Interventions for recurrent corneal erosions.

BACKGROUND: Recurrent corneal erosion is a common cause of disabling ocular symptoms and predisposes the cornea to infection. It may follow corneal trauma. Measures to prevent the development of recurrent corneal erosion following corneal trauma have not been firmly established. Once recurrent corneal erosion develops, simple medical therapy (standard treatment) may lead to resolution of the episode. However, some people continue to suffer when such therapy fails and repeated episodes of erosion develop. A number of treatment and prophylactic options are then available but there is no agreement as to the best option. This review version is an update to the original version published in 2007 and a previous update published in 2012. OBJECTIVES: To assess the effectiveness and adverse effects of regimens for the prophylaxis of further recurrent corneal erosion episodes, the treatment of recurrent corneal erosion and prophylaxis of the development of recurrent corneal erosion following trauma. SEARCH METHODS: We searched CENTRAL, which contains the Cochrane Eyes and Vision Trials Register; MEDLINE; Embase; LILACS; the ISRCTN registry; ClinicalTrials.gov and the ICTRP. The date of the search was 14 December 2017. SELECTION CRITERIA: We included randomised and quasi-randomised trials that compared a prophylactic or treatment regimen with another prophylaxis/treatment or no prophylaxis/treatment for people with recurrent corneal erosion. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. Two authors independently screened search results, extracted data and assessed risk of bias in the included studies using the Cochrane tool for assessing risk of bias. We considered the following outcome measures: resolution of symptoms after treatment; recurrence after complete or partial resolution; symptoms (pain); adverse effects (corneal haze, astigmatism). We graded the certainty of the evidence using GRADE for the three most clinically relevant comparisons. MAIN RESULTS: We included eight randomised and two quasi-randomised controlled trials in the review, encompassing 505 participants. Seven studies were from Europe (Germany, Sweden and the UK), two from East Asia (Hong Kong and Japan) and one from Australia. Nine of the studies examined treatments for episodes of recurrent corneal erosions and one study considered prophylaxis to prevent development of recurrent corneal erosions after injury. Two of the nine treatment studies also enrolled participants in a study of prophylaxis to prevent further episodes of recurrent corneal erosions. The studies were poorly reported; we judged only one study low risk of bias on all domains.Two studies compared therapeutic contact lens with topical lubrication but one of these studies was published over 30 years ago and used a therapeutic contact lens that is no longer in common use. The more recent study was a two-centre UK study with 29 participants. It provided low-certainty evidence on resolution of symptoms after treatment with similar number of participants in both groups experiencing resolution of symptoms at four months (risk ratio (RR) 0.97, 95% confidence interval (CI) 0.62 to 1.53). There was very low-certainty evidence on recurrence after partial or total resolution at seven months' follow-up (RR 1.07, 95% CI 0.07 to 15.54). There was no evidence of an important difference in pain score (score of 3 in the contact lens group and score of 2 in the topical lubrication group, low-certainty evidence) and no adverse effects were reported. The older study, using a contact lens no longer in common use, found an increased risk of pain and complications with the contact lens compared with hypromellose drops and paraffin ointment at night.A single-centre, Australian study, with 33 participants, provided low-certainty evidence of an increased risk of recurrence with phototherapeutic keratectomy compared with alcohol delamination but with wide confidence intervals, compatible with increased or decreased risk (RR 1.27, 95% CI 0.48 to 3.37). Time to recurrence was similar in both groups (6.5 and 6 months, low-certainty evidence). On average people receiving phototherapeutic keratectomy reported less pain but confidence intervals included no difference or greater pain (mean difference (MD) -0.70, 95% CI -2.23 to 0.83, low-certainty evidence). No adverse effects were reported.A 48-participant study in Hong Kong found recurrences were less common in people given diamond burr superficial keratectomy after epithelial debridement compared with sham diamond burr treatment after epithelial debridement (RR 0.07, 95% CI 0.01 to 0.50, moderate-certainty evidence). The study did not report pain scores but adverse effects such as corneal haze (RR 0.92, 95% CI 0.06 to 13.87, low-certainty evidence) and astigmatism (0.88 versus 0.44 dioptres, moderate-certainty evidence) were similar between the groups.A study comparing transepithelial versus subepithelial excimer laser ablation in 100 people found low-certainty evidence of a small increased risk of recurrence of corneal erosion at one-year follow-up in people given the transepithelial compared with subepithelial technique, however, the confidence intervals were wide and compatible with increased or decreased risk (RR 1.20, 95% CI 0.58 to 2.48, low-certainty evidence). Other outcomes were not reported.Other treatment comparisons included in this review were only addressed by studies published two decades or more ago. The results of these studies were inconclusive: excimer laser ablation (after epithelial debridement) versus no excimer laser ablation (after epithelial debridement), epithelial debridement versus anterior stromal puncture, anterior stromal puncture versus therapeutic contact lens, oral oxytetracycline and topical prednisolone (in addition to 'standard therapy') versus oral oxytetracycline (in addition to 'standard therapy') versus 'standard therapy'. AUTHORS' CONCLUSIONS: Well-designed, masked, randomised controlled trials using standardised methods are needed to establish the benefits of new and existing prophylactic and treatment regimes for recurrent corneal erosion. Studies included in this review have been of insufficient size and quality to provide firm evidence to inform the development of management guidelines. International consensus is also needed to progress research efforts towards evaluation of the major effective treatments for recurrent corneal erosions.

Infectious keratitis after keratoplasty.

PURPOSE OF REVIEW: Infectious keratitis is an uncommon but serious complication after corneal transplantation that threatens the visual potential of corneal grafts. Several large retrospective studies from sites worldwide have documented the experiences of corneal surgeons with this sight-threatening complication. The present review synthesizes and compares incidence rates, risk factors, common microorganisms, treatments, and visual prognoses of patients with postkeratoplasty infectious keratitis. RECENT FINDINGS: In 2012, endothelial keratoplasty replaced penetrating keratoplasty as the most commonly performed corneal transplantation procedure in the United States. Although reported rates of infectious keratitis after endothelial keratoplasty appear to be less than after penetrating keratoplasty, there are still too few publications documenting infectious keratitis after endothelial keratoplasty or anterior lamellar keratoplasty to adequately assess outcomes. SUMMARY: Infectious keratitis continues to be a serious complication among all types of keratoplasty, threatening the viability of the grafted tissues and visual outcomes of patients. Reports from various sites worldwide indicate differences in incidence rates and common infecting microorganisms between high- and middle-income countries. Most reports agree that suture-related problems and factors contributing to a suboptimal ocular surface are the primary risk factors for developing infectious keratitis. In general, patients with infectious keratitis following keratoplasty have a poor visual prognosis because of the difficulty of successful treatment without residual scarring.

Infections after refractive surgery.

PURPOSE OF REVIEW: The purpose of the review is to provide a summary of the recent literature concerning infections after refractive surgery pertinent to each procedure category. RECENT FINDINGS: New data from a large retrospective study suggest that the incidence of post-laser assisted in-situ keratomileusis infectious keratitis is declining. Additionally, recent case studies have reported viral, fungal, and Acanthamoeba pathogens. Corneal collagen cross-linking is emerging as an alternative therapeutic option for early stage post-LASIK infectious keratitis. Postoperative bandage contact lens used in patients undergoing surface ablation procedures may confer a higher risk of infection because of greater colonization rates in those individuals, such as healthcare providers, with relatively high risk of exposure to potential pathogens. In the setting of post-penetrating keratoplasty astigmatism, femtosecond laser astigmatic keratotomy procedures pose a risk of infectious keratitis and even endophthalmitis. Lastly, recent case reports of endophthalmitis after refractive lens procedures highlight the importance of postoperative monitoring for this sight threatening, albeit rare, complication. SUMMARY: The risks and management of infections after surgical refractive procedures vary widely depending on the specific technique employed. As technology and treatment options continue to evolve with further research, we anticipate continued success in the management of postoperative infections after refractive surgery.

Emerging trends in contact lens-related infections.

PURPOSE OF REVIEW: This article reviews the literature on past and recent trends in contact lens-related microbial keratitis from bacterial, fungal, and Acanthamoeba infections. RECENT FINDINGS: Contact lens wear is the most important risk factor for microbial keratitis. Despite increased use of daily disposable contact lens wear, the incidence of bacterial ulcers related to contact lens wear remains high. Overnight contact lens wear is the leading risk factor in contact lens-related bacterial infections. There may be a trend towards increasing antibiotic resistance of Gram-positive bacteria to fourth-generation fluoroquinolones. The incidence of Acanthamoeba and fungal infections, despite resolution of two outbreaks involving multipurpose solutions, are also on the rise. SUMMARY: Contact lens-related microbial keratitis is rising and may be associated with more severe, vision threatening, infections.

The Safety of Orthokeratology--A Systematic Review.

OBJECTIVES: The aim of this review is to evaluate the ocular safety of orthokeratology (OrthoK) treatment of myopia correction and retardation. DATA SOURCES: Clinical studies published in English and Chinese were identified from MEDLINE, EMBASE CNKI, CQVIP, and WANFANG DATA (all from 1980 to April 2015). The reference lists of the studies and the Science Citation Index were also searched. SELECTION CRITERIA: Relevant clinical studies including case series, case reports, patient/practitioner surveys, retrospective and prospective cohort studies, and clinical trials were all included in the review. The material of OrthoK lenses was limited to gas-permeable lens. MAIN RESULTS: This review incorporated a total of 170 publications, including 58 English and 112 Chinese literature. The risk of microbial keratitis in overnight OrthoK was similar to that of other overnight modality. The most common complication was corneal staining. Other clinically insignificant side effects included epithelial iron deposit, prominent fribrillary lines, and transient changes of corneal biomechanical properties. There was no long-term effect of OrthoK on corneal endothelium. CONCLUSIONS: There is sufficient evidence to suggest that OrthoK is a safe option for myopia correction and retardation. Long-term success of OrthoK treatment requires a combination of proper lens fitting, rigorous compliance to lens care regimen, good adherence to routine follow-ups, and timely treatment of complications.

Microbial Bioburden of Orthokeratology Contact Lens Care System.

OBJECTIVE: To assess the bioburden in an orthokeratology contact lens (OK) care system (defined by microbial identification from OK case fluid) and to identify the risk factors causing high bioburden for pediatric OK wearers in southern Taiwan. METHODS: A prospective study for the investigation of bioburden in the OK care system was performed in a tertiary medical center in southern Taiwan. Microbial isolates from the case fluids soaking OKs were analyzed, and pathogenicity was determined. Age, gender, OK experiences, and contact lens care habits were considered the potential risk factors of microbial bioburden (colony-forming units per milliliter) for causal analysis. RESULTS: Forty-one OK wearers (20 female and 21 male subjects) participated in this study. The mean age was 12.7 years, and the mean OK-wearing experience was 3.5 years. A total of 86 microbial strains were isolated from 38 culture-positive specimens. Frequently reported pathogens in contact lens-related microbial keratitis were less common in the current study, but still present, including 4 strains (5%) of Serratia marcescens, 1 strain (1%) of Pseudomonas aeruginosa, and 1 strain (1%) of Staphylococcus aureus. Microbial bioburden of the OK care system was significantly higher (P<0.05) in male subjects. CONCLUSIONS: The contamination rate of the OK care system was high, and many isolated microorganisms had potential pathogenicity. Reinforcement of proper contact lens care and education should be mandatory for OK wearers, particularly for male subjects, to decrease the risk of high bioburden of the OK care system.

Impact of Eye Cosmetics on the Eye, Adnexa, and Ocular Surface.

Despite the fact that cosmetic products undergo rigorous testing to ensure they are safe for human use, some users report mild discomfort following their application. The cutaneous changes, such as allergic dermatitis, are well reported, but the ocular changes associated with eye cosmetic use are less so. Some pigmented cosmetic products may accumulate within the lacrimal system and conjunctivae over many years of use, but immediate reports of eye discomfort after application are most common. Changes to the tear film and its stability may occur shortly after application, and contact lens wearers can also be affected by lens spoliation from cosmetic products. Additionally, creams used in the prevention of skin aging are often applied around the eyes, and retinoids present in these formulations can have negative effects on meibomian gland function and may be a contributing factor to dry eye disease. The aim of this review is to summarize current knowledge regarding the impact of cosmetic products on the eye, ocular surface, and tear film.

A case-control study of post-traumatic endophthalmitis at a Spanish hospital.

Our aim was to identify the potential risk factors for developing post-traumatic endophthalmitis (PTE) and the possible measures of prevention. Retrospective case-control study, with 15 cases of PTE and 2 matched controls. We reviewed the medical records of the cases and their respective controls during the period 1996-2008 at a Spanish Hospital. We collected demographic data and information about the type of trauma, the potential risk factors, comorbidities, microbial isolations, antimicrobial susceptibility, administered treatments, and the visual outcome. The independent predictor factors identified for PTE were intraocular foreign body (IOFB) (OR 5.48; CI 95 % 1.05-28.7), dirty wound (OR 4.91; CI 95 % 0.96-25.3), and wound closure delays of 24 h or more (OR 5.48; CI 95 % 1.05-28.7). The probability of endophthalmitis in patients without these risk factors was 5.9 %, but ascended to 65.3 % and 90.3 %, in those patients with two and three risk factors, respectively. Infected patients presented a complication rate of 80 %, with an evisceration rate of 53 %; both were significantly associated with infection. The visual outcome was poor and related to the presence of IOFB and virulent microorganisms (Bacillus sp., filamentous fungus), visual acuity at presentation, and retinal detachment. Patients who presented an IOFB, dirty wound, and delayed wound closure were 15 times more likely to develop infection, and when infected, patients fared much worse than those non-infected. We thus recommend aggressive prophylactic measures in patients with these risk factors, adding antifungal prophylaxis when the injury is contaminated with vegetable matter.

Making a Difference in Eye Care of the Critically Ill Patients.

Ocular surface disorders are frequently encountered in patients under sedation and paralyzed patients in intensive care units (ICUs). In the ICUs, treatment is usually focused on the management of organ failures, and eye care becomes a side issue. As a result, ophthalmological complications do occur (incidence ranges from 3.6% to 60%) and are frequently overlooked in this setting. To identify the best available evidence in providing the best eye care to prevent exposure keratopathy, a literature review was performed. The databases of PUBMED, COCHRAN, and EMBASE library were searched. We only looked at higher quality articles. Among various eye care measures that have been advocated to prevent exposure keratopathy, the most effective is the application of polyethylene covers. Early diagnosis and effective treatment will help prevent microbial keratitis and visual loss.

Prevention and treatment of injection-related endophthalmitis.

BACKGROUND: Intravitreal injections are the fastest growing cause of endophthalmitis and can result in severe vision loss. The prevention, diagnosis and management of such infections remain unclear and at times controversial. METHODS: We searched Pubmed for keywords "prophylaxis," "endophthalmitis," "intravitreal injection." We focused on studies published in the last 2 years as well as other recent studies with particular attention to data on the incidence, microbiology, prevention, and treatment of injection-related endophthalmitis. RESULTS: Over 20 relevant studies were found. With povidone-iodine preparation, the per-injection endophthalmitis rate is low at about 0.03%. Antibiotics do not appear to be beneficial for prevention of post-injection endophthalmitis. The best timing of vitrectomy is unclear. CONCLUSIONS: Antibiotic prophylaxis is probably not needed when giving intravitreal injections. More data is needed to help determine the proper treatment for post-injection endophthalmitis.

Scleral buckle removal in the vitrectomy era: a 20-year clinical experience.

PURPOSE: To describe the effect of scleral buckle (SB) removal on preoperative symptoms and signs prompting removal and to assess the risk of recurrent retinal detachment (RD) after SB removal. METHODS: A retrospective study of 36 patients who underwent SB removal between August 1988 and December 2007 was performed. Indications for SB removal, presence or absence of pain or diplopia, and recurrence of RD were recorded. Composite RD rates were estimated from previously published studies and stratified into those occurring during the previtrectomy era versus later (1980 to present). RESULTS: Mean follow-up time was 75.5 months after SB removal. Thirty-two of 33 patients (97%) who had preoperative pain had symptom relief. Twelve of 12 patients who had clinical infection had resolution. Of the four patients with diplopia, two experienced complete resolution and two reported substantial improvement but required prisms to obtain single vision. Four of 34 patients (12%) whose retinas were attached at the time of SB removal developed recurrent RD but were successfully repaired without significant visual loss from the RD. CONCLUSION: Scleral buckle removal is effective in eliminating SB-related pain and infection. Symptomatic diplopia can sometimes improve after SB removal. The rates of RD after SB removal observed in this study (12%) and in others performed in the era of vitrectomy were notably lower than those of previous reports.

Ocular surface disorders in intensive care unit patients.

Patients in intensive care units (ICU) are at increased risk of corneal abrasions and infectious keratitis due to poor eyelid closure, decreased blink reflex, and increased exposure to pathogenic microorganisms. The aim of this retrospective study was to evaluate the ocular surface problems in patients who stayed in ICU more than 7 days and were consulted by an ophthalmologist. There were 26 men and 14 women with a mean age of 40.1 ± 18.15 years (range 17-74 years). Conjunctiva hyperemia, mucopurulent or purulent secretion, corneal staining, and corneal filaments were observed in 56.25%, 36.25%, 15%, and 5% of the eyes, respectively. Keratitis was observed in 4 patients (10%) who were treated successfully with topical antibiotics. Mean Schirmers test results were 7.6 ± 5.7 mm/5 min (median 6.5 mm/5 min) in the right, and 7.9 ± 6.3 mm/5 min (median 7 mm/5 min) in the left eyes. Schirmers test results were <5 mm/5 min in 40% of the subjects. The parameters did not show statistically significant difference according to mechanical ventilation, sedation, and use of inotropes. As ICU patients are more susceptible to develop dry eye, keratopathy, and ocular infections, they should be consulted by an ophthalmologist for early diagnosis of ocular surface disorders.

The results of pars plana vitrectomy and silicone oil tamponade for endophthalmitis after intravitreal injections.

To report the role of early vitrectomy and silicone oil tamponade in acute endophthalmitis following intravitreal injection. Medical records of eight patients who presented with acute endophthalmitis after intravitreal injection of different drugs were retrospectively reviewed. Initial treatment consisted of vitreous tap with cultures and injection of intravitreal antibiotics, with the patients subsequently undergoing pars plana vitrectomy and silicone oil tamponade within 24 h following initial vitreous tap. The mean time to presentation was 1.7 days (1-3 days). The initial best-corrected visual acuity was hand motion to 0.05 before treatment and 0.05-0.8 (Snellen) after treatment. Vitreous cultures were obtained from all patients, of which four were culture positive. Endophthalmitis was controlled in all patients. There was no retinal detachment or phthisis bulbi during the follow-up period (1-4 years). Acute endophthalmitis following intravitreal injection occurs rapidly and requires urgent treatment. If intravitreal antibiotics fail to control inflammation, early pars plana vitrectomy and silicone oil tamponade would be an appropriate option.

Interventions for recurrent corneal erosions.

BACKGROUND: Recurrent corneal erosion is a common cause of disabling ocular symptoms and predisposes the cornea to infection. It may follow corneal trauma. Measures to prevent the development of recurrent corneal erosion following corneal trauma have not been firmly established. Once recurrent corneal erosion develops simple medical therapy (standard treatment) may lead to resolution of the episode. However, some patients continue to suffer when such therapy fails and once resolved further episodes of recurrent erosion may occur. A number of treatment and prophylactic options are then available but there is no agreement as to the best option. OBJECTIVES: To assess the effectiveness and safety of prophylactic and treatment regimens for recurrent corneal erosion. SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2012, Issue 6), MEDLINE (January 1946 to June 2012), EMBASE (January 1980 to June 2012), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to June 2012), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com), ClinicalTrials.gov (www.clinicaltrials.gov) and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 13 June 2012. We also contacted researchers in the field. SELECTION CRITERIA: We included randomised and quasi-randomised trials that compared a prophylactic or treatment regimen with another prophylaxis/treatment or no prophylaxis/treatment for patients with recurrent corneal erosion. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed trial quality. We contacted study authors for additional information. MAIN RESULTS: Seven randomised and one quasi-randomised controlled trial were included in the review. The trials were heterogenous and of poor quality. Safety data presented were incomplete. For the treatment of recurrent corneal erosion, a single-centre trial in the UK with 30 participants showed that oral tetracycline 250 mg twice daily for 12 weeks or topical prednisolone 0.5% four times daily for one week, or both, in addition to standard treatment, accelerated healing rates and improved symptoms. A single-centre trial in Sweden with 56 participants showed that excimer laser ablation in addition to mechanical debridement may reduce the number of erosions and improve symptoms. Furthermore, in a single-centre trial in Germany with 100 participants, transepithelial technique for excimer laser ablation had the same efficacy as the traditional subepithelial excimer laser technique but caused less pain. In a small study of 24 participants in UK, therapeutic contact lens wear was inferior to lubricant drops and ointment in abolishing the symptoms of recurrent corneal erosion and had a high complication rate, although the contact lenses used were the older generation with low oxygen permeability. A recent study in Hong Kong with 48 participants found diamond burr polishing to reduce episodes of recurrent corneal erosion. For prophylaxis of further episodes of recurrent corneal erosion, there was no difference in the occurrence of objective signs of recurrent erosion between hypertonic saline ointment versus tetracycline ointment or lubricating ointment in a small Japanese study with 26 participants. Also, in a single-centre study in the UK with 117 participants, there was no difference in symptom improvement between hypertonic saline versus paraffin ointment when used for prophylaxis. In a UK study with 42 participants, lubricating ointment at night in addition to standard treatment to prevent recurrence following traumatic corneal abrasion (erosion) caused by fingernail injury led to increased symptoms of recurrent corneal erosion compared to standard therapy alone. AUTHORS' CONCLUSIONS: Well-designed, masked, randomised controlled trials using standardised methods are needed to establish the benefits of new and existing prophylactic and treatment regimes for recurrent corneal erosion. International consensus is also needed to progress research efforts towards evaluation of the major effective treatments for recurrent corneal erosions.

Big-bubble deep anterior lamellar keratoplasty for post-keratitis and post-traumatic corneal stromal scars.

BACKGROUND: Evaluation of outcomes of big-bubble deep anterior lamellar keratoplasty in cases with post-keratitis and post-traumatic corneal scars. DESIGN: Interventional case series. PARTICIPANTS: Patients with corneal stromal scarring secondary to healed infectious keratitis or trauma were recruited from the Corneal Clinic of the M. M. Joshi Eye Institute, Karnataka, India between August 2007 and December 2009. METHODS: All patients underwent big-bubble deep anterior lamellar keratoplasty surgery. MAIN OUTCOME MEASURES: Best-corrected visual acuity, as well as intra- and postoperative complications. RESULTS: Big-bubble deep anterior lamellar keratoplasty was performed in 36 patients (25 males, 11 females) with post-infectious keratitis (n = 22) and post-traumatic (n = 14) corneal stromal scars sparing the Descemet's membrane and endothelium. Mean age was 39.7 ± 11.3 years (range: 22-58 years). Although a big bubble was achieved in all eyes (100%), intraoperative perforation of the Descemet's membrane occurred in six eyes (16%) during stromal dissection. Two cases required conversion to penetrating keratoplasty. A double anterior chamber occurred in the immediate postoperative period in three cases (8.3%). Raised intraocular pressure was seen in one eye. Mean preoperative best-corrected visual acuity (0.03 ± 0.04) improved significantly at the end of 6 months follow-up postoperatively (0.43 ± 0.20; P < 0.01, Wilcoxon signed-ranks test). Corneal stromal graft rejection was noted in two cases (5.5%) during the first 3 months after surgery. Graft failure occurred in two cases (5.5%). CONCLUSIONS: Deep anterior lamellar keratoplasty using the big-bubble technique is a viable option in cases with post-infectious keratitis and post-traumatic corneal stromal scarring with normal Descemet's membrane and endothelium.

Post-surgical management of cataract: Light and dark in the 2020s.

Cataract surgery is the most frequently performed elective surgery worldwide. Although considered a safe procedure, potentially sight-threatening adverse events are possible. Among these, post-surgical inflammation and infections are the most relevant. Anti-inflammatory drugs, such as corticosteroids, and topical antibiotics are the pillars for the treatment of inflammation and for the prevention of infections. However, uncertainties remain regarding the duration of both topical antibiotic prophylaxis and corticosteroid treatment. LEADER7, a recent international clinical study conducted with the new fixed combination of levofloxacin and dexamethasone eye drops in patients undergoing uncomplicated cataract surgery, found that 1-week topical antibiotic prophylaxis is just as effective as the 2-week course commonly used in clinical practice. The study also showed that treatment for 1 week with dexamethasone results in complete resolution of inflammatory signs and symptoms in over 85% of patients, for whom further prolongation of corticosteroid treatment is, therefore, not necessary. This new treatment strategy can represent a significant step forward to reduce the unjustified use of prophylactic antibiotics after cataract surgery, limiting the emergence of bacterial resistance, as well as representing an opportunity to optimize the use and safety of the corticosteroid treatment.