Long-Term Effectiveness of XEN 45 Gel-Stent in Open-Angle Glaucoma Patients.

Purpose: To assess the effectiveness of XEN45, either alone or in combination with phacoemulsification, in open-angle glaucoma (OAG) patients in clinical practice. Methods: Retrospective and single-center study conducted on OAG patients who underwent XEN45 implant, either alone or in combination with cataract surgery. We compared the clinical outcomes of the eyes of thosewho underwent XEN-solo versus those who underwent XEN+Phacoemulsification. The primary endpoint was the mean change in intraocular pressure (IOP) from baseline to the last follow-up visit. Results: A total of 154 eyes, 37 (24.0%) eyes that underwent XEN-solo and 117 (76.0%) eyes that underwent XEN+Phacoemulsification, were included. The mean preoperative IOP was significantly lowered from 19.1±5.0 mmHg to 14.9±3.8 mmHg at month-36, p<0.0001. Preoperative IOP was significantly lowered from 21.2±6.2 mmHg and 18.4±4.3 mmHg to 14.3±4.0 mm Hg and 15.2±3.7 mmHg at month-36 in the XEN-solo and XEN+Phacoemulsification groups, p<0.0004 and p=0.0009; with no significant differences between them. In the overall study population, the mean number of antiglaucoma medications was significantly reduced from 2.1±0.8 to 0.2±0.6, p<0.0001. There were no significant differences in the proportion of eyes with a final IOP ≤14 mmHg and ≤16 mmHg between XEN-solo and XEN+Phaco groups (p=0.8406 and 0.04970, respectively). Thirty-six (23.4%) eyes required a needling procedure. Conclusion: XEN implant significantly lowered IOP and reduced the need of ocular hypotensive medication, while maintaining a good safety profile. Beyond week-1, there were no significant differences in IOP lowering between XEN-solo and XEN+Phacoemulsification groups.

Microglia activation and neuronal alterations in retinas from COVID-19 patients: correlation with clinical parameters.

BACKGROUND: Different ocular alterations have been described in patients with coronavirus disease 2019 (COVID-19). Our aim was to determine whether COVID-19 affected retinal cells and establish correlations with clinical parameters. METHODS: Retinal sections and flat-mount retinas from human donors with COVID-19 (n = 16) and controls (n = 15) were immunostained. The location of angiotensin-converting enzyme 2 (ACE2) and the morphology of microglial cells, Müller cells, astrocytes, and photoreceptors were analyzed by confocal microscopy. Microglial quantification and the area occupied by them were measured. Correlations among retinal and clinical parameters were calculated. RESULTS: ACE2 was mainly located in the Müller cells, outer segment of cones and retinal pigment epithelium. Cell bodies of Müller cells in COVID-19 group showed greater staining of ACE2 and cellular retinaldehyde-binding protein (CRALBP). The 81.3% of COVID-19 patients presented disorganization of honeycomb-like pattern formed by Müller cells. Gliosis was detected in 56.3% of COVID-19 patients compared to controls (40%) as well as epiretinal membranes (ERMs) or astrocytes protruding (50%). Activated or ameboid-shape microglia was the main sign in the COVID-19 group (93.8%). Microglial migration towards the vessels was greater in the COVID-19 retinas (P < 0.05) and the area occupied by microglia was also reduced (P < 0.01) compared to control group. Cone degeneration was more severe in the COVID-19 group. Duration of the disease, age and respiratory failure were the most relevant clinical data in relation with retinal degeneration. CONCLUSIONS: The retinas of patients with COVID-19 exhibit glial activation and neuronal alterations, mostly related to the inflammation, hypoxic conditions, and age.

Liposomal Ozonated Oil in Ocular Infections: A Review of Preclinical and Clinical Studies, Focusing on Its Antiseptic and Regenerative Properties.

Ozonated oil has shown antimicrobial, anti-inflammatory and regenerative properties that make it useful in the prevention of infectious diseases and also as an adjuvant in wound-healing management. This review brings together most aspects of the use of liposomal ozonated oil for ocular infections and regeneration of the ocular surface. A search was performed in PubMed, Medline, Web of Science and Cochrane Library for studies published by June 2021. Search terms were combined to sort out papers on the properties and use of ozonated oil in ocular infections. A total of 25 publications were selected for this review on the composition, mechanism of action, restorative action, and preclinical and clinical studies of liposomal ozonated oil focused on ocular infections. In patients with complicated corneal pathology, liposomal ozonated oil has been found to restore corneal ulcers and improve keratitis. In patients with ocular pathologies involving inflammation and infections, liposomal ozonated oil has been found to improve and almost completely restore the signs of vernal, granulomatous and even adenoviral conjunctivitis. Liposomal ozonated oil has also been found to be effective in reducing ocular microbial flora. In conclusion, liposomal ozonated oil has an antiseptic and regenerative effect on corneoconjunctival tissues. It has demonstrated efficacy and safety profile for its use in ocular infections and can be considered as a suitable supportive strategy both alone and combined with other antimicrobial agents.

Corneal Endothelial Dysfunction as a Manifestation of Digoxin Toxicity.

PURPOSE: The purpose of this study was to report a case of corneal endothelial dysfunction and subsequent corneal edema in a patient with digoxin toxicity. METHOD: This was a case report. RESULTS: A 77-year-old woman diagnosed with open-angle glaucoma and treated with a topical prostaglandin analog for 5 years developed blurred vision and photopsia in both eyes. Systemic medications included digoxin, furosemide, apixaban, amlodipine, enalapril, and simvastatin. Ocular examination revealed folds in Descemet membrane and corneal stromal edema in both eyes, with normal fundoscopy. Ancillary tests revealed elevated serum digoxin levels. No intervention other than discontinuation of digoxin was initiated. The corneal edema improved after that and resolved in the next 2 weeks. CONCLUSIONS: We encountered 1 case of corneal edema secondary to corneal endothelial dysfunction in a patient with digoxin toxicity. Special care should be taken to elicit a complete history because ocular signs can be manifestations of systemic alterations with vital importance for patients.

Loss of Melanopsin-Expressing Ganglion Cell Subtypes and Dendritic Degeneration in the Aging Human Retina.

In mammals, melanopsin-expressing retinal ganglion cells (mRGCs) are, among other things, involved in several non-image-forming visual functions, including light entrainment of circadian rhythms. Considering the profound impact of aging on visual function and ophthalmic diseases, here we evaluate changes in mRGCs throughout the life span in humans. In 24 post-mortem retinas from anonymous human donors aged 10-81 years, we assessed the distribution, number and morphology of mRGCs by immunostaining vertical retinal sections and whole-mount retinas with antibodies against melanopsin. Human retinas showed melanopsin immunoreactivity in the cell body, axon and dendrites of a subset of ganglion cells at all ages tested. Nearly half of the mRGCs (51%) were located within the ganglion cell layer (GCL), and stratified in the outer (M1, 12%) or inner (M2, 16%) margin of the inner plexiform layer (IPL) or in both plexuses (M3, 23%). M1 and M2 cells conformed fairly irregular mosaics, while M3 cell distribution was slightly more regular. The rest of the mRGCs were more regularly arranged in the inner nuclear layer (INL) and stratified in the outer margin of the IPL (M1d, 49%). The quantity of each cell type decrease after age 70, when the total number of mRGCs was 31% lower than in donors aged 30-50 years. Moreover, in retinas with an age greater than 50 years, mRGCs evidenced a decrease in the dendritic area that was both progressive and age-dependent, as well as fewer branch points and terminal neurite tips per cell and a smaller Sholl area. After 70 years of age, the distribution profile of the mRGCs was closer to a random pattern than was observed in younger retinas. We conclude that advanced age is associated with a loss in density and dendritic arborization of the mRGCs in human retinas, possibly accounting for the more frequent occurrence of circadian rhythm disorders in elderly persons.

Novel Candidate Genes and a Wide Spectrum of Structural and Point Mutations Responsible for Inherited Retinal Dystrophies Revealed by Exome Sequencing.

BACKGROUND: NGS-based genetic diagnosis has completely revolutionized the human genetics field. In this study, we have aimed to identify new genes and mutations by Whole Exome Sequencing (WES) responsible for inherited retinal dystrophies (IRD). METHODS: A cohort of 33 pedigrees affected with a variety of retinal disorders was analysed by WES. Initial prioritization analysis included around 300 IRD-associated genes. In non-diagnosed families a search for pathogenic mutations in novel genes was undertaken. RESULTS: Genetic diagnosis was attained in 18 families. Moreover, a plausible candidate is proposed for 10 more cases. Two thirds of the mutations were novel, including 4 chromosomal rearrangements, which expand the IRD allelic heterogeneity and highlight the contribution of private mutations. Our results prompted clinical re-evaluation of some patients resulting in assignment to a syndromic instead of non-syndromic IRD. Notably, WES unveiled four new candidates for non-syndromic IRD: SEMA6B, CEP78, CEP250, SCLT1, the two latter previously associated to syndromic disorders. We provide functional data supporting that missense mutations in CEP250 alter cilia formation. CONCLUSION: The diagnostic efficiency of WES, and strictly following the ACMG/AMP criteria is 55% in reported causative genes or functionally supported new candidates, plus 30% families in which likely pathogenic or VGUS/VUS variants were identified in plausible candidates. Our results highlight the clinical utility of WES for molecular diagnosis of IRD, provide a wider spectrum of mutations and concomitant genetic variants, and challenge our view on syndromic vs non-syndromic, and causative vs modifier genes.

Self-Reported Sleep Duration in Patients with Neovascular Age-Related Macular Degeneration.

PURPOSE: To examine the relationship between self-reported sleep duration and neovascular age-related macular degeneration (nAMD). METHODS: This case-control study comprised 165 subjects (57 patients with nAMD and 108 controls). Controls were matched to cases by age and sex. Participants completed a questionnaire that included questions about sleep duration and quality. Four categories of sleep duration were established; <6 hours, 6-7 hours, 7-8 hours and >8 hours. Association of sleep duration and nAMD was assessed by logistic regression analysis. Multiple logistic regression models were performed to control for possible confounders. RESULTS: We found a significant association between short sleep duration and nAMD (for <6 hours, odds ratio, OR, 3.29, 95% confidence interval, CI, 1.32-8.27; for 6-7 hours, OR 2.25, 95% CI 0.80-6.32; and for >8 hours, OR 1.39, 95% CI 0.53-3.73) compared with the reference category of 7-8 hours. This association remained significant after adjustment for confounders (<6 hours, OR 3.09, 95% CI 1.20-7.97). In addition, a borderline significant association was observed between self-reported very bad sleep quality and nAMD (OR 2.84, 95% CI 1.02-7.88). The highest rate of sleep medication use was found in the nAMD group (p < 0.001). CONCLUSION: Our findings provide evidence to support an association between short sleep duration and nAMD. Considering strategies to improve sleep in these patients may prevent the negative effects of sleep deficiency.

Effect of Visual Impairment on Teleretinal Imaging for Diabetic Retinopathy Screening.

BACKGROUND AND OBJECTIVE: To evaluate the effect of decreased visual acuity on image quality obtained by non-mydriatic retinal photography in diabetic subjects. PATIENTS AND METHODS This case-control study comprised 422 eyes (211 cases with ungradable images after non-mydriatic retinal photography, and 211 controls). All subjects underwent complete ophthalmic examination. The association between ungradable image rate and several eye factors, such as corrected distance visual acuity (CDVA), spherical equivalent (SE), astigmatism, and cataracts, was evaluated using a generalized estimating equations model. RESULTS: Visual impairment (Snellen CDVA worse than 20/40) was significantly associated with an increased likelihood of ungradable images. The odds ratio (OR) for this association was 7.79 (95% CI, 4.19-14.50; P < .0001). This relationship remained significant in the multivariable model (OR: 5.23; 95% CI, 2.82-9.71; P < .0001). Similarly, refractive error worse than -6.0 diopters (D) SE or +5.0 D SE was associated with increased risk of ungradable scans, with an OR of 13.21 (95% CI, 2.61-66.77; P = .002). CONCLUSION: Decreased visual acuity may be a predictor of inaccurate image analysis in subjects screened for diabetic retinopathy by non-mydriatic retinal photography.

Evaluation of macular thickness changes after intracameral vancomycin in cataract surgery.

The purpose of this study was to determine the effect of intracameral injection of vancomycin at the end of routine cataract surgery on macular thickness using spectral domain optical coherence tomography. This prospective comparative case series included sixty eyes of 42 patients undergoing cataract surgery. Eyes were divided into two groups: 30 eyes (Group 1) received an intracameral injection of vancomycin (1 mg/0.1 ml) at the end of surgery, and 30 eyes (Group 2) received an intracameral injection of cefuroxime (1 mg/0.1 ml). Visual acuity, average macular thickness, and retinal thickness in 9 Early Treatment Diabetic Retinopathy Study (ETDRS) sectors were measured at baseline, and 1 week, 1 month, and 3 months after surgery. There were no differences in age, gender, visual acuity, and preoperative macular thickness between groups. In Group 1, average macular thickness significantly increased 1 month after surgery compared with baseline (P = 0.000) and then stabilized. Retinal thickness significantly increased in most of the ETDRS map sectors at 1-month follow-up. In Group 2, there was a significant increase in average macular thickness 1 month after surgery compared with baseline (P = 0.037). Likewise, retinal thickness increased in most of the ETDRS subfields at 1 month. Postoperative retinal thickness values and best-corrected visual acuity were similar in both groups 1 week, 1 month, and 3 months after surgery. Intracameral injection of vancomycin at the end of cataract surgery showed comparable effects to cefuroxime in terms of macular thickness changes and visual acuity.

Severe keratomalacia after 12 months of continuous hydrogel contact lens wear in a psychiatric patient.

A 53-year-old cachectic patient diagnosed with major depressive disorder was referred to our department for evaluation of a visible deformation of the right eye. She had been wearing hydrogel contact lenses on a continuous basis without removal for the last 12 months, influenced by low self-esteem and social isolation. Slit-lamp examination of the right eye showed a conical cornea, extensive neovascularization, severe stromal melting with descemetocele formation and forward bulging of the iris. Examination of the left eye revealed multiple corneal opacities, deep stromal neovascularization and anterior chamber inflammation. No sign of infection was present. Vitamin A deficiency was suspected and later confirmed. The patient required evisceration of the right eye and psychiatric treatment. Inflammatory signs of the left eye resolved within 1 week of initiating treatment. This case illustrates the synergistic effect of soft contact lens abuse and vitamin A deficiency in a psychiatric patient, and emphasizes the importance of instructing vulnerable patients on appropriate lens use and care.

Corneal endothelial changes after intracameral vancomycin injection in cataract surgery.

PURPOSE: To evaluate corneal endothelial changes after intracameral injection of vancomycin at the end of routine cataract surgery. SETTING: Department of Ophthalmology, Hospital Virgen de los Lirios, Alcoy, Alicante, Spain. DESIGN: Prospective comparative case series. METHODS: Eyes received an intracameral injection of vancomycin (1 mg/0.1 mL) or cefuroxime (1 mg/0.1 mL) at the end of surgery. The visual acuity, corneal clarity, pachymetry, anterior chamber reaction, endothelial cell density (ECD), coefficient of variation (CoV), and hexagonality were evaluated at baseline and 1 week, 1 month, and 3 months after surgery. RESULTS: Sixty eyes (42 patients), 30 in each group, were enrolled. In the vancomycin group, there was a significant decrease in ECD 1 week after surgery (P = .000), after which the ECD stabilized. There were no statistically significant changes in postoperative CoV values between preoperatively and postoperatively, although there was a transient decrease in hexagonality 1 week after surgery (P = .006). In the cefuroxime group, the ECD significantly decreased 1 week after surgery (P = .000) and then stabilized. There was a statistically significantly decrease in the CoV between preoperatively and 3 months postoperatively (P = .014). No changes were noted in hexagonality. The postoperative ECD, CoV, and hexagonality values were not significantly different between the vancomycin group and the cefuroxime group. CONCLUSIONS: Endothelial cell changes observed after intracameral vancomycin were similar to those observed after intracameral cefuroxime in cataract surgery. The results indicate that intracameral vancomycin is safe for use in cataract surgery. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Epidemiological analysis of an outbreak of diffuse lamellar keratitis.

PURPOSE: To describe the incidence, causes, risk factors, and preventive strategies regarding an outbreak of diffuse lamellar keratitis (DLK). METHODS: Between March and October 2007, an epidemic of DLK was detected in one center. During this period, 6 surgeons performed 1161 LASIK or flap lift procedures. From March to August 2007, data were retrospectively collected corresponding to pre- and postoperative clinical findings and environmental risk factors related to the operating room, auxiliary staff, sterilization, and surgical equipment (phase 1). Incidence and distribution of cases are described. From August to October 2007, a prospective epidemiological study was completed, analyzing the clinical and intraoperative variables associated with the outbreak (phase 2). A plan of action was applied covering a wide range of possible causes. RESULTS: During phase 1, 25.79% of eyes developed DLK. A greater incidence was found in eyes operated on Mondays and a smaller incidence was found when povidone-iodine was used for disinfection of the instruments. Actions taken by the staff to stop the outbreak had no effect, and epidemiologists designed a strategy aimed at addressing all possible weak points and the prospective study for detecting causes. The incidence decreased to 1.87% and a weak significant association was found for sex, atopy, drug allergies, spherical equivalent refraction, and mechanical microkeratome. CONCLUSIONS: Strategies aimed at addressing all possible etiological factors can stop an epidemic of DLK even when a single cause has not been isolated.

Refractive stability of LASIK with the Visx 20/20 excimer laser vs ZB5m phakic iol implantation in patients with high myopia (>-10.00 d): a 10-year retrospective study.

PURPOSE: To compare the long-term outcomes of LASIK and ZB5M phakic intraocular lens implantation (PIOL) (Domilens) for high myopia (>-10.00 diopters [D]). METHODS: This long-term (10 years) follow-up retrospective interventional case series study included 126 eyes that underwent LASIK and 52 eyes that underwent ZB5M angle-supported PIOL implantation. Both groups of eyes were similar in terms of preoperative spherical equivalent refraction (SE), corrected distance visual acuity (CDVA), and age. RESULTS: Mean preoperative SE was -14.33 D in the LASIK group and -14.84 D in the PIOL group. At 10-year follow-up, mean postoperative SE was -1.47±2.00 D in the LASIK group and -1.01±1.36 D in the PIOL group (P=.21). In the LASIK group, 67% of eyes were within ±1.00 D of emmetropia at 2 years after surgery, compared to 42% at 10 years. In the PIOL group, 68% of eyes were within ±1.00 D of emmetropia 2 years after implantation compared to 53% at 10 years. In the LASIK group, 43.5% of eyes achieved UDVA of 20/40 or better 10 years after surgery compared to 67.9% in the PIOL group (P=.02). CONCLUSIONS: The ZB5M angle-supported PIOL was shown to have better predictability and stability compared to LASIK over 10 years. However, reductions in endothelial cell count over time were observed in eyes with PIOLs.

New corneal neovascularization model in rabbits for angiogenesis research.

PURPOSE: To evaluate a new experimental model of suture-induced corneal neovascularization (NV) for angiogenesis research. METHODS: The new model was created in the right eye of 20 New Zealand rabbits using 5 interrupted silk sutures following an inverted triangle pattern. At different time points after suture placement, calibrated photographs were taken to quantify the corneal surface covered by the sutures (SCS) and the corneal NV response. At the end of the experiment, the corneas were processed for histological study. RESULTS: Vascular sprouts were already observed on the 3rd day. On the 7th day, the mean corneal NV surface was 19.02 ± 4.65 mm(2). On the 14th day, the mean corneal NV surface increased up to 28.96 ± 6.33 mm(2), representing 112.18% of the SCS and 21.04% of the total corneal surface. Histological sections showed that the new vessels were located at the two anterior thirds of the corneal stroma with an intense inflammatory infiltration. CONCLUSION: Our results indicate that this experimental model is effective, reliable and reproducible to induce corneal NV for angiogenesis research.

Inhibition of corneal neovascularization by topical bevacizumab (Anti-VEGF) and Sunitinib (Anti-VEGF and Anti-PDGF) in an animal model.

PURPOSE: To evaluate the effects of topically applied bevacizumab and sunitinib on experimentally induced corneal neovascularization. DESIGN: Experimental animal study. METHODS: Thirty-six New Zealand rabbits were involved. One eye per rabbit was used. Corneal neovascularization was induced by placing 5 silk sutures in the upper cornea. Rabbits were randomized to 1 of 3 groups (12 rabbits each): Group 1 received saline 0.9%, Group 2 bevacizumab 5 mg/mL, and Group 3 sunitinib 0.5 mg/mL. All treatments were administered 3 times daily for 14 days. Photographs were taken on a slit lamp on days 7 and 14, and angiographic photographs were taken on day 14. The area of neovascularization was measured in mm(2), percentage of the total corneal area, and percentage of the corneal surface covered by sutures. RESULTS: On day 14, corneal neovascularization area in Group 1 (25.92 ± 5.08 mm(2), 18.78% ± 3.5% of corneal surface, 105.59% ± 18.9% of corneal surface with sutures) was larger than in Groups 2 (18.52 ± 7.94 mm(2), 13.67% ± 5.8%, 76.35% ± 33.2%) (1-way analysis of variance, P = .041) and 3 (4.57 ± 2.32 mm(2), 3.40% ± 1.7%, 18.94% ± 9.2%)(P < .001). Neovascularization in Group 2 was larger than in Group 3 (P < .001). Compared to saline, corneal neovascularization was inhibited 28.5% by bevacizumab and 82.3% by sunitinib. Sunitinib settled on the iris. CONCLUSIONS: Topical administration of both bevacizumab and sunitinib inhibits corneal neovascularization in rabbits. But vascular endothelial growth factor (VEGF) pathway blockade by bevacizumab was not sufficient for a profound inhibition. Blocking both VEGF and platelet-derived growth factor pathways using sunitinib was 3-fold more effective.

Microbial keratitis after intrastromal corneal ring segment implantation.

PURPOSE: To evaluate the incidence of acute microbial keratitis after intrastromal corneal ring segment implantation and to investigate whether microbial keratitis is related to the intrastromal corneal ring type or surgical technique. METHODS: Intrastromal corneal ring segments were implanted in 212 eyes of 149 patients. Two different types of intrastromal corneal ring segments were used during the study, Intacs and Ferrara rings, and two surgical techniques were used for intrastromal corneal ring segment implantation, manual and femtosecond laser. RESULTS: One hundred thirty-four eyes (63.2%) underwent Intacs implantation and 78 (36.8%) eyes received Ferrara rings. Corneal tunnels were created using the manual technique in 119 (56.1%) eyes and by femtosecond laser in 93 (43.9%) eyes. Three cases (1.4%) of acute microbial keratitis were clinically identified. Cultures were positive in 2 eyes and negative in 1 eye, and polymerase chain reaction was positive in all 3 cases. The microorganisms isolated from cultures were Streptococcus mitis and Staphylococcus aureus. In 2 cases, the femtosecond laser technique was used (1 eye Intacs, 1 eye Ferrara), and in 1 case, the manual technique was used (Intacs). No statistically significant difference was noted between techniques (P=.582) or segment type (P=1.000). In all cases, intrastromal corneal ring segments were explanted and intensive topical antibiotics were used with clinical success. CONCLUSIONS: Acute microbial keratitis incidence after intrastromal corneal ring segment implantation was 1.4%. Gram-positive cocci were the organisms isolated more frequently. Proper management of this condition requires intrastromal corneal ring segment explantation and intensive topical antibiotics.

Comparison of LASIK and photorefractive keratectomy for myopia from -10.00 to -18.00 diopters 10 years after surgery.

PURPOSE: To compare the long-term outcomes of LASIK and photorefractive keratectomy (PRK) for high myopia (> or = -10.00 diopters [D]). METHODS: This retrospective study included eyes with high myopia that underwent PRK (51 eyes) and LASIK (141 eyes) at the Instituto Oftalmologico de Alicante, Spain, and returned for 10-year follow-up. RESULTS: Ten years after surgery, 45.5% of eyes in the LASIK group achieved uncorrected visual acuity (UCVA) of 20/40 or better compared to 31.3% in the PRK group. Mean efficacy indices after 10 years in both groups were similar (0.87 in the LASIK group and 0.82 in the PRK group, P=.51). Twenty-one (41%) eyes in the PRK group were within +/-1.00 D whereas 60 (42.5%) eyes from the LASIK group were within +/-1.00 D 10 years after surgery. Six (14%) eyes from the PRK group lost 2 or more lines of BSCVA compared to 7 (6%) eyes from the LASIK group. CONCLUSIONS: LASIK and PRK have been shown to have similar visual acuity efficacy in the treatment of eyes with high myopia in the long-term, with LASIK having superior visual acuity efficacy and safety over PRK within the first 2 years after surgery. However, treatment of myopia > or =-10.00 D by LASIK is no longer routinely advocated whereas the treatment of high myopia by PRK is no longer performed due to potential complications associated with the treatment. Haze in postoperative PRK eyes was a significant long-term problem in our study.

Pyrenochaeta keratinophila sp. nov., isolated from an ocular infection in Spain.

The new coelomycete Pyrenochaeta keratinophila, isolated from corneal scrapings of a case of keratitis in Spain, is described and illustrated. This fungus is morphologically characterized by grey-olivaceous to greenish olivaceous colonies, scarce pycnidial setae placed mainly near the ostiole and production of phialoconidia from the aerial mycelium. The latter feature is unknown in any other species of the genus Pyrenochaeta. Sequencing of the ITS rDNA region of this clinical strain confirmed this proposal and revealed its close genetic relationship with the Leptosphaeriaceae.

Microbial keratitis after corneal collagen crosslinking.

Several infiltrates appeared in the upper midperipheral cornea of a 29-year-old woman who had had uneventful corneal collagen crosslinking (CXL) with riboflavin and ultraviolet-A light (UVA) for the treatment of keratoconus in the right eye. Staphylococcus epidermidis keratitis was confirmed by microbiological studies, which guided treatment with topical fortified antibiotic agents. Before CXL, the best spectacle-corrected visual acuity (BSCVA) in the right eye was 20/25, the manifest refraction was -0.25 -0.25 x 125, and the anterior segment was normal under biomicroscopy. Five months after the procedure, the BSCVA was 20/22, the manifest refraction was +1.00 -2.50 x 40, and slitlamp examination revealed a mild residual haze in the upper midperipheral cornea. Collagen crosslinking with riboflavin-UVA is a minimally invasive method but traditionally requires epithelial removal, which could be a predisposing factor to bacterial keratitis.