No abstract

Objective: To examine factors affecting penetrating corneal graft survival and visual outcomes in patients under the age of 20 years.

Analysis 1.2. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 2 Postoperative BCVA (varied follow-up times, post-suture removal) (LogMAR).. .. .. .. .. .. Analysis 1.3. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 3 Postoperative functional BCVA achieved (varied follow-up times, post-suture removal).. .. .. .. . Analysis 1.4. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 4 Postoperative UCVA (varied follow-up times, post-suture removal) (LogMAR).. .. .. .. .. .. Analysis 1.5. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 5 Postoperative functional UCVA achieved (varied follow-up times, post-suture removal).. .. .. .. . Analysis 1.6. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 6 Postoperative keratometric astigmatism (varied follow-up times, post-suture removal) (D).. .. .. .. Analysis 1.7. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 7 Postoperative spherical equivalent (varied follow-up times, post-suture removal) (D).. .. .. .. .. Analysis 1.8. Comparison 1 Deep anterior lamellar keratoplasty (DALK) versus penetrating keratoplasty (PK), Outcome 8 Postoperative keratometric astigmatism (12 months

'This is the peer reviewed version of the following article: Keane MC, Galettis RA, Mills RA, Coster DJ, Williams KA; for Contributors to the Australian Corneal Graft Registry. A comparison of endothelial and penetrating keratoplasty outcomes following failed penetrating keratoplasty: a registry study. Br J Ophthalmol. 2016 Feb 18. pii: bjophthalmol-2015-307792. doi:10.1136/ bjophthalmol-2015 which has been published in final form at after a first penetrating keratoplasty (PK), with outcomes of repeat PK after a first PK.Methods 400 eyes with a second graft (65 EK, 335 PK) performed after failure of a primary PK were identified through the Australian Corneal Graft Registry, a national prospectivelyfollowed cohort. Grafts were performed after January 2008 (follow-up of the second graft extending to 6.75 years maximum). Kaplan-Meier graft survival plots were constructed and Cox proportional hazards regression was used to identify independent risk factors for graft failure. Best corrected Snellen visual acuity (BCVA) at last follow-up was compared with pregraft acuity.Results Poorer Kaplan-Meier graft survival was observed for PK-EK compared with PK-PK (log-rank=29.66, p<0.001). Variables retained in multivariate analysis as significantly influencing survival of the second graft included graft type (PK-EK or PK-PK, p<0.001), length of survival of the previous PK (global p=0.011), graft era (global p=0.018), occurrence of rejection in the second graft (p=0.005) and a history of raised intraocular pressure at any time (p=0.048), but not indication for the first graft. BCVA improved in the majority of surviving grafts and attainment of 6/12 vision was similar for both PK-EK and PK-PK groups.Conclusions Our Registry findings suggest that repeat penetrating keratoplasty may deliver a better outcome in terms of graft survival than endokeratoplasty after a failed PK that was performed initially for keratoconus or pseudophakic bullous keratopathy. For surviving grafts, visual outcomes appear equivalent across groups.3

Objective:To investigate the current information sources of patients with multiple sclerosis (MS) in the early stages of their disease and to identify patients’ preferred source of information. The relative amounts of information from the different sources were also compared.Methods:Participants at a newly diagnosed information session organized by the Multiple Sclerosis Society of South Australia were invited to complete a questionnaire. Participants were asked to rate on a visual analog scale how much information they had received about MS and optic neuritis from different information sources and how much information they would like to receive from each of the sources.Results:A close to ideal amount of information is being provided by the MS society and MS specialist nurses. There is a clear deficit between what information patients are currently receiving and the amount of information they actually want from various sources. Patients wish to receive significantly more information from treating general practitioners, eye specialists, neurologists, and education sessions. Patients have identified less than adequate information received on optic neuritis from all sources.Conclusion:This study noted a clear information deficit regarding MS from all sources. This information deficit is more pronounced in relation to optic neuritis and needs to be addressed in the future.Practice implications:More patient information and counselling needs to be provided to MS patients even at early stages of their disease, especially in relation to management of disease relapse.

The VA LV VFQ-48 and IVI demonstrated improvements in QoL after low-vision rehabilitation. The timing of the observed changes varied between the two questionnaires, reflecting the different content of these instruments and the timing of delivery of multidisciplinary services, but also suggests that continued rehabilitation may be warranted to maintain a patient's QoL.

Widespread adoption of modern lamellar procedures has altered the pattern of practice of corneal transplantation. Herein, we describe recent findings from the Australian Corneal Graft Registry and place these data into an international context. The total number of grafts reported to the Registry has doubled over the past decade. Deep anterior lamellar keratoplasty is increasingly used for keratoconus, while endokeratoplasty has displaced penetrating keratoplasty for Fuchs endothelial dystrophy. Graft survival and visual outcomes for modern lamellar procedures have shown improvement over time. First deep anterior lamellar and penetrating grafts for keratoconus show comparable survival and long-term best-corrected visual acuity is equivalent. Penetrating grafts for Fuchs endothelial dystrophy exhibit significantly better survival than do endokeratoplasties, largely because the latter undergo more early graft failures.However, visual rehabilitation is swifter in surviving endokeratoplasties. Significantly fewer recipients of a deep anterior lamellar graft or endokeratoplasty require spectacle or contact lens correction, compared with penetrating keratoplasty.

Objective: To identify eye banking practices that influence corneal graft survival. Design, setting and participants: Prospective cohort study of records of 19 254 followed corneal grafts in 15 160 patients, submitted to the Australian Corneal Graft Registry between May 1985 and July 2012. Main outcome measures: Influence of corneal preservation method (organ culture, moist pot, Optisol, other); death‐to‐enucleation, death‐to‐preservation and enucleation‐to‐graft times; transportation by air; graft era; and indication for graft on probability of graft survival at most recent follow‐up. Results: In multivariate analysis, 919 penetrating grafts performed using corneas transported interstate by air exhibited worse survival than 14 684 grafts performed using corneas retrieved and used locally (hazard ratio [HR], 1.44; 95% CI, 1.21–1.73; P = 0.001). This was also the case for traditional lamellar grafts (64 corneas transported by air and 813 used locally; HR, 1.69; 95% CI, 1.03–2.78; P = 0.038). Indication for graft influenced survival of penetrating grafts (4611 keratoconus, 727 emergency or high‐risk, 10 265 other indication; global P < 0.001) and traditional lamellar grafts (65 keratoconus, 212 emergency or high‐risk, 600 other indication; global P < 0.001). The preservation medium in which corneas used for traditional lamellar grafts were stored exerted a marginal influence on graft survival (global P = 0.047). Conclusions: Donor corneas transported interstate exhibited poorer survival after transplantation than those retrieved and grafted locally. Higher proportions of emergency procedures involving transported corneas did not account for this difference. Where possible, efforts to avoid transportation of corneal tissue by air freight within Australia may be warranted.