No author has a financial or proprietary interest in any material or method mentioned.

BackgroundThe purpose of this study was to compare endothelial cell counts after Descemet’s stripping automated endothelial keratoplasty (DSAEK) and penetrating keratoplasty in Asian eyes.MethodsThis was a retrospective study of patients from our prospective Singapore Corneal Transplant Study cohort who received corneal transplantation in 2006–2008. We compared eyes that underwent DSAEK or penetrating keratoplasty for Fuchs’ endothelial dystrophy or pseudophakic and aphakic bullous keratopathy. Clinical data, and donor and recipient characteristics were recorded. Of 241 patients who met our inclusion criteria, 68 underwent DSAEK and 173 underwent penetrating keratoplasty. The main outcome measure was endothelial cell loss at 1 year. Secondary outcome measures were graft survival and visual outcomes at 1-year follow-up.ResultsThere were no significant differences in baseline characteristics of patients between the treatment groups. Percent endothelial cell loss at 1-year follow-up was greater in penetrating keratoplasty eyes (40.9% ± 2.9%) compared with DSAEK eyes (22.4% ± 2.3%; P < 0.001). DSAEK-treated eyes had significantly superior uncorrected visual acuity (mean difference = 0.42 ± 0.0059; P < 0.001) and best spectacle-corrected visual acuity (mean difference = 0.14 ± 0.032; P < 0.001) as compared with penetrating keratoplasty-treated eyes. Penetrating keratoplasty-treated eyes had worse astigmatism as compared with DSAEK-treated eyes (−3.0 ± 2.1 versus −1.7 ± 0.8; P < 0.001). Graft survival at 1 year was comparable in both groups, ie, 66/68 (97.0%) DSAEK-treated eyes versus 158/173 (92.0%) of penetrating keratoplasty-treated eyes had clear grafts (P = 0.479).ConclusionWe report lower percent endothelial cell loss comparing DSAEK and penetrating keratoplasty at 1-year follow-up in Asian eyes, with comparable graft survival rates in both groups.

Purpose To review the outcomes of 23-gauge transconjunctival vitrectomy in patients with postoperative endophthalmitis. Methods Non-randomized, interventional case series of patients with postoperative endophthalmitis over a 1-year period.Results 23-gauge transconjunctival vitrectomy was performed on 6 patients with a mean age of 67.7 years without intraoperative or postoperative complications. There were no cases of postoperative hypotony or wound leak. The mean change in IOP was À4.2 mmHg compared to the preoperative IOP (P ¼ 0.239). Final VA improved significantly compared to preoperative VA (P ¼ 0.062), with VA of at least 20/40 in 5 of 6 patients (83.3%). Conclusions 23-gauge transconjunctival vitrectomy is a useful technique for treating postoperative endophthalmitis.

We congratulate Tan et al. 1 for reporting on their experience with antibiotic prophylaxis of pseudophakic endophthalmitis in an Asian population. Given the ethical concerns regarding future randomized trials on this subject, only large retrospective case series can confute or confirm the positive effect of intracameral cephalosporins for pseudophakic endophthalmitis prophylaxis that was established by the European Society of Cataract & Refractive Surgeons (ESCRS) endophthalmitis prophylaxis study. 2 In Tan et al.'s study, of 50 177 eyes having cataract surgery, 20 638 received intracameral cefazolin. The authors found a significantly favorable effect of the intracameral cefazolin bolus over the subconjunctival cefazolin, in line with the results of a similar study. 3 Commendably, the rate of endophthalmitis, already low in the control group (first series), became extremely low in the treated groupdless than 0.01%.For a better understanding of the findings and to enable comparison with the available clinical evidence, the timeframe from surgery should be stated. The study enrolled only eyes with "recent" ocular surgery without quantifying the time from surgery. We remind Tan et al. that a 3-month interval from surgery was the timeframe in the ESCRS study. 2 We also query the rationale for the simultaneous administration of cefazolin and gentamicin. With the spectrum being similar and the safety issues related to gentamicin administered subconjunctivally, 4 as done in the Tan et al. study, is it justifiable to routinely add aminoglycosides only to cover for the very rare Pseudomonas cases? It would be helpful to know whether the authors saw any case of retinal toxicity in their large case series.Besides the absence of information on whether the samples were from aqueous or vitreous taps, we noted that 43% of cultures were negative for bacterial growth, which reinforces the recommendation to use a molecular biology technique for endophthalmitis specimens, as previously suggested. 5