Corneal epithelial defects following vitreoretinal surgery:incidence and outcomes from the DISCOVER study

AIM:To investigate the incidence,risk factors,clinical course,and outcomes of corneal epithelial defects(CED)following vitreoretinal surgery in a prospective study setting.METHODS:This was a post-hoc analysis of all participants in DISCOVER intraoperative optical coherence tomography study.Subjects with CED 1 d after surgery without intraoperative corneal debridement was defined as the postoperative CED group.Subjects who underwent intraoperative debridement were defined as intraoperative debridement group.Eyes were matched 2:1 with controls(eyes without postoperative CED)for comparative assessment.The primary outcomes were the incidence of CED on postoperative day one and the incidence of required intraoperative debridement.Secondary outcomes included time to defect closure,delayed healing(>2 wk),visual acuity(VA)and presence of scarring at one year and cornea consult.RESULTS:This study included 856 eyes that underwent vitreoretinal surgery.Intraoperative corneal debridement was performed to 61(7.1%)subjects and postoperative CED developed spontaneously in 94(11.0%)subjects.Significant factors associated with postoperative CED included prolonged surgical duration(P=0.003),diabetes mellitus(P=0.04),postoperative ocular hypotension(P<0.001).Prolonged surgical duration was associated with intraoperative debridement.Delayed defect closure time(>2 wk)was associated with corneal scar formation at the end of the 1 y in all epithelial defect subjects(P<0.001).The overall rate of corneal scarring for all eyes undergoing vitrectomy was 1.8%.CONCLUSION:Prolonged duration of surgery is the strongest factor associated with both intraoperative debridement and spontaneous postoperative CED.Delayed defect closure is associated with a greater risk of corneal scarring at one year.The overall rate of corneal scarring following vitrectomy is low at<2%.

25-gauge transconjunctival diagnostic vitrectomy in suspected cases of intraocular lymphoma: a case series and review of the literature

AIM:To report the cytology results of 25-gauge transconjunctival(25G-TSV)diagnostic vitrectomy in cases suspicious for intraocular lymphoma(IOL),and compare the results to those reported in the literature.METHODS:Clinical and cytopathological records of 18vitreous biopsy specimens obtained via 25G-TSV diagnostic vitrectomy in 12 patients suspicious for IOL were reviewed retrospectively.A review of the literature in regards to the diagnostic yields of vitreous specimens obtained via 25-gauge and 20-gauge diagnostic vitrectomy in suspected cases of IOL was performed.RESULTS:Eighteen eyes from 12 patients with clinical suspicion of IOL underwent diagnostic 25G-TSV.The cytopathological investigations demonstrated IOL in 15eyes(83.3%).Vitreous analysis was non-diagnostic in 3eyes(16.7%).CONCLUSION:Twenty-five-gauge diagnostic vitrectomy yields adequate sample for cytological evaluation of the vitreous in cases suspicious for IOL.The diagnostic results of the 25G-TSV in the current study are superior to those reported for 20-gauge vitrectomy but equivalent to those reported for 25G-TSV in the published literature.

利用大气泡技术进行深板层角膜移植术治疗圆锥角膜的疗效观察

PURPOSE: To evaluate the efficacy of deep lamellar keratoplasty using the big-bubble technique in patients with keratoconus. DESIGN: Interventional case series. METHODS: Thirteen eyes of 12 patients (eight male and four female subjects) with moderate to advanced keratoconus and intolerance to contact lens wear were included in this study. Deep lamellar keratoplasty was performed by the intrastromal air injection technique. Full-thickness donor tissue devoid of Descemet membrane and endothelium was then sutured into place. Best-corrected visual acuity, refractive results, surgical technique, and complication rates were analyzed. RESULTS: Big bubble was successfully achieved in nine eyes (69.2%). Average postoperative best-corrected visual acuity was 20/25 (range 20/50 to 20/20) at a mean follow-up of 5 months. Intraoperative microperforation of Descemet membrane occurred in two eyes (15.3%). Three eyes (23%) developed a steroid-induced increase in intraocular pressure, which responded to medical therapy. CONCLUSIONS: Deep lamellar keratoplasty that uses the big-bubble technique is safe and effective in patients with keratoconus. Visual outcome is comparable to standard penetrating keratoplasty, without the risk of endothelial rejection.

Polymicrobial Keratitis—Importance of Detecting and Treating More Than One Organism

Corneal ulcers may become non-healing if inappropriately managed. Empirically giving broad spectrum antibiotics or prescription of a “cocktail” of topical antibacterial, antifungal and antiviral medication may only add to drug toxicity and drug resistance. We present a series of four cases of microbial keratitis which are complicated due to presence of more than one causative organism. Microbiological work-up revealed Proteus species and fungal hyphae in smears only in the first case, atypical Mycobacteria and Staphyloccocus species in the second case, Moraxella and Streptococcus viridans in the third case and Aspergillus flavus and Nocardia species in the fourth case. Authors would like to emphasize the need for laboratory support in the treatment of corneal ulcers and importance of proper management of this sight threatening disease.

小切口深板层角膜内皮移植术的初期结果

PURPOSE: To evaluate the results of replacing the posterior stroma and endothelium, using small incision deep lamellar endothelial keratoplasty (DLEK) surgical techniq-ue, in patients with corneal endothelial dysfunction. DESIGN: Noncomparative case series. METHODS: Fifteen eyes of 15 patients (six males and nine females) with endothelial dysfunction were included in this study. Through a 5-mm scleral incision, a deep lamellar pocket was created across the cornea, followed by excision of an 8.0-mm disk of posterior lamellar corneal tissue. Same size lamellar donor disk was prepared and placed in position without the need of suture fixation. Best spectaclecorrected visual acuity (BSCVA), refraction, endothelial cell density, corneal topography, and corneal thickness were analyzed. RESULTS: Average BSCVA preoperative was 20/200 (range 20/40 to hand movements (HM)), improving to 20/50 (range 20/20 to 20/120) at a mean follow-up of 7.2 months. Average refractive astigmatism at last follow-up was 1.46 ±1.21 diopters (range, 0 to 4 diopters). Preoperative average donor endothelial cell density was 2047 ±311 cells/mm2, and that at last follow-up was 1732 ±514 cells/mm2. Preoperative average pachymetry was 801.4 ±211.3 μm, improving to 553 ±90.4 μm at last follow-up. CONCLUSIONS: Initial results with small incision DLEK procedure indicate that it is a safe procedure that provides healthy donor endothelial cell count and function postoperatively, with encouraging visual results.

Bilateral benign reactive lymphoid hyperplasia of the conjunctiva: a case treated with oral doxycycline and review of the literature

Background:To report a case of bilateral benign reactive lymphoid hyperplasia(BRLH)of the conjunctiva treated with oral doxycycline and perform review of the literature evaluating the presentation,treatment and risk of transformation to lymphoma.Case presentation:A case report is described and review of the literature from January 1975 to January 2019 was performed.A 30-year-old man presented with bilateral enlarging fleshy pink medial canthal conjunctival lesions.Incisional biopsy revealed BRLH.Oral doxycycline was initiated(100 mg two times a day)for a total of 2 months.Both lesions decreased in size significantly at the patient’s two-month follow up visit.The residual lesion in the right eye was excised along with an adjacent pterygium and the patient has been free of recurrence for the past 1.5 years.The lesion in the left eye has remained stable in size after cessation of the oral doxycycline.A total of 235 cases of conjunctival BRLH were identified in our literature search.The mean age at diagnosis was 35.2 years(range,5 to 91 years).BRLH lesions were unilateral in 75%of patients and bilateral in 25%of them.Seven patients(2.9%)had a concurrent Epstein-Barr virus(EBV)infection at the time of lesion appearance.The most common treatments were surgical excision(155/235 or 65.9%)and corticosteroids(30/235 or 12.7%),while 14%(33/235)of the patients were observed and 4.6%(11/235)received external beam radiotherapy alone.Recurrence occurred in ten patients(10/235 or 4.2%),of whom five had undergone surgical excision alone,two excision followed by external beam radiotherapy,one excision and oral corticosteroids,one radiotherapy alone and one had been treated with topical corticosteroids.Overall,only 2 of the 235 reported cases(0.8%)developed malignancy,one localized to the conjunctiva and one systemic.Conclusions:Benign reactive lymphoid hyperplasia is one of the lymphoproliferative disorders of the conjunctiva and ocular adnexa.Extensive literature review shows that most cases are treated with surgery,steroids or observation.Oral doxycycline may be considered an alternative non-invasive treatment of BRLH conjunctival lesions.BRLH lesions warrant careful follow up as they can rarely transform into conjunctival or systemic lymphoma.