doi: 10.1097/ico.0000000000003146pmid: 36538423
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Shree, Neha; Das, Sima; Arya, Deepanjali; Srivastava, Ankit; Singh, Aastha; Sangwan, Virender
doi: 10.1097/ico.0000000000003021pmid: 35543574
Purpose:The purpose of this study was to study the outcome of single-staged entropion surgery along with lid margin mucous membrane grafting for cicatrizing ocular surface disease.Methods:Retrospective review of medical records of patients who underwent single-staged surgical correction of cicatricial entropion along with lid margin mucous membrane grafting for lid margin keratinization.Results:Twenty-six eyes of 19 patients were studied. The mean age of patients was 42.5 years (standard deviation, SD-17.67), of which 7 patients were male and 12 were female. The most common disorder was Stevens–Johnson syndrome (SJS) sequelae (83.33%, n = 20), followed by mucous membrane pemphigoid (n = 4, 16.67%). The most common eyelid changes observed were cicatricial entropion in all 26 eyes (100%, n = 26), followed by trichiasis in 13 eyes (50%, n = 13). Lid margin keratinization was noted in all eyes. Postoperative improvement in corneal surface staining was noted in 70% of the patients (n = 13), no change in 20% of the patients (n = 4), and worsening of corneal surface staining in 10% of the patients (n = 2). Postoperative visual acuity improvement was noted in 50% of the eyes (n = 13), no improvement in 39% of the eyes (n = 10), and vision worsened in 12% of the eyes (n = 3). An entropion recurrence rate of 25% (n = 6) was observed over an average 10-month follow-up, whereas 75% (n = 20) reported no recurrence.Conclusions:Single-staged correction of eyelid cicatricial entropion with a lid margin mucous membrane graft (MMG) has promising outcomes in ocular surface diseases. It can decrease the need for multiple surgeries and provide symptomatic relief in patients with chronic cicatricial surface changes.
Nche, Eleanor N.; Katzir, Ayala; Solomon, Avraham; Wolf, Dana; Panet, Amos; Lavy, Itay
doi: 10.1097/ico.0000000000002977pmid: 36859790
Purpose:The purpose of this study was to detect the occurrence of herpes simplex virus (HSV) types 1 and 2 and varicella zoster virus (VZV) DNA in transplanted corneas using polymerase chain reaction (PCR) and to determine the relationship between latent HSV and VZV and herpetic eye disease in recipients.Methods:This was a retrospective, interventional case series. Samples from 88 donor corneoscleral buttons (CSBs) were collected from the conjunctiva, iris, and endothelium and tested for HSV-1, HSV-2, and VZV DNA using PCR. All transplanted eyes were evaluated and followed up. The main outcome measures were HSV-1, HSV-2, and VZV DNA positivity rates in donor CSBs and the occurrence of herpetic eye disease or graft failure in recipients of positive corneas.Results:HSV-1 DNA was detected in 5 (5.7%) of 88 CSBs. HSV-2 was not detected in any CSBs, and VZV was found in 1 (1.2%) of the 82 examined CSBs. One recipient (16.7%) developed dendritic epitheliopathy and keratouveitis typical of HSV 12 months after transplantation, although the graft remained clear after treatment. One cornea was used for a tectonic graft and stayed edematous at the 20-month follow-up. The remaining corneas remained clear.Conclusions:Morphologically normal donor corneas may be PCR-positive for herpes viruses, especially HSV-1. Recipients of herpes-positive corneal grafts could be at risk for herpetic eye disease. Further studies using viral RNA by reverse transcriptase PCR are needed to provide more information on HSV and VZV latency and active replication in donor corneas.
Rinert, Janosch; Branger, Giacomo; Bachmann, Lucas M.; Pfaeffli, Oliver; Iselin, Katja; Kaufmann, Claude; Thiel, Michael A.; Baenninger, Philipp B.
doi: 10.1097/ico.0000000000003052pmid: 35543570
Purpose:The purpose of this study was to assess the diagnostic performance of measurements from a new noninvasive, automated ocular surface analyzer (IDRA) in the diagnosis of dry eye disease (DED).Methods:We prospectively identified patients with and without DED using best practice methods. Subsequently, all participants underwent IDRA analysis, consisting of 5 components: noninvasive tear film break-up time, tear meniscus height, lipid layer interferometry, eye blink quality, and infrared meibography. The manufacturer provides cutoff values for a pathologic result for each of these components. Using a stepwise augmentation multivariate logistic regression model, we identified the components with the strongest association for the presence of DED. For the 3 components with the strongest association (interferometry, tear meniscus, and infrared meibography), we calculated the probability of DED.Results:We enrolled 40 patients (80 eyes) with DED (mean age 60.5 years; women 78.3%) and 35 healthy subjects (70 eyes, mean age 31.1 years; women 21.7%). The IDRA had an area under the curve of 0.868 (95% confidence interval: 0.809–0.927) to detect DED. A normal (≥80) interferometry combined with a normal (>0.22) tear meniscus and a normal (≤40) infrared meibography was associated with an estimated probability of 18% for the presence of DED, whereas the estimated probability of DED was as high as 96% when all 3 findings were pathologic.Conclusions:The results of IDRA showed a positive concordance with routine clinical diagnostic tests. The new analyzer is an easy-to-access diagnostic tool to rule out the presence of DED in the extramural setting and to guide a timely DED treatment.
Vorobichik Berar, Ofri; Rotenberg, Michael; Berger, Yoav; Matani, Adham; Avni-Zauberman, Noa; Barequet, Irina S.
doi: 10.1097/ico.0000000000003165pmid: 36455071
Purpose:Keratoconus is a progressive visually impairing disorder. Despite the beneficial effects of epithelial off-crosslinking (CXL) on the stabilization of keratoconus, progression may still occur. We report the efficacy and safety of a repeated CXL for significant progression of keratoconus after a single CXL procedure.Methods:This retrospective study includes patients diagnosed with progressive keratoconus who were previously treated with CXL and underwent repeated CXL. Demographic, clinical, and surgical data were retrieved and analyzed.Results:Ten consecutive eyes of nine patients who developed progressive keratoconus after CXL were identified. The mean age at diagnosis of keratoconus was 20.2 ± 6.0 years. The post-repeated CXL follow-up period was 2.1 ± 1.3 years. The mean best corrected visual acuity (BCVA) remained stable throughout the follow-up period. The mean Kmax at baseline was 60.4 ± 3.6 D. Before the repeated CXL, Kmax progressed significantly (P = 0.018) and was 62.2 ± 6.3 D, and at the last follow-up, the value decreased significantly (P = 0.037) and was 60.3 ± 6.4 D. The mean minimal pachymetry was 464.0 ± 27.0 µ at base line. Before the repeated CXL, minimal pachymetry was significantly lower (P = 0.018), and after the repeated CXL, the minimal pachymetry was stable (P = 0.2). No intra- or postoperative complications were noted.Conclusions:Repeated CXL is a safe and effective treatment option when failure of the initial CXL is diagnosed, even in young patients. This procedure may prevent visual deterioration and a potential need for keratoplasty.
Stevens, Shanlee M.; Reyes-Capo, Daniela P.; Patel, Umangi; Choudhary, Anjalee; Khzam, Rayan Abou; Tang, Vincent; Galor, Anat; Karp, Carol L.; Dubovy, Sander
doi: 10.1097/ico.0000000000003039pmid: 35439777
Purpose:The purpose of this study was to compare the clinical characteristics and high-resolution optical coherence tomography (HR-OCT) findings between corneal squamous metaplasia and ocular surface squamous neoplasia (OSSN).Methods:A retrospective case–control study of 8 patients, 4 with histologically confirmed squamous metaplasia and 4 with histologically confirmed OSSN, who presented to the Miami Veterans Administration Medical Center and Bascom Palmer Eye Institute between 2016 and 2020 was performed. Clinical characteristics, HR-OCT findings, and pathology were evaluated and compared.Results:Four patients with squamous metaplasia and 4 with OSSN were evaluated. In the metaplasia group, 75% were male, 2 were White, and 2 were Black. In the OSSN group, all 4 were White males. All lesions were opalescent and occurred at the limbus; however, the borders were more smooth and rounded in the metaplastic lesions compared with OSSN. HR-OCT findings were indistinguishable between the 2 groups.Conclusions:There is overlap in clinical characteristics and HR-OCT findings between corneal squamous metaplasia and OSSN, highlighting one limitation of HR-OCT. As such, if a corneal opacity has some but not all HR-OCT findings of OSSN, squamous metaplasia should also be considered. A biopsy may be indicated to further evaluate and guide treatment.
Yeu, Elizabeth; Wirta, David L.; Karpecki, Paul; Baba, Stephanie N.; Holdbrook, Mark; ,
doi: 10.1097/ico.0000000000003097pmid: 35965392
Purpose:The purpose of this study was to evaluate the safety and efficacy of lotilaner ophthalmic solution, 0.25%, compared with vehicle for the treatment of Demodex blepharitis.Methods:In this prospective, randomized, controlled, double-masked, phase 2b/3 clinical trial, 421 patients with Demodex blepharitis were randomly assigned in a 1:1 ratio to receive either lotilaner ophthalmic solution, 0.25% (study group), or vehicle without lotilaner (control group) bilaterally, twice daily for 43 days. Patients were evaluated at days 8, 15, 22, and 43. Outcome measures were complete collarette cure (collarette grade 0), clinically meaningful collarette cure (grade 0 or 1), mite eradication (0 mites/lash), erythema cure (grade 0), composite cure (grade 0 for collarettes/erythema), and drop comfort. Adverse events were also evaluated.Results:At day 43, the study group achieved a statistically significantly higher proportion of patients with clinically meaningful collarette cure (81.3% vs. 23.0%; P < 0.0001), complete collarette cure (44.0% vs. 7.4%; P < 0.0001), mite eradication (67.9% vs. 17.6%; P < 0.0001), erythema cure (19.1% vs. 6.9%; P = 0.0001), and composite cure (13.9% vs. 1.0%; P < 0.0001) than the control group. Nearly 92.0% of patients rated the study drop as neutral to very comfortable. All ocular adverse events in the study group were mild, with the most common being instillation site pain.Conclusions:Twice-daily treatment with a novel lotilaner ophthalmic solution, 0.25% for 43 days, is safe and effective for the treatment of Demodex blepharitis compared with the vehicle control.
Karmakar, Ranit; Nooshabadi, Saeid; Lohmeier, John; Terrin, Staci; Eghrari, Allen O.
doi: 10.1097/ico.0000000000003067pmid: 36279476
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Price, Marianne O.; Price, Francis W.
doi: 10.1097/ico.0000000000003022pmid: 35389930
Purpose:The purpose of this study was to evaluate 15-year outcomes of Descemet stripping endothelial keratoplasty (DSEK).Methods:We retrospectively reviewed an initial, consecutive series of 350 DSEK cases in 290 patients (mean age 69 years), performed between December 2003 and December 2005 for Fuchs dystrophy (86%), pseudophakic/aphakic bullous keratopathy (10%), or failed penetrating keratoplasty (4%). Outcomes included best spectacle-corrected visual acuity (BSCVA), endothelial cell density (ECD), and graft failure (defined as regraft for any reason or persistent loss of stromal clarity).Results:At 15 years, 46 of 350 DSEK grafts (13%) had failed, 155 (44%) were in patients who died, and 84 of the remaining 149 grafts (56%) were examined. After accounting for loss to follow-up, the probability of graft failure was 7% at 5 years, 16% at 10 years, and 23% at 15 years. The main risk factor for late endothelial failure was preoperative glaucoma (hazard ratio: 4.4 for medically managed and 24 for surgically managed glaucoma). The probability of an immunologic rejection episode was 7% by 1 year, 14% by 10 years, and 17% by 15 years. The median donor ECD decreased from 3030 cells/mm2 before DSEK to 1973 cells/mm2 at 6 months (36% loss) and 705 cells/mm2 at 15 years (78% loss). The median BSCVA, including the eyes with ocular comorbidity, was 20/60 preoperatively, 20/40 at 3 through 12 months, and 20/30 from 2 to 15 years.Conclusions:DSEK provided excellent long-term visual rehabilitation and graft survival in this early cohort, performed when the technique was still being refined.
Karmakar, Ranit; Nooshabadi, Saeid V.; Eghrari, Allen O.
doi: 10.1097/ico.0000000000003186pmid: 36633942
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