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Purpose: The aim of this study was to describe the clinical outcome of Descemet's membrane endothelial keratoplasty (DMEK) performed with split corneal grafts and to evaluate the influence of tamponade material and endothelial storage time on DMEK success. Material and Method: The records of 43 patients who underwent DMEK surgery with a split corneal graft were reviewed. Diagnosis of the patients, preoperative and postoperative best-corrected visual acuity (BCVA), corneal and endothelial storage time, tamponade material, complications, and success rates were specifically tabulated. Results: The most common indication for DMEK was pseudophakic bullous keratopathy (n = 25, 58.2%). Re-bubbling was needed in 10 cases (23.2%), and a re-DMEK was scheduled in 2 cases and penetrating keratoplasty in 4 cases (9.3%). BCVA improved significantly postoperatively (p < .001). There was an insignificant trend towards a lower re-bubbling rate and better long-term anatomic outcome in favor of 20% SF6 group compared to air tamponade (p = .18 and p = .25). There was no significant difference between the early endothelial transplant (<24 h) and delayed endothelial transplant (3 to 14 days) groups for anatomic success, corneal thickness or BCVA (p = .94, p = .13 and p = .35). Conclusion: The success rate of DMEK was satisfactory with split corneal grafts. There was no adverse influence of delayed endothelial transplantation on clinical outcome. The success rate of 20% SF6 tamponade was slightly better than room air. [ABSTRACT FROM AUTHOR]

Objective. To report a case of toxic anterior segment syndrome (TASS) that was caused by inadvertent anterior chamber and cornea stromal injection with high dose gentamicin following cataract surgery. Methods. Case report. Results. We report a 72-year-old female patient who developed TASS that was caused by high dose gentamicin (20mg/0.5 mL), which was inadvertently used during the formation of the anterior chamber and hydration of the corneal incision. Unlike previous cases, hyphema and hemorrhagic fibrinous reaction were seen in the anterior chamber. Despite treatment, bullous keratopathy developed and penetrating keratoplasty was performed. The excised corneal button was sent for histopathological examination. Conclusions. Subconjunctival gentamicin is highly toxic to the corneal endotheliumand anterior chamber structures. Including it on the surgical table carries a potentially serious risk for contamination of the anterior chamber. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate long-term clinical results of 2 different accelerated corneal crosslinking (CXL) protocols in pediatric patients with keratoconus. Setting: Beyoglu Eye Training and Research Hospital, Istanbul, Turkey. Design: Retrospective case-control study. Methods: Patients who were younger than 18 years were included in the study. Group 1 received 4 minutes of illumination at 30 mW/cm2, and Group 2 received 5 minutes of illumination at 18 mW/cm2. Uncorrected and corrected distance visual acuities, manifest refraction, corneal topographic parameters, and corneal higher-order aberrations (HOAs) were evaluated at baseline and during 1-, 3-, and 5-year follow-up visits. Results: A total of 143 eyes from 86 patients were included in the study. There were 30 eyes in Group 1 and 113 eyes in Group 2. The mean follow-up time was 4.15 +/- 0.99 years. Mean keratometry (K) and/or maximum K progressed >=1.00 diopter (D) in 7 eyes (23.3%) in Group 1 and 19 eyes (16.8%) in Group 2 (P =.411). Mean K and/or maximum K decreased >=2.00 D in 2 eyes (6.7%) in Group 1 and 24 eyes (21.2%) in Group 2 (P =.06). In Group 1, there were no statistically significant differences in topographic parameters during follow-up. In Group 2, there was a statistically significant reduction in total HOA and coma during the 5-year visit when compared with the preoperative visit (P =.005 and P =.045, respectively). Conclusions: Accelerated CXL is beneficial in terms of halting the progression of keratoconus in pediatric patients throughout 5 years of follow-up examinations. An increased irradiance with a reduced application time reduces the topographic effects of CXL. [ABSTRACT FROM AUTHOR]