Comparison of the Surgical Outcomes of Various Methods of Endothelial Keratoplasty.

PURPOSE: The objective of this study was to evaluate the outcomes of various techniques of endothelial keratoplasty (EK) including deep lamellar endothelial keratoplasty (DLEK), Descemet stripping endothelial keratoplasty (DSEK), and Descemet stripping automated endothelial keratoplasty (DSAEK). DESIGN: This was a retrospective comparative case series. METHODS: The medical records of 48 consecutive patients who have undergone EK in a tertiary eye center between January 2005 and June 2011 were reviewed. Information related to demographics, visual acuity, corneal endothelial cell count, and postoperative complications was recorded. RESULTS: The series included 11 eyes with DLEK, 11 eyes with DSEK, and 26 eyes with DSAEK. There was no significant difference in visual outcomes, endothelial cell loss, and postoperative complications between the 3 groups 1 year after surgery. The mean logMAR visual acuity at 12 months was 0.54 (SD, 0.26) for DLEK, 0.55 (SD, 0.47) for DSEK, and 0.63 (SD, 0.48) for DSAEK, respectively. The 6-month endothelial cell density loss was 48.4%, 39.2%, and 47.5% for the DLEK, DSEK, and DSAEK groups, respectively. Early postoperative graft dislocation occurred in 1 (9%) of the DLEK cases, 2 (18%) of the DSEK cases, and 1 (4%) of the DSAEK cases. All of these cases were successfully repositioned. CONCLUSIONS: Despite the various evolution and surgical modifications and development in EK in the past few years, the visual outcomes and postoperative complications between DLEK, DSEK, and DSAEK were comparable.

Graft suturing for lenticule dislocation after descemet stripping automated endothelial keratoplasty.

PURPOSE: To report the mid-term outcomes of graft suturing in a patient with lenticule dislocation after Descemet stripping automated endothelial keratoplasty (DSAEK). CASE REPORT: A 78-year old woman was found to have graft dislocation involving the nasal half of the cornea after uneventful DSAEK. Graft repositioning, refilling the anterior chamber with air, and placement of four full-thickness 10/0 nylon sutures over the detached area were performed two weeks after the initial surgery. The sutures were removed 6 weeks later. Serial specular microscopy and anterior segment optical coherence tomography were performed. At 18 months, there was good lenticule apposition and a clear graft. CONCLUSION: Anchoring sutures seem to be effective for management of graft detachment following DSAEK.

Surgical management of double-head pterygium by using a novel technique: conjunctival rotational autograft combined with conjunctival autograft.

PURPOSE: To describe a novel technique for the surgical management of double-head pterygium and to evaluate its safety and efficacy. METHODS: A prospective noncomparative interventional case series was conducted. Patients with primary double-head pterygium underwent pterygium excision, followed by conjunctival rotational autograft (CRA) combined with conjunctival autograft (CA). CRA was harvested from the larger pterygium and placed over the bare scleral defect of the smaller pterygium with 180-degree rotation. The bare scleral defect of the larger pterygium was covered with CA harvested from the superior bulbar conjunctiva. Patients were followed up for 1 year, and the outcomes and recurrence rates were noted. RESULTS: Twenty patients were recruited into the study, of which 7 (35%) were men and 13 (65%) were women. The mean age was 63.8 years. No intraoperative complication was encountered. Postoperatively, there was significant improvement in best-corrected visual acuity (P = 0.005) and reduction in magnitude of astigmatism (P = 0.016). At 1 year after operation, there were 7 cases of recurrence (35%), but 4 were 1 mm. The main postoperative complication was persistent CRA injection in 9 cases. CONCLUSIONS: CRA combined with CA is a safe alternative in the management of double-head pterygium. Further modifications of the surgical techniques are warranted to decrease prolonged hyperemia of the CRA.

Randomized clinical trial of the efficacy and safety of tropicamide and phenylephrine in preoperative mydriasis for phacoemulsification.

PURPOSE: To compare the mydriatic effect and safety between different concentrations of tropicamide and phenyle-phrine in preoperative mydriasis for phaco-emulsification. METHODS: Two hundred and seventeen consecutive eyes in the same number of Chinese patients undergoing phaco-emulsification under local or topical anaesthesia in a university-based eye hospital were analyzed. Patients were randomized into two groups by cluster randomization, each group receiving a different preoperative mydriatic regimen. Regimen A consisted of tropicamide 1.0% with phenylephrine 2.5%, and Regimen B consisted of tropicamide 0.5% with phenylephrine 0.5%. The main outcome measures were horizontal pupillary diameter, systolic, diastolic and pulse pressure and pulse rate. RESULTS: The group who received Regimen A attained a mean horizontal pupillary diameter of 7.00 +/- 1.06 mm. Their pupils were significantly larger than those receiving Regimen B (6.61 +/- 1.03 mm, P = 0.007). No untoward cardiovascular effects were noted in either groups. CONCLUSION: Regimen A attained better preoperative mydriasis for phacoemulsification than Regimen B. Both regimens were safe with regard to their cardiovascular effects. The combination of tropicamide 1.0% and phenylephrine 2.5% is recommended as preoperative mydriatic for phacoemulsification in Chinese patients who have darkly pigmented irides.