Comparison of Manual and Femtosecond Laser–Assisted Descemet Membrane Endothelial Keratoplasty for Failed Penetrating Keratoplasty
Nir Sorkin; Michael Mimouni; Gisella Santaella; Tanya Trinh; Eyal Cohen; Adi Einan-Lifshitz; Clara C.Chan; David S.Rootman
Purpose
To compare outcomes of manual Descemet membrane endothelial keratoplasty (M-DMEK) and femtosecond laser–assisted Descemet membrane endothelial keratoplasty (F-DMEK) in treatment of penetrating keratoplasty (PK) graft failure.
Methods
Setting: Retrospective, interventional comparative case series. Patient Population: Included were all patients with a failed PK graft who underwent either F-DMEK (10 eyes of 10 patients) or M-DMEK (29 eyes of 29 patients) at Toronto Western Hospital and the Kensington Eye Institute between 2014 and 2019, and had 6 months of postoperative follow-up. Outcome Measures: Rates of graft detachment, rebubbling, rejection and failure, best spectacle-corrected visual acuity (BSCVA), and endothelial cell (EC) density.
Results
Rate of significant graft detachment (detachment requiring either rebubble or repeat keratoplasty) was 10.0% in F-DMEK and 65.5% in M-DMEK (P = .003). Rebubble rate was 10.0% in F-DMEK and 58.6% in M-DMEK (P = .011). Primary failure rate was 0% in F-DMEK and 27.6% in M-DMEK (P = .086). Rates of rejection and secondary failure did not differ between the groups (P = 1.000 for both). In a multivariable analysis, F-DMEK was found to be the only independent factor significantly associated with reduced postoperative detachment. Postoperative BSCVA at 6 months returned to prefailure levels in both groups, with no significant difference between the groups at any time point. EC loss rates were 43.8% in F-DMEK and 38.0% in M-DMEK at 6 months (P = .453).
Conclusions
F-DMEK is a safe and effective procedure in failed PK patients, with outcomes comparable to M-DMEK, and with reduced detachment and rebubble rates. A trend towards reduced primary failure should be further studied.
Risk Factors for Intraocular Lens Dislocation After Phacoemulsification: A Nationwide Population-Based Cohort Study
Ga-InLee; Dong Hui Lim; Sang Ah Chi; Seon Woo Kim; Dong Wook Shin; Tae-Young Chunga
Purpose
Few studies have measured the incidence and risk factors of intraocular lens (IOL) dislocation in the total population. We investigate the risk factors for IOL dislocation in a nationwide Korean cohort.
Design
Retrospective cohort study.
Methods
National data on 2,162,191 subjects who underwent cataract surgery were collected from the Health Insurance Review and Assessment service database of health claims from 2009 to 2016. The Health Insurance Review and Assessment database was used to identify potential risk factors for IOL dislocation, including age, sex, and various pre- and postoperative ophthalmic conditions. The hazard ratios (HRs) and confidence intervals (CIs) of these risk factors were assessed with a multivariable-adjusted Cox regression model.
Results
IOL dislocation occurred in 15,170 patients (0.7%) in the cataract surgery cohort (2,162,191 patients). The incidence rate of IOL dislocation peaked at 40-50 years of age, although the mean age of IOL dislocation was 65.25 ± 10.81 years. The average male:female ratio was 1.8. The adjusted HR for IOL dislocation in patients with partial vitrectomy was 11.93 (95% CI 10.95-12.99; P < .0001). Posterior capsulotomy performed within 1 year after the cataract surgery significantly decreased IOL dislocation, with an adjusted HR of 0.48 (95% CI 0.44-0.51; P < .0001).
Conclusions
IOL dislocation tended to occur in young males. Anterior vitrectomy was a significant risk factor for IOL dislocation, while posterior capsulotomy after surgery was associated with a decreased risk of IOL dislocation.
Endothelial Safety and Efficacy of Ex Vivo Collagen Cross-linking of Human Corneal Transplants
Jan Lammera; Maria Laggner; Niklas Pircher; Isaak Fischinger; Christina Hofmann; Gerald Schmidingera
Purpose
To assess endothelial safety and efficacy of ex vivo corneal collagen cross-linking (CXL) in human corneal transplants stored in 2 different culture media.
Design
Fellow-eye controlled laboratory study of ex vivo human donor corneas.
Methods
Three sets of paired human donor corneas, 5 pairs each, were stored in organ culture medium before deswelling either at 31 C or at room temperature. One eye of each pair was cross-linked by 0.1% riboflavin in hydroxylpropyl methylcellulose (HPMC) instillation for 10 minutes followed by 10 minutes of ultraviolet-A (9 mW/cm2) irradiation while contralateral eyes served as controls. In Set 1, endothelial cell densities were determined. In Set 2, paired samples were assigned to the 2 deswelling media and CXL efficacy was assessed comparing to untreated controls using collagenase-A-assisted enzymatic digestion. In Set 3, biomechanical testing was performed in the eye pairs (treated vs control) by stress/strain measurements.
Results
There was no difference in endothelial cell counts between CXL samples and controls (P = .21). No statistically significant difference in digestion dynamics was found between tissues stored in the 2 different culture media. Complete enzymatic digestion was slowed down by 3 hours in the cross-linked samples (P = .036). Stress needed for a 12% strain was increased by 34% in the treatment group compared to control (P = .04).
Conclusions
Ex vivo CXL of human donor tissue is an effective and safe procedure with no difference regarding efficacy between 2 commercially available deswelling media. Biochemical and biomechanical resistance were significantly increased after CXL. Patients requiring keratoplasty owing to corneal melting might benefit from the strengthening effect of preoperative CXL of donor tissue.
Long-Term Outcomes of Upper Eyelid Loading with Platinum Segment Chains for Lagophthalmos: An Adjustable Approach
Ela d Ben Artsi; Katja Ullrich; Luca Brusasco; Raman Malhotra
Purpose
This article reports the outcomes of a 5-year series of individually sutured platinum segment chains for upper eyelid loading.
Design
Consecutive case series.
Methods
Platinum segments of 0.4 and 0.2 g were assembled to create the desired weight and were placed in a supratarsal location after levator aponeurosis recession. Primary outcome measures included lagophthalmos on blink, gentle and forced eyelid closure, upper eyelid margin-to-reflex distance (MRD1), corneal staining, static and dynamic validated scoring for facial palsy patients, and complications. Secondary outcome measures were visual acuity, occurrence of induced ptosis, need for further surgery, cosmesis, and quality of life evaluation.
Results
During 2013-2018, a total of 122 upper eyelids of 117 patients received platinum segment chains (mean weight, 1.2 ± 0.2 g; range, 0.8-1.6 g) for lagophthalmos. Median follow-up was 17.4 months. All grades of lagophthalmos were reduced (P < 0.001), with mean reductions of 3.6, 2.5, and 1.5 mm on blink, gentle, and forced closures, respectively. Mean MRD1 was reduced by 1.4 mm (P < 0.001). Overall, 36 eyelids (29.5%) underwent revision surgery at 9.1 ± 9.2 months after implantation. Of those, 6 eyelids (5.0%) required 2 or more procedures. No platinum allergy occurred. The chain was graded as having no prominence in 77.5% of eyelids; the eyelids were graded as having a normal contour in 70.8% of cases.
Conclusions
Platinum segments are US Food and Drug Administration approved and provide benefits of platinum chains with the additional advantages of allowing postoperative adjustability, reduced health care costs, and less likelihood of inducing allergy than gold. Platinum segments are an ideal first-line loading implant for lagophthalmos.