Anterior Segment Optical Coherence Tomography Research Articles

Calcifediol and paricalcitol as adjunctive therapies for HSV-1 keratitis and corneal perforation: A case report.

Herpes simplex virus 1 establishes a latent infection in trigeminal ganglia. Reactivation causes cold sores, as well as viral keratitis. The purpose of this study was to report potential benefits of using active vitamin D receptor ligands (VDR-agonists) as adjunctive therapies for the treatment of infectious corneal perforations, and prevention of HSV recurrence. A 57-year-old female with a past history of episodic, poorly-healing, corneal erosions, recurring orolabial herpetic lesions, as well as PCR-confirmed recurrences of herpes simplex keratitis presented with a burning sensation and slight pain in the right eye. Examination indicated HSV keratitis. Topical antibiotic and oral antiviral treatments were prescribed. Despite these standard-of-care treatments, a perforated corneal ulcer ensued. Corneal perforation associated with HSV-1 keratitis recurrence, later confirmed by PCR analysis of corneal scrapings. Corneal perforation was treated with a human fibrin glue, fortified with multilayered amniotic membrane transplant, as well as a therapeutical contact lens. Following surgery, calcifediol and paricalcitol were started as oral adjunctive therapies in an attempt to boost tissue regeneration and innate-immunity within the slow-healing cornea. Anterior segment optical-coherence tomography was used to measure corneal thickness. Frequent follow-ups with various specialists allowed for comprehensive patient evaluation, and meticulous screening for any signs indicating potential HSV-1 recurrence. Following calcifediol-paricalcitol therapy corneal thickening, and re-epithelization ensued. During combined calcifediol-paricalcitol therapy, the patient has had no recurrence of herpes simplex keratitis, or orolabial herpes lesions. Corneal stabilization avoided a high-risk, full-thickness corneal transplantation, facilitating future cataract surgery, and allowing for some degree of visual recovery in this eye.

Prognostic Significance of Biointegration at the Optic-Cornea Joint in Keratoprosthesis Implantation.

The purpose of this study was to characterize the morphological and immunological aspects of biointegration at the optic-cornea joint of a second-generation synthetic corneal device. The initial prototype, single-piece optic-skirt configuration, is constructed from compact and flexible perfluoroalkoxy alkane with porous expanded polytetrafluoroethylene (ePTFE) overlying the skirt to allow skirt-cornea biointegration. The second-generation version was modified to add ePTFE around the optic wall to allow optic-cornea biointegration. Initial and amended second-generation devices were implanted into healthy rabbit eyes. Clinical examination, anterior segment optical coherence tomography, light microscopy, and immunofluorescence studies were performed to assess structural integrity and determine molecular signatures indicative of inflammation and tissue remodeling between the 2 prototypes. Recipient eyes with both device versions showed no epithelial defects or tissue retraction at 3 months postoperatively. Optical coherence tomography images demonstrated no appreciable perioptic space with either prototype. Histopathology of the initial device demonstrated lack of stromal adhesion at the optic-cornea joint with epithelium filling the perioptic space. Second-generation devices demonstrated full sealing of the recipient stroma along the optic stem. Although the routine histopathology did not demonstrate inflammatory cells in the recipient cornea with either device, immunohistochemistry stains demonstrated quiescent phenotype of stromal and epithelial cells only in the second-generation devices. Biointegration between the synthetic corneal device and recipient tissue at the optic-cornea joint seems to avert inflammation and may help prevent sterile tissue lysis and prolong retention.

Microscope-Integrated OCT-Assisted Real-time Monitoring of Central Corneal Thickness During Corneal Cross-linking.

To assess real-time intraoperative pachymetry changes occurring during corneal cross-linking (CXL) using microscope-integrated optical coherence tomography (Mi-OCT) and compare accuracy of various modalities of pachymetry assessment. This was a cross-sectional observational comparative study including 45 consecutive patients with progressive keratoconus planned for CXL. Mi-OCT (RESCAN 700) was used to measure central corneal thickness (CCT) during four stages of CXL: before epithelial debridement, after debridement, after riboflavin instillation, and after ultraviolet irradiation. Scheimpflug imaging, anterior segment OCT (AS-OCT), and ultrasound pachymetry were used to assess CCT preoperatively. All data were entered into Excel software (Microsoft Corporation) and analyzed. The CCT significantly decreased after each step of CXL as measured on Mi-OCT (P < .0001). Mi-OCT overestimated the CCT significantly by 1.12 times on average (range: 1.02 to 1.43) compared to ultrasound pachymetry (P = .0004). CCT measured using Scheimpflug imaging and anterior segment OCT was statistically comparable to ultrasound pachymetry. Mi-OCT provides a real-time assessment of CCT during CXL. However, because it overestimates the pachymetry, ultrasound pachymetry remains the gold standard for decision-making during CXL. [J Refract Surg. 2024;40(12):e934-e940.].

Refractive Outcome, Lens Power Calculation, and Surgically Induced Astigmatism After Four-Flanged Intrascleral Intraocular Lens Fixation.

To evaluate the refractive prediction error of common intraocular lens (IOL) power calculation formulas in patients who underwent intrascleral IOL fixation using the four-flanged technique. This prospective, longitudinal, single-site, single-surgeon study's setting was the Department for Ophthalmology and Optometry, Medical University of Vienna, Austria. Patients who received IOL implantation via the four-flanged technique were followed up to 3 months after the operation. Refraction was measured using the Early Treatment of Diabetic Retinopathy Study visual acuity test at 4 m. Lens decentration, tilt, and aqueous anterior chamber depth were evaluated using anterior segment optical coherence tomography. The SRKT, Holladay 1, and Hoffer-Q formulas were used to assess prediction error (PE) and absolute error (AE). Correlations between axial length, keratometry, and white-to-white distance were subsequently evaluated. A total of 28 eyes of 28 patients were examined in this study. The application of all formulas resulted in a hyperopic PE (SRKT: 0.35 ± 0.86 diopters [D], Holladay 1: 0.36 ± 0.78 D and Hoffer-Q: 0.37 ± 0.73 D). There was no variation between the PE of different formulas discovered (P > .05). The AE was within 0.50 D in 54% to 61% and within 1.00 D in 79% of eyes, depending on the formula used. Furthermore, Cochrane's Q test detected no significant distinctions between formulas (P > .05). The PE of each formula demonstrated a significant correlation to the axial length of the eyes (P < .05). The correlation estimates ranged from -0.25 D/mm to -0.39 D/mm, subject to the applied formula. This study demonstrates that the four-flanged technique for scleral IOL fixation yields reliable outcomes. PE was closest to zero using the Hoffer-Q formula, although there was no statistically significant difference compared to the other formulas. Axial length emerged as the most pertinent factor for PE. Short eyes resulted in a more hyperopic outcome, whereas longer eyes resulted in a more myopic outcome than intended. This myopic and hyperopic shift was due to the standardized surgical technique with an externalization of the haptics 2.5 mm behind the limbus resulting in a consistent aqueous anterior chamber depth across all eye lengths, coupled with a reduction or increase in the distance from the IOL to the macula, which is dependent on the length of the eye. [J Refract Surg. 2024;40(12):e985-e993.].

Clinical Comparison of Decentration and Tilt Effects in Iris-Claw and Trans-scleral Plug Lenses: Wavefront Analysis With a Pyramidal Sensor Aberrometer.

To compare the aberrometric profile of the Artisan Aphakia lens (Opthec BV) and transscleral plug FIL-SSF lens (Soleko) and to assess the impact of tilt and decentration on their optical performance. This retrospective observational study was conducted at Azienda Ospedaliera Universitaria Careggi, Florence, Italy, with a consecutive cohort of aphakic eyes undergoing secondary lens implantation with an Artisan or FIL-SSF lens. Wavefront analysis was performed using a pyramidal wavefront-based aberrometer (Osiris-T; CSO). Tilt and decentration were calculated using anterior segment optical coherence tomography (MS-39; CSO). The study included 47 eyes from 45 patients: 24 eyes in the FIL-SSF group and 23 eyes in the Artisan group. Decentration was 0.39 ± 0.14 mm in the FIL-SSF group and 0.51 ± 0.16 mm in the Artisan group (P = .02). The mean tilt value was 6.6 ± 2.35 degrees in the FIL-SSF group and 5.9 ± 1.86 degrees in the Artisan group (P = .13). Internal higher order aberrations (HOAs) were 0.23 ± 0.07 μm in the FIL-SSF group and 0.29 ± 0.13 μm in the Artisan group (P = .02). The point spread function (PSF) Strehl ratio was 0.12 ± 0.05 in the FIL-SSF group and 0.10 ± 0.04 (P = .11) in the Artisan group. The PSF Strehl ratio without lower order aberration (PSFw2) was 0.28 ± 0.12 in the FIL-SSF group and 0.23 ± 0.09 in the Artisan group (P = .01). The Artisan and FIL-SSF lenses provide comparable optical performance in terms of the PSF Strehl ratio. However, the Artisan lens appears to be more susceptible to decentration, which may result in increased higher order aberrations and a consequently lower PSFw2 Strehl ratio. [J Refract Surg. 2024;40(12):e926-e933.].

Keratoprosthesis of Brazil (KoBra): Preliminary Results of the First 2 Human Cases

Purpose: We evaluated the clinical performance of a novel keratoprosthesis (KPro) named KoBra (Keratoprosthesis of Brazil) in patients with corneal blindness. Methods: Two-piece KPro was three-dimensionally (3D) printed using titanium alloy powder (Ti-6Al-4V) and polymethyl methacrylate (PMMA). The KPros were implanted unilaterally in 2 patients who had corneal disease that was not amenable to standard corneal transplantation. An autologous full-thickness corneal graft was used as the KPro carrier. Patients were examined for at least 16 months to evaluate retention and postoperative complications. Biomicroscopy and anterior segment optical coherence tomography (AS-OCT) were performed throughout the experiment to evaluate the relationship between the KPro and the carrier graft. Results: No intraoperative complications occurred during the surgeries, and the immediate postoperative period was uneventful. The implanted KoBra integrated well into all operated eyes, and clear optics without prothesis extrusion were maintained. The mean duration of the postoperative follow-up was 17 months (range 16–18 months). AS-OCT demonstrated the correct relationship of the device and carrier at the final follow-up in all cases. Conclusions: The first short-term clinical analysis demonstrated good outcomes associated with this new technology in 2 patients who were not amenable to standard corneal transplantation. Longer follow-up and additional implantations are necessary to better assess the safety and efficacy of this device.

Management of late postoperative capsular bag distension syndrome - two year case series.

Late capsular bag distension syndrome (CBS) is a rare complication of the ^lcataract surgery. The aim is to present 9 cases with delayed presentation and describe their successful management with surgical approach. A two-year retrospective review of 9 cases was undertaken. Anterior segment optical coherence tomography (AS-OCT) was used to confirm this diagnosis. Aspiration of the milky fluid with 26 gauge needle followed by capsular bag lavage was performed and aspirated fluid was examined. Patients showed signs of late CBS 6,56 ± 1,94 years after uncomplicated phacoemulsification with intraocular lens (IOL) implantation into the capsular bag. All 9 patients presented with a turbid fluid collection within the distended capsular bag. AS-OCT showed a hyper-reflective material in the space between the IOL and distended posterior capsule. Awareness of the manifestations of CBS and choice of the correct imaging modality may lead to regular diagnosis and successful treatment. Management with aspiration of the milky fluid and lavage of the capsular bag is technically safe and effective procedure. It has the advantage of microbial testing of the fluid. AS-OCT is useful tool to differentiate this condition clearly from IOL opacification and posterior capsule opacification.

Distinctive intrableb structures of functioning blebs following trabeculectomy according to amniotic membrane transplantation.

Intrableb structures are hallmark features of the filtering bleb. This study aimed to compare the characteristics of functioning blebs using anterior segment optical coherence tomography (AS-OCT) according to amniotic membrane transplantation (AMT). Forty eyes from 40 patients diagnosed with primary open-angle glaucoma who underwent trabeculectomy, either with AMT (20 eyes) or without AMT (control group, 20 eyes), were included. Parameters including bleb height, bleb wall thickness, striping layer thickness, striping to bleb wall ratio, bleb wall reflectivity, fluid-filled space score/height/area, and presence of microcysts were assessed using AS-OCT. Surgical success was defined at the time of AS-OCT as an IOP ≤18 mmHg and IOP reduction ≥30% without medication. In these patients, if the bleb had a clinically diffuse and healthy without any signs of an encapsulated bleb, the bleb was then defined as functioning bleb. Except for bleb height (P = 0.352) and microcyst formation (P = 0.266), significant differences were observed between the two groups. The functioning blebs of the AMT group exhibited greater fluid-filled space score, area, and height than those of the control group, following adjustment for AS-OCT time (all P < 0.001). Conversely, the functioning bleb of the control group demonstrated thicker bleb wall and striping layer, higher striping to bleb wall ratio, and lower bleb wall reflectivity than those of the AMT group, following adjustment for AS-OCT time (all P ≤ 0.001). Distinct intrableb structures were identified in functioning blebs according to amniotic membrane transplantation. The reflectivity and thickness of the bleb wall structures were more pronounced in the functioning bleb after trabeculectomy alone. In contrast, the extent of the fluid-filled space emerged as a more distinctive feature of the intrableb structures in the functioning bleb after trabeculectomy with AMT.

Human Amniotic Membrane (hAM) graft in the management of Peripheral Hypertrophic Subepithelial Corneal Degeneration – A case report

: Introduction: In this report, we describe the case of Peripheral Hypertrophic Subepithelial Corneal Degeneration (PHSCD), managed with surgical excision and a human amniotic membrane (hAM) graft. In this article, we also propose a table for differential diagnosis, which might help physicians recognize this uncommon clinical entity in practice. Case presentation: A 45-year-old female Caucasian patient presented with decreased vision, itching and burning in both eyes, and a presence of pseudopterygium in the right eye, causing visual decline. Routine ocular exams an Anterior Segment OCT led to the diagnosis of PHSCD, after a careful differential diagnosis with other similar clinical occurrences. Subsequently, the patient was successfully managed with surgical intervention and an amniotic membrane graft placement. Conclusion: PHSCD is a rare disease, which in advanced cases can be successfully managed with hAM graft. No recurrence of the lesions was observed at one-year follow-up in our patient.

Clinical and pathologic characteristics of inflamed juvenile conjunctival nevus and its treatment with immunosuppressant eye drops.

To clarify the clinical and pathologic findings of 7 patients with inflamed juvenile conjunctival nevus (IJCN) treated with tacrolimus. Retrospective study. The medical records of 7 male patients diagnosed with IJCN between February 2007 and October 2022 at the Kansai Medical University Hospital and Ideta Eye Hospital were retrospectively reviewed. The patients' mean age was 11.3 (8-20) years, and the average follow-up period was 18 months. The patients underwent anterior segment optical coherence tomography (AS-OCT) and anterior segment optical coherence tomography angiography (AS-OCTA). All the patients were treated with steroids or immunosuppressant eye drops, or both. Histopathologic examinations were performed on specimens resected from 2 patients. The clinical characteristics of IJCN were as follows: (1) presence of cysts within a pigmented conjunctival mass, (2) tumor accompanied by feeder vessels, and (3) predominantly found in boys with allergic diseases. AS-OCT and AS-OCTA revealed the presence of a cystic structure with poor vascular signals within it and numerous vessels distributed on the sclera underlying the lesion. Immunosuppressant eye drops relieved the congestion, diminished the inflow vessels, and induced shrinkage of the cysts in all the patients. Histopathologic examinations revealed infiltration of inflammatory cells such as lymphocytes and macrophages and low proliferative activity of melanocytes with no division pattern. This study clarified the clinical and histologic characteristics of IJCN. Noninvasive AS-OCT and AS-OCTA might be useful for diagnosing IJCN. The histopathologic findings of this study indicate that immunosuppressive and antiallergic agents can effectively bring about disease remission.

Potential utility of anterior segment optical coherence tomography and biometry in differentiating plateau iris configuration from pupillary block

ABSTRACT Clinical relevance Angle closure glaucoma is one of the most common blinding diseases encountered mainly in older age groups, although it may also occur at a younger age. Identifying the underlying cause of angle closure helps in designing specific treatment strategies essential for effective disease management. Background Primary angle closure disease, caused due to pupillary block (PB) and plateau iris configuration (PIC), necessitates different management strategies. This study assessed the potential utility of anterior segment optical coherence tomography (ASOCT) and optical biometry in distinguishing PIC from PB in primary angle closure disease of the young (PACDy). Methods Patients aged 20–40 years with PACDy and age-matched healthy controls were recruited. Ophthalmic examinations included gonioscopy, ultrasound biomicroscopy, ASOCT, and biometry. Anterior chamber depth, lens thickness, axial length, central corneal thickness, lens position, relative lens position, vitreous cavity length, lens vault, relative lens vault and angle opening distance, trabecular iris space area, and trabecular iris angle were measured. Receiver operating characteristics curve analysis evaluated the discriminative ability of these parameters. Results Of the 280 eyes, 128 were normal and 152 had PACDy. Of 128 PACDy, 88 had PIC, and 64 had PB. Both PIC and PB had significantly smaller ASOCT and biometric parameters than normal eyes. However, PIC had intermediate biometric values that fell between normal eyes and PB. All the aforementioned parameters, except central corneal thickness, showed excellent discriminating ability of PIC and PB from normal eyes; however, no single parameter can strongly differentiate PB from PIC. Axial length and relative lens vault had the highest, although weak, power for discriminating PB from PIC. Conclusion ASOCT and biometry effectively distinguish PIC and PB from normal eyes, but no single parameter reliably differentiates PIC from PB. Comprehensive gonioscopy and ultrasound biomicroscopy may be necessary for accurate diagnosis in PACDy.

Analysis of intraocular lens tilt and decentration after cataract surgery in eyes with high myopia using the anterior segment optical coherence tomography

This retrospective study investigated the degree of intraocular lens (IOL) tilt and decentration after cataract surgery in eyes with varying degrees of myopia using the anterior segment optical coherence tomography (AS-OCT). Eyes of 76 patients were analyzed and divided into three groups: mild myopia (emmetropia to − 1.5 diopter [D], Group 1), moderate myopia (− 1.5 D to − 6.0 D, Group 2), and high myopia (over − 6.0 D, Group 3). Postoperative IOL decentration, tilt, and lens diameter were evaluated using swept-source AS-OCT under mesopic conditions without dilation eyedrop. Postoperative parameters revealed no difference in IOL tilt, but IOL decentration was significantly different among the groups, and the degree of decentration was greater in Group 3 (P = 0.007). Univariable regression analysis indicated that age, sex, preoperative uncorrected distant visual acuity, corrected distant visual acuity, intraocular pressure, spherical equivalent, preoperative anterior chamber depth and lens thickness had no influence on postoperative IOL decentration, but axial length (AL) was significantly related to IOL decentration (P = 0.001). This association was confirmed using multivariable regression analysis, establishing a significant correlation between AL and IOL decentration (P = 0.001) on AS-OCT, showing an increase in IOL decentration associated with increasing AL.

Analysis of candidate variants in a Chinese family with monozygotic twins with keratoconus: a case report

ABSTRACT Background Keratoconus (KC) is an asymmetrical bilateral corneal ectasia, of which the pathogenesis is unknown. Moreover, genetic factors play an important role. We reported ophthalmic findings in a Chinese family with monozygotic twins with KC to describe the clinical features and identify genetic variants. Methods Comprehensive ophthalmic clinical assessments and examinations, including history, slit-lamp biomicroscopy, best-corrected visual acuity, corneal topography, anterior segment optical coherence tomography, and corneal biomechanics, were carried out on the twins and their parents. Whole-genome sequencing (WGS) was performed to identify variants in this family. SIFT, PolyPhen2, MutationTaster, and CADD were used to predict the effect of amino acid substitutions on the affected protein. Results The twins presented typical KC features. However, their mother did not meet the criteria for a KC diagnosis but exhibited KC subclinical manifestations. After screening, 12 potentially pathogenic variants in 10 genes were identified in both twins and emerged as candidate variants for this family. These genes included 1 previously reported KC-associated variant (ZNF469, c.4384 G>A); 8 variants in 6 KC-associated genes (GRHPR, c.337 G>A, c.862_863del; COL6A1, c.920 G>A; FLG, c.8753C>G; HSPG2, c.9503C>T; KRT82, c.1306 G>A; SCN9A, c.5702_5706del, c.641 G>A); and 3 variants in 3 non-KC-associated genes (PDE6G, c.6C>A; HAL, c.1724C>T; AGBL1, c.2381 G>A). Conclusions The accumulation of these potentially pathogenic variants in twins may have caused KC in these twins. These results expand the spectrum of KC candidate variants and provide a basis for further studies on KC.

Size Matters: A Comparative Study on Midday Fogging and Lens Settling in Patients With Keratoconus Wearing Mini-Scleral Lenses With Two Different Diameters

Purpose: The objective of this study was to compare the changes in postlens fluid optical density, timing and quantity of lens settling, and the clinical performance between two different mini-scleral lenses. Methods: Seventeen eyes of 10 patients with keratoconus were fitted with a 15-mm mini-scleral lens (AirKone Scleral Lenses; Laboratoire LCS, Normandy, France), and 15 eyes of 10 patients with keratoconus were fitted with 16.5-mm mini-scleral lenses (Misa Lenses; Microlens Contactlens Technology, Arnhem, The Netherlands). The lens fit was evaluated with biomicroscopy and anterior segment optical coherence tomography (AS-OCT). At 0, 2, and 4 hrs, corneal clearances were measured with AS-OCT, and optical density measurements were made by Scheimpflug tomography. High-contrast visual acuity (HCVA) and contrast sensitivity (CS) were assessed at each time point. At the end of the 4th hour, participants' comfort, visual quality, and general satisfaction were evaluated with a 5-point Likert scale and 100-mm Visual Analog Scale (VAS) scale. Results: The mean age (24.4 ± 5.4 vs. 21.7 ± 4.5, P = 0.145) and best spectacle-corrected HCVA (0.36 ± 0.15 vs. 0.35 ± 0.20, P = 0.984) were similar in both groups. The mean Snellen HCVA significantly improved with dispensing both mini-scleral lenses and remained stable at 4 hrs in both groups. In comparison, CS significantly decreased at 4 hrs in both groups (P = 0.02). Both groups' optical density significantly increased over time (P = 0.003). In the 15-mm mini-scleral lens group, the settling amount was 62.2 ± 11.9 μm (62.6%) and 99.5 ± 14.2 μm (100%) at 2 and 4 hrs, respectively; in the 16.5-mm mini-scleral lens group, it was 46.4 ± 22.3 μm (56.4%) and 82.1 ± 37.3 μm (100%) at 2 and 4 hrs, respectively. More than 50% of settling occurred in the first 2 hrs in both groups. No significant difference was observed between the two groups with regard to visual acuity, CS, optical density, and total settling amount at 4 hrs (P &gt; 0.05). Patient in the 15-mm mini-scleral lens group scored higher in comfort (4.65 ± 0.7 vs. 3.60 ± 0.9), visual quality (4.76 ± 0.4 vs. 3.73 ± 0.7), and overall satisfaction (95.7 ± 6.0 vs. 65.3 ± 20.3) (P &lt; 0.0001). Conclusion: Patients reported a heightened level of contentment with the smaller-diameter lens; however, it is crucial to emphasize that both diameter scleral lenses showcase comparable clinical efficacy, midday fogging, and settling.

A novel sandwich technique of minimally invasive surgery for corneal perforation

This study aimed to describe a novel sandwich technique of minimally invasive surgical implantation by using corneal stromal lenticules for corneal perforation. This prospective observational study included nine patients aged 23–79 years (mean, 54 ± 9) from Tianjin Eye Hospital. Corneal stromal lenticules with a central thickness of 120 μm were obtained from small incision lenticule extraction(SMILE). With the corneal perforation as the central point, an iris-repositor was used to manually create a mid-stromal pocket; the stromal lenticular button was gently inserted into the intrastromal pocket and flattened. The graft was sandwiched between the anterior and posterior corneal stromal pockets; the incision was closed using two sutures. The primary health outcome measured in this study was the logMAR best spectacle-visual acuity at 6 months postoperatively. Corneal perforation closure and anterior chamber formation occurred immediately after surgery. No epithelial implantation, infection, or allogeneic rejection was observed during the follow-up. No patients required a penetrating keratoplasty. Anterior segment optical coherence tomography revealed a mean thickness of the grafted tissue of 122 ± 21 μm, with a clear interface in all cases. Comparing the baseline and postoperative 6-month values, the mean logMAR best spectacle-corrected visual acuity was improved from 0.18 ± 0.12 to 0.52 ± 0.31 (P < 0.001). There was significant reduction in the mean manifest spherical equivalent, refractive cylinder, and mean keratometry readings. The novel minimally invasive surgical method for corneal implantation. It was an effective alternative treatment that could restore corneal integrity and improve vision in patients with corneal perforations. This method appears safe, easy, cost- and time-effective, and reliable.

Topical 5-fluorouracil as monotherapy for ocular surface squamous neoplasia

Ocular surface squamous neoplasia (OSSN) comprises a gamut of diseases, which encompass conjunctival intraepithelial neoplasia, conjunctival carcinoma in situ, and squamous cell conjunctival neoplasia. Gold standard treatment for OSSN entails excision with cryotherapy. A lot of progress has been made recently that shows that chemotherapeutic drugs, such as mitomycin C, 5-fluorouracil (5-FU), and interferon alfa2b, can be just as effective. This is a case report that includes two cases: An 81-year-old Filipino female and a 65-year-old Filipino male who presented with a pinkish lesion on the bulbar conjunctiva. Documentation was done through clinical observation, slit-lamp examination, and the use of anterior segment optical coherence tomography (OCT). 1% topical 5-FU was given as chemotherapy administered at 1 drop 4×/day for 1 week with a 3-week drug holiday. During the course of treatment, we noted clinical resolution of the lesions grossly on slit-lamp examination. On anterior segment OCT, a decrease in diameter and thickness was noted, but with remaining areas of hyperreflectivity and thickened epithelium at the site of the lesion. No decrease in visual acuity was noted during the course of treatment, as well as any adverse effects such as eye pain or inflammation. Considering its safety and efficacy profile, 5-FU has great potential to be considered as a first-line therapy in the topical treatment of OSSN. Topical chemotherapy can target microscopic diseases that may be missed surgically and decrease adverse effects. As seen in this case report, 5-FU shows much promise as a possible alternative in the treatment of OSSN.

Advanced UltraTech approach for distinguishing granulomatous from non-granulomatous corneal endothelial exudates in autoimmune rheumatic anterior uveitis

Background: Anterior uveitis is a common manifestation in individuals with rheumatic conditions such as spondylarthritis, Beh&amp;ccedil;et&amp;rsquo;s syndrome, juvenile idiopathic arthritis, and sarcoidosis. Clinical differentiation between granulomatous and non-granulomatous corneal endothelial exudates is crucial to subsequent diagnosis and treatment. Anterior segment optical coherence tomography (AS-OCT) can ensure an accurate differential diagnosis and appropriate follow-up after local and systemic therapy. Objective: This study aimed to distinguish between granulomatous and non-granulomatous endothelial exudates in patients with anterior uveitis using AS-OCT. Methods: This longitudinal observational study involved 30 patients diagnosed with or suspected of having rheumatic autoimmune disease presenting with anterior uveitis. The study was conducted at the combined Rheumatology and Ophthalmology Clinic, San Marco Hospital, Catania, Italy. All patients underwent slit-lamp examination, which revealed or suspected corneal endothelial exudates. A comprehensive rheumatological and ophthalmological evaluation was also performed. Subsequently, the patients were subjected to AS-OCT using the Optovue Solix device. Results: Granulomatous corneal exudates were identified in 30% of the subjects, with counts ranging from 5 to 20 and sizes varying between 50 and 150 &amp;mu;m. Detailed 3D scans further exhibited the morphology of these exudates. A follow-up of patients after steroid therapy (both topical and systemic) and immunosuppressive treatment demonstrated a progressive reduction in the exudates, ultimately leading to their complete resolution. Conclusion: Use of ophthalmological equipment that allows for simple, rapid, and non-invasive investigations in combination with a multidisciplinary approach, enables appropriate diagnosis and monitoring of therapeutic efficacy in patients with inflammatory ocular conditions presenting with corneal endothelial exudates.

Effects of clear corneal incision location and morphology on corneal surgically induced astigmatism and higher-order aberrations after ICL V4c implantation.

To evaluate the effects of clear corneal incision (CCI) location and morphology on corneal surgically induced astigmatism (SIA) and higher-order aberrations (HOAs) in patients receiving implantable collamer lens (ICL V4c) implantation. This retrospective study classified right eyes that underwent ICL implantation into two groups based on temporal or superior CCI. The Pentacam HR analyzer was used to measure the corneal astigmatism and HOAs. Analysis of the clear corneal incision (CCI) morphology, including incision width (Angle-W), incision length (IL), incision angles (Angle-En/Ex), and distance from the incision to corneal apex (Dis-En/Ex), was conducted using anterior segment optical coherence tomography (AS-OCT). There were 75 eyes in the temporal CCI group and 47 eyes in the superior CCI group. Both groups showed satisfactory safety and efficacy postoperatively. In the temporal CCI group, Dis-En and Dis-Ex were considerably longer, whereas the superior CCI group displayed a significantly wider Angle-W. The anterior and posterior corneal SIA were comparable in both groups. Anterior corneal SIA was significantly correlated to Dis-En and Dis-Ex in the superior CCI group. Superior CCI caused a notable rise in corneal Z (3, 3), while temporal CCI led to increased Z (3, 1). CCI morphology was correlated to corneal Z (4, -4) and Z (4, 4) in the superior CCI group. CCI locations caused slight variations in postoperative corneal SIA and HOAs following ICL implantation. Optimal postoperative visual outcomes may be better achieved with a CCI design featuring an increased distance from the corneal centroid and a decreased Angle-W.

Deep learning-based normative database of anterior chamber dimensions for angle closure assessment: the Singapore Chinese Eye Study.

The lack of context for anterior segment optical coherence tomography (ASOCT) measurements impedes its clinical utility. We established the normative distribution of anterior chamber depth (ACD), area (ACA) and width (ACW) and lens vault (LV), and applied percentile cut-offs to detect primary angle closure disease (PACD; ≥180° posterior trabecular meshwork occluded). We included subjects from the Singapore Chinese Eye Study with ASOCT scans. Eyes with ocular surgery or laser procedures, and ocular trauma were excluded. A deep-learning algorithm was used to obtain Visante ASOCT (Carl Zeiss Meditec, USA) measurements. Normative distribution was established using 80% of eyes with open angles. Multivariable logistic regression was performed on 80% open and 80% angle closure eyes. Diagnostic performance was evaluated using 20% open and 20% angle closure eyes. We included 2157 eyes (1853 open angles; 304 angle closure) for analysis. ACD, ACA and ACW decreased with age and were smaller in females, and vice versa for LV (all p<0.022). ACD 20th percentile and LV 85th percentile had a balanced accuracy of 84.4% and 84.2% in detecting PACD, respectively. When combined, ACD 20th and LV 85th percentile had 88.68% sensitivity and 88.85% specificity in detecting PACD as compared with a multivariable regression model (ACA, angle opening distance, LV, iris area) with 88.33% sensitivity and 83.75% specificity. Anterior chamber parameters varied with age and gender. The ACD 20th and LV 85th percentile values may be used in silos or in combination to detect PACD in the absence of more sophisticated classification algorithms.

Corneal Artificial Endothelial Layer (EndoArt): Literature Review and Our Experience.

Background/Objectives: The objective of this study was to examine the morphological corneal changes and outcomes following the implantation of an artificial endothelial layer (EndoArt) in patients with chronic corneal oedema. Methods: A systematic review of the literature was conducted alongside a detailed analysis of two clinical cases with chronic corneal oedema that were treated using EndoArt. Our experience with these two cases is included to provide practical insights and real-world outcomes. Results: Across the 24 cases reported (including the two presented here), an analysis was possible in 23 cases. Notably, 82% of patients had undergone at least one previous corneal transplant, with 39% having undergone three or more transplants. Additionally, 78% of cases had ocular comorbidities, with glaucoma surgery being the most prevalent (83%), which could have impacted visual outcomes. The follow-up period ranged from 3 to 17 months with a median of 3 months. After EndoArt implantation, the average reduction in the central corneal thickness (CCT) was 29%, and the rebubbling rate was 47.8%, with some cases requiring no rebubbling, while others required it up to 100% of the time. Visual acuity significantly improved from a mean best-corrected visual acuity (BCVA) value of 1.61 ± 0.5 logMAR to 1.07 ± 0.59 logMAR (p < 0.001). The CCT decreased from 771 ± 146 µm to 580 ± 134 µm (p < 0.001). These findings are consistent with our experience. Conclusions: EndoArt shows promise as an alternative treatment for chronic corneal oedema in complex cases where conventional corneal transplantation has failed or carries a high risk of failure. The morphological changes observed using anterior segment optical coherence tomography (OCT) and in vivo confocal microscopy (IVCM) were similar to those reported after endothelial keratoplasty, with the notable exception of the absence of the hyper-reflective donor-host interface.