Purpose To evaluate outcomes of Descemet membrane endothelial keratoplasty (DMEK) in eyes with prior trabeculectomy or drainage device. Methods This is a retrospective study of 108 consecutive DMEK performed between October 2013 and December 2015. All eyes were divided into three groups: surgical treatment [ST] group, medical treatment [MT] group, and control group. Visual improvement, endothelial cell (EC) loss, and postoperative complications, including rejection, graft failure, and IOP elevation (≥ 25 mm Hg) were evaluated. Results The length of follow-up was 9.7±7.3 months. Best-corrected visual acuity (BCVA) improved postoperatively in 85.3% of the ST group, 100% of the MT group, and 93% of the control (p=0.24). Significantly more lines of BCVA were gained in the ST and MT groups (8.1±8.1 and 9.2±6.3 lines, respectively) than in the control (4.8±5.6 lines, p<0.05). The mean time to BCVA was 2.9±2.8 months for the ST group, 4.7±5.3 months for the MT group, and 3.0±3.3 months for the control (P=0.75). EC loss was greater in the ST group (44.6±17.8%) than in the MT group (29.9±12.0%) and the control group (32.7±11.3%, P=0.001). There was one primary failure and no secondary graft failures. The overall rejection rate was 0.9%. Postoperative IOP elevation was less common in the ST group (14.7%) and control (23.3%) than in the MT group (50.0%, P=0.04). There was no difference in the air injection rate among all groups (P=1.0). Conclusion DMEK in eyes with previous trabeculectomy and drainage device can result in very good short-term outcomes.

The KPro provides significant visual improvement in most eyes, with more than 50% regaining and maintaining 20/200 CDVA each year through 8 years after surgery. The incidence of each postoperative complication decreases significantly over the first 10 years after surgery. Although almost one-quarter of implanted keratoprostheses were removed, over 90% of eyes reaching 5 years of follow-up retain a keratoprosthesis at final follow-up.

Purpose To quantify the changes of subbasal nerve plexus in patients with limbal stem cell deficiency (LSCD) using in vivo laser scanning confocal microscopy. Design: Retrospective cross-sectional comparative study Methods Confocal images of 51 eyes of 37 patients with LSCD collected between 2010 and 2015 by the Heidelberg Retina Tomograph III Rostock Corneal Module Confocal Microscope. Two independent observers evaluated the scans of the central cornea. Seventeen normal eyes of 13 patients served as controls. Total subbasal nerve density (SND), density of long nerves (i.e., nerves 200 μm or longer) and the degree of tortuosity were quantified. Results The mean (± SD) total SND and long nerve density were 48.0 ± 34.2 nerves/mm2 and 9.7 ± 10.9 nerves/mm2, respectively, in all eyes with LSCD and 97.3 ± 29.9 nerves/mm2 and 35.3 ± 25.3 nerves/mm2, respectively, in eyes of the control group (P<0.001 for both comparisons). Compared with SND in control subjects, SND was reduced by 34.9% in the early stage, 54.0% in the intermediate stage, and 73.5% in the late stage of LSCD. The degrees of nerve tortuosity were significantly greater in patients with LSCD than in control subjects and differed among the early, intermediate, and late stages of LSCD. Reductions in total SND and long nerve density were positively correlated with the severity of LSCD. Conclusions Reductions in total SND and long nerve density were accompanied by increases in nerve tortuosity in eyes with LSCD. These parameters could be used as quantifiable measures of LSCD severity.