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Correction associated with amblyopia inside cats as well as rats following the crucial time period.
PURPOSE To analyze the clinical results of repeat Descemet membrane endothelial keratoplasty (re-DMEK) for failed primary DMEK graft at a referral center for keratoplasty in Spain. DESIGN Retrospective, interventional, comparative case series. METHODS From a single-center, single-surgeon series of 189 consecutive DMEK surgeries, fourteen (7.41%) were re-DMEK eyes. Primary outcome was best-corrected visual acuity change (ΔBCVA,logMAR) from baseline (prior to first DMEK) to last follow-up. Secondary outcomes were ΔBCVA from baseline at 3, 6, and 12 months post-operatively, endothelial cell loss (%ECL), re-bubbling rate, and re-DMEK graft failure. Outcomes were compared with an age-matched control group of 18 successful primary DMEK eyes. RESULTS After re-DMEK (median follow-up time 14.5 (42.5) months), mean BCVA improved from 0.55 (0.42)logMAR (Snellen 20/71 (20/53)) at baseline to 0.09 (0.26)logMAR (Snellen 20/25 (20/36)) (p=0.037). ΔBCVA from baseline was statistically significant at months 3 (p=0.028), 6 (p=0.023), and 12 (p=0.012), and ΔBCVA was significant observed between months 6 and 12 (p=0.028). BCVA differences between patient groups were statistically non-significant at 3 (p=0.397), 6 (p=0.468), and 12 months (p=0.647). Mean %ECL in re-DMEK eyes with follow-up ≥12 months was 48.2 (15.1)%, and re-bubbling rate was 28.6%; differences between groups were statistically non-significant for both variables (p=0.580 and p=0.669, respectively). Three re-DMEK eyes developed graft failure, all achieving final BCVA≤0.30 logMAR (Snellen≥20/40) after tertiary keratoplasty. CONCLUSIONS Repeat DMEK produces significant, continuous visual improvement after failed primary DMEK. Although visual outcomes and %ECL are comparable to primary DMEK, there was a relatively high rate of graft failure after re-DMEK. PURPOSE To evaluate the features of the axial length to corneal radius ratio (AL/CR) in Japanese patients with cataracts and determine the accuracy of intraocular lens (IOL) power calculation formulas according to the AL/CR features and the AL. selleck screening library DESIGN Retrospective observational case series. METHODS Setting Clinical practice. PATIENT POPULATION A total of 1,135 eyes (1,135 patients) with cataracts. OBSERVATION PROCEDURES Measurement of the AL and CR by optical biometry and evaluation of the refractive outcomes using the SRK/T, Holladay 1, Hoffer Q, Haigis, and Barrett Universal II formulas. MAIN OUTCOME MEASURES The features of the AL/CR ratio and the accuracy of IOL power calculations based on the AL/CR and the AL. RESULTS The mean AL/CR was 3.15 ± 0.19. Significant weak negative correlations were observed between the spherical equivalent (SE) and AL (r = -0.7489, P less then 0.001) and the SE and AL/CR (r = -0.8069, P less then 0.001); no correlation was found between the SE and CR (r = 0.0208, P = 0.483). For medium ALs and high AL/CRs, the SRK/T formula performed less accurately. For long ALs and high AL/CRs, the Holladay 1 and Hoffer Q formulas performed less accurately. The Barrett Universal II formulas performed well across a range of ALs and AL/CRs. CONCLUSIONS The AL/CR explained the total variation in the SE better than the AL alone. Surgeons should pay attention to the selection of IOL power calculation formulas in eyes with high AL/CRs. PURPOSE To investigate baseline characteristics of patients undergoing additional anti-vascular endothelial growth factor (VEGF) injections for residual or recurrent diabetic macular edema (DME) in the first year after 0.19 mg fluocinolone acetonide (FAc) implant. DESIGN Prospective cohort study METHODS Ninety-four eyes of 66 patients received FAc implant. Eyes with persistent or recurrent DME were managed with pro-re-nata anti-VEGF agents. Demographic data and medical history were collected at baseline. Best-corrected visual acuity(BCVA) and central macular thickness(CMT) were measured every 2 months. Three outcomes explored1) risk factors for administration of additional anti-VEGF agents;2) interval from FAc to first anti-VEGF injection;3) number of anti-VEGF doses required to maintain regression of DME. RESULTS Eighteen eyes(19.1%) of 13 patients received 1.3±0.6 anti-VEGF injections. These eyes had significantly thicker CMT at baseline and over entire follow-up(p less then 0.001); BCVA was similar at every time-point to eyes not receiving extra DME treatments. Eyes without preexistent panretinal photocoagulation(PRP) had higher risk to undergo supplemental treatments(HR1.5;95%CI1.1-2.5, p=0.03). The interval between FAc implant and the first anti-VEGF had significant linear positive relationship with the number of dexamethasone implant before FAc implant(p=0.002, R2=0.47).No association was found between baseline factors and the number of injections given. CONCLUSION Anti-VEGF agents are efficient treatment to maintain visual acuity in residual/recurrent DME after FAc. Patients with higher baseline CMT and with no previous PRP are more likely to require additional treatments to control DME. PURPOSE To compare tear protein markers between normal subjects and dry eye (DE) patients with high and low lymphotoxin (LT)-alpha levels. DESIGN Prospective cross-sectional study. METHODS DE patients were divided into low (≤700 pg/ml) and high (>700 pg/ml) LT-alpha groups. Twelve protein markers were measured by microsphere-based immunoassay and ocular surface parameters were determined in right eyes (33 high LT-alpha DE, 27 low LT-alpha DE, 20 control) and left eyes (21 high LT-alpha DE, 39 low-LT-alpha DE, 20 control). RESULTS In both eyes, tumor necrosis factor-α (TNF-α), interleukin (IL)-10, IL-1beta, IL-1Ra, IL-17A, and IL-12/23 p40 levels in high LT-alpha DE were significantly higher (p less then 0.01) than in low LT-alpha DE. Significant correlations identified in high LT-alpha DE were SPEED with IL-10 (R=0.43, P=0.013), IL-1beta (R=0.4 8, P=0.005), and IL-12/23 p40 (R=0.50, P=0.003); IL-12/23 p40 with ocular surface disease index (OSDI) (R=0.35, P =0.049); and epidermal growth factor (EGF) with corneal fluorescein staining (CFS) score (R=-0.36, P=0.038). Significant correlations in low LT-alpha DE were SPEED with IL-10 (R=-0.39, P=0.046), TNF-α (R=-0.39, P=0.047), and IL-17A (R=-0.48, P=0.013); OSDI with TNF-α (R=-0.47, P=0.017) and IL-17A (R=-0.46, P=0.018); and IL-6 with tear breakup time (R=-0.40, P=0.044). Lastly, IL-1Ra levels significantly increased in DE patients, positively correlated with temporal conjunctival hyperemia index (TCHI) and negatively correlated with Schirmer I test (p less then 0.05). CONCLUSIONS Our study identified tear IL-1Ra level as a potential biomarker to replace Schirmer I test. Multiple tear protein marker levels increased in high LT-alpha DE, indicating that high LT-alpha DE might have a different pathogenesis.
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