Although refractive astigmatism decreased in both groups, toric IOL implantation was more effective and predictable, resulting in greater spectacle independence.

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Purpose To identify the causes of failure of the different surgical corneal graft techniques: penetrating keratoplasty (PK), deep anterior lamellar keratoplasty (DALK), Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK). Methods This multicentric retrospective study enrolled a consecutive cohort of patients who had undergone any type of keratoplasty between 2001 and 2016. The clinical data were obtained from the patient's medical records, following ethical guidelines, permissions and data protection. The main outcome measured in the study was the cause of graft failure, defined as any irreversible loss of graft transparency capable of compromising vision. The main causes of graft failure were classified as follows: (A) primary graft failure (PGF), (B) immunological rejection, (C) non‐rejection (which includes endothelial decompensation without rejection, IOP elevation/glaucoma, diseases of the ocular surface, recurrence of the primary disease, wound dehiscence/hypotonia and trauma, among others) and (D) specific causes of lamellar keratoplasty failure. A descriptive study of the obtained data was carried out. The distribution of the causes of failure was evaluated according to the type of corneal transplant. Results Our research included a cohort of 571 keratoplasty failures, of which 509 met the inclusion criteria. The analysis of the causes of the PK failure showed that immunological allograft rejection represented the main cause, with 28.2% of the failures, followed by surface diseases (17.8%) and endothelial decompensation without rejection (17.3%). For the PK re‐grafts group, the main cause of failure was immunological allograft rejection (34.0%), followed by diseases of the ocular surface (18.5%). For the DALK group, the failures mainly occurred due to surface diseases such as limbal stem cell insufficiency, infectious keratitis, keratolysis or persistent epithelial defect (37.8%). However, the main reason for failure in the DSAEK group was endothelial decompensation without rejection (31.9%) while primary graft failure was the main cause of failure in the DMEK group (64.1%). Conclusion The main reason for failure in PK was immunological allograft rejection, both in primary and secondary transplants. The leading causes for failure were diseases of the ocular surface in the DALK population, endothelial decompensation without rejection in DSAEK and primary graft failure in DMEK.

Purpose: To characterize pachymetric, keratometric, and surface elevation parameters in pseudophakic eyes with Fuchs dystrophy that underwent Descemet membrane endothelial keratoplasty (DMEK) and to compare these characteristics with those in normal pseudophakic eyes. Methods: Postoperative corneal tomography with a median follow-up of 20 months was evaluated using the Pentacam tomographer on 46 DMEK eyes. Results were compared with data from an age-matched cohort of 46 normal eyes. Parameters included curvature analysis, keratometry values, corneal thickness (CT), pachymetric progression index, Ambrósio relational thickness, posterior elevation, and D-index values. Bonferroni correction was used for multiple comparisons. Results: CT at the apex (mean difference 41 μm; 95% confidence interval 28–54) and CT at the thinnest point (46 μm; 33–60) were statistically significantly lower in the DMEK group (P < 0.001), whereas pachymetric progression index average (0.47; 0.32–0.62), Ambrósio relational thickness maximum (172; 126–228), IHD (0.096; 0.005–0.014), and the global D-index (1.03; 0.51–1.56) were significantly higher in eyes with DMEK (P < 0.001). The mean CT along the vertical and horizontal meridians was significantly lower in the DMEK group within the central 5 mm. A quarter and one half of the DMEK eyes had a CT of less than 500 μm at the apex or at the thinnest point, respectively. Conclusions: Resolution of corneal edema after DMEK was associated with a thinner-than-normal central cornea, steeper pachymetric progression from the thinnest point to the periphery, and some high-end outliers for posterior elevation values. Caution should be exerted in planning corneal refractive surgery for residual refractive errors.

Objectives: To describe the characteristics and hygiene habits of contact lens (CL) wearers who acquire CLs over the Internet, as well as their awareness of modifiable risk factors (RFs). Methods: A web-based survey was conducted among clients of an online CL sales platform during 6 months. Demographic data, CL hygiene-related awareness, and compliance were collected and analyzed. Results: The questionnaire was completed by 1,264 CL wearers: the average age was 40.8 years; most were women (71.1%), had myopia (76.4%), and wore monthly disposable CLs (63.6%). The frequency of eye examination was significantly lower among those buying the CL exclusively online (15.8% vs. 6.6%, P<0.001) and those who had begun CL use on their own (17.5% vs. 8.8%, P<0.001). Initiation to CL wear without the intervention of an eye care practitioner was more frequent in wearers with less experience. Common risk behaviors included water exposure (68.1% in swimming and 64.9% in the shower), use of the case (61.9%) and CL (65.1%) beyond the recommended replacement time, and reuse of the maintenance solution (31.9%). Ignorance of recommended hygiene increased the probability of risky behavior. Conclusion: There were no differences in compliance or awareness of risks between those purchasing exclusively online and other CL wearers. However, the growing frequency of self-taught initiation in CL wear among less-experienced online customers and online exclusive purchase was associated with a decrease in eye examination frequency and therefore worse compliance and increased risks. This finding underlines the importance of publicizing correct hygiene habits by all possible means so as to increase compliance.