Agreement between a new swept-source ocular coherence tomography and a Placido disc-dual Scheimpflug ocular biometric devices.

PURPOSE: To evaluate the agreement between two biometry devices, the Heidelberg Anterion and the Galilei G6 Lens Professional. METHODS: Eyes were scanned with both biometry devices. Analysis of inter-device agreement was conducted for the following metrics: flat (K1), steep (K2) and mean K (Km) for anterior, posterior and total cornea, lens thickness (LT), central corneal thickness (CCT), anterior chamber depth (ACD), white to white (WTW) and axial length (AL). Generalised Estimating Equations were used to account for inter-eye correlation. Bland-Altman analysis was conducted to derive the mean difference (MD) and limits of agreement (LoA) between devices. Differences were deemed clinically significant if they would result in a change in post-operative refraction of 0.25D or more. RESULTS: 159 eyes of 91 patients were included. For the anterior cornea, no significant MD was found for K1 (-0.11D) and K2 (-0.10D), although a significant MD was found for Km (-0.10D). For posterior cornea, while there were no significant MDs between devices, the LoAs were wide for both posterior K1(-0.70, 0.68) and posterior K2 (-1.01, 1.29). For total corneal power, significant MDs were found in K1 (0.36D), and Km (0.26D) but not for K2 (0.17D). Significant MDs were found for LT (0.179mm), CCT (-0.005mm), ACD (-0.111mm) and WTW (-0.158mm), but not for AL (-0.021mm, p > 0.05).Conclusion: There are statistically but not clinically significant differences between Anterion and Galilei G6 Lens Professional in anterior Km, LT, CCT, ACD and WTW. Measurements of the posterior and total cornea are not interchangeable between devices.

Ocular Surface Squamous Neoplasia: A 12-Month Prospective Evaluation of Incidence in Waikato, New Zealand.

Ocular surface squamous neoplasia (OSSN) has a high incidence in the southern hemisphere. This prospective study evaluated the incidence of OSSN in the Waikato region of New Zealand. All patients presenting with pterygium or conjunctival lesions in the Waikato region in 2020 were included. All surgeons in the region were asked to send all conjunctival and corneal specimens excised for histopathologic examination. The primary outcome measure was the incidence of OSSN. Eighty-eight percent of all excised specimens were sent for histopathologic examination. Of the 185 excised lesions sent for histopathological assessment, 18 (10%) were reported as OSSN. Patients were on average 69.4 years of age (standard deviation, SD = 6.9), predominantly male (78%), and of New Zealand-European ethnicity (89%). The OSSN annual incidence was 3.67/100,000/year. Histology grades included conjunctival intraepithelial neoplasia (CIN)-I (25%), CIN-II (25%), CIN-III (12.5%), carcinoma in situ (25%), and invasive squamous cell carcinoma (SCC) (12.5%). One patient with invasive SCC required exenteration. This study identified a high incidence rate of OSSN and is the first prospective study to analyze OSSN epidemiology in New Zealand.

Visual Outcomes of Patients With Peripheral Ulcerative Keratitis and the Effect of Immunosuppression-A 6-Year Experience in Queensland, Australia.

OBJECTIVE: Peripheral ulcerative keratitis (PUK) can cause significant ocular morbidity and mortality. This study aimed to review the effects of systemic immunosuppression on visual outcomes. METHODS: A state-wide, retrospective case series based in Queensland, Australia, was performed. A review of patients who presented with PUK to the major tertiary ophthalmology referral centers between January 2015 and January 2021 was undertaken. Parameters recorded included clinical features at presentation, investigations undertaken, treatment provided, visual outcomes, and mortality outcomes. The effect of immunomodulatory therapy on the change in vision from presentation to the most recent review was analyzed. RESULTS: Twenty-two eyes of 26 patients with PUK (average age 69.81±14.54 years) were included and had a mean follow-up period of 577.73 days. Twelve patients (54.5%) had systemic autoimmune disease, one patient (4.5%) had positive syphilis serology, and nine patients (40.9%) had idiopathic PUK. Eighteen patients (81.8%) were treated with systemic steroids and 10 patients (45.5%) were treated with steroid-sparing immunomodulatory therapy. Average logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) at presentation and final follow-up were 0.63±0.65 and 0.64±0.82, respectively. Those who were treated with immunomodulatory therapy had a nonstatistically significant improvement in BCVA (-0.10±0.29 with vs. +0.10±0.35 without), and a similar trend was seen for doxycycline (-0.08±0.09 with vs. +0.22±0.49 without). Four of five perforations (80%) were surgically managed. Four patients (18.2%) were deceased. CONCLUSIONS: Peripheral ulcerative keratitis poses significant clinical challenges and requires intensive medical treatment, frequently involving systemic immunomodulatory therapy. Surgical treatment is required in a significant minority of cases. Ocular management alongside the use of doxycycline and immunomodulatory therapy in consultation with specialist physicians can optimize visual and systemic outcomes.

Agreement between 2 SS-OCT biometry devices.

PURPOSE: To assess the agreement between 2 swept-source optical coherence tomography biometry devices, Anterion and IOLMaster 700. SETTING: Tertiary referral center, Brisbane, Australia. DESIGN: Prospective comparative study. METHODS: Bland-Altman analysis was used to assess agreement between devices for flat (K1), steep (K2), and mean (Km) keratometry for anterior, posterior, and total cornea, lens thickness (LT), anterior chamber depth (ACD), central corneal thickness (CCT), white to white (WTW), and axial length (AL). Generalized estimating equations were used to control for within-patient between-eye correlations. Interdevice differences were considered clinically significant if they were likely to alter the spherical refractive outcome by 0.25 diopter (D) or more. RESULTS: 159 eyes of 91 patients (41 male, 50 female) were included. Statistically significant differences were found for K1, K2, and Km for anterior, posterior, and total cornea. When the Anterion was compared with the IOLMaster 700, the mean differences were as follows: anterior K1: -0.17 D, anterior K2: -0.18 D, anterior Km: -0.17 D, posterior K1: -0.38 D, posterior K2: -0.36 D, posterior Km: -0.37 D, total K1: -0.65 D, total K2: -0.82 D, and total Km: -0.74 D. The difference in posterior and total K metrics was clinically significant. Statistically significant differences were noted for LT: 0.159 mm, CCT: -0.004 mm, ACD: 0.054 mm, and WTW: -0.152 mm, although these were not found to be clinically significant. There was no significant difference between devices for AL. CONCLUSIONS: This study found statistically and clinically significant differences for both posterior and total keratometry between the Anterion and the IOLMaster 700. Posterior and total corneal parameters cannot be considered interchangeable between devices.

Outcomes of a Toric Monofocal Piggyback Intraocular Lens for Residual Astigmatic Refractive Error in Pseudophakic Eyes.

PURPOSE/AIM: To evaluate the visual outcomes, refractive outcomes and rotational stability of a toric piggyback intraocular lens (1stQ AddOn, GmbH, Mannheim, Germany) for astigmatic refractive error in pseudophakic eyes. MATERIALS AND METHODS: Visual and refractive outcomes were assessed based on the standard graphs for reporting refractive surgery outcomes. Rotational stability was assessed according to the Intraocular Lens (IOL) standards of the International Organisation for Standards. RESULTS: Twenty-two eyes of 17 patients (age: 65.1 ± 9.3 years) underwent toric piggyback IOL insertion. After a minimum follow-up of 3 months, 18 eyes (82%) achieved an uncorrected distance visual acuity (UDVA) of 0.00 logMAR (20/20) or better and all eyes achieved 0.1 logMAR (20/25). Mean UDVA improved from 0.27 ± 0.03 to 0.12 ± 0.03 and 0.04 ± 0.04 at one and 3 months (all p < .05). Nineteen eyes (86%) achieved an UDVA at least equal to the pre-operative corrected distance visual acuity (CDVA). No eyes lost more than one line of CDVA. All eyes achieved within 0.5D of target spherical equivalent (SE). In 18 eyes (82%), the residual astigmatism magnitude was 0.5D or less. The mean absolute difference between the target axis and the achieved axis 1 and 3 months postoperatively was 2.5° ± 2.7° and 3.2° ± 3.3°, respectively. The final IOL orientation was within 10 degrees of target axis in 19 of 22 (86.4%) eyes, within 20 degrees in 21 of 22 (95.2%) eyes and within 30 degrees in 22 of 22 (100%) eyes. IOL rotational repositioning was required in two eyes (9.1%). CONCLUSIONS: In this cohort of patients, the 1stQ AddOn toric monofocal piggyback IOL resulted in very good visual and refractive outcomes and showed reasonable rotational stability. This IOL appears to be an effective treatment option for residual astigmatic refractive error in pseudophakic eyes.

Ferrara Rings for Visual Rehabilitation in Eyes with Keratoconus and Previous Cross-Linking Using the Ferrara Ring Nomogram.

PURPOSE: To report the visual, refractive and tomographic outcomes following the implantation of intrastromal corneal ring segments (ICRS) (Ferrara rings, AJL Ophthalmics, Miñano, Spain) in eyes with a history of keratoconus and corneal cross-linking using the Ferrara ring nomogram. METHODS: Retrospective, interventional case series performed at the Corneoplastics Unit, Queen Victoria Hospital, East Grinstead, United Kingdom. RESULTS: 21 eyes of 19 patients with a history of keratoconus and prior corneal collagen cross-linking had Ferrara Intrastromal Corneal Ring Segments implanted between December 2015 and October 2017. The number, thickness and length of ring segments was chosen based on the Ferrara ring company nomogram. Mean uncorrected visual acuity (UDVA) improved from 0.88 to 0.52 logMAR (p < 0.001). Mean corrected visual acuity (CDVA) improved from 0.47 to 0.36 logMAR (p = 0.046). The percentage of eyes achieving 20/40 UDVA and CDVA increased from 5% to 38% and from 38% to 67%, respectively. Of the eyes, 52.3% gained at least two lines of CDVA. The spherical equivalent improved from -7.51D to -3.76D (p < 0.001) and the refractive astigmatism magnitude improved from 5.14D to 2.76D (p = 0.004). There were significant improvements in the corneal tomography with mean keratometry (KM) improving from 50.40D (3.53) to 48.24D (3.00) (p = 0.01) and keratometric astigmatism magnitude improving from 5.14D (2.91) to 2.76D (1.67) (p = 0.004). CONCLUSION: Insertion of Ferrara rings in keratoconic eyes with a history of prior cross-linking using the company nomogram results in significant improvements in visual, refractive and tomographic outcomes.

Tear film parameters before and after intracorneal ring segment implantation in keratoconic eyes.

PURPOSE: To assess signs of dry eye syndrome in keratoconic eyes following intracorneal ring segment (ICRS) implantation. PATIENT AND METHODS: Twenty eyes of 20 consecutive patients with keratoconus were assessed for tear film changes following ICRS implantation at 6 months postoperatively. Evaluated parameters included tear osmolarity, non-invasive tear breakup time test (NI-BUT test) and Schirmer test I and II before and after treatment. RESULTS: No significant changes were found with respect to osmolarity, Schirmer I and II (p = 0.9, p < 0.64, and p < 0.91, respectively). The NITUBT was significantly lower after surgery (p = 0.04). CONCLUSION: Our results suggest that implantation of ICRS does not result in a significant change in tear film osmolarity, or tear film volume nor improves the tear film stability.

Outcomes of sequential intracorneal ring segment and phakic intraocular lens insertion for visual rehabilitation in keratoconus.

PURPOSE: To report the visual and refractive outcomes of sequential intracorneal ring segment (ICRS) and toric phakic intraocular lens (IOL) insertion for visual rehabilitation in keratoconus. METHODS: A retrospective interventional cohort study was performed through the Corneoplastics unit and Eye Bank, Queen Victoria Hospital, East Grinstead, United Kingdom. RESULTS: 14 eyes of 12 patients had sequential ICRS and phakic IOL implantation for visual rehabilitation of keratoconus between June 2014 and February 2018. After at least 6 months follow-up, the number of eyes with an uncorrected distance visual acuity (UDVA) of 20/40 UDVA or better increased from zero (0%) to 10 (71%). 12 (85.7%) eyes achieved a post-operative UDVA equal to or better than the pre-operative corrected distance visual acuity (CDVA). The number percentage of eyes with a CDVA of 20/40 or better increased from 3 (31%) to 14 (100%). The mean final spherical equivalent improved from -4.07 to -0.17 (p ⩽ 0.001). The mean refractive astigmatism magnitude improved from 4.76D to 1.23D (p = 0.002). Seven (50%) eyes had 1.0D or less of refractive astigmatism post-operatively. CONCLUSION: In this cohort of eyes with keratoconus, sequential ICRS and phakic IOL implantation resulted in excellent visual and refractive outcomes after at least 6 months.

Comparison of Visual and Tomographic Outcomes of Epithelium-On and Epithelium-Off Accelerated Corneal Crosslinking: A Longitudinal Study.

PURPOSE: To compare the visual and tomographic outcomes of epithelium-on and epithelium-off corneal collagen crosslinking (CXL) in an accelerated protocol in eyes with progressive keratoconus. METHODS: Sixty-one patients with progressive keratoconus (female patients, n = 30; male patients, n = 31) aged 17 and 48 years (mean age: 25.8 ± 6.2 yrs) were included in this study. Patients underwent either epithelium-off (n = 27) or epithelium-on (n = 34) CXL using an accelerated protocol. Patients with at least 12 months of follow-up were included in the study. Visual and tomographic data from 3, 6, and 12 months after surgery were analyzed. RESULTS: There were no differences between the visual and tomographic characteristics of the epithelium-on and epithelium-off groups at baseline (P > 0.05). No significant changes in uncorrected and best spectacles-corrected visual acuity were found at any stage during the first 12 months within either group or between the groups (all P > 0.05). There were no changes in thickness and keratometric parameters at any stage during the first 12 months within either group, or between groups (P > 0.05) except for a transient significant thinning of the central cornea in all groups in the first 3 months which recovered by 6 months. There was no significant difference between groups regarding the number of eyes with progression in the 12 months after treatment (P > 0.05). CONCLUSIONS: Epithelium-on and epithelium-off CXL in an accelerated protocol provide comparable visual and tomographic outcomes after 1 year in eyes with progressive keratoconus.

Outcomes of toric supplementary intraocular lenses for residual astigmatic refractive error in pseudophakic eyes.

PURPOSE: To evaluate rotational stability and visual and refractive outcomes of supplementary toric IOLs (Sulcoflex Toric 653T, Rayner Intraocular Lenses Ltd) for residual astigmatic refractive error in pseudophakic eyes. METHODS: A retrospective interventional case series was conducted in a single surgeon practice. Charts of patients who had Sulcoflex Toric supplementary IOLs inserted between June 2009 and September 2015 were reviewed. Outcomes were compared between eyes with and without prior corneal transplant. Patients with at least 3-months follow-up were included. RESULTS: In 51 eyes, mean UDVA improved from 20/86 to 20/43 (p = 0.002), though UDVA was better in eyes without corneal grafts (20/31) than eyes with (20/62). The proportion of eyes achieving 20/20 UDVA was 43%, 61% and 17% overall, in eyes with prior graft and in eyes with no prior graft, respectively. Sixty-four percentage achieved a spherical equivalent of within 0.5D of target (84% no graft, 34% prior graft). Fifty-three percentage of eyes achieved a cylinder of within 0.5D of target (no graft: 73%, prior graft: 0%). Mean lens rotation was 8.23° on day 1, and mean maximal rotation during follow-up was 17.63°. Sixty-two percentage of IOLs required repositioning. Of those that required repositioning, this was conducted a mean of 2.3 times. The mean final IOL rotation (following repositioning if required) was 6.17°. CONCLUSION: Sulcoflex Toric supplementary IOLs result in good visual and refractive outcomes in eyes with no prior corneal graft. However, outcomes are sub-optimal in eyes with prior corneal transplantation, and the majority of lenses require repositioning.

Bilateral Ulcerative Keratitis Associated With Afatinib Treatment for Non-Small-cell Lung Carcinoma.

PURPOSE: To report a case of afatinib-related bilateral ulcerative keratitis. METHODS: An 85-year-old female patient on treatment with afatinib for non-small-cell lung carcinoma presented with progressive redness, pain, and decreased vision in both eyes. Four weeks before the onset of symptoms, afatinib therapy had been commenced at a dose of 40 mg, once daily. Clinical examination, OCT imaging, photographs, and corneal scrapes were completed at presentation. Afatinib was discontinued. Topical and oral therapy were commenced to treat ulcerative keratitis with close monitoring for signs of progression or corneal perforation. RESULTS: Significant stromal thinning was detected in the inferior cornea of both eyes with an overlying epithelial defect and no infiltrate. No organisms were identified from the corneal scrapes. The patient responded well to treatment, and her vision returned to baseline 4 months after presentation. CONCLUSIONS: To the best of our knowledge, this is the first case in the literature that reports afatinib-related ulcerative keratitis. Careful monitoring for signs of ocular adverse events is recommended during treatment with afatinib for non-small-cell lung carcinoma.

Clinical Outcomes after Keraring Implantation for Keratoconus Management in Patients Older Than 40 Years: A Retrospective, Interventional, Cohort Study.

BACKGROUND: Intracorneal ring segment implantation is an effective and safe method of visual improvement in patients with keratoconus. The aim of our study was to evaluate the long-term clinical outcomes after Keraring implantation for keratoconus in patients older than 40 years. METHODS: Eleven eyes from 11 patients with keratoconus who underwent femtosecond laser-assisted Keraring implantation for keratoconus were included in this retrospective study. The uncorrected visual acuity (UCVA), corrected visual acuity, keratometric readings, central corneal thickness and thinnest corneal pachymetry were evaluated preoperatively and 6 months after the Keraring implantation. RESULTS: UCVA, BCVA and keratometric readings improved at 6 months postoperatively. CONCLUSION: Our data showed significant keratometric amelioration and visual improvement after Keraring implantation for keratoconus in patients older than 40 years at 6 months postoperatively.

Management of recurrent Paecilomyces lilacinus keratitis.

A 72-year-old man presented with Paecilomyces keratitis subsequent to immunosuppressive treatment. Despite medical therapy with voriconazole, perforation occurred requiring a tectonic keratoplasty of 10 mm. Despite oral, topical and intracameral voriconazole, there was recurrent stromal infiltration. A corneoscleral graft of 15 mm was undertaken. Two weeks later, hyphae were seen on the anterior lens capsule with hypopyon requiring phacoemulsification and anterior chamber washout. Six weeks later, there was evidence of endophthalmitis. Pars plana vitrectomy, capsulectomy and intravitreal injection of voriconazole were performed. Voriconazole treatment was continued for a further 10 months and then ceased. At 16 months following the last recurrence of Paecilomyces, there was no evidence of infection. After 20 months, the patient had a sutured intraocular lens with an artificial iris. Vision is 6/36 unaided and 6/24 pinhole.