Adult ; Aged ; Cataract Extraction ; methods ; Endothelial Cells ; pathology ; Female ; Fuchs' Endothelial Dystrophy ; pathology ; Humans ; Male ; Middle Aged ; Phacoemulsification

PURPOSE: Information regarding corneal dystrophy among Koreans were examined according to the subtypes. METHODS: Two hundred sixteen patients, 340 eyes, diagnosed as corneal dystrophy and followed by one ophthalmologist from the year 1993 to 2001 were include. The incidence of the disease, the progression level of visual impairment, differences between genders, treatment method, and rate of recurrence after the treatment were analyzed according to the location of the lesion. RESULTS: Granular dystrophy was the most common type (103 eyes, 29.17%). There were 84 eyes (23.61%) with Fuchs dystrophy and 46 eyes (12.96%) with macular dystrophy. Macular dystrophy had the most rapid disease progression with 0.18 reduction in eyesight every year. There was a higher prevelance in female than male granular dystrophy (15.9/84.1%) and in Fuchs dystropy (23.5/76.5%). Keratoplasty was the most popular method of treatment in 45%. CONCLUSIONS: There was no difference of prevalence in between Koreans and Western people. The most common type of corneal dystrophy was granular dystrophy. Infrequent type of dystrophy tended to increase by virtue of the development in diagnotic medicine.
Corneal Transplantation ; Disease Progression ; Epidemiology* ; Female ; Fuchs' Endothelial Dystrophy ; Humans ; Incidence ; Korea* ; Macular Degeneration ; Male ; Prevalence ; Recurrence ; Virtues ; Vision Disorders

We performed keratoplasty and did not remove suture material in 189 patients (189 eyes) after operation. Among them, 48 eyes which had clear grafts with spontaneous suture breakage had been analyzed retrospectively for the age, the sex distribution, the time and the site of broken suture, the preoperative diagnosis and the relationship between the suture breakage and the presence of vasculized recipient bed or suture method. The time when suture was broken after keratoplasty ranged from 3 months to 80 months(average 30 months). Leukoma cornea, 25 eyes(52.1%) and keratoconus, 13 eyes(27.1%) were the most common cause of keratoplasty and the others were corneal dystrophy, Fuchs dystrophy and re-keratoplasty. The most common site of broken suture was at superior quadrant(30 eyes, 62.5%), The vasculized recipient bed was found in 16 eyes, 13 eyes of leukoma cornea and 3 eyes of fe-keratoplasty in preoperative state. The statistical analysis showed significant relationship between the presence of vasculized recipient bed and the suture breakage(p<0.05). Suture was broken in 28 eyes(26.7%) of 105 eyes with single continuous suture, 6 eyes(21.9%) of 20 eyes with combined interupted suture and 14 eyes(21.9%) of 64 eyes with combined interupted and continuous suture. The statistical analysis showed no significant relationship between the suture method and the suture breakage(p>0.05).
Cornea ; Corneal Opacity ; Corneal Transplantation* ; Diagnosis ; Fuchs' Endothelial Dystrophy ; Humans ; Keratoconus ; Retrospective Studies ; Sex Distribution ; Sutures* ; Transplants

PURPOSE: To compare long-term outcomes of penetrating keratoplasty in treating macular corneal dystrophy, transforming growth factor beta induced (TGFBI) dystrophy, and Fuchs' dystrophy. METHODS: The present retrospective study describes the postoperative results of 123 eyes in 70 patients; 53 eyes with macular corneal dystrophy, 20 eyes with TGFBI dystrophy, and 50 eyes with Fuchs' dystrophy. All patients received penetrating keratoplasty. The outcome measures included recurrence rate, graft rejection, graft survival rate and corneal endothelial density and other complications. RESULTS: As compared with the other groups, TGFBI dystrophy had the highest recurrence rate (p-value < 0.0001). Fuchs' dystrophy had the lowest graft survival rate (p-value = 0.03). Corneal endothelial cell density was lowest in Fuchs' dystrophy 10 years postoperatively (p-value = 0.0006), but there was no significant difference in corneal endothelial cell density between the 3 groups 1 and 5 years postoperatively. There was no significant difference between the 3 groups in other complications such as graft rejection, secondary glaucoma and persistent epithelial defect (p-value = 0.809, p-value = 0.584, p-value = 0.972, respectively). CONCLUSIONS: Penetrating keratoplasty showed different long-term outcomes in treating 3 types of corneal dystrophies. The difficulty may depend on the pathogenesis of corneal dystrophies.
Endothelial Cells ; Eye ; Fuchs' Endothelial Dystrophy ; Glaucoma ; Graft Rejection ; Graft Survival ; Humans ; Keratoplasty, Penetrating ; Macular Degeneration ; Outcome Assessment (Health Care) ; Recurrence ; Retrospective Studies ; Transforming Growth Factor beta

PURPOSE: To compare the clinical characteristics and prognosis of Fuchs dystrophy patients according to COL8A2 gene mutation status. METHODS: Eighty-one patients (162 eyes) initially diagnosed with Fuchs dystrophy from 1996 to 2015 were divided into two groups according to COL8A2 gene mutation status. Retrospective analysis was performed comparing gender, age at diagnosis, presence of family history, diabetes mellitus, symptoms of blurred vision in the morning, changes in central corneal thickness and endothelial cell density with time, need for corneal transplantation, and pre-operative corneal status in the two groups. RESULTS: Of the 81 patients, 12 were shown to harbor a COL8A2 gene mutation. Individuals with mutation were significantly associated with presence of family history, diabetes mellitus, and blurred vision in the morning (p = 0.021, p = 0.024, p = 0.044, respectively). They also had significantly thicker central cornea and lower endothelial cell density at the time of diagnosis (p = 0.020, p = 0.005, respectively). The differences in central corneal thickness and endothelial cell density between the two eyes in one patient were significantly smaller in patients with gene mutation (p = 0.043, p = 0.022, respectively). Over a 5-year follow-up period, 60.0% of eyes in patients with gene mutation and 19.2% of eyes in patients without gene mutation underwent corneal transplantation, a significant difference between the two groups (p = 0.014). CONCLUSIONS: By testing for COL8A2 gene mutation, early binocular disease progression and the possible need for corneal transplantation in the future can be predicted among patients diagnosed with Fuchs dystrophy.
Cornea ; Corneal Transplantation ; Diabetes Mellitus ; Diagnosis ; Disease Progression ; Endothelial Cells ; Follow-Up Studies ; Fuchs' Endothelial Dystrophy* ; Humans ; Prognosis* ; Retrospective Studies ; Telescopes

PURPOSE: To report a case of fungal endophthalmitis developed early after penetrating keratoplasty (PKP). CASE SUMMARY: A 67-year-old man was diagnosed with cataract, bullous keratopathy, and Fuchs' dystrophy. He underwent phacoemulsification, posterior chamber intraocular lens implantation, and PKP. The preoperative visual acuity was counting fingers. One day after surgery, his visual acuity was 20/200, and there was no abnormal finding. In the afternoon, a slit lamp examination showed endothelial plaque and white materials in the anterior chamber, and ultrasonography revealed vitritis. A Gram stain and a KOH smear of donor corneoscleral rim, which was conducted during the operation, revealed yeast-like organisms. An intravitreal amphotericin B injection was performed, and topical and systemic amphotericin B were administered. The donor corneoscleral rim scraping grew Candida albicans on culture. Amphotericin B injection into the anterior chamber and anterior chamber irrigation were performed. The patient's vitritis worsened, so we performed pars plana total vitrectomy. Two months after treatment, the cornea showed complete clearing, and the endothelial cell density was 1779 cells/mm2 on noncontact specular microscopy. Five months after treatment, the final best corrected visual acuity was 20/20. CONCLUSIONS: If a diagnosis of fungal endophthalmitis, which develops soon after PKP, is delayed, treatment could be very difficult. Culture of a donor corneoscleral rim may provide a guide to early diagnosis and successful treatment in cases of fungal endophthalmitis following PKP.
Aged ; Amphotericin B ; Anterior Chamber ; Candida albicans ; Cataract ; Cornea ; Early Diagnosis ; Endophthalmitis ; Endothelial Cells ; European Continental Ancestry Group ; Fingers ; Fuchs' Endothelial Dystrophy ; Humans ; Keratoplasty, Penetrating ; Lens Implantation, Intraocular ; Microscopy ; Phacoemulsification ; Tissue Donors ; Visual Acuity ; Vitrectomy

PURPOSE: To report two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase(R); IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.
Aged ; Aged, 80 and over ; Corneal Edema/*surgery ; Corneal Surgery, Laser/*methods ; Corneal Topography ; Corneal Transplantation/*methods ; Endothelium, Corneal/*transplantation ; Female ; Fuchs' Endothelial Dystrophy/*surgery ; Humans ; Male ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To report two cases of femtosecond laser-assisted small incision deep lamellar endothelial keratoplasty (DLEK) for patients with corneal endothelial decompensation by Fuchs dystrophy and glaucoma METHODS: Femtosecond laser (IntraLase(R); IntraLase Corp., Irvine, CA) with 15 kHz of repetition rate, was used for a 9.5 mm diameter by 400 micrometer thickness donor corneal lamellar dissection. RESULTS: In Case 1, the graft was clear and compact without interface haze, Orbscan showed smooth and regular corneal surface, specular microscopy was unremarkable without sign of corneal endothelial damage, and Optical coherence tomography showed uniform graft well attached to recipient stroma with minimal interface reflection at 2 months postoperation. In Case 2, the graft was clear and compact with minimal interface haze at 1 month postoperation. Femtosecond laser-assisted small incision DLEK was safe and technically feasible in our cases; however, further evaluation is required to determine long-term effects.
Aged ; Aged, 80 and over ; Corneal Edema/*surgery ; Corneal Surgery, Laser/*methods ; Corneal Topography ; Corneal Transplantation/*methods ; Endothelium, Corneal/*transplantation ; Female ; Fuchs' Endothelial Dystrophy/*surgery ; Humans ; Male ; Tomography, Optical Coherence ; Visual Acuity

PURPOSE: To evaluate the natural course of the long-term endothelial cell changes in Fuchs corneal dystrophy (FCD) patients and investigate the effects of phacoemulsification on the annual rate of change in endothelial indices in FCD patients. METHODS: Thirty-four patients diagnosed with FCD at Seoul National University Hospital from 1994 to 2010 were retrospectively reviewed. Sixteen patients who had been followed up for more than 1 year were selected and classified into 3 groups: group A, patients with no ocular surgery; group B, patients who had undergone phacoemulsification only; and group C, patients who had undergone penetrating keratoplasty with cataract surgery. Endothelial cell density, polymegethism, pleomorphism, and pachymetry were measured and the exponential rates of endothelial cell and pachymetry change were analyzed. RESULTS: A non-linear mixed model of non-operated FCD patients showed that only pachymetric data tended to increase with statistical significance (p = 0.001) with a mean follow-up period of 4.15 years. Using an exponential regression analysis fitting curve, the mean rates of annual endothelial cell loss were 0.82%/yr, 20.39%/yr, and 29.27%/yr in groups A, B, and C respectively, and statistical significance was seen only in group C (p < 0.05). CONCLUSIONS: Retrospective long-term follow-up data showed that changes in endothelial density did not significantly decrease over at least 4 years in middle-aged FCD patients. The changes in pachymetric corneal thickness appeared to increase over the same period. Considering that no exponential changes were aggravated after performing cataract surgery alone, cataract surgery would be a preferable option in FCD patients compared to an approach of "wait-and-do" penetrating keratoplasty combined with cataract surgery.
Adult ; Aged ; Aged, 80 and over ; Cataract/*complications/pathology ; Cell Count ; Corneal Pachymetry ; Disease Progression ; Endothelium, Corneal/*pathology ; Female ; Follow-Up Studies ; Fuchs' Endothelial Dystrophy/complications/*pathology/surgery ; Humans ; *Keratoplasty, Penetrating ; Male ; Middle Aged ; *Phacoemulsification ; Postoperative Period ; Retrospective Studies ; Time Factors ; Young Adult