Causes of congenital corneal opacities and their management in a tertiary care center.

PURPOSE: To evaluate causes and management of congenital corneal opacities (CCO) diagnosed in a tertiary care eye center and to compare the data with a previous study at the same institution. METHODS: Computerized medical records in all patients with congenital corneal opacities diagnosed in the Cornea Service at Wills Eye Hospital (Philadelphia, PA) between January 1, 2007, and December 31, 2015, were retrospectively reviewed. Children aged 12 years and younger at the first visit were included in the study. Patients\u27 demographics, ocular diagnosis, laterality, associated ocular abnormalities, other ocular surgery performed prior or subsequent to the first visit, and their treatment were extracted from the medical records. RESULTS: A total of 77 eyes in 56 patients were examined. The mean age at presentation was 32.8 ± 44.2 months, with the mean follow-up period of 26.7 ± 30.1 months. The most frequent diagnosis was Peters anomaly (53.2%), followed by limbal dermoid (13.0%), aniridia with glaucoma and microphthalmos (6.5%), sclerocornea and congenital glaucoma (5.2%), idiopathic (3.9%), Axenfeld-Rieger anomaly and Hurler syndrome (2.6%), and microcornea (1.3%). Primary keratoplasty was performed in 26 eyes, with the outcome rate in the clear cornea of 76.0% during the follow-up. CONCLUSION: Peters anomaly is the most common cause of congenital corneal opacities encountered at our institution. Penetrating keratoplasty is the most frequent choice of corneal surgery to treat congenital corneal opacities. Additional interventions during penetrating keratoplasty were moderately positively correlated with graft failure. This study also shows the rates of some etiologies of that changed over the recent decades in our tertiary care Cornea Service. Although Peters anomaly remains the most common presenting reason for congenital corneal opacities, its rate appears to be increasing over the recent decade. Congenital corneal opacities due to birth trauma, which is one of the preventable causes, were observed in a previous study in our clinic; however, no new cases were noted in this study

Anterior Chamber Characteristics, Endothelial Parameters, and Corneal Densitometry After Descemet Stripping Automated Endothelial Keratoplasty in Patients With Fuchs Dystrophy

Purpose: To compare anterior segment parameters in patients with Fuchs endothelial dystrophy (FED) who underwent Descemet stripping automated endothelial keratoplasty (DSAEK) in one eye and no corneal surgery in the fellow eye. Methods: This prospective study was conducted on 28 eyes of 14 patients with FED who underwent DSAEK in one eye at least one year prior (DSAEK group) and no corneal surgery in the fellow eye (control group). Each eye was analyzed with the anterior segment optical coherence tomography, specular microscopy, and Scheimpflug imaging systems. Data were compared between the two groups. Results: The mean age of the patients was 76.9 ± 7.0 years. There were no statistically significant differences in the mean central corneal thickness (CCT), central anterior chamber depth, anterior chamber angle parameters, cylinder and keratometry values between two groups (all P-values > 0.05). The paracentral corneal thickness, corneal volume, endothelial cell density, and hexagonal cell ratio measurements were statistically significantly higher in the DSAEK group than the control (all P-values < 0.05), and anterior chamber volume in the DSAEK group was significantly less than the control (P = 0.046). While posterior and total corneal densitometry values in the DSAEK group were statistically significantly lower than the control (P < 0.001 and P = 0.011, respectively), there were no statistically significant differences in the anterior or middle corneal densities (P = 0.108 and P = 0.134, respectively). Conclusion: We found that total corneal densitometry value decreased in DSAEK group. Although DSAEK surgery did not affect the anterior chamber angle parameters, it reduced the anterior chamber volume and increased the corneal volume and paracentral corneal thickness due to the addition of the DSAEK graft

Microbial Keratitis After Penetrating and Endothelial Keratoplasty

Introduction: The purpose of this study is to review the incidence, risk factors, and outcomes of bacterial and fungal keratitis after penetrating keratoplasty (PK) and endothelial keratoplasty (EK). Methods: The medical records at Wills Eye Hospital were reviewed for all cases of confirmed microbial keratitis following PK or EK performed between May 1, 2007 and September 1, 2018. Charts were examined to obtain demographic information, past ocular history, details of the microbial keratitis, and graft outcomes. Results:A total of 2100 transplants (1269 PK and 831 EK) were performed in 1864 eyes of 1601 patients. The incidence of microbial keratitis after PK (7.5%) was significantly higher than after EK (1.3%) (p Discussion: : Microbial keratitis is a relatively common occurrence in patients with prior keratoplasty, and particularly in eyes with prior PK or multiple prior transplants. Infection is an important cause of graft failure and further surgical intervention. To the best of our knowledge, this is the largest review of microbial keratitis in cases of prior PK, and the only review in eyes with prior EK

Bleb-associated endophthalmitis: clinical characteristics and visual outcomes

To analyze the clinical characteristics and treatment outcomes of patients with bleb-associated endophthalmitis (BAE). Retrospective, noncomparative, interventional case series. Consecutive patients treated at one institution for BAE. Prompt pars plana vitrectomy (PPV) with intravitreal injection of antibiotics, or prompt vitreous biopsy and intravitreal injection of antibiotics (tap and inject). Retrospective analysis of 68 consecutive cases of BAE between July 1, 1989 and June 30, 2001. Clinical presentation, treatment modality, microbiologic data, and clinical course were analyzed. Visual outcomes were compared between vitrectomy and tap-and-inject groups, culture-positive and culture-negative groups, and early and late times. Snellen visual acuities (VAs) at 3 months and 12 months after treatment and at most recent follow-up. The incidence of no light perception (NLP) at 12 months after treatment for BAE was 35%. Vitreous isolates included streptococcal species (32% of positive cultures), Staphylococcus epidermidis (26%), Enterococcus, and Serratia (12% each). Patients with a positive vitreous culture had significantly worse VA (median, hand movements [HM] at 3 and 12 months after treatment) and a higher rate of NLP vision. Patients treated with tap-and-inject had a significantly worse final VA (medians, HM at 3 months and LP at 12 months) and a significantly higher rate of NLP vision than patients treated with PPV. One third of patients who underwent PPV achieved a final VA of 20/100 or better 12 months after treatment (P = 0.09). Bleb-associated endophthalmitis causes significant visual morbidity. Patients with culture-negative BAE and patients treated with prompt PPV may achieve better visual outcome