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Objective: To analyze graft survival and the outcome of the corneal endothelium after corneal transplantation in a single model to predict the long-term prognosis of these grafts., Design: Cohort study. Data were recorded prospectively and then analyzed retrospectively., Participants: One thousand one hundred forty-four consecutive eyes of 1144 patients who underwent corneal transplantation between 1992 and 2006., Interventions: Penetrating keratoplasty and deep anterior lamellar keratoplasty., Main Outcome Measures: Slit-lamp examination and wide-field specular microscopy results. A joint analysis of endothelial cell loss and time to graft failure was undertaken. From midterm simultaneous analysis of graft survival and endothelial cell loss, long-term graft survival was predicted., Results: The observed 5- and 10-year graft survival estimates were, respectively, 74% and 64%. The average endothelial cell density (cell loss) was 2270 cells/mm(2) before surgery, 1058 cells/mm(2) (-53%) during the sixth postoperative year, and 865 cells/mm(2) (-61%) during the 10th postoperative year. Overall, the predicted graft survival estimate was 27% at 20 years and 2% at 30 years. Both observed and predicted graft survival were higher in patients who had undergone lamellar keratoplasty than in patients who had undergone penetrating keratoplasty and had normal recipient endothelium and higher in patients who had undergone penetrating keratoplasty and had normal recipient endothelium than in patients who had undergone penetrating keratoplasty and had impaired recipient endothelium., Conclusions: For corneal diseases involving the endothelium, penetrating keratoplasty seems to be a good therapeutic approach in elderly patients because the graft life-span may be similar to the patient life expectancy. Conversely, for younger patients, penetrating keratoplasty is only a midterm therapeutic approach. For corneal diseases not involving the endothelium, deep anterior lamellar keratoplasty seems to be a promising therapeutic approach with higher long-term expected survival.

Objective: To compare 3 techniques used for removing the recipient stroma during anterior lamellar keratoplasty (ALK): the "big-bubble" technique, manual dissection using a crescent blade and slitlamp operating microscope, and microkeratome lamellar cut., Design: Retrospective comparative cohort study of 69 consecutive ALKs and 69 consecutive penetrating keratoplasties (PKs). Manifest refraction, slitlamp examination, Goldmann tonometry, ultrasound pachymetry, specular microscopy, and confocal microscopy findings were recorded., Results: The 12-month graft survival estimate was 98.5% in the ALK group and 94.1% in the PK group (P = .19). Higher endothelial cell density was found after ALK (P < .001). At 12 months (before suture removal), 53% of eyes that underwent ALK and 44% of eyes that underwent PK had 20/40 or better spectacle-corrected visual acuity (P = .24). In keratoconic eyes, these values were 83% and 69%, respectively (P = .18). Significant differences in visual acuity, corneal central thickness, and keratocyte density among ALK subgroups were found, with the best results obtained using the big-bubble technique and the worst results obtained using the microkeratome. In eyes that underwent ALK, visual acuity increased with keratocyte density., Conclusions: Better results were obtained after ALK vs PK, and the big-bubble technique seemed to provide the best results.

Purpose A 38‐year‐old Egyptian man was referred to our department due to bilateral loss of vision over a six‐year period.Slit lamp examination revealed extensive bilateral corneal opacitiesBlood analysis revealed lipid metabolism abnormalities with a lack of plasma alpha‐lecithin:cholesterol acyltransferase (LCAT) (high‐density) activity Methods We used PCR to amplify, to sequence and to determine the genotype of the LCAT gene. Direct sequencing of the six exons of the gene (figure 2) revealed a new homozygous mutation in exon 1 confirming the diagnosis of Fish Eye Disease (FED). This new homozygous mutation caused a C‐to‐T transition, resulting in a substitution of a leucine by a proline at position 34 of the protein. Results We performed a penetrating keratoplasty on right eye in december 2004. Despite a clear graft with normal anterior segment and normal fundoscopy, the patient did not recover significant visual acuity from the graft. His visual acuity was 20/100 on right eye. Visual Evoked potential and neuroimaging was normal, but electroretinography revealed a bilateral maculopathy. Conclusion Similarly to what occurs in cornea ,retinal deposits could explain the macular involvement we have discovered in Fish eye disease. Full‐thickness corneal transplantation should be performed in cases of severe corneal opacification with impaired vision, but success of keratoplasty could be limited by visual impairement due to retinal degeneration. The indication for perforating keratoplasty has to be thought very carefully in these multimorbid patients. [ABSTRACT FROM AUTHOR]