We wished to assess whether ocular toxoplasmosis can be reactivated during pregnancy in immunocompetent females, and whether such reactivation is confined to the eye or whether the fetus is exposed to the risk of vertical transmission. For this purpose, we retrospectively examined 18 females with ocular toxoplasmosis during the course of 35 pregnancies. Of these 18 patients, seven developed recurrences during seven pregnancies. Due to the potential risk of functional damage to the mother and the possibility of vertical disease transmission to the fetus, we suggest following such cases carefully during pregnancy until the dimensions of the problem are more fully appreciated.