New Imaging Technology for Simultaneous Multiwavelength-UWF Fundus Fluorescein Angiography and Indocyanine Green Angiography With Navigated Central and Peripheral SS-OCT.

OBJECTIVE: Our aim was to assess central and peripheral retinal and choroidal diseases using novel simultaneous multiwavelength-ultra-widefield (MW-UWF) fundus fluorescein angiography (FFA)/indocyanine green angiography (ICGA) with navigated central and peripheral swept-source optical coherence tomography (SS-OCT) technology. METHODS: Retrospective evaluation was carried out of 30 consecutive patients (60 eyes) who underwent UWF red/green (RG), infrared (IR), FFA and ICGA with simultaneous navigated SS-OCT using Optos Silverstone (Optos PLC). Angiographic retinal and choroidal findings in vascular pathologies and their relationship with the vitreoretinal interface (VRI) were assessed. RESULTS: Simultaneous FFA with navigated SSOCT was performed in all patients and simultaneous FFA-ICGA with SS-OCT in 18 eyes (30%). Cross-sectional central and peripheral changes in the retina, choroid, and VRI corresponding with angiographic findings in several diseases were imaged. CONCLUSION: First-in-human study of a new technology providing UWF RG/FFA/ICGA with simultaneous navigated central and peripheral SS-OCT can guide clinical management and provide new insights and understanding of central and peripheral retinal and choroidal disease. [Ophthalmic Surg Lasers Imaging Retina 2023;54:401-410.].

Surgically induced corneal necrotizing keratitis following LASIK in a patient with inflammatory bowel disease.

We describe a case of necrotizing keratitis that developed after laser in situ keratomileusis (LASIK) in a 50-year-old woman with inflammatory bowel disease. The patient had not disclosed her history of a total colectomy for recurrent ulcerative colitis and developed bilateral stromal inflammation and corneal melting along the flap edge with ulceration within 3 days of uneventful bilateral LASIK for myopia. She was aggressively managed with topical and systemic corticosteroid therapy. Flap infiltrates gradually resolved, with no relapse during the 12-month follow-up. This case highlights the importance of taking a detailed history, specifically addressing autoimmune diseases, before corneal refractive surgery.

Penetrating and deep anterior lamellar keratoplasty for keratoconus: a comparison of graft outcomes in the United kingdom.

PURPOSE: To compare outcomes after penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) for keratoconus in the United Kingdom. METHODS: Patient outcome data were collected at the time of transplantation and at 1, 2, and 5 years after surgery. Data were analyzed by Kaplan-Meier survival curves, Cox regression, and binary logistic regression to determine the influence of surgical procedure on graft survival and visual outcome. RESULTS: The risk of graft failure for DALK was almost twice that for PK (P = 0.02). Nineteen percent of the DALK failures occurred in the first 30 postoperative days compared with only 2% of PK failures. When these early failures were excluded, there was little difference between the 3-year graft survivals for DALK (92%; 95% confidence interval [CI], 85%-95%) and PK (94%; 95% CI, 92%-95%) (P = 0.8). Although the mean best corrected visual acuity (BCVA) was similar for the two procedures (P = 0.7), 33% of patients who underwent PK achieved a BCVA of 6/6 or better at 2 years compared with only 22% of those who underwent DALK (P < 0.001). Those with DALK were also likely to be more myopic (< -3 D) but there was little difference in scalar cylinder. CONCLUSIONS: DALK had a higher overall failure rate than PK. The difference was largely accounted for by early failures, which appeared to be related to the surgeon's experience. DALK recipients were less likely to achieve BCVA of 6/6 than were PK recipients and were more likely to have -3 D or worse myopia.

Deep corneal calcification associated with preservative-free eyedrops and persistent epithelial defects.

PURPOSE: To describe the formation of deep calcareous degeneration of the cornea associated with the use of preservative-free eyedrops in patients with a persistent epithelial defect and active ocular surface inflammation. METHODS: A case series of 6 patients with persistent epithelial defects (1 with diabetes, 3 with penetrating keratoplasty, and 2 with herpes zoster) treated with preservative-free medications was reviewed over 18 months. Each patient subsequently developed deep calcareous corneal degeneration. Data regarding underlying etiology, diagnosis, clinical findings, and medications used were recorded. Each medication used was analyzed for phosphate levels by using a Roche 917 analyzer. RESULTS: All 6 cases of calcareous degeneration of the cornea had persistent epithelial defects, treated with preservative-free medications (timolol, dexamethasone, and prednisolone), in the presence of active inflammation on the ocular surface. The mean levels of phosphate were 130, 42.9, and 22.9 mM in timolol, dexamethasone, and prednisolone, respectively. All 6 patients had some degree of corneal opacification and reduced visual acuity. CONCLUSIONS: A contributory factor in our case series seems to be the use of preservative-free medications in persistent epithelial defects. The preservative-free medications we measured had high levels of phosphate, which may not be common knowledge.

Acute retinal necrosis secondary to herpes simplex virus type 2 with preexisting chorioretinal scarring.

Acute retinal necrosis in children is a devastating disease that requires early diagnosis and treatment. The authors describe a rarely reported case of bilateral acute retinal necrosis in a child caused by neonatal herpes simplex virus type 2, where the presence of previous chorioretinal scarring made diagnosis challenging.

Clinical outcome study of a modified surgical technique for pterygium excision.

BACKGROUND: Pterygium is a common condition that has many and varied surgical management techniques. Our aim was to describe and evaluate the safety and efficacy of a modified tissue-sparing surgical procedure for management of pterygium. METHODS: This was a retrospective, clinical outcome study of 67 consecutive pterygium head excisions and mini inferior conjunctival autografts (PHEMICA), performed by a single senior surgeon over 7 years. The technique evaluated was a modified pterygium head removal and inferior conjunctival autograft, maximising host tissue preservation. RESULTS: Group A (primary pterygia): 5.25% recurrence rate (3 of 57 eyes). Group B (recurrent pterygia): 30% recurrence rate (3 of 10 eyes). No major complications occurred. One partial autograft necrosis was noted (1.5%, 1 of 67 eyes), with full resolution. INTERPRETATION: The described technique is fast, safe, and effective with a 5.25% recurrence rate in those with primary pterygia. It is not, however, recommended in the treatment of recurrent pterygia; this group of patients requires a more radical excision with a larger autograft and the use of adjuncts such as mitomycin C.

Tumor necrosis factor alpha blockade with infliximab for refractory uveitis and scleritis.

OBJECTIVE: To assess the efficacy and safety of the anti-tumor necrosis factor alpha agent infliximab in treatment-resistant uveitis and scleritis. DESIGN: Retrospective, noncomparative interventional case series. PARTICIPANTS: Seven patients with noninfectious ocular inflammatory disease that was refractory to alternative immunosuppression. These included one patient with idiopathic retinal vasculitis and panuveitis, one patient with intermediate uveitis, one patient with chronic juvenile anterior uveitis, three patients with scleritis, and one patient with scleritis and peripheral ulcerative keratitis. Four patients had an underlying systemic disease that was in remission in three cases. INTERVENTION: Infusions of infliximab, 200 mg, were given at 4-week to 8-week intervals, depending on the clinical response. MAIN OUTCOME MEASURES: Clinical response, including symptoms, visual acuity, degree of scleral vascular engorgement, corneal thinning, anterior chamber activity, and posterior segment inflammation, reduction in concomitant immunosuppression, and adverse effects. RESULTS: The mean patient age was 47 years (range, 24-78), and four patients were female. The mean number of infliximab infusions was seven (range, 2-19), and the mean follow-up period was 12 months (range, 4-22 months). Six patients experienced a clinical improvement, with five achieving remission and significant reduction in immunosuppression. One patient showed an initial response but developed a delayed hypersensitivity response that precluded further treatment. No other adverse effects occurred. CONCLUSIONS: Infliximab seems to be an effective and safe treatment for noninfectious uveitis and scleritis and may be indicated as rescue therapy for relapses of ocular inflammation or as maintenance therapy when conventional immunosuppression has failed. Further investigation of infliximab for treatment-resistant scleritis and uveitis is warranted.