Bilateral methicillin-resistant Staphylococcus aureus keratitis after corneal crosslinking for keratoconus in a child.

We report the case of an 11-year-old boy known to have atopic dermatitis who was referred for management of allergic conjunctivitis, meibomian gland dysfunction, and anterior blepharitis. After achieving quiescence of these ophthalmic manifestations, he was lost to follow-up and subsequently presented with bilateral keratoconus. He developed bilateral keratitis with methicillin-resistant Staphylococcus aureus (MRSA) 1 week after corneal cross-linking. Children with underlying atopic dermatitis are more likely to harbor MRSA on their eyelid margins and conjunctival sacs and are therefore at higher risk of postoperative infection. Prevention and treatment measures, such as preoperative screening and the use of appropriate perioperative antibiotics against MRSA should always be considered in this population.

Tomographic and Refractive Characteristics of Pediatric First-Degree Relatives of Keratoconus Patients.

PURPOSE: To evaluate the tomographic and refractive characteristics of pediatric first-degree relatives of patients with keratoconus. DESIGN: Cross-sectional study. METHODS: Setting: Department of Ophthalmology at the American University of Beirut Medical, Beirut, Lebanon. STUDY POPULATION: Pediatric first-degree relatives of patients with keratoconus. Both eyes of all participants aged between 6 and 18 years were included and studied. EXCLUSION CRITERIA: Soft contact lens use in the past 2 weeks or rigid gas-permeable lens wear within 4 weeks, history of prior ocular surgery or infectious keratitis, and unreliable corneal tomography. Masking and Randomization: Two masked cornea and refractive surgeons of different training backgrounds independently evaluated the participants' tomographic outputs. Additionally, the tomographic data were analyzed using Smadja's decision tree. OBSERVATION PROCEDURES: Scheimpflug tomography, manifest refraction, and slit-lamp examination. MAIN OUTCOME MEASURES: Anterior curvature indices, posterior elevation values, thinnest pachymetry, and subjective and objective tomographic interpretation. RESULTS: One hundred eighty-three subjects were recruited. Tomographic evaluation after Cohen's kappa coefficient analysis revealed 32 patients as having keratoconus (17.5%), while 35 patients (19.1%) were labeled as keratoconus by objective analysis. There were 11.5%-15.5% of patients with keratoconus aged less than 11 years, 18.0% aged 12-15 years, and 25.5% aged 16-18 years. Their respective steepest anterior curvature and thinnest pachymetry are 44.8 ± 6.5 diopters (D) and 515.9 ± 39.2 µm, 47.34 ± 3.4 D and 496.1 ± 37.9 µm, and 49.7 ± 6.1 D and 486.0 ± 66.5 µm. A total of 37.5% of the keratoconus patients were unilateral as evaluated by tomography alone. CONCLUSIONS: The prevalence of keratoconus in pediatric first-degree relatives of diagnosed keratoconus patients is high. Screening in this high-risk group is warranted.

Automated Detection of the Stromal Demarcation Line Using Optical Coherence Tomography in Keratoconus Eyes After Corneal Cross-linking.

PURPOSE: To evaluate the role of a novel automated detection software as compared to human operators in assessing the presence and depth of stromal demarcation line on optical coherence tomography (OCT) in keratoconus eyes post cross-linking. DESIGN: Reliability analysis study. METHODS: Two independent operators and an automated detection software examined corneal OCTs of 25 eyes of 25 patients post corneal cross-linking using the Dresden protocol, at 3 months postoperatively. Operators evaluated the presence of the demarcation line and measured its depth by looking at OCT images (128 cuts) on 2 separate occasions 1 week apart. The automated software examined all 128 cuts of each OCT measurement. RESULTS: The mean corneal demarcation line depth was 321.54 ± 47.71, 322.86 ± 45.77, and 309.21 ± 40.98 µm, as computed by the automated detection software and the human operators, respectively. The intraclass correlation coefficients (ICC) between the automated detection software and Observers #1 and #2 were 0.884 and 0.847, respectively (P < .001). The ICC for interoperator reproducibility was 0.890, and for intraoperator repeatability for Operator #1 and Observer #2 were 0.922 and 0.925, respectively. The ICC for intersoftware repeatability was 1. Bland-Altman plots showed a good agreement between both observers and the software, with adequate 95% limits of agreement. CONCLUSION: Detection of the demarcation line by human operators is repeatable and reproducible, but it can be further optimized and standardized by an ultrafast and accurate automated software detection tool, providing a reliable indicator for treatment success.

Corrigendum to "Five-Year Incidence and Progression of Diabetic Retinopathy in Patients with Type II Diabetes in a Tertiary Care Center in Lebanon".

[This corrects the article DOI: 10.1155/2017/9805145.].

Ophthalmologic Outcomes of Children Born Premature Without ROP: Correlations With Gestational Age and Psychomotor Development.

PURPOSE: To study ophthalmological outcomes of premature children with no retinopathy of prematurity (ROP) and correlate with neurodevelopmental outcomes. METHODS: A total of 69 former preterm infants were evaluated at 2 to 7 years of age. Detailed ophthalmologic examinations were performed. Neurodevelopment was assessed using the Peabody Developmental Motor Scale and Wechsler Preschool and Primary Scale of Intelligence. Another 69 healthy children served as controls. RESULTS: The 69 preterm children (38 of 69 boys) and 69 controls (38 of 69 boys) had a mean age of 4.9 ± 1.5 and 4.9 ± 1.4 years, respectively. Compared to controls, preterm infants had vision impairment of 19% versus 1.4% (P = .001), hyperopia of 87% versus 98.5% (P = .21), myopia of 11% versus 1.4% (P = .017), and astigmatism of 39% versus 30.4% (P = .37). Children with any motor disability tended to have worse vision. CONCLUSIONS: In the absence of ROP, hyperopia was more common in infants 32 weeks or older who weighed more than 1,500 g at birth; other vision problems were similar in subgroups. This may represent impending myopia in those younger than 32 weeks weighing less than 1,500 g. [J Pediatr Ophthalmol Strabismus. 2017;54(1):32-38.].

Choroidal Changes in Anisometropic and Strabismic Children With Unilateral Amblyopia.

BACKGROUND AND OBJECTIVE: To detect changes in the choroidal layer at the macular area in amblyopic eyes. PATIENTS AND METHODS: A cross-sectional study of 50 amblyopic patients (20 strabismic and 30 anisometropic) and 50 controls was done. Cross-sectional images using enhanced depth optical coherence tomography (OCT) were taken. Thicknesses were measured subfoveally and at 1,500 µm nasally, temporally, inferiorly, and superiorly. Submacular corresponding choroidal areas were also computed. Parameters were compared between amblyopic eyes, fellow eyes, and controls. RESULTS: Significantly thicker choroid was detected in the subfoveal, temporal, and nasal locations (P = .007, .009, and .01, respectively) in amblyopic compared to fellow eyes; areas were also significantly greater temporally, nasally, and inferiorly. Significant differences in all choroidal measurements were found between amblyopic eyes and controls; these persisted only in the anisometropic subgroup. CONCLUSION: Using enhanced depth OCT, the choroid of amblyopic eyes was observed to be thicker compared to normal fellow eyes and controls. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:900-907.].

Central Corneal Thickness After Cross-linking Using High-Definition Optical Coherence Tomography, Ultrasound, and Dual Scheimpflug Tomography: A Comparative Study Over One Year.

PURPOSE: To assess central corneal thickness (CCT) and corneal haze in keratoconus eyes following corneal cross-linking (CXL). DESIGN: Prospective noncomparative case series. METHODS: Forty patients (44 eyes) with keratoconus that had serial evaluation for CCT, following CXL, using high-definition optical coherence tomography (HD-OCT), ultrasound pachymetry (USP), and dual Scheimpflug tomography. CCT was measured at baseline, then at 2 weeks and 1, 3, 6, and 12 months postoperatively. RESULTS: The mean baseline CCT measurements were 470.02 µm, 469.79 µm, and 466.66 µm using the HD-OCT, the USP, and dual Scheimpflug tomography, respectively (P = .91). Following CXL, the mean CCT measurements by dual Scheimpflug, at all follow-up periods, were lower compared to mean baseline reading (P < .003). The mean CCT measurements by the HD-OCT and USP were similar to baseline readings except for the thicker readings at the 2-week follow-up visit. Overall, the mean CCT obtained by the USP was similar to that obtained by the HD-OCT throughout the 12-month period. However, the mean CCT measurements obtained by dual Scheimpflug tomography were statistically and clinically significantly lower than those obtained by both HD-OCT and USP at all follow-up visits. CONCLUSIONS: USP and HD-OCT showed better agreement in CCT readings at all visits, and may better estimate the true CCT following CXL as compared to dual Scheimpflug tomography. The lower mean CCT post-CXL as measured by the latter seems to be correlated with the amount of haze that develops after cross-linking.