Price Vision Group

To evaluate investigational use of corneal crosslinking (CXL) to treat corneal neovascularization (CNV) with or without concomitant infection. This prospective, single-center study assessed investigational use of epithelium-off CXL with 0.1% riboflavin/20% dextran ophthalmic solution to treat various scenarios of CNV with standard 30-minute or accelerated 10-minute irradiation. The CXL treatment was investigated for 38 CNV scenarios in 37 eyes of 35 participants (2 bilateral) and was repeated once in 2 eyes and twice in 1 eye. Treatment was considered successful in 24 cases, partially successful in 1 case, and unsuccessful in 8 cases; 2 cases were lost to follow up and 3 developed complications unrelated to the CXL that precluded efficacy evaluation. The CXL was considered successful in all 4 cases treated for CNV with melting and/or cheese wiring of the recipient cornea postkeratoplasty, in 7 of 9 cases with active infection, in 5 of 10 cases treated in conjunction with penetrating keratoplasty, in 3 of 4 cases treated in conjunction with lamellar keratoplasty or wound revision, and in 6 of 11 cases without associated infection or surgery. Investigational use of CXL can contribute to CNV regression in the following scenarios: postkeratoplasty corneal melting and suture cheese wiring, infectious keratitis, and combined with keratoplasty. However, it has limited, if any, benefit in treating CNV in situations where the stimulus for CNV is not eliminated, such as ongoing infection or chronic conditions such as limbal stem cell dysfunction.

The aim of this study was to assess long-term endothelial cell loss (ECL) and graft failure with Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty (DSEK) versus penetrating keratoplasty (PK) performed for the same indications (primarily Fuchs dystrophy and pseudophakic corneal edema) in the Cornea Donor Study. This retrospective study included consecutive primary DMEK (529 recipients, 739 eyes) and DSEK cases (585 recipients, 748 eyes) with 1 or more endothelial cell density (ECD) measurements at 6 months to 16 years. Main outcomes were ECD, longitudinal ECL, and graft failure. Between 6 months and 8 years the ECD declined linearly by approximately 118 cells/mm 2 /yr after DMEK and 112 cells/mm 2 /yr after DSEK. Beyond 8 years postoperatively the rate of decline slowed substantially. Selective dropout from graft failure did not significantly affect the ECD trend. At 10 years, median ECL (interquartile range) was 63% (45, 73) with DMEK, 68% (48, 78) with DSEK, and 76% (70, 82) with PK ( P = 0.01 DMEK vs. DSEK, P <0.001 DMEK vs. PK, and P < 0.001 DSEK vs. PK). The proportion of surviving grafts with 10-year ECD <500 cells/mm 2 was 1.4% with DMEK, 7.3% with DSEK, and 23.9% with PK. The cumulative risk of graft failure between 6 months and 10 years was 5% with DMEK, 11% with DSEK, and 19% with PK ( P < 0.001). Compared with PK and DSEK, DMEK had significantly lower ECL and significantly lower risk of secondary graft failure through 10 years.

To assess outcomes of presbyopia-correcting intraocular lens (IOL) implantation after Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal dystrophy. This retrospective single-center study evaluated a consecutive series of patients with Fuchs endothelial corneal dystrophy who received presbyopia-correcting IOLs after DMEK. The main outcomes were corrected distance visual acuity, uncorrected distance visual acuity, uncorrected near visual acuity, and refractive error. Fourteen extended depth of focus and 2 bifocal IOLs were implanted in 16 eyes of 8 patients (5 women and 3 men; age, 47-68 years). Fourteen IOLs were spherical and 2 were toric. Postoperatively, the median corrected distance visual acuity was 20/20 (range, 20/15-20/25), the median binocular uncorrected distance visual acuity was 20/25 (range, 20/15-20/25), the median binocular uncorrected near visual acuity was 20/20 (range, 20/20-20/50), and the median manifest spherical equivalent refraction was 0.05 diopters (D) (range, -0.75 to +0.75 D). Implantation of toric extended depth of focus lenses reduced refractive cylinder from 1 and 2.25 D preoperatively to 0 D in both eyes of 1 patient postoperatively. A comparison of biometry measurements taken before and after DMEK showed the median change in average keratometry was 0.26 D with a substantial range of -1.74 to +1.18 D. The median endothelial cell loss was 63 cells/mm (3%) after staged phacoemulsification. Favorable visual and refractive outcomes were obtained with presbyopia-correcting IOLs in patients with Fuchs dystrophy when the biometry measurements and IOL implantation were staged after DMEK had cleared the guttae and corneal edema.