Assessing the Risk Factors For Diagnosed Symptomatic Dry Eye Using a Smartphone App: Cross-sectional Study.

BACKGROUND: Dry eye (DE) is a chronic inflammatory disease of the ocular surface of the eye that affects millions of people throughout the world. Smartphone use as an effective health care tool has grown exponentially. The "Dry eye or not?" app was created to evaluate the prevalence of symptomatic DE, screen for its occurrence, and provide feedback to users with symptomatic DE throughout Thailand. OBJECTIVE: The purpose of this study was to compare the prevalence of symptomatic dry eye (DE), blink rate, maximum blink interval (MBI), and best spectacle-corrected visual acuity (BSCVA) between people with and without symptomatic DE and to identify risk factors for symptomatic DE in Thailand. METHODS: This cross-sectional study sourced data from the "Dry eye or not?" smartphone app between November 2019 and July 2020. This app collected demographic data, Ocular Surface Disease Index (OSDI) score, blink rate, MBI, BSCVA, and visual display terminal (VDT) use data. The criterion for symptomatic DE was OSDI score ≥13. RESULTS: The prevalence of symptomatic DE among individuals using this smartphone app in Thailand was 85.8% (8131/9482), with the Northeastern region of Thailand having the highest prevalence, followed by the Northern region. Worse BSCVA (median 0.20, IQR 0.40; P=.02), increased blink rate (median 18, IQR 16; P<.001), reduced MBI (median 8.90, IQR 10.80; P<.001), female sex (adjusted OR 1.83; 95% CI 1.59-2.09; P<.001), more than 6 hours of VDT use (adjusted OR 1.59; 95% CI 1.15-2.19; P=.004), and lower than bachelor's degree (adjusted OR 1.30; 95% CI 1.03-1.64; P=.02) were significantly associated with symptomatic DE. An age over 50 years (adjusted OR 0.77; 95% CI 0.60-0.99) was significantly less associated with symptomatic DE (P=.04). CONCLUSIONS: This smartphone DE app showed that the prevalence of symptomatic DE in Thailand was 85.8%. Signs and risk factors could be also evaluated with this smartphone DE app. Screening for DE by this app may allow for the development of strategic plans for health care systems in Thailand.

Rare manifestation of ocular immune reconstitution inflammatory syndrome from mycobacterium scrofulaceum infection in a patient with AIDS.

Immune reconstitution inflammatory syndrome (IRIS) is a common complication following the initiation of antiretroviral therapy (ART). The most commonly associated pathogens include Mycobacterium tuberculosis and Cryptococcus spp.[1] IRIS following nontuberculosis mycobacteria (NTM) infection is uncommon, particularly, IRIS following NTM conjunctivitis.[2] Herein, we present a case of Mycobacterium scrofulaceum conjunctivitis with peripheral ulcerative keratitis and orbital cellulitis in a 45-year-old patient with AIDS who developed IRIS 1 month after starting ART therapy. A combination of both systemic and topical antibiotics together with corticosteroids were used and resulted in a satisfactory outcome with no early recurrence. This case demonstrated a rare ocular IRIS manifestation involving both the external eye and orbit and to the author's knowledge is the first case in the literature in which M. scrofulaceum has been found to be involved in the eye.

The effect of cold tetracaine on the severity of burning sensation upon instillation.

PURPOSE: Tetracaine is one of the most common eye drops that are used for analgesia in clinical practice. However, it causes ocular burning sensation when instilled. This study aimed to compare the effects of the cold and room temperature tetracaine on burning sensation. PATIENTS AND METHODS: We conducted a prospective, double-blinded, randomized controlled trial at the ophthalmology outpatient clinic, Phramongkutklao Hospital during January 2016-February 2017. In this study, 424 consecutive patients (those with a history of keratopathy or neuropathy were excluded) who received dilated fundus examination were randomized to receive cold tetracaine (4°C) in one eye and room temperature tetracaine (22.5°C) in the other eye. Each patient was asked to answer the questionnaire on the severity of burning sensation using 100 mm visual analog scale. RESULTS: Patients reported less burning sensation on the eye that received cold tetracaine (visual analog scale 20.50±18.8 vs 22.70±20 mm; P=0.025). In the subgroup analysis, young patients (≤40 years old), female subjects, patients who received tetracaine for the first-time and those who had no previous ocular surgery reported more benefit from cold tetracaine. The subgroup of patients who had normal corneal sensation, identified by using a Cochet-Bonnet esthesiometer, also showed greater benefit from cold tetracaine compared to those with impaired corneal sensation. CONCLUSION: Cold tetracaine caused less burning sensation than room temperature solution. Its benefit was greater in the subgroup of patients who reported more severe burning sensation. We recommend using cold tetracaine in routine practice, especially in those who are anticipated to have this common side effect.

Immediate Postoperative Intraocular Pressure Changes After Anterior Chamber Air Fill in Descemet Membrane Endothelial Keratoplasty.

PURPOSE: To monitor the intraocular pressure (IOP) changes immediately after anterior chamber air tamponade in Descemet membrane endothelial keratoplasty (DMEK). METHODS: Twenty-four patients undergoing DMEK and 16 patients undergoing rebubbling after DMEK were enrolled (n = 40). All DMEK patients had inferior iridectomy and nearly full intracameral air tamponade with an aimed IOP of 25 mm Hg at the end of surgery. The IOP was measured at 1, 2, 3, 5, 12, 24 hours and 1 week postoperatively. RESULTS: After anterior chamber air fill in DMEK, the IOP increased from preoperative baseline, 12.1 ± 2.9 mm Hg, to 26.3 ± 4.7 mm Hg, P < 0.001. Mean IOP was significantly elevated in the first 2 hours, 19.4 ± 10.5 mm Hg and 17.0 ± 7.4 mm Hg, P = 0.007 and 0.006, respectively. Then, it lowered to the baseline level, 14.0 ± 4.7 mm Hg, P > 0.05, and remained stable during follow-ups. An asymptomatic IOP elevation above 30 mm Hg was detected in 3 patients (12.5%) within the first 2 hours. None had preexisting glaucoma. Most episodes could be controlled by antiglaucoma medications and upright positioning. The pattern of IOP changes after rebubbling was similar to that after DMEK but the IOP dropped sharply to the baseline level after 1 hour and had no incidence of IOP elevations beyond 30 mm Hg. CONCLUSIONS: Adequate inferior iridectomy greatly alleviates the risk and severity of acute IOP rises after nearly full anterior chamber air tamponade in DMEK. Standard IOP adjustment at the end of DMEK surgery with postoperative IOP monitoring especially in the first 2 postoperative hours is advisable when there is no postoperative default air release.

Changes in macular thickness after Descemet stripping automated endothelial keratoplasty.

PURPOSE: To assess changes in macular thickness after Descemet stripping automated endothelial keratoplasty (DSAEK), using optical coherence tomography. DESIGN: Prospective interventional case series. METHODS: setting: Institutional. patients and intervention: Thirty-three eyes of 31 patients who had Fuchs dystrophy or pseudophakic bullus keratopathy (PBK) and underwent DSAEK or combined DSAEK with cataract surgery. main outcome measure: Changes in macular thickness. RESULTS: There were 7 eyes with Fuchs endothelial dystrophy and 9 eyes with pseudophakic bullous keratopathy (PBK) that underwent DSAEK, and 17 eyes with Fuchs endothelial dystrophy and cataract that underwent combined DSAEK with phacoemulsification cataract surgery. For the whole group there was a significant increase of 19.32 µm in macular thickness at 1 month after surgery (P = .025). At 3 months the increase of 10.33 µm was not statistically significant (P = .192). For the Fuchs endothelial dystrophy there was a mean increase of 11.83 µm and a mean decrease of 9 µm at 1 and 3 months, respectively. For the PBK group there was an increase of 12.37 µm and 2.428 µm at 1 month (P = .603) and at 3 months after surgery (P = .883), respectively. These changes were not significant. For the Fuchs endothelial dystrophy and cataract group there was a significant increase of 26.50 µm at 1 month (P = .012) and 23.15 µm at 3 months after surgery (P = .038). CONCLUSIONS: Macular thickness significantly increased after DSAEK combined with cataract surgery but did not change significantly when only DSAEK was performed.

The effect of successful rebubbling after descemet stripping automated endothelial keratoplasty on endothelial cell counts.

PURPOSE: To examine the effect of successful repositioning/rebubbling of the graft on endothelial cell counts (ECCs) in eyes after Descemet stripping automated endothelial keratoplasty. METHODS: This retrospective study reviewed the outcomes of 58 eyes that underwent Descemet stripping automated endothelial keratoplasty. Fifty-one eyes were attached after surgery. Seven were detached and underwent rebubbling with minimal manipulation in 5 and significant manipulation in 2, after which the graft was attached and clear. Visual outcomes and endothelial cell loss at 6 months were compared between eyes that underwent repositioning/rebubbling and those that did not. The following were excluded: 2 eyes that had primary failure, 2 eyes that had rejection, 1 eye that failed to attach after rebubbling, 2 eyes that failed to clear after rebubbling, and 24 eyes that did not have ECC at 6 months. RESULTS: The 2 groups were comparable considering age, preoperative best-corrected visual acuity, surgical variables, combined procedures, donor cell count, and graft size. The mean postoperative spherical equivalent, manifest and topographic astigmatism, uncorrected visual acuity, and best-corrected visual acuity did not differ significantly between the 2 groups at 6 months. Mean pre- and postoperative ECC did not differ significantly between the group that underwent repositioning/rebubbling and the group that did not (preoperative counts 2742 +/- 268 vs. 2747 +/- 353 and postoperative counts 1590 +/- 367 vs. 1746 +/- 491, respectively). Endothelial cell loss also did not differ significantly between the 2 groups, although there was a trend to greater cell loss in the reattachment group (-39.4% +/- 11.1% vs. -38.3% +/- 16.2%, respectively; P = 0.6). CONCLUSION: Successful reattachment procedure does not seem to cause significant endothelial cell loss.

Topical treatment with 1% cyclosporine for subepithelial infiltrates secondary to adenoviral keratoconjunctivitis.

PURPOSE: To evaluate the treatment with topical 1% cyclosporine A (CsA) in patients with subepithelial corneal infiltrates (SEIs). METHODS: We retrospectively reviewed the records of 9 patients (12 eyes) before and after the treatment with CsA 1% eyedrops twice daily. All patients had been treated with topical corticosteroids previously without improvement or had to stop the medication secondary to intraocular pressure elevation. The objective data recorded included best-corrected Snellen visual acuity, intraocular pressure, number of medications in use, and evaluation of severity of SEIs (improved, stable, or worse). For their subjective evaluation, patients were asked to complete a questionnaire based on the last follow-up visit. RESULTS: Five males (56%) and 4 females (44%), mean age of 47 +/- 13 years, were included. Mean follow-up on CsA was 13 +/- 7 months. The mean best-corrected Snellen visual acuity (logarithm of the minimum angle of resolution) before and after treatment was 0.42 +/- 0.40 and 21 +/- 0.28, respectively, with no statistically significant improvement. There was statistically significant reduction in the number of medications before and after treatment from 1.88 +/- 1.05 to 1.22 +/- 0.44, respectively (P = 0.049). Six patients (66%) showed clinical improvement, and 3 (34%) were stable during the treatment period. Patients reported statistically significant reduction in the severity of symptoms before and after the treatment. Most of the patients reported no foreign body sensation, glare, or other side effects with topical CsA treatment. Overall, patients noted an improvement in vision and satisfaction with CsA treatment. CONCLUSIONS: Topical CsA 1% is a safe and effective alternative treatment in patients with SEIs who do not respond to other treatment modalities or have unwanted side effects from topical steroids.

Deep lamellar endothelial keratoplasty: up to 5-year follow-up.

PURPOSE: To evaluate the outcomes of small-incision deep lamellar endothelial keratoplasty (DLEK) for the treatment of endothelial dysfunction at up to 5 years of follow-up. DESIGN: Prospective, noncomparative case series. PARTICIPANTS: Sixty eyes of 55 consecutive patients who had corneal edema as a result of Fuchs' dystrophy, pseudophakic bullous keratopathy, bullous keratopathy secondary to glaucoma tube placement, failed graft, or deep endothelial scar. METHODS: Patients underwent DLEK surgery at the Toronto Western Hospital. MAIN OUTCOMES MEASURES: Best spectacle-corrected visual acuity (BSCVA), manifest refraction, corneal endothelial cell density (ECD), and postoperative complications. RESULTS: Data were available for 57, 49, 46, 23, and 7 eyes for examination at 1, 2, 3, 4, and 5 years, respectively. The mean spherical equivalent and refractive astigmatism were -0.18+/-1.62 diopters (D) and 1.67+/-1.36 D, respectively, at 1 year after surgery and remained stable at 2, 3, and 4 years after DLEK. Eliminating eyes with known significant macular or optic nerve disease, BSCVA of 20/188.5 before surgery improved to 20/56.9 at 1 year after surgery (P = 0.0002) and remained stable with BSCVA of 20/52.3, 20/46.2, and 20/56.8 at 2, 3, and 4 years, respectively, (P = 0.59, P = 0.31, P = 0.24, respectively). The number of patients who achieved 20/40 or better visual acuity, increased from a preoperative level of 13.5% to 44.1%, to 40%, to 48.4%, and to 50% at 1, 2, 3, and 4 years after surgery, respectively. The mean donor ECD before surgery was 2762+/-536 cells/mm2 and decreased by 43% at 1 year after surgery (1604+/-787 cells/mm2; P<0.0001), an additional yearly decrease by 14% (1257+/- 684 cells/mm2; P = 0.03), by 4% (1136+/-613 cells/mm2; P = 0.41), and by 1% (1064+/-515 cells/mm2; P = 0.68) was found at 2, 3, and 4 years, respectively. Complications included 4 graft dislocations, 2 primary graft failures, 5 rejections, and 12 secondary failures, with 27.5% graft failure at 4 years. CONCLUSIONS: Small-incision DLEK provides good and stable refractive and visual outcomes. The accelerated endothelial cell loss reported during the first 2 years after DLEK was shown to decrease and stabilize at low rates during the longer-term follow-up, which reduces the concern about progressive cell loss and secondary late endothelial failure. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Intrastromal corneal ring segment SK implantation for moderate to severe keratoconus.

PURPOSE: To report the efficacy and safety of intrastromal corneal ring segment (ICRS) implantation using a femtosecond laser in the management of advanced keratoconus. SETTING: Private laser center, Toronto, Ontario, Canada. METHOD: In this retrospective nonrandomized study, Intacs SK ICRS were implanted using an IntraLase femtosecond laser in eyes with moderate to severe keratoconus. Evaluation included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, slitlamp examination, corneal topography, and wavefront analysis of higher-order aberrations. Postoperative visits were at 1, 7, and 30 days and 3 and 6 months. RESULTS: The study evaluated 10 eyes of 8 patients with a mean age of 28 years (range 21 to 42 years). The mean UDVA was significantly better 6 months postoperatively than preoperatively (0.66 logMAR +/- 0.21 [SD] versus 1.19 +/- 0.57 logMAR) (P = .004), as was the mean CDVA (0.25 +/- 0.15 logMAR versus 0.51 +/- 0.20 logMAR) (P = .018). The mean spherical equivalent refractive error was -8.08 diopters (D) preoperatively and -5.03 D at 6 months (P = .65); the mean refractive astigmatism, -5.05 D and -3.90 D, respectively (P = .22); and the mean simulated keratometry value, 57.94 D and 50.07 D, respectively (P = .15). The mean total aberration improved significantly, from 13.48 +/- 4.64 mum preoperatively to 9.42 +/- 1.80 mum postoperatively (P = .007). There were no complications. CONCLUSION: Implantation of ICRS for advanced keratoconus was safe and effective, leading to significant improvement in UDVA, CDVA, and total aberrations. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

IntraLase-enabled astigmatic keratotomy for post-keratoplasty astigmatism: on-axis vector analysis.

PURPOSE: To determine the refractive predictability, stability, efficacy, and complication rate of femtosecond laser-enabled astigmatic keratotomy for post-keratoplasty astigmatism. DESIGN: A retrospective case series (pilot study). PARTICIPANTS: Thirty-seven eyes of 34 patients. METHODS: All eyes underwent IntraLase-enabled astigmatic keratotomy for high astigmatism (>5 diopters [D]) after penetrating keratoplasty. MAIN OUTCOME MEASURES: Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, higher-order aberrations, and complications. RESULTS: Mean follow-up was for 7.2 months. Uncorrected visual acuity improved from a mean of 1.08+/-0.34 logarithm of the minimum angle of resolution preoperatively to a mean of 0.80+/-0.42 postoperatively (P=0.0016). Best-corrected visual acuity improved from a mean of 0.45+/-0.27 preoperatively to 0.37+/-0.27 postoperatively (P=0.018). The defocus equivalent was significantly reduced by more than 1 D (P=0.025). The value of absolute astigmatism was reduced from 7.46+/-2.70 D preoperatively to 4.77+/-3.29 D postoperatively (P=0.0001). Higher-order aberrations were significantly increased. The efficacy index was 0.6+/-0.6. There were no cases of perforation, wound dehiscence, or infectious keratitis. Three eyes (8%) experienced an episode of graft rejection. Overcorrection occurred in 9 eyes (24%). CONCLUSIONS: IntraLase-enabled astigmatic keratotomy is an effective treatment for high astigmatism after penetrating keratoplasty with an encouraging refractive predictability. Future studies may help refine the treatment parameters required to achieve reduction of cylinder with greater accuracy.

Femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty.

PURPOSE: To review patient outcomes after femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty. METHODS: Seven eyes of seven patients with a mean age of 30 years underwent femtosecond laser-assisted mushroom configuration deep anterior lamellar keratoplasty from April 2008 to September 2008. Patients had keratoconus, corneal ectasia or scarring. Set for 100 mum of residual cornea, the femtosecond laser was used to create a mushroom-shaped recipient bed and donor button (having a larger anterior than posterior diameter). The posterior central lamella was manually dissected using Melles technique. RESULTS: Mean follow up was 4 months (range, 3-6.5 months). Preoperative mean best-corrected visual acuity was 20/95 (range, 20/40-20/400). Intraoperative complications included two cases (28.6%) of small Descemet membrane perforation. Postoperatively, there was one case of stromal rejection that resolved with topical steroids and two cases of steroid-related intraocular pressure rise that were treated with a prostaglandin analog. At 3 months, mean best-corrected visual acuity was 20/40 (range, 20/25-20/60), mean spherical equivalent refraction was -3.21 D (range, -6.75 D to plano), mean cylindrical refractive error was 3.57 D (range, 1.5-7 D), and mean keratometric cylinder measured 5.56 D (range, 3.79-7.00 D). Selective suture removal occurred in six patients (86%) at a mean of 3.8 months (range, 2-6 months) postoperatively. CONCLUSIONS: This preliminary series demonstrates that the use of the femtosecond laser to perform corneal cuts in a mushroom configuration for deep anterior lamellar keratoplasty is feasible. The mechanical stability and wound healing advantages for stepped corneal wounds should be considered in lamellar surgery.

Retrospective contralateral study comparing descemet stripping automated endothelial keratoplasty with penetrating keratoplasty.

PURPOSE: To compare the visual outcomes and complications rate after penetrating keratoplasty (PKP) and Descemet stripping automated endothelial keratoplasty (DSAEK), in the fellow eye of the same subjects, and to evaluate the patient's perspective on these operations. METHODS: A retrospective cohort study was undertaken in the Cornea Clinic at the Toronto Western Hospital. We reviewed the records of 12 patients (24 eyes) who underwent PKP in one eye and DSAEK surgery in their fellow eye. Patient's satisfaction for both procedures was evaluated using a subjective questionnaire. These techniques were compared for intraoperative and postoperative complications and visual and refractive outcomes including contrast acuity, contrast threshold, and high-order ocular aberrations (HOA). RESULTS: All the patients in this study preferred the DSAEK operation. They reported faster recovery time [1.5 week in the DSAEK vs 5.3 weeks in the PKP operation (P = 0.01)], significantly less pain, and better visual outcomes with the DSAEK operation. Uncorrected visual acuity and best-corrected visual acuity were significantly better in the DSAEK operated eyes. The DSAEK surgery was associated with significantly less astigmatism (P = 0.0003) and ametropia. Contrast acuity was significantly better in the eye that underwent DSAEK procedure (P < 0.05), whereas contrast threshold was better in the PKP eye. The PKP operated eyes demonstrated increased level of HOA. CONCLUSIONS: Patients preferred the DSAEK operation compared with PKP. Better uncorrected visual acuity, best-corrected visual acuity, and contrast acuity together with avoidance of surgery-induced astigmatism and HOA are the main benefits of the DSAEK technique.

Busin Guide vs Forceps for the Insertion of the Donor Lenticule in Descemet Stripping Automated Endothelial Keratoplasty.

PURPOSE: To compare two insertion methods in Descemet stripping automated endothelial keratoplasty (DSAEK): Busin guide-assisted vs Forceps-assisted insertion of the corneal lenticule graft. DESIGN: Prospective, consecutive, comparative, nonrandomized study. METHODS: setting: Cornea clinic at the Toronto Western Hospital. study population: Sixty-three eyes of 63 consecutive patients were included. All patients underwent DSAEK for Fuchs endothelial dystrophy, pseudophakic bullous keratopathy, aphakic bullous keratopathy, failed graft, or iridocorneo endothelial syndrome. Twenty-six consecutive donor discs were inserted with the Busin guide and 37 consecutive eyes underwent forceps assisted insertion of the donor. main outcome measures: Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest refraction, corneal endothelial cell loss, and postoperative complications. RESULTS: Busin guide-assisted DSAEK group had significantly worse UCVA and lower donor endothelial cell counts preoperatively. No significant differences were noted in the intraoperative or postoperative complications. Six months following surgery, BCVA was not significantly different between groups: 20/37 in the Busin guide-assisted DASEK group vs 20/42 in the Forceps-assisted group (P = .39). Mean spherical equivalent was -0.02 diopters (D) and 0.82 D (P = .06), and mean refractive cylinder was 2.2 D and 1.31 D (P = .0006), respectively. Endothelial cell loss was significantly lower in the Busin guide-assisted DASEK group: 25% loss vs 34.3% loss in the Forceps-assisted DSAEK group. (P = .04). CONCLUSIONS: Although visual outcomes were not different between the groups studied, Busin guide-assisted DSAEK resulted in lower percentage of endothelial cell loss compared with forceps insertion, six months following surgery.

The effect of mitomycin C on corneal endothelium in pterygium surgery.

PURPOSE: To evaluate the changes in endothelial cell counts in patients after pterygium surgery with mitomycin C (MMC) 0.02% and to compare them with patients undergoing pterygium excision without MMC. DESIGN: Prospective nonrandomized study. METHODS: Forty-three consecutive patients were included in this study. Sixteen patients underwent pterygium surgery with conjunctival autograft and MMC for recurrent pterygium and 27 patients underwent pterygium excision without MMC for primary pterygium removal (control group) at the Toronto Western Hospital. Endothelial images were acquired at the center of the cornea with a specular microscope before surgery and at one week, one month, and three months following surgery. RESULTS: Mean preoperative endothelial cell counts were 2330 +/- 318 cells/mm(2) in the pterygium excision without MMC group and 2486 +/- 327 cells/mm(2) in the pterygium excision with MMC group (P = .13). One month after surgery, the pterygium with MMC group showed a significant endothelial cell loss of 6% which was not present in the control group (P = .03). Three months after surgery, endothelial cell loss was reduced to 4%. (P = .08 compared with the control). In the pterygium excision with MMC group, endothelial polymeghatism was increased (at one and three months) and the percentage of hexagomal cells was reduced (at one month). CONCLUSIONS: The use of topical MMC during recurrent pterygium surgery was found to have a deleterious effect on corneal endothelium one month following surgery. Judicious use of this drug is therefore recommended.

Salzmann nodules -- a possible new ocular manifestation of Crohn's disease: a case report.

PURPOSE: The purpose of this article was to describe an association between Salzmann nodules and Crohn's disease. METHODS: Single observational case report. RESULTS: Multiple bilateral Salzmann nodules were found in a 50-year-old woman with inactive Crohn's disease. Her visual acuity was 20/25 in OD and 20/20 in OS because of involvement of the midperipheral cornea. Intraocular pressure was significantly elevated in both eyes. However, there were no other signs of glaucoma. The rest of the ocular examination was unremarkable. CONCLUSIONS: Salzmann nodules may represent a distinct clinical sign of ocular involvement in Crohn's disease.

IntraLase-enabled astigmatic keratotomy for postkeratoplasty astigmatism.

PURPOSE: To report on the outcomes of IntraLase-enabled astigmatic keratotomy (IEAK) and to compare it with manual astigmatic keratotomy (AK) for the management of postkeratoplasty astigmatism. DESIGN: Retrospective, comparative case series. METHODS: Forty eyes of 39 patients treated at a cornea clinic at the Toronto Western Hospital were included. Twenty eyes underwent manual AK and 20 eyes underwent IEAK. The main outcome measures included preoperative and postoperative manifest refraction, uncorrected and best-corrected visual acuity (UCVA, BCVA), corneal topography, high-order ocular aberrations, and complications. RESULTS: In the manual AK group, UCVA (logarithm of the minimum angle of resolution) improved from 1.08 +/- 0.29 before surgery to 0.93 +/- 0.45 after surgery (P = .09), and in the IEAK group, UCVA improved from 1.14 +/- 0.42 before surgery to 0.82 +/- 0.44 after the procedure (P = .004). BCVA improved from 0.63 +/- 0.40 to 0.44 +/- 0.38 (manual AK; P = .16) and from 0.52 +/- 0.38 to 0.29 +/- 0.26 (IEAK; P = .01), respectively. Mean cylinder reduction was 3.23 +/- 4.69 diopters in the manual AK group and 4.26 +/- 1.72 diopters in the IEAK group (P = .36). Two eyes in each group lost one line of BCVA. Three patients (15%) in the manual AK group had corneal perforation and required resuturing of the AK wound (P = .23) Overcorrection occurred at a similar rate in the two groups. CONCLUSIONS: Treatment of postkeratoplasty astigmatism with IntraLase is a safe and effective surgical procedure and resulted in a significant improvement in UCVA and BCVA compared with manual AK. A larger sample series is needed to refine further this new technique of AK and to compare it with accepted manual techniques.