Ocular Surface Disease and Glaucoma Medications: A Clinical Approach.

OBJECTIVES: Ocular surface disease frequently coexists with glaucoma and may be initiated or exacerbated by topical glaucoma medications. We performed a review of current literature to assess the prevalence, causes, and treatment of ocular surface disease in glaucoma patients, specifically those on topical therapy. METHODS: A Pubmed database search was conducted. A total of 720 articles published from 1972 to 2018 were found in relation with ocular surface disease, glaucoma, and glaucoma medications. Of these, 102 articles were included in this analysis. We included primary and empirical studies for patients on topical glaucoma medications. Exclusion criteria included case reports, non-English studies, and articles unrelated to the primary subject of this review. RESULTS: Ocular surface disease among normal and glaucomatous eyes was evaluated based on diagnostic testing including clinical examination and questionnaires to determine visual function and quality of life. Glaucoma medications can be associated with toxicities to the ocular surface, most often due to the nature of the preservative included in the medication; however, the incidence of toxicity can be mitigated by the use of preservative free medications, decreased preservative medications, or treatment of dry eye disease. Treatment of glaucoma with laser trabeculoplasty or minimally invasive glaucoma surgeries that spare the conjunctiva and the cornea may avoid or decrease reliance on topical glaucoma medications, potentially avoiding the initiation or progression of ocular surface disease. CONCLUSIONS: Recognition and treatment of ocular surface disease in glaucoma patients may improve patient quality of life and medication adherence. This may ultimately improve glaucoma treatment outcomes.

Precut Post-Laser In Situ Keratomileusis / Photorefractive Keratectomy Donor Corneas for Use in Endothelial Keratoplasty: Potential Impact of Postcut Morphology on Visual Outcomes.

PURPOSE: To evaluate the accuracy, complication rates, cut quality, and degree of induced hyperopic shift of eye bank-prepared post-laser in situ keratomileusis (LASIK)/photorefractive keratectomy (PRK) donor corneas compared to those of non-post-LASIK/PRK donor corneas. METHODS: The cut accuracy and failure rates of all post-LASIK/PRK donor cornea tissue processed for use in Descemet stripping automated endothelial keratoplasty (DSAEK) from January 2012 through December 2016 were compared to control cornea donor tissue. Corneas were analyzed for regularity and morphology of cut using anterior segment optical coherence tomography images. Using a mathematical model, the hyperopic shifts induced by post-LASIK/PRK donor lenticules were compared to the control corneas. RESULTS: During the study period, 733 post-LASIK/PRK and 10 437 non-post-LASIK/PRK donor corneas were processed for DSAEK. Cut accuracy and quality were similar (P > .05), but there was an increased tissue wastage rate of 5.0% compared to 2.2% (P < .000001). For tissue < 100 µm in central thickness (P = .0001), and for tissue between 100 and 150 µm in central thickness (P = .0023), the difference between central and peripheral thickness when comparing the post-LASIK/PRK and control corneas was statistically significant. These differences resulted in a 1.96 diopter (D), 1.60 D, and 2.35 D hyperopic shift when using donor corneas 100 µm, 125 µm, and 150 µm thick, respectively, from post-LASIK/PRK donors compared to 1.11 D, 0.38 D, and 1.96 D from control donors. CONCLUSIONS: Eye bank technicians and surgeons should be aware of the increased risk of tissue wastage when cutting post-LASIK/PRK corneas compared to non-post-LASIK/PRK donors. Surgeons should also be aware of the theoretical increase in hyperopic shift when using post-LASIK/PRK donor corneas compared to non-post-LASIK/PRK donors when cut to less than 150 µm. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.

Management of chronic complications associated with herpes zoster ophthalmicus.

PURPOSE OF REVIEW: Herpes zoster ophthalmicus (HZO) has the potential to cause significant visual morbidity and functional disability in patients with recalcitrant disease, keratitis, and postherpetic neuralgia. This article will review the current methods of prevention and treatment of anterior segment-related chronic complications of HZO. RECENT FINDINGS: HZO-related anterior segment ocular complications can range to include conjunctivitis, keratitis, and uveitis that can all be difficult to manage. Furthermore, many clinicians differ in their approach to disease management given the relative lack of large randomized controlled trials to guide therapy. The goal in managing complications of HZO is to reduce visual morbidity and to improve analgesia, and here, we present current recommendations for the management of anterior segment complications of HZO. SUMMARY: Recent advances in vaccine technology and the initiation of the Zoster Eye Disease Study improve the possibility of reducing the burden of disease while also further standardizing management of HZO.

Management of Herpes Simplex Virus Keratitis in the Pediatric Population.

Herpes simplex virus (HSV) keratitis is a highly prevalent and visually disabling disease in both the pediatric and adult population. While many studies have investigated the treatment of HSV keratitis in adult patients, few have focused on managing this condition in children. Children are at particularly high risk for visual morbidity due to unique challenges in diagnosis and treatment, and the often more aggressive disease course that results in corneal scarring, and subsequently amblyopia. This review presents the pathogenesis and most current recommendations for the medical and surgical management of HSV keratitis in the pediatric population.