Comparison of optical aberrations in keratoconus with scleral versus rigid gas permeable lenses.

PURPOSE: to assess optical aberrations under scleral (SL) versus rigid gas permeable (RGP) lenses in patients with keratoconus. METHODS: A prospective study including 25 eyes of 14 patients. The best-corrected visual acuity (BCVA) with corrective glasses, RGP and SL, stage of keratoconus (Amsler-Krumeich classification), minimum pachymetry, maximum keratometry, and corneal higher-order aberrations (i.e, total HOAs, coma, and trefoil) with RGP and with SL were collected. Aberrometry was performed using iTrace® aberrometer (Tracey Technologies, USA). RESULTS: 80% of the included keratoconus patients were stage 4, with a mean age of 34.3 years (±8.8). There were no significant differences in mean BCVA (logMAR) between SL and RGP. The mean BCVAs were significantly better both with SL (p < 0.0001) and RGP (p < 0.0001) compared with corrective glasses. Total HOAs (p = 0.01), coma (p = 0.003) and trefoil (p = 0.008) were significantly lower with SL compared with RGP. The BCVA decreased with the stage of keratoconus in SL (p = 0.01) and RGP (p = 0.02). The BCVA decreased with decreasing minimum pachymetry in SL (p = 0.02) and RGP (p = 0.002), and with increasing maximum keratometry in SL (p = 0.02) and RGP (p = 0.01). Significant correlations were found between BCVA, total HOAs (p = 0.008), and coma (p = 0.02) in SL. CONCLUSION: For the same keratoconus patients, total higher order, coma and trefoil optical aberrations were reduced with scleral lenses compared to rigid gas permeable lenses.

Freeze-dried amniotic membrane graft with a spongy layer in bilateral peripheral ulcerative keratitis: a case report.

BACKGROUND: Peripheral ulcerative keratitis (PUK) is a group of inflammatory corneal ulcers with stromal thinning and peripheral localization. Amniotic membranes (AM) are used for their anti-inflammatory and healing properties. A freeze-drying process now allows maintaining the AM viable for a long time at room temperature without altering its physical, biological, and morphologic characteristics. The effectiveness of spongy freeze-dried amniotic membrane (FD-AM) graft with multimodal imaging in the management of severe corneal thinning PUK has not been reported. CASE PRESENTATION: A 67-year-old Caribbean man histologically diagnosed with ulcerative colitis, was referred to our tertiary eye care center for a deep nasal juxtalimbal ulcer of the left eye. He was treated with topical steroids and antibiotics, methylprednisolone pulses, and oral prednisone. Due to continuous stromal thinning with 100 µm of residual corneal thickness, the decision was made to perform surgery. Conjunctival resection, inlay and overlay spongy FD-AM (Visio Amtrix® S, Tissue Bank of France, FR) were performed to preserve globe integrity. Despite tapering off oral steroids, PUK developed in the fellow eye on the 2 months follow-up. Treatment with human monoclonal antibody against tumor necrosis factor-alpha was initiated to control the active underlying inflammation. Six months following surgery, the ulcer was healed and corneal thickness in front of the former ulceration was measured at 525 µm on anterior segment-optical coherence tomography. Confocal microscopy confirmed the integration of the amniotic membrane between the corneal epithelium and the anterior stroma. CONCLUSION: Transplantation of FD-AM with a spongy layer was associated with restoration of normal corneal thickness in the PUK area. It seems to be a safe, effective, and easily accessible solution for the surgical management of PUK with impending perforation.

EYERUBBICS: The Eye Rubbing Cycle Study.

Purpose: Describe the cognitive and behavioral symptomatology of patients with chronic ocular rubbing in keratoconus (KC) and Ocular Surface Disease (OSD) using a self-questionnaire. Methods: A prospective study was conducted in a tertiary ophthalmology center between May and July 2021. We consecutively included all patients presenting with one of the following conditions: KC and OSD. A questionnaire including the evaluation of Goodman and CAGE-modified criteria for eye rubbing was given to patients in consultation to evaluate their ocular symptoms and medical background. Results: We included 153 patients in the study. Of these, 125 (81.7%) patients reported eye rubbing. The average Goodman score was 5.8 ± 3.1 and was ≥ 5 in 63.2% of cases. The CAGE score was ≥ 2 in 74.4% of patients. Addiction (p = 0.045) and psychiatric family history (p = 0.03) were more frequent in patients with higher scores. Ocular symptoms and eye rubbing were significantly more frequent and intense in patients with higher scores; Conclusion: Eye rubbing presents addictive-like cognitive and behavioral characteristics in patients with KC or OSD. The eye rubbing cycle could play an essential role in the onset and progression of keratoconus and could be a factor in the maintenance of dry eye.

Corneal Epithelial Thickness Mapping in the Diagnosis of Ocular Surface Disorders Involving the Corneal Epithelium: A Comparative Study.

PURPOSE: The purpose of this study was to analyze the role of corneal epithelial thickness (ET) mapping provided by spectral domain optical coherence tomography in the diagnosis of ocular surface disorders (OSDs) involving the corneal epithelium. DESIGN: This was a retrospective comparative study. METHODS: Institutional settings are as follows. Study population includes 303 eyes with an OSD and 55 normal eyes (controls). Observation procedures include spectral domain optical coherence tomography with epithelial mapping in the central 6 mm. Main outcome measures include ET map classification (normal, doughnut, spoke-wheel, localized/diffuse, and thinning/thickening patterns) and ET data and statistics (minimum, maximum, and SD). A quantitative threshold was determined with receiver operating curves to distinguish pathological from normal corneas. Sensitivity and specificity of classification and quantitative data were calculated using all eyes to assess the ability to distinguish corneas with a given corneal disorder from other conditions. RESULTS: Classification of full agreement between 3 readers was obtained in 75.4% to 99.4% of cases. Main OSD features were keratoconus (135 eyes), doughnut pattern (sensitivity/specificity = 56/94%), and max-min ET ≥ 13 µm (84/43%); limbal deficiency (56 eyes), spoke-wheel pattern (66/98%), and max-min ET ≥ 14 µm (91/59%); epithelial basement membrane dystrophy (55 eyes), inferior thickening pattern (55/92%), and central ET > 56 µm (53/81%); dry eye (21 eyes), superior thinning pattern (67/88%), and minimal ET ≤ 44 µm (86/48%); pterygium (10 eyes), nasal thickening pattern (100/86%), and nasal ET > 56 µm (80/71%); and in situ carcinoma (11 eyes), max ET > 60 µm (91/60%), and ET SD >5 µm (100/58%). CONCLUSIONS: The epithelial map pattern recognition combined with quantitative analysis of ET is relevant for the diagnosis of OSDs and for distinguishing various OSDs from each other. Deep learning analysis of big data could lead to the fully automated diagnosis of these disorders.

Anterior chamber tap cytology in acute postoperative endophthalmitis: a case-control study.

AIMS: To determine anterior chamber tap cytology characteristics in acute postoperative bacterial endophthalmitis. METHODS: 488 eyes of 488 patients were included in this retrospective case-control study. The study group included 93 eyes with bacteriologically documented endophthalmitis and 85 eyes with clinical endophthalmitis. The control group included 33 eyes with non-infectious postoperative inflammation, 116 eyes with acute uveitis and 161 cataract surgery eyes with no ocular inflammation. Cytological analysis, direct examination and microbiological cultures were performed in aqueous humour (AqH) samples. Inclusion criteria for the study group were the following: suspected endophthalmitis within 30 days following cataract surgery by phacoemulsification, secondary lens implantation, pars plana vitrectomy or intravitreal injection; best-corrected visual acuity (BCVA) <20/400; hypopyon or cyclitic membrane; absence of visibility of the retina; vitritis at a slit-lamp examination or in ultrasound B-scan. RESULTS: Cell line counts (mainly polymorphonuclear neutrophils) were significantly higher in the two endophthalmitis study subgroups than in the three control subgroups. The study group showed a predominance of polymorphonuclear neutrophils as opposed to the three control subgroups including uveitis (p<0.00001). The best sensitivity/specificity was obtained using a polymorphonuclear neutrophil threshold of 10 per field (sensitivity, 0.90; specificity, 0.75). The sensitivity of the bacterial culture was 32% in the AqH. High neutrophil count was associated with poorer initial BCVA (rs=0.62; p<0.00001) and higher risk of retinal detachment during (p=0.04) and after (p<0.001) hospitalisation. CONCLUSION: Anterior chamber tap cytology is a quick and accessible tool complementary to culture and PCR for the management of acute postoperative endophthalmitis.

Freeze-Dried Versus Cryopreserved Amniotic Membranes in Corneal Ulcers Treated by Overlay Transplantation: A Case-Control Study.

PURPOSE: The purpose of this study was to assess cryopreserved amniotic membrane (C-AM) versus chorion-free freeze-dried amniotic membrane (FD-AM) overlay transplantation for corneal ulcers in a French tertiary ophthalmology hospital. METHODS: Between March and July 2020, when C-AMs were not available because of the COVID-19 pandemic, 28 corneal ulcers underwent FD-AM overlay transplantation and were retrospectively compared with 22 corneal ulcers treated with C-AM during the same period in 2018. All patients had at least 3 months of follow-up, and those who underwent combined surgeries were excluded. Ulcers were assessed at baseline and then at 72 hours, 1 month, and 3 months. Population demographics, follow-up time, ulcer etiologies, epithelial defect size, ulcer depth, and complications were also recorded. RESULTS: Baseline characteristics and clinical features of both groups were comparable. There was no statistically significant difference in the number of overlay AM transplantations (P = 0.52) or early detachments (P = 0.57). At 3 months, the corneal healing rate was almost the same in both groups (89% and 91% for FD-AM and C-AM, respectively; P = 0.87). Complications were equally uncommon (11% and 9%, respectively; P = 0.92). In logistic regression, the type of the membrane did not influence corneal healing at 1 month (P = 0.42) or 3 months (P = 0.99), regardless of the depth of the ulcer. However, whatever the type of AM used, the deeper the ulcer was, the less likely it was to heal at 3 months (P = 0.02). CONCLUSIONS: This is the first study that provides positive insight into the effectiveness of FD-AM compared with C-AM when used as overlay transplantation for treating corneal ulcers.

Update on fungal keratitis in France: a case-control study.

PURPOSE: To report an epidemiological update of documented fungal keratitis (FK) in a French tertiary ophthalmological centre from 2014 to 2018 in comparison with a previous period from 1993 to 2008. METHODS: Sixty-two consecutive FK documented by microbiological corneal scrapings were compared with the 64 FK of the previous study. Amphotericin B and voriconazole eye drops were administered hourly. Population characteristics, clinical findings, aetiological organisms and treatments were analysed. RESULTS: The most frequently identified fungi were Fusarium (61%), Aspergillus (6.5%) and Candida (5%). Thirty out of 44 cases examined with in vivo confocal microscopy (IVCM) presented filaments. Ten required conventional cross-linking, 9 therapeutic penetrating keratoplasty, and 2 enucleation. Risk factors significantly associated with the absence of response to medical treatment were patient age (p = 0.01), presence of a deep stromal infiltrate at presentation (p = 0.04) and high numbers of filaments in IVCM images (p = 0.01). The two populations were comparable in age, but not in sex ratio males/females (18/44 versus 37/26 in the previous study; p = 0.001). The frequency of contact lens-associated infection increased from 35.5% to 71% (p = 0.0001) between the two periods. Since then, filamentous FK increased from 69% (44/64) to 95% (59/62) (p = 0.0001). A history of keratoplasty was less frequently reported during the last period (3.2% (2/62) versus 17% (11/64) of cases (p = 0.01)). A clear decrease in the frequency of therapeutic keratoplasty was noted from 39% (25/64) to 14% (9/62) (p = 0.02). CONCLUSION: The frequency of filamentous keratomycosis is currently increasing. Elderly patients and the presence of numerous filaments in IVCM are associated with poor clinical outcomes.

Prevention of infection after corneal refractive surgery: a French survey.

PURPOSE: To report the French refractive surgeons' real-life practices for preventing infection after corneal refractive surgery (photorefractive keratotomy [PRK], laser in situ keratomileusis [LASIK], and small-incision lenticule extraction). SETTING: France. DESIGN: Anonymous practice survey. METHODS: The questionnaire was sent in a single email invitation to 400 declared refractive surgeons. The following information was recorded between December 2019 and April 2020, before the coronavirus pandemic: demographics data, preoperative evaluation and preparation of the patient, surgical management, immediate and postoperative protocol, and infections reported after corneal refractive surgery. RESULTS: Eighty-three of 400 surgeons (20.75%) responded to the questionnaire; 55 (66.0%) performed more than 50 corneal refractive surgeries a year, and 25 (30.1%) performed more than 200 procedures a year. Thirty-six (43.4%) surgeons wore 3 protective items, 37 (44.6%) 2, 5 (6.0%) 1, and 5 (6.0%) zero. Seventy-seven (92.8%) surgeons used povidone-iodine for skin area disinfection and 54 (65%) for conjunctival fornix disinfection. The contact time of povidone-iodine was less than 3 minutes for 71 (85.0%) surgeons. Twenty surgeons (24.1%) reported at least 1 postrefractive surgery infection. Twenty percent of surgeons who wore sterile gloves for PRK reported postoperative infections compared with 62.5% for those who did not (P = .008). These figures were, respectively, 8.7% and 66.7% for the use of sterile gloves during LASIK (P = .002); 8.9% of surgeons who wore surgical masks for LASIK reported postoperative infections compared with 50.0% for those who did not (P = .01). CONCLUSIONS: Practices are variable among French refractive surgeons. Wearing a surgical mask and sterile gloves during corneal refractive surgery appears to be advisable.