Eyeworld

JUL 2013

EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.

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Although Descemet's stripping automated endothelial keratoplasty (DSAEK) is by far the most popular endothelial keratoplasty (EK) technique, more recently Descemet's membrane endothelial keratoplasty (DMEK) has been introduced, claiming that it could further improve the outcomes of EK, both in terms of vision and risk of immunologic graft rejection. However, DMEK is still not gaining popularity over DSAEK because of its technical difficulty and higher rate of complications. In 2009, Massimo Busin, MD, introduced ultrathin (UT) DSAEK, aimed at optimizing the DSAEK results by standardizing the morphologic features of the DSAEK graft. The twoyear results of this prospective study of 285 UT-DSAEK cases confirm that DMEK-like outcomes are possible after DSAEK performed with UT grafts. Visual acuity and immunologic graft rejection probability compare favorably with those of conventional DSAEK and do not differ substantially from those of DMEK. In addition, UT grafts do not increase the rate of complications of conventional DSAEK. Infectious keratitis after Boston type I keratoprosthesis implantation: incidence, organisms, risk factors, and outcomes Michelle J. Kim, BS, Fei Yu, PhD, Anthony J. Aldave, MD Infectious keratitis is a potentially serious complication following Boston type I keratoprosthesis implantation. In a retrospective, single surgeon consecutive case series of 125 keratoprosthesis procedures performed in 110 eyes of 105 patients at the Jules Stein Eye Institute (Los Angeles), the incidence of microbial keratitis was 13.6%, occurring at a rate of 0.073 infections per eye-year. The rate of culture-positive bacterial keratitis was 0.022 infections per eye-year, and the rate of culturepositive fungal keratitis was 0.015 infections per eye-year. Topical vancomycin use, topical steroid use, and contact lens wear at any given time point were not found to be risk factors for infectious keratitis, but prolonged vancomycin use and persistent corneal epithelial defect were associated with an increased risk for fungal keratitis and infectious kerati- tis overall. The observed rate of microbial keratitis suggests the need for additional topical antimicrobial prophylaxis following keratoprosthesis implantation in eyes at higher risk. Dell* Toric Axis Markers Precise Alignment For Correct Toric Axis Placement, From Upright Through The Supine Position. Sensitivity and speci´Čücity of corneal Bowman and epithelial layers topographic thickness indices in diagnosis of keratoconus Mohamed Abou Shousha, MD In our study we were able to disclose for the first time in literature in vivo Bowman's layer (BL) structural changes specific to keratoconus. We revealed characteristic BL peripheral inferior thinning and quantified that by an index defined as the inferior thinnest point measured on a 2dimensional 9 mm map of BL. Our BL index has shown excellent predictive accuracy for the diagnosis of keratoconus with 90% sensitivity and specificity. Moreover, it was found to be an accurate representation of the severity of ectasia. Furthermore, an epithelial map was created and disclosed a characteristic pattern of superior thickening followed by inferior thinning over the cone. This was also quantified by an index that was found to be 90% sensitive but only 80% specific. Combining the BL and epithelial indices has maximized the sensitivity and specificity for the diagnosis of keratoconus to 96 and 95%, respectively. Automated detection program for subclinical forms of keratoconus David Smadja, MD, Marcony R. Santhiago, MD, Ronald R. Krueger, MD, David Touboul, MD In this study, we developed a screening program using an artificial intelligence system for differentiating subclinical keratoconus (KC) from normal corneas in an objective and quantitative way and without requiring preliminary expertise in interpreting corneal imaging. This program works similarly to an automated medical reasoning by providing the discriminating rules as a decision tree. Fifty-six parameters were measured and analyzed in each cornea using the Galilei Analyzer system (Ziemer, Port, Switzerland) and used g Bezel ith Rotatin Marker W Toric Lens sition Supine Po Dell Fixed In 8-12119: n Patient Is Used Whe r arke ns M When d ic Le l Tor ezel Use ion e B Swiv osit Dell Rotating pright P 20: With t Is In U -121 8 n Patie 8-12119: Rotating Inner Bezel Automatically Orients Mark s For The Placement Of A Toric IOL In The Correct Meridian. W h i le T he Patient Is Upright, An Orientation Mark I s Placed Ve r t i c a l l y On The Conjunctiva. In Surger y T he Rotating Inner Bezel Is Set To The Desired Meridian. While The Instrument Is Positioned So That The Vertical Conjunctival Mark Is Aligned With The 90 Degree Position On The Outer Bezel Of The Marker. The Marking Blades On The Undersurface Of The Instrument Will Automatically Place A Mark In The Correct Meridian When The Cornea Is Indented. 8-12120: Weighted So That Correct Horizontal Orientation Is Assured. Rotating Inner Bezel Automatically Orients Blades For Corneal Marks For The Placement Of A Toric IOL In The Correct Meridian. Designed For Use With The Patient Upright Immediately Prior To Surgery, The Inner Bezel Is Rotated To The Desired Meridian, And The Cornea Is Indented. The Marking Blades On The Undersurface Of The Instrument Will Automatically Place Marks In The Correct Meridian. www.RheinMedical.com 3360 Scherer Drive, Suite B. St.Petersburg, Florida s 4EL s &AX %MAIL )NFO 2HEIN-EDICALCOM s 7EBSITE WWW2HEIN-EDICALCOM $EVELOPED )N #OORDINATION 7ITH 3TEVEN * $ELL -$ continued on page 14 Moses, Michelangelo 1269 Rev.D BABC

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