Faculty Bibliography

OBJECTIVE: To study the clinical course of herpes zoster ophthalmicus (HZO) and to compare the demographics, treatments, and outcomes in patients aged <60 years versus patients aged >/=60 years at the time of diagnosis. DESIGN: Retrospective chart review of all 112 patients presenting for management of HZO from January 1, 2008 to December 31, 2008. PARTICIPANTS: A total of 112 patients (58 aged <60 years and 54 aged >60 years) at the time of HZO onset. INTERVENTIONS: Anterior segment complications, treatments, and surgical procedures were documented at 3 months, 6 months, and 1 year, and then annually for the remainder of the follow-up period. MAIN OUTCOME MEASURES: Intraocular pressure, inflammation, steroid use, surgical procedures, anterior segment complications, post-herpetic neuralgia, and delayed herpes zoster pseudodendrites. RESULTS: Equal numbers of patients were affected with HZO in the younger and older age groups (51.8%, n = 58 vs. 48.2%, n = 54, respectively, P = 0.69). The most common decade of HZO onset was between 50 and 59 years. Younger patients were more likely to be healthy compared with older patients (P = 0.05). Delayed herpes zoster pseudodendrites were more common in the younger patients (36.7% vs. 16.7%, P = 0.03). The mean number of flares per patient-years was significantly higher in the younger patients (z test, P = 0.024). Post-herpetic neuralgia, neurotrophic keratopathy, and secondary infectious keratitis were more frequent in the older patients (P = 0.05). Prevalence of corneal perforation, corneal thinning, cataract formation, and glaucoma was similar between the 2 groups. Most patients in both groups (84.2% of younger patients and 89.5% of older patients) were taking topical steroids 3 years after referral for HZO. CONCLUSIONS: Herpes zoster ophthalmicus affects individuals aged younger than and older than 60 years in similar numbers, with the most common decade of onset between age 50 and 59 years. Younger patients had more episodes of delayed pseudodendritiform keratitis and flares of inflammation compared with older patients, who had more problems related to neurotrophic keratopathy. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article

Two patients were diagnosed as having unilateral iris pigment epithelial (IPE) cysts that were documented to enlarge and induce angle closure. Transpupillary IPE cystotomies were performed using the Nd:YAG laser as a prophylactic measure to prevent angle-closure glaucoma. Anterior chamber anatomy and cyst dimensions were assessed before, during, and after long-term follow-up using slit-lamp biomicroscopy, gonioscopy, and 20- or 35-MHz high-frequency ultrasound imaging. Cystotomy resulted in immediate, visible deflation of both IPE cysts with subsequent resolution of angle closure. The cyst contents appeared clear and no secondary inflammation or glaucoma occurred. No evidence of cyst recurrence has been noted during 3 and 8 years of follow-up, respectively. Transpupillary Nd:YAG laser cystotomy offered a minimally invasive and effective treatment for angle closure induced by progressive IPE cysts

PURPOSE OF REVIEW: Endothelial transplantation has supplanted penetrating keratoplasty as the procedure of choice for endothelial dysfunction. Its recent widespread acceptance has encouraged innovation in the field in an attempt to offer faster, better surgery to a broader number of patients while reducing surgical risk. This review focuses on the best studied and the most widely used form; Descemet's stripping automated endothelial keratoplasty (DSAEK). RECENT FINDINGS: Recent advances in endothelial keratoplasty include expansion of indications, modification in host preparation, and proliferation of insertion techniques. DSAEK has been successfully used in postpenetrating keratoplasty, ICE syndrome, aniridia, aphakia, complex anterior chambers with anterior chamber lenses, and pediatric patients. SUMMARY: Innovations in endothelial keratoplasty have broadened its use, improved intraoperative ease, and reduced postoperative complication. As we make this surgical procedure faster and easier, surgeons must critically evaluate the impact of these modifications on long-term patient outcomes.