Spectacle-corrected Visual Acuity Research Articles

EndoArt®: results in patients with glaucoma drainage devices

EndoArt® (Eye Yon Medical, Ness Ziona, Israel) is anovel artificial corneal inner layer transplant and an innovative treatment alternative for patients at high risk for graft failure after posterior lamellar corneal transplantation (EK). We present the initial results of the EndoArt® implantation in patients with glaucoma drainage devices (GDD). In this study 12eyes with GDD were retrospectively evaluated. All had ahigh risk of transplant rejection in cases of EK (previous other glaucoma surgery in addition to GDD, n = 8, condition following Descemet membrane endothelial keratoplasty, DMEK, n = 9, uveitis, n = 2, or synechiae, n = 2). The EndoArt® was secured with agas bubble and one to three holding sutures. The preoperative and postoperative best spectacle-corrected visual acuity (BSCVA) and central corneal thickness (CCT) were determined. The need for additional gas injections (rebubbling) was analyzed. Octafluoropropane (C3F8) 12% was used in nine patients and sulfur hexafluoride (SF6) 20% in three patients as anterior chamber tamponade to ensure adhesion of the EndoArt®. At least one rebubbling was necessary in four eyes. The preoperative BSCVA was 1.6 (± 0.5) logMAR and significantly improved to 1.1 (± 0.6) logMAR after 12weeks (p = 0.028). The preoperative CCT was 719 µm ± 145.7, which significantly decreased to 622.4 µm ± 174.9 after six weeks (p = 0.004) and to 591.7 µm ± 190.8 after 12weeks (p = 0.096). In one eye, the prosthesis was explanted due to a suspected fibrotic remodelling of the cornea following multiple previous DMEKs. EndoArt® led to asignificant improvement in BSCVA and reduction in CCT; however, there was ahigh rebubbling rate in patients with GDD. In high-risk patients, the use of EndoArt® may be advantageous in avoiding graft failure after EK.

Descemet Endothelial Thickness Comparison Trial II (DETECT II): multicentre, outcome assessor-masked, placebo-controlled trial comparing Descemet membrane endothelial keratoplasty (DMEK) to Descemet stripping only (DSO) with adjunctive ripasudil for Fuchs dystrophy

IntroductionIt remains uncertain whether Descemet membrane endothelial keratoplasty (DMEK) or Descemet stripping only (DSO) yields better outcomes in patients with symptomatic Fuchs endothelial corneal dystrophy (FECD). This paper presents the...

Vision Improvement in Keratoconus Patients Trained With Perceptual Learning: A Randomized Controlled Trial

BackgroundKeratoconus (KC) is a corneal ectasia disease in which the vision of some patients cannot achieve satisfaction by spectacle corrections. However, not everyone can embrace contact lenses to achieve better vision. Perceptual learning (PL) is a potential treatment for vision improvement in such patients. PurposeTo investigate the effectiveness and maintenance of PL on vision improvement in KC patients corrected with spectacles. DesignRandomized, double-blind clinical trial. ParticipantsThirty-five non-progressive KC patients aged 9 years or older with unsatisfied spectacle-corrected vision were enrolled. MethodsNon-progressive KC patients with best spectacle-corrected distance visual acuity (CDVA) of 0 to 1.0 logMAR (Snellen equivalent range 20/20 to 20/200) and contact lenses intolerant were enrolled. Eligible subjects were randomized into PL and control groups to receive PL and placebo training for 3 months, respectively. Spectacle-corrected visual acuity, contrast sensitivity function (CSF), stereoacuity, and visual functioning and quality of life questionnaires were measured at baseline, 3 months, and 6 months of follow-up. Statistics were analyzed following the intention-to-treat (ITT) principle. ResultsAfter 3 months of training, the CDVA of patients in the PL group improved as compared to the placebo group (0.17 ± 0.15 logMAR vs. 0.02 ± 0.06 logMAR; P = 0.0006). Eight out of seventeen (47.06 %) patients in the PL group reached CDVA improvement ≥ 2 lines (P=0.0010). This improvement persisted for at least 6 months (from baseline) as compared to the placebo group (0.17 ± 0.17 logMAR vs. 0.01 ± 0.07 logMAR; P = 0.0011). The increase of CSF in the PL group mainly was found for moderate spatial frequency (0.11 ± 0.17 log units at 3 cpd; 0.12 ± 0.19 log units at 6 cpd). Linear regression indicated that patients with worse initial CDVA achieved better gains in CDVA after PL (P = 0.009). No side effects were observed and no subjects quit because of training difficulties. ConclusionThree-month perceptual learning improved vision in KC patients and the improvement maintained after 3 months of treatment cessation. The results indicate that perceptual learning may be a promising therapy for KC patients with unsatisfied spectacle-corrected visual acuity.

A double-masked, sham-controlled trial of rose bengal photodynamic therapy for the treatment of fungal and acanthamoeba keratitis: Rose Bengal Electromagnetic Activation with Green Light for Infection Reduction (REAGIR) study

BackgroundInfectious keratitis secondary to fungus or acanthamoeba often has a poor outcome despite receiving the best available medical therapy. In vitro rose bengal photodynamic therapy (RB-PDT) appears to be effective against fungal and acanthamoeba isolates (Atalay HT et al., Curr Eye Res 43:1322–5, 2018, Arboleda A et al. Am J Ophthalmol 158:64-70, 2014). In one published series, RB-PDT reduced the need for therapeutic penetrating keratoplasty in severe bacterial, fungal, and acanthamoeba keratitis not responsive to medical therapy.MethodsThis international, randomized, sham and placebo controlled 2-arm clinical trial randomizes patients with smear positive fungal and acanthamoeba and smear negative corneal ulcers in a 1:1 fashion to one of two treatment arms: 1) topical antimicrobial plus sham RB-PDT or 2) topical antimicrobial plus RB-PDT.DiscussionWe anticipate that RB-PDT will improve best spectacle-corrected visual acuity and also reduce complications such as corneal perforation and the need for therapeutic penetrating keratoplasty. This study will comply with the NIH Data Sharing Policy and Policy on the Dissemination of NIH-Funded Clinical Trial Information and the Clinical Trials Registration and Results Information Submission rule. Our results will be disseminated via ClinicalTrials.gov website, meetings, and journal publications. Our data will also be available upon reasonable request.Trial registrationNCT, NCT05110001, Registered on November 5, 2021.

Small-incision lenticule extraction in a patient with congenital motor nystagmus: case report

Introduction: In patients with congenital motor nystagmus, vision correction might be challenging, and laser refractive surgery is thought to be not advisable because of the patient's inability to fixate and uncontrollable eye movements. Patient and Clinical Findings: A 25-year-old man presented with congenital motor nystagmus and reported that he could not wear contact lenses and that spectacles gave him headaches. Diagnosis, Intervention, and Outcomes: Diagnosis of motor nystagmus was established clinically, with exclusion of other abnormalities, intact vision, and a history dating back decades. Small-incision lenticule extraction (SMILE) surgery using a 2000-kHz VisuMax 800 (VM800) femtosecond laser was performed successfully on both eyes. Preoperative uncorrected distance visual acuity (UDVA) was 6/24-1 in the right eye and 6/60-1 in the left eye, improving to 6/7.5+1 and 6/9-1, respectively, on postoperative day 1. At day 7, UDVA further improved to 6/6+2 and 6/7.5-1, and after 1 month, it reached 6/6 for the right eye and 6/7.5-1 for the left eye. The patient had a vision gain of 1 line compared with preoperative best spectacle-corrected visual acuity. Refraction at 1 month was right +0.25 diopter sphere and left +0.25 diopter sphere. No intraoperative complications were observed. Conclusions: SMILE surgery using VM800 proved effective for a patient with congenital motor nystagmus, resulting in a vision gain of 1 line compared with preoperative best spectacle-corrected visual acuity, with no intraoperative complications. Centration was within 0.2 mm of the target. These objective outcomes demonstrate the feasibility and effectiveness of SMILE surgery using a newer generation laser in this population.

Outcomes in Patients With Vogt–Koyanagi–Harada Disease From the First-Line Antimetabolites for Steroid-Sparing Treatment Uveitis Trial

PurposeTo compare the effectiveness of methotrexate (MTX) and mycophenolate mofetil (MMF) in achieving corticosteroid-sparing control of uveitis in patients with Vogt-Koyanagi-Harada (VKH) disease. MethodsA subanalysis of patients with VKH from the First-line Antimetabolites as Steroid-sparing Treatment (FAST) Uveitis Trial, a randomized, observer-masked, comparative effectiveness trial, with comparisons by treatment (MTX versus MMF) and disease stage (acute versus chronic). Individuals with noninfectious uveitis were placed on a standardized corticosteroid taper and block randomized 1:1 to either 25mg weekly oral MTX or 1.5g twice daily oral MMF. The primary outcome was treatment success defined by corticosteroid-sparing control of uveitis at 6 months. Additional outcomes included change in best spectacle-corrected visual acuity (BSCVA), retinal central subfield thickness (CST), and resolution of serous retinal detachment (SRD). ResultsNinety-three out of 216 enrolled patients had VKH; 49 patients were randomized to MTX and 44 to MMF, of which 85 patients (46 on MTX, 39 on MMF) contributed to the primary outcome. There was no significant difference in treatment success by antimetabolite (80.4% for MTX compared to 64.1% for MMF; P=.12) or in BSCVA improvement (P=.78). Methotrexate was superior to MMF in reducing CST (P=.003) and resolving SRD (P=.02). There was no significant difference in treatment success by disease stage (P=.25), but patients with acute VKH had greater improvement in BSCVA (P<.001) and reduction of CST (P=.02) than chronic VKH patients. ConclusionsMTX and MMF have comparable outcomes as corticosteroid-sparing immunosuppressive therapies for VKH. Visual acuity improvement was greater in acute vs chronic VKH. Trial RegistrationClinicalTrials.gov Identifier: NCT 0182929

A Standardized Protocol of Simultaneous Transepithelial Phototherapeutic Keratectomy (PTK) Followed by Corneal Collagen Crosslinking for Keratoconus.

To report outcomes in patients with progressive keratoconus who underwent a standardized protocol of transepithelial phototherapeutic keratectomy (t-PTK) laser followed by accelerated corneal collagen crosslinking (CXL). All patients with progressive keratoconus undergoing our protocol at a London clinic between 2019 and 2023 were included. The protocol involved t-PTK at 58-μm central ablation depth at a 9-mm treatment zone on the Schwind Amaris 1050RS platform. Preoperative K readings of 43.0D (both K1 and K2) were inputted for all cases. Patients then underwent CXL with a pulsed-light accelerated protocol (30 mW/cm2 for 8 minutes of UVA exposure time with 1 second on/1 second off). Seventy-nine eyes from 55 patients were included with an average follow-up of 12 months (range 6-24 months). Both mean uncorrected distance visual acuity (UDVA) and best spectacle-corrected visual acuity improved significantly from 0.42 preoperatively to 0.29 postoperatively (P < 0.01) and 0.11 to 0.06 postoperatively (P < 0.01), respectively. The refractive cylinder reduced significantly from -3.07D to -2.63D (P < 0.05). The mean Km improved from 46.15D to 45.44D (P < 0.01) and mean Kmax from 54.03D to 52.52D (P < 0.01). 77% of eyes (n = 61) exhibited Kmax improvement postoperatively, and 56% showed an improvement in UDVA (n = 44). 16% (n = 13) had worsening of vision, but of these, only 1 patient had visual loss of more than 2 lines. No eyes had corneal haze reported at the final follow-up, and none required additional treatment. This standardized simultaneous t-PTK and CXL protocol is safe and effective for the treatment of progressive keratoconus, providing visual, refractive, and topographic improvements.

A Functional and Immunologic Point of View on Corneal Endothelial Transplantation: A Systematic Review and Meta-Analysis.

Background: To systematically review and meta-analyze the immunologic aspects and outcomes of various endothelial keratoplasty (EK) techniques, specifically comparing Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK), Ultra-Thin Descemet's Stripping Automated Endothelial Keratoplasty (UT-DSAEK), and Descemet's Membrane Endothelial Keratoplasty (DMEK). Methods: Systematic review and meta-analysis. Main outcomes were the proportion of patients achieving a best spectacle-corrected visual acuity (BSCVA) of 20/20 at 6 months after keratoplasty, rejection rate one year after surgery, BSCVA at last follow up, and postoperative immunomodulating regimen. Results: A higher proportion of DMEK patients achieved a BSCVA of 20/20 after 6 months. UT-DSAEK and DMEK showed similar rejection rates with a lower risk of re-bubbling for UT-DSAEK (4% vs. 20%). Conclusions: DMEK showed faster visual recovery than UT-DSAEK but a similar rejection rate and long-term visual acuity. One-year postoperative slow tapering steroid regimen has a positive but not (yet) significant effect on rejection risk and visual outcomes.

Topical tacrolimus for high-risk corneal transplantation: a randomized, clinical trial

BackgroundThe prevalence of rejection is 10–30% in penetrating keratoplasty (PKP) case, and the rate is higher in cases of high-risk patients. Although using topical corticosteroids is a standard method for management the rejection of post-PKP patients, it may not be sufficiently potent in high-risk patients. Topical administration of tacrolimus (TAC) may be effective in suppression rejection after corneal transplantation. This study aimed to investigate the efficacy and safety of topical TAC in high-risk PKP patients in Japan.MethodsThis study was a single centre, single-blinded, randomized controlled trial. Patients with a history of PKP, graft rejection, atopic dermatitis, or deep corneal neovascularisation who underwent PKP were enrolled. They were randomly assigned to receive 0.1% TAC ophthalmic suspension or artificial tear (AT) up to week 52 after surgery. All participants received 0.1% betamethasone up to week 13 after surgery then they received 0.1% fluorometholone up to week 52. The incidence of immunological rejection during the observation period was the main outcome measure in this study.ResultsThirty patients were enrolled in this study, and 12 eyes in the TAC group and 13 eyes in the AT group completed the study, respectively. Five out of 30 patients discontinued participation after providing informed consent. No serious adverse effects were developed in patients who received 0.1% TAC ophthalmic suspension. No rejection episodes occurred in the TAC group, while one eye in the AT group had rejection. Graft clarity, best spectacle-corrected visual acuity, intraocular pressure, and corneal endothelial cell density were not significantly different between the TAC and AT groups.ConclusionOur results demonstrated that good tolerability of 0.1% TAC ophthalmic suspension. However, we failed to demonstrate its efficacy in preventing immunological rejection in high-risk patients undergoing PKP.Trial registrationThis study was first registered in the University Hospital Medical Information Network (UMIN000029669, Date of registration: November 1, 2017). With the enforcement of the Clinical Trial Act in Japan, the study re-registered in the Japan Registry of Clinical Trials (jRCTs031180342, Date of registration: March 18, 2019).

Recurrence Characteristics on Optical Coherence Tomography and Treatments of Reis-Bücklers Corneal Dystrophy After Phototherapeutic Keratectomy or Penetrating Keratoplasty

PurposeTo evaluate the recurrence characteristics on optical coherence tomography and clinical outcomes after phototherapeutic keratectomy (PTK) or penetrating keratoplasty (PKP) in patients with Reis-Bücklers corneal dystrophy (RBCD). DesignRetrospective interventional case series. MethodsSeventeen patients with RBCD (31 eyes, including six surgery-naïve eyes and 25 surgical eyes) received 44 surgical interventions from 1996 through 2022. PTK or PKP was performed as the initial surgical procedure. Significant recurrence was determined when best spectacle-corrected visual acuity decreased at least two lines with increased opacity in the superficial cornea. Repeated PTK or PTK on the corneal graft (CG-PTK) was considered if patients could not endure poor vision due to significant recurrence. Recurrence depth and annual increase in thickness of the central cornea and subepithelial deposits were assessed by anterior segment optical coherence tomography. ResultsThe mean follow-up time was 12.8±8.5 years (range, 2.0–25.5 years). The mean logMAR best spectacle-corrected visual acuity improved from 1.24±0.48 preoperatively to 0.27±0.09 postoperatively in the initial PTK group (13 eyes, P<0.001), from 1.84±0.69 to 0.40±0.13 in the PKP group (12 eyes, P<0.001), from 1.04±0.46 to 0.30±0.07 in the repeated PTK group (12 times in 7 eyes, P<0.001), and from 1.29±0.43 to 0.39±0.11 in the CG-PTK group (7 times in 5 eyes, P=0.001). The median significant recurrence time was 27 months (95% confidence interval 23.9-30.1), 96 months (84.1-107.9), 31 months (28.8-33.1), and 24 months (19.8-28.2), respectively (P<0.001). The depth of superficial deposits located between the epithelium and the anterior stroma was approximately 115μm (85-159μm). The annual thickening of subepithelial deposits was 14±2μm after initial PTK, 7±3μm after PKP, 14±3μm after repeated PTK, and 30±11μm after CG-PTK, compared to 4±2μm in surgery-naïve eyes (P=0.002, 0.515, 0.002, <0.001). The thickness of the central cornea increased by 15±2μm, 7±2μm, 15±3μm, and 31±10μm per year in the four surgery groups, respectively, compared to 5±2μm in surgery-naïve eyes (P=0.001, 0.469, 0.001, <0.001). ConclusionsBetter visual acuity can be achieved after PTK than PKP for treatment of RBCD. The annual thickening of subepithelial deposits may approximate an increase in central corneal thickness. The superficial distribution of subepithelial deposits makes it feasible to perform repeated PTK, even on the corneal allograft, for recurrent RBCD.

Conventional Epithelial-Off Corneal Crosslinking in Patients With Progressive Keratoconus: 10-Year Outcomes.

Corneal crosslinking (CXL) is the standard treatment of progressive keratoconus (KC). We evaluated the safety and 10-year outcomes of conventional "epithelial-off" CXL for progressive KC for the first time in a cohort in France. We conducted a retrospective review of patients undergoing conventional CXL (Dresden protocol) in our tertiary ophthalmology department from 2006 to 2011 with 10-year follow-up. The primary outcome was change in preoperative versus postoperative keratometry measured by maximum keratometry (Kmax), steep keratometry (K2), flat keratometry (K1), mean keratometry (Km), and topographic cylinder. Secondary outcomes were changes in visual and refractive outcomes. We report postoperative complications and adverse events. Eighty-nine eyes from 76 patients (67% male patients, mean age 22.7 ± 7.6 years) were included. Mean Kmax (-2.31 ± 2.98 diopters (D); P < 0.00001), K2 (-2.07 ± 3.15 D; P < 0.00001), K1 (-1.00 ± 2.29 D; P = 0.00008), Km (-1.53 ± 2.47 D; P < 0.00001), and topographic cylinder (-1.15 ± 2.53 D; P = 0.00004) significantly decreased 10 years after CXL compared with preoperative baseline. Significant decreases were still observed between 5 and 10 years after for mean Kmax, mean K2, mean K1, and mean Km. Mean distance best spectacle-corrected visual acuity and mean manifest refraction spherical equivalent were significantly improved after 10 years versus before CXL. The 10-year rate of repeat CXL was n = 3/76 patients (4%) (all younger than 18 years at first CXL) and of loss of >3 lines in best spectacle-corrected visual acuity was n = 1/76 patients (1%). Progressive KC was effectively stabilized with a prolonged flattening and maintenance of functional vision improvements after 10 years. Repeat CXL was rare and only required among younger patients.

Modified Method for Nanothin Descemet Stripping Automated Endothelial Keratoplasty.

The purpose of this study was to describe a method to achieve a high success rate for nanothin (NT, ≤50 μm) Descemet stripping automated endothelial keratoplasty (DSAEK) graft preparation using anterior chamber pressurizer (ACP) with a modified setting and evaluate its postoperative efficacy. A prospective cohort (study group) of 24 patients with corneal endothelial dysfunction was consecutively enrolled and received DSAEK grafts using the modified ACP method from December 2021 to May 2022. The control group included 24 historical patients who received DSAEK grafts using conventional ACP procedure. Central graft thickness (CGT), graft regularity (3-mm and 5-mm diameter zones), best spectacle-corrected visual acuity, and endothelial cell density (ECD) were compared between 2 groups. A 100% ultrathin (UT, ≤100 μm) DSAEK rate and 62.5% NT-DSAEK rate was achieved at 3 months postsurgery in the study group, with a 51.3 ± 14.8 μm CGT, while a 70.8% UT-DSAEK rate and 4.2% NT-DSAEK rate was achieved in the control group, with an 89.0 ± 15.4 μm CGT (P <0.001). At 3-month postoperative follow-up, the regularity of graft thickness was significantly better in the study group (central-to-peripheral thickness difference: P = 0.044 and 0.014 for 3-mm and 5-mm diameter zones, respectively, graft thickness uniformity: P <0.001 and 0.012, respectively). There was no statistical difference in the best spectacle-corrected visual acuity (P = 0.170) or ECD (P = 0.833) between 2 groups at 3-month postoperative follow-up. DSAEK grafts harvested using modified ACP method were thinner and more regular compared with the conventional ACP method.

Keratoconus characteristics and associations: A cross-sectional keratoconus study in western India (CKSWI).

To study the clinical and tomographic characteristics and associations of keratoconus (KC) patients visiting a tertiary eye care hospital. This was a cross-sectional, observational study that included 242 newly diagnosed clinical KC patients. Detailed ocular and systemic history, visual complaints, habit of eye rubbing, best spectacle-corrected visual acuity (BSCVA), retinoscopy reflex, detailed slit-lamp examination and tomographic findings, and presence of any ocular and systemic associations were documented for the included patients. Severity of KC was further graded into stages 0, 1, 2, 3, and 4 according to the ABCD grading system. The most common visual complaint was blurred vision (82.64%), followed by itching (48.76%), tearing (43.80%), and photophobia (41.32%). A total of 44.62% of patients had the habit of eye rubbing and 4.54% had a family history of KC. Most common clinical signs were scissor reflex (94.21%), Rizutti's sign (77.27%), corneal protrusion (69.83%), and Fleischer ring (67.35%). A total of 14.05% of patients had stage 0, 42.15% had stage 1, 19.83% had stage 2, 18.60% had stage 3, and 5.37% had stage 4 KC. Of these patients, 70.25% had a BSCVA visual acuity of ≥6/12 or better; 26.45% had a BSCVA of ≥6/60 to <6/12; and 3.30% had a BSCVA of <6/60. Ocular allergies, atopy, and asthma were found in 32.32%, 4.96%, and 2.48% cases, respectively. This study gives an overview of the clinical findings of KC cases in western India. Our results suggest that use of retinoscopy should be promoted in early KC detection in primary eyecare screening programs.

Clinical, Anatomical, and Densitometric Changes following Dresden vs. Accelerated Corneal Cross-Linking in Progressive Keratoconus.

To compare clinical, anatomical, and densitometric changes following Dresden (DCXL) vs. accelerated (ACXL) corneal UVA cross-linking (CXL; Avedro KXL, Geuder, Heidelberg, Germany) in progressive keratoconus (KC). In this retrospective study, we analyzed 20 patients following DCXL (3 mW/cm², 30 min, 5.4 J/cm²) and 44 patients following ACXL (9 mW/cm², 10 min, 5.4 J/cm²) between January 2016 and February 2020. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), central corneal thickness (CCT), steepest keratometry (Kmax), keratoconus index (KI), thinnest pachymetry (Pthin), and corneal densitometry (CD) were measured before and 3, 6, 12, and 24 months after CXL. During the follow-up period, no changes in UCVA, BSCVA, Kmax, KI, or Pthin occurred. CCT significantly decreased 3 months after DCXL (p = 0.032) and ACXL (p = 0.006). At the 12- and 24-month follow-up, CCT remained decreased in the DCXL (p = 0.035, 0.036, respectively) but not in the ACXL group. At the 12-month follow-up, the reduction in CCT was significantly greater in DCXL compared to ACXL (p = 0.012). At the 3-, 6-, 12-, and 24-month follow-ups, we found a significant increase in the anterior stroma CD following DCXL (p = 0.019, 0.026, 0.049, 0.047, respectively) but not ACXL. The CD changes were localized in the central concentric zones (0.0 to 6.0 mm). No intra- or postoperative complications occurred. ACXL and DCXL effectively halted KC progression. ACXL proved to be a safe time-saving alternative to conventional DCXL. DCXL led to a reduction in CCT and an increment in the CD of the central anterior stroma during 24 months of follow-up.

Donut-shaped Corneal Allogeneic Intrastromal Segment as an Alternative to Deep Anterior Lamellar Keratoplasty in Advanced Keratoconus.

The aim of this study was to describe a new technique of selective corneal stromal transplantation for keratoconus treatment, donut-shaped CAIRS (corneal allogeneic intrastromal ring segment). A donut-shaped corneal graft is obtained using a double-bladed trephine. Descemet membrane, endothelium, and epithelium are all removed from the graft. Only stromal tissue is transplanted. A wide 360-degree intrastromal tunnel is created using the femtosecond laser, with a 30-degree angulation. The diameter is from 5.4 mm to 8 mm optical zone. After dehydration, the corneal graft is inserted into the tunnel. We report the clinical and tomographic outcomes after the procedure in 3 patients. The mean follow-up time after donut-shaped CAIRS was 6.01 ± 1.02 months. In case 1, best spectacle-corrected visual acuity improved from 20/150 to 20/40. In case 2, it improved from 20/400 to 20/40, and in case 3 from 20/200 to 20/40. The mean preoperative K was 57.3 ± 4.5 D and reduced to 44.2 ± 2.5 D after donut-shaped CAIRS. The mean spherical equivalent decreased from -9.8 ± 3.2 preoperatively to -3.2 ± 2.2 postoperatively. No intraoperative or postoperative complications were observed. Anterior segment OCT showed a mid-stroma implant, fusiform in shape, equidistant from the epithelium and endothelium. Donut-shaped CAIRS is a variation of the traditional CAIRS technique and showed to be an alternative option for keratoconus treatment, especially in moderate to advanced cases with a central clear cornea without scars. The technique is minimally invasive, and the visual axis remains untouched.

The effect of pterygium on front and back corneal astigmatism and aberrations in natural-light and low-light conditions

BackgroundTo investigate the effect of different sizes of pterygium on the front and back corneal topography, refractive changes and aberrations in natural-light and low-light conditions.MethodsSixty subjects with unilateral primary nasal pterygium were enrolled in this study. All the patients’ uncorrected, best spectacle-corrected visual acuity, corneal topographic aberration data in 3 mm and 7 mm areas were collected. The pterygium size was evaluated by the slit-lamp photography and Sirius Scheimpflug Analyzer.ResultsThe front topographic astigmatism values, corneal total aberrations, and higher-order aberrations in 3 mm and 7 mm areas were higher in the pterygium group than those in the control group. The pterygium horizontal length and thickness were moderately to strongly correlated with astigmatism and RMS of aberrations, while pterygium vertical length showed no or just mild correlation with the corneal astigmatism and aberrations. Compared to the readings in 3 mm area, the front and back corneal astigmatism and aberrations were larger in 7 mm area.ConclusionsPterygium led to visual impairment by inducing astigmatism and aberrations. In low-light condition, the visual function worsened due to increased corneal astigmatism values and aberrations.

Descemet Endothelial Thickness Comparison Trial 1 (DETECT 1): outcome masked, placebo-controlled trial comparing two types of corneal transplant surgeries and effect of rho kinase inhibitors on endothelial cell loss protocol

BackgroundIt remains uncertain which endothelial keratoplasty (EK) technique yields the best outcomes while maintaining safety, particularly in eyes with coexisting ocular conditions. Moreover, the impact of endothelial cell loss (ECL)...

Deep Anterior Lamellar Keratoplasty Using Dehydrated versus Standard Organ Culture-Stored Donor Corneas: Prospective Randomized Trial

PurposeTo compare the outcomes of deep anterior lamellar keratoplasty (DALK) using dehydrated versus standard organ culture stored donor corneas for eyes with keratoconus. DesignProspective, randomized, single-center trial conducted in Italy ParticipantsAdult patients with keratoconus (≥ 18 years old) with keratoconus scheduled for an elective DALK MethodsCases with successful type 1 bubble pneumatic dissection using standard DALK technique were intraoperatively randomized to receive either dehydrated (n=30) or standard organ culture stored donor corneas (n=30). Main Outcome MeasuresThe primary study outcome was best spectacle-corrected visual acuity (BSCVA) 12 months after surgery. Secondary outcomes were refractive astigmatism (RA), endothelial cell density (ECD) and complication rates. ResultsPostoperative logMAR BSCVA did not significantly differ between groups at both time points (mean difference at 6 months = 0.030 [95%CI: -0.53-0.10] p = 0.471) and at 12 months = -0.013 [95%CI: -0.10-0.08] p = 0.764). No significant differences between groups were observed in terms of postoperative RA and ECD at all time points. In the first 3 days after DALK, an epithelial defect was present in 10 cases (33%) of the organ culture cornea group and in 29 cases (97%) of the dehydrated cornea group. Complete re-epithelialization was achieved by day 7 in all cases (100%) of both groups. ConclusionsThe study provides evidence that the use of dehydrated corneas is non-inferior to the use of standard organ culture donor corneas for DALK. Corneal tissue dehydration represents a viable solution that can allow long-term cornea preservation and avoid wastage of unused corneas.

Surgical and visual outcomes of flap repositioning for various flap-related pathologies post laser in-situ keratomileusis (LASIK).

To evaluate the surgical and visual outcomes of flap repositioning for various post-laser-assisted in-situ keratomileusis (LASIK) flap pathologies. Retrospective review of consecutive cases between April 1, 2017 and February 28, 2022, where surgical flap repositioning was performed following LASIK for various flap-related complications. Of the 6018 eyes, 31 needed flap repositioning (0.51%). Indications were flap displacement and folds in 20 eyes (64%), flap subluxation in five eyes (16%), epithelial ingrowth and interface debris in two each, and one eye each of diffuse lamellar keratitis and incomplete flap. Final best spectacle-corrected visual acuity of ≥ 20/25 was obtained in 25/31 (80%) eyes. The efficacy index pre to post repositioning showed significant improvement (0.86 ± 0.39 vs. 0.63 ± 0.29 preop, P = 0.011). Flap repositioning incidence was significantly higher (7/602 (1.16%)) during the COVID lockdown phases compared to the non-COVID lockdown phase (24/5416 (0.44%, P = 0.019)). The COVID group had lower efficacy (0.72 ± 0.36 vs. 0.90 ± 0.39, P = 0.300) and safety indices (0.85 ± 0.24 vs. 1.06 ± 0.35, P = 0.144) compared to the non-COVID group; however, the results were not statistically significant. The flap displacement rate was statistically higher in nasal hinged (microkeratome) flaps (18/2013, 0.89%) compared to superior hinged (Femto) flaps (13/4005, 0.32%) (0.32%, P = 0.003). Our study shows that flap repositioning has a low incidence in LASIK, with the most common indication being flap displacement/folds. The outcome post flap repositioning was poorer during the lockdown period, perhaps due to the inability to follow up early. Early identification and surgical repositioning are successful in both anatomical and visual restoration.

The role of optical coherence tomography angiography in dome-shaped maculopathy

Purpose: To demonstrate the role of optical coherence tomography angiography (OCT-A) in the management of dome-shaped maculopathy (DSM). Methods: Retrospective case review. Results: A 52-year-old woman was referred to our retina service for potential bilateral choroidal neovascular membrane (CNVM) and blurry vision bilaterally. Initial spectacle-corrected visual acuity (VA) was 20/30-2 in the right eye (RE) and 20/30+2 in the left eye (LE). DSM was diagnosed on OCT. In both eyes, OCT B-scan passing through the fovea showed shallow, irregular RPE elevation (SIRE) suspicious of occult (type 1) CNVM. The outer retina and choriocapillaris angiograms showed a zone of nonexudative CNVM in the RE and exudative CNVM in the LE. Given the persistent SRF with CNVM in the LE, we elected to perform intravitreal injections of ranibizumab 0.5 mg on a treat and extend regimen. Upon the most recent follow-up, the best corrected VA improved to 20/20 in the LE with no persisting SRF. Conclusion: We present a case where assessing disease progression, the development of CNVM and evaluating the efficiency of therapies were realized through the application of novel OCT-A technology. This diagnostic tool may be used to guide clinicians in their management of DSM, as demonstrated through our experience. OCT-A can also make it possible to visualize nonexudative CNVM lesions that may be missed on traditional imaging assessments.