Background: To systematically review and meta-analyze the immunologic aspects and outcomes of various endothelial keratoplasty (EK) techniques, specifically comparing Descemet\'s Stripping Automated Endothelial Keratoplasty (DSAEK), Ultra-Thin Descemet\'s Stripping Automated Endothelial Keratoplasty (UT-DSAEK), and Descemet\'s Membrane Endothelial Keratoplasty (DMEK). Methods: Systematic review and meta-analysis. Main outcomes were the proportion of patients achieving a best spectacle-corrected visual acuity (BSCVA) of 20/20 at 6 months after keratoplasty, rejection rate one year after surgery, BSCVA at last follow up, and postoperative immunomodulating regimen. Results: A higher proportion of DMEK patients achieved a BSCVA of 20/20 after 6 months. UT-DSAEK and DMEK showed similar rejection rates with a lower risk of re-bubbling for UT-DSAEK (4% vs. 20%). Conclusions: DMEK showed faster visual recovery than UT-DSAEK but a similar rejection rate and long-term visual acuity. One-year postoperative slow tapering steroid regimen has a positive but not (yet) significant effect on rejection risk and visual outcomes.

Corneal calcification typically progresses slowly but can occasionally advance rapidly. This report details severe stromal calcification following repeat Descemet\'s stripping automated endothelial keratoplasty (DSAEK) in a 75-year-old patient with diabetes, hypertension, and prior ocular surgeries, including cataract surgery, intraocular lens extraction with suturing, and trabeculectomy. Persistent epithelial defects after the surgery led to rapid central stromal calcification within four weeks, significantly reducing visual acuity. Management included switching from betamethasone sodium phosphate to fluorometholone, facilitating complete epithelial recovery within two months. However, persistent stromal opacity necessitated a subsequent penetrating keratoplasty. Infrared absorption spectrophotometry identified calcium phosphate as the primary component of the calcification. This case highlights the importance of vigilant monitoring and proactive management of epithelial defects to prevent rapid calcification following endothelial keratoplasty.

Microbial keratitis in a post-transplant cornea should be considered a distinct entity from microbial keratitis in a non-transplant cornea. Firstly, the use of immunosuppressive treatments and sutures in corneal transplants changes the etiology of keratitis. Secondly, corneal transplant has an impact on corneal biomechanics and structure, which facilitates the spread of infection. Finally, the emergence of lamellar transplants has introduced a new form of keratitis known as interface keratitis. Given these factors, there is a clear need to update our understanding of and management strategies for microbial keratitis following corneal transplantation, especially in the era of lamellar transplants. To address this, a comprehensive review is provided, covering the incidence, risk factors, causes, and timing of microbial keratitis, as well as both clinical and surgical management approaches for its treatment in cases of penetrating and lamellar corneal transplants.

Background: To evaluate changes in the visual field (VF) after Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with advanced glaucoma and previous trabeculectomy. Methods: Changes in VF, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and number of glaucoma medications were analyzed before and after DSAEK in 19 eyes. The VFs were evaluated using the 10-2 program of the Humphrey Field Analyzer (HFA) and/or Goldmann perimetry (GP). Results: In nine eyes, the MD improved from -22.24 ± 6.5 dB to -18.36 ± 5.1 dB in HFA. In five out of nine eyes, postoperative MD improved >1 dB compared to preoperative MD. In GP testing, 10 out of 15 eyes showed an improvement, that is, greater than 20° in VF enlargement by the isopter of I-4e and/or new detection of a smaller or darker isopter. Overall, improvement in VF with the HFA and/or GP test was observed in 12/19 (63.2%) eyes after DSAEK. Postoperative BCVA improved by more than two lines in logMAR VA in 18 of 19 (94.7%) eyes. There were no significant differences between the preoperative and postoperative IOP and the number of glaucoma medications. Conclusions: DSAEK may produce subjective improvement in the visual field as well as improved visual acuity, even in advanced glaucomatous eyes.

Fuchs endothelial corneal dystrophy (FECD) is caused by a corneal endothelial cell loss, leading to corneal edema and visual impairment. The most significant genetic risk factor for FECD is an expansion of the CTG18.1 locus in transcription factor 4 (TCF4). The current treatment for severe FECD is corneal transplantation, with Descemet stripping automated keratoplasty (DSAEK) as a common surgical method. Although successful in most cases, the risk for transplant failure due to diverse causes must be considered. In this study, we investigated if presence of TCF4 CTG18.1 expansion with more than 31 (n ≥ 31) repeats in donated corneal grafts could be a reason for corneal transplant failure after DSAEK. For this, nine consecutively failed DSAEK corneal grafts were genotyped for CTG18.1 repeat length. One-sided Mann-Whitney U test was performed to evaluate if failed DSAEK corneal grafts had longer CTG18.1 repeats than healthy controls from the same population. All failed corneal grafts had CTG18.1 n ≤ 27 with a median of 18 (IQR 8.0) repeats for the longest allele. There was no statistical difference in CTG18.1 repeat lengths between failed corneal grafts and the geographically matched healthy control group. In conclusion, none of the nine failed corneal grafts in our material had CTG18.1 repeat lengths ≥ 31, a cut-off known to have a biological relevance in FECD. Thus, our results suggest that the assessment of donors and inspection of the corneal tissue before the decision for procurement is sufficient, in terms of recognizing FECD in the donor.

UNASSIGNED: The most common complications after performing the triple Descemet\'s stripping automated endothelial keratoplasty (DSAEK), which combines the cataract phacoemulsification, intraocular lens implantation and DSAEK procedure, are detachment or decentration of the donor lamella and postoperative interface haze. One reason for this is the retained viscoelastic used during surgery.
UNASSIGNED: This study aimed to describe triple DSAEK procedure without the usage of viscoelastic and to discuss its potential benefits on surgical outcomes.
UNASSIGNED: The surgical procedures and outcomes of patients with Fuchs\' dystrophy and lens opacification who underwent the triple DSAEK were retrospectively reviewed. The surgical procedure was described, and postoperative complications were studied.
UNASSIGNED: The study included 10 eyes of 10 patients. Capsulorhexis and IOL implantation performed in locally potentiated anesthesia compared to general anesthesia did not significantly differ (P > 0,05). The mean preoperative best-corrected visual acuity was 0.75 LogMar. The mean postoperative best-corrected visual acuity was 0.2 LogMar. The central graft thickness before surgery was 129.6 μm and 6 months after surgery was 114.2 μm. Successful attachment of the donor lamellae was observed in all 10 patients. None of the patients had postoperative interface haze or any other possible viscoelastic caused complication.
UNASSIGNED: Although viscoelastic can facilitate certain aspects of the triple DSAEK procedure, we conclude that this procedure can be performed completely without its use. If performed by a trained surgeon, the procedure can be feasible without the complications of donor lamella detachment, decentration, or interface haze.

Sutureless scleral fixation of intraocular lens (sSFIOL) is a commonly employed method of optical rehabilitation of aphakic patients with deficient capsular support, and corneal transplant surgeries can be simultaneously combined with sSFIOL to handle aphakic corneal opacities. A single-stage procedure circumvents the need for repeat intraocular procedures and carries lower risk of graft endothelial damage, endophthalmitis, and macular edema associated with sequential surgeries. However, it mandates surgical expertise and increases the chances of postoperative inflammation. A basket of options is available with the corneal surgeons regarding the manner of host and donor preparation as well as the approaches to scleral fixation and certain intraoperative modifications along with postoperative vigilance may enhance the surgical outcomes. Most of the studies pertaining to keratoplasty with sSFIOL categorize to case reports/series, surgical techniques, and retrospective studies with very limited prospective data available currently. The purpose of the present review is to consolidate all available literature on concomitant sSFIOLs and keratoplasty procedures.

UNASSIGNED: Postoperative hydrophilic intraocular lens opacification can lead to decreased vision and may require intraocular lens exchange. This study aims to identify the incidence of scleral-fixated Akreos AO60\'s (Bausch + Lomb) lens opacification and risk factors for this phenomenon.
UNASSIGNED: This is a retrospective case series of all patients who underwent scleral-fixated Akreos AO60 lens at our institution between January 1, 2015 and December 31, 2019. The following data were recorded: age, sex, medical history, indication for Akreos AO60 implantation, laterality, ocular history, previous ocular surgical procedures, subsequent intraocular surgical procedures after the Akreos implantation, lens opacification, visual significance of opacification, and Akreos explantation. Intraoperative and postoperative complications were recorded. Main outcome measures were the overall incidence of Akreos lens opacification as well as the incidence of these eyes undergoing subsequent intraocular surgery.
UNASSIGNED: A total of 262 eyes of 257 patients underwent Akreos lens implantation. Overall, 2% (5 of 262) developed lens opacification. Two patients had Descemet stripping automated endothelial keratoplasty (DSAEK) concurrently with Akreos implantation. One patient underwent subsequent Baerveldt glaucoma implantation and DSAEK. The fourth patient had vitrectomy with sulfur hexafluoride gas followed by DSAEK. This represents a 25% (4 of 16) opacification rate among all patients who underwent DSAEK (P ≤ .01, Fisher exact test). One patient developed opacification after undergoing 2 vitrectomies for retinal detachment in the absence of DSAEK.
UNASSIGNED: Akreos lens opacification can be visually significant and may occur after a retinal or corneal procedure that involves the use of intraocular gas or air.

UNASSIGNED: Corneal endothelial cell density (ECD) gradually decreases after corneal transplantation by unknown biologic, biophysical, or immunologic mechanism. Our purpose was to assess the association between donor corneal endothelial cell (CEC) maturity in culture and postoperative endothelial cell loss (ECL) after successful corneal transplantation.
UNASSIGNED: Prospective cohort study.
UNASSIGNED: This cohort study was conducted at Baptist Eye Institute, Kyoto, Japan, between October 2014 and October 2016. It included 68 patients with a 36-month follow-up period who had undergone successful Descemet stripping automated endothelial keratoplasty (DSAEK) or penetrating keratoplasty.
UNASSIGNED: Human CECs (HCECs) from remaining peripheral donor corneas were cultured and evaluated for maturity by surface markers (CD166+, CD44-/dull, CD24-, and CD105-) using fluorescence-activated cell sorting. Postoperative ECD was assessed according to the mature-differentiated HCEC contents: high-maturity group: > 70%, middle-maturity group: 10% to 70%, low-maturity group: < 10%. The successful rate of ECD maintained at 1500 cells/mm2 at 36 months postoperative was analyzed using the log-rank test.
UNASSIGNED: Endothelial cell density and ECL at 36 months postoperative.
UNASSIGNED: The 68 included patients (mean [standard deviation] age 68.1 [13.6] years, 47.1% women, 52.9% DSAEK). The high, middle, and low-maturity groups included 17, 32, and 19 eyes, respectively. At 36 months postoperative, the mean (standard deviation) ECD significantly decreased to 911 (388) cells/mm2 by 66% in the low-maturity group, compared with 1604 (436) by 40% and 1424 (613) cells/mm2 by 50% in the high and middle-maturity groups (P < 0.001 and P = 0.007, respectively) and the low-maturity group significantly failed to maintain ECD at 1500 cells/mm2 at 36 months postoperative (P < 0.001). Additional ECD analysis for patients who underwent DSAEK alone displayed a significant failure to maintain ECD at 1500 cells/mm2 at 36 months postoperative (P < 0.001).
UNASSIGNED: The high content of mature-differentiated HCECs expressed in culture by the donor peripheral cornea was coincident with low ECL, suggesting that a high-maturity CEC content predicts long-term graft survival. Understanding the molecular mechanism for maintaining HCEC maturity could elucidate the mechanism of ECL after corneal transplantation and aid in developing effective interventions.
UNASSIGNED: Proprietary or commercial disclosure may be found after the references.

UNASSIGNED: Early postoperative graft detachment remains one of the most common complications of DSAEK.
UNASSIGNED: To describe a modification of a simple method to facilitate a firm AC, without a leak, during DSAEK.
UNASSIGNED: Ten consecutive DSAEK surgeries were reviewed. Surgery was performed by a single surgeon (HA). At the beginning of surgery, a trapezoid paracentesis was made at the limbus using a 20G MVR blade. The trapezoid incision was made by inserting the blade halfway, creating a cut with an internal opening half the width of its external opening. After inserting the corneal disc and suturing the main incision, air was injected with a 25G tapered hydrodelineation cannula. The tip was engaged at the trapezoid paracentesis and did not enter the anterior chamber. A firm, full air bubble was formed in the anterior chamber, and no leaking occurred at the paracentesis site, which acted as a one-way valve.
UNASSIGNED: All grafts were adhered from the first day after surgery, and no dislocations were observed. All corneas were clear at the one-month postoperative visit.
UNASSIGNED: Wound-assisted air injection is a safe, effective, simple method for achieving a firm air bubble during DSAEK, potentially reducing dislocation rates.