Deep anterior lamellar keratoplasty for keratoconus: Elements for success

Advanced keratoconus may require keratoplasty when the patient can no longer achieve functional vision with glasses and contact lenses. Deep anterior lamellar keratoplasty (DALK) has become the surgical treatment of choice due to its undisputed advantages over penetrating keratoplasty including the reduced risk of intraoperative complications, the absence of endothelial immune rejection, and the longer graft survival. Albeit "big-bubble" DALK still represents the most popular surgical method, several modifications have been developed over the years. This allowed standardization of the technique, with improved success rates and clinical outcomes. This review presents an overview on the literature on DALK surgery for keratoconus. We discuss state-of-the art surgical techniques, current evidence on the clinical outcomes and complications as well as possible future directions

Bilateral Corneal Perforation in a Patient with Chronic Ocular Graft-Versus-Host Disease: A Case Report and Literature Review

Graft-versus-host disease (GVHD) is a serious complication that may occur in patients receiving allogeneic hematopoietic stem cell transplant (HSCT). GVHD occurs because of the immunological reaction between the donor’s T cells and the recipient’s antigens; GVHD may develop in different tissues, including the eye. Corneal perforation is an uncommon but vision-threatening manifestation of GVHD. We reported the case of a 65-year-old male patient who developed corneal perforation sequentially in both eyes 3 years after receiving HSCT. Conservative treatment with topical steroids and lubricants, bandage contact lens, and lacrimal punctal occlusion surgery resulted in the successful resolution of the corneal perforation with satisfactory visual recovery in the right eye. Therefore, corneal perforation can occur as the presenting manifestation of ocular GVHD. Regular ophthalmological examinations are recommended after HSCT to enable the early diagnosis of ocular GVHD and prompt treatment initiation

Detection of severe acute respiratory syndrome coronavirus 2 in corneas from asymptomatic donors

The detection of SARS-CoV-2 RNA in corneas from asymptomatic donors underscores the need for further research to better understand the role that corneal transplantation may play in viral transmission

Intravitreal Dexamethasone Implant in Patients Who Did Not Complete Anti-VEGF Loading Dose During the COVID-19 Pandemic: a Retrospective Observational Study

Introduction To compare the functional and anatomic outcomes between eyes in patients with diabetic macular edema (DME) who underwent a complete anti-vascular endothelial growth factor (VEGF) loading dose with aflibercept and those who were switched to dexamethasone intravitreal (DEX) implant after an incomplete anti-VEGF treatment regimen during the coronavirus disease 2019 (COVID-19) pandemic. Methods This was a retrospective and comparative study conducted on patients with DME. Main outcome measures were mean change in best corrected visual acuity (BCVA) and central retinal thickness (CRT) from baseline to month 4. Results Forty-three eyes (23 eyes in the anti-VEGF group and 20 eyes in the DEX group) were included. Mean BCVA significantly improved from 37.7 +/- 25.3 and 35.7 +/- 22.0 letters at baseline to 45.4 (23.9) (mean adjusted BCVA improvement 7.6 +/- 20.8 letters, p = 0.033) and 46.1 +/- 26.0 (mean adjusted BCVA improvement 10.6 +/- 15.9 letters, p = 0.049) at month 4 in the anti-VEGF and DEX groups, respectively, with no significant differences between study groups (mean adjusted BCVA difference 2.8 letters, 95% CI - 9.4 to 14.9 letters, p = 0.648). There were no statistically significant differences in the proportion of eyes that achieved a BCVA improvement of >= 5, >= 10, and >= 15 letters between groups. CRT was significantly reduced from baseline to month 4 in both DEX (mean adjusted CRT reduction 167.3 +/- 148.2 mu m, p = 0.012) and anti-VEGF groups (mean adjusted CRT reduction 109.9 +/- 181.9 mu m, p < 0.001), with no differences between them (mean adjusted CRT difference 56.1 mu m, 95% CI - 46.0 to 158.2 mu m, p = 0.273). Of 20 eyes in the DEX group, 16 (80.0%) and 9 (45.0%) eyes achieved a CRT reduction of >= 20% from baseline at 2 months and at 4 months, respectively. Conclusions Our results seem to suggest that DEX implant can significantly improve both functional and anatomic clinical outcomes in patients who were unable to complete anti-VEGF loading dose during the COVID-19 pandemic

September consultation #2

Currently, the standard approach for managing epithelial ingrowth involves lifting of the LASIK flap followed by removal of the ingrowth through mechanical debridement. However, 30 years after surgery, safely lifting the LASIK flap without causing tears or damaging the flap may prove quite challenging

Comment on: "Descemet-Stripping Automated Endothelial Keratoplasty Centration and Interface Folds: Surgical Management"

No abstract availabl

The Ongoing Debate: Descemet Membrane Endothelial Keratoplasty Versus Ultrathin Descemet Stripping Automated Endothelial Keratoplasty

Currently, the ability to perform DMEK is widely perceived as the hallmark of superior technical prowess in the field of corneal surgery, thereby unduly driving many novice surgeons to solely perform DMEK. Beyond the analysis of empirical evidence from published data, surgical decision-making must be informed by pragmatic and pru- dent determination of the right procedure for the right patient by the right surgeon. Ultimately, both DMEK and ultrathin DSAEK represent valuable tools in the surgical armamentarium of any corneal specialist

Reply [Re: Busin et al.: The ongoing debate: Descemet membrane endothelial keratoplasty versus ultrathin Descemet stripping automated endothelial keratoplasty (Ophthalmology. 2020;127:1160e1161)]

hen the intended graft thickness is <100 μm, as in ultrathin DSAEK, there is a greater probability of obtaining a regular and symmetric graft, thus resulting in better vision.3 Although highly functional vision can still be achieved in a large number of cases, raising the bar for DSAEK must also involve standardized graft preparation that yields consistent graft qualit

Re: Singh et al.: Vaccine-associated uveitis following COVID-19 vaccination: vaccine adverse event reporting system database analysis (Ophthalmology. 2023;130:179-186)

Although the VAERS database represents an essential tool for pharmacovigilance and its analysis allows prompt identification of safety signals and due consideration of serious vaccine side effects, higher levels of evidence would still be required to definitively establish causation. As we await more epidemiological data, we agree with the authors that it remains prudent to distinguish the observed temporal relationship from a true causal association.

Large-Diameter Modified Big-Bubble Deep Anterior Lamellar Keratoplasty in Post-Radial Keratotomy Eyes

PURPOSE: To report the outcomes of our modified large-diameter (9-mm) big-bubble deep anterior lamellar keratoplasty (DALK) technique with improved success rates of pneumatic dissection in post-radial keratotomy (RK) eyes.DESIGN: Retrospective case series.METHODS: At Ospedali Privati Forli, "Villa Igea," Forli, Italy., modified big-bubble DALK was performed in consecutive post-RK eyes. The technique included large-diameter (9-mm) deep partial-thickness trephination based on the thinnest anterior segment optical coherence tomography pachymetry value at 9 mm, air injection through a cannula advanced 2 mm centripetally from the base of the trephination, limited stromal clearance of the central 6-mm optical zone, and suturing of a 9-mm anterior lamellar graft prepared by microkeratome dissection. Success rate of pneumatic dissection, corrected distance visual acuity (CDVA), keratometric astigmatism, and complications were recorded.RESULTS: Eight eyes of 7 patients were included. Pneumatic dissection succeeded in 7 cases (87.5%). CDVA significantly improved from 0.94 +/- 0.43 to 0.14 +/- 0.06 logMAR (P <.001). All eyes reached Snellen CDVA >= 20/40, whereas 3 eyes (37.5%) reached >= 20/25. At the last follow-up, 5 eyes (62.5%) had a final keratometric astigmatism <= 4 diopters, whereas 2 eyes (25.0%) had <= 2 diopters.CONCLUSION: Big-bubble DALK can be successfully performed in post-RK eyes with our standardized technique. (c) 2022 Elsevier Inc. All rights reserved