Comparison of corneal tomographic parameters between Hispanic and non-Hispanic patients.

PURPOSE: To compare corneal tomographic parameters between Hispanic White and non-Hispanic White patients using Pentacam data. METHODS: This retrospective study evaluated preoperative Pentacam data from 641 patients 50 years or older who underwent surgery for senile cataract and self-identified as Hispanic or non-Hispanic White. Patients of non-White race or multiethnic groups, or a history of surgery, trauma, or any abnormality of the cornea or anterior segment were excluded. Cornea and anterior segment parameters, as measured with Pentacam, were then compared between Hispanics and non-Hispanics. RESULTS: There were 352 Hispanic White and 289 non-Hispanic White patients. These included 231 men and 410 women, with a mean age of 69.5 ± 8.2 years. There were no significant differences between Hispanics and non-Hispanics in front or back keratometry or amount of front astigmatism. However, Hispanics had a greater amount of back astigmatism (0.36 ± 0.19 vs 0.32 ± 0.17 diopter, P = 0.04). Moreover, there was a statistically significant difference in front steep axis of the left eyes between Hispanics and non-Hispanics (97.8 ± 47.9 vs 108.2 ± 48.9 deg, P = 0.01), and a marginally significant difference in front steep axis of the right eyes (81.0 ± 48.2 vs 73.5 ± 49.9 deg, P = 0.06). Hispanics also had a lower vertex pachymetry (548.1 ± 34.5 vs 553.4 ± 37.4 µm, P = 0.04) and a smaller anterior chamber volume (134.7 ± 39.0 vs 146.1 ± 39.9 mm3, P < 0.001). CONCLUSIONS: There are some differences in cornea and anterior segment parameters between Hispanics and non-Hispanics 50 years or older who underwent surgery for senile cataract. However, such differences may not be clinically significant.

Cultivated autologous limbal epithelial cell (CALEC) transplantation: Development of manufacturing process and clinical evaluation of feasibility and safety.

To treat unilateral limbal stem cell (LSC) deficiency, we developed cultivated autologous limbal epithelial cells (CALEC) using an innovative xenobiotic-free, serum-free, antibiotic-free, two-step manufacturing process for LSC isolation and expansion onto human amniotic membrane with rigorous quality control in a good manufacturing practices facility. Limbal biopsies were used to generate CALEC constructs, and final grafts were evaluated by noninvasive scanning microscopy and tested for viability and sterility. Cultivated cells maintained epithelial cell phenotype with colony-forming and proliferative capacities. Analysis of LSC biomarkers showed preservation of "stemness." After preclinical development, a phase 1 clinical trial enrolled five patients with unilateral LSC deficiency. Four of these patients received CALEC transplants, establishing preliminary feasibility. Clinical case histories are reported, with no primary safety events. On the basis of these results, a second recruitment phase of the trial was opened to provide longer term safety and efficacy data on more patients.

Level of Eye Care Among Eye Care Providers Themselves.

OBJECTIVES: To assess the prevalence of eye disease and frequency of eye examinations among eye care providers themselves. METHODS: In this cross-sectional study, an anonymous questionnaire was used to evaluate occurrence of eye disease and frequency of eye examinations among eye care providers including the clinicians (ophthalmologists, ophthalmology residents, and optometrists) as well as the support staff (ophthalmic technicians and eye clinic administrative staff). RESULTS: The survey response rate was 98 of 173 (56.6%) including 50 ophthalmic technicians, 27 ophthalmologists, 7 ophthalmology residents, 6 optometrists, and 8 eye clinic administrative staff members. The most common reported ocular condition was dry eye disease (36.7%). Myopia and hyperopia were present in 60 (61.2%) and 13 (13.3%), respectively. Myopia was significantly more prevalent among the clinicians (75.0%) than in the support staff (51.7%, P =0.02). The most recent eye examination was within the past year in 42 (42.9%), 1 to 2 years in 28 (28.6%), 3 to 5 years in 14 (14.3%), and over 5 years in 10 (10.2%). Four (4.1%) had never had an eye examination before. The number of eye examinations received was significantly higher in the support staff compared with the clinicians for the past one year (0.86±0.74 vs 0.43±0.59, respectively, P =0.003) and the past five years (2.81±2.08 vs 1.75±1.78, respectively, P =0.01). CONCLUSIONS: Dry eye disease and myopia are common among eye care providers. A significant portion of eye care providers do not have regular eye examinations for themselves.

Local ocular safety of the subconjunctival injection of cetuximab in rabbits.

BACKGROUND: To evaluate the safety of different doses of subconjunctival cetuximab in rabbits. METHODS: After general anesthesia rabbits received a subconjunctival injection of 2.5 mg in 0.5 ml, 5 mg in 1 ml, and 10 mg in 2 ml of cetuximab in their right eyes (two rabbits in each group). A similar volume of normal saline solution was injected subconjunctivally in the left eyes. The histopathologic changes were evaluated after enucleation with the aid of H&E staining. RESULTS: No significant difference were observed between the treated and control eyes in terms of conjunctival inflammation, goblet cell density, or limbal blood vessel density for all administered doses of cetuximab. CONCLUSION: Subconjunctival injection of cetuximab with the administrated doses in rabbit eyes are safe.

Accuracy of IOL Power Calculation Formulas for AcrySof SN60WF versus Tecnis ZCB00 Intraocular Lenses.

Purpose: To compare the accuracy of various intraocular lens power formulas for two monofocal hydrophobic foldable lenses, the AcrySof SN60WF and the Tecnis ZCB00. Methods: This retrospective study included 409 eyes from 409 patients who underwent uncomplicated cataract surgery (299 eyes with SN60WF and 110 eyes with ZCB00). Biometry was performed for all eyes with an IOLMaster 700. Predicted refraction from five different IOL power formulas (Barrett Universal II, Haigis, Hoffer-Q, Holladay 2, and SRK/T) was compared to postoperative refraction at one to three months for the following axial length strata: short eyes ( < 22.5 mm), medium eyes (22.5-25.5 mm), and long eyes ( > 25.5 mm). Results: In patients with medium eyes, there were no significant differences in the mean absolute error (MAE) and the percentage of eyes within ± 0.5 D (% ± 0.5 D) between both IOLs. In short eyes, although MAE was similar between both lenses, % ± 0.5 D was significantly higher for Barrett Universal II in ZCB00 than in SN60WF (P = 0.01) while Hoffer-Q and Holladay 2 performed equally for both lenses. In long eyes, ZCB00 had a higher MAE than SN60WF for Barrett Universal II, Haigis, and Hoffer-Q. Additionally, in long eyes, the percentage of eyes within % ± 0.5 D was significantly higher for SN60WF than ZCB00 for all formulas (P < 0.001). Conclusion: Although there were no significant differences in the formula accuracy between these two lenses in medium eyes for all formulas and in short eyes for most formulas, the accuracy decreased significantly in long eyes for ZCB00 compared to SN60WF. The effect of IOL model on the postoperative outcomes should be further investigated.

Comparison of Ocular Biometric Parameters Between Hispanic and Non-Hispanic Ethnicities in White Adults Undergoing Cataract Surgery.

OBJECTIVES: To compare ocular biometric parameters between Hispanic and non-Hispanic White adult patients undergoing cataract surgery. METHODS: We included 433 adult patients undergoing surgery for senile cataract. Only patients with race and ethnicities of Hispanic and non-Hispanic White were included. The following parameters measured by the IOLMaster 700 were compared between Hispanic and non-Hispanic patients: mean keratometry, corneal astigmatism, anterior chamber depth (ACD), lens thickness, vitreous length, axial length, white-to-white diameter, and emmetropic intraocular lens power. RESULTS: There were 219 Hispanic patients and 214 non-Hispanic patients with a mean age of 70.1±7.7 years (range, 50-88 years), and 66.7% were women. Although sex distribution was similar between the two groups, Hispanic patients had a lower age compared with non-Hispanic patients (69.3±8.3 vs. 70.9±6.9 years, P=0.02). In biometric values, ACD was significantly lower in Hispanic patients (3.07±0.40 mm) than in non-Hispanic patients (3.16±0.37 mm, P=0.01). Such statistically significant difference persisted after adjustment for age and sex (P=0.01). No other significant differences were found in other ocular parameters measured. CONCLUSIONS: Anterior chamber depth is significantly shorter in Hispanic patients compared with non-Hispanic patients. Such ethnic difference should be considered when performing cataract and corneal surgeries because this ethnic difference may be associated with a higher risk of corneal endothelial injury.

Peripheral Ulcerative Keratitis: A Review.

Peripheral ulcerative keratitis (PUK) is a rare but serious ocular condition that is an important clinical entity due to its ophthalmological and systemic implications. It is characterized by progressive peripheral corneal stromal thinning with an associated epithelial defect and can be associated with an underlying local or systemic pro-inflammatory condition, or present in an idiopathic form (Mooren ulcer). Associated conditions include autoimmune diseases, systemic and ocular infections, dermatologic diseases, and ocular surgery. Cell-mediated and auto-antibody-mediated immune responses have been implicated in the pathogenesis of PUK, destroying peripheral corneal tissue via matrix metalloproteinases. Clinically, patients with PUK present with painful vision loss, a peripheral corneal ulcer, and often adjacent scleritis, episcleritis, iritis, or conjunctivitis. Diagnostic evaluation should be focused on identifying the underlying etiology and ruling out conditions that may mimic PUK, including marginal keratitis and Terrien marginal degeneration. Treatment should be focused on reducing local disease burden with topical lubrication, while simultaneously addressing the underlying cause with antimicrobials or anti-inflammatory when appropriate. Existing and emerging biologic immunomodulatory therapies have proven useful in PUK due to autoimmune conditions. Surgical treatment is generally reserved for cases of severe thinning or corneal perforation.

Occurrence of Occult Neoplasia in Pterygium Specimens Among Hispanic and Non-Hispanic Patients.

PURPOSE: To determine the role of race and ethnicity in the prevalence of occult ocular surface squamous neoplasia in pterygium specimens. METHODS: This retrospective study reviewed pathology reports and medical records of 504 patients who underwent pterygium surgery in South Texas. Those with clinical signs of ocular surface squamous neoplasia were excluded. Clinical data including age, sex, and self-reported race and ethnicity were analyzed to determine risk factors for presence of occult ocular surface squamous neoplasia in pterygium specimens. RESULTS: There were 504 specimens; 95.8% were from patients identified as White, 1.8% from African Americans, and 2.4% from Asians. Ethnicity included Hispanic in 70.8% and non-Hispanic in 29.2%. Among all specimens, 18 (3.6%) were positive for occult ocular surface squamous neoplasia. The prevalence of occult ocular surface squamous neoplasia in pterygium specimens was higher in Hispanics compared to non-Hispanics (4.8% vs. 0.7%, respectively, p = .025). The prevalence of occult ocular surface squamous neoplasia in different races included 8.3% for Asians, 3.5% for Whites, and 0% for African Americans. However, the racial difference did not reach statistical significance (p = .57). There were also no statistically significant differences between those with or without occult ocular surface squamous neoplasia regarding age or sex. CONCLUSIONS: A significant but low rate of occult ocular surface squamous neoplasia was found in pterygium specimens. The percentage of those with ocular surface squamous neoplasia in pterygium specimens was significantly greater in Hispanics compared to non-Hispanics. As treatment and prognosis of pterygium and ocular surface squamous neoplasia differ, histopathologic evaluation of all pterygium specimens is warranted.

Comparison of Pterygium Recurrence Rates Between Attending Physicians and Supervised Trainee Residents.

PURPOSE: To compare the recurrence rates after pterygium surgery performed by supervised trainee residents and attending physicians. METHODS: This retrospective study included pterygium surgeries performed by trainee residents and attending physicians in an academic institution in South Texas in the years 2008 to 2019. All residents performed surgeries under direct supervision of an attending physician. Only primary pterygium cases with a minimum postoperative follow-up of 6 months were included. Patients' demographics, primary surgeon, use of conjunctival autograft (CAU) or amniotic membrane graft (AMG), recurrence of pterygium, follow-up length, and complications were recorded. RESULTS: This study included 240 eyes of 229 patients with a mean age of 55.6 ± 12.3 years (range, 28-91 years). Of these eyes, 100 surgeries were performed by attending physicians (including 87 with CAU and 13 with AMG) and 140 surgeries by trainee residents (including 119 with CAU and 21 with AMG). There were no significant differences between the 2 groups of patients regarding age, sex, and surgical technique (CAU vs. AMG). Patients were followed up for an average of 19.8 ± 15.2 months. No statistically significant differences were found in comparing the rate of pterygium recurrence between attending physicians and residents when using CAU (6.8% vs. 10.0%, respectively; P = 0.42) and AMG (69.2% vs. 47.6%, respectively; P = 0.22). Moreover, there were no significant differences in other postoperative complications between the groups. CONCLUSIONS: Pterygium recurrence rates were similar between attending physicians and supervised trainee residents. Thus, acceptable outcomes can be expected when pterygium surgery is performed by a supervised ophthalmology resident.

Topical Erythropoietin for Treatment of Scleral Necrosis.

PURPOSE: To investigate the safety and efficacy of topical erythropoietin for the treatment of scleral necrosis. METHODS: This study enrolled eight consecutive patients with scleral necrosis due to previous ocular surgery, rheumatoid arthritis-associated necrotizing anterior scleritis, and thermal and chemical burns. Conventional treatments failed to heal avascular scleral lesions in all eyes. Patients were treated with topical erythropoietin (3000 IU/mL) four times a day. RESULTS: The mean patient age was 37.6 ± 15.5 years. The interval between the development of scleral necrosis and initiation of topical erythropoietin was 25.6 ± 12.0 days. The necrotic sclera completely healed within 31.9 ± 16.9 days in all patients. The avascular lesions did not recur, and there was no evidence of side effects during the study. CONCLUSION: Our results showed that topical erythropoietin could be safely used to manage scleral necrosis. Randomized clinical trials are needed to further explore the efficacy of this intervention in patients with avascular scleral lesions.

Moraxella Keratitis: A Case Series.

OBJECTIVE: To report the ocular and systemic risk factors, clinical manifestations, and management outcomes of Moraxella keratitis. METHODS: This retrospective study included patients with culture-proven Moraxella keratitis in South Texas between 2012 and 2018. Clinical data including demographics, ocular and systemic risk factors, clinical presentation, speciation, and treatment course were collected. RESULTS: Fourteen eyes of 14 patients had culture-proven Moraxella keratitis which made up 8.1% of cases of culture-proven bacterial keratitis in the period studied. These included 10 men and 4 women with a mean age of 52.7±11.3 years. Ten patients (71.4%) had different ocular risk factors such as ocular trauma, corneal foreign body, contact lens use, preceding viral keratitis, neurotrophic cornea, and recent corneal transplant on topical steroids. Systemic risk factors included diabetes mellitus, systemic immunosuppressive therapy, cancer chemotherapy, and AIDS. There was no specific clinical manifestation. The size of stromal infiltration on initial presentation varied among the cases, with 71.4% stromal infiltrations of 4 mm or less. The patients were managed with fortified tobramycin, fortified vancomycin, and moxifloxacin eye drops. No eyes required surgical intervention during treatment for the active infection, except for one eye with pre-existing no light perception that was enucleated because of chronic pain. CONCLUSIONS: Moraxella keratitis is a less frequent form of bacterial keratitis that appears more prevalent in patients with previous ocular conditions. Early diagnosis of this infection and medical treatment with a conventional corneal ulcer regimen can result in good clinical outcomes without the need for a surgical intervention.

Management of corneal complications in vernal keratoconjunctivitis: A review.

Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, allergic conjunctivitis with episodes of acute exacerbations. Although VKC has a self-limiting course, chronic recurrent inflammation can cause long-term visual impairment due to corneal complications including shield ulcers, infectious keratitis, keratoconus, corneal opacities, and limbal stem cell deficiency. The initial step in the management of corneal involvement is medical treatment of the acute stage of VKC and prevention of recurrences. Giant papillae not responding to medical treatment can be removed surgically in the case of corneal involvement. Shield ulcer with no inflammatory plaque usually heals with appropriate medical therapy. For shield ulcer with inflammatory plaque, however, surgical debridement with or without amniotic membrane transplantation might be necessary. Keratoconus may develop in chronic and severe VKC. An annual evaluation of these patients with corneal topography and/or tomography is essential for early detection of keratoconus and its timely management that includes collagen cross-linking and intrastromal corneal ring segment implantation. Corneal transplantation may be required in the advanced stage of keratoconus. Both penetrating keratoplasty and deep anterior lamellar keratoplasty can result in excellent visual outcomes in keratoconic eyes with concomitant VKC. Appropriate management of inflammation in the perioperative period is crucial for achieving successful outcomes after corneal transplantation. Limbal stem cell deficiency, a rare complication of long-standing and severe VKC, might be treated with living-related conjunctival limbal allograft.

Acute neurotrophic keratitis with trigeminal trophic syndrome after craniotomy.

We report the case of a child who, shortly after undergoing suboccipital craniotomy for resection of a medullary cavernoma, developed corneal and conjunctival epithelial breakdown of the right eye with ipsilateral facial hypoesthesia as well as erosions and crusting of the eyelids, nostril, and lips on the right side. This combination of findings likely results from acute injury to the ipsilateral trigeminal ganglion, leading to acute neurotrophic keratitis and trigeminal trophic syndrome.

Giant papillary conjunctivitis: A review.

Giant papillary conjunctivitis (GPC), which is characterized by the development of "giant" papillae on the superior tarsal conjunctiva, is a common complication in contact lens wearers. This condition can be associated with excessive mucus production, itching, blurry vision, and diminished contact lens tolerance. Risk factors for GPC include non-disposable lenses, infrequent lens replacement, long wearing time, inadequate lens hygiene, and atopy. Although the exact pathophysiology of GPC remains incompletely understood, it likely develops from the combination of mechanical trauma to the superior tarsal conjunctiva and an immunologic response by the conjunctiva to deposits on the anterior surface of the contact lens. With proper management, GPC has an excellent prognosis. In mild cases, prompt contact lens cessation is sufficient for the resolution of signs and symptoms. For more severe cases, the use of topical anti-histaminic agents is indicated. Uncommonly, topical steroids, non-steroidal anti-inflammatory agents, immunomodulatory medications, or very rarely surgery may be needed. In this review article, we provide a comprehensive review of the available literature on GPC, with an emphasis on recent findings and treatment advances for this common condition.

A surgical skills assessment rubric for pterygium surgery.

PURPOSE: To introduce an assessment tool (rubric) for evaluating ophthalmology residents' competency in pterygium surgery. METHODS: A panel of experienced international surgeons collaborated and developed the rubric. After describing various stages of the procedure, the Dreyfus scale of skill acquisition was used for scoring each stage. After finalizing the rubric, two surgeons independently evaluated 20 masked pterygium surgery videos of 10 residents and scored the videos according to the rubric. The agreement between the scores of them was examined with the intra-class correlation coefficient test. RESULTS: This rubric divides pterygium surgery into 13 different stages and covers the two most common techniques of pterygium surgery; conjunctival autograft and amniotic membrane transplant. The rubric showed face and content validity. Overall, an intraclass correlation coefficient of 0.90 (95% confidence interval 0.76-0.96, P < 0.001) was achieved between the two surgeons. The residents scored significantly higher on surgeries performed later in their rotation compared to the earlier surgeries (4.32 ± 0.35 vs 3.96 ± 0.31, P = 0.006). Certain stages of pterygium surgery were more strongly correlated with the residents' past pterygium surgical experience. CONCLUSION: This study introduces an international rubric for assessing competency in pterygium surgery. In addition to face and content validity, this rubric shows high inter-rater reliability. This may be a useful tool for teaching and measuring competency in pterygium surgery.

Floppy eyelid syndrome: A comprehensive review.

Floppy eyelid syndrome (FES) is defined as eyelid hyperlaxity with reactive palpebral conjunctivitis. It is a common condition that can be associated with significant ocular irritation. FES presents with easily everted eyelids and chronic papillary conjunctivitis in the upper eyelids. It is frequently associated with ocular and systemic diseases, notably keratoconus and obstructive sleep apnea, respectively. This comprehensive review describes the epidemiology, pathological changes, proposed pathogenesis, clinical manifestations, and a variety of treatment options for this condition. Conservative treatment of FES includes aggressive lubrication, nighttime eye shield, and avoiding sleeping on the affected eye. Patients with FES and obstructive sleep apnea may have an improvement in their ocular signs and symptoms after long-term therapy with continuous positive airway pressure. In refractory cases, a corrective surgery that addresses the eyelid laxity can result in significant improvement. All patients with ocular irritation should be evaluated for the presence of FES.

Limbal and Conjunctival Epithelial Thickness in Ocular Graft-Versus-Host Disease.

PURPOSE: To compare the thickness of the limbal epithelium (LE) and the bulbar conjunctival epithelium (BCE) between patients with dry eye disease (DED) with and without ocular graft-versus-host disease (GVHD). METHODS: This cross-sectional study enrolled 40 patients with moderate to severe DED including 20 with and 20 without chronic ocular GVHD. All patients had a comprehensive clinical ophthalmic assessment. Moreover, the thickness of the LE and BCE in both nasal and temporal regions of both eyes was measured using spectral domain optical coherence tomography. RESULTS: The average LE thickness in all patients with dry eye (GVHD and non-GVHD) was 65.8 ± 11.9 µm temporally and 69.7 ± 11.1 µm nasally (P = 0.02). The average BCE thickness was 55.8 ± 11.4 µm temporally and 60.1 ± 11.0 µm nasally (P = 0.03). There were no statistically significant differences between GVHD and non-GVHD groups in LE thickness (69.6 ± 11.7 vs. 66.1 ± 6.2 µm, respectively, P = 0.31) or BCE thickness (58.9 ± 9.6 vs. 57.3 ± 9.8 µm, respectively, P = 0.82). There was a significant correlation between LE thickness and BCE thickness (P = 0.01, Rs = 0.41). A statistically significant negative correlation was also observed between LE thickness and age (P = 0.002, Rs = -0.35). There were no significant correlations between the thickness of the LE or BCE and other clinical parameters. CONCLUSIONS: No difference exists in the thickness of the ocular surface epithelia between dry eyes with and without ocular GVHD, which would suggest that these epithelial changes may be independent of the underlying etiology and possibly only reflect the disease severity. Furthermore, there are regional variations in the thickness of the ocular surface epithelia in patients with DED.

Sutureless repair of corneal injuries using naturally derived bioadhesive hydrogels.

Corneal injuries are common causes of visual impairment worldwide. Accordingly, there is an unmet need for transparent biomaterials that have high adhesion, cohesion, and regenerative properties. Herein, we engineer a highly biocompatible and transparent bioadhesive for corneal reconstruction using a visible light cross-linkable, naturally derived polymer, GelCORE (gel for corneal regeneration). The physical properties of GelCORE could be finely tuned by changing prepolymer concentration and photocrosslinking time. GelCORE revealed higher tissue adhesion compared to commercial adhesives. Furthermore, in situ photopolymerization of GelCORE facilitated easy delivery to the cornea, allowing for bioadhesive curing precisely according to the required geometry of the defect. In vivo experiments, using a rabbit stromal defect model, showed that bioadhesive could effectively seal corneal defects and induce stromal regeneration and re-epithelialization. Overall, GelCORE has many advantages including low cost and ease of production and use. This makes GelCORE a promising bioadhesive for corneal repair.

Efficacy of autologous serum tears for treatment of neuropathic corneal pain.

OBJECTIVE: Corneal nerve damage may result in neuropathic corneal pain (NCP). Autologous serum tears (AST) have been shown to results in nerve regeneration and may help alleviate corneal pain. This study aimed to evaluate the efficacy of AST in the treatment of NCP. METHODS: This was a retrospective case-control study. Sixteen patients suffering from severe NCP and no current ocular surface disease were compared to 12 controls. In vivo confocal microscopy (IVCM) (HRT3/RCM; Heidelberg Engineering GmbH, Germany) of the central corneas was performed bilaterally. Change in pain severity (scale of 0-10), corneal nerve density, tortuosity, reflectivity and presence of beading and micro-neuromas before and after treatment were recorded. RESULTS: All patients had severe pain, with a mean of 9.1 ±â€¯0.2 (range 8-10). Subbasal nerves were significantly decreased before treatment as compared to controls, including total nerve length (10,935.5 ±â€¯1264.3 vs. 24,714.4 ±â€¯1056.2 µm/mm2; p < 0.0001) and total number of nerves (10.5 ±â€¯1.4 vs. 28.6 ±â€¯2.0; p < 0.0001), respectively. Morphologically, significantly increased reflectivity (2.9 ±â€¯0.2 vs. 1.2 ±â€¯0.1; p = 0.00008) and tortuosity (2.4 ±â€¯0.2 vs. 1.7 ±â€¯0.1; p = 0.001), both graded on a scale of 0-4, were noted. After a mean of 3.8 ±â€¯0.5 months (range 1-8 months) of AST treatment, pain severity decreased to 3.1 ±â€¯0.3 (range 0-4), (p < 0.0001). Further, IVCM demonstrated a significant improvement (p < 0.005) in total nerve length (17,351.3 ±â€¯1395.6  µm/mm2) and number (15.1 ±â€¯1.6), as well as significant decrease in reflectivity (2.4 ±â€¯0.2; p = 0.001) and tortuosity (2.2 ±â€¯0.2; p = 0.001). CONCLUSION: IVCM demonstrates underlying alterations of the subbasal corneal nerve plexus in patients suffering from debilitating NCP. AST-induced nerve regeneration is seen following treatment with AST, which correlates with improvement in patient symptoms of NCP.

Clinically Relevant Immune-Cellular Metrics of Inflammation in Meibomian Gland Dysfunction.

Purpose: To determine the reliability and clinical relevance of in vivo confocal microscopy (IVCM)-based immune-cellular metrics of palpebral conjunctival inflammation in meibomian gland dysfunction (MGD). Methods: Sixteen MGD patients and 13 reference controls included in this cross-sectional, retrospective study, had an ocular surface exam, symptom assessment (Ocular Surface Disease Index questionnaire [OSDI]), and palpebral conjunctival IVCM imaging. Bland-Altman analyses, intraclass correlation coefficient (ICCa), Lin's concordance correlation coefficient (ρc), receiver operating characteristic (ROC) analyses, and correlations were performed. Clinical outcome measures were symptom severity (OSDI scores), tear break-up time (TBUT), and corneal fluorescein staining (CFS grade). Results: Compared to controls, patients with MGD had variable symptom severity (average OSDI score: 48.3 ± 7.6, P = 0.0008, range: 8.3-85.42), shorter TBUT (6.8 ± 0.9 seconds, P = 0.002), comparable corneal staining (0.31 ± 0.19, P = 0.20), and greater conjunctival inflammation (epithelial immune cells [EIC]: 477.8 ± 54.2 vs. 123.3 ± 17.2 cells/mm2, P < 0.0001; intraglandular immune cells [IGIC]: 41.9 ± 3.3% vs. 20.33 ± 7.3%, P < 0.01). Immune-cellular metrics had high inter- and intraobserver agreement (ρc: 0.86-0.94; ICCa and Cronbach's α: 0.85-0.97, P < 0.0001). EIC correlated positively with OSDI (rs: 0.49, P = 0.03), while both EIC and IGIC correlated inversely with TBUT (rs: -0.47, -0.45, P < 0.05), and had high accuracy in detecting inflammation (ROC area under the curve [AUC]: 0.97 and 0.89, P ≤ 0.001). Conclusions: EIC and IGIC are increased in highly symptomatic patients with MGD that have minimal corneal staining, and correlate with symptoms and clinical signs. EIC and IGIC may provide reliable and clinically relevant metrics of inflammation.