Purpose To evaluate eye rubbing and sleeping position in patients with Unilateral or Highly Asymmetric Keratoconus (UHAKC). Methods Case-control study of consecutive UHAKC patients diagnosed at the Rothschild Foundation. Controls were age- and sex-matched, randomly selected refractive surgery clinic patients. Patients self-administered questionnaires regarding their family history of keratoconus, eye rubbing, and sleeping habits. All the eyes underwent a comprehensive ocular examination. Logistic regression was used to analyze univariate and multivariate data to identify risk factors for keratoconus. Results Thirty-three UHAKC patients and 64 controls were included. Univariate analyses showed that daytime eye rubbing [OR = 172.78], in the morning [OR = 24.3], or in eyes with the steepest keratometry [OR = 21.7] were significantly different between groups. Allergy [OR = 2.94], red eyes in the morning [OR = 6.36], and sleeping on stomach/sides [OR = 14.31] or on the same side as the steepest keratometry [OR = 94.72] were also significantly different. The multivariate model also showed statistical significance for most factors including daytime eye rubbing [OR = 134.96], in the morning [OR = 24.86], in the steepest eye [OR = 27.56], and sleeping on stomach/sides [OR = 65.02] or on the steepest side [OR = 144.02]. A univariate analysis in UHAKC group, comparing the worse and better eye, showed that eye rubbing [OR = 162.14] and sleeping position [OR = 99.74] were significantly (p < 0.001) associated with the worse eye. Conclusion Our data suggests that vigorous eye rubbing and incorrect sleeping position are associated with UHAKC. This is especially true in rubbing the most afflicted eye, and contributory sleep position, including positions placing pressure on the eye with the steepest keratometry.

Surgical experience allowed faster graft preparation and faster unrolling time in DMEK. Neither experience nor percentage cell loss influenced postoperative visual acuity gain. The number of procedures needed to reach a good standard of care was estimated to be 50 in our patient database.

Purpose: To demonstrate the feasibility of Descemet membrane endothelial keratoplasty (DMEK) performed after previous penetrating keratoplasty (PK) failure and to describe primary outcomes. Methods: Twenty-eight eyes of 28 patients who underwent DMEK after primary PK failure between January 2013 and November 2017 were included in this single-center retrospective study. Best spectacle-corrected visual acuity, endothelial cell density, and the recipient's central corneal thickness were recorded preoperatively and at 1, 3, and 6 months after surgery. Results: The main indications for primary PK were keratoconus (32%), Fuchs dystrophy (18%), and pseudophakic bullous keratopathy (14%). After a 6-month follow-up, best spectacle-corrected visual acuity was significantly improved in 26 patients (93%) with a mean gain of +0.59 ± 0.47 LogMAR (P < 0.0004). Mean pachymetry reduction was 110 ± 108 μm (P < 0.00003) at 6 months. Mean endothelial cell density was 2016 ± 288 cells/mm2 (P < 0.006), (24% decrease compared with preoperative values). Graft detachment (>1/3) was observed in 14 cases (50%) and rebubbling was needed (100% effective) during the first 2 weeks after surgery. Elevated intraocular pressure was reported in 5 cases. No early graft rejections were reported. Conclusions: In case of previous PK failure, DMEK is an alternative treatment to re-PK. A longer follow-up to ensure the long-term viability of the graft is needed.

For hyperopic patients, combining the customized corneal aspheric ablation profile with monovision is safe, effective, and reproducible, inducing intended changes in corneal spherical aberrations. [J Refract Surg. 2016;32(11):734-741.].