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Purpose: The purpose of this study was to assess long-term stability and outcomes of femtosecond astigmatic keratotomy (FSAK) after treatment of high postkeratoplasty astigmatism., Methods: This retrospective study included patients who underwent FSAK for high astigmatism (≥4 D) after penetrating keratoplasty or deep anterior lamellar keratoplasty. Main outcome measures were corneal astigmatism, uncorrected visual acuity, and best-corrected visual acuity (BCVA) at 1 month and 1, 5, and 10 years., Results: Overall, 61 eyes of 61 patients (mean age 56 ± 19 years, 54.1% male) were included in this study. Preoperative corneal astigmatism ranged from 4 to 25 D. One month after FSAK, mean corneal astigmatism was significantly reduced from 9.02 ± 3.97 D to 4.86 ± 3.10 D ( P < 0.001). Thereafter, corneal astigmatism remained stable at all visits up to 10 years ( P < 0.05 for all compared with baseline). After FSAK, there was a significant improvement in logMAR uncorrected visual acuity from 1.21 ± 0.48 to 0.87 ±0.54 ( P < 0.001) and logMAR BCVA from 1.03 ± 0.55 to 0.49 ± 0.45 ( P < 0.001) which remained stable up to 10 years. A mild reduction in BCVA improvement was seen between 1 month and 1 year., Conclusions: Femtosecond astigmatic keratotomy was effective and stable at reducing very high magnitudes of postkeratoplasty astigmatism over the long term. The procedure also had a stable effect on visual acuity, albeit some reduction in the degree of BCVA improvement was seen over the early postoperative period., Competing Interests: A. R. Slomovic: consultant for Alcon, Bausch & Lomb, Santen, and Abvie; advisory board member at Allergan and Shire; received research funding from AMO. D. S. Rootman: consultant for Alcon; received research funding from Johnson & Johnson. C. C. Chan: received personal fees for lectures, honoraria, and consulting from Santen, Johnson & Johnson, Allergan, Alcon, Bausch & Lomb, Zeiss, Novartis, TearLab, Sun Pharma, Aequus, Daichii, and Labtician Thea; received research funding from Novartis, Allergan, Bausch & Lomb, and Tear Laboratory. M. Mimouni: consultant for Eye Yon Medical and Lapidot Medical. N. Sorkin: received advisory board honoraria from Beyeonics Vision. The remaining authors have no conflicts of interest to disclose., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: To report outcomes of tape splint tarsorrhaphy (TST) for persistent corneal epithelial defects (PCED)., Design: Retrospective, interventional case series., Methods: The study population was consecutive patients with a PCED (14 days or longer) treated at a tertiary cornea clinic with TST. Patients with a corneal epithelial defect that did not respond to treatment with a bandage contact lens were included. Patients with a follow-up time of less than 3 months were excluded. Time to PCED resolution was the main outcome measure., Results: Thirty-four eyes of 33 patients (mean age 62.9 ± 17.8 years; range, 27-90 years) were included in this study. The main etiologies of the PCED were post keratoplasty (n = 15), herpes simplex virus (n = 4), superficial keratectomy (n = 3), neurotrophic cornea (n = 4), fungal keratitis (n = 2), exposure keratopathy (n = 2), failed graft (n = 1), peripheral ulcerative keratitis (n = 1), rosacea (n = 1), and stitch abscess (n = 1). Mean ± SD time from PCED presentation to TST was 58.9 ± 106.3 days (range, 14-390 days). The mean ± SD area of the PCED was 25.1 ± 15.7 mm 2 (range, 0.50-42.0 mm 2 ). After TST, resolution of the PCED was achieved in 29/34 eyes (85.3%) without the need for additional interventions within 22.5 ± 24.3 days (range, 2-105 days). The mean ± SD logMAR best-corrected visual acuity improved significantly from 1.11 ± 0.41 to 0.83 ± 0.70 (P = .02). There were no complications attributed to TST and 2 patients elected to discontinue due to discomfort., Conclusions: TST achieved resolution of PCEDs secondary to various etiologies in 85.3% of eyes, with significant improvement in vision demonstrated. This simple, inexpensive, noninvasive technique may be considered for patients with PCEDs., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Purpose: To compare the outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with Descemet membrane endothelial keratoplasty (DMEK) for the treatment of failed penetrating keratoplasty (PKP)., Methods: This is a retrospective chart review of patients with failed PKP who underwent DMEK or DSAEK. The median follow-up time for both groups was 28 months (range 6-116 months). Data collection included demographic characteristics, number of previous corneal transplants, previous glaucoma surgeries, best-corrected visual acuity, endothelial cell density, graft detachment and rebubble rate, rejection episodes, and graft failure., Results: Twenty-eight eyes in the DMEK group and 24 eyes in the DSAEK group were included in the analysis. Forty-three percent of eyes in the DMEK group and 50% of eyes in the DSAEK group had to be regrafted because of failure (P = 0.80). The most common reason for failure was persistent graft detachment (58%) in the DMEK group and secondary failure (58%) in the DSAEK group; hence, the time between endothelial keratoplasty and graft failure differed significantly between the groups (P = 0.02). Six eyes (21%) in the DMEK group and 7 eyes (29%) in the DSAEK group developed graft rejection (P = 0.39). Rejection was the cause of failure in 67% and 71% in the DMEK and DSAEK groups, respectively. The best-corrected visual acuity 6 months after surgery was better in the DMEK group compared with the DSAEK group (P = 0.051)., Conclusions: Both DSAEK and DMEK have a role in treating PKP failure. Primary failure due to persistent graft detachment was significantly higher in the DMEK group, although the overall failure rate in the medium term was similar.