Descemet's-stripping automated endothelial keratoplasty has been shown to be a viable and effective option in patients with existing glaucoma tube shunts in the anterior segment, according to new research. This news comes from the results of a retrospective review of four patients with a history of tube shunt placement that experienced corneal decompensation and subsequently underwent DSAEK at one institution. The researchers recorded details of the surgical procedures as well as postoperative features, including graft attachment, visual acuity, intraocular pressure, graft clarity and central corneal thickness.
The review revealed that there were no graft detachments postoperatively. In all but one case, the corneal edema resolved with a corresponding decrease in corneal thickness. In one case in which there was excessive donor tissue manipulation intraoperatively, the edema failed to resolve. This patient underwent a repeat DSAEK with subsequent graft attachment and resolution of the corneal edema. In all four patients, the tube shunt was revised at the time of DSAEK. The tube was not tied or plugged in any of the patients. Except for one patient with fibrin reaction, there were no IOP spikes postoperatively. At the six-month follow-up, visual acuity had improved in all patients and the IOP had not changed significantly from preoperative levels.
Though DSAEK is a viable option and the presence of a tube did not affect the rate of graft dislocation, it did appear to increase the rate of complications postoperatively. Despite that, the outcomes support the use of DSAEK as an alternative to penetrating keratoplasty in this patient population, the group concludes.
Riaz KM, Sugar J, Tu EY, et al.
AMD Associated with Vascular Disease
The recently conducted Cardio-vascular Health Study has revealed evidence that age-related macular degeneration is associated with underlying systemic vascular disease, such as coronary heart disease. Authors of the Cardiovascular Health Study—a population-based, prospective cohort study—reviewed a total of 1,786 white and African-American participants free of CHD and 2,228 participants free of stroke, aged 69 to 97 years. AMD was evaluated from photographs taken in 1997 and 1998, while incident CHD and stroke were ascertained using standardized methods.
Of the 1,786 initially free of CHD, 303 developed incident CHD over seven years. Participants with early AMD (n=277) had a higher cumulative incidence of CHD than participants without early AMD (25.8 percent vs. 18.9 percent, p=0.001). After adjusting for age, gender, race, systolic and diastolic blood pressure, hypertension status, fasting glucose, triglyceride, low-density lipoprotein cholesterol, cigarette smoking, pack years of smoking and C-reactive protein, the presence of early AMD was associated with an increased risk of incident CHD (hazard ratio 1.57; 95 percent confidence interval, 1.17 to 2.22). Late AMD (n=25) was not associated with incident CHD (hazard ratio 0.78; 95 percent confidence interval, 0.25 to 2.48). Among 2,228 persons at risk of stroke, 198 developed incident stroke; but neither early nor late AMD was associated with it, thus suggesting that in a population aged 69 to 97 years persons with early AMD have a higher risk of CHD but not stroke.
Ophthalmology 2009;116:1913-9. Epub 2009 Jul 9
Sun C, Klein R, Wong TY.