Importance Open‐globe injuries (OGI) are a leading cause of monocular blindness world‐wide with considerable cost to the individual and society. Background To characterize the epidemiology, severity and outcomes of OGI treated at a major ophthalmology centre in New Zealand. Design Retrospective study. Participants A total of 385 eyes of 381 patients over a 10‐year period. Methods Eligible patients were identified using diagnosis and surgery codes on hospital discharge summaries. Clinical notes were reviewed to determine patient demographics, injury details, treatments and outcomes. Main Outcome Measures Complications of injury, visual acuity at 3 months and final follow‐up, and final status of the eye. Results The estimated annual incidence of OGI was 2.8 per 100 000. Working‐age males predominated but age at injury ranged from 9 months to 90 years. Maori and Pacific peoples were over‐represented. Injuries were severe with 58.7% presenting with vision of hand movements or worse. Penetrating injuries (56.4%) were most common, followed by globe ruptures (35.6%). Major complications included retinal detachment (15.8%), enucleation/evisceration (9.1%), phthisis bulbi (9.9%), endophthalmitis (2.6%) and sympathetic ophthalmia (0.26%). Despite the injury severity, 46% of eyes achieved final BCVA of ≥6/12. The Ocular Trauma Score (OTS) was a useful prognostic tool for stratifying severity of injury and predicting visual outcome (Fisher's exact test P < 0.001). Conclusions and Relevance The incidence and severity of OGI in NZ are comparable to global statistics. Surgical repair can effectively recover vision, predicted well by the OTS. We identified at‐risk groups to target with education and prevention strategies.

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ObjectiveTo capture and better understand patients’ experience during their healthcare journey from hospital admission to discharge, and to identify patient suggestions for improvement.DesignProspective, exploratory, qualitative study. Patients were asked to complete an unstructured written diary expressed in their own words, recording negative and positive experiences or anything else they considered noteworthy.Participants and settingPatients undergoing vascular surgery in a metropolitan hospital.Primary outcome measuresComplete diary transcripts underwent a general inductive thematic analysis, and opportunities to improve the experience of care were identified and collated.ResultsWe recruited 113 patients in order to collect 80 completed diaries from 78 participants (a participant response rate of 69%), recording patients’ experiences of their hospital-stay journey. Participating patients were a median (range) age of 69 (21–99) years and diaries contained a median (range) of 197 (26–1672) words each. Study participants with a tertiary education wrote more in their diaries than those without—a median (range) of 353.5 (48–1672) vs 163 (26–1599) words, respectively (Mann-Whitney U test, p=0.001). Three primary and eight secondary themes emerged from analysis of diary transcripts—primary themes being: (1) communication as central to care; (2) importance of feeling cared for and (3) environmental factors shaping experiences. In the great majority, participants reported positive experiences on the hospital ward. However, a set of 12 patient suggestions for improvement were identified, the majority of which could be addressed with little cost but result in substantial improvements in patient experience. Half of the 12 suggestions for improvement fell into primary theme 1, concerning opportunities to improve communication between healthcare providers and patients.ConclusionsUnstructured diaries completed in a patient’s own words appear to be an effective and simple approach to capture the hospital-stay experience from the patient’s own perspective, and to identify opportunities for improvement.

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Purpose: To compare the biomechanical properties of the cornea after epithelial removal in eyes with keratoconus undergoing corneal cross-linking. Methods: Prospective interventional case series at a university hospital tertiary referral center. Corneal biomechanical properties were measured in patients with keratoconus undergoing corneal cross-linking, immediately before and after epithelial debridement by using a dynamic ultrahigh-speed Scheimpflug camera equipped with a noncontact tonometer. Results: The study comprised 45 eyes of 45 patients with a mean age of 19.6 ± 4.9 years (range 14–34). The cornea was found to be 23.7 ± 15.7 μm thinner after epithelial removal (P < 0.01). Corneal stiffness was reduced after epithelial removal as demonstrated by a significant decrease of parameters such as stiffness parameter A1 (12.31, P < 0.01), stiffness parameter-highest concavity (2.25, P < 0.01), A1 length (0.13 mm, P = 0.04), highest concavity radius of curvature (0.26 mm, P = 0.01), highest concavity time (0.22 ms, P = 0.04) and an increase in A1 velocity (−0.01 m/s, P = 0.01), A1 deformation amplitude (−0.03 mm, P ≤ 0.01), A1 deflection length (−0.32 mm, P < 0.01), A2 deformation amplitude (−0.03 mm, P = 0.01), and A2 deflection length (−1.00 mm, P < 0.01). There were no significant differences in biomechanical intraocular pressure (0.15 mm Hg, P = 0.78), deformation amplitude (0.03, P = 0.54), maximum inverse radius (−0.01 mm, P = 0.57), and whole eye movement length (−0.02 mm, P = 0.12). Conclusions: Dynamic ultrahigh-speed Scheimpflug camera equipped with a noncontact tonometer offers an alternative method for in vivo measurements of the epithelial layer's contribution to corneal biomechanical properties. Our results suggest that corneal epithelium may play a more significant role in corneal biomechanical properties in patients with keratoconus than previously described.

Cataract surgery in HSV ocular disease improves visual acuity for most but carries a guarded prognosis and high risk for recurrence of inflammation in the first 12 months.

Importance In New Zealand, repeat keratoplasty has become the second leading indication for corneal transplantation. Background To report the indications, outcomes and survival of repeat keratoplasty and evaluate the risk factors for graft failure. Design Retrospective study in a public corneal service. Participants Two hundred nineteen patients undergoing 279 repeat keratoplasty procedures during 1991‐2017. Methods The New Zealand National Eye Bank prospectively collects data on all corneal transplants. This was utilized to identify patients undergoing repeat keratoplasty in Auckland. Clinical records were retrospectively reviewed. Main Outcome Measures Graft survival and visual outcome. Results The repeat keratoplasty technique was penetrating keratoplasty (PK) in 242 cases (86.7%) and endothelial keratoplasty in 37 (13.3%). The most common primary indication was keratoconus (46.6%). The most common indication for repeat keratoplasty was endothelial decompensation (37.6%). For PK performed as a repeat keratoplasty, the median survival in years was 12.0 for first, 3.5 for second and 2.3 for third repeat keratoplasty. Keratoconus had the longest graft survival (median 13.0 years). In surviving grafts, median visual acuity was 6/15 at 1 year and 6/12 at 2 years. On multivariate analysis, regraft number (P = .022), non‐European ethnicity (P = .007), concurrent surgical procedure (P < .0005), lower donor endothelial density (P = .028), previous glaucoma surgery (P < .0005), postoperative raised intraocular pressure (P = .001) and graft rejection (P = .032) were associated with keratoplasty failure. Conclusions and Relevance Repeat keratoplasty survival is affected by multiple interacting factors and prognosis worsens with each subsequent regraft. These results will help guide clinicians in addressing patients' individual risk factors when embarking on repeat corneal transplant surgery.

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