Purpose To investigate the influence of ethnic origin on the incidence of keratoconus and the association of atopic diseases in patients with keratoconus. Methods Retrospective study of new patients referred to Dewsbury District General Hospital and diagnosed with keratoconus in a 6-year period between 1994 and 2000. The ethnic origin of the patient was defined as white, Asian, or other. Incidence was calculated from the catchment population of 176 774 (82% white people, 17% Asians, 1% others). t-Test, confidence intervals and v 2 tests were used to show statistical significance. Results A total of 74 cases of keratoconus were diagnosed over this period. Of these patients 29 (39%) were white and 45 (61%) were Asian. This equated to an incidence of keratoconus of 25 per 100 000 (1 in 4000) per year for Asians, compared with 3.3 per 100 000 (1 in 30 000) per year for white people (Po0.001). Asians presented significantly younger than white patients. The incidence of atopic disease was found to be significantly higher in white compared to Asian keratoconic patients. Conclusions Asians were significantly more likely to present with keratoconus. The Asian patients were mostly of Northern Pakistani origin. This community has a tradition of consanguineous, especially first-cousin marriages. The higher incidence in this population was highly suggestive of a genetic factor being significant in the aetiology. The incidence was higher than revealed by previous studies. Atopic disease was significantly less common in Asians compared to white people, supporting the theory of a different aetiology in these patients.

Aim To compare the outcomes and complications of deep lamellar keratoplasty (DLK) and penetrating keratoplasty (PK) for keratoconus.

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Aims: To compare outcomes of phacoemulsification combined with trabeculectomy (PT) or deep sclerectomy (PDS) with intraoperative mitomycin C (MMC) application. Methods: Non-randomised, consecutive, retrospective comparative study. 97 eyes of 97 patients (59 PDS, 38 PT) undergoing combined surgery with intraoperative MMC (0.1-0.4 mg/ml for 1-3 minutes) were identified for inclusion in the study. Results: The probability of maintaining intraocular pressure (IOP) below 19 mm Hg and 15 mm Hg, with a 30% drop from preoperative IOP and without additional medication, 1 year after surgery were 77.6% (95% CI: 67 to 90) and 71.5% (60 to 85) for the PDS group and 89.5% (80 to 99) and 89.5 (80 to 99) for the PT group, respectively, and these differences were not statistically significant (p.0.05, log rank test). After excluding ocular co-morbidity no differences were observed in the improvement of visual acuity between the two groups. There were no major differences in the complication rates except that delayed bleb leaks were seen in seven eyes (18.4%) of the PT group (p = 0.004). Conclusion: In this study, no statistically significant difference was found in the IOP and visual outcomes between PDS and PT. A significantly higher frequency of late bleb leaks after PT was observed.T he decision to do sequential or combined cataract and glaucoma surgery depends on several individual patient factors including the degree of visual impairment, target intraocular pressure (IOP), stage of glaucoma, compliance, age, and life expectancy. 1-3Combined phacoemulsification and trabeculectomy (PT) is the most widely reported procedure for combined surgery. 4 Augmentation of the procedure with mitomycin C (MMC) has been shown to be beneficial when risk factors for failure are present. 2Newer surgical techniques, loosely termed as non-penetrating glaucoma surgery (NPGS), have been reported to successfully lower IOP in the long term.5 6 Compared to trabeculectomy, the IOP lowering efficacy of NPGS is the same or less depending on the publication but all randomised trials agree that the complication rates are less with NPGS. 7-11The success rates of deep sclerectomy can be improved and IOPs in the low teens achieved using by intraoperative MMC application and postoperative Nd:YAG laser goniopuncture in selected cases. 12Reports suggest that phaco-deep sclerectomy (PDS) and phaco-viscocanalostomy (PVCT) are effective in lowering IOP.13-16 MMC augmentation of PDS has not previously been reported. The aim of this study was to compare the outcomes of PT with MMC and PDS with MMC and selective Nd:YAG laser goniopuncture. METHODSConsecutive patients undergoing combined glaucoma and phacoemulsification surgery with intraoperative MMC between September 2001 and November 2003, were identified from an ongoing correlational database (Microsoft Access) of all glaucoma surgery performed by the glaucoma unit. The surgeries were done or closely supervised by one surgeon (NA). The decision to do PDS or PT was based on several factors including available ope...

MethodsAll cases of newly diagnosed keratoconus patients seen in the Ophthalmology Department between September 1997 and December 2001 were analysed retrospectively using the videokeratography database. This included the vast majority of cases of keratoconus seen in the department during the analysed periodFthe clinical diagnosis on presentation was made by an ophthalmologist.BRI is the only ophthalmology service in the city of Bradford (catchment population of 470 000) and receives all GP or optician (via GP) referrals of this type.According to Census 2001, the ethnic background of population in Bradford is white 93.48%, Asian 4.49%, black 0.5%, Chinese 0.25%, and others 1.18%. The ethnic groups in the Asian population in Bradford are Pakistani (87%), Indian (7.3%), and Bangladeshi (5.7%).The proportion of population other than white and Asian (ie 1.93%) was considered negligible for the purpose of this study.Normally distributed data were analysed using Student's t-test for unpaired groups of patients. A significance level of o5% was chosen in all tests. Data are presented as mean7standard deviation.

Aims To assess the effect of assisted conception (AC) on retinopathy of prematurity (ROP) and ROP screening. Follow-up to the study by McKibbin et al.

Sir, Mid-term outcomes of penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK)Since our publication in 2006, 1 we have revisited our keratoconic cohort and retrospectively collected refraction and best (spectacle)-corrected visual acuities (BCVAs) at 2 and 4 years post-PK or post-DALK plus the incidence of rejection and graft failure. Data analyses were undertaken via independent t-tests or the Mann-Whitney test.At 2 years, there were visual acuity data for 17 eyes with PK and 10 with DALK, and refractive data for 16 eyes with PK and 12 with DALK; at four years, there were visual acuity data for 17 eyes with PK and 9 with DALK, and refractive data for 14 eyes with PK and 9 with DALK (Table 1). The refractive outcomes were similar except that the DALK group had significantly less astigmatism at 2 years compared with those that had undergone PK. A BCVA of 6/6 or better was achieved 4 years postoperatively by more than three-quarters of the PK group, but only a third of the DALK group (Figure 1). Two of the PK patients (10%) underwent a second PK: one had secondary graft failure following infective keratitis at 9 months and another developed large, fluctuating astigmatism following suture removal at 32 months. None of the DALKs required repeat corneal transplantation. Both groups had graft rejection episodes; three in the PK group had endothelial rejections and two in the DALK group suffered epithelial or stromal rejection, all of which resolved with the appropriate treatment.This report confirms both PK and DALK as successful surgical options for keratoconus. A constant significant finding was the attainment of better visual acuity via PK than following DALK with improvement in both sets over time (Figure 1). The two groupings experienced similar rates of graft rejection episodes, yet none of the DALKs required regrafting; these outcomes are similar to earlier studies. 2,4 Furthermore, we too observed that the DALK patients had a shorter post-op rehabilitation period than PK patients. 3,5 Consequently, we propose that DALK offers faster rehabilitation plus an improved chance of long-term graft survival, but at the expense of reduced BCVA compared with PK.

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