Research highlights of the September 2009 issue of Ophthalmology
Highlights of September's Ophthalmology, the journal of the American Academy of Ophthalmology (Academy), include a 2009 review by the Academy of the safety and efficacy of a widely used corneal transplant procedure and a warning about an unusual but serious reaction to systemic fluroquinolones, a class of antibiotics used to treat a variety of bacterial infections.
DSEK Deemed Safe, Effective Treatment for Corneal Diseases
Descemet's Stripping Endothelial Keratoplasty (DSEK) corneal transplant procedure is a safe and effective treatment for corneal endothelial diseases, says a 2009 review by the cornea panel of the Academy's Ophthalmic Technology Assessment Committee, led by W. Barry Lee, M.D. The panel reached this conclusion through a comprehensive review of pertinent studies published from 1980 to 2009. Eighty-five percent of corneal transplants performed in the United States are associated with endothelial diseases. The cornea is the eye's clear outer tissue that refracts, or bends, incoming light to focus images on the retina at the back of the eye; the endothelial layer lines the back surface of the cornea and regulates water levels (hydration). In February 2009 the Board of Trustees approved the corneal panel's conclusions for use in official Academy statements.
In outcome comparisons derived from the review, DSEK was superior to penetrating keratoplasty (PK)-the dominant procedure prior to DSEK's development-in terms of earlier recovery and stability of vision, refractive status after surgery, and specific risks and complications associated with surgery and recovery. The most common DSEK complications apparently do not hinder ultimate recovery of vision in most patients. DSEK and PK outcomes were similar in terms of survival of the transplanted cornea, visual sharpness (acuity) and endothelial cell loss, and specific surgical risks and complication rates.
"To further improve DSEK and related procedures and provide the best patient care, we need prospective clinical studies to set expectations for long-term endothelial cell survival and to determine acceptable complication rates," Dr. Lee said. "Another important research area is how to improve tissue (donor cornea) preparation and surgical techniques to increase endothelial cell survival," he added.
Seeing Double? A Type of Antibiotic May be the Cause