The edition · Ophthalmology
Diabetic donor corneas held up after DMEK, and the angle closure that was really Vogt-Koyanagi-Harada
A secondary analysis of 1,421 eyes found no link between donor diabetes severity and one-year DMEK success; an Indian series shows how VKH can masquerade as angle closure.
The edition in brief
A multisociety position paper, approved by the American Academy of Ophthalmology board, found no published evidence that tonometer tips, gonioscopy and laser lenses transmit sight-threatening infection or that high-level disinfection reduces transmission, and argues it should be discretionary rather than routine. An Indian tertiary series found that 18 of 768 patients with Vogt-Koyanagi-Harada disease first presented as angle closure, with diagnostic delays of up to seven years when the fundus was not examined. The practice-changer is a secondary analysis of the Diabetes Endothelial Keratoplasty Study: across 1,421 eyes, one-year DMEK graft success was 93% to 97% whatever the donor's postmortem HbA1c, and no measure of donor diabetes severity predicted graft failure or endothelial cell loss, supporting the use of diabetic donor tissue without extra screening.
High-level disinfection of tonometer tips and contact lenses: a case against routine use
Meet local disinfection rules, but reserve enhanced disinfection for higher-risk situations such as suspected infection, as the position paper argues.
Vogt-Koyanagi-Harada disease presenting as angle closure
Look for choroidal thickening or effusion in bilateral or inflamed angle closure, and consider VKH before treating it as primary.
Bilateral angle closure: think beyond the pupil block
In bilateral simultaneous angle closure, look for drug-induced or inflammatory ciliochoroidal effusion before reaching for miotics or iridotomy.
Donor diabetes severity did not affect DMEK success at one year
Use corneas from donors with diabetes for routine DMEK without extra screening by diabetes status, applying standard eye bank criteria.
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