Sanjay V. Patel

Purpose: The objective of this study was to investigate outcomes of Descemet stripping endothelial keratoplasty (DSEK) in eyes regrafted for failed penetrating keratoplasty (PK) or failed DSEK. Methods: This was a retrospective consecutive series of all DSEK cases performed from April 2006 to November 2015 for failed PK or failed DSEK. Graft survival and graft rejection risk were estimated by Kaplan-Meier analysis. Results: Of 76 DSEK cases, 42 (55%) were regrafted for failed PK and 34 (45%) for failed DSEK. The mean age at regraft was 72 years; 49 participants (64%) were women. The median follow-up was 4.0 years. DSEK graft survival was 72% and 57% at 5 and 10 years, respectively (failed PK: 64% and 41%; failed DSEK: 81% and 76%, [ P = 0.051]). The cumulative risk of graft rejection was 17% at 5 and 10 years (failed PK: 24% at 5 and 10 years; failed DSEK: 10% at 5 and 10 years [ P = 0.21]). A rebubble procedure was needed in 16 cases (21%) (13 for failed PK cases and 3 for failed DSEK cases, P = 0.02). For eyes without vision-limiting comorbidities (n = 42), the mean preoperative best spectacle-corrected visual acuity (BSCVA) was 0.83 ± 0.36 logMAR (mean ± SD) in eyes with failed PK and 0.51 ± 0.32 logMAR for failed DSEK ( P = 0.02). After adjusting for preoperative BSCVA, the BSCVA (least-square mean [95% confidence interval]) at one-year follow-up was 0.58 logMAR [0.44–0.72] for failed PK and 0.28 logMAR [0.18–0.30] for failed DSEK ( P = 0.002). Conclusions: Compared with DSEK regrafts for failed PK, DSEK regrafts for failed DSEK were associated with better visual outcomes and lower rebubble procedure rates.

Purpose: To describe a case of locally invasive conjunctival squamous cell carcinoma (SCC) refractory to plaque radiotherapy. Case Description: A 69-year-old man presented with a recurrent conjunctival tumor after 6 previous cycles of topical 5-fluorouracil chemotherapy and excisional biopsy showing invasive SCC with positive margins. There was a mild anterior chamber reaction. By the time of repeat excisional biopsy, the conjunctiva had ulcerated with underlying scleralysis associated with histopathologic evidence of scleral involvement by SCC. After subsequent tectonic scleral patch grafting, plaque radiotherapy was applied after which the disease appeared to be controlled for 9 months. The eye then developed progressive conjunctival ulceration and scleralysis with progressive ectropion. Exenteration was performed, revealing locally invasive SCC into palpebral conjunctiva, ciliary body, and choroid. Conclusions: Conjunctival SCC can be locally invasive with destruction of the globe, despite plaque radiotherapy. Clinicians should be suspicious of invasive diseases in cases of ocular surface squamous neoplasia that are poorly responsive to topical chemotherapy. Associated anterior chamber cell and progressive scleralysis should also raise concern for invasive malignancy.

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Background/Objectives: The Visual Function and Corneal Health Status (V-FUCHS) questionnaire assesses vision-related quality of life in patients affected by Fuchs endothelial corneal dystrophy (FECD) through 15 items, which are divided into the “visual acuity (VA) Factor” and “glare Factor” domains. The purpose of this study was to translate and validate the Italian version of the V-FUCHS instrument. Methods: The original V-FUCHS questionnaire was translated into Italian using certified forward and backward translation methods and administered to patients with FECD undergoing a unilateral or bilateral Descemet membrane endothelial keratoplasty (DMEK) for FECD and healthy controls. Its test–retest reliability was assessed by administering the questionnaire twice, four weeks apart. Modified Krachmer grade, best-corrected visual acuity (BCVA) and central corneal thickness (CCT) were also measured. Results: A total of 74 participants, aged 45 to 83 years, were prospectively enrolled and divided into five subgroups: mild-to-moderate FECD (n = 18), advanced FECD (n = 15), unilateral DMEK (n = 9), bilateral DMEK (n = 12), and healthy controls (n = 20). Retest reliability confirmed the consistency and agreement of their responses (intraclass correlation coefficient > 0.90 for both factors). The Italian V-FUCHS effectively discriminated between different stages of FECD severity, with significant differences in VA and glare factor scores across all subgroups (p < 0.001). While both BCVA and CCT showed correlations with V-FUCHS scores, only the association between the VA factor and BCVA was statistically significant (p < 0.05), indicating that the VA factor meaningfully reflects patients’ measured VA. Conclusions: The proposed Italian version of the V-FUCHS questionnaire is a valid and reliable tool for assessing visual disability in patients with FECD before and after DMEK. This instrument may aid in optimizing endothelial keratoplasty timings and evaluating postoperative symptomatic improvements in FECD patients.