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Sanjay V Patel - One of the best experts on this subject based on the ideXlab platform.
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Long-term keratometric changes after penetrating keratoplasty for keratoconus and Fuchs endothelial Dystrophy.
Transactions of the American Ophthalmological Society, 2020Co-Authors: Matthew E. Raecker, Sanjay V Patel, Jay C. Erie, William M. BourneAbstract:PURPOSE: To compare long-term keratometric changes after penetrating keratoplasty (PK) for keratoconus and Fuchs endothelial Dystrophy. METHODS: We retrospectively analyzed 168 corneas after PK for keratoconus (85 eyes of 63 subjects) and Fuchs Dystrophy (83 eyes of 60 subjects). Patients were examined after final suture removal at 12 months after PK to 30 years after surgery. Operations were performed by one surgeon using the same suturing technique in all cases. Eyes were excluded from further analysis after regrafting or after relaxing incisions. Mean keratometric corneal power and astigmatism were measured by manual keratometry. Data were assessed by using generalized estimating equation models to determine change over time. RESULTS: Mean keratometric corneal power and keratometric astigmatism increased through 30 years after PK for keratoconus (P < .001 and P < .001) but did not change through 20 years after PK for Fuchs Dystrophy (P = .55 and P = .55). The change in keratometric corneal power and astigmatism after PK in keratoconus patients differed from the change in Fuchs Dystrophy patients only at 10 or more years after PK (P = .002 and P = .003). CONCLUSIONS: Corneal curvature and regular astigmatism increase progressively after PK for keratoconus but remain stable after PK for Fuchs Dystrophy. This keratometric instability after PK for keratoconus may lead to delayed corneal ectasia.
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corneal abnormalities early in the course of Fuchs endothelial Dystrophy
Ophthalmology, 2014Co-Authors: Sejal R Amin, Keith H Baratz, Jay W Mclaren, Sanjay V PatelAbstract:Purpose Corneas with advanced Fuchs' endothelial Dystrophy that require endothelial keratoplasty manifest anterior corneal structural and cellular abnormalities that have been associated with visual deficits before and after endothelial keratoplasty. In this study, we determined the onset of these abnormalities in the course of the disease. Design Cross-sectional study. Participants Sixty-three eyes (39 subjects) with a range of severity of Fuchs' Dystrophy and 25 eyes (13 subjects) with normal corneas. Methods All corneas were examined using slit-lamp biomicroscopy, ultrasonic pachymetry, and confocal microscopy. The clinical grade of Fuchs' Dystrophy was assessed according to the presence and extent of guttae and clinically evident edema and was categorized as mild (grades 1 and 2), moderate (grades 3 and 4), or advanced (grades 5 and 6). Normal corneas were devoid of any central guttae (grade 0). Corneal backscatter (haze) was measured from the confocal image light intensity profile. Stromal cell density and number and the presence of abnormal subepithelial cells were determined from confocal images. Comparisons between groups were made by using generalized estimating equation models. Main Outcome Measures Anterior corneal backscatter, stromal cell density and number, presence of subepithelial cells, and central corneal thickness. Results Anterior corneal backscatter was 18% to 67% higher in eyes with moderate and advanced Fuchs' Dystrophy compared with normal eyes ( P ≤ 0.003); a similar trend was noted in mild Fuchs' Dystrophy eyes compared with normal eyes ( P = 0.08). Stromal cell density and the absolute number of stromal cells in the anterior 10% of the stroma were approximately 20% and 27% lower, respectively, in Fuchs' Dystrophy (regardless of severity) compared with normal ( P P Conclusions Anterior corneal cellular and structural abnormalities begin early in the course of Fuchs' Dystrophy, before the onset of clinically evident edema. The chronicity of these changes can explain their incomplete resolution after endothelial keratoplasty, and understanding the onset of these may help to determine the optimal time to intervene to achieve best outcomes.
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in vivo confocal microscopy of Fuchs endothelial Dystrophy before and after endothelial keratoplasty
JAMA Ophthalmology, 2013Co-Authors: Sanjay V Patel, Jay W MclarenAbstract:Importance This study reveals significant changes of the anterior cornea in Fuchs endothelial Dystrophy that probably affect the visual outcomes of endothelial keratoplasty for the disease. Objective To determine whether abnormalities of corneal stromal and subepithelial cells in Fuchs endothelial Dystrophy resolve after Descemet stripping endothelial keratoplasty (DSEK). Design Prospective observational study of 49 corneas of 42 patients with Fuchs Dystrophy before DSEK and during 3 years of postoperative follow-up. None of the preoperative corneas were vascularized or had pronounced subepithelial fibrosis on results of slitlamp examination. Corneas were examined using in vivo confocal microscopy to determine stromal cell density and the presence of abnormal subepithelial cells (presumed fibroblasts). Setting The cornea service at Mayo Clinic, Rochester, Minnesota. Participants Forty-nine corneas of 42 patients. Intervention Descemet stripping endothelial keratoplasty. Main Outcome Measures Stromal cell density and presence of subepithelial cells. Results Subnormal cell density in the most anterior 10% of the host stroma in Fuchs Dystrophy before DSEK (mean [SD], 22 030 [6479] cells/mm 3 [n = 41]) remained unchanged at 2 (20 433 [4993] cells/mm 3 [n = 35]; P = .36) and 3 years (20 925 [5433] cells/mm 3 [n = 23]; P = .99) after DSEK. Abnormal subepithelial cells, which formed reticular networks deep to the basal epithelial cells, were visible in 33 eyes (67%) and remained present at 3 years after DSEK. Mean preoperative central corneal thicknesses when these subepithelial cells were and were not visible were 652 (45) and 668 (56) μm, respectively (P = .75). Conclusions and Relevance The reduced cellularity of the anterior stroma in Fuchs Dystrophy does not recover 3 years after restoring endothelial function. Abnormal subepithelial cells, presumably fibroblasts, are present in most corneas with Fuchs Dystrophy requiring DSEK, even in cases with mild edema and in the absence of clinically obvious preoperative subepithelial fibrosis. Anterior corneal structural abnormalities might be related to visual outcomes after DSEK.
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Fuchs endothelial corneal Dystrophy subjective grading versus objective grading based on the central to peripheral thickness ratio
Ophthalmology, 2013Co-Authors: Daniel J Repp, Keith H Baratz, Jay W Mclaren, David O Hodge, Sanjay V PatelAbstract:Purpose To assess interobserver agreement between 2 corneal specialists grading Fuchs' Dystrophy clinically and to determine if the corneal central-to-peripheral thickness ratio (CPTR) may be an alternative and objective metric of disease severity. Design Cross-sectional study. Participants Forty-five eyes (26 subjects) with mild and moderate Fuchs' Dystrophy, 73 eyes (60 subjects) with advanced Fuchs' Dystrophy, and 267 eyes (142 subjects) with normal corneas. Methods Corneas with Fuchs' Dystrophy were graded by 2 corneal specialists based on the confluence and area of guttae and the presence or absence of edema. Central corneal thickness (CCT) and peripheral corneal thickness at 4 mm from the center (PCT 4 ) were measured by using scanning-slit pachymetry. The value of CPTR 4 was the quotient of CCT and PCT 4 . Main Outcome Measures Interobserver agreement for clinical grade and CPTR 4 . Results Interobserver agreement for clinical grading of Fuchs' Dystrophy was moderate (κ = 0.32; 95% confidence interval, 0.19–0.45). In normal corneas, CCT was not correlated with age ( r = −0.10; P = 0.28; n=267), PCT 4 decreased with age ( r = −0.33; P 4 increased with age ( r = 0.59; P P 4 was higher in Fuchs' Dystrophy (650±51 μm; n=107) than in normal corneas (643±43 μm; n=254; P 4 was higher in advanced Fuchs' Dystrophy (1.03±0.07; n=65) than in mild and moderate Fuchs' Dystrophy (0.95±0.07; n=42; age-adjusted P P 4 was highly correlated with clinical grade of Fuchs' Dystrophy ( r = 0.77; P Conclusions Agreement between corneal specialists for the subjective and morphologic clinical grading of Fuchs' Dystrophy is only moderate . The corneal CPTR is an objective, repeatable, and possibly functional, metric of severity of Fuchs' Dystrophy that warrants further investigation to determine its role in monitoring disease progression and predicting the need for keratoplasty. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Decreased corneal sensitivity and abnormal corneal nerves in Fuchs endothelial Dystrophy.
Cornea, 2012Co-Authors: Yachna Ahuja, William M. Bourne, Jay W Mclaren, Keith H Baratz, Sanjay V PatelAbstract:Purpose:To determine corneal sensitivity and evaluate corneal nerves before and after keratoplasty for Fuchs endothelial Dystrophy.Methods:Central corneal sensitivity, measured by using a Cochet–Bonnet esthesiometer in 69 eyes before and after different keratoplasty procedures for Fuchs Dystrophy, w
Jay W Mclaren - One of the best experts on this subject based on the ideXlab platform.
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corneal abnormalities early in the course of Fuchs endothelial Dystrophy
Ophthalmology, 2014Co-Authors: Sejal R Amin, Keith H Baratz, Jay W Mclaren, Sanjay V PatelAbstract:Purpose Corneas with advanced Fuchs' endothelial Dystrophy that require endothelial keratoplasty manifest anterior corneal structural and cellular abnormalities that have been associated with visual deficits before and after endothelial keratoplasty. In this study, we determined the onset of these abnormalities in the course of the disease. Design Cross-sectional study. Participants Sixty-three eyes (39 subjects) with a range of severity of Fuchs' Dystrophy and 25 eyes (13 subjects) with normal corneas. Methods All corneas were examined using slit-lamp biomicroscopy, ultrasonic pachymetry, and confocal microscopy. The clinical grade of Fuchs' Dystrophy was assessed according to the presence and extent of guttae and clinically evident edema and was categorized as mild (grades 1 and 2), moderate (grades 3 and 4), or advanced (grades 5 and 6). Normal corneas were devoid of any central guttae (grade 0). Corneal backscatter (haze) was measured from the confocal image light intensity profile. Stromal cell density and number and the presence of abnormal subepithelial cells were determined from confocal images. Comparisons between groups were made by using generalized estimating equation models. Main Outcome Measures Anterior corneal backscatter, stromal cell density and number, presence of subepithelial cells, and central corneal thickness. Results Anterior corneal backscatter was 18% to 67% higher in eyes with moderate and advanced Fuchs' Dystrophy compared with normal eyes ( P ≤ 0.003); a similar trend was noted in mild Fuchs' Dystrophy eyes compared with normal eyes ( P = 0.08). Stromal cell density and the absolute number of stromal cells in the anterior 10% of the stroma were approximately 20% and 27% lower, respectively, in Fuchs' Dystrophy (regardless of severity) compared with normal ( P P Conclusions Anterior corneal cellular and structural abnormalities begin early in the course of Fuchs' Dystrophy, before the onset of clinically evident edema. The chronicity of these changes can explain their incomplete resolution after endothelial keratoplasty, and understanding the onset of these may help to determine the optimal time to intervene to achieve best outcomes.
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in vivo confocal microscopy of Fuchs endothelial Dystrophy before and after endothelial keratoplasty
JAMA Ophthalmology, 2013Co-Authors: Sanjay V Patel, Jay W MclarenAbstract:Importance This study reveals significant changes of the anterior cornea in Fuchs endothelial Dystrophy that probably affect the visual outcomes of endothelial keratoplasty for the disease. Objective To determine whether abnormalities of corneal stromal and subepithelial cells in Fuchs endothelial Dystrophy resolve after Descemet stripping endothelial keratoplasty (DSEK). Design Prospective observational study of 49 corneas of 42 patients with Fuchs Dystrophy before DSEK and during 3 years of postoperative follow-up. None of the preoperative corneas were vascularized or had pronounced subepithelial fibrosis on results of slitlamp examination. Corneas were examined using in vivo confocal microscopy to determine stromal cell density and the presence of abnormal subepithelial cells (presumed fibroblasts). Setting The cornea service at Mayo Clinic, Rochester, Minnesota. Participants Forty-nine corneas of 42 patients. Intervention Descemet stripping endothelial keratoplasty. Main Outcome Measures Stromal cell density and presence of subepithelial cells. Results Subnormal cell density in the most anterior 10% of the host stroma in Fuchs Dystrophy before DSEK (mean [SD], 22 030 [6479] cells/mm 3 [n = 41]) remained unchanged at 2 (20 433 [4993] cells/mm 3 [n = 35]; P = .36) and 3 years (20 925 [5433] cells/mm 3 [n = 23]; P = .99) after DSEK. Abnormal subepithelial cells, which formed reticular networks deep to the basal epithelial cells, were visible in 33 eyes (67%) and remained present at 3 years after DSEK. Mean preoperative central corneal thicknesses when these subepithelial cells were and were not visible were 652 (45) and 668 (56) μm, respectively (P = .75). Conclusions and Relevance The reduced cellularity of the anterior stroma in Fuchs Dystrophy does not recover 3 years after restoring endothelial function. Abnormal subepithelial cells, presumably fibroblasts, are present in most corneas with Fuchs Dystrophy requiring DSEK, even in cases with mild edema and in the absence of clinically obvious preoperative subepithelial fibrosis. Anterior corneal structural abnormalities might be related to visual outcomes after DSEK.
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Fuchs endothelial corneal Dystrophy subjective grading versus objective grading based on the central to peripheral thickness ratio
Ophthalmology, 2013Co-Authors: Daniel J Repp, Keith H Baratz, Jay W Mclaren, David O Hodge, Sanjay V PatelAbstract:Purpose To assess interobserver agreement between 2 corneal specialists grading Fuchs' Dystrophy clinically and to determine if the corneal central-to-peripheral thickness ratio (CPTR) may be an alternative and objective metric of disease severity. Design Cross-sectional study. Participants Forty-five eyes (26 subjects) with mild and moderate Fuchs' Dystrophy, 73 eyes (60 subjects) with advanced Fuchs' Dystrophy, and 267 eyes (142 subjects) with normal corneas. Methods Corneas with Fuchs' Dystrophy were graded by 2 corneal specialists based on the confluence and area of guttae and the presence or absence of edema. Central corneal thickness (CCT) and peripheral corneal thickness at 4 mm from the center (PCT 4 ) were measured by using scanning-slit pachymetry. The value of CPTR 4 was the quotient of CCT and PCT 4 . Main Outcome Measures Interobserver agreement for clinical grade and CPTR 4 . Results Interobserver agreement for clinical grading of Fuchs' Dystrophy was moderate (κ = 0.32; 95% confidence interval, 0.19–0.45). In normal corneas, CCT was not correlated with age ( r = −0.10; P = 0.28; n=267), PCT 4 decreased with age ( r = −0.33; P 4 increased with age ( r = 0.59; P P 4 was higher in Fuchs' Dystrophy (650±51 μm; n=107) than in normal corneas (643±43 μm; n=254; P 4 was higher in advanced Fuchs' Dystrophy (1.03±0.07; n=65) than in mild and moderate Fuchs' Dystrophy (0.95±0.07; n=42; age-adjusted P P 4 was highly correlated with clinical grade of Fuchs' Dystrophy ( r = 0.77; P Conclusions Agreement between corneal specialists for the subjective and morphologic clinical grading of Fuchs' Dystrophy is only moderate . The corneal CPTR is an objective, repeatable, and possibly functional, metric of severity of Fuchs' Dystrophy that warrants further investigation to determine its role in monitoring disease progression and predicting the need for keratoplasty. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Decreased corneal sensitivity and abnormal corneal nerves in Fuchs endothelial Dystrophy.
Cornea, 2012Co-Authors: Yachna Ahuja, William M. Bourne, Jay W Mclaren, Keith H Baratz, Sanjay V PatelAbstract:Purpose:To determine corneal sensitivity and evaluate corneal nerves before and after keratoplasty for Fuchs endothelial Dystrophy.Methods:Central corneal sensitivity, measured by using a Cochet–Bonnet esthesiometer in 69 eyes before and after different keratoplasty procedures for Fuchs Dystrophy, w
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anterior corneal aberrations after descemet s stripping endothelial keratoplasty for Fuchs endothelial Dystrophy
Ophthalmology, 2012Co-Authors: Sanjay V Patel, Leo J. Maguire, Keith H Baratz, David O Hodge, Jay W MclarenAbstract:Purpose To determine the change in anterior corneal high-order aberrations (HOAs) after Descemet's stripping endothelial keratoplasty (DSEK) for Fuchs' Dystrophy, and to compare the HOAs with those of age-matched controls. Design Prospective cohort and cross-sectional study. Participants and Controls Forty-eight eyes with Fuchs' Dystrophy were examined before and after DSEK, and were compared with 52 eyes of age-matched controls with normal corneas. Methods Corneas of patients with Fuchs' Dystrophy were examined prospectively before and at intervals through 2 years after DSEK. Wavefront errors from the anterior corneal surface were derived from corneal topograms and were expressed as Zernike polynomials through the sixth order. Best-corrected visual acuity (BCVA) was measured by the electronic Early Treatment of Diabetic Retinopathy Study protocol, and subepithelial haze was measured from the brightness of confocal images. Total HOAs were compared before and after DSEK, and with those of age-matched controls, by using generalized estimating equation models. Relationships between HOAs, BCVA, subepithelial haze, and recipient age were determined. Main Outcome Measures Anterior corneal HOAs, BCVA, and subepithelial haze (backscattered light). Results In Fuchs' Dystrophy before DSEK, total HOAs (4 mm optical zone) from the anterior corneal surface (0.29±0.13 μm) were higher than those of controls (0.17±0.08 μm; P P = 0.99), and remained higher than in controls ( P r = 0.59; P r = 0.41; P = 0.01; n=25), and with recipient age ( r = 0.59; P Conclusions Anterior corneal HOAs are higher in Fuchs' Dystrophy than in controls, and remain higher through 2 years after DSEK. The aberrated anterior surface might be related to anterior corneal ultrastructural changes and haze formation in Fuchs' Dystrophy, and should not be ignored as a source of decreased visual acuity after DSEK. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.
Francis W. Price - One of the best experts on this subject based on the ideXlab platform.
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Implantation of Presbyopia-Correcting Intraocular Lenses Staged After Descemet Membrane Endothelial Keratoplasty in Patients With Fuchs Dystrophy.
Cornea, 2020Co-Authors: Marianne O. Price, Denisse Pinkus, Francis W. PriceAbstract:PURPOSE: To assess outcomes of presbyopia-correcting intraocular lens (IOL) implantation after Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal Dystrophy. METHODS: This retrospective single-center study evaluated a consecutive series of patients with Fuchs endothelial corneal Dystrophy who received presbyopia-correcting IOLs after DMEK. The main outcomes were corrected distance visual acuity, uncorrected distance visual acuity, uncorrected near visual acuity, and refractive error. RESULTS: Fourteen extended depth of focus and 2 bifocal IOLs were implanted in 16 eyes of 8 patients (5 women and 3 men; age, 47-68 years). Fourteen IOLs were spherical and 2 were toric. Postoperatively, the median corrected distance visual acuity was 20/20 (range, 20/15-20/25), the median binocular uncorrected distance visual acuity was 20/25 (range, 20/15-20/25), the median binocular uncorrected near visual acuity was 20/20 (range, 20/20-20/50), and the median manifest spherical equivalent refraction was 0.05 diopters (D) (range, -0.75 to +0.75 D). Implantation of toric extended depth of focus lenses reduced refractive cylinder from 1 and 2.25 D preoperatively to 0 D in both eyes of 1 patient postoperatively. A comparison of biometry measurements taken before and after DMEK showed the median change in average keratometry was 0.26 D with a substantial range of -1.74 to +1.18 D. The median endothelial cell loss was 63 cells/mm (3%) after staged phacoemulsification. CONCLUSIONS: Favorable visual and refractive outcomes were obtained with presbyopia-correcting IOLs in patients with Fuchs Dystrophy when the biometry measurements and IOL implantation were staged after DMEK had cleared the guttae and corneal edema.
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Prevention and Management of Pupil Block After Descemet Membrane Endothelial Keratoplasty.
Cornea, 2016Co-Authors: Andres A. Gonzalez, Marianne O. Price, Francis W. Price, Matthew T. FengAbstract:Purpose:To assess frequency, associations, and outcomes of full air fill after Descemet membrane endothelial keratoplasty (DMEK).Methods:This retrospective study reviewed 368 consecutive DMEK cases performed to treat Fuchs Dystrophy, bullous keratopathy, or failed keratoplasty. Primary outcomes were
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long term follow up and complications of stripping descemet membrane without placement of graft in eyes with Fuchs endothelial Dystrophy
Cornea, 2014Co-Authors: Juan Arbelaez, Marianne O. Price, Francis W. PriceAbstract:Purpose:The aim of this study was to describe the clinical course in Fuchs Dystrophy where the central Descemet membrane was removed and not replaced with donor tissue.Methods:Three patients with Fuchs endothelial Dystrophy had descemetorhexis without endothelial keratoplasty.Results:In each case, e
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Descemet membrane endothelial keratoplasty combined with epithelial debridement and mitomycin-C application for Fuchs Dystrophy with preoperative subepithelial fibrosis or anterior basement membrane Dystrophy.
Cornea, 2014Co-Authors: Sunita Chaurasia, Marianne O. Price, Yuri Mckee, Francis W. PriceAbstract:PURPOSE: The aim of this study was to evaluate the anterior corneal surface regularity and light scattering before and after Descemet membrane endothelial keratoplasty (DMEK) with epithelial debridement and application of mitomycin C in Fuchs Dystrophy-affected eyes with preoperative subepithelial fibrosis or anterior basement membrane Dystrophy. METHODS: In this case-control study, a chart review identified 37 eyes with Fuchs Dystrophy and anterior corneal changes evident on preoperative slit lamp examination and that underwent DMEK combined with epithelial removal plus mitomycin-C application. These cases were compared with 83 contemporaneous DMEK procedures performed in eyes with Fuchs Dystrophy without clinically evident anterior surface problems (controls). The outcome measures were corrected distance visual acuity (CDVA), corneal surface regularity assessed by topography, anterior corneal light scattering by densitometry, endothelial cell loss, and complications. RESULTS: Cases and controls had comparable demographics. Preoperatively, the cases had significantly poorer corneal surface regularity and transparency than did controls (P 0.05), and 77% had a CDVA ≥ 20/25, excluding 2 eyes with preexisting retinal problems. The median 6-month endothelial cell loss was 25% and did not differ significantly between cases and controls (P = 0.31). In 1 case, there was delayed epithelial healing. CONCLUSIONS: Even patients with endothelial dysfunction with anterior stromal changes can realize a significant improvement in corneal surface topography and transparency by undergoing combined epithelial removal with DMEK, and this can preclude the need for a subsequent procedure to address residual corneal surface problems or the need for a penetrating keratoplasty.
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descemet s stripping automated endothelial keratoplasty three year graft and endothelial cell survival compared with penetrating keratoplasty
Ophthalmology, 2013Co-Authors: Marianne O. Price, Francis W. Price, Mark S Gorovoy, Beth Ann Benetz, Harry J Menegay, Jonathan H LassAbstract:Purpose To assess 3-year outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) in comparison with penetrating keratoplasty (PKP) from the Cornea Donor Study (CDS). Design Prospective, multicenter, nonrandomized clinical trial. Participants A total of 173 subjects undergoing DSAEK for a moderate risk condition (principally Fuchs' Dystrophy or pseudophakic corneal edema) compared with 1101 subjects undergoing PKP from the CDS. Methods The DSAEK procedures were performed by 2 experienced surgeons using the same donor and similar recipient criteria as for the CDS PKP procedures, performed by 68 surgeons. Graft success was assessed by Kaplan-Meier survival analysis. Central endothelial cell density (ECD) was determined from baseline donor and postoperative central endothelial images by the reading center used in the CDS Specular Microscopy Ancillary Study. Main Outcome Measures Graft clarity and ECD. Results The donor and recipient demographics were comparable in the DSAEK and PKP groups, except that the proportion of Fuchs' Dystrophy cases was higher in the DSAEK cohort. The 3-year survival rate did not differ significantly between DSAEK and PKP procedures performed for either Fuchs' Dystrophy (96% for both; P = 0.81) or non-Fuchs' cases (86% vs. 84%, respectively; P = 0.41). Principal causes of graft failure or regraft within 3 years after DSAEK and PKP were immunologic graft rejection (0.6% vs. 3.1%), endothelial decompensation in the absence of documented rejection (1.7% vs 2.1%), unsatisfactory visual or refractive outcome (1.7% vs. 0.5%), and infection (0% vs. 1.1%), respectively. The 3-year predicted probability of a rejection episode was 9% with DSAEK versus 20% with PKP ( P = 0.0005). The median 3-year cell loss for DSAEK and PKP was 46% and 51%, respectively ( P = 0.33), in Fuchs' Dystrophy cases and 59% and 61%, respectively ( P = 0.70), in the non-Fuchs' cases. At 3 years, use of a smaller DSAEK insertion incision was associated with significantly higher cell loss (60% vs. 33% for 3.2- and 5.0-mm incisions, respectively; P = 0.0007), but not with a significant difference in graft survival ( P = 0.45). Conclusions The graft success rate and endothelial cell loss were comparable at 3 years for DSAEK and PKP procedures. A 5-mm DSAEK incision width was associated with significantly less cell loss than a 3.2-mm incision. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.
Marianne O. Price - One of the best experts on this subject based on the ideXlab platform.
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Implantation of Presbyopia-Correcting Intraocular Lenses Staged After Descemet Membrane Endothelial Keratoplasty in Patients With Fuchs Dystrophy.
Cornea, 2020Co-Authors: Marianne O. Price, Denisse Pinkus, Francis W. PriceAbstract:PURPOSE: To assess outcomes of presbyopia-correcting intraocular lens (IOL) implantation after Descemet membrane endothelial keratoplasty (DMEK) in patients with Fuchs endothelial corneal Dystrophy. METHODS: This retrospective single-center study evaluated a consecutive series of patients with Fuchs endothelial corneal Dystrophy who received presbyopia-correcting IOLs after DMEK. The main outcomes were corrected distance visual acuity, uncorrected distance visual acuity, uncorrected near visual acuity, and refractive error. RESULTS: Fourteen extended depth of focus and 2 bifocal IOLs were implanted in 16 eyes of 8 patients (5 women and 3 men; age, 47-68 years). Fourteen IOLs were spherical and 2 were toric. Postoperatively, the median corrected distance visual acuity was 20/20 (range, 20/15-20/25), the median binocular uncorrected distance visual acuity was 20/25 (range, 20/15-20/25), the median binocular uncorrected near visual acuity was 20/20 (range, 20/20-20/50), and the median manifest spherical equivalent refraction was 0.05 diopters (D) (range, -0.75 to +0.75 D). Implantation of toric extended depth of focus lenses reduced refractive cylinder from 1 and 2.25 D preoperatively to 0 D in both eyes of 1 patient postoperatively. A comparison of biometry measurements taken before and after DMEK showed the median change in average keratometry was 0.26 D with a substantial range of -1.74 to +1.18 D. The median endothelial cell loss was 63 cells/mm (3%) after staged phacoemulsification. CONCLUSIONS: Favorable visual and refractive outcomes were obtained with presbyopia-correcting IOLs in patients with Fuchs Dystrophy when the biometry measurements and IOL implantation were staged after DMEK had cleared the guttae and corneal edema.
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Prevention and Management of Pupil Block After Descemet Membrane Endothelial Keratoplasty.
Cornea, 2016Co-Authors: Andres A. Gonzalez, Marianne O. Price, Francis W. Price, Matthew T. FengAbstract:Purpose:To assess frequency, associations, and outcomes of full air fill after Descemet membrane endothelial keratoplasty (DMEK).Methods:This retrospective study reviewed 368 consecutive DMEK cases performed to treat Fuchs Dystrophy, bullous keratopathy, or failed keratoplasty. Primary outcomes were
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long term follow up and complications of stripping descemet membrane without placement of graft in eyes with Fuchs endothelial Dystrophy
Cornea, 2014Co-Authors: Juan Arbelaez, Marianne O. Price, Francis W. PriceAbstract:Purpose:The aim of this study was to describe the clinical course in Fuchs Dystrophy where the central Descemet membrane was removed and not replaced with donor tissue.Methods:Three patients with Fuchs endothelial Dystrophy had descemetorhexis without endothelial keratoplasty.Results:In each case, e
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Descemet membrane endothelial keratoplasty combined with epithelial debridement and mitomycin-C application for Fuchs Dystrophy with preoperative subepithelial fibrosis or anterior basement membrane Dystrophy.
Cornea, 2014Co-Authors: Sunita Chaurasia, Marianne O. Price, Yuri Mckee, Francis W. PriceAbstract:PURPOSE: The aim of this study was to evaluate the anterior corneal surface regularity and light scattering before and after Descemet membrane endothelial keratoplasty (DMEK) with epithelial debridement and application of mitomycin C in Fuchs Dystrophy-affected eyes with preoperative subepithelial fibrosis or anterior basement membrane Dystrophy. METHODS: In this case-control study, a chart review identified 37 eyes with Fuchs Dystrophy and anterior corneal changes evident on preoperative slit lamp examination and that underwent DMEK combined with epithelial removal plus mitomycin-C application. These cases were compared with 83 contemporaneous DMEK procedures performed in eyes with Fuchs Dystrophy without clinically evident anterior surface problems (controls). The outcome measures were corrected distance visual acuity (CDVA), corneal surface regularity assessed by topography, anterior corneal light scattering by densitometry, endothelial cell loss, and complications. RESULTS: Cases and controls had comparable demographics. Preoperatively, the cases had significantly poorer corneal surface regularity and transparency than did controls (P 0.05), and 77% had a CDVA ≥ 20/25, excluding 2 eyes with preexisting retinal problems. The median 6-month endothelial cell loss was 25% and did not differ significantly between cases and controls (P = 0.31). In 1 case, there was delayed epithelial healing. CONCLUSIONS: Even patients with endothelial dysfunction with anterior stromal changes can realize a significant improvement in corneal surface topography and transparency by undergoing combined epithelial removal with DMEK, and this can preclude the need for a subsequent procedure to address residual corneal surface problems or the need for a penetrating keratoplasty.
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descemet s stripping automated endothelial keratoplasty three year graft and endothelial cell survival compared with penetrating keratoplasty
Ophthalmology, 2013Co-Authors: Marianne O. Price, Francis W. Price, Mark S Gorovoy, Beth Ann Benetz, Harry J Menegay, Jonathan H LassAbstract:Purpose To assess 3-year outcomes of Descemet's stripping automated endothelial keratoplasty (DSAEK) in comparison with penetrating keratoplasty (PKP) from the Cornea Donor Study (CDS). Design Prospective, multicenter, nonrandomized clinical trial. Participants A total of 173 subjects undergoing DSAEK for a moderate risk condition (principally Fuchs' Dystrophy or pseudophakic corneal edema) compared with 1101 subjects undergoing PKP from the CDS. Methods The DSAEK procedures were performed by 2 experienced surgeons using the same donor and similar recipient criteria as for the CDS PKP procedures, performed by 68 surgeons. Graft success was assessed by Kaplan-Meier survival analysis. Central endothelial cell density (ECD) was determined from baseline donor and postoperative central endothelial images by the reading center used in the CDS Specular Microscopy Ancillary Study. Main Outcome Measures Graft clarity and ECD. Results The donor and recipient demographics were comparable in the DSAEK and PKP groups, except that the proportion of Fuchs' Dystrophy cases was higher in the DSAEK cohort. The 3-year survival rate did not differ significantly between DSAEK and PKP procedures performed for either Fuchs' Dystrophy (96% for both; P = 0.81) or non-Fuchs' cases (86% vs. 84%, respectively; P = 0.41). Principal causes of graft failure or regraft within 3 years after DSAEK and PKP were immunologic graft rejection (0.6% vs. 3.1%), endothelial decompensation in the absence of documented rejection (1.7% vs 2.1%), unsatisfactory visual or refractive outcome (1.7% vs. 0.5%), and infection (0% vs. 1.1%), respectively. The 3-year predicted probability of a rejection episode was 9% with DSAEK versus 20% with PKP ( P = 0.0005). The median 3-year cell loss for DSAEK and PKP was 46% and 51%, respectively ( P = 0.33), in Fuchs' Dystrophy cases and 59% and 61%, respectively ( P = 0.70), in the non-Fuchs' cases. At 3 years, use of a smaller DSAEK insertion incision was associated with significantly higher cell loss (60% vs. 33% for 3.2- and 5.0-mm incisions, respectively; P = 0.0007), but not with a significant difference in graft survival ( P = 0.45). Conclusions The graft success rate and endothelial cell loss were comparable at 3 years for DSAEK and PKP procedures. A 5-mm DSAEK incision width was associated with significantly less cell loss than a 3.2-mm incision. Financial Disclosure(s) Proprietary or commercial disclosure may be found after the references.
John D. Gottsch - One of the best experts on this subject based on the ideXlab platform.
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CTG18.1 Expansion in TCF4 Among African Americans With Fuchs' Corneal Dystrophy.
Investigative Ophthalmology & Visual Science, 2017Co-Authors: Allen O Eghrari, Sina Vahedi, Natalie A. Afshari, S. Amer Riazuddin, John D. GottschAbstract:Purpose: Studies of Fuchs' Dystrophy have largely focused on individuals of European origin. Characterization of disease among African Americans is required to ensure prognostic factors and therapeutic approaches are applicable across diverse patient populations. Methods: We assessed all self-reported black and white patients aged older than 40 years at a tertiary care institution with a diagnosis of cataract over a 3-year period for concurrent diagnosis of Fuchs' Dystrophy. Affected patients in a longitudinal cohort were invited to provide a blood sample from which we extracted genomic DNA. The CTG18.1 trinucleotide repeat length was determined using a two-step, triplet repeat primed PCR protocol. Expansion was defined as >40 CTG repeats. Demographic information, including race, was documented. Results: Of 59,365 self-reported black and white adults who presented for cataract evaluation, the odds ratio of presenting with Fuchs' Dystrophy among black compared to white patients was 0.6992 (95% confidence interval [CI], 0.6210-0.7872). A total of 60 black and 549 white patients with Fuchs' corneal Dystrophy enrolled in the longitudinal study, of which 21 (35.0%) black and 343 (62.5%) white patients demonstrated trinucleotide repeat expansion, a significant difference (P = 7.7 × 10-5). In a multivariable linear regression model, repeat expansion but not race was significantly associated with mean clinical grading of severity. Conclusions: Black patients with Fuchs' Dystrophy were less likely than white patients to demonstrate CTG18.1 allele expansion. The data contribute to our understanding of population differences in clinical presentation, and highlight the need for considering diversity of patient populations in clinical research.
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ctg18 1 expansion in tcf4 increases likelihood of transplantation in Fuchs corneal Dystrophy
Cornea, 2017Co-Authors: Allen O Eghrari, Shivakumar Vasanth, Jiangxia Wang, Farnoosh Vahedi, Amer S Riazuddin, John D. GottschAbstract:Purpose Fuchs Dystrophy is the leading indication of corneal transplantation in the United States. A CTG18.1 trinucleotide repeat in TCF4 correlates with increased severity in Fuchs Dystrophy; however, quantitative estimates of increased transplantation risk, including effects of age and sex, are unclear. Methods In a tertiary institution clinical practice, 574 participants were enrolled in a longitudinal study of Fuchs Dystrophy after slit-lamp biomicroscopy confirmed significant central guttae and/or corneal transplantation in both eyes. We documented clinical history, examination findings, and demographic information. We acquired blood samples, extracted DNA, and sequenced the CTG18.1 trinucleotide repeat in TCF4. In this retrospective case-control study, the number of participants with triplet expansion, defined as greater than 40 CTG repeats, and transplantation status were assessed. Kaplan-Meier estimates of timing and transplantation events were produced. The Cox proportional hazard regression model was used to assess the relationship between age, sex, triplet expansion, and surgery. Results A total of 106 participants (18.5%) previously underwent corneal transplantation in at least 1 eye at the time of initial evaluation. A higher proportion of individuals harboring allele expansion had undergone transplantation (78/357, 21.8%) compared with those without the expanded allele (28/217, 12.9%), a significant association (P = 0.007). The log-rank test demonstrates a significant difference in survival function over time (P = 0.027), with a hazard ratio of 1.64 (95% confidence interval, 1.05-2.55). Conclusions Expansion of the TCF4 CTG trinucleotide repeat was associated with 1.64 times higher likelihood of corneal transplantation at a given age in patients with Fuchs Dystrophy.
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A morphologic study of Fuchs Dystrophy and bullous keratopathy
Cornea, 2005Co-Authors: Hunter K L Yuen, Charles E. Rassier, Maria Stephanie R Jardeleza, W. Richard Green, Zenaida De La Cruz, Walter J. Stark, John D. GottschAbstract:PURPOSE: To describe the morphologic features of Fuchs corneal Dystrophy and compare them with those of bullous keratopathy. METHODS: This was an observational case series. The study group consisted of 32 corneal buttons with a diagnosis of Fuchs Dystrophy and the comparison group consisted of 22 corneal buttons with bullous keratopathy. Morphologic analysis was performed of corneal buttons from patients with the clinical diagnosis of Fuchs Dystrophy or bullous keratopathy by light and electron microscopy. RESULTS: The main outcome measure was identification of degenerated keratocytes, granular material in and around keratocytes, and lipid keratopathy. The overall morphologic features of Fuchs Dystrophy and bullous keratopathy are similar to those described in previous literature. A high proportion of keratocytes exhibited degenerative changes (78.9% in Fuchs Dystrophy versus 50.5% in bullous keratopathy). Granular material was identified in and around variably degenerated keratocytes in all cases of Fuchs Dystrophy and in 14 of 22 (64%) of the corneas with bullous keratopathy. The percentage of keratocytes with granular deposits was higher in Fuchs Dystrophy corneas as compared with corneas with bullous keratopathy (51.7% versus 14.1%, P < 0.0005). Lipid keratopathy was a common occurrence in both Fuchs Dystrophy and bullous keratopathy (23/32 [72%] versus 12/22 [55%]). CONCLUSIONS: Histopathologic changes in the corneal stroma and keratocytes occur in Fuchs Dystrophy. Secondary lipid keratopathy ensues and may contribute to corneal haze. A higher proportion of keratocytes in Fuchs Dystrophy have granular deposit than in bullous keratopathy. That a high proportion of keratocytes had degenerative changes in both Fuchs Dystrophy and bullous keratopathy suggests that keratocytes may degenerate secondary to altered stromal microenvironment because of endothelial cell loss.
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cataract surgery in patients with Fuchs corneal Dystrophy expanding recommendations for cataract surgery without simultaneous keratoplasty
Ophthalmology, 2005Co-Authors: Gerami D. Seitzman, John D. Gottsch, Walter J. StarkAbstract:Objective To evaluate the use of preoperative pachymetry in patients with Fuchs' Dystrophy who are undergoing cataract extraction to predict the need for future penetrating keratoplasty and to compare these findings with current published recommendations. Design Retrospective noncomparative case series. Participants A series of patients with Fuchs' Dystrophy (136 eyes) undergoing cataract surgery. Methods We reviewed the medical records of 136 patients with Fuchs' Dystrophy who underwent phacoemulsification and intraocular lens implantation between October 1990 and May 2002. Main outcome measures Preoperative and postoperative visual acuity, pachymetry, and postoperative corneal decompensation requiring penetrating keratoplasty. Results The average preoperative corneal thickness was 584±39.5 μm (range, 482–674 μm). Fifty eyes (36.8%) had preoperative corneal thickness of ≥600 μm. The average postoperative best-corrected visual acuity (BCVA) was 20/33 (range, 20/15–20/250). Of the 50 eyes with preoperative pachymetry measurements of ≥600 μm, 5 (10%) progressed to penetrating keratoplasty; 90% of the 50 eyes did not need corneal transplants within the first year after cataract surgery and had an average postoperative BCVA of 20/35 (range, 20/20–20/200). Of those with a corneal thickness of ≥640 μm, 83% did not need a corneal transplant within this same time period and had an average postoperative BCVA of 20/50 (range, 20/20–20/200). Conclusions To avoid unnecessary cost and delay in visual rehabilitation, we suggest changing the current recommendations for an initial triple procedure for eyes with preoperative pachymetry measurements of >600 μm. Our data suggest that current cataract removal techniques allow for excellent visual rehabilitation in patients with Fuchs' Dystrophy who have a preoperative corneal thickness of >600 μm, and we suggest that preoperative pachymetry measurements of >640 μm may be a better guideline. This recommendation can be further expanded above 640 μm if a visual acuity of less than 20/20 is acceptable. A prospective randomized controlled study is required for validation of this analysis.
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Original articleCataract surgery in patients with Fuchs' corneal Dystrophy: Expanding recommendations for cataract surgery without simultaneous keratoplasty
Ophthalmology, 2005Co-Authors: Gerami D. Seitzman, John D. Gottsch, Walter J. StarkAbstract:Objective To evaluate the use of preoperative pachymetry in patients with Fuchs' Dystrophy who are undergoing cataract extraction to predict the need for future penetrating keratoplasty and to compare these findings with current published recommendations. Design Retrospective noncomparative case series. Participants A series of patients with Fuchs' Dystrophy (136 eyes) undergoing cataract surgery. Methods We reviewed the medical records of 136 patients with Fuchs' Dystrophy who underwent phacoemulsification and intraocular lens implantation between October 1990 and May 2002. Main outcome measures Preoperative and postoperative visual acuity, pachymetry, and postoperative corneal decompensation requiring penetrating keratoplasty. Results The average preoperative corneal thickness was 584±39.5 μm (range, 482–674 μm). Fifty eyes (36.8%) had preoperative corneal thickness of ≥600 μm. The average postoperative best-corrected visual acuity (BCVA) was 20/33 (range, 20/15–20/250). Of the 50 eyes with preoperative pachymetry measurements of ≥600 μm, 5 (10%) progressed to penetrating keratoplasty; 90% of the 50 eyes did not need corneal transplants within the first year after cataract surgery and had an average postoperative BCVA of 20/35 (range, 20/20–20/200). Of those with a corneal thickness of ≥640 μm, 83% did not need a corneal transplant within this same time period and had an average postoperative BCVA of 20/50 (range, 20/20–20/200). Conclusions To avoid unnecessary cost and delay in visual rehabilitation, we suggest changing the current recommendations for an initial triple procedure for eyes with preoperative pachymetry measurements of >600 μm. Our data suggest that current cataract removal techniques allow for excellent visual rehabilitation in patients with Fuchs' Dystrophy who have a preoperative corneal thickness of >600 μm, and we suggest that preoperative pachymetry measurements of >640 μm may be a better guideline. This recommendation can be further expanded above 640 μm if a visual acuity of less than 20/20 is acceptable. A prospective randomized controlled study is required for validation of this analysis.
