BackgroundCorneal graft (CG) surgery is the most common and successful tissue transplant worldwide. A small and important group of patients are operated in emergency situations, typically to save a perforated eye. Our knowledge of the indications and outcomes of emergency corneal graft (eCG) is limited.MethodsRetrospective, multifactorial analysis of all CGs registered by the UK Transplant Service from April 1999 to March 2005.ResultsA total of 12 976 CGs were performed. 1330 (11.4%) were eCGs including 433 regrafts. Actual perforation occurred in 876 (65.9%) patients. 420 (31.5%) grafts were for tectonic purposes alone and 217 (16.3%) were also grafted for visual rehabilitation. The main diagnostic categories were infection (39.4%), non-infectious ulcerative keratitis (32.2%) and other causes (ectasias, previous ocular surgery, injury, dystrophies and opacification). Graft survival of first eCG at 1, 2 and 5 years was 78%, 66% and 47%, respectively. Best-corrected visual acuity of surviving grafts at 1 year was: 6/12 or better in 29.9%, 6/18 to 6/60 in 38.4%, counting finger to LP in 30.6% and NPL in 1%, with worsening of vision in only 8.7% of the patients.ConclusionThis study which is the largest of its kind shows that despite the seriousness of the critical corneal pathology and the surgical challenges that it poses, the outcomes of eCG are favourable with most patients keeping their eyesight and avoiding immediate rejection. These clinical outcomes show the value of eye banking facilities that are developed to support corneal tissue supply for eCG.

Purpose: To report the front corneal versus central and paracentral corneal changes after Bowman layer transplantation for keratoconus in a tertiary hospital in the United Kingdom.Methods: Five eyes of 5 patients receiving Bowman layer transplant for advanced keratoconus in Royal Gwent Hospital (Newport, United Kingdom) were included. Preoperative and postoperative visual acuity; Kmax; Kmean, and corneal cylinder in the front cornea, 4.5 mm central, and 6 mm central; and corneal thickness were analyzed.Results: Corneal flattening and reduction in corneal astigmatism was observed, more marked in the central and paracentral zone, allowing for improvement in best-corrected visual acuity with the aid of visual correction in 4 eyes. Conclusions: These results support previous data reportingBowman layer transplantation as a useful strategy in the treatment of advanced keratoconus and suggest greater attention may be focused on central or paracentral corneal changes.

Purpose: Corneal perforations pose a considerable challenge for ophthalmic surgeons. The aim remains restoring the anatomical integrity of eye while attempting to preserve as much visual function as possible. To our knowledge, we report the first case series of 4 successful tectonic Descemet stripping endothelial keratoplasty (DSEK) grafts completed for acute corneal perforation. In all cases, restoration of globe integrity was achieved. In cases where visual potential remained, deep anterior lamellar keratoplasty over DSEK was offered. Methods: Four patients presenting to Royal Gwent Hospital (Newport, Wales) with corneal perforation were included. Etiological origins included exposure keratopathy, corneal hydrops secondary to pellucid marginal degeneration with fistulization-associated aqueous leak, and herpetic keratitis. Patients were treated with initial temporary therapies, including glue patch, the use of bandage contact lenses, amniotic membrane transplant, and antibiotic cover, depending on the size and location of the perforation. Subsequent DSEK was subsequently performed under local anesthesia. Results: All patients had successful tectonic grafts (3 DSEKs and 1 hemi-DSEK) up to 4 months postoperatively. In the case involving a hemi-DSEK, the patient underwent 2 refloating attempts of the graft before anchoring suture placement because of repeated graft detachment. Successful graft placement and tectonic globe restoration was confirmed by anterior segment imaging. Conclusions: Tectonic DSEK provides corneal surgeons with a new modality of treating corneal perforations. It provides clinicians an additional tool in their armamentarium in complex cases where anterior lamellar or penetrating keratoplasty may be contraindicated or deemed high risk of complications.

After the application of multivariate analysis techniques, some risk factors do not show the expected impact over graft failure at 1y.

The interrelationships between the 3 keratoconic cone parameters suggest that the thinner cones are largely central, that is, decenter less, but show greater steepening.

The purpose of this manuscript is to report the case of a 12-year-old patient who presented for routine ophthalmic examination after congenital cataract surgery performed at 2 months of age.The patient was diagnosed with bilateral Brown-McLean syndrome by slit lamp examination. No treatment was required because the patient was asymptomatic and had a clear central cornea. This is the first described case of Brown-McLean syndrome in a pediatric patient, representing the importance of clinical examination in the pediatric age group after cataract surgery because of the risk for patients of developing peripheral edema.

Aim: To propose a new system of keratoconus staging using a set of parameters describing the keratoconic cone. Materials and methods: Retrospective case series study of 101 keratoconic eyes of 58 patients was undertaken. They all had complete eye examination including corneal topography (Oculus Pentacam). K mean , K max , higher order aberrations (HOAs) root mean square (HOARMS) value, pachymetry at thinnest point and steepest corneal meridian were obtained from Pentacam. Apex to thinnest pachymetry distance (D) was calculated using trigonometry. Pearson correlation coefficients between K max and HOARMS, between D on the one hand and the adjusted angle of steepest meridian, K mean and K max respectively on the other, were calculated. Results: There is a statistically significant positive correlation between K max and HOARMS (p < 0.00001). There is a negative correlation, a "horizontalization," of the steep meridian with D increase, although it fell short of statistical significance (p = 0.07). D and K mean (p = 0.003), and D and K max (p = 0.005) are significantly negatively correlated. Conclusion: K max correlates with significant changes in HOAs. D correlates with corneal astigmatic meridian change and has a divergent path to K mean and to K max. We propose a new keratometry, decentration, and thinnest pachymetry staging using the parameters K max (K), distance from the corneal apex to the thinnest pachymetry point (D), and corneal thickness at its thinnest point (T) to give a better, detailed description of a keratoconic cornea which could lead to improvements in assessment of its severity and treatment outcomes.

Introduction To report the posterior corneal changes after Bowman Layer Transplant for keratoconus in a tertiary hospital in the UK. Methods 5 eyes of 5 patients receiving Bowman Layer Transplant for advanced keratoconus in Royal Gwent Hospital (Newport, UK) were included. Pre and postoperative posterior corneal astigmatism, posterior Kmean, and back surface elevation were analysed. Results No significant changes were seen in the posterior corneal astigmatism, posterior Kmean, or back surface elevation between the pre- and postoperative period. Conclusion This results would support the idea that the corneal changes seen after Bowman Layer Transplant are mainly in the anterior corneal surface.