The Neuropeptide α-Melanocyte-Stimulating Hormone Prevents Persistent Corneal Edema following Injury.

Corneal endothelial cells (CEnCs) regulate corneal hydration and maintain tissue transparency through their barrier and pump function. However, these cells exhibit limited regenerative capacity following injury. Currently, corneal transplantation is the only established therapy for restoring endothelial function, and there are no pharmacologic interventions available for restoring endothelial function. This study investigated the efficacy of the neuropeptide α-melanocyte-stimulating hormone (α-MSH) in promoting endothelial regeneration during the critical window between ocular injury and the onset of endothelial decompensation using an established murine model of injury using transcorneal freezing. Local administration of α-MSH following injury prevented corneal edema and opacity, reduced leukocyte infiltration, and limited CEnC apoptosis while promoting their proliferation. These results suggest that α-MSH has a proregenerative and cytoprotective function on CEnCs and shows promise as a therapy for the prevention and management of corneal endothelial dysfunction.

Corneal Opacity in the United States: An American Academy of Ophthalmology IRIS® Registry (Intelligent Research in Sight) Study.

PURPOSE: Vision loss associated with opacification of the cornea is one of the leading causes of blindness globally. However, the epidemiological data pertaining to the demographics, associated etiological causes and reduced vision in corneal opacity patients continue to be sparse. This study assesses the case frequencies, underlying etiologies, and vision outcomes in patients diagnosed with corneal opacity, in the United States. DESIGN: Retrospective cohort study PARTICIPANTS: Patients in the IRIS® Registry (Intelligent Research in Sight) who were diagnosed with corneal opacity between January 1st, 2013, and November 30th, 2020. METHODS: The IRIS Registry contains demographic and clinical data of 79,887,324 patients who presented to eye clinics during the study period. We identified patients with corneal opacity using International Classification of Disease (ICD) codes (ICD-9, and -10) of "371" (corneal scar) and "H17" (corneal opacity), respectively. The analyzed data included demographic parameters included age, sex, race, ethnicity, and geographical location. We evaluated clinical data including laterality, etiology, disease descriptors, and best-corrected visual acuity (VA) up to 1 year before the onset (± 30 days), at the time of diagnosis, and at one year following diagnosis (± 30 days). MAIN OUTCOME MEASURES: Case frequencies, etiology, and vision outcomes in patients diagnosed with corneal opacity. RESULTS: We identified 5,220,382 patients who were diagnosed with corneal opacity and scars using H17 (ICD-10) and 371.0 (ICD-9) codes over seven years. The case frequency of corneal opacity during the study period was 6,535 cases per 100,000 patients (6.5%). The mean age of the patients was 63.36±18.14 years and the majority were female (57.6%). In the cohort, 38.39% and 30.00% of patients had bilateral and unilateral corneal opacity, respectively. Most of the patients were White (69.13%), followed by Black or African American (6.84%), Asian (2.45%), American Indian or Alaska Native(0.34%), Native Hawaii or other Pacific Islander(0.19%). Among the patients with corneal opacity, 7.34% had Hispanic or Latino ethnicity. The primary etiologies associated with corneal opacity included corneal dystrophies (64.66%) followed by edema (18.25%), ulcer (7.78%), keratoconjunctivitis (7.18%), degeneration (5.62%), neovascularization (6.27%), and trauma (5.28%). Visual acuity of the patients significantly worsened due to corneal opacity (0.46±0.74 logMAR; ∼20/58 in Snellen) and did not improve to the baseline (0.37±0.68 logMAR, ∼20/46 in Snellen) post-management (0.43±0.77 logMAR, ∼20/54 in Snellen). The multiple linear regression analysis showed worse vision outcomes in females (compared to males), and Asian, Black or African American, and American Indian or Alaska Native (compared to White) patients. Additionally, worse vision outcomes were observed in patients with opacity associated with corneal malformation, degenerative disorders, edema, injury, and ulcer compared to those with hereditary corneal dystrophy. CONCLUSIONS: Our study shows that the corneal opacity was diagnosed in 6.5% of the patients in the IRIS Registry and it was primarily associated with corneal dystrophies. The final vision outcomes in corneal opacity patients were significantly worse compared to baseline. The worse vision outcomes were associated with sociodemographic differences that might be associated with disparities in access, utilization, and care patterns.

Effect of thyroid hormone status on complete blood cell count-derived inflammatory biomarkers in patients with moderate-to-severe Graves' ophthalmopathy.

PURPOSE: To evaluate the systemic inflammation in moderate-to-severe Graves' ophthalmopathy patients with abnormal thyroid function by using complete blood cell count-derived inflammatory biomarkers and compare to moderate-to-severe GO patients with regulated thyroid function and healthy controls. The second aim is to evaluate the relationship of complete blood cell count-derived inflammatory biomarkers with clinical findings in moderate-to-severe GO. METHODS: In this retrospective study, 90 GO patients with abnormal thyroid function composed Group 1, 58 patients who had normal thyroid function for at least 3 months composed Group 2, and 50 healthy individuals composed Group 3. Demographic data, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and systemic immune-inflammatory index (SII) were evaluated. RESULTS: There was no statistically significant difference between groups in terms of age, sex, and smoking habits (p > 0.05). There was a statistically significant difference in NLR (p = 0.011), MLR (p = 0.013), MPV (p < 0.001), and SII (p < 0.001) values among 3 groups. For NLR, MLR, and SII the highest values were detected in Group 1. MPV levels were higher in Group 3 than Groups 1 and 2 (p < 0.001). None of the hematological parameters were found to be a risk factor for any clinical severity findings of GO. CONCLUSION: The higher levels of NLR, MLR, and SII levels may show systemic inflammation in GO patients with abnormal thyroid function, and this may have an impact on the clinical course of ophthalmopathy. These findings may suggest that cautious control of thyroid hormone levels is important in the management of GO.

Topical cyclosporine a (0.05%) treatment in dry eye patients: a comparison study of Sjogren's syndrome versus non-Sjogren's syndrome.

PURPOSE: To evaluate the clinical effect of topical cyclosporine A (CsA) (0.05%) on dry eye patients with Sjogren's syndrome (SS) and non-Sjogren's syndrome (NSS). METHOD: This retrospective comparative study includes the dry eye (DE) patients who were treated with topical CsA. DE patients were divided into two groups as follows: DE with Sjogren's syndrome (DE-SS) and DE with Non-Sjogren's syndrome (DE-NSS). Dry eye parameters were recorded at baseline and each visit. RESULTS: Schirmer's test 1 scores were 2.7 ± 0.5 mm at baseline and 3.5 ± 0.7 mm at 12th month in DE-SS, 2.9 ± 0.7 mm at baseline and 9.5 ± 0.7 mm in DE-NSS groups at 12th month. Mean ST score was higher in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (both p = 0.001). Tear break-up time score showed a significant improvement in DE-NSS group, and it was lower in DE-NSS group than DE-SS group group at sixth and 12th months of the treatment (p = 0.044 and 0.027, respectively). Mean OSDI score was lower in DE-NSS group than DE-SS group at sixth and 12th months of the treatment (p = 0.030 and 0.032, respectively). CONCLUSION: Topical CsA seems to be more effective in the treatment of the DE-NSS.

Descemet's membrane area and posterior corneal power may predict the Descemet membrane folds after deep anterior lamellar keratoplasty in patients with advanced keratoconus.

AIMS: To investigate possible predictive topographic characteristics for the development of Descemet's membrane (DM) folds after the uneventful deep anterior lamellar keratoplasty (DALK). METHODS: A retrospective study included 56 eyes of 56 consecutive patients who underwent uneventful DALK using the big-bubble technique to treat advanced keratoconus. At baseline and each visit, best-corrected logMAR visual acuity (BCVA), slit-lamp findings, endothelial cell density, topographic parameters were recorded. DM area is calculated using morphogeometric modelling. RESULTS: Twelve (21.4%) of them exhibited DM folds, whereas the remaining 44 (78.6%) did not exhibit any DM folds after the surgery. The mean follow-up time was 36.3 ± 16.7 (range, 12-71) months. The mean posterior corneal power was - 13.8 ± 0.6 D in patients with DM folds, whereas - 13.0 ± 0.8 D in those without DM folds (p = 0.016). The mean DM area was 53.6 ± 2.3 (50.9-57.9) mm2 in patients with DM folds, whereas 51.6 ± 1.7 (47.1-53.9) mm2 in those without DM folds (p = 0.001). The ROC curve showed that two best cut-off value for the posterior corneal power and DM area were 13.75 D and 53.8 mm2, respectively, to predict the occurrence of DM folds. CONCLUSION: DALK surgery seems to cause DM folds in patients with large DM area and high posterior corneal power.

Effect of topical pilocarpine on refractive surgery outcomes.

PURPOSE: To investigate the effect of topical pilocarpine on topical cycloplegia and on the results of refractive surgery. METHODS: The study included 100 eyes of 100 patients who underwent laser-assisted in situ keratomileusis. Group 1 comprised patients who wanted to undergo surgery on the same day after cycloplegic examination and were applied with 2% pilocarpine hydrochloride; group 2 comprised patients whose pupils spontaneously went into the natural position. Corneal thickness, mean refractive spherical equivalent (MRSE), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), pupil diameter, pupil center shift and high-order aberrations (HOAs) were compared between the two groups. RESULTS: There were no statistically significant differences between the groups in respect of preoperative age, gender, corneal thickness, MRSE, UDVA and CDVA. The pupil diameter was not statistically significant between the groups. Pupil diameter after pilocarpine was not statistically significant when compared with the natural pupil diameter. There were no statistically significant differences in postoperative HOA between the two groups. CONCLUSIONS: The pupillary dilatation and the associated pupillary shift were reduced with pilocarpine. Postoperative refractive values and aberrations showed no difference between the groups.

Preliminary effects of treating the half of high latent hyperopia on refractive and visual results of femtosecond laser-assisted in situ keratomileusis in subjects with hyperopia.

BACKGROUND: To evaluate the preliminary effects of treating the half of high latent hyperopia on refractive and visual outcomes of femtosecond laser-assisted in situ keratomileusis (LASIK) in young subjects with hyperopia. METHODS: This non-randomized comparative study includes 120 eyes of 60 subjects who underwent femtosecond LASIK to correct hyperopia. Group 1 (n = 60) includes subjects with ≤ 1D algebraic difference (DRSE) between cycloplegic (CRSE) and manifest (MRSE) refraction spherical equivalents and was treated by entering manifest refraction values. Group 2 includes subjects with > 1D DRSE and was treated by entering the mean manifest and cycloplegic refraction values. Refractive and subjective outcomes obtained at the 1-, 3-, and 6-month postoperative visits were compared. RESULTS: The mean age of the subjects was 26.2 ± 3.5 and 26.2 ± 5.2 years for Group 1 and Group 2, respectively. The male-to-female ratios were 10/10 in both groups. Demographic values of the groups were similar (p > 0.05). Preoperative MRSE values were similar (p = 0.924), while CRSE and DRSE values were significantly higher in Group 2 (p < 0.001). At the 1- and 3-month postoperative visits, MRSE was higher and uncorrected distance visual acuity (UDVA) was lower in Group 2 (p < 0.001). Subjective visual parameters and quality of vision scores were also worse in Group 2 during these visits (p < 0.001); however, at the 6-month visit, all outcomes for Group 2 improved, and MRSE, UDVA, some subjective visual parameters, and quality of vision scores became similar between groups (p > 0.05). CONCLUSION: At the 6-month visit after treating the half of > 1D latent hyperopia with femtosecond LASIK, refractive and visual outcomes like MRSE, UDVA, subjective visual parameters, and quality of vision scores become similar to those obtained in ≤ 1D latent hyperopia.

Comparison of Samfilcon A and Lotrafilcon B silicone hydrogel bandage contact lenses in reducing postoperative pain and accelerating re-epithelialization after photorefractive keratectomy.

PURPOSE: To compare the efficacy of Samfilcon A and Lotrafilcon B bandage contact lenses after photorefractive keratectomy (PRK). METHODS: In this study, patients with bilateral PRK were assigned for the fitting of Lotrafilcon B lens and Samfilcon A lens. The patients were examined on the day of surgery and on postoperative days 1, 2 and 3. Slit biomicroscopy was performed to assess epithelial defect size in the postoperative examinations. The subjective evaluation of pain and visual symptoms was recorded on postoperative days 1, 2 and 3. RESULTS: Analysis was made of 68 eyes of 34 patients who fulfilled the criteria and had PRK for correction of low to moderate myopia/astigmatism. On postoperative days 1 and 2, pain and epiphora scores were significantly lower in eyes with Samfilcon A lens (p < 0.001 for all), and on postoperative day 3, the differences were not significant (p = 0.414 and p = 0.180, respectively). There was no significant difference between the two lenses in respect of the levels of photophobia. The difference in epithelial defect size was statistically lower in eyes with Samfilcon A lens compared to Lotrafilcon B on day 1 (16.89 mm2 vs. 21.07 mm2; p = 0.003) and day 2 (1.49 mm2 vs. 2.46 mm2; p < 0.001). The difference was not significant on day 3. (0.05 mm2 vs. 0.05 mm2; p = 1.000). CONCLUSIONS: The Samfilcon A lens is superior to the Lotrafilcon B lens in reducing postoperative pain and accelerating re-epithelialization.

The Management of Refractory Dry Eye With Semi-Scleral Contact Lens.

We presented a case of refractory dry eye management with semi-scleral contact lens. Dry eye was associated with facial nerve (cranial nerve VII) palsy as a result of cerebellopontine angle tumor surgery. She was treated with several topical treatments and punctal plug. Despite the treatments, her symptoms still persisted. Her ophthalmic examination revealed scleral exposure because of lagophthalmos, conjunctival hyperemia, corneal debris, scar, and diffuse punctate epitheliopathy on her right eye. Lissamine green staining showed diffuse conjunctival and corneal staining. Therapeutic semi-scleral lenses were fitted. The corneal findings were resolved and the quality of patient life was improved with the aid of semi-scleral lens after 3 months.

Pharmacologic Management of Pressure-Induced Stromal Keratopathy after LASIK.

PURPOSE: To emphasize the importance of anticipation of pressure-induced stromal keratopathy (PISK) in eyes with a previous history of LASIK. CASE REPORT: A 40-year-old man developed LASIK-related pressure-induced stromal keratopathy after uneventful phacoemulsification (Phaco) and intraocular lens (IOL) implantation in his left eye. With immediate discontinuation of the steroid drops and initiation of antiglaucoma medication, his visual acuity, interface edema, and haze improved rapidly. One year later, during Phaco with IOL implantation in his other eye, with anticipation of a similar LASIK-related pressure-induced stromal keratopathy, a very brief course of soft steroid therapy was given together with antiglaucoma medication. Intraocular pressure elevation was avoided, and no interface edema or haze was observed. CONCLUSIONS: This case illustrates that the risk for LASIK-related pressure-induced stromal keratopathy may be reduced with appropriate precautions.

Can possible toxic effect of ultraviolet-A after corneal cross-linking be prevented? In vitro transmittance study of contact lenses at 370 nm wavelength.

CONTEXT: Corneal collagen cross linking (CCL) with ultraviolet A (UVA) has been proposed as a treatment for the progression of corneal ectasia associated with keratoconus and post-laser-assisted in situ keratomileusis (LASIK) ectasia. Despite the reports about safety of procedure, we consider that UVA of sunlight can effect riboflavin saturated and de-epitelizated cornea early after CCL. OBJECTIVES: To evaluate the UVA blockage capability of 11 different silicone hydrogel contact lenses which are widely used after CCL treatment. METHODS: Eleven different silicone hydrogel and daily disposable contact lenses were evaluated. The UVA light at 365 nm wavelength for UVA source and UV light meter to measure UVA radiation were used. 3, 9 and 18 mW/cm(2) power of UV radiance was applied centrally to the each type of contact lenses. The power of UVA transmittance for each radiance and percentage of blockage were evaluated for each brand. Also, protection factor (PF) was calculated. RESULTS: The senofilcon A and narafilcon A had the highest blockage and lowest transmittance (p = 0.02). PF was significantly higher in the senofilcon A and narafilcon A at 3, 9 and 18 mW/cm(2) (p = 0.0001). And also, the hilafilcon B, filcon IV, nelfilcon A, enfilcon A, lotrafilcon A and lotrafilcon B had the highest UVA transmittance. CONCLUSION: The narafilcon A and the senofilcon A may be a good options for epithelial healing after CCL procedure to protect the cornea from UVA of sunlight. And also, the hilafilcon B, filcon IV, nelfilcon A, enfilcon A, lotrafilcon A and lotrafilcon B contact lenses that have high-UVA transmittance feature can be a treatment choice for contact lens-assisted CCL technique in thin corneas.

A two-stream deep model for automated ICD-9 code prediction in an intensive care unit.

Assigning medical codes for patients is essential for healthcare organizations, not only for billing purposes but also for maintaining accurate records of patients' medical histories and analyzing the outputs of certain procedures. Due to the abundance of disease codes, it can be laborious and time-consuming for medical specialists to manually assign these codes to each procedure. To address this problem, we discuss the automatic prediction of ICD-9 codes, the most popular and widely accepted system of medical coding. We introduce a two-stream deep learning framework specifically designed to analyze multi-modal data. This framework is applied to the extensive and publicly available MIMIC-III dataset, enabling us to leverage both numerical and text-based data for improved ICD-9 code prediction. Our system uses text representation models to understand the text-based medical records; the Gated Recurrent Unit (GRU) to model the numerical health records; and fuses these two streams to automatically predict the ICD-9 codes used in the intensive care unit. We discuss the preprocessing and classification methods and demonstrate that our proposed two-stream model outperforms other state-of-the-art studies in the literature.

Intravitreal bevacizumab treatment for refractory diabetic macular edema.

To evaluate the effect of intravitreal bevacizumab (IVB) on visual function and retinal thickness in patients with refractory diabetic macular edema (DME). Eyes with DME treated with IVB which were resistant to different previous treatments were enrolled in this retrospective, non-randomized series study. Each patient underwent a complete ophthalmic examination including best-corrected visual acuity (BCVA), slit-lamp examination, intraocular pressure measurement, fundus examination, retinal thickness measurement with optic coherence tomography at baseline and at each visit. Digital fundus fluorescein angiography was performed at baseline for each patient. A total of 71 eyes of 59 patients (36 male and 23 female) were included in the study. All eyes had focal laser photocoagulation (71 eyes, 100 %) and had one other additional treatment including an intravitreal (23 eyes, 32 %) or subtenon (18 eyes, 25 %) injection of triamcinolone acetonide. The mean follow-up period was 9.79 ± 8.6 months and the mean number of IVB treatments was 2.01 ± 1.06 (min-max, 1-4). Mean logMAR BCVA was 0.88 ± 0.4 at baseline, 0.78 ± 0.4 at 4 weeks and 0.79 ± 0.4 at the last visit (p = 0.036). The mean central foveal thickness was 515.4 ± 150.3 µm at baseline which significantly decreased to 367.01 ± 166.6 µm at 4 weeks (p = 0.0001) and 338.1 ± 159.7 µm at the last visit (p = 0.0001). Sixteen percent of the eyes did not respond to IVB treatment. IVB treatment for refractory DME seems to be effective and safe and repeated treatments are necessary for a significant portion of the cases.

Immediate sequential bilateral cataract surgery is a reasonable and safe option during a pandemic.

PURPOSE: To evaluate the preoperative and intraoperative features, intraoperative and postoperative complications and postoperative satisfaction of patients who underwent immediate sequential bilateral cataract surgery (ISBCS) during the COVID-19 pandemic. METHODS: The study included ISBCS patients from September 2021 through January 2022. Demographics, comorbidities, type of anesthesia (topical/general), intraoperative complications, postoperative refractive errors, and complications were examined. The one-month postoperative appointment included a patient satisfaction questionnaire. RESULTS: ISBCS was performed in 206 eyes of 103 patients. Intraoperative complications did not occur in 99 (96.1%) of ISBCS patients. No patients had visually significant corneal edema, wound leakage, endophthalmitis, or toxic anterior segment syndrome during postoperative follow-up. Final manifest spherical equivalent refraction was less than 1.00 D in all patients and less than 0.50 D in 70.7% of patients. In the questionnaire given to the patients at the one-month follow-up, 96.1% of patients did not change their preference for surgery on the same day. CONCLUSION: ISBCS provides an advantage during the pandemic period by reducing hospital visits, especially for the elderly population and patients with comorbidities. ISBCS is a safe and reasonable method that can be used during a pandemic due to the low rates of complications, the success of the refractive results, and the high patient satisfaction rates.

Development and characterization of a hydrogel-based adhesive patch for sealing open-globe injuries.

Full-thickness wounds to the eye can lead to serious vision impairment. Current standards of care (from suturing to tissue transplantation) usually require highly skilled surgeons and use of an operating theater. In this study, we report the synthesis, optimization, and in vitro and ex vivo testing of photocrosslinkable hydrogel-based adhesive patches that can easily be applied to globe injuries or corneal incisions. According to the type and concentration of polymers used in the adhesive formulations, we were able to finely tune the physical properties of the bioadhesive including viscosity, elastic modulus, extensibility, ultimate tensile strength, adhesion, transparency, water content, degradation time, and swellability. Our in vitro studies showed no sign of cytotoxicity of the hydrogels. Moreover, the hydrogel patches showed higher adhesion on freshly explanted pig eyeballs compared to a marketed ocular sealant. Finally, ex vivo feasibility studies showed that the hydrogel patches could seal complex open-globe injuries such as large incision, cruciform injury, and injury associated with tissue loss. These results suggest that our photocrosslinkable hydrogel patch could represent a promising solution for the sealing of open-globe injuries or surgical incisions. STATEMENT OF SIGNIFICANCE: Current management of severe ocular injuries require advanced surgical skills and access to an operating theater. To address the need for emergent management of wounds that cannot be handled in the operating room, surgical adhesives have gained popularity, but none of the currently available adhesives have optimal bioavailability, adhesive or mechanical properties. This study describes the development, optimization and testing of a light-sensitive adhesive patch that can easily be applied to the eye. After solidification using visible light, the patch shows no toxicity and is more adherent to the tissue than a marketed sealant. Thus this technology could represent a promising solution to stabilize ocular injuries in emergency settings before definitive surgical repair.

Prevalence of neurotrophic keratopathy in patients with chronic ocular graft-versus-host disease.

PURPOSE: To determine the prevalence, clinical characteristics, and risk factors associated with neurotrophic keratopathy (NK) in patients with chronic ocular graft-versus-host disease (oGVHD). DESIGN: Retrospective cohort study. METHODS: We performed a chart review of patients diagnosed with chronic oGVHD between January 2015 and December 2018 at a single academic institution and recorded demographic data, systemic and ocular comorbidities, history of hematologic malignancy, transplant characteristics, oGVHD severity scores, and adnexal and ocular examination findings. We determined the prevalence of NK and clinical characteristics associated with NK in these patients. A multivariate logistic regression analysis was performed to determine the risk factors associated with NK in these patients. MAIN OUTCOME MEASURE: Prevalence of NK in chronic oGVHD. RESULTS: We identified 213 patients diagnosed with chronic oGVHD following hematopoietic stem cell or bone marrow transplantation from our electronic patient database, and the prevalence of NK was 14%. The mean age of oGVHD patients with NK was 62.6 ± 12.9 years; 48% were women, 19 had unilateral NK, and ten had bilateral NK. In the cohort, 56%, 20%, and 24% eyes of the patients had grades 1, 2, and 3 of NK, respectively. The mean time to diagnose NK after transplantation was 52.9 ± 45.4 months. oGVHD patients diagnosed with NK had a significantly higher NIH oGVHD severity score (p = 0.04) and a lower corneal sensation score (p = 0.0001) than those without NK. Our analyses showed a significantly higher CFS score (p = 0.01) and a trend toward lower Schirmer test scores (p = 0.16) and tear break-up times (p = 0.08) in oGVHD patients with NK. Additionally, we observed a significantly higher prevalence of persistent epithelial defect (p = 0.0001), corneal ulceration (p = 0.0001), and corneal perforation (p = 0.005) in oGVHD patients diagnosed with NK. A logistic regression analysis to determine factors associated with NK showed that a higher NIH oGVHD score (odds ratio [OR] = 2.03, p = 0.026) and history of cataract surgery (odds ratio [OR] = 5.03, p = 0.001) are significant risk factors for NK in oGVHD patients. CONCLUSIONS: The prevalence of NK in chronic oGVHD patients was 14% during the study period. Our analysis shows that oGVHD patients with a higher NIH oGVHD severity score and previous history of cataract surgery are at a higher risk of developing NK and may develop severe sequelae such as persistent epithelial defect or corneal ulceration.

Ocular pain in ocular graft-versus-host disease patients with neurotrophic keratopathy.

PURPOSE: Neurotrophic keratopathy (NK) is a degenerative disorder of the cornea characterized by decreased sensory innervation, epitheliopathy, and impaired epithelial healing. In this study, we assessed ocular pain and quality-of-life-related parameters in ocular graft-versus-host disease (oGVHD) patients with and without NK. METHODS: We included 213 oGVHD patients in this retrospective study, including 29 patients with NK assessed by the Cochet-Bonnet esthesiometer. We evaluated their records for ocular pain assessment survey (OPAS) scores and clinical parameters, including corneal sensation, corneal fluorescein staining (CFS) score, Schirmer's test, tear break-up time (TBUT), and ocular surface disease index (OSDI) score. RESULTS: oGVHD patients with NK had lower corneal sensation (3.4 ± 1.4 vs. 5.9 ± 0.3; p < 0.0001), higher CFS scores (6.4 ± 4.2 vs. 4.7 ± 4.0; p = 0.01), and lower TBUT scores (1.2 ± 2.1 vs. 2.2 ± 3.1; p = 0.08) compared to oGVHD patients without NK and additionally had significantly higher ocular pain intensity scores (OPAS 24-h average eye pain intensity: 2.0 ± 2.8 vs. 1.1 ± 1.9; p = 0.03). Patients with NK more commonly reported burning (0.2 ± 0.3 vs. 0.3 ± 0.4; p = 0.021) and sensitivity to light (0.2 ± 0.3 vs. 0.3 ± 0.4; p = 0.049) as compared to patients without NK. CONCLUSION: Clinical signs of ocular surface disease are worse in oGVHD patients with NK compared to oGVHD patients without NK. These patients additionally experience higher intensity ocular pain and lower quality-of-life-related parameters.

A Comparative Evaluation of Diffractive Trifocal and New Refractive/Extended Depth of Focus Intraocular Lenses for Refractive Lens Exchange.

PURPOSE: To evaluate and compare the visual performance and quality of life (QOL) associated with refractive/extended depth of focus (EDOF) intraocular lenses (IOLs) and diffractive trifocal IOLs in refractive lens exchange patients. MATERIALS AND METHODS: This was a comparative interventional study of patients undergoing implantation of Lucidis (Swiss Advanced Vision, SAV­IOL SA, Neuchâtel, Switzerland) or AT LISA tri 839MP (Carl Zeiss Meditec AG, Germany) IOLs. Near, intermediate, and distance best corrected and uncorrected visual acuities were collected at 1 and 3 months postoperatively. The vision-related QOL was evaluated 1 and 3 months after surgery, using the National Eye Institute Visual Function Questionnaire-14 (VF-14 QOL questionnaire). RESULTS: A total of 74 patients underwent refractive lens exchange and IOL implantation, with 38 patients in the EDOF group and 36 in the trifocal group. Among all visual acuities, uncorrected near visual acuity was statistically significantly better with the Lucidis IOL at the first month (p = .02) and diminished at the third-month visit (p = .16). When we compared the VF-14 QOL questionnaire scores, reading small print, reading a newspaper or book, and driving at night were statistically significantly better in the Lucidis group at the first month (p = .00, for each). That difference persisted only in driving at night at the third-month visit (p = .04). Reading small print, driving at night, and doing fine handwork were the most difficult tasks in the AT LISA group at the first month, and only driving at night remained so at the third-month visit. CONCLUSIONS: The refractive results and visual outcomes at all distances of EDOF and trifocal IOLs were highly satisfactory. However, the EDOF design in the Lucidis IOL achieves lower rates of glare in the early period after refractive lens exchange.

Intracameral endoilluminator-assisted phacoemulsification surgery in patients with severe corneal opacity.

While phacoemulsification cataract surgery is a routine and safe procedure, clear visualization of the anterior segment is challenging in patients with corneal opacity. Illumination from the operating microscope can cause scattering and light reflection in a patient with corneal opacity. A frequent approach for these cases is cataract surgery with sequential or simultaneous corneal transplantation. This method has serious preoperative, intraoperative, and postoperative drawbacks, such as a long wait for a donor cornea, choroidal hemorrhage, and delayed visual rehabilitation. In this case series, the technique of intracameral endoilluminator-assisted phacoemulsification surgery in patients with severe corneal opacity was shown to provide better visualization and reduced scattering and reflection in patients with corneal opacity.