Primary meningococcal conjunctivitis in an adult patient.

Primary meningococcal conjunctivitis from Neisseria meningitidis is a rare cause for acute, purulent conjunctivitis most commonly presenting in children. Here we present a case of primary meningococcal conjunctivitis in an adult patient with mild signs/symptoms mimicking non-gonococcal bacterial conjunctivitis. The patient was immediately treated with topical and systemic antibiotics. Here we highlight that an early diagnosis of a mild case can be missed thus, clinicians need to keep a high index of suspension as prompt recognition is important to initiate appropriate systemic antimicrobial therapy to prevent systemic disease.

Long-term results of hyperopic ablations using alcohol-assisted PRK and FS-LASIK: comparative study.

PURPOSE: To evaluate the long-term visual and refractive outcomes of hyperopic excimer ablation using alcohol-assisted photorefractive keratectomy (PRK) and femtosecond laser-assisted laser in situ keratomileusis (FS-LASIK). SETTING: American University of Beirut Medical Center, Beirut, Lebanon. DESIGN: Retrospective, matched comparative study. METHODS: Eyes that underwent alcohol-assisted PRK were compared to matched eyes that underwent FS-LASIK. All patients were followed up for at least 3 years after surgery. The refractive and visual outcomes of each group were compared at different postoperative time points. The main outcome measures were spherical equivalent deviation from target (SEDT), manifest refraction, and visual acuity. RESULTS: 83 eyes underwent alcohol-assisted PRK and 83 matched eyes underwent FS-LASIK. Preoperative manifest refraction spherical equivalent was 2.44 ± 1.18 diopters (D) and 2.20 ± 0.87 D ( P = .133) in the PRK and FS-LASIK groups, respectively. Preoperative manifest cylinder was -0.77 ± 0.89 D and -0.61 ± 0.59 D ( P = .175) for the PRK and LASIK groups, respectively. 3 years postoperatively, SEDT was 0.28 ± 0.66 D and 0.40 ± 0.56 D for the PRK and LASIK groups, respectively ( P = .222), whereas manifest cylinder was -0.55 ± 0.49 D and -0.30 ± 0.34 D for PRK and LASIK, respectively ( P < .001). The mean difference vector was 0.59 ± 0.46 for PRK and 0.38 ± 0.32 for LASIK ( P < .001). 13.3% of PRK eyes and 0% of LASIK eyes had >1 D of manifest cylinder ( P = .003). CONCLUSIONS: Both alcohol-assisted PRK and FS-LASIK are safe and effective for the treatment of hyperopia. PRK induces slightly more postoperative astigmatism than LASIK. Larger optical zones and recently introduced ablation profiles that lead to a smoother ablation surface might improve the clinical results of hyperopic PRK.

Extended Depth of Focus Versus Trifocal for Intraocular Lens Implantation: An Updated Systematic Review and Meta-Analysis.

PURPOSE: To compare the extended depth of focus (EDOF) vs trifocal intraocular lenses (IOLs) in patients undergoing IOL implantation. DESIGN: Systematic review and meta-analysis. METHODS: An electronic search was conducted as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to include studies comparing EDOF vs trifocal IOLs. Refraction and visual acuity were primary outcomes. Secondary outcomes included defocus curves, intraocular aberrations, contrast sensitivity (CS), quality of vision (QoV) questionnaire score, haloes and glare, spectacle independence, and patient satisfaction. RESULTS: A total of 22 studies enrolling 2200 eyes were identified. Trifocal IOL showed a significant improvement in sphere (mean difference [MD] = -0.23; P = .001) and spherical equivalence (MD = -0.11, P = .0001) compared to EDOF IOL. No difference was observed in cylinder (MD = -0.03, P = .25) or astigmatism. Trifocal IOL had superior near visual acuity outcomes, namely uncorrected near visual acuity (MD = 0.12, P < .00001) and distance-corrected near visual acuity (MD = 0.12, P = .002). Postoperative corrected distance visual acuity (MD = -0.01, P = .01) was significantly improved for the EDOF group, although no difference was noted in postoperative uncorrected distance visual acuity (MD = 0.00, P = .84), uncorrected intermediate visual acuity (MD = 0.01, P = .68) or distance-corrected intermediate visual acuity (MD = -0.01, P = .39). Defocus curve favored trifocal IOLs at near vision and EDOF IOLs at intermediate vision. Ocular aberration, CS, haloes (odds ratio = 0.64, P = .10), glare, and patient satisfaction were not statistically significant between the groups. The trifocal IOL was associated with an improved QoV questionnaire score (MD = 1.24, P = 0.03) and spectacle independence (odds ratio = 0.26, P = .02). CONCLUSIONS: Trifocal IOLs improved uncorrected near visual acuity compared to EDOF IOLs. Uncorrected distance and intermediate visual acuity, halos, and glare were not statistically different between both groups.

Biochemical and molecular alterations and potential clinical applications of biomarkers in keratoconus.

Keratoconus (KC) is a complex multifactorial corneal ectatic disorder, with disease onset commonly in the second-third decades significantly affecting quantity, quality of vision, and quality of life. Several pathways and factors such as eye rubbing, inflammatory, oxidative, metabolic, genetic, and hormonal among others have been studied in the last two decades. However, the management of KC is still based on a few "one-size fits all" approaches and is predominantly guided by topo/tomographic parameters. Consideration of the several novel factors which have the potential to be biomarkers in addressing several unanswered questions in the disease process could help in the better predictive ability of progression or vision loss and customization of treatment options. This article delves into the understanding of these novel factors or biomarkers based on the pathogenesis of KC and features a special focus on their potential clinical applications and their future role in personalized medicine.

Corneal neurotization.

PURPOSE OF REVIEW: Neurotrophic keratopathy is a devastating corneal condition that can lead to ocular morbidity and blindness. Current medical and surgical treatments poorly tackle the essential problem of corneal aesthesia and hence fail to provide a permanent cure. Recent advances in corneal neurotization techniques have shown promise to restore corneal nerves in neurotrophic keratopathy. This article aims at reviewing the current surgical advances, along with the current thoughts and evidence available for corneal nerve regeneration. RECENT FINDINGS: Corneal neurotization was first introduced in 2009 by Terzis et al., but recently picked up more interest since 2014. Direct and indirect neurotization are being developed, and different nerves (sural nerve, great auricular nerve) have been explored for interposition between frontal nerve branches and the cornea. New endoscopic techniques are introduced for less invasive approaches. On the corneal front, confocal microscopy and esthesiometry studies have established that the regeneration of the corneal nerves is happening 6 months after the procedure. SUMMARY: Neurotization is a budding revolutionary technique that shows promise of cure for neurotrophic corneas, but at this stage, it is still reasonably invasive and still reserved for selected patients.

BrightOcular® Cosmetic Iris Implant: A Spectrum from Tolerability to Severe Morbidity.

PURPOSE: The BrightOcular® implants are the newest model of cosmetic iris devices that are currently advertised as safe. The previous generation known as NewColorIris® have had severe ocular side effects and were subsequently withdrawn from the market. There is little literature on the safety profile of BrightOcular® implants. CASE REPORT: Herein we describe two cases with varying degrees of ocular tolerability. The first case had a normal ocular exam 1 year after implantation, whereas the second case had unilateral severe corneal edema requiring explantation of the iris device and Descemet membrane endothelial keratoplasty 9 months after bilateral implantation. CONCLUSIONS: These two cases attest to the unpredictability of the results of these cosmetic surgeries. Patients should be counseled about the vision-threatening complications of iris implants.

Physiologic and Psychologic Risk Factors in Central Serous Chorioretinopathy.

PURPOSE: Central serous chorioretinopathy (CSCR) is characterized by macular detachment due to thickened choroid, mostly affecting young men under perceived stress. Although most previous studies on CSCR have been retrospective and have focused on a single facet of the patient's personality, we conducted a prospective, intercontinental, controlled study to analyze the multifaceted personality profile in CSCR. DESIGN: Prospective, cross-sectional, case-control study. PARTICIPANTS: Subjects with CSCR from 6 university-based eye clinics consented to participate in a questionnaire. Controls without retinal disease were recruited from the same clinics. METHODS: The interview consisted of a 60-item questionnaire. Recruitment of participants was from January 2015 to February 2016. Controls were matched for age, gender, and race. Statistical analyses were performed using univariate and multivariate analyses. MAIN OUTCOME MEASURES: The main parameters registered were presence of stress, daily number of cups caffeine intake, and personality traits (Type A; obsessive-compulsive; aggressive). RESULTS: A total of 83 consecutive patients with CSCR (mean age, 45.9 years; male, 80.7%) and 83 controls (mean age, 46.0 years; male, 80.7%) were analyzed for 60 variables. Multivariate analysis revealed a strong association with obsessive-compulsive behavior (P = 0.001), caffeine intake (P = 0.002), Type A personality (P = 0.002), continuous stress (P = 0.001), and premature ejaculation (P = 0.001). CONCLUSIONS: This study sheds light on the unique psychologic functioning of patients with CSCR: preoccupied, inflexible, perfectionist (obsessive-compulsive tendency), competitive, ambitious, impatient, high achiever (Type A personality), and under continuous stress. In addition, caffeine abuse and premature ejaculation were linked to CSCR.