COVID-19 associated mucormycosis surge: A review on multi-pathway mechanisms.

Mucormycosis is a fungal infection caused by moulds from the Mucorales order. Concerns have been mounting due to the alarming increase in severe morbidity and mortality associated with mucormycosis during the COVID-19 pandemic. This condition, known as COVID-19-associated mucormycosis (CAM), has been linked to various environmental, host-related, and medical factors on a global scale. We have categorized the most significant potential risk factors for developing mucormycosis in individuals with a previous history of coronavirus infection into 10 major categories. These categories include acute hyperglycemia, the impact of cytokine release, immune response deficiencies in COVID-19 patients, microvasculopathy and dysfunction of endothelial cells, imbalances in iron metabolism, metabolic acidosis, organ damage resulting from COVID-19, underlying health conditions (such as diabetes), environmental factors, and medical treatments that can be iatrogenic in nature (such as inappropriate glucocorticoid use). Many of these factors can lead to potentially life-threatening infections that can complicate the treatment of COVID-19. Physicians should be vigilant about these factors because early detection of mucormycosis is crucial for effective management of this condition.

Retinal and choroidal thickness in fuchs uveitis syndrome: a contralateral eye study.

BACKGROUND: To investigate the subfoveal retinal and choroidal thickness in patients with unilateral Fuchs Uveitis Syndrome (FUS). METHODS: This comparative contralateral study was performed in affected eyes with FUS versus fellow eyes. For each eye parameters such as subfoveal choroidal thickness (SCT), subfoveal choriocapillary thickness (SCCT), central macular thickness (CMT), and central macular volume (CMV) were measured; then the measured values of affected and fellow unaffected eye were compared. RESULTS: Thirty-seven patients (74 eyes) including 19 females (51.4%) with a mean age of 36.9 ± 7.6 years were enrolled. The mean SCT was lower in the affected eyes (344.51 ± 91.67) than in the fellow (375.59 ± 87.33) with adjusting for duration of disease and axial lengths (P < 0.001). The mean SCCT, CMT, and CMV were higher in eyes with FUS than in fellow eyes (P < 0.05). CONCLUSIONS: The result of our study demonstrated that affected eyes in patients with FUS tend to have thinner SCT and thicker SCCT and CMT compared to uninvolved fellow eyes.

A new computer-aided diagnosis tool based on deep learning methods for automatic detection of retinal disorders from OCT images.

PURPOSE: Early detection of retinal disorders using optical coherence tomography (OCT) images can prevent vision loss. Since manual screening can be time-consuming, tedious, and fallible, we present a reliable computer-aided diagnosis (CAD) software based on deep learning. Also, we made efforts to increase the interpretability of the deep learning methods, overcome their vague and black box nature, and also understand their behavior in the diagnosis. METHODS: We propose a novel method to improve the interpretability of the used deep neural network by embedding the rich semantic information of abnormal areas based on the ophthalmologists' interpretations and medical descriptions in the OCT images. Finally, we trained the classification network on a small subset of the online publicly available University of California San Diego (UCSD) dataset with an overall of 29,800 OCT images. RESULTS: The experimental results on the 1000 test OCT images show that the proposed method achieves the overall precision, accuracy, sensitivity, and f1-score of 97.6%, 97.6%, 97.6%, and 97.59%, respectively. Also, the heat map images provide a clear region of interest which indicates that the interpretability of the proposed method is increased dramatically. CONCLUSION: The proposed software can help ophthalmologists in providing a second opinion to make a decision, and primitive automated diagnoses of retinal diseases and even it can be used as a screening tool, in eye clinics. Also, the improvement of the interpretability of the proposed method causes to increase in the model generalization, and therefore, it will work properly on a wide range of other OCT datasets.

Corneal biomechanics in normal and subclinical keratoconus eyes.

BACKGROUND: The diagnosis of keratoconus, as the most prevalent corneal ectatic disorder, at the subclinical stage gained great attention due to the increased acceptance of refractive surgeries. This study aimed to assess the pattern of the corneal biomechanical properties derived from Corneal Visualization Scheimpflug Technology (Corvis ST) and evaluate the diagnostic value of these parameters in distinguishing subclinical keratoconus (SKC) from normal eyes. METHODS: This prospective study was conducted on 73 SKC and 69 normal eyes. Subclinical keratoconus eyes were defined as corneas with no clinical evidence of keratoconus and suspicious topographic and tomographic features. Following a complete ophthalmic examination, topographic and tomographic corneal assessment via Pentacam HR, and corneal biomechanical evaluation utilizing Corvis ST were done. RESULTS: Subclinical keratoconus eyes presented significantly higher Deformation Amplitude (DA) ratio, Tomographic Biomechanical Index (TBI), and Corvis Biomechanical Index (CBI) rates than the control group. Conversely, Ambrósio Relational Thickness to the Horizontal profile (ARTh), and Stiffness Parameter at the first Applanation (SPA1) showed significantly lower rates in SKC eyes. In diagnosing SKC from normal eyes, TBI (AUC: 0.858, Cut-off value: > 0.33, Youden index: 0.55), ARTh (AUC: 0.813, Cut-off value: ≤ 488.1, Youden index: 0.58), and CBI (AUC: 0.804, Cut-off value: > 0.47, Youden index: 0.49) appeared as good indicators. CONCLUSIONS: TBI, CBI, and ARTh parameters could be valuable in distinguishing SKC eyes from normal ones.

Pediatric Open Globe Injuries Caused by Firecrackers in a Tertiary Eye Care Hospital in Iran.

OBJECTIVE: The aim of the study is to determine characteristic features of open globe injuries caused by firecrackers among pediatric population. METHODS: In this retrospective cross-sectional chart review, medical records of children with ocular trauma who were hospitalized in Isfahan, Iran, during 2013-2017 were reviewed. We analyzed the collected data before and after propensity score (PS) matching. RESULTS: Of 396 pediatric patients with open globe injury, 22 injuries (5.9%) were caused by firecrackers. Hyphema, iris prolapse, and lens rupture were noted in 15 (68.18%), 10 (45.45%), and 2 (9.09) eyes, respectively. None of patients had endophthalmitis. The mean age of patients in firecracker group was higher and significant (11.86 ± 4.05 in firecracker vs 7.80 ± 4.68 in nonfirecracker, P < 0.001). Furthermore, most boys were in firecracker group (95.5%, P = 0.005). Patients in firecracker group resided more in urban areas (86.4%, P = 0.054) and had more intraocular foreign body (IOFB) in the eyes (40.9%, P < 0.001). After PS matching, patients in firecracker group had higher IOFB ( P = 0.008). In logistic regression models, patients with corneal lacerations had lower odds for long-time admission (≥4 days) than patients with both corneal and scleral lacerations in crude model (odds ratio, 0.35; 95% confidence interval, 0.17-0.69) and adjusted model (odds ratio, 0.37; 95% CI, 0.18 to 0.74). After PS matching, there was no significant association between risk factors and outcomes. CONCLUSIONS: The present study showed several differences between the pediatric open globe injuries caused by firecrackers and other mechanisms of injuries, including the age, sex, living place, presence of IOFB, and length of hospital stay.

Stereopsis after corneal refractive surgeries: a systematic review and meta-analysis.

PURPOSE: To systematically review the published manuscripts on stereopsis after corneal refractive surgery. METHODS: The Web of Science, PubMed, Scopus, ProQuest, Clinical Key, Embase, and Cochrane Library were searched for relevant articles published until August 2020. The fixed- or random-effects models were used to estimate the Weighted mean difference (WMD) or Relative risk (RR) and 95% Confidence interval (CI) for postoperative stereopsis changes and incidence when applicable. Meta-regression was conducted for adjusting the effects of potential confounders. RESULTS: Seven studies (1266 eyes) in adults and ten studies in pediatrics (259 eyes) were included. In adults, stereopsis improved significantly compared to the preoperative state (WMD = - 27.4, 95% CI = - 40.0, - 14.7; I2 = 97.8%; P < 0.001). In pediatrics, proportion of patients with stereoacuity postoperatively was 2.18 times compared to preoperative evaluation. (RR = 2.18, 95% CI = 1.2, 3.9; I2 = 68.6%, P < 0.001). CONCLUSIONS: Stereopsis improves after corneal refractive surgery in adults and pediatrics.

Wavefront-guided photorefractive keratectomy with and without iris registration: comparison of astigmatic correction.

This study aimed to compare the visual outcomes after photorefractive keratectomy (PRK), with and without the iris registration (IR) technology. The retrospective cohort study was performed for wavefront-guided PRK using the Technolas 217z100 excimer laser system in patients with myopic astigmatism (cylinder error - 2 to - 4 diopter [D]). Eyes were divided into IR group (IRPRK) and non-IR group (non-IRPRK). Visual acuity (VA), cylindrical refraction, and the astigmatic vector components using the Alpins method were compared between the two groups preoperatively and 6 months postoperatively. Fifty IRPRK patients (66% female, mean age 30.56 ± 6.31 years) and 50 non-IRPRK (60% female, mean age 29.60 ± 5.63 years) were enrolled. The mean logMAR uncorrected VA improved from 0.89 ± 0.44 to 0.032 ± 0.05 in the IRPRK group (P < 0.001) and from 0.89 ± 0.46 to 0.042 ± 0.06 postoperatively while follow-up in the non-IRPRK group (P < 0.001). No statistically significant differences were observed between the two groups regarding mean uncorrected distance VA (P = 0.4), corrected distance VA (P = 0.5), spherical equivalent (P = 0.16), defocus equivalent (P = 0.18), and absolute cylinder (P = 0.94). More than 90% eyes were within ± 1.00 D of emmetropia in both groups. Moreover, Alpins vector analysis revealed that no significant differences were found in any astigmatic parameters between the two groups (P > 0.05). Wavefront-guided PRK independent of the IR status is effective, safe, and predictable in patients with myopic astigmatism. No statistical significance was observed supporting data for the better outcome of visual acuity and astigmatism correction using IR in comparison with a non-IR system.

Interleukin-6 and tumor necrosis factor-α levels in tear film of Keratoconus patients.

BACKGROUND: It is hypothesized that increased inflammatory markers in keratoconus (KC) may be one of the causes of corneal damage. The aim of our study was to the measurement of tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL)-6 in tear of patients with KC and investigate their relationship with the severity of KC. MATERIALS AND METHODS: The current study was performed on KC patients and healthy controls with a case-control setting. Tear levels of TNF-α and IL-6 were measured after collecting the tears from the tear lake using a filter paper via Schirmer I method without anesthesia. RESULTS: Eighty-one KC patients (mean age 29.45 ± 5.06 years) and 85 controls (mean age 28.01 ± 5.14 years) were enrolled. The mean levels of IL-6 and TNF-α were 26.77 ± 8.16, and 34.58 ± 9.82 pg/ml in the healthy group and 103.22 ± 51.94, and 183.76 ± 54.61 pg/ml in the KC group, respectively (P < 0.001). There was a significant relationship between the severity of the KC and the mean levels of IL-6 TNF-α in the case group (P < 0.001). CONCLUSION: Our results indicated that the mean levels of IL-6 and TNF-α are significantly higher in KC than the healthy group, and the disease severity was significantly associated with TNF-α and IL-6.

A model for predicting sulcus-to-sulcus diameter in posterior chamber phakic intraocular lens candidates: correlation between ocular biometric parameters.

PURPOSE: The aim of this study was to determine the correlation between ocular biometric parameters and sulcus-to-sulcus (STS) diameter. METHODS: This was a cross-sectional study of preoperative ocular biometry data of patients who were candidates for phakic intraocular lens (IOL) surgery. Subjects underwent ocular biometry analysis, including refraction error evaluation using an autorefractor and Orbscan topography for white-to-white (WTW) corneal diameter and measurement. Pentacam was used to perform WTW corneal diameter and measurements of minimum and maximum keratometry (K). Measurements of STS and angle-to-angle (ATA) were obtained using a 50-MHz B-mode ultrasound device. Anterior optical coherence tomography was performed for anterior chamber depth measurement. Pearson's correlation test and stepwise linear regression analysis were used to find a model to predict STS. RESULTS: Fifty-eight eyes of 58 patients were enrolled. Mean age ± standard deviation of sample was 28.95 ± 6.04 years. The Pearson's correlation coefficient between STS with WTW, ATA, mean K was 0.383, 0.492, and - 0.353, respectively, which was statistically significant (all P < 0.001). Using stepwise linear regression analysis, there is a statistically significant association between STS with WTW (P = 0.011) and mean K (P = 0.025). The standardized coefficient was 0.323 and - 0.284 for WTW and mean K, respectively. The stepwise linear regression analysis equation was: (STS = 9.549 + 0.518 WTW - 0.083 mean K). CONCLUSION: Based on our result, given the correlation of STS with WTW and mean K and potential of direct and essay measurement of WTW and mean K, it seems that current IOL sizing protocols could be estimating with WTW and mean K.

Tonic Pupil, a Paraneoplastic Neuro-Ophtalmological Disease Associated with Occult Breast Cancer.

Here, we present a case of tonic pupil associated with occult breast cancer as a paraneoplastic neuro-ophthalmology syndrome. A 45-year-old woman developed progressive photophobia and blurred vision due to unilateral Adie's tonic pupil. Magnetic resonance image of her brain and neurological examination (including deep tendon reflexes) were normal at first visit. Follow-up examinations performed by ophthalmologist every 6 month without any change in her condition. After 2 years, patient discovered a mass in her breast which identified to be malignant after diagnostic procedures. Despite surgical and medical treatment for cancer, no change in the ocular condition was happened.

Characteristics of Hospitalized Pediatric Patients Following Traumatic Open Globe Injuries; a Cross-sectional Study.

Introduction: One of the main causes of acquired blindness and impairment in children is ocular trauma. This study aimed to evaluate the epidemiological and clinical characteristics of pediatric patients hospitalized with open globe injuries (OGI). Methods: A retrospective cross-sectional study was conducted on children diagnosed with OGI at a referral Hospital affiliated with Isfahan University of Medical Sciences, Isfahan, Iran, from 2014 to 2018. Results: 375 OGI medical records were detected during the study period. The common culprits for OGI in boys were knives (21.3%), wood (19.7%), metal bodies (12.2%), and glass (11.8%). In girls, the common causes were knives (28.7%), glass (24.3%), pencils (11.3%), and wood (10.4%). Boys had a greater rate of Intraocular foreign body (IOFB) (p= 0.052) but had lower odds of blindness compared to girls (OR=0.48; 95% CI: (0.24, 0.98); p = 0.04). Patients with corneal lacerations had lower chances of long-term admission than those with corneal and scleral lacerations (OR= 0.35, 95% CI: (0.17, 0.69); p = 0.02). Conclusion: Most pediatric OGIs occur in boys. knives were the principal culprit for OGI, followed by glass and wood. Boys had a greater IOFB rate but lower blindness odds than girls.

Predisposing Factors and Clinical-Microbiological Profile of Neonatal Corneal Ulcer: A Systematic Review and Analysis.

OBJECTIVE: To provide a comprehensive overview of predisposing factors and clinical-microbiological profile of neonatal corneal ulcer. METHODS: The literature search was undertaken in PubMed, SCOPUS, Embase, Web of Science, and Google Scholar databases on published papers from inception to May 31, 2023. The included articles were independently assessed for methodological quality using a Joanna Briggs Institute checklist. Weighted analysis was utilized, assigning a weight of one to each case report and a weight equivalent to the sample size for the case series/original studies. RESULT: We included 34 relevant case reports/series and one original study. Seventy-four neonates were enrolled with a boy-to-girl ratio of 1.3:1 and a median age of 17 days (1-27 days). Prematurity and neonatal intensive care unit (NICU) care (21.6%), congenital horizontal tarsal kink (13.5%), neonatal herpes infection (13.5%), congenital entropion (5.4%), and jaundice (5.4%) were the most common potential risk factors and coexisting conditions. Microbiology evaluation showed positive results in 53.8% (21/39 cases). Viral and bacterial infections were the most common cause, followed by fungal infections. Herpes virus (18.9%), Pseudomonas aeruginosa (18.9%%) and Staphylococcus epidermidis (6.7%) were the most prevalent causative agents. Negative microbiology was significantly more common in neonates with structural abnormalities (14.9%) compared to others (6.8%) (p = 0.01). CONCLUSION: Based on the findings of reported studies, this systematic review has increased awareness of the risk factors and etiologies that lead to developing corneal ulcers in neonates.

Laser vision correction after radial keratotomy: systematic review and meta-analysis.

Laser vision correction for residual refractive errors in patients with previous radial keratotomy (RK) presents a challenging task. Different techniques have been used with varying outcomes. This study aimed to systematically review published articles on refractive surgeries in post-RK patients by conducting a search on PubMed, Scopus, and Web of Science. The final analysis included 35 studies that described a total of 888 eyes. Our systematic review and meta-analysis demonstrated a significant improvement in uncorrected distance visual acuity (UDVA) for photorefractive keratectomy (PRK), topography-guided PRK, wavefront-guided PRK, and femtosecond laser-assisted in situ keratomileusis (LASIK) while mechanical microkeratome LASIK did not yield such significant improvements. Moreover, our results suggest that post-RK patients with hyperopia had a significant improvement in UDVA, whereas no such improvement was observed in patients with myopia.

Association of Patient Satisfaction with Cataract Grading in Five Types of Multifocal IOLs.

INTRODUCTION: This study investigated patient satisfaction levels in five premium intraocular lenses (IOLs). A secondary aim was to determine whether patient satisfaction was associated with the cataract grade before lens surgery. METHODS: In this multicenter prospective comparative study, 164 patients from diverse backgrounds underwent cataract surgery and were assigned for identical bilateral implantation of multifocal IOLs. In addition to visual performance, quality of life was measured using the National Eye Institute Refractive Error Quality Of Life Instrument (NEI-RQL 42) scoring questionnaire. The Sirius Scheimpflug Analyzer was used to evaluate the posterior cornea and aberrations. Finally, the association of patient satisfaction reports with the Pentacam Cataract Grading Scale (PCGS) and Lens Opacities Classification System (LOCS III) was evaluated. RESULTS: A considerable subjective improvement was observed in uncorrected far, near (40 cm), and intermediate (60 cm) visual acuity in the five groups (P values < 0.001). A significant difference was observed in mesopic and photopic contrast sensitivity between Symfony, Trinova, and AT LISA at the spatial frequency of 12 cycles per degree, favoring Symfony (P < 0.001). PanOptix users had considerably lower mean coma values (P < 0.001), while AT LISA users had lower mean spherical aberrations (P = 0.009) compared to the other groups. No additional safety concerns relating to IOLs were recorded. Mean satisfaction had a high correlation with LOCS and Pentacam Nuclear Staging (PNS) in each lens group, e.g., correlation coefficient and P value for AT LISA were respectively r = 0.99, P < 0.001 and r = 0.97, P = 0.004. CONCLUSION: Despite discrepancies between groups of lenses, most patients who received multifocal IOLs reported satisfaction at more than 3 years after the initial operation. A growing number of patients with cataracts are seeking spectacle-free vision with presbyopia-correcting IOLs. Hence, the high satisfaction rate among patients with cataract could indicate the value of offering a wider range of available lenses.

The association between residual astigmatism and refractive errors in a population-based study.

PURPOSE: To examine the relationship of spherical equivalent (SE) with refractive, corneal, and residual astigmatism. METHODS: Using stratified cluster sampling, 6,311 individuals were invited and 82.2% participated in this study. Examinations including uncorrected and corrected distance visual acuity tests, refraction, slit-lamp examination, and funduscopy were performed for all participants. Refraction and keratometry were used to calculate refractive and corneal astigmatism, respectively, and their difference was regarded as residual astigmatism. RESULTS: Refractive astigmatism showed a U-shaped relationship with SE; with every diopter (D) increase in astigmatism, the SE increased by 0.230 D in hyperopes and 0.664 D in myopes (P < .001). With every 1.0 D increase in residual astigmatism, the SE showed 0.376 D myopic shift in myopes (P = .004) and 0.077 D hyperopic shift in hyperopes (P = .224). Mean SE was highest among cases of with-the-rule (WTR) astigmatism (P < .001). Cases of high myopia and high hyperopia mostly had WTR and most emmetropes had against-the-rule (ATR) refractive astigmatism. Residual astigmatism was mostly WTR in emmetropic cases; at higher levels of SE error in myopes and hyperopes, WTR residual astigmatism decreased, whereas ATR and oblique residual astigmatism increased. CONCLUSIONS: Increases in SE are associated with higher levels of refractive and residual astigmatism among myopic and hyperopic cases. Unlike refractive astigmatism, WTR residual astigmatism was mostly seen in near emmetropic individuals.

Comparing the Effectiveness and Safety of Giving Fentanyl or Ketamine Intranasally during Phacoemulsification Surgery.

BACKGROUND: Phacoemulsification is the main method of cataract surgery in developed countries. Due to the importance of appropriate analgesia and the immobility of the participants throughout the procedure, the study aimed to assess the impact of intranasal ketamine vs. intranasal fentanyl on the quality of sedation and analgesia in phacoemulsification surgery. MATERIALS AND METHODS: This double-blinded study was carried out on participants who underwent cataract surgery in Faiz Hospital, Isfahan, Iran. Eighty subjects were randomly assigned to two groups of 40 receiving ketamine at a dosage of 1.5 mg/kg intranasally (Intranasal Ketamine (INK) group) or fentanyl at 1.5 µg/kg nasally (Intranasal Fentanyl (INF) group). The drugs were administered through the nasal passage 15 minutes before the operation. The primary outcomes were a difference in the quality of sedation and pain relief between groups during the procedure and recovery unit. Secondary outcomes were cardiovascular parameters, side effects, the need for sedative rescues, and changes in vital signs. RESULTS: During the study, 25 patients (62.5%) in the INK cohort and 19 patients (47.5%) in the INF cohort had no pain. In the INK group, 22 (55%) and in the INF group 20 (50.0%) patients achieved optimal sedation (Ramsay sedation score 4). There was no discernible disparity observed between the two cohorts in terms of the quality of sedation (P=0.071), receipt of rescue dosage of propofol (P=0.601), hemodynamic parameters (P0.05), and side effects during treatment Operation (P=0.542) and in recovery (P=0.104), patient (P=0.098) and surgeon (P=0.120) satisfaction, operative time (P=0.082), and duration of stay in recovery (P=0.110). CONCLUSION: Although INK was more effective than INF in reducing pain and achieving optimal sedation in cataract surgery, it was not significantly superior to INF.

Recurring nodular scleritis following inactivated vaccination for COVID-19.

Key Clinical Message: Though COVID-19 vaccination saved many lives all around the world, it has had many adverse effects including ophthalmologic side effects. It is important to report such adverse effects to provide timely diagnosis and management. Abstract: Since the COVID-19 global outbreak, many types of vaccines have been introduced. These vaccines have been associated with some adverse effects including ocular manifestations. Herein, we report a case of a patient who developed nodular scleritis shortly after receiving the first and second doses of the inactivated COVID-19 vaccine, Sinopharm.

Automatic Choroidal Segmentation in Optical Coherence Tomography Images Based on Curvelet Transform and Graph Theory.

Background: Automatic segmentation of the choroid on optical coherence tomography (OCT) images helps ophthalmologists in diagnosing eye pathologies. Compared to manual segmentations, it is faster and is not affected by human errors. The presence of the large speckle noise in the OCT images limits the automatic segmentation and interpretation of them. To solve this problem, a new curvelet transform-based K-SVD method is proposed in this study. Furthermore, the dataset was manually segmented by a retinal ophthalmologist to draw a comparison with the proposed automatic segmentation technique. Methods: In this study, curvelet transform-based K-SVD dictionary learning and Lucy-Richardson algorithm were used to remove the speckle noise from OCT images. The Outer/Inner Choroidal Boundaries (O/ICB) were determined utilizing graph theory. The area between ICB and outer choroidal boundary was considered as the choroidal region. Results: The proposed method was evaluated on our dataset and the average dice similarity coefficient (DSC) was calculated to be 92.14% ± 3.30% between automatic and manual segmented regions. Moreover, by applying the latest presented open-source algorithm by Mazzaferri et al. on our dataset, the mean DSC was calculated to be 55.75% ± 14.54%. Conclusions: A significant similarity was observed between automatic and manual segmentations. Automatic segmentation of the choroidal layer could be also utilized in large-scale quantitative studies of the choroid.

Clinical efficacy of Fluorometholone versus Loteprednol eye drops after photorefractive keratectomy: A triple-blinded randomized controlled trial.

PURPOSE: This study aimed to compare the anti-inflammatory efficacy and safety of 0.1% Fluorometholone (FML) versus (vs.) 0.5% Loteprednol etabonate (LE) following photorefractive keratectomy (PRK). METHODS: A triple-blinded randomized controlled trial was conducted on both eyes of 100 patients with stable refraction who were candidates for PRK. Both eyes in each subject were randomly allocated to the FML or LE groups. The product to be tested was 0.1% FML eye drops packaged in droppers vs. the 0.5% LE sterile ophthalmic suspension (Lotemax®) packaged in identical droppers. The main clinical outcomes were changes in best-corrected distance visual acuity (BCDVA) and corneal optical density. The second clinical outcomes were a change in intraocular pressure (IOP) after the intervention. RESULTS: There was no significant difference regarding mean corneal optical density changes between the two groups, one (P = 0.55) and three months (P = 0.98) after the intervention. The mean ± SD BCDVA after one month of the intervention was 0.79 ± 0.11 and 0.84 ± 0.11 in LE and FML groups, retrospectively (P = 0.02). There was no significant difference regarding mean BCDVA between the two groups three months after intervention (P = 0.21). The IOP showed no significant difference between the two groups after one (P = 0.18) and three months (P = 0.53) of the intervention. CONCLUSIONS: The results of this clinical trial demonstrate that LE and FML treatment was effective with no clinically meaningful effect on IOP following a short course of treatment.