Outcomes of cataract surgery in graft-versus-host disease.

PURPOSE: To study the outcomes of cataract surgery in patients with graft-versus-host disease (GVHD) after allogeneic hematopoietic stem cell transplantation (HSCT). METHODS: Retrospective review of 72 eyes of 41 patients (age, 17-69 years at the time of surgery) with chronic GVHD after HSCT, who underwent cataract surgery between 2008 and 2012 at the Department of Ophthalmology and Visual Sciences, W. K. Kellogg Eye Center, University of Michigan. Ophthalmic data collected included best-corrected visual acuity (BCVA), responses to Ocular Surface Disease Index (OSDI) questionnaire, dry eye severity, and postoperative complications. RESULTS: BCVA improved from 20/49 to 20/25 (P < 0.0001) after surgery. Eight patients (20%) had pretransplantation total body irradiation and 39 patients (95%) received systemic corticosteroids for the treatment of GVHD. Postoperative complications included cystoid macular edema (4 eyes), corneal ulceration with perforation (2 eyes: 1 infected and 1 sterile), and band keratopathy (1 eye). After surgery, subjective OSDI responses and dry eye disease (DED) did not change significantly from before cataract surgery, although OSDI showed a trend toward worsening. CONCLUSIONS: With careful monitoring and management of DED and concurrent ocular surface disease, cataract surgery generally has good visual outcomes in patients with GVHD. However, aggravation of the preexisting ocular surface disease is frequent, and despite meticulous postoperative maintenance therapy, vision-threatening complications may occur.

Outcomes of cataract surgery in eyes with previous herpes zoster ophthalmicus.

PURPOSE: To report the outcomes of cataract surgery in eyes with previous herpes zoster ophthalmicus (HZO). SETTING: Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA. DESIGN: Retrospective case series. METHODS: Eyes with a history of HZO that had phacoemulsification and intraocular lens implantation were reviewed. The information analyzed included the ophthalmologic history, visual acuity, preoperative and postoperative adjunct treatments, and complications. Analysis of the mean corrected distance visual acuity (CDVA) at 1 month, 1 year, and the last follow-up was performed. RESULTS: Twenty-four eyes were evaluated. The mean CDVA improved from 20/112 (0.75 logMAR ± 0.63 [SD]) preoperatively to 20/53 (0.42 ± 0.56 logMAR) 1 month postoperatively (P = .007) and 20/44 (0.34 ± 0.55 logMAR) at 1 year (P = .052) but decreased to 20/71 (0.55 ± 0.72 logMAR) by last follow-up (P = .605 versus preoperative CDVA). Eleven patients (45.8%) had recurrent keratouveitis after the first episode, 5 before cataract surgery and 6 after cataract surgery. Three had penetrating keratoplasty for worsening corneal opacification. Two patients had tractional retinal detachment from chronic uveitis and required vitrectomy and retinal repair. CONCLUSIONS: Visual recovery after cataract surgery in HZO might be compromised by chronic factors such as ocular surface disease and keratouveitis. Despite long quiescent waiting periods before surgery and aggressive preoperative and postoperative maintenance therapy, visual improvement might be hindered by the inherent pathology associated with HZO. Nevertheless, with careful patient selection, reasonable visual improvement can be achieved. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Dry Eye Disease Incidence Associated with Chronic Graft-Host Disease: Nonconcurrent Cohort Study (An American Ophthalmological Society Thesis).

PURPOSE: To determine if chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (HSCT) is associated with stable or progressive dry eye disease and to determine the true incidence in patients with no prior history of dry eye disease. METHODS: A nonconcurrent cohort study at a single institution with 136 patients who had no previous history of dry eye disease before HSCT. Survival analysis was used to estimate dry eye disease incidence. The incidence rate was calculated using life tables as the number of observed dry eye disease cases divided by the person-time at risk accumulated by the cohort. Transition probabilities were calculated from time of transplant to time of diagnosis, and then to last recorded visit. RESULTS: Incidence rate was 0.8 cases of dry eye disease per person-year, and half of the population at risk developed dry eye disease during the first 10 months post transplant. Time to develop dry eye disease was 2.5 months for mild dry eye disease, 9.6 months for moderate dry eye disease, and 13.2 months for severe dry eye disease. In terms of cumulative incidence, 73% of subjects developed dry eye disease (50% mild, 16% moderate, and 7% severe) at the time of diagnosis. CONCLUSIONS: Our findings suggest that dry eye disease associated with cGVHD is an extremely frequent event and shows a wide spectrum of severity, with a mild form presenting early and a moderate to severe form presenting later after HSCT. These findings need to be studied further to elucidate if these are two different pathophysiological entities or just different expressions of the same pathology.

Anterior chamber gas bubbles during femtosecond laser flap creation in LASIK: video evidence of entry via trabecular meshwork.

UNLABELLED: Femtosecond laser photodisruption of corneal stroma during laser in situ keratomileusis flap creation is accompanied by the formation of cavitation gas bubbles consisting of carbon dioxide and water vapor. Entry of these bubbles into the anterior chamber is an infrequent complication. We present video evidence that these bubbles enter via the trabecular meshwork. FINANCIAL DISCLOSURE: Neither author has a financial or proprietary interest in any material or method mentioned.