Duke Eye Center Links Obstructive Sleep Apnea to Keratoconus

Research Digest
New & Noteworthy Journal Articles
Compiled by Andrew E. Mathis, PhD, Medical Editor
► Keratoconus and sleep apnea. Noting the sparseness of post-keratoplasty patients among their elderly patients, ophthalmologists Preeya Gupta, M.D., Assistant Professor of Ophthalmology and Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal Service at the Duke Eye Center in Durham, NC, undertook a study to determine whether there was any correlation between keratoconus and mortality, looking specifically at sleep apnea as a primary symptom. They report their findings in the June 2012 issue of Cornea.

The authors conducted telephone interviews with 101 patients diagnosed with […]

Ceremonial Ground-Breaking for New Duke Eye Center Clinical Facility

Thanks to Bill and Kathy Hudson and LC Industries for their generosity toward the new state-of-the-art clinical Duke Eye Center in Durham, NC. 

From: Victor J. Dzau, M.D., Chancellor for Health Affairs; CEO, DUHS

Subject: Ceremonial Ground-Breaking for New Eye Center Clinical Facility

This morning we held a ground-breaking ceremony for a new, state-of-the-art Duke Eye Center building that will add much-needed clinical examination space and enhance the patient experience.

The ceremony celebrated the team effort that has turned this dream of building a new Eye Center clinical facility into a reality. Thanks to the collaborative efforts of our legion of generous donors, […]

The Dry Eye Patient 4-Months After LipiFlow Thermal Pulsation Therapy

Early results representing my clinical observations and also the subjective response of several patients after treatment have overall led me to believe that the LipiFlow Thermal Pulsation device from TearScience has been one of the most worthwhile additions to my clinical practice in recent years.  Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center in Durham, NC subspecializes in cataract surgery, corneal transplantation, and laser vision correction (LASIK) and as studied optimizing surgical outcomes for best practices and recognizes that the treatment of symptomatic dry eye syndromes is […]

Recent Advances is the Surgical Management of Keratoconus

Two of the most significant surgical advances now available for patients suffering from keratoconus who develop contact lens intolerance are Intacs instrastromal corneal ring segments (ICRS) and deep anterior lamellar keratoplasty (DALK) – both provide an alternative to full thickness (or penetrating) keratoplasty or corneal transplantation.  Many folks are going to immediately wonder about corneal collagen cross-linking and I am going to cover that later as “the jury” is still out and as I try to meticulously “connect the dots” of how people develop disease progression, I am less convinced that we will be doing cross-linking 10 years from now.  […]

By |February 16th, 2012|Blog, Corneal Transplantation, Duke Eye Center, Keratoconus|0 Comments

Observations and Recommendations For Patients with Residual Astigmatism





Are there mechanisms of which we can take advantage for patients with a high degree of astigmatism including residual, post-surgical astigmatism?  Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center in Durham, NC has observed that the astigmatic patient becomes particularly symptomatic under poorly lit conditions.  An example of this would include the “drop off” in quality of vision while driving at night under poorly lit conditions.  This might also include added eye strain with prolonged reading or computer usage.  This latter group of patients may benefit from […]

By |February 15th, 2012|Blog, Cataract Surgery, Corneal Transplantation, Duke Eye Center|0 Comments

DALK (Deep Anterior Lamellar Keratoplasty) For Advanced Keratoectasia Caused by Radial Keratotomy (RK)

I am very excited about the recent success I have experienced using a partial thickness or “lamellar” corneal transplant procedure referred to as DALK (deep anterior lamellar keratoplasty) for the treatment of keratoconus, post-LASIK Keratoectasia, and post-RK Keratoectasia.  This technique allows retention of the host endothelium which means that donor rejection is essentially eliminated.  Since post-RK keratoectasia has been the most challenging, I thought I would tackle that condition and discuss how to correct it.  Most patients with post-RK Keratoectasia have multiple and deep incisions and if these incisions perforate Descemet’s membrane, it will be difficult to use the so […]

By |February 2nd, 2012|Blog, Corneal Transplantation, Duke Eye Center, LASIK|0 Comments

Fuchs’ Corneal Dystrophy, Dense Cataract, Salzmann’s Nodular Degeneration, and Monocular = Needs Fixing

Today’s patient presentation has Fuchs’ Corneal Dystrophy, a visually significant nuclear sclerotic cataract, an elevated Salzmann’s Nodule, and only has one eye.  Each monocular patient, having only one eye, requires special consideration in preparation for eye surgery in terms of surgical options, timing, limitations, benefits, risk analysis, emotional support, postoperative care, and also the process of informed choice and consent.  I feel fortunate to have operated on over 500 patients considered “monocular” and consider it a privilege to be able to walk these patients through the additional education and decision-making process that is required.  My dear patient who has lost […]

Corneal Transplantation (Keratoplasty) Using the DSAEK Technique in the Multitube Hypotonous Glaucoma Patient

Glaucoma, previous filtering tube surgery, and hypotony are ALL risk factors for DSAEK surgery and increase the risk of donor tissue detachment.  Alan N. Carlson, M.D., Professor of Ophthalmology and Chief of the Corneal and Refractive Surgery Service at the Duke Eye Center demonstrates the techniques behind successful corneal transplantation using the DSAEK (Descemets Stripping Automated Endothelial Keratoplasty  technique that ultimately required transcorneal sutures to secure the donor tissue.  THis particular patient had low intraocular pressure and repeated detachments eventually needing sutures to accomplish success!

Corneal Transplantation (Penetrating Keratoplasty) at the Duke Eye Center

Macular corneal dystrophy (MCDC; sometimes also Fehr corneal dystrophy) is a rare pathological condition affecting the stroma of cornea. The first signs are usually noticed in the first decade of life, and progress afterwards, with opacities developing in the cornea.  There is also a predisposition to developing painful recurrent corneal erosions.  MCDC is inherited in autosomal recessive fashion and is thought to be caused by the lack or abnormal confuguration of keratan sulfate. Most cases of MCD are caused by mutations in CHST6 gene.  The condition was first described by Arthur Groenouw in 1890.

Alan N. Carlson, M.D., Professor of Ophthalmology […]

By |January 14th, 2012|Blog, Corneal Transplantation, Duke Eye Center|0 Comments

Keratoplasty with Poor Surgeon Visibility contributes to higher risk:


Poor Visibility due to corneal swelling or edema along with a shallow anterior chamber contribute to a lower success rate.   Fortunately, here is an example of a successful case despite extremely poor visibility.  The cornea continues to clear having performed the surgery only a week ago: