Am Joussen

Retrospective contralateral study comparing Descemet membrane endothelial keratoplasty with Descemet stripping automated endothelial keratoplasty

PurposeIn this retrospective study, the visual outcomes and postoperative complications after Descemet stripping automated endothelial keratoplasty (DSAEK) and Descemet membrane endothelial keratoplasty (DMEK) in the fellow eye were compared. The patient’s satisfaction was evaluated.MethodsA retrospective analysis of 10 patients, who underwent DSAEK in one eye and DMEK surgery in their fellow eye, was performed. Intraoperative and postoperative complications were recorded. Visual and refractive outcomes were evaluated, including higher-order aberrations (HOA) and contrast thresholds. A subjective questionnaire was used to evaluate patient satisfaction.ResultsBest-corrected visual acuity (BCVA) was significantly better in DMEK when compared with DSAEK (0.16±0.10 vs 0.45±0.58 logMAR, P=0.043). Contrast threshold was significantly higher after DMEK than after DSAEK (0.49±0.23 vs 0.25±0.18, P=0.043). Post-keratoplasty astigmatism, mean spherical equivalent, and HOA did not differ. Nine out of ten patients preferred the DMEK procedure. Visual outcome (4.80±1.14 vs 4.50±1.58, P=0.257), surgery associated pain and burden (DMEK: 1.30±0.48 vs DSAEK: 1.30±0.48, P=1.0), estimated time for recovery and rehabilitation (27.6±54.0 vs 24.9±54.8 days, P=0.173), and mean patient satisfaction (5.40±0.84 vs 5.00±1.05, P=0.257) were evaluated equally.ConclusionPatient satisfaction reached high, equal values after DMEK and after DSAEK. Nevertheless, patients preferred DMEK, if given a choice. Reasons for the preference may include better uncorrected and BCVA, and especially a better contrast sensitivity.

Trabeculectomy ab interno (trabectome): yet another possibility in the treatment of uncontrolled glaucomatocyclitic crisis under systemic valganciclovir therapy?

PurposeTo assess the outcome of trabectome surgery in the treatment of glaucomatocyclitic crisis (Posner–Schlossman syndrome) in patients with uncontrolled intraocular pressure (IOP).Patients/MethodsTrabectome surgery was performed in seven patients with diagnosed glaucomatocyclitic crisis and uncontrolled IOP where cytomegalovirus DNA was verified by polymerase chain reaction in aqueous humour samples. All patients were treated with oral valganciclovir. After surgery the patients were followed-up for 12 months.ResultsMean IOP before trabectome surgery was 40±10u2009mmu2009Hg (range 33–58u2009mmu2009Hg). The mean number of antiglaucoma medication prior to surgery was 3.1±0.4. By the end of the 12 months, IOP in all patients was reduced to normal level (13±1u2009mmu2009Hg) and their antiglaucoma medication was decreased to 0.8±1.1. No recurring attack of glaucomatocyclitic crisis occurred.DiscussionIn addition to oral valganciclovir therapy, trabectome surgery seems to be a reliable and effective tool for the management of glaucomatocyclitic crisis with uncontrolled IOP.