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To evaluate the efficacy and outcomes of tectonic epikeratoplasty with use of ethanol-preserved corneal grafts for the management of perforated corneal melts. The present retrospective case series includes 10 eyes which underwent tectonic epikeratoplasty for perforated corneal melts. The stromal remainders of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation were stored in 95% ethanol and used as emergency tectonic grafts for restoring globe integrity after sterile and infectious perforated corneal melts. In 6 cases with subtotal corneal melt, DMEK remainders (endothelium-denuded corneoscleral buttons) were used for 'limbus to limbus' tectonic epikeratoplasty and in 4 cases DSAEK remainders (anterior stroma) were used to seal focal perforated melts. Graft storage time was 5.1 ± 4.9 (ranging from 0.5 to 17) months. The surgeries were successful in all cases with restitution of the globe integrity. During the postoperative course 4 cases developed a graft melt (corneoscleral button for limbus to limbus tectonic epikeratoplasty, n = 3; lamellar patch, n = 1) within 2-6 months after the initial procedure. Three patients underwent successful repeat tectonic epikeratoplasty. In the fourth case of graft melt the globe was enucleated due to underlying expulsive haemorrhage and severe pain. The short-term results of the present case series suggest that the use of ethanol-stored stromal remainder of donor corneas after endothelial keratoplasty is an efficient temporary measure for tectonic restoration of perforated corneas.

To describe the outcomes of endothelial keratoplasty (EK) for bullous keratopathy in eyes with a retained angle-supported anterior chamber intraocular lens (acIOL). Among 263 consecutive EK procedures, 7 DMEK and 11 DSAEK procedures were identified in eyes with an acIOL and included in the present retrospective case series. Pre- and postoperative status including ocular history, anatomical outcome and complications as well as best-corrected visual acuity was evaluated. Ocular history included complicated cataract surgery (n = 11), ocular trauma (n = 4) and primary intracapsular cataract extraction (n = 3). Surgery-related complications included primary graft failure (n = 1), graft detachment (n = 1), endophthalmitis (n = 1) and allograft rejection (n = 1). A clear cornea at the final examination (14 ± 4 months) was observed in 14/18 (78%), while the visual outcome was limited due to significant ocular comorbidity in 9 out of 14 uncomplicated procedures. The presented short-term outcomes suggest that both DMEK and DSAEK are feasible in eyes with an angle-supported acIOL yielding an acceptable graft survival rate in the first postoperative year.

Purpose To evaluate the presence and the evolution of cyst formation in optic disc pit maculopathy. Methods In this prospective study, 18 cases with optic disc pit maculopathy were studied. Five of them showed cyst formation in the fovea at the initial examination. The fundus findings were documented with slit-lamp biomicroscopy, indirect ophthalmoscopy, and stereoscopic photography of the posterior pole. All 5 patients were treated with a macular scleral buckle procedure. Results The presence of cysts in the elevated macula depends on the grade of the disease. Cyst formation can develop not only in the later stage of the disease but also quite early. In all 5 patients cyst formation gradually decreased and finally disappeared after the surgical procedure. Conclusions Cyst formation is an entity which accompanies the macular detachment associated with optic disc pit. The development of the cysts has been noticed after the establishment of the schisis-like separation and before or in conjunction with the formation of a lamellar macular hole which usually accompanies the optic disc pit maculopathy.

Sir, We would like to thank Perera and Ali1 for their interest in our case report and their useful comments. It is true that serous retinal detachments can occur in patients suffering from septicemia or disseminated intravascular coagulation (DIC).2, 3 In our case,4 an 89-year-old immunocompromised patient presented with fever and elevated inflammatory markers (that is, raised ESR, C-reactive protein and neutrophilic leukocytosis), but the blood cultures that were performed were negative for any microorganism. Additionally, culture of nasal aspirates revealed methycillin-resistant Staphylococcus aureus and Warneri-Staphylococcus, which were consistent with ethmoid sinusitis leading to orbital cellulitis and subsequent exudative retinal detachment.

RE: Long-term outcomes and risk factors for failure with the EX-press glaucoma drainage device

We performed a prospective study of 87 cases with avulsed retinal vessels in conjunction with tears and rhegmatogenous retinal detachment. The postoperative follow-up period ranged from 6 months to 5 years. The avulsed vessels were classified according to their location (peripheral or central) as well as with respect to their form (5 types). The surgical procedure comprised the fixation of an episcleral sponge implant (high indentation), cryoapplication, and, if necessary, laser coagulation or endodiathermy at a later stage. The postoperative condition of the avulsed vessel mainly depended on its location, the type of avulsion, and the buckle height.