Peripheral Corneal Research Articles

Early and late-onset cell migration from peripheral corneal endothelium.

In this study we describe peripheral corneal endothelial cell migration in vitro in the absence and presence of a ROCK-inhibitor. For this study, 21 corneal endothelial graft rims, with attached trabecular meshwork (TM), were prepared from Descemet membrane-endothelial cell sheets by 6.5 mm trepanation. For the initial proof-of-concept, 7 outer graft rims were cultured in a thermo-reversible hydrogel matrix for up to 47 days. To assess the effect of a ROCK-inhibitor, 14 paired outer rims were cultured either with or without ROCK-inhibitor for up to 46 days. At the end of culture, tissue was retrieved from the hydrogel matrix and examined for cell viability and expression of different endothelial cell markers (ZO-1, Na+/K+-ATPase, NCAM, glypican, and vimentin). All cultured rims remained viable and displayed either single regions (n = 5/21) or collective areas (n = 16/21) of cell migration, regardless of the presence or absence of ROCK-inhibition. Migration started after 4±2 days and continued for at least 29 days. The presence of ROCK-inhibitor seemed to contribute to a more regular cell morphology of migrating cells. In addition, 7 outer rims demonstrated a phenotypically distinct late-onset but fast-growing cell population emerging from the area close to the limbus. These cells emerged after 3 weeks of culture and appeared less differentiated compared to other areas of migration. Immunostaining showed that migrated cells maintained the expression patterns of endothelial cell markers. In conclusion, we observed 2 morphologically distinct migrating cell populations with the first type being triggered by a broken physical barrier, which disrupted contact inhibition and the second, late-onset type showing a higher proliferative capacity though appearing less differentiated. This cell subpopulation appeared to be mediated by stimuli other than loss of contact inhibition and ROCK-inhibitor presence. Further exploration of the differences between these cell types may assist in optimizing regenerative treatment options for endothelial diseases.

Graft Outcome of Corneal Patch for Perforated Corneal Ulcer

Background: Corneal patch graft (CPG) is a part of the tectonic penetrating keratoplasty procedure performed on the perforated corneal ulcer. This procedure involves filling affected areas with full or partial-thickness cornea donors. This study aimed to determine the clinical results of corneal patch grafts in perforated corneal ulcers.
 Methods: A retrospective study assessing clinical results of CPG on the perforated corneal ulcer with iris prolapse. Clinical assessments include graft condition, anterior chamber depth (ACD), and visual acuity after surgery, with a follow-up duration of up to 8 weeks.
 Results: Twenty-one cases of perforated corneal ulcer with iris prolapse in 15 males (71.4%) and 6 females (28.6%). Locations of ulcer are peripheral and paracentral corneal. Visual acuity showed around light perception (LP) to 0.4. The most common etiology for corneal ulcers was infection (88.9%), followed by non-infection (Mooren’s ulcer) (11.1%). The graft condition after surgery showed promising results in 18 cases (85.7%), infection in 1 case (4.8%), and melting in 2 cases (9.5%). Adequate ACD was obtained in 77.8% of cases. An increase in visual acuity was shown in 44.4% of cases, depending on the location and severity of the ulcer.
 Conclusion: A corneal patch graft is an appropriate choice in treating perforated corneal ulcers to maintain ocular integrity (tectonic keratoplasty). However, in non-infectious ulcers, this procedure has not shown a good result, which may be related to disease progressivity.

Role of descemet's stripping without keratoplasty in management of endothelial disease.

To summarize recent literature on Descemet's stripping only (DSO) in management of endothelial disease with particular focus on Fuchs endothelial corneal dystrophy (FECD). DSO is currently indicated in patients with early FECD, central guttae, and preserved peripheral corneal endothelial cell (CEC) count. Time to corneal clearance may be accelerated and maintained with addition of topical rho-kinase inhibitor (ROCKi). There are reports describing successful use of DSO to treat endothelial disease due to iatrogenic trauma. In patients with transcription factor 4 gene mutation, increased cytosine, thymine, guanine (CTG) triplet repeat load may be associated with DSO failure risk. Emerging pharmacotherapies and cell-suspension treatments may improve procedure effectiveness and expand clinical indications. DSO can be used as the initial surgical treatment in management of symptomatic endothelial disease due to FECD where peripheral CEC function appears preserved. Stand-alone DSO or DSO combined with cataract surgery is effective and postoperative topical ROCKi supplementation will improve time to corneal clearance and CEC count.

Repeatability of corneal pachymetry and epithelial thickness measurements with spectral-domain optical coherence tomography (SD-OCT) and correlation to ocular surface parameters.

To assess the repeatability of corneal pachymetry and epithelial thickness measurements with spectral-domain optical coherence tomography (SD-OCT) and identify correlations between epithelial thickness and ocular surface parameters. Adults who happened to have prolonged computer use were recruited, excluding those with conditions interfering with corneal measurements or tear production. All subjects filled in the ocular surface disease index (OSDI) questionnaire. Three consecutive measurements of central and peripheral corneal and epithelial thickness were performed with SD-OCT (RTVue XR). Schirmer test I and tear film break-up time (TBUT) were performed. Repeatability was evaluated with intraclass correlation coefficient (ICC), coefficient of variation and repeatability limit. Spearman correlation was used for non-parametric variables. 113 eyes of 63 subjects were included in the study. ICC was ≥ 0.989 for all corneal and ≥ 0.944 for all epithelial pachymetry segments. The best repeatability was found centrally and the worst superiorly both for corneal and epithelial measurements. Central epithelial thickness was weakly correlated with Schirmer test I (rho = 0.21), TBUT (rho = 0.02), OSDI symptoms and OSDI score (rho <|0.32|). OSDI symptoms and OSDI score were weakly correlated with Schirmer test I (rho <|0.3|) and TBUT (rho <|0.34|). RTVue XR measurements of corneal and epithelial thickness are highly repeatable in all segments. The lack of correlation between epithelial thickness and ocular surface parameters could suggest the assessment of epithelial integrity with reliable methods such as SD-OCT.

Ocular Manifestations of Peters Plus-Like Syndrome in 8q21.11 Microdeletion Syndrome.

The aim of this study was to report a case of Peters plus-like syndrome, which revealed to have an 8q21.11 microdeletion by copy number variation analysis using exome data. A 6-month-old Japanese boy presented with bilateral corneal opacity since birth. The right eye maintained central corneal transparency with slightly inferior nasal and superior peripheral corneal opacities. The entire cornea was opacified in the left eye, particularly in the superior quadrants with vascularization, suggesting Peters anomaly. Identification of intraocular structures in the left eye was difficult; however, hypoplasia of the circumferential anterior iris stroma appeared bilaterally present, and no abnormalities were present in the posterior segment on funduscopic examination of the right eye and ultrasonography in the left eye. He had several facial malformations in addition to corneal opacity, but no other external abnormalities. General examination, including biochemical tests of blood and urine, physiological and imaging tests including abdominal echo, auditory brain stem response, brain computed tomography, and magnetic resonance imaging, showed no abnormalities. However, the patient showed intellectual disability and delayed motor development. Although his karyotype was normal, copy number variation analysis using exome data and subsequent quantitative polymerase chain reaction identified a de novo 4.6-Mb deletion at 8q21.11q21.13; thus, the patient was diagnosed with 8q21.11 microdeletion syndrome. We identified a de novo 4.6-Mb deletion at 8q21.11q21.13 in a patient with ophthalmic anterior segment dysgenesis and systemic complications, clinically diagnosed as Peters plus-like syndrome. Clinically, the 8q21.11 microdeletion syndrome shows a phenotype similar to that of Peters plus syndrome, and a genetic diagnosis is required.

Peripheral corneal ulcer secondary to acquired eyelash trichomegaly following treatment with erlotinib in Asia: a case report.

Peripheral corneal ulcer secondary to acquired eyelash trichomegaly following treatment with erlotinib in Asia: a case report.

Advanced ocular heterotopic bone formation in a guinea pig

Heterotopic bone formation (HBF) of the ciliary body is most often reported in the guinea pig (Cavia porcellus), with a prevalence of eight of 1000.1 The most common treatment for ocular HBF is observation without any interventions, and the prognosis is generally considered favourable.2, 3 However, given this case report, once HBF is diagnosed with the lesion covering the entire angle, attention should be paid to glaucoma. Although a possible association between HBF and glaucoma has been raised,4 to date this possibility has received relatively little attention, based on published reports. Normal IOPs for the guinea pig are reported to be 18.3 ± 4.6 mmHg.5 The case described here involves a 5-year-old guinea pig (Elm Hill pigmented strain), which was diagnosed with bilateral HBF approximately 1.5 years ago. Its first 7-month follow-up history has been reported.6 The lesions and intraocular pressures (IOPs) of both eyes were monitored regularly. One year after initial detection, the lesion was most advanced in the right eye, encompassing 360 degrees of the iridocorneal angle (Figure 1a,b). Vitamin C can lead to calcium deposition, which causes HBF.7 Consistent with the latter interocular difference, the IOP of the right eye measured by rebound tonometry (iCare; Tonolab) was initially found to be higher than that of the left eye, although IOPs of both eyes were within the normal range (e.g., 15.3 ± 0.6 vs. 10.3 ± 1.5 mmHg) during the first year. Follow-up IOP recordings revealed significant fluctuations, with IOPs of the right eye being frequently outside the normal range from time to time (e.g., 48.3 ± 0.58 vs. 15.0 ± 1.0 mmHg), and IOPs of the left eye showing a similar, albeit, delayed trajectory. Subsequent electron microscopy analysis of the lesions revealed numerous small holes (pores) in the bone deposits (Figure 1c,d), which hint at bone remodelling8 and may underlie the IOP fluctuations. Although posterior subcapsular cataracts impaired the quality of optical coherence tomography (OCT) images (Figure 2), there is an apparent peripapillary depression adjacent to the optic nerve head, which together with the progressive elevation in IOP, compared to initial OCT images and IOP,6 is consistent with a diagnosis of glaucoma. In conclusion, periodic measurement of IOP is recommended after a diagnosis of HBF, due to the high risk of obstruction of the iridocorneal angle with disease progression. As advanced ocular heterotopic bone formation has the potential to increase intraocular pressure and ultimately cause glaucoma, periodic intraocular pressure monitoring is recommended. So Goto and Christine F. Wildsoet conceived and designed the project. So Goto and Qiurong Zhu acquired the data. SG analysed and interpreted the data. So Goto and Christine F. Wildsoet wrote the paper. So Goto, Qiurong Zhu and Christine F. Wildsoet reviewed the paper. The authors thank Kelly Jensen and Jennifer Frohlich (Clinical Veterinarians, UC Berkeley) for overseeing veterinary care of the guinea pig during this case. This study is supported by International Retinal Research Foundation (So Goto) and National Eye Institute Grants R01EY012392 (Christine F. Wildsoet). The authors declare no conflicts of interest. All animal care and treatments used in this study conform to the ARVO Statement for the Use of Animals in Ophthalmic and Vision Research. Experimental protocols were approved by the Animal Care and Use Committee of the University of California, Berkeley. What is your diagnosis, based on the ocular anterior segment changes evident in this guinea pig (Figure 1)? ANSWER: Ocular heterotopic bone formation. How do you think intraocular pressure (IOP) is likely to change if the iridocorneal angle, which is the site of a major drainage channel for aqueous humor, is fully occupied, that is, around its circumference by bony deposits, as in this case? A. Elevate B. Decrease C. No change Answer: A Located in the angular recess where the peripheral posterior corneal and anterior surface of the iris meet, known as the iridocorneal angle, are drainage structures, including the trabecular meshwork, through which aqueous humor escapes from the eye into episcleral veins and beyond. The importance of this drainage route for regulating IOP is demonstrated by the elevation in the latter, resulting from the injection of microbeads or oil into the iridocorneal angle, as used in animal models of glaucoma, while in humans, accumulation of pigment granules in the iridocorneal angle is also known to elevate IOP. In the current case, bony lesions/deposits appear to almost fully occupy the iridocorneal angles of both eyes, that is encompassing 360 degrees, offering a likely explanation for the observed elevated IOPs, with dynamic remodelling of the bone deposits suggested by observed fluctuations in IOP.

A Case of Sterile Peripheral Corneal Infiltrative Event after LASIK

Purpose: To report a rare, sterile, peripheral, corneal infiltrative event after laser in situ keratomileusis (LASIK).Case summary: A 29-year-old male presented with left-eye conjunctival injection and peripheral corneal infiltration 3 days after LASIK. A whitish, oval, peripheral infiltration around the corneal flap was apparent from 6-to-10 o’clock in the limbus. Slit lamp examination revealed conjunctival injection and mild corneal edema but neither a corneal epithelial defect nor an inflammatory reaction of the anterior chamber. Intensive cycloplegic, steroid ointment, steroid drops, antibiotic drops, and artificial tear therapies were prescribed under the impression of a sterile, peripheral, corneal infiltrative event. After 1 month, the symptoms and corneal opacity resolved without any complications.Conclusions: A sterile, peripheral, corneal infiltrative event, namely, an oval infiltration of the periphery of the cornea without pain or epithelial damage can develop after LASIK but responds well to steroid eye drops.

Wegener’s Granulomatosis Revealed by Bilateral Orbital Inflammatory Pseudotumor: a Case Report and Literature Review

Purpose: To describe the chronology and the extent of orbital involvement in a case of granulomatosis with polyangiitis (GPA). Methods: Descriptive case report and literature review. Results: A thirty-two years old male consulted with the following complaints: A retro-orbital discomfort in both eyes, a bilateral fast progressive proptosis and a decrease in visual acuity in the left eye. Eye examination revealed a proptosis, ptosis, epiphora and a motility restriction and peripheral corneal ulcer infiltrates with nodular scleritis in the left eye. A palpable orbital mass was located in the sub temporal orbit in both eyes. Orbit magnetic resonance imaging (MRI) unveiled a diffuse and elongated enlargement of both lacrimal glands with enhancing mass in the superior lateral aspect of both eyes globe. The diagnosis of an orbital pseudotumor was suspected. The biological work-up revealed a high blood levels of inflammation markers and antineutrophil cytoplasmic antibodies (c-ANCA). The diagnostic of active systemic granulomatosis with polyangiitis was then made. Conclusion: As seen in this case, clinicians should consider a differential diagnosis of granulomatosis with polyangiitis in patients with an orbital pseudotumor mimic aspect.

Customised Peripheral Corneal Cross-linking (P-CXL) for Ultra-thin Corneas with Stage III and IV Keratoconus

ABSTRACT Purpose This study aims to determine whether customised peripheral corneal cross-linking (P-CXL) can halt keratoconus progression in ultrathin corneas with stage 3 and 4 keratoconus, with thinnest pachymetry well below 400 μm and therefore excluded from most treatment protocols. Methods This retrospective study included 21 eyes with progressive keratoconus and thinnest pachymetry ranging from 97 to 399 μm (mean 315 μm), who underwent P-CXL between 2007 and 2020. The procedure involved preoperative NSAIDs therapy, tomography-guided customized epithelial debridement, the use of both hypo-osmolar and iso-osmolar riboflavin solutions, and 9.0 mW/cm2 UV-A irradiation for 10 minutes. The outcome measures were best spectacle-corrected visual acuity (BSCVA), mean keratometry, maximum keratometry, and thinnest pachymetry. Results After a minimum follow-up period of 12 months, P-CXL stabilized or improved mean keratometry and maximum keratometry in 85.7% of eyes (Kavg from 57.48 ± 9.38 to 56.43 ± 8.96 D, p < 0.001; Kmax from 72.77 ± 12.74 to 70.00 ± 11.50 D, p < 0.001), BSCVA in 90.5% of eyes (from 4.48 ± 2.85 to 5.72 ± 3.34 decimals, p < 0.001), and thinnest pachymetry in 81% of eyes (from 315.81 ± 90.05 to 342.33 ± 74.22 μm, p = 0.08). No adverse events and no loss of endothelial cell density occurred. Conclusions Customised peripheral corneal cross-linking (P-CXL) treated very severe keratoconus with a success rate of 85.7% and improved visual acuity and tomographic indicators in most cases. While a longer follow-up and a larger sample would help to support such conclusions to a greater extent, these results allow to broaden the treatment spectrum for patients with stage 3 and 4 keratoconus and contact lens tolerance.

The influence of corneal tunnel length on surgically induced astigmatism after various types of microincision phacoemulsification.

To evaluate the influence of the corneal tunnel length on surgically induced astigmatism (SIA) after 3 phacoemulsification techniques. Patients who underwent a planned phacoemulsification surgery with an implantation of a foldable, acrylic IOL were selected for the study. All surgeries were performed under topical anaesthesia, with the same phaco machine. Group I consisted of 30 eyes of 30 patients after bimanual 1.4 mm microincision cataract surgery (B-MICS). Group II consisted of 30 eyes of 30 patients after coaxial 1.8 mm microincision cataract surgery (C-MICS). Group III consisted of 30 eyes of 30 patients after coaxial 2.4 mm small incision cataract surgery (C-SICS).Best corrected visual acuity, autorefractometry, tonometry, a slit lamp examination and anterior segment OCT were performed preoperatively and 1, 7, 30 and 90 days postoperatively. The temporal peripheral corneal thickness and the chord length of the main incision were measured. Vector method was used to calculate SIA. Mean preoperative BCVA was 0.52 ± 0.19 and it improved to 0.98 ± 0.05 (p < 0.05). Mean corneal tunnel chord length was 1.30 ± 0.16 mm 90 days postoperatively in group I, 1.30 ± 0.19 mm in group II and 1.48 ± 0.22 mm in group III. SIA was 0.54 ± 0.48 mm in group I, 0.45 ± 0.21 mm in group II and 0.62 ± 0.30 mm in group III. There were no correlations between the chord length of the corneal tunnel and SIA calculated with using vector analysis method. Unlike the incision width, the length of the clear corneal tunnel in small incisions and microinicions, has no significant influence on SIA.

Histological Changes Indused by Monosodium Glutamate on the Growth and Development of the Offsprings Albino Mice Cornea

This research aim to study the effect of different doses of a Monosodium Glutamate (MSG) to cause histopathological changes in the offspring corneal for the ages 7, 15, 21, 30, and 60 days. The mothers, type Mus musculus mice has been orally administrated from 17th day of pregnancy by different concentrations (2, 4, and 8 g/Kg/ body weight) of MSG using stomach tube. Microscopic examination showed no changes in the cornea for a seventh day and administrated concentrations of 2 and 4 g / kg body weight, but observed degeneration of fibre stroma, necrosis and the reduction of the anterior epithelial layer of the cornea at dose of 8 g / kg. In the group of 15 days, these changes are mentioned; hyperplasia in the anterior epithelium of the peripheral cornea of 2 g, deformation in the peripheral part of the cornea and the reduction of thickness and intensify the stroma components at a concentration of 4 g either at a concentration of 8 g / kg has appeared hyperplasia in fibroblast cells in the corneal stroma and wave of the basement membrane of anterior epithelial tissue of central cornea. In a group 21days, these changes are shown; necrosis and rarefaction in stroma of central cornea while the reduction of the anterior epithelial layer of the peripheral cornea notes and wave anterior surface of the cornea in the concentration of 2 g / kg. Deformation appeared and reduction layers and irregular with dissociation in the stromal fibers in some areas in the concentration of 4 g / kg, while in the concentration of 8 g / kg show damage in the anterior part of epithelial of the central corneal tissue. In a group 30 days and concentration of 2 g / kg, these changes were observed; necrosis, swelling in some anterior epithelial cells, condensation of nuclei in endothelial cells, with Keratinized at the surface of the cornea and edema in the stroma. Bulge appeared in the stroma of peripheral cornea and hyperplasia in fiberoblast at a concentration of 4g/kg, meanwhile at a concentration of 8 g/kg show necrosis under the anterior epithelium of central cornea and dissociation of stromal fiberoblast. In the group 60 Days at the concentration of 2 g / kg show damage in the anterior epithelial tissue of the peripheral cornea and hyperplasia in some parts of the anterior epithelial tissue in the central cornea. At the concentration of 4g/kg show damage in the stromal fibers of peripheral corneal epithelium and detachment of endothelial tissue. In concentration 8 g/kg reduction appeared in the anterior epithelial tissue in the certain part of the cornea, hyperplasia in endothelial tissue, condensed layer appeared on the surface of anterior epithelial tissue.

The use of occlusive contact lenses after failure of conventional for treatment of amblyopia.

The purpose of this study was to evaluate the usefulness and assess the risks associated with occlusive contact lenses (OCLs) use to treat refractory amblyopia in children who failed the conventional amblyopia treatment with patching and atropine penalization. This was a retrospective case series of all children treated with an OCL in the sound eye over an 8-year period. Data were collected on the age, gender, and type of amblyopia, previous treatment received, and its duration. The compliance, tolerance, and adverse effects of OCL were recorded. There were 12 patients of which 10 were male. The mean age at the time of OCL use was 47.3 months (range 26-86 months). Anisometropic amblyopia was present in 1, combined anisometropia and strabismus in 3, strabismic amblyopia in 5, and stimulus deprivation amblyopia in 3. All patients had conventional patching for a mean period of 14 months, followed by atropine penalization in nine patients for a mean period of 4 months. The mean duration of OCL use ranged from 2 weeks to 6 months. There were nine patients with visual improvement (75%). The mean improvement seen was 0.4 log of the minimum angle of resolution. There was no occlusion amblyopia. Four patients had conjunctivitis; one had a peripheral corneal abrasion. The OCL is a useful adjunct in the treatment of amblyopia that is refractory to conventional treatment. The side effect profile is acceptable, but patients require close monitoring.

A systematic review on the effects of ROCK inhibitors on proliferation and/or differentiation in human somatic stem cells: A hypothesis that ROCK inhibitors support corneal endothelial healing via acting on the limbal stem cell niche.

Rho kinase inhibitors (ROCKi) have attracted growing multidisciplinary interest, particularly in Ophthalmology where the question as to how they promote corneal endothelial healing remains unresolved. Concurrently, stem cell biology has rapidly progressed in unravelling drivers of stem cell (SC) proliferation and differentiation, where mechanical niche factors and the actin cytoskeleton are increasingly recognized as key players. There is mounting evidence from the study of the peripheral corneal endothelium that supports the likelihood of an internal limbal stem cell niche. The possibility that ROCKi stimulate the endothelial SC niche has not been addressed. Furthermore, there is currently a paucity of data that directly evaluates whether ROCKi promotes corneal endothelial healing by acting on this limbal SC niche located near the transition zone. Therefore, we performed a systematic review examining the effects ROCKi on the proliferation and differentiation of human somatic SC, to provide insight into its effects on various human SC populations. An appraisal of electronic searches of four databases identified 1 in vivo and 58 in vitro studies (36 evaluated proliferation while 53 examined differentiation). Types of SC studied included mesenchymal (n=32), epithelial (n=11), epidermal (n=8), hematopoietic and other (n=8). The ROCK 1/2 selective inhibitor Y-27632 was used in almost all studies (n=58), while several studies evaluated ≥2 ROCKi (n=4) including fasudil, H-1152, and KD025. ROCKi significantly influenced human somatic SC proliferation in 81% of studies (29/36) and SC differentiation in 94% of studies (50/53). The present systemic review highlights that ROCKi are influential in regulating human SC proliferation and differentiation, and provides evidence to support the hypothesis that ROCKi promotes corneal endothelial division and maintenance via acting on the inner limbal SC niche.

Bilateral peripheral ulcerative keratitis

A 13-year-old girl presenting with mucopurulent conjunctivitis (left &gt; right) was diagnosed with Behçet's disease. Intraoperatively, the left eye had 360° culture-negative marginal corneal ulcer with scleral necrosis, managed with a scleral patch graft. Postoperatively, the right eye also developed a peripheral corneal lesion that resolved with immunosuppressants along with the skin lesions. Subsequently, wound gaping and uveal prolapse were noted in the left eye and was managed with a lamellar corneal graft and later with a corneoscleral patch graft. Following this, the patient improved very well in terms of visual acuity. Peripheral ulcerative keratitis can be a clinical presentation in pediatric Behçet's disease despite the unusual occurrence. Hence, any pediatric case with peripheral ulcerative keratitis should be thoroughly investigated for Behçet's disease, for which immunosuppressants may prove to be beneficial.

Case series on scleral patch graft for peripheral corneal perforations

Case series on scleral patch graft for peripheral corneal perforations

Ocular manifestations in a case of herpes zoster ophthalmicus with human immunodeficiency virus

Abstract This is a case report of human immunodeficiency virus infection whose primary presentation was with herpes zoster ophthalmicus with sterile corneal perforation which is unusual. A 48-year-old female patient presented with redness and painful decrease in vision in the right eye for the past two weeks. Examination revealed skin lesions in right side of face, with complete ptosis in right eye with restricted ocular movements suggestive of third nerve palsy. Slit lamp examination revealed sterile perforated peripheral corneal ulcer in right eye. Screening of viral markers revealed that patient was positive for human immunodeficiency virus. The case was treated conservatively with oral antivirals, topical antibiotics, and lubricants. The patient was started on highly active antiretroviral therapy from nearby antiretroviral therapy centre. We planned to do a corneal patch graft for the patient but the patient was not willing for any surgical intervention.

Comparison of Changes in Corneal Thickness and Curvature After Myopia Correction Between SMILE and FS-LASIK.

To comparatively investigate the changes in corneal thickness and curvature between small incision lenticule extraction (SMILE) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). Data were collected preoperatively and postoperatively at 1 week, 1 month, and 3 months, including central corneal thickness (CCT), midperipheral corneal thickness (MPCT), peripheral corneal thickness (PCT), central keratometry (CK), midperipheral keratometry (MPK), and peripheral keratometry (PK), using a dual rotating Scheimpflug analyzer. At 1 week postoperatively, changes in CCT, MPCT, PCT, and PK were significantly greater in the SMILE group than in the FS-LASIK group (P = .003 for CCT and < .001 for MPCT, PCT, and PK), but no significant inter-group differences were found between changes in CK and MPK (P = .883 and .513, respectively). CCT, MPCT, and PK values showed a similar increase in both groups, but significantly more increase in PCT and significantly less increase in CK and MPK was observed in the SMILE group from 1 week to 3 months after surgery. At 3 months postoperatively, CCT and MPCT were significantly thinner in the SMILE group than in the FSLASIK group (P = .018 and .022, respectively), and there was no significant difference in PCT, CK, MPK, and PK between the two groups. SMILE caused significantly more corneal thinning at the center, midperiphery, and periphery, and more corneal flattening at the periphery, compared to FS-LASIK. A different pattern of corneal remodeling was observed between the two surgeries during the 3-month follow-up period. [J Refract Surg. 2023;39(1):15-22.].

Surgical goniolens for tag identification and removal in DMEK surgery.

We describe a novel technique for identifying endothelial Descemet membrane (DM) tags remaining after descemetorhexis in patients undergoing Descemet membrane endothelial keratoplasty (DMEK) surgery. A surgical goniolens is applied to the corneal surface after descemetorhexis in order to visualize the peripheral inner corneal layer at 360° and identify endothelial-DM tags. A detailed visualization of the peripheral inner corneal layer is possible using goniolens, without using any staining in the anterior chamber. The technique may be used to screen the posterior corneal surface for any retained endothelial-DM tags. It may to lower the risk of remaining tags and indirectly lower the incidence of DMEK graft detachment.

Risk factors for peripheral hypertrophic subepithelial corneal opacification.

To evaluate the phenotype, tear secretion and refractive changes of patients diagnosed with peripheral hypertrophic subepithelial corneal opacification (PHSCO). This is a retrospective, interventional case series conducted at the Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz. Medical records of patients diagnosed with PHSCO were analysed. Sex, age, fluorescein tear film breakup time (FTBUT), Schirmer Test II, iris colour and hair colour were assessed. Objective refraction was evaluated at different time points and, in case of surgery, 1 month and 1 year postoperatively. One hundred ninety-five eyes of 112 patients (78.6% female, 21.4% male; mean age 56.2± 14.3) were included. The median FTBUT was 6sec. (Q1: 4/Q3: 8.75; range 1-20 s) (measured in 70 eyes of 36 patients), the median Schirmer Test II was 8 mm (Q1: 5/ Q3:15; range 1-35 mm). In 83 patients (74.1%) both eyes were involved. In 86 eyes of 64 patients (55.3%) superficial keratectomy was performed. Sphere and cylinder changed significantly 1 month and 1 year postoperative compared to the pre-operative objective refraction, while there was no significant change between 1 month and 1 year postoperatively. We found that PHSCO occurs mostly bilaterally in middle-aged women and appears to be associated with decreased tear production and reduced tear film stability.