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Ocular media
Published in Fiona Rowe, Visual Fields via the Visual Pathway, 2016
These may be anterior (epithelial), stromal, posterior or ecstatic (keratoconus). They are often progressive and bilateral conditions affecting one of the layers of cornea. Anterior dystrophies can be due to recurrent erosions. Stromal dystrophies involve accumulation of deposits in the stromal layer, e.g. granular, macular and lattice dystrophies. Posterior dystrophies involve Descemet’s membrane and the endothelium, e.g. corneal guttata. Corneal dystrophy may be secondary to systemic disease, e.g. Fuchs dystrophy.
Combined Cataract and Glaucoma Surgery
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Arvind Neelakantan, Mary Fran Smith, Maher M. Fanous, Mark B. Sherwood
During the preoperative evaluation of a patient with cataract and glaucoma, the question of whether to do phacoemulsification alone or a combined cataract and glaucoma procedure is considered. One approach is to make this decision based on the number of medications the patient requires preoperatively for glaucoma control, modified by optic nerve and visual field appearance as well as by the patient’s life expectancy. For example, a patient requiring few medications might do well with phacoemulsification alone or with minimally invasive glaucoma surgery (MIGS) combined with phacoemulsification. However, if the patient is young and already has advanced nerve and field changes, a combined phacotrabeculectomy might be the better choice. Close attention should be paid to the status of the corneal endothelium and the integrity of the zonules at this evaluation. This is particularly important in glaucoma patients, such as those with irido-corneal endothelial syndrome, Fuchs’ dystrophy, or pseudoexfoliation. If a MIGS procedure is being considered, preoperative gonioscopy is essential to first confirm an open angle and also to ensure angle landmarks, such as trabecular meshwork and scleral spur, are clearly identified. The preoperative evaluation is also a good opportunity to judge the extent of pupillary dilation. Eliciting a prior history of systemic alpha-1 blocker use for benign prostatic hypertrophy helps anticipate the possible occurrence of intraoperative floppy iris syndrome (IFIS).
Prior Contralateral Penetrating Keratoplasty Is a Risk Factor for Second Eye Graft Rejection
Published in Ocular Immunology and Inflammation, 2023
Eric J. Shiuey, Qiang Zhang, Christopher J. Rapuano, Brandon D. Ayres, Kristin M. Hammersmith, Parveen K. Nagra, Zeba A. Syed
With a mean follow-up of 4.00 ± 2.87 years, at least one episode of allograft rejection occurred in 35.6% of all study eye PKs. Previously reported PK rejection rates range between 9.6% and 34%.11,12 Our relatively high rate of rejection may have been due to our institution being a tertiary care center, where patients with urgent and complex pathologies are referred. For example, as described above, 14.0% of our cohort had a PK performed during an active microbial infection, demonstrating the large number of therapeutic PKs. We corroborated risk factors for rejection previously found in other studies, namely corneal vascularization13 and anterior segment inflammation related to active microbial infection or a history of anterior uveitis/endophthalmitis.14 We did not find recipient female sex or younger age to influence the risk of rejection, despite their significance in other investigations.12,13 Interestingly, aphakia and PCIOL at the conclusion of PK were protective against rejection, relative to phakia. Similar findings have been previously demonstrated, as Stulting et al. reported lower rates of graft rejection in eyes with Fuchs’ dystrophy that were pseudophakic or aphakic as compared to phakic.12 The authors proposed one possible explanation of more intense or longer steroid regimens in eyes undergoing lens removal at the time of PK. Furthermore, successful outcomes have been observed with secondary IOL placement during PK and aphakic keratoplasty.15,16
Changing Trends in Penetrating Keratoplasty Indications between 2011 and 2018 – Histopathology of 2123 Corneal Buttons in a Single Center in Germany
Published in Current Eye Research, 2020
Milán Tamás Pluzsik, Berthold Seitz, Fidelis A. Flockerzi, Achim Langenbucher, Gábor Tóth, Rainer M. Bohle, Nóra Szentmáry
In our study, Fuchs’ endothelial dystrophy (9.1%) was the sixth most common PKP indication and its incidence decreased to the second time-period. In contrast, in our previous report, the second most common PKP indication was Fuchs’ dystrophy.8 The decreasing incidence of Fuchs dystrophy between PKP patients in a previous8 and the current study is shown in Figure 3. This fact may mostly be related to the introduction of posterior lamellar keratoplasty techniques in Homburg but even more so in other leading keratoplasty centers in Germany (such as Erlangen, Cologne, and Freiburg). In the USA (23.2%)13 it was the second, in Great Britain (13.5%)20 the third most common PKP indication. In Asia (4.5%)41 it was reported as the fifth most common PKP indication.
Targeting the integrated stress response in ophthalmology
Published in Current Eye Research, 2021
Hsiao-Sang Chu, Cornelia Peterson, Albert Jun, James Foster
Fuchs endothelial corneal dystrophy, a disorder of the corneal endothelium that is characterized by loss of endothelial cells and abnormalities of Descemet’s membrane, may result in progressive corneal edema.69,70 Enlargement of rough ER of endothelial cells has been demonstrated in Fuchs dystrophy specimens. Meanwhile, significantly higher peIF2α and CHOP expression were quantified in Fuchs dystrophy corneal endothelium as compare to the non-Fuchs dystrophy controls.71 Okumura et al also reported elevated PERK activation and CHOP expression in cultivated human Fuchs endothelial cells as compared to its normal controls.72 Both studies have shown that accumulation of unfolded proteins may induce corneal endothelial cell apoptosis.