Purpose: To compare the visual outcomes, reading performance, and quality of life (QoL) of working-age cataractous patients bilaterally implanted with 3 different diffractive multifocal intraocular lenses (MIOLs).Design: Two-center, randomized, prospective, double-masked study.Participants: Sixty-three consecutive patients (126 eyes) seen at Ophthalmology Section, Palermo and Florence University, Italy, randomized to receive the ReSTOR SN6AD3 (Alcon Laboratories, Inc, Irvine, CA) (20 patients, group A), ReSTOR SN6AD1 (Alcon Laboratories, Inc) (21 patients, group B), or TECNIS ZMA00 (Abbott Medical Optics, Santa Ana, CA) (22 patients, group C) MIOL.Intervention: Phacoemulsification.Main Outcome Measures: One-year follow-up differences among the 3 MIOL groups in visual acuity, reading performance by MNREAD (Minnesota Laboratory for Low-Vision Research, University of Minnesota, Minneapolis, MN) reading acuity (RA), critical print size (CPS), and maximum reading speed (MRS) under mesopic and photopic conditions.Secondary Outcome Measures: Photopic and mesopic contrast sensitivity (CS) by Pelli–Robson test and patient satisfaction by National Eye Institute Refractive Error Quality of Life Instrument-42 (NEI RQL-42) questionnaire.Results: Mean photopic uncorrected near visual acuity (UNVA), distance-corrected near visual acuity (DCNVA), and corrected near visual acuity (CNVA) did not differ among groups, with a preferred reading distance greater in group B (P < 0.0005). Photopic distance-corrected intermediate visual acuity (DCIVA) was best in group B (P = 0.001) and better in group C than in group A. Mesopic UNVA and DCNVA were worse in groups A and B compared with group C (P < 0.0005 in both cases), with better DCNVA in group B than in group A (P = 0.031). Mesopic uncorrected intermediate visual acuity (UIVA) and DCIVA were worst in group A, with better results in group C (P < 0.0005 and P = 0.001, respectively). Mesopic MNREAD RA was better in group C (P = 0.02), and mesopic MRS was higher in groups B and C than in group A (P = 0.002). The QoL scores by the NEI RQL-42 test exhibited no differences among groups in 9 over 13 scales. “Near vision” (P = 0.005), “symptoms” (P = 0.001), and “satisfaction with correction” scale scores (P = 0.030) were lowest in group A, and “appearance” scale score was lowest in group B (P = 0.045).Conclusions: Newer-generation aspheric diffractive MIOLs, especially low-add hybrid apodized or full diffractive, are highly suited for working-age cataractous patients in terms of visual outcomes, reading performance, and QoL. Intrinsic optical differences, such as optimization for computer or dim-light working, or night driving, could be useful tools to customize the IOL in each single case.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Category: Peer-reviewed
Role of Corneal Collagen Cross-Linking in Pseudophakic Bullous Keratopathy: A Clinicopathological Study – Corrected Proof
Objective: To evaluate the clinical and histopathologic changes induced by collagen cross-linking (CXL) in pseudophakic bullous keratopathy (PBK).Design: Randomized, prospective, interventional study.Participants: Twenty-four patients with PBK were included in the study.Methods: Twenty-four patients with PBK underwent CXL followed by keratoplasty at 1 or 3 months. Twelve patients underwent penetrating keratoplasty 1 month after CXL (group A) and the remaining 12 patients underwent penetrating keratoplasty 3 months after CXL (group B). The main outcome measures were assessed at 1 week and 1 month for all patients and at 3 months for 12 patients only. The corneal buttons underwent histopathologic and immunofluorescence evaluation.Main Outcome Measures: Visual acuity, ocular discomfort (tearing, redness, pain), corneal haze, central corneal thickness, histopathologic evaluation, and immunofluorescent microscopy.Results: Mean visual acuity showed a significant improvement after CXL, from 1.925±0.173 before surgery to 1.75±0.296 at 1 month after surgery (P = 0.010), but deteriorated to 1.81±0.23 at 3 months. Symptomatic relief after CXL was at a maximum at 1 month, with a worsening trend at 3 months. Eighteen patients showed a reduction in corneal haze 1 month after CXL. The effect was maintained in 9 of 12 patients at 3 months. The mean central corneal thickness decreased significantly from 846.46±88.741 to 781.0±98.788 μm at 1 month (P<0.01) after CXL, but increased to 805.08±136.06 μm at 3 months. Immunofluorescence microscopy revealed anterior stromal compaction in 7 of 12 patients (58.3%) in group A and in 5 of 12 patients (41.6%) in group B. Staining of keratocyte nuclei with 4′,6-diaminido-2-phenylindole dihydrochloride (Molecular Probes, Carlsband, CA) revealed a relative uniform distribution throughout the stroma.Conclusions: Collagen cross-linking causes symptomatic relief and a decrease in central corneal thickness and anterior stromal compaction in PBK. However, the effect decreases with time and depends on disease severity.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Evaluation of Progressive Neuroretinal Rim Loss as a Surrogate End Point for Development of Visual Field Loss in Glaucoma – Corrected Proof
Purpose: To evaluate the validity of using progressive loss of neuroretinal rim area as a surrogate end point for the development of visual field loss in glaucoma.Design: Prospective, observational cohort study.Participants: The study group included 492 eyes of 328 patients classified with suspected glaucoma at the baseline visit. These eyes had an average of 7.4±2.8 confocal scanning laser ophthalmoscopy (CSLO) images during a mean follow-up time of 6.6±1.6 years.Methods: Rim area measurements were acquired with CSLO during follow-up. The visual field end point was considered the development of 3 consecutive abnormal visual fields on standard automated perimetry. Strong predictive ability and large proportion of treatment effect (PTE) explained are requisites for a suitable surrogate end point. A joint longitudinal survival model was used to evaluate the ability of rates of rim area loss in predicting visual field development, adjusting for confounding variables (baseline age, race, and corneal thickness and follow-up measurements of intraocular pressure [IOP] and pattern standard deviation). The PTE was calculated by comparing the effect of IOP on the risk of development of visual field loss when incorporating rim area loss in the same model with the effect of IOP in the model excluding rim area measurements.Main Outcome Measures: Predictive strength was measured by survival-adapted R2 and PTE.Results: Sixty-two of 492 eyes (13%) developed visual field loss during follow-up. The mean rate of rim area change in eyes that developed visual field loss was −0.011 mm2/year versus −0.003 mm2/year in eyes that did not (P<0.001). In the multivariable model, each 0.01 mm2/year faster rate of rim area loss was associated with a 2.94 higher risk of visual field loss (hazard ratio, 2.94; 95% confidence interval, 1.38–6.23; P = 0.005). R2 values were 62% and 81% for univariable and multivariable models, respectively. The PTE was 65%.Conclusions: Progressive rim area loss was highly predictive of the development of visual field loss in glaucoma and explained a significant PTE on the clinically relevant outcome. These findings suggest that rim area measurements may be suitable surrogate end points in glaucoma clinical trials.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Association between Perifoveal Hyperfluorescence and Serous Retinal Detachment in Diabetic Macular Edema – Corrected Proof
Objective: To study the association between the fluorescence levels on fluorescein angiography images and the characteristics on spectral-domain optical coherence tomography (SD OCT) images in diabetic macular edema (DME).Design: Retrospective, observa…
Three-Dimensional Evaluation of Accommodating Intraocular Lens Shift and Alignment In Vivo – Corrected Proof
Objective: To quantify 3-dimensionally the anterior segment geometry, biometry, and lens position and alignment in patients before and after implantation of the Crystalens-AO (Bausch & Lomb, Rochester, NY) accommodating intraocular lens (A-IOL).Design: Prospective, observational study.Participants: Ten patients (20 eyes) with cataract before and after implantation of the Crystalens-AO A-IOL.Methods: Custom full anterior segment 3-dimensional (3-D) spectral optical coherence tomography (OCT) provided with quantification tools was used to image the cornea, iris, and natural lens preoperatively and intraocular lens postoperatively. Measurements were obtained under phenylephrine preoperatively and under natural viewing conditions and phenylephrine (for accommodative efforts ranging from 0 to 2.5 diopters [D]) and pilocarpine postoperatively.Main Outcome Measures: Three-dimensional quantitative anterior segment images, corneal geometry and power, anterior chamber depth (ACD), lens thickness, pupil diameter, A-IOL shift with accommodative effort or drug-induced accommodation, and A-IOL alignment.Results: Crystalline lens and IOLs were visualized and quantified 3-dimensionally. The average ACD were 2.64±0.24 and 3.65±0.35 mm preoperatively and postoperatively (relaxed state), respectively, and they were statistically significantly correlated (although their difference was not statistically correlated with lens thickness). The A-IOL did not shift systematically with accommodative effort, with 9 lenses moving forward and 11 lenses moving backward (under natural conditions). The average A-IOL shift under stimulated accommodation with pilocarpine was −0.02±0.20 mm. The greatest forward shift occurred bilaterally in 1 patient (−0.49 mm in the right eye and −0.52 mm in the left eye, under pilocarpine). The high right/left symmetry in the horizontal tilt of the crystalline lens is disrupted on IOL implantation. Accommodative IOLs tend to be slightly more vertically tilted than the crystalline lens, with increasing tendency with accommodative effort. Two subjects showed postoperative IOL tilts >9 degrees. Changes in pupillary diameter correlated with pilocarpine-induced A-IOL axial shift. Intermediate accommodative demands (1.25 D) elicited the greater shifts in axial A-IOL location and tilt and pupil diameter.Conclusions: Quantitative 3-D anterior segment OCT allows full evaluation of the geometry of eyes implanted with A-IOLs preoperatively and postoperatively. High-resolution OCT measurements of the Crystalens 3-D positioning revealed small (and in many patients backward) A-IOL axial shifts with both natural or drug-induced accommodation, as well as tilt changes with respect to natural lens and accommodative effort.Financial Disclosure(s): Proprietary or commercial disclosure may be found after the references.
Demographic and Clinical Profile of Ocular Chemical Injuries in the Pediatric Age Group – Corrected Proof
Objective: To review the risk factors, management, and visual outcomes of pediatric chemical eye injuries in a tertiary care hospital in North India.Design: Retrospective hospital-based study.Participants: Patients aged <16 years with ocular chemical burns.Methods: Case records of patients with ocular chemical injury who presented to the Dr. Rajendra Prasad Centre for Ophthalmic Sciences were reviewed over a 5-year period.Main Outcome Measures: Demographic profile, nature of chemical injury, complications, and visual outcomes after chemical injury.Results: A total of 134 pediatric patients with a history of ocular chemical burns were seen between March 2006 and March 2011. The mean age of patients at the time of injury was 8.95±4.89 years (range, 1.2–15.5 years); 63.4% were male. Sixty-nine patients (51.4%) belonged to the preschool (0–5 years) age group. Bilateral chemical injuries were seen in 24 patients (17.9%). Lime (“chuna”) was the most commonly involved chemical (88, 65.6%) followed by toilet cleaner (20, 14.9%). The mean time between injury and presentation was 68.3 days (range, 1–365 days). Severe (grade 3 and 4) ocular chemical injury was seen in 94 patients (70.1%). Surgical intervention was performed in 114 eyes (85%) in the form of amniotic membrane grafting (n = 78), symblepharon release (n = 56), limbal stem cell transplantation (n = 26), and lamellar keratoplasty (n = 14). The average number of surgeries conducted per patient was 2.3 (range, 1–4). Median visual acuity at final follow-up (mean, 537±354 days) was 3/60.Conclusions: Chemical injuries in pediatric patients are more commonly encountered in the preschool age group and are associated with severe visual loss. Alkali injury from bursting of chuna packets was the most common mode of injury in pediatric patients in our study.Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.
Fourier-Domain Optical Coherence Tomography Imaging in Keratoconus: A Corneal Structural Classification – Corrected Proof
Objective: To study corneal morphologic changes in a large keratoconic population and to establish a structural optical coherence tomography (OCT) classification.Design: Cross-sectional, observational study.Participants: A total of 218 keratoconic eyes…
Myopia and Age-Related Cataract: A Systematic Review and Meta-analysis – Corrected Proof
Purpose: To examine if myopia is a risk factor for age-related cataract.Design: Systematic review and meta-analysis.Methods: A systematic review of the literature was performed using PubMed and Embase from their inception to March 2013 for population-b…
Canaliculops: Clinicopathologic Features and Treatment With Marsupialization – Corrected Proof
Purpose: To report the features of the rare and under-recognized condition of canaliculops (or canaliculocele) of the eyelid, which is a dilation of the canaliculus, and to evaluate treatment with marsupialization.Design: Retrospective interventional c…
Associations of Candidate Genes to Age-Related Macular Degeneration Among Racial/Ethnic Groups in the Multi-Ethnic Study of Atherosclerosis – Corrected Proof
Purpose: To describe the relationships of selected candidate genes to the prevalence of early age-related macular degeneration (AMD) in a cohort of whites, blacks, Hispanics, and Chinese Americans.Design: Cross-sectional study.Methods: setting: Multicenter study. study population: A total of 2456 persons aged 45-84 years with genotype information and fundus photographs. procedures: Twelve of 2862 single nucleotide polymorphisms (SNPs) from 11 of 233 candidate genes for cardiovascular disease were selected for analysis based on screening with marginal unadjusted P value <.001 within 1 or more racial/ethnic groups. Logistic regression models tested for association in case-control samples. main outcome measure: Prevalence of early AMD.Results: Early AMD was present in 4.0% of the cohort and varied from 2.4% in blacks to 6.0% in whites. The odds ratio increased from 2.3 for 1 to 10.0 for 4 risk alleles in a joint effect analysis of Age-Related Maculopathy Susceptibility 2 rs10490924 and Complement Factor H Y402H (P for trend = 4.2×10−7). Frequencies of each SNP varied among the racial/ethnic groups. Adjusting for age and other factors, few statistically significant associations of the 12 SNPs with AMD were consistent across all groups. In a multivariate model, most candidate genes did not attenuate the comparatively higher odds of AMD in whites. The higher frequency of risk alleles for several SNPs in Chinese Americans may partially explain their AMD frequency’s approaching that of whites.Conclusions: The relationships of 11 candidate genes to early AMD varied among 4 racial/ethnic groups, and partially explained the observed variations in early AMD prevalence among them.
Prevalence and Characteristics of Age-Related Macular Degeneration in the Japanese Population: The Nagahama Study – Corrected Proof
Purpose: To estimate the age- and sex-specific prevalence of early age-related macular degeneration (AMD; drusen and retinal pigment abnormalities) and late AMD (exudative AMD and geographic atrophy) in the Japanese population.Design: Community-based, cross-sectional study.Methods: The study was held in Nagahama, Japan, and included 6065 Japanese individuals (aged ≥50 years) recruited in 2008-2010. We graded fundus photographs of both eyes for the AMD phenotype based on drusen size, the presence of retinal pigment abnormalities, and late AMD. The associations between smoking and AMD phenotypes were also evaluated.Results: We assessed 5595 subjects (women, 65%) with a gradable macular condition. Early and late AMD prevalence increased from 16.1% and 0.27% at 50-59 years to 31.2% and 0.98%, respectively, at 70-74 years and was predominant in male subjects in each age group. Smoking was associated with both early and late AMD stages and retinal pigment abnormalities (P < .0001), but not with drusen (P = .305). The prevalence of retinal pigment abnormalities was significantly higher in men (P < .0001), which was associated with high rates of cigarette smoking. We found no sex difference for the prevalence of large drusen (P = .264).Conclusions: The prevalence of early AMD among adult Japanese persons was similar to the rates in white populations. The prevalence of late AMD in Japanese people aged <70 years was similar to that observed in white populations, whereas that in Japanese people aged ≥70 years was relatively lower.
Postoperative Optical Coherence Tomographic Appearance and Relation to Visual Acuity After Vitrectomy for Myopic Foveoschisis – Corrected Proof
Purpose: To investigate the appearance of postoperative spectral-domain optical coherence tomography (SD-OCT) and the relationship of the findings to visual acuity in myopic foveoschisis.Design: Retrospective observational case series.Methods: We studied 17 eyes (17 women; mean age, 66.4 years) with myopic foveoschisis. SD-OCT was performed preoperatively and 1, 3, 6, and 12 months after vitrectomy. The average central foveal thickness and choroidal thickness and the integrity of the foveal photoreceptor inner segment/outer segment junction as well as the external limiting membrane were correlated with the postoperative best-corrected visual acuity (BCVA).Results: The mean refractive error was −11.9 diopters, axial length 29.7 mm, choroidal thickness 29.9 μm, and logarithm of the maximum angle of resolution (logMAR) visual acuity 0.52 at baseline. The mean preoperative central foveal thickness was 470.8 μm, which was not associated with age, refractive error, symptom duration, or BCVA. The mean postoperative retinal thicknesses at 1, 3, 6, and 12 months were 310.4, 251.8, 218.2, and 218.7 μm, respectively (P < 0.01 at all time points). The final BCVA improved significantly (P < 0.001). The preoperative BCVA (P < 0.0001) difference in central foveal thickness between 3 and 12 months postoperatively (P < 0.05), the final integrity of the inner segment/outer segment junction (P < 0.05), and the ELM (P < 0.05) were significantly associated with the final BCVA. The preoperative choroidal thickness was negatively associated with axial length (P < 0.05) but not with postoperative central foveal thickness or BCVA.Conclusions: The final BCVA in myopic foveoschisis is associated with the retinal thickness changes postoperatively and recovery of the photoreceptor cells as seen in OCT images.
Correlation Between Corneal and Scleral Pneumatonometry: An Alternative Method for Intraocular Pressure Measurement – Corrected Proof
Purpose: To evaluate scleral pneumatonometry as an alternative method for measuring intraocular pressure (IOP).Design: Prospective cross-sectional study.Methods: Adult subjects with healthy eyes were recruited from the Comprehensive Eye Service at the University of Illinois Eye and Ear Infirmary from August 2008 through February 2009. Study measurements included corneal pneumatonometry (IOPk), scleral pneumatonometry (IOPs), axial length (AL), spherical equivalent (SE), and central corneal thickness (CCT). Main outcome measures were scleral IOP and corneal IOP.Results: Analysis included a monocular data set from single eyes of 97 subjects (age: 18-82 years). IOPs was consistently higher than IOPk, and correlated positively with IOPk (r = 0.57, P < .0001), age (r = 0.51, P < .0001), and SE (r = 0.32, P = .0002). The difference between scleral and corneal IOP (IOPs − IOPk) correlated positively with IOPs (r = 0.89, P < .0001), age (r = 0.57, P < .0001), and SE (r = 0.34, P < 0.0001). Bland-Altman analysis for agreement between scleral and corneal pneumatonometry measurements showed a mean difference of 8.08 mm Hg, with the 95% limit of agreement between -3.47 and 19.64 mm Hg. Regression analysis yielded the following equation: IOPk = 11.9 + 0.32(IOPs) − 0.05(Age).Conclusions: Scleral pneumatonometry correlates positively with corneal pneumatonometry and is more accurate at lower values and in younger patients. When adjusted for age, scleral pneumatonometry may be an adequate alternative in situations where corneal measurements are impractical.
Anterior Segment Optical Coherence Tomography of Long-Term Phakic Angle-Supported Intraocular Lenses – Corrected Proof
Purpose: To evaluate the long-term age-related anterior chamber changes by anterior segment optical coherence tomography (OCT) and the impact of such changes on the stability and behavior of angle-supported phakic intraocular lenses (IOLs).Design: A re…
Long-term Stability of Vascular Endothelial Growth Factor Suppression Time Under Ranibizumab Treatment in Age-Related Macular Degeneration – Corrected Proof
Purpose: To determine intra-individual long-term stability of vascular endothelial growth factor (VEGF) suppression time in eyes with neovascular age-related macular degeneration (AMD) treated with ranibizumab.Design: Nonrandomized, prospective clinica…
Aging Is Not a Disease: Distinguishing Age-Related Macular Degeneration from Aging
Publication date: Available online 9 August 2013
Source:Progress in Retinal and Eye Research
Author(s): Daniel Ardeljan , Chi-Chao Chan
Age-related macular degeneration (AMD) is a disease of the outer retina, characterized most significantly by atrophy of photoreceptors and retinal pigment epithelium accompanied with or without choroidal neovascularization. Development of AMD has been recognized as contingent on environmental and genetic risk factors, the strongest being advanced age. In this review, we highlight pathogenic changes that destabilize ocular homeostasis and promote AMD development. With normal aging, photoreceptors are steadily lost, Bruch’s membrane thickens, the choroid thins, and hard drusen may form in the periphery. In AMD, many of these changes are exacerbated in addition to the development of disease-specific factors such as soft macular drusen. Para-inflammation, which can be thought of as an intermediate between basal and robust levels of inflammation, develops within the retina in an attempt to maintain ocular homeostasis, reflected by increased expression of the anti-inflammatory cytokine IL-10 coupled with shifts in macrophage plasticity from the pro-inflammatory M1 to the anti-inflammatory M2 polarization. In AMD, imbalances in the M1 and M2 populations together with activation of retinal microglia are observed and potentially contribute to tissue degeneration. Nonetheless, the retina persists in a state of chronic inflammation and increased expression of certain cytokines and inflammasomes is observed. Since not everyone develops AMD, the vital question to ask is how the body establishes a balance between normal age-related changes and the pathological phenotypes in AMD.
Selective Laser Trabeculoplasty Following Failed Combined Phacoemulsification Cataract Extraction and Ab Interno Trabeculectomy – Corrected Proof
Purpose: To assess the effect of selective laser trabeculoplasty (SLT) following failed phacoemulsification cataract extraction combined with ab interno trabeculectomy (AIT) using the Trabectome (phaco-trabectome).Design: Randomized, interventional case series.Methods: Retrospectively, the medical records of patients who underwent SLT between March 2010 and July 2012 by 1 surgeon at a single center after a failed phaco-AIT were evaluated. Inclusion criteria were age ≥18 years with no upper limit and prior failed phaco-AIT attributable to glaucoma progression. Exclusion criterion was performance of any additional glaucoma procedure with influence on intraocular pressure (IOP) during follow-up and a follow-up after surgery of <3 months. Success was defined by reduction of IOP of >3 mm Hg and 20% and number of antiglaucoma medications equal to or less than baseline. Main outcome measures were IOP, antiglaucoma medications, time to failure, and Kaplan-Meier survival curve.Results: Fourteen eyes of 13 subjects were included. Mean follow-up after SLT was 12.9 ± 8.7 months. Total laser energy was 59.5 ± 8.7 mJ. Baseline IOP was 17.9 ± 3.3 mm Hg and number of antiglaucoma medications at baseline was 2.0 ± 1.0. All SLT procedures failed. Median time to failure after SLT was 3.6 ± 0.8 (range 2.1-5.1) months. Number of antiglaucoma medications did not change.Conclusions: In eyes in which the IOP was no longer controlled following phaco-trabectome, SLT had a limited duration of significant IOP-lowering effect. Other alternatives, such as incisional filtration surgery, should be considered following failed phaco-trabectome.
Lifetime Risk of Blindness in Open-Angle Glaucoma – Corrected Proof
Purpose: To determine the lifetime risk and duration of blindness in patients with manifest open-angle glaucoma (OAG).Design: Retrospective chart review.Methods: We studied glaucoma patients who died between January 2006 and June 2010. Most glaucoma patients living in the catchment area (city of Malmö; n = 305 000) are managed at the Department of Ophthalmology at Skåne University Hospital in Malmö. From the patient records we extracted visual field status, visual acuity, and low vision or blindness as defined by the World Health Organization (WHO) criteria and caused by glaucoma at the time of diagnosis and during follow-up. We also noted age at diagnosis and death and when low vision or blindness occurred.Results: Five hundred and ninety-two patients were included. At the time of the last visit 250 patients (42.2%) had at least 1 blind eye because of glaucoma, while 97 patients (16.4%) were bilaterally blind, and 12 patients (0.5%) had low vision. Median time with a glaucoma diagnosis was 12 years (<1-29), median age when developing bilateral blindness was 86 years, and median duration of bilateral blindness was 2 years (<1-13). The cumulative incidences of blindness in at least 1 eye and bilateral blindness from glaucoma were 26.5% and 5.5%, respectively, after 10 years, and 38.1% and 13.5% at 20 years.Conclusions: Approximately 1 out of 6 glaucoma patients was bilaterally blind from glaucoma at the last visit. Median duration of bilateral blindness was 2 years.
Changing Incidence of Lens Extraction over 20 Years: The Beaver Dam Eye Study – Corrected Proof
Objective: To investigate trends in the incidence of lens extraction over the past 20 years.Design: Longitudinal population-based cohort study.Participants: Persons who participated in the Beaver Dam Eye Study.Methods: Eligible persons 43 to 84 years o…
Novel Technique for the Preparation of Corneal Grafts for Descemet Membrane Endothelial Keratoplasty – Corrected Proof
Purpose: To report a simple novel technique to facilitate preparation of Descemet membrane grafts for Descemet membrane endothelial keratoplasty (DMEK).Design: Laboratory investigation and retrospective, single-center, consecutive case series.Methods: Preparation of the endothelial graft is performed on an artificial anterior chamber, endothelial side up. After an incomplete circular superficial trephination, we describe a simple technique using a 27 gauge cannula to detach the Descemet membrane (DM). Endothelial cell density (ECD) was measured before dissection on 12 human corneas for research and 3 days after storage in organ culture. Histologic and electron microscopy analysis were performed. A DMEK was performed in 50 patients with Fuchs dystrophy. Visual acuity and ECD were evaluated 2 and 6 months after surgery.Results: ECD was 2765 ± 256 cells/mm2 on corneas for research before dissection and 2651 ± 305 cells/mm2 after 3 days in organ culture (P < .01). Histologic and electronic sections confirm that the cleavage was between DM and posterior stroma. Clinically, preparation of 2 corneas from a single donor was unsuccessful; 48 corneas were clear at 2 months and 47 at 6 months. At 2 months 77% of the patients had recovered a visual acuity of at least 20/30. At 6 months, 91.5% of the patients had a visual acuity of at least 20/30. ECD was 2656 ± 28 cells/mm2 (range: 2450-3100 cells/mm2) preoperatively, 1797 ± 41 cells/mm2 (range: 1100-2700 cells/mm2) at 2 months, and 1658 ± 43 cells/mm2 (range: 900-2600 cells/mm2) at 6 months.Conclusion: We report here a reliable and efficient technique for the preparation of pure Descemet membrane grafts.