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Comment on: "Micropulse Transscleral Cyclophotocoagulation in Keratoplasty Eyes".

transplantation. Although some studies indicate reduced endothelial cell density in corneal grafts harvested from donors with diabetes, the bulk of the literature reports a nonsignificant association between diabetes mellitus in donors and corneal graft survival. Lass et al3 found that diabetes in donors had no correlation with time to graft failure or endothelial cell count 10 years after penetrating keratoplasty in 1090 patients. Vislisel et al4 compared corneal graft survival using tissues from donors with and without diabetes in 183 patients undergoing Descemet stripping automated endothelial keratoplasty and penetrating keratoplasty. They also found similar rates of graft failure in tissues coming from donors with and without diabetes in all patients undergoing keratoplasty during a 72-month follow-up period. The Cornea Donor Study also examined the association between donor factors and 5-year graft survival and reported that graft failure rates were not affected by diabetes in donors.5 In our study, the scan quality was considered acceptable when the corneal vertex reflex was aligned and both reflections of the anterior and posterior corneal boundaries were visible. If the operator could not ascertain either boundary, the scan was discarded. At least 3 consecutive images were captured, and the scan with the best quality regarding alignment of the corneal vertex and the visibility of the anterior and posterior corneal boundary reflexes was chosen for measurement. It is worth mentioning that signal strength index values are used to evaluate scan quality on the RTVue spectral-domain OCT but not on the Visante time-domain OCT that was used in our study.6 What we reported for central, pericentral, and peripheral thicknesses were not a single measurement of each point; the central graft thickness was an average of the 2 central measurements, and each pericentral and peripheral graft thickness was calculated by averaging 4 measurements as described in the article.1 The present study did not measure intertest difference because many studies have already evaluated this issue. Huang et al7 demonstrated that average intertest difference in the central 2-mm zone was 0.38 6 5.35 mm for the Visante OCT. Using the same device, other investigators obtained a coefficient of repeatability between 4.63 and 8.3 mm for corneal thickness in the central 2-mm zone.8,9 In the study by Huang et al,7 the repeatability of the Visante OCT was excellent for measuring corneal thickness in each section of the pericentral 2to 5-mm zone with an intraclass correlation of 0.99. Mean reproducibility coefficients in the periphery were less than 13 mm in the study by Mohamed et al.9 These results suggest that central, pericentral, and peripheral corneal thickness measurements in the sectors up to 7-mm diameter are highly reproducible with the pachymetric mapping protocol of the Visante OCT.