Corneal transplantation activity in Catalonia, Spain, from 2011 to 2018: evolution of indications and surgical techniques.

Purpose: To report corneal transplant activity carried out in Catalonia (Spain) and the evolving indications for keratoplasty over an 8-year period. Methods: Annual reports from the Catalan Transplant Organization, Spain, on corneal graft indications and techniques from 2011 to 2018 were reviewed. Results: A total of 9457 keratoplasties were performed in Catalonia, from January 2011 to December 2018. The most frequent indications were bullous keratopathy (BK; 20.5%), Fuchs endothelial dystrophy (FED; 17.9%), re-graft (13.7%), and keratoconus (11.3%). Penetrating keratoplasty (PKP) accounted for 63.4% of all performed keratoplasties. Since the introduction of eye bank precut tissue for Descemet stripping automated endothelial keratoplasty (DSAEK) in 2013 and for Descemet membrane endothelial keratoplasty (DMEK) in 2017 the number of endothelial keratoplasties has drastically increased. An increasing trend of posterior lamellar techniques over the total of keratoplasties was found (p<0.001). Endothelial keratoplasties for different endothelial diseases indications (BK, FED, and re-graft), also showed and increasing trend (p<0.001). DMEK is the technique with the highest increase (statistically significantly different from linearity) over other endothelial keratoplasties in FED (p<0.001) but not in BK (p = 0.67) or re-grafts (p = 0.067). Conclusion: Endothelial diseases represented the top indication for keratoplasty over the 8-year period. PKP is still the most used technique in Catalonia, but endothelial keratoplasties and especially DMEK showed a significant increasing trend over the last years. This is congruent withthe main rationale nowadays for keratoplasties: to customize and transplant as less tissue as possible. Therefore, the availability of precut tissue could have definitely enforced such approach

Biosustitutos para el tratamiento de la patología de la córnea y la superficie ocular: epidemiología, aplicaciones clínicas y controles microbiológicos

[spa] INTRODUCCIÓN: La patología de la superficie ocular puede requerir de biosustitución mediante el implante de diferentes tipos de tejido. Se han descrito diversos biosustitutos de la superficie ocular. Las indicaciones, técnicas quirúrgicas, formulaciones y controles de calidad han sufrido modificaciones y cambios en los últimos años. HIPÓTESIS: Existe un cambio de tendencias en las indicaciones y formulaciones y/o técnicas quirúrgicas para el manejo y tratamiento de la patología de la córnea y superficie ocular. Asimismo, se considera que el control de la calidad de estos biosustitutos es de suma importancia para evitar efectos adversos y complicaciones para el receptor. Además, la investigación y desarrollo constantes de los biosustitutos de origen humano, ha permitido recientemente disponer de nuevos formatos y formulaciones para la aplicación clínica en el tratamiento de diferentes patologías de la superficie ocular OBJETIVO: Conocer las indicaciones de biosustitutos de origen humano - córnea, esclera, membrana amniótica - para el tratamiento de las patologías de la córnea y superficie ocular en Catalunya. Evaluar el uso de los cultivos microbiológicos de anillos esclerocorneales y medios de conservación corneal como control perioperatorio del tejido donante en el mundo real. Evaluar los resultados clínicos de los biosustitutos autólogos, como la conjuntiva, y evaluar los resultados clínicos de los recientes formatos de la membrana amniótica disponibles en Cataluña – liofilizada y extracto de membrana amniótica – desde un punto de vista de validación y estudio en la práctica clínica. RESULTADOS: Las indicaciones más frecuentes en Catalunya para queratoplastia entre los años 2011-18 son queratopatía bullosa, distrofia endotelial de Fuchs y retrasplante. La queratoplastia penetrante es aún la técnica más prevalente a pesar de que se ha encontrado una tendencia creciente estadísticamente significativa de las queratoplastias endoteliales y especialmente para la Descemet Membrane Endothelial Keratoplasty, en estrecha relación con la disponibilidad de tejido precortado. Las principales indicaciones del implante de tejido escleral en Catalunya entre los años 2011-18 son la cirugía del glaucoma y la reconstrucción palpebral. Y para la utilización de la membrana amniótica en Catalunya entre los años 2011-18 son las úlceras corneales y la reconstrucción conjuntival. Con relación a los controles microbiológicos de las córneas utilizadas para queratoplastia, las técnicas de preservación de tejido mediante las aproximaciones en hipotermia muestran una mayor tasa de contaminación de los tejidos, estadísticamente significativa, que las aproximaciones en cultivos organotípicos. El estudio de la adherencia al tratamiento postoperatorio tras cirugía de pterigión con autoinjerto conjuntival muestra que la adherencia está relacionada de manera estadísticamente significativa con el protocolo de tratamiento. La membrana amniótica es un biosustituto que ha demostrado tener efectos beneficiosos tanto en la presentación liofilizada - como coadyuvante para la reconstrucción de la superficie ocular en la cirugía del pterigión -, como en forma de colirio de extracto - para el cierre epitelial y en la disminución de la sintomatología asociada al ojo seco tanto es un entorno controlado como en un estudio de vida real. Conclusión: Las técnicas de queratoplastia lamelares aún no son las predominantes en nuestro medio, a pesar de que ha habido un cambio de tendencias importante y en relación con la disponibilidad de tejido precortado. Las principales indicaciones del implante de tejido escleral son la cirugía del glaucoma y la reconstrucción palpebral; y las principales indicaciones de la utilización de la membrana amniótica son las úlceras corneales y la reconstrucción conjuntival. Las técnicas de preservación de tejido corneal mediante las aproximaciones en hipotermia muestran una mayor tasa de contaminación. Los pacientes tras cirugía de pterigión con autoinjerto conjuntival presentan diferente tasa de adherencia al tratamiento postoperatorio según el protocolo postoperatorio indicado. La membrana amniótica es un biosustituto que ha demostrado tener efectos beneficiosos tanto en la presentación liofilizada - como coadyuvante para la reconstrucción de la superficie ocular en la cirugía del pterigión -, como en forma de colirio de extracto - para el cierre epitelial y en la disminución de la sintomatología asociada al ojo seco.[eng] Ocular surface patologies treatment could require of substitutes of human origin (SoHO). Diferent SoHO have been described and its indications, surgical techniques, formulations and quality controls have been modified for the last years. The objectives of this investigation were to know the indications in Catalonia for SoHO for ocular surface treatment, to evaluate the microbiological cultures as a perioperative quality control and evaluate clinical outcomes of autologous and allogenic SoHO in Catalonia. RESULTS: main indications of queratoplasty from 2011 to 2018 were bullous keratoplasty, Fuchs endothelial dystrophy and regraft. Penetrant keratoplasty was the principal technique despite a statistical significant ascendent trend in lamellar keratoplasties, related to precut tissue availability. Main indications of sclera tissue were glaucoma surgery and lid reconstruction and of amniotic membrane were corneal ulcer and conjunctival recontruction. Corneas preserved in hypothermia had a statistical significant higher contamination rate. Adherence to postoperative treatment in patients with previous pterigium surgery is statistically related to the protocol. Amniotic membrane showed to have beneficial effects in its different formulations – liophylized and as a amniotic membrane extract eye drops for different patologies as wound healing defects, dry eye disease and pterigium. CONCLUSION: lamelar keratoplasty techniques have not yet achived the predominance in our area despite a statistical significant shift in trends has been detected indeed. Main indications of keratoplasty were bullous keratoplasty and Fuchs endothelial dystrophy; of scleral tissue were glaucoma surgery and lid reconstruction and of amniotic membrane were corneal ulcer and conjunctival recontruction. Corneas preserved in hypothermia showed a higher contamination rate. Adherence to postoperative treatment in patients with previous pterigium surgery is statistically related to the protocol. Amniotic membrane showed to have beneficial effects in its different formulations – liophylized and as a amniotic membrane extract eye drops

Comparison of two methods for obtaining and transporting corneal samples in suspected infectious keratitis

Background and purpose The purpose of this study is to compare two alternative methods of collecting and transporting media for the diagnosis of corneal ulcers, as not all clinical settings have conventional culture materials and transport media available. Methods In this open-label, prospective, comparative, and randomized study, patients with clinical suspicion of infectious keratitis with high risk of loss of vision had corneal specimens collected using two methods and transport media: Eswab scraping with Amies transport medium and 23-gauge needle scraping in BACTEC Peds broth. The order of each collection method was randomized. The samples were processed by standard methods, comparing the positivity frequencies for both by parametric and nonparametric tests, according to normality criteria. Results Corneal infiltrates from 40 eyes of 40 patients were analyzed. Culture positivity rate was 50% for Eswab and 35% for 23-gauge needle (P = 0.258). The overall growth rate of the two methods combined was not higher than with the swab alone. The results obtained with a swab were not influenced by the collection sequence (P = 0.112); however, the positivity rate was significantly higher when the sample taken with the needle was performed first (P = 0.046). Conclusions The single sample Eswab method of collection and transportation for the diagnosis of high risk corneal ulcers is a valid alternative and can be used in cases in which, for various reasons, there is no access to the full set of traditional culture materials

P09-A130 Management of an eye bank with organ-cultured and hypothermic corneas: microbiology in endothelial grafts

Eye bank; Endothelial graftsBanco de ojos; Injertos endotelialesBanc d'ulls; Empelts endotelialsPurpose To analyse the microbiologic control results taken during the processing of hypothermic and cultured corneas for endothelial transplants comparing the two groups from January to September 2022. METHODS The microbiological controls of hypothermic corneas prepared for DSAEK or DMEK are: Transport Eusol control (pre-manipulation) and new Eusol control (post-manipulation). In cultured corneas the number of controls is increased to 4: first culture medium, evaluation culture medium, transport medium 24 hours post-evaluation and transport medium post-manipulation. RESULTS A total of 1438 corneas were processed for transplant during the 9 months studied (321 fresh corneas and 1113 cultured corneas). A total of 557 corneas were prepared for DSAEK or DMEK, from which 89 (15,98%) were hypothermic corneas and 468 (84.O2%) were cultured. From hypothermic corneas, 65 were cut for DSAEK and with 24 corneas, pre-stripping for DMEK was done. In the case of cultured corneas, 187 were cut for DSAEK and with 281 pre-stripping for DMEK was done. The number of corneas with positive results in the microbiological controls were 15 (16,85%) in the case of fresh corneas (in 7 corneas that were prepared for DSAEK and in 8 for DMEK) and 4 cases (0,85%) in cultured corneas (in 3 corneas for DSAEK and in 1 corneas for DMEK) resulting in a clear difference between both preservation methods. Bio-surveillance notifications notified during the studied period have been a total of 5, from which 2 were SAE in hypothermic corneas and other 2 were SAE and 1 SAR, in cultured corneas, all for endothelial transplantations. Conclusion The number of positive results for microorganisms was higher in the case of hypothermic corneas and the Bio-surveillance notifications were also a little bit higher in hypothermic corneas (2,25%) comparing to organ cultured corneas (0.64%). The management of an eye bank with both preservation systems is challenging with its advantages and disadvantages. The main disadvantage of hypothermic corneas is the risk of not detecting contaminations because the corneas are released without any definitive results but it is compensated by the fact that they allow us to respond to emergencies, tissue returns, apart from the economic aspect

Visual Quality and Subjective Satisfaction in Ultrathin Descemet Stripping Automated Endothelial Keratoplasty (UT-DSAEK) versus Descemet Membrane Endothelial Keratoplasty (DMEK): A Fellow-Eye Comparison

Background: To analyze objective and subjective visual quality differences between descemet membrane endothelial keratoplasty (DMEK) and ultra-thin descemet stripping automated endothelial keratoplasty (UT-DSAEK) with a paired contralateral-eye design. Methods: A cross-sectional, comparative, and observational case series study between DMEK and UT-DSAEK were presented. Visual acuity, refractive status and corneal quality assessment were compared between both endothelial keratoplasty techniques. The sample consisted of 20 eyes (10 patients) diagnosed with Fuchs endothelial corneal dystrophy. All measurements were performed preoperatively and at six months after surgery. Analyzed data included the measurement of objective scattering index, modulation transfer function, Strehl ratio, and optical quality assessment (OQAS) values. Contrast sensitivity, subjective patient satisfaction, visual acuity, tomography, pachymetry, endothelial cell count, and refraction status were also analyzed. Results: Objective and subjective visual quality variables had similar results among UT-DSAEK and DMEK procedures. Statistically significant differences favoring DMEK against UT-DSAEK were found in endothelial cell density (658.80 ± 139.33 and 1059.00 ± 421.84 cells/mm2, respectively), pachymetry (621.20 ± 33.74 and 529.70 ± 30.00 µm, respectively), and follow-up (45.50 ± 24.76 and 15.50 ± 8.43 months, respectively). Conclusions: UT-DSAEK and DMEK revealed no differences in terms of objective and subjective visual quality. However, DMEK showed a faster recovery during the follow-up, increased endothelial cell density, lower pachymetry, and a more anatomical posterior keratometry against UT-DSAEK in this case series paired-eye study

Global multi-site, prospective analysis of cataract surgery outcomes following ICHOM standards: the European CAT-Community

Purpose To evaluate in a large sample of patients from 10 different European centers the results of cataract surgery, characterizing the relationship between patient-reported outcomes (PROMs) and clinician-reported outcome measures (CROMs). Methods Prospective non-interventional multicenter observational descriptive study analyzing the clinical outcomes of a total of 3799 cases undergoing cataract surgery (mean age: 72.7 years). In all cases, the cataract surgery standard developed by the International Consortium for Health Outcomes Measurements (ICHOM) was used to register the clinical data. Three-month postoperative visual acuity and refraction data were considered CROMs, whereas Rasch-calibrated item 2 (RCCQ2) and total Catquest-9SF score (CQ) were considered PROMs. Results Postoperative corrected distance visual acuity (CDVA) was 0.3 logMAR or better in 88.7% (2505/2823) of eyes. Mean differences between preoperative and postoperative RCCQ2 and CQ scores were −3.09 and −2.39, respectively. Visual function improvement with surgery was reported by 91.5% (2163/2364) of patients. Statistically significant, although weak, correlations of postoperative CDVA with postoperative refraction, PROMs, and complications were found (0.133 ≤ r ≤0.289, p < 0.001). A predictive model (R2: 0.254) of postoperative CDVA considering 10 variables was obtained, including preoperative CDVA, different ocular comorbidities, age, gender and intraoperative complications. Likewise, another predictive model (R2: 0.148) of postoperative CQ considering a total of 14 variables was obtained, including additionally preoperative CQ, target refraction and previous surgeries. Conclusions Cataract surgery provides an improved functional vision in most of patients although this improvement can be limited by ocular comorbidities and complications. The relationship between PROMs and CROMs is multifactorial and complex.This study has been sponsored by a grant from Johnson & Johnson Vision. The author David P Piñero has been supported by the Ministry of Economy, Industry and Competitiveness of Spain within the program Ramón y Cajal, RYC-2016-20471

Diagnostic yield of chest and thumb ECG after cryptogenic stroke, Transient ECG Assessment in Stroke Evaluation (TEASE): an observational trial

Objective In stroke survivors, atrial fibrillation (AF) is typically evaluated solely by short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring or insertable cardiac monitors require substantial resources. Chest and thumb ECG could provide an alternative means of AF detection, which in turn could allow prompt anticoagulation to prevent recurrent stroke. The objective of this study was to assess the yield of newly diagnosed AF during 28 days of chest and thumb ECG monitoring two times per day in cryptogenic stroke.Methods This study, Transient ECG Assessment in Stroke Evaluation, included patients who had a stroke from Region Gävleborg, Sweden, between 2017 and 2019. Patients with a recent ischaemic stroke without documented AF (or other reasons for anticoagulation) before or during ECG evaluation in the stroke unit were evaluated using the Coala Heart Monitor connected to a smartphone application for remote monitoring.Results The prespecified number of 100 patients (mean age 67.6±10.8 years; 60% men) was analysed. In nine patients (9%, number needed to screen 11) AF but no other significant atrial arrhythmias (&gt;30 s) was diagnosed. The mean CHA2DS2-VASc score was similar among patients with AF and no AF (4.9±1.1 vs 4.3±1.3; p=0.224) and patients with AF were older (74.3±9.0 vs 66.9±10.8; p=0.049). Patients performed on average 90.1%±15.0% of scheduled transmissions.Conclusion In evaluation of cryptogenic stroke, 9% of patients had AF detected using chest and thumb ECG two times per day during 1 month. In many stroke survivors, this is a feasible approach and they will be potentially protected from recurrent stroke by anticoagulation treatment.Trial registration number NCT03301662

Prevalence and genotype distribution of cervical human papilomavirus infection in the pre-vaccination era: a population-based study in the Canary Islands

Objective National Spanish studies show that prevalence of cervical human papillomavirus (HPV) infection in the female population is increasingly frequent, with an overall estimate of 14% in women aged 18–65 years. The objective of this study is to know the prevalence and distribution of HPV types in the female population of the Canary Islands prior to the introduction of HPV vaccines and to investigate the associated clinical and sociodemographic factors.Methods Based on the Primary Health Care database, a sample of adult women (aged 18–65 years) of Gran Canaria (GC) and Tenerife (TF) stratified into nine age groups was carried out between 2002 and 2007. Women were contacted by postal letter and telephone call and were visited in their primary care centre. A clinical-epidemiological survey was completed and cervical samples were taken for cytological study and HPV detection. HPV prevalence and its 95% CI were estimated, and multivariate analyses were performed using logistic regression to identify factors associated with the infection.Results 6010 women participated in the study, 3847 from GC and 2163 from TF. The overall prevalence of HPV infection was 13.6% (CI 12.8%–14.5%) and 11.1% (CI 10.3%–11.9%) for high-risk types. The most frequent HPV type was 16 followed by types 51, 53, 31, 42 and 59. HPV types included in the nonavalent vaccine were detected in 54.1% of infected women. Factors associated with an increased risk of infection were: young ages (18–29 years), the number of sexual partners throughout life, not being married, being a smoker, and having had previous cervical lesions or genital warts.Conclusions It is confirmed that prevalence of HPV infection in the female population of the Canary Islands is high, but similar to that of Spain, HPV 16 being the most frequent genotype. The determinants of infection are consistent with those of other populations