Purpose To report the outcomes of secondary Descemet Membrane Endothelial Keratoplasty (DMEK) performed for failed primary DMEK. Methods The medical records of all patients undergoing secondary DMEK due to failure of primary DMEK were reviewed. Reasons for failure were sought and best-corrected visual acuity (BCVA), endothelial cell density (ECD) and complications of secondary DMEK were evaluated. Results A total of 10 cases undergoing secondary DMEK following failed primary DMEK were identified. Presumed reasons for failure included donor ECD B 2300 cells/mm 2 (n = 4), difficulty during graft preparation (n = 2), graft detachment (n = 2), acute angle closure due to retroiridal air dislocation (n = 1), inverse graft positioning (n = 1) and phacoemulsification (n = 1). Eyes with low visual potential were not excluded from the study group. We should note that one patient (case no7) had both low ECD and graft detachment as reasons for failure and as a result he is counted twice.Median BCVA (decimal fraction) increased from 0.1 (range, 0.01; 0.3) to 0.5 (0.05; 1.0) at one month and remained stable thereafter. A BCVA of 0.5 or higher was achieved in 7 cases at the final follow-up. Mean ECD fell from 2628 ± 284 cells/mm 2 to 1391 ± 252cells/mm 2 at 6 months (47% reduction) and 959 ± 225cells/mm 2 at 24 months (64% reduction) (P B 0.028). Complications included the incomplete removal of the primary graft and mild iris bleeding, decompensation of a preexisting primary open-angle glaucoma and retroiridal air dislocation. Conclusions Apart from low donor ECD, surgical challenges, i.e., difficulty with graft preparation, inverse graft positioning, and retroiridal air dislocation, were main reasons for failure of primary DMEK. Secondary DMEK showed a good safety profile and reasonable visual outcomes.
The field of ophthalmic imaging has grown substantially over the last years. Massive improvements in image processing and computer hardware have allowed the emergence of multiple imaging techniques of the eye that can transform patient care. The purpose of this review is to describe the most recent advances in eye imaging and explain how new technologies and imaging methods can be utilized in a clinical setting. The introduction of optical coherence tomography (OCT) was a revolution in eye imaging and has since become the standard of care for a plethora of conditions. Its most recent iterations, OCT angiography, and visible light OCT, as well as imaging modalities, such as fluorescent lifetime imaging ophthalmoscopy, would allow a more thorough evaluation of patients and provide additional information on disease processes. Toward that goal, the application of adaptive optics (AO) and full-field scanning to a variety of eye imaging techniques has further allowed the histologic study of single cells in the retina and anterior segment. Toward the goal of remote eye care and more accessible eye imaging, methods such as handheld OCT devices and imaging through smartphones, have emerged. Finally, incorporating artificial intelligence (AI) in eye images has the potential to become a new milestone for eye imaging while also contributing in social aspects of eye care.
Purpose The lamina cribrosa (LC) is a leading target for initial glaucomatous damage. We investigated the in vivo microstructural deformation within the LC volume in response to acute IOP modulation while maintaining fixed intracranial pressure (ICP). Methods In vivo optic nerve head (ONH) spectral-domain optical coherence tomography (OCT) scans (Leica, Chicago, IL, USA) were obtained from eight eyes of healthy adult rhesus macaques (7 animals; ages = 7.9–14.4 years) in different IOP settings and fixed ICP (8–12 mm Hg). IOP and ICP were controlled by cannulation of the anterior chamber and the lateral ventricle of the brain, respectively, connected to a gravity-controlled reservoir. ONH images were acquired at baseline IOP, 30 mm Hg (H1-IOP), and 40 to 50 mm Hg (H2-IOP). Scans were registered in 3D, and LC microstructure measurements were obtained from shared regions and depths. Results Only half of the eyes exhibited LC beam-to-pore ratio (BPR) and microstructure deformations. The maximal BPR change location within the LC volume varied between eyes. BPR deformer eyes had a significantly higher baseline connective tissue volume fraction (CTVF) and lower pore aspect ratio ( P = 0.03 and P = 0.04, respectively) compared to BPR non-deformer. In all eyes, the magnitude of BPR changes in the anterior surface was significantly different (either larger or smaller) from the maximal change within the LC (H1-IOP: P = 0.02 and H2-IOP: P = 0.004). Conclusions The LC deforms unevenly throughout its depth in response to IOP modulation at fixed ICP. Therefore, analysis of merely the anterior LC surface microstructure will not fully capture the microstructure deformations within the LC. BPR deformer eyes have higher CTVF than BPR non-deformer eyes.
Purpose: Rhesus macaques (Macaca mulatta) are the premier nonhuman primate model for studying human health and disease. We aimed to investigate if age was associated with ocular features of clinical relevance in a large cohort of free-ranging rhesus macaques from Cayo Santiago, Puerto Rico. Methods: We evaluated 120 rhesus macaques (73 males, 47 females) aged from 0 to 29 years old (mean±SD: 12.6/6.4) from September to December, 2021. The ophthalmic evaluation included IOP assessment, corneal pachymetry, anterior segment biomicroscopy, A-Scan biometry, automated refraction, and fundus photography after pupil dilation. The effects of age on the outcome variables were investigated through multilevel mixed-effects models adjusted for sex and weight. Results: On average, IOP, pachymetry, axial length, and automated refraction spherical equivalent were 15.47±2.47 mmHg, 474.43±32.21 micras, 19.49±1.24 mm, and 0.30±1.70 D, respectively. Age was significantly associated with pachymetry (Coef.= -1.20; 95%CI: -2.27 to -0.14; p=0.026), axial length (Coef.= 0.03; 95%CI: 0.01 to 0.05; p=0.002), and spherical equivalent (Coef.= -0.12; 95%CI: -0.22 to -0.02; p=0.015). No association was detected between age and IOP. The prevalence of cataracts in either eye was 10.83% (95% CI: 6.34 - 17.89%) and was significantly associated with age (OR= 1.20; 95%CI: 1.06 - 1.36; p=0.004). Retinal drusen in either eye was observed in 15.00% (95% CI: 9.60 - 22.68%) of the animals, which was also significantly associated with age (OR=1.14; 95%CI: 1.02 - 1.27; p=0.020). Conclusions: Rhesus macaques exhibit age-related ocular associations similar to those observed in human aging, including decreased corneal thickness, increased axial length, myopic shift, and higher occurrence of cataract and retinal drusen.
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