Midwest Eye Center

Purpose To compare clinical outcomes of eyes undergoing Descemet stripping automated endothelial keratoplasty (DSAEK) with 51-99 μm and <50 μm lenticules. Methods Retrospective, multi-center case series of 480 eyes undergoing DSAEK with precut tissue from a single eye bank between 2019 and 2022 performed by five surgeons at five centers. Eyes were divided into 51-99 μm or <50 μm groups according to post-cut graft thickness. The main outcome measure was inter-group comparison according to best-corrected distance visual acuity (BCDVA); additional outcome measures were primary graft failure (PGF), rebubbling, and cystoid macular edema (CME) rates in context of specific preoperative risk factors, intraoperative characteristics, and vision-limiting vs. non-vision-limiting morbidities. Results BCDVA at one year postoperatively was 0.5 ± 0.5 and 0.4 ± 0.4 logMAR for the 51-99 μm and <50 μm groups, respectively (p = 0.692). Regraft rate was 3.21% for 51-99 μm and 1.89% for <50 μm grafts (p = 0.4854). Rebubbling rate was 8.56% for the 51-99 μm group and 13.21% for the <50 μm group (p = 0.151). Analysis of rebubbled eyes showed no difference in rate of sulfur hexafluoride tamponade (p = 0.201), lenticule insertion method (p = 0.293), and glaucoma surgery history (p = 0.996). Higher rebubbling rates occurred in eyes with previous scleral-fixated intraocular lenses (p < 0.001). The effect of potential preoperative and intraoperative risk factors (e.g. insertion method (p = 0.979) and concurrent cataract surgery (p = 0.701)) on rebubbling was not significantly different between the two groups. CME rate was 4.01% for 51-99 μm and 7.54% for <50 μm groups (p = 0.131). Conclusions 51-99 μm and <50 μm DSAEK grafts offer similar visual outcomes. Both lenticule thicknesses have similar regrafting, rebubbling, and CME rates.

Purpose: To report a case of multifocal central serous chorioretinopathy (CSCR) mimicking Vogt-Koyanagi-Harada (VKH) disease. Methods: A 42-year-old man was evaluated for an exudative retinal detachment (RD) with a presumptive diagnosis of VKH while being treated with corticosteroids. The examination showed subretinal fibrin deposition with a bullous, exudative, macula-involved RD in the left eye and a progressive decline in visual acuity (VA) to hand motions. Multimodal imaging showed multifocal hyperfluorescent leaks bilaterally by angiography, highly suggestive of CSCR exacerbated by corticosteroids. Results: After the multifocal CSCR diagnosis, the systemic corticosteroids were tapered and eventually discontinued. The patient was then managed with focal laser photocoagulation, photodynamic therapy, and acetazolamide. The VA improved to 20/30 with complete resolution of the bullous RD at the 12-month follow-up. Conclusions: Extensive bullous RD with subretinal fibrin deposition is an infrequent manifestation of CSCR commonly associated with corticosteroid use that can mimic VKH. Thus, it is important to distinguish CSCR from VKH and the potential of combination therapy in managing chronic multifocal CSCR with a bullous RD.

This study develops a method to determine toricity ratios used by arbitrary toric intraocular lens calculators. Access to this information allows for the improvement of refractive results. We derive the Sayegh-Gabra formula, which uses input and output parameters in a toric calculator to extract toricity ratios that are typically not disclosed. We illustrate the method on a number of commercial calculators. For each calculator, high, average, and low axial length values are crossed with high, average, and low mean corneal power values to generate a 3 × 3 matrix. A toricity ratio is generated for each axial length and mean corneal power pair. We thus identify several toric lens manufacturers’ calculators that use a constant toricity ratio, often 1.46. Some others use a variable ratio centered at 1.46, but varying as axial length and mean K increases over a range of values corresponding to physiological myopia and hyperopia. There is an emerging trend away from constant toricity ratios. Using our methodology, it is possible to extract the toricity ratio used by specific calculators/manufacturers, distinguish those using constant versus variable toricity ratios, and use this information to improve surgical outcomes by refining current and future toric intraocular lens calculators.

JDSMStudy Objectives: Patients with obstructive sleep apnea syndrome (OSAS) using continuous positive airway pressure (CPAP) often report pressure-related discomfort.Both lower pressure and increased comfort may improve patients' compliance with CPAPtherapy, thereby improving therapeutic effectiveness.Combining CPAP with an oral appliance (hybrid therapy) could be an adequate alternative therapy.Methods: Seven patients with moderate to severe OSAS who tolerated their CPAP despite high pressures (≥ 10 cm H2O) were fitted with hybrid therapy.The mandible was set at 70% of patient's maximum protrusion, and CPAP pressure was set at 6 cm H2O.When OSAS complaints persisted, pressure was increased.After 3 months, a polysomnographic study was performed.At baseline (conventional CPAP) and after 3 months (hybrid therapy) patients filled in questionnaires assessing comfort, compliance, and satisfaction with treatment, excessive daytime sleepiness, and quality of life.Results: Four of seven patients reported hybrid therapy to be more comfortable and effective and preferred it over conventional CPAP.There were no differences between baseline (conventional CPAP) and follow-up (hybrid therapy) scores in compliance, satisfaction, daytime sleepiness, and quality of life.Effectiveness of hybrid therapy was good as apnea-hypopnea index (AHI) significantly decreased from median AHI 64.6/h (interquartile range [IQR] 31.0-81.0)at diagnosis to median AHI 1.5/h (IQR 1.0-33.4)with hybrid therapy.There was no statistical difference in effectiveness between conventional CPAP and hybrid therapy (median AHI with conventional CPAP was 2.4/h [IQR 0.0-5.0]). Conclusions:Although pressure could be lowered and hybrid therapy seems a comfortable alternative to conventional CPAP, there were no differences between both therapies regarding compliance, satisfaction, and both objective and experienced effectiveness.Combined therapy is feasible in OSAS and should now be investigated in a RCT including assessment of comfort and long-term compliance.

JDSMStudy Objectives: Patients with obstructive sleep apnea syndrome (OSAS) using continuous positive airway pressure (CPAP) often report pressure-related discomfort.Both lower pressure and increased comfort may improve patients' compliance with CPAPtherapy, thereby improving therapeutic effectiveness.Combining CPAP with an oral appliance (hybrid therapy) could be an adequate alternative therapy.Methods: Seven patients with moderate to severe OSAS who tolerated their CPAP despite high pressures (≥ 10 cm H2O) were fitted with hybrid therapy.The mandible was set at 70% of patient's maximum protrusion, and CPAP pressure was set at 6 cm H2O.When OSAS complaints persisted, pressure was increased.After 3 months, a polysomnographic study was performed.At baseline (conventional CPAP) and after 3 months (hybrid therapy) patients filled in questionnaires assessing comfort, compliance, and satisfaction with treatment, excessive daytime sleepiness, and quality of life.Results: Four of seven patients reported hybrid therapy to be more comfortable and effective and preferred it over conventional CPAP.There were no differences between baseline (conventional CPAP) and follow-up (hybrid therapy) scores in compliance, satisfaction, daytime sleepiness, and quality of life.Effectiveness of hybrid therapy was good as apnea-hypopnea index (AHI) significantly decreased from median AHI 64.6/h (interquartile range [IQR] 31.0-81.0)at diagnosis to median AHI 1.5/h (IQR 1.0-33.4)with hybrid therapy.There was no statistical difference in effectiveness between conventional CPAP and hybrid therapy (median AHI with conventional CPAP was 2.4/h [IQR 0.0-5.0]). Conclusions:Although pressure could be lowered and hybrid therapy seems a comfortable alternative to conventional CPAP, there were no differences between both therapies regarding compliance, satisfaction, and both objective and experienced effectiveness.Combined therapy is feasible in OSAS and should now be investigated in a RCT including assessment of comfort and long-term compliance.

To evaluate retrospectively whether the findings from the Cornea Donor Study (CDS) led to changes in the transplantation of corneas from older donors. Eye banks in United States provided complete data on donor age and placement (domestic or international) for 86,273 corneas from 1998 to 2009. The data were analyzed by 3 periods, preceding CDS (1998-1999), during CDS (2000-2007), and after publication of CDS 5-year results (2008-2009), and separately for corneas placed within versus outside the United States. For corneal tissues transplanted in the United States, the percentage of donors who were 66 years or older increased from 19% before CDS to 21% during CDS and 25% after CDS (P<0.001). Corresponding median (25th-75th percentile) donor ages were 53 (39-63), 54 (41-64), and 57 (46-66), respectively (P<0.001). The opposite trend was observed for corneas distributed outside the United States, with the percentage of donors 66 years and older decreasing from 56% to 42% to 34%, respectively. Donor age trends over time varied by eye bank. There was a modest overall increase in the donor age of corneas transplanted in the United States from 1998 to 2009, but the retrospective nature of the study limits our ability to attribute this change to the CDS. The modest increases in the donor age of corneas transplanted is a positive finding, but wider acceptance of older corneal donor tissue should be encouraged based on the 5-year evidence generated by the CDS.

To compare the 12-hour efficacy and safety of dorzolamide/timolol fixed combination (DTFC) dosed twice daily versus latanoprost dosed every evening following a timolol run-in in primary open-angle glaucoma patients. Following a 6-week timolol run-in patients were randomized to either DTFC or latanoprost for 6 weeks and then changed to the opposite treatment for 6 weeks. At the end of the run-in, and the end of each treatment period, the intraocular pressure (IOP) was measured every 2 hours between 8:00 AM and 8:00 PM. Thirty-one patients completed at least one time point in both treatment periods. Both treatments reduced the IOP for the diurnal curve, and at each time point, from the timolol run-in baseline (p<0.0001). The 12-hour IOP on timolol was 22.1+/-2.8 mmHg, whereas on DTFC it was 18.1+/-2.8 and latanoprost 18.3+/-3.1 mmHg (p=0.4). Further, there was no statistical difference in IOP between treatments at any time point (p< or =0.1). There was no statistical difference for any individual adverse event between treatments (p>0.05). This study suggests that following a timolol run-in both DTFC and latanoprost provide comparable daytime efficacy and safety.

University of Illinois Eye Center, Chicago, IL Original study reprint requests: Jeffrey S. Heier, 50 Staniford St., Suite 600, Boston, MA 02114.