Management and Outcomes of Traumatic Cataract During Ruptured Globe Repair.

PURPOSE: To compare outcomes of primary lensectomy (PL) versus no lensectomy (NL) during repair of zone I (involving cornea and limbus) and II (up to 5mm posterior to the limbus) ruptured globe injuries (RGIs) with lens involvement. DESIGN: Retrospective clinical cohort study. METHODS: 107 patients with RGIs involving both blunt and penetrating injury to the lens who presented to Wills Eye Hospital between April 1, 2017 and August 31, 2022 were included. Data from presenting visit was collected including demographic information, time from injury to surgery, visual acuity (VA), intraocular pressure (IOP), injury characteristics, and years since residency graduation of surgeon. VA, IOP, retinal detachment (RD) rate, and endophthalmitis incidence were compared between PL and NL groups at postoperative week 1 (POW1) and postoperative month 1 (POM1). VA, peak IOP, need for further surgeries, and types of additional surgery were compared between the two groups at the final visit. RESULTS: 19 (17.8%) patients underwent PL. Age, sex, and initial VA were similar between groups (all p≥0.05). The PL group had surgery later from the time of injury (6.1±14.6 days vs. 1.3±1.9 days; p=0.010), higher IOP at presentation (12.9±11.6 mmHg vs. 7.7±11.3 mmHg; p=0.046), shorter wounds (2.3±1.4mm vs. 4.7±3.2mm; p=0.003), more frequent lens capsule violation (89.5% vs. 50%; p=0.010), increased likelihood of intraocular foreign bodies (52.6% vs. 17.0%; p=0.004), and were more likely to be operated on by surgeons with ≥ 5 years of experience post-residency (68.4% vs. 28.4%; p<0.001). At POW1, the PL group had significantly better logMAR VA (1.2±0.9 vs. 2.0±1.0; p=0.002), and this continued at POM1 (1.0±0.8 vs. 1.6±1.1; p=0.031) and the final visit (0.4±0.7 vs. 1.0±1.1; p=0.010). The PL group had lower IOP at POW1 (12.4±3.0 mmHg vs. 17.3±8.2 mmHg; p=0.005) than the NL group. There was no difference in RD or endophthalmitis rates between the two groups at POW1 or POM1 (p>0.05 for all). The NL group was more likely to require additional surgery by final follow-up (77.3% vs. 47.4%; p<0.001). In the multivariable analysis, PL had better final VA and decreased need for further surgery (both p<0.05). CONCLUSIONS: In the appropriate circumstance, PL during lens-involving anterior RGI repair may lead to improved patient outcomes.

Long-term outcomes of corneal crosslinking.

PURPOSE OF REVIEW: This manuscript summarizes contemporary research from 2018 to 2023 evaluating long-term (≥2 years) outcomes of corneal crosslinking (CXL) for progressive keratoconus (KCN). RECENT FINDINGS: The standard Dresden protocol (SDP) has been utilized clinically since the early 2000 s to treat ectatic disorders, primarily progressive KCN and postrefractive ectasia. Various modifications have since been introduced including accelerated and transepithelial protocols, which are aimed at improving outcomes or reducing complications. This review summarizes data demonstrating that the SDP halts disease progression and improves various visual and topographic indices (UDVA, CDVA, Kmax, K1, K2) up to 13 years postoperatively. Accelerated and transepithelial protocols have been found to be well tolerated alternatives to SDP with similar efficacy profiles. Studies focusing on pediatric populations identified overall higher progression rates after CXL. All protocols reviewed had excellent safety outcomes in adults and children. SUMMARY: Recent studies revealed that SDP successfully stabilizes KCN long term, and a variety of newer protocols are also effective. Pediatric patients may exhibit higher progression rates after CXL. Further research is required to enhance the efficacy and ease of these protocols.

New forays into measurement of ocular biomechanics.

PURPOSE OF REVIEW: The field of corneal biomechanics has rapidly progressed in recent years, reflecting technological advances and an increased understanding of the clinical significance of measuring these properties. This review will evaluate in-vivo biomechanical properties obtained by current technologies and compare them regarding their relevance to established biomechanical properties obtained by gold-standard ex-vivo techniques normally conducted on elastic materials. RECENT FINDINGS: Several new technologies have appeared in recent years, including vibrational optical coherence tomography (VOCT) and the corneal indentation device (CID). These techniques provide promising new opportunities for minimally invasive and accurate measurements of corneal viscoelastic properties. SUMMARY: Alterations in corneal biomechanics are known to occur in several corneal degenerative diseases and after refractive surgical procedures. The measurement of corneal biomechanical properties has the capability to diagnose early disease and monitor corneal disease progression. Several new technologies have emerged in recent years, allowing for more accurate and less invasive measurements of corneal biomechanical properties, most notably the elastic modulus.

Epibulbar simple cartilaginous choristoma associated with unique pigmented multicystic component.

PURPOSE: To report an atypical presentation of an epibulbar simple cartilaginous choristoma with a unique pigmented multicystic component. CASE DESCRIPTION: A 69-year-old African American female presented for evaluation of a right nasal epibulbar lesion that had progressed over the prior year. Slit-lamp evaluation revealed an immobile, mildly pigmented multicystic lesion measuring 6.0 × 4.5 mm that involved the nasal bulbar conjunctiva and the plica semilunaris. The lesion appeared benign, without feeder vessels or features of epithelial dysplasia. Given its recent growth and the patient's cosmetic concerns, the lesion was excised with ocular surface reconstruction. Histopathological evaluation disclosed a well-circumscribed nodule of well-differentiated cartilage in the substantia propria, consistent with a simple cartilaginous choristoma. The overlying conjunctival stroma contained multiple cysts lined by focally pigment epithelium. The patient recovered well from surgery, with satisfactory cosmetic results. CONCLUSIONS: Our case of epibulbar simple cartilaginous choristoma includes a prominent superficial component of pigmented epithelial cysts, which has not been previously reported in the literature. This augments our knowledge on the spectrum of presentations of cartilaginous choristomas and underscores the importance of histopathological evaluation for definitive diagnosis.

Variations in Management of Zone 1 Open Globe Injuries Across Corneal Specialists.

PURPOSE: The aim of this study was to describe variations in practice patterns for the management of zone 1 open globe injuries among corneal specialists worldwide. METHODS: This cross-sectional study was performed using an online survey distributed to members of The Cornea Society. Responses were collected between September 9, 2021, and September 30, 2021. RESULTS: Of 94 responses included in analysis, respondents averaged 18.2 ± 14.5 years of postfellowship experience. Among respondents, 53 (56.4%) were affiliated with an academic institution and 41 (43.6%) with private practice. Ophthalmologists practicing in the United States were significantly more likely to use an eye shield preoperatively (98.5% vs. 85.7%, P = 0.03) and less likely to perform primary lensectomy in cases of lens involvement (40.9% vs. 75.0%, P = 0.002) compared with those practicing outside the United States. Ophthalmologists in practice fewer than 10 years were more likely to administer preoperative systemic antibiotics (91.4% vs. 66.1%, P = 0.006) and tetanus prophylaxis (88.6% vs. 67.8%, P = 0.03), and to obtain preoperative computed tomography scans (85.7% vs. 54.2%, P = 0.002) compared with more senior physicians. Ophthalmologists at academic institutions were more likely to perform preoperative B-scan (30.2% vs. 9.8%, P = 0.02), use general anesthesia (90.6% vs. 70.7%, P = 0.03), and admit for postoperative antibiotics (28.3% vs. 9.8%, P = 0.04), and were less likely to perform surgery overnight (45.3% vs. 70.7%, P = 0.02) compared with private practice physicians. CONCLUSIONS: There is significant variation in the practice patterns for the management of zone 1 open globe injuries among corneal specialists, which presents an opportunity to investigate whether certain treatment options lead to better outcomes in these injuries.

Bilateral interstitial keratitis following COVID-19: a case report.

BACKGROUND: Although the primary target of severe acute respiratory syndrome coronavirus 2 is the respiratory tract, the expression of the angiotensin-converting enzyme 2 receptor in other tissues facilitates viral entry in others parts of the body, including ocular structures. Ocular manifestations may occur before, during, or after systemic infection. CASE PRESENTATION: We report the case of a 60-year-old male who presented with bilateral interstitial keratitis after the onset of COVID-19, with ocular symptoms starting within 7 days after systemic symptoms. Laboratory investigation did not identify any alternative etiology for his disease, although the possibility of Epstein-Barr virus or herpes simpex virus could not be definitively ruled out. The patient had already developed significant corneal scarring and visual debilitation by the time topical steroids were initiated, and his final corrected visual acuity with rigid gas permeable contact lenses was 20/50 and 20/80 in the right and left eye, respectively. CONCLUSIONS: The involvement of ocular tissue by the virus can lead to permanent sequelae such as severe visual loss, and clinicians should be aware of and recognize ophthalmic manifestations of this disease to prompt early intervention.

Corneal Wound Healing in the Presence of Antifibrotic Antibody Targeting Collagen Fibrillogenesis: A Pilot Study.

Highly organized collagen fibrils interlacing with proteoglycans form the crucial architecture of the cornea and facilitate its transparency. Corneal scarring from accidental injury, surgery, or infection alters this highly organized tissue, causing severe consequences, including blindness. There are no pharmacological or surgical methods to effectively and safely treat excessive corneal scarring. Thus, we tested the anticorneal scarring utility of a rationally designed anticollagen antibody (ACA) whose antifibrotic effects have already been demonstrated in nonocular models. Utilizing a rabbit model with an incisional corneal wound, we analyzed ACA's effects on forming collagen and proteoglycan-rich extracellular matrices in scar neotissue. We used microscopic and spectroscopic techniques to quantify these components and measure crucial parameters characterizing the structure and organization of collagen fibrils. Moreover, we analyzed the spatial distribution of collagen and proteoglycans in normal and healing corneas. Our study demonstrated significant changes in the quality and quantity of the analyzed molecules synthesized in scar neotissue. It showed that these changes extend beyond incision margins. It also showed ACA's positive impact on some crucial parameters defining proper cornea structure. This pilot study provides a stepping stone for future tests of therapeutic approaches that target corneal extracellular scar matrix assembly.

Applications of Mitomycin C in Cornea and External Disease.

Isolated from Streptomyces caespitosus, mitomycin C (MMC) has various applications in the management of corneal and external disease due to its ability to modulate cellular proliferation. It has been employed in pterygium surgery, ocular surface neoplasia, and refractive surgery. Currently, there is no definite consensus on the treatment protocols for each of the aforementioned applications. Although its benefits in the management of corneal and external diseases are promising, MMC use has potential complications including endothelial cell loss, corneal perforation, scleral melt, secondary glaucoma, iritis, and endophthalmitis. This article will review the literature regarding the use of MMC in the field of cornea and external disease and describe protocols employed with corresponding outcomes.

Neurotrophic keratopathy following rhegmatogenous retinal detachment surgery.

OBJECTIVE: To describe clinical characteristics and visual outcomes of eyes developing neurotrophic keratopathy (NK) following rhegmatogenous retinal detachment (RRD) repair. METHODS: All eyes with NK at Wills Eye Hospital following RRD repair from June 1, 2011, to December 1, 2020 were included. Patients with prior ocular procedures (other than cataract surgery), herpetic keratitis, and diabetes mellitus were excluded. RESULTS: During the study period, 241 patients were diagnosed with NK, and 8179 eyes underwent RRD surgery, giving a 9-year prevalence rate of 0.1% (95% CI, 0.1%-0.2%). Mean age was 53.4 ± 16.6 years during RRD repair and 56.5 ± 13.4 years during NK diagnosis. Mean time to NK diagnosis was 3.0 ± 5.6 years (range, 6 days to 18.8 years). Mean visual acuity before NK was 1.10 ± 0.56 logMAR (20/252 Snellen), and it was 1.01 ± 0.62 logMAR (20/205 Snellen) at final visit (p = 0.75). Six eyes (54.5%) developed NK <1 year following RRD surgery. Mean final visual acuity was 1.01 ± 0.53 logMAR (20/205 Snellen) in this group versus 1.01 ± 0.78 logMAR (20/205 Snellen) in the delayed NK group (p = 1.00). CONCLUSIONS: NK may present acutely or up to several years following surgery, with severity of corneal defects ranging from stage 1 to stage 3 NK. Surgeons should be mindful of the potential for this rare complication following RRD repair.

Open-Globe Injury Repairs in the American Academy of Ophthalmology IRIS® Registry 2014 - 2018: Incidence, Risk Factors, and Visual Outcomes.

PURPOSE: To estimate incidence and evaluate demographic risk factors and visual acuity (VA) outcomes of open-globe injuries requiring surgical repair in the IRIS® Registry (Intelligent Research in Sight). DESIGN: Retrospective cohort study. PARTICIPANTS: Patients with open-globe injury repairs (OGRs) were identified by Current Procedural Terminology codes (65275, 65280, 65285, 65286, 65235, 65260, and 65265) from 2014 through 2018 in the IRIS Registry. METHODS: Logistic regression models adjusting for age, sex, race, ethnicity, United States region, concurrent and subsequent surgeries, and baseline VA. MAIN OUTCOME MEASURES: Outcomes included annual and 5-year incidence rates per 100 000 people and factors associated with OGR, VA better than 20/40, and VA of 20/200 or worse at final follow-up (3-12 months after OGR). RESULTS: Thirteen thousand seven hundred sixty-six OGRs were identified; 5-year cumulative incidence was 28.0 per 100 000 patients. Open-globe repair was associated with age 21 to 40 years compared with younger than 21 years (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.5-1.7]), male sex (OR, 2.8; 95% CI, 2.7-2.9), Black versus White race (OR, 1.3; 95% CI, 1.2-1.4), Hispanic versus non-Hispanic ethnicity (OR, 1.7; 95% CI, 1.6-1.8), and South (OR, 1.4; 95% CI, 1.3-1.5) and West (OR, 1.3; 95% CI, 1.2-1.4) versus Midwest regions and associated inversely with Asian versus White race (OR, 0.6; 95% CI, 0.6-0.7). Visual acuity outcomes, analyzed in a subset of 2966 patients with VA data available, showed vision impairment (VA < 20/40) at final follow-up was associated with VA of 20/200 or worse at presentation (20/200 better than 20/40; OR, 11.1; 95% CI, 8.0-15.7), older age (e.g., > 80 years vs. < 21 years; OR, 5.8; 95% CI, 3.2-10.7), and Black versus White race (OR, 1.8; 95% CI, 1.3-2.6). Risk factors were similar for VA of 20/200 or worse after OGR. Among the 1063 patients undergoing OGR with VA of 20/200 or worse at presentation, VA did not improve to better than 20/200 at follow-up in 35% of patients (1063/2996). CONCLUSIONS: Our findings bring to light racial disparities in risk of OGR and poor visual outcomes that warrant further exploration. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Graft Outcomes After Temporary Keratoprosthesis in Combined Penetrating Keratoplasty and Vitreoretinal Surgery.

PURPOSE: Corneal pathology can obstruct the visualization required for surgical management of coexisting posterior segment diseases, and use of a temporary keratoprosthesis (TKP) permits combined penetrating keratoplasty (PK) and vitreoretinal surgery. We evaluated graft outcomes after TKP for combined PK and vitreoretinal surgery and analyzed risk factors for graft failure. METHODS: We reviewed the electronic medical records for patients who underwent TKP for PK combined with vitreoretinal surgery at Wills Eye Hospital between May 2007 and April 2021. Overall, 28 variables were analyzed. The main outcome measure was corneal graft failure, defined as irreversible graft edema or opacification. RESULTS: A total of 46 eyes of 46 patients underwent combined surgery and were included in the study. The mean age at surgery was 55.7 ± 18.6 years (range 19-86 years), and the mean follow-up was 31.8 ± 30.5 months (range 1.6-114.0 months). Multivariable analysis revealed 2 factors significantly associated with graft failure: history of trauma (hazard ratio = 5.38; 95% confidence interval, 1.53-18.91; P = 0.009) and intraocular silicone oil after transplant (hazard ratio = 5.67; confidence interval 1.66-19.44; P = 0.006). Corneal graft failure occurred in 60.9% of all cases over the course of follow-up, but the absence of both variables yielded a 33.3% failure rate. CONCLUSIONS: Although outcomes vary, previous ocular trauma and the presence of intraocular silicone oil are risk factors for failure that may facilitate patient selection and improve counseling about long-term graft potential after TKP for combined PK and vitreoretinal surgery.

Development of a Nomogram to Predict Graft Survival After Descemet Stripping Endothelial Keratoplasty.

BACKGROUND/PURPOSE: The purpose of this study was to analyze Descemet stripping endothelial keratoplasty (DSEK) outcomes and develop a nomogram to compute the probability of 3- and 5-year DSEK graft survival based on risk factors. STUDY DESIGN/METHODS: The medical records of 794 DSEK procedures between January 1, 2008, and August 1, 2019, were retrospectively reviewed to identify 37 variables. We also evaluated for the presence of corneal graft failure, defined as irreversible and visually significant graft edema, haze, or scarring. Variables were assessed by multivariable Cox models, and a nomogram was created to predict the probability of 3- and 5-year graft survival. RESULTS: Graft failure occurred in 80 transplants (10.1%). The strongest risk factors for graft failure included graft detachment [hazard ratio (HR) = 4.46; P < 0.001], prior glaucoma surgery (HR = 3.14; P = 0.001), and glaucoma (HR = 2.23; P = 0.018). A preoperative diagnosis of Fuchs dystrophy was associated with a decreased risk of graft failure (HR = 0.47; P = 0.005) compared with secondary corneal edema. Our nomogram has a concordance index of 0.75 (95% confidence interval, 0.69 to 0.81), which indicates that it may predict the probability of graft survival at 3 and 5 years with reasonable accuracy. We also analyzed graft rejection, which occurred in 39 cases (4.9%). The single risk factor found to be significantly associated with graft rejection was prior glaucoma surgery (HR = 2.87; P = 0.008). CONCLUSIONS: Our nomogram may accurately predict DSEK graft survival after 3 and 5 years based on 4 variables. This nomogram will empower surgeons to share useful data with patients and improve collective clinical decision-making.

Haptic Erosion Following Sutureless Scleral-fixated Intraocular Lens Placement.

PURPOSE: To describe the clinical features and visual outcomes of eyes with conjunctival haptic erosion after sutureless intrascleral (SIS) fixated intraocular lens (IOL) placement. DESIGN: Retrospective case series. SUBJECTS: Patients experiencing haptic erosion after SIS fixation between January 1, 2013, and March 1, 2022. METHODS: A multicenter, multisurgeon, retrospective review. MAIN OUTCOME MEASURES: Clinical features, visual outcomes, and treatment options following haptic erosions after SIS fixation. RESULTS: Nineteen eyes with haptic erosion were identified. The mean age at initial SIS fixation was 64 ± 12 years (range, 38-81 years). There were 5 (26%) eyes with a history of conjunctiva involving ocular surgery, including scleral buckle surgery and tube shunt surgery. Trocar-assisted fixation was performed in 15 (79%) eyes, whereas needle fixation was used in 4 (21%) eyes. Eighteen (95%) sets of haptics were flanged with a low temperature cautery. Seventeen (90%) sets of haptics were externalized superiorly and inferiorly, and 2 (10%) sets of haptics were externalized nasally and temporally. Haptics were covered by conjunctiva in 14 (74%) eyes and by scleral flap in 5 (26%) eyes. All patients experienced a single haptic erosion, of which 8 (43%) were located superiorly, 9 (47%) inferiorly, and 2 (10%) temporally. The mean interval between the initial SIS fixation and haptic erosion was 278 ± 437 days. After correction of the erosion, 18 (95%) eyes had a stable IOL at the last follow-up, with no recurrence of haptic erosion. In this series, there were no cases of endophthalmitis. CONCLUSIONS: Haptic erosion is a notable complication after SIS fixated IOL surgery but may be repaired with favorable visual outcomes. Careful evaluation of the conjunctiva should be considered before the surgery. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.

Geographic and socioeconomic access disparities to Phase 3 clinical trials in ophthalmology in the United States.

BACKGROUND/OBJECTIVE: To identify geographic and socioeconomic variables associated with residential proximity to Phase 3 ophthalmology clinical trial sites. METHODS: The geographic location of clinical trial sites for Phase 3 clinical trials in ophthalmology was identified using ClinicalTrials.gov. Driving time from each United States (US) census tract centroid to nearest clinical trial site was calculated using real traffic patterns. Travel data were crosslinked to census-tract level public datasets from United States Census Bureau American Community Survey (ACS). Cross-sectional multivariable regression was used to identify associations between census-tract sociodemographic factors and driving time (>60 min) from each census tract centroid to the nearest clinical trial site. RESULTS: There were 2330 unique clinical trial sites and 71,897 census tracts. Shortest median time was to retina sites [33.7 min (18.7, 70.1 min)]. Longest median time was to neuro-ophthalmology sites [119.8 min (48.7, 240.4 min)]. Driving >60 min was associated with rural tracts [adjusted odds ratio (aOR) 7.60; 95% CI (5.66-10.20), p < 0.0001]; Midwest [aOR 1.84(1.15-2.96), p = 0.01], South [aOR 2.57 (1.38-4.79), p < 0.01], and West [aOR 2.52 (1.52-4.17), p < 0.001] v. Northeast; and tracts with higher visual impairment [aOR 1.07 (1.03-1.10), p < 0.001)]; higher poverty levels [4th v.1st Quartile of population below poverty, aOR 2.26 (1.72-2.98), p < 0.0001]; and lower education levels [high school v. Bachelor's degree or higher aOR 1.02 (1.00-1.03), p = 0.0072]. CONCLUSIONS: There are significant geographic and socioeconomic disparities in access to ophthalmology clinical trial sites for rural, non-Northeastern, poorer, and lower education level census tracts, and for census tracts with higher levels of self-reported visual impairment.

Descriptive analysis of cornea and anterior segment fellowship program directors in 2020.

PURPOSE: To investigate demographic characteristics, educational backgrounds, and academic achievements among program directors (PDs) of cornea and external disease and anterior segment fellowships in the United States in 2020. SETTING: Database study of U.S. fellowship programs. DESIGN: Cross-sectional study. METHODS: PDs of cornea and external disease and anterior segment fellowships were identified using the San Francisco Match website. Fellowship program features reviewed included academic or private practice type, number of cornea faculty, and sex of chairperson. PD demographic characteristics, educational and training background, and academic productivity were analyzed using publicly available profiles and databases. RESULTS: 76 cornea and external disease and 10 anterior segment fellowships were reviewed. Of 86 reviewed programs, 55 (64.0%) were considered academic, 30 (34.9%) were private practice, and 1 (1.2%) was hybrid. 76 cornea and external disease PDs and 12 anterior segment PDs were identified. Overall, 21 (23.9%) of PDs were women, and the mean age for all PDs was 52.6 ± 11.5 years. Of the 88 PDs, the average number of publications was 45.1 ± 55.9. The mean h-index was 16.7 ± 15.4 and was higher among cornea and external disease than anterior segment PDs (18.2 ± 15.5 vs 7.1 ± 11.4, P = .008) and also higher among academic than private practice PDs (19.9 ± 15.1 vs 11.2 ± 14.7, P = .011). More female PDs were in departments with a female chairperson compared with male PDs (6 [28.6%] vs 4 [6.0%], P = .011). CONCLUSIONS: Cornea and external disease and anterior segment fellowship PDs represent a wide array of backgrounds and scholarly achievements. Female PDs remain in the minority and are more common in departments with female chairpersons.

Retained lens fragment presenting 32 years after cataract extraction.

Purpose: To report a patient with retained lens material presenting over three decades after initial cataract extraction with fluctuating corneal edema and intraocular inflammation. Observations: A 66-year-old man presented with a first episode of decreased vision and photophobia 32 years after cataract extraction without intraocular lens implantation in the right eye. Slit lamp examination revealed a tan-colored oblong mass in the inferior angle, in addition to corneal edema and an anterior chamber reaction. The patient was aphakic with traumatic mydriasis, and accordingly it was noted that the mass shifted location between anterior and posterior chambers over subsequent evaluations. The anterior chamber inflammation resolved in the latter position. The patient was requested to remain prone prior to clinical evaluation, and an in-office anterior chamber aspiration was performed. Histopathologic evaluation confirmed the presence of lens material and a phacolytic response. Conclusions And importance: Although unusual, retained lens material may manifest with ocular morbidity decades after cataract extraction. In patients with corneal edema and intraocular inflammation, retained lens material should be considered as a possible underlying cause even in patients with a remote history of cataract extraction. This case represents one of the longest reported time periods from cataract extraction to clinical presentation of retained lens material.

Female Editorial Authorship Trends in High-Impact Ophthalmology Journals.

IMPORTANCE: Individuals with perceived experience and expertise are invited by editorial boards to provide commentary through editorials. Female representation among editorialists is not yet defined. OBJECTIVE: To determine female representation as editorial authors in 3 high-impact general ophthalmology journals. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study investigates the proportion of female authorship in editorials published between 2005 to 2009 and 2015 to 2019 in 3 journals: Ophthalmology, JAMA Ophthalmology, and American Journal of Ophthalmology. Data were collected from April to June 2020. MAIN OUTCOMES AND MEASURES: Proportions of female first and senior (last or solo) authors between 2005 to 2009 compared with 2015 to 2019. Secondary outcome measures include representation by sex across degree types and subspecialties. Comparisons were made for all editorialists and ophthalmologist editorialists. RESULTS: Of 814 editorial articles, there were 1179 (first and senior) authors identified. Women held 301 (25.5%) of these authorships, including 116 of 365 first authorships (32.9%) and 185 of 814 senior authorships (23.9%). Overall, female first and senior authorships grew by 68.0% between 2005 to 2009 and 2015 to 2019 (85 of 469 [18.1%] vs 216 of 710 [30.4%]; difference, 12.3%; 95% CI, 7.4-317.2; P < .001). Between 2005 to 2009 and 2015 to 2019, first and senior authorships by women increased (first: 33 of 133 [24.8%] vs 83 of 232 [35.8%]; difference, 11.0%; 95% CI, 1.4-320.6; P = .03; senior: 52 of 336 [15.5%] vs 133 of 478 [27.8%]; difference, 12.3%; 95% CI, 6.8-317.9; P < .001). JAMA Ophthalmology most substantially contributed to the increase in female first and senior authorships (13.8% and 16%), although the test for homogeneity among the 3 journals was not significant. The proportion of female ophthalmologist first authors was greater than the proportion of American Board of Ophthalmology-certified female ophthalmologists (81 of 281 [28.9%] vs 123 of 672 [18.3%]; difference, 10.6%; 95% CI, 5.3-315.9; P < .001). CONCLUSIONS AND RELEVANCE: The proportion of female senior authors increased by 68.0% between 2005 to 2009 and 2015 to 2019, but female authors represented only 25.5% of editorialists. Compared with male ophthalmologists, female ophthalmologists were more commonly first than senior authors. Additionally, female authors were more likely to be nonophthalmologists or to hold nonmedical, non-PhD degrees. While the swelling rank of female editorialists has paralleled the rising proportion of female ophthalmologists over time, parity by sex has yet to be attained. Greater awareness of disparities and strategies to mitigate them may help equalize representation.

Infectious Scleritis: Pathophysiology, Diagnosis, and Management.

ABSTRACT: Infectious scleritis (IS) is a rare and severe ocular disorder responsible for approximately 5%-15% of all scleritis cases. It is often associated with a poor prognosis due to its similar clinical presentation to autoimmune scleritis, resulting in a delayed diagnosis and treatment. Therefore, differentiating between infectious and noninfectious entities is critical. Several details extracted from the patient's history and clinical examination can raise suspicion for infection. The most common predisposing factor is previous ocular surgery, especially pterygium, cataract, and vitreoretinal surgeries. Ocular trauma, poor contact lens hygiene, "eye-whitening" procedures, and subtenon triamcinolone injections have also been implicated. Clinical features of infection include the presence of scleral necrosis, hypopyon, unifocal or multifocal scleral abscesses, and mucopurulent discharge. Thorough diagnostic testing is essential before excluding infection as a possibility. Empiric broad-spectrum topical and systemic antibiotic therapy should be initiated while awaiting laboratory results and adjusted accordingly. Most IS cases require both aggressive medical and surgical treatment, and various studies have reported favorable outcomes with this combination. At this time, there is no consensus on the management of this severe ocular condition, and future studies are needed to establish clear treatment guidelines.

Long term results of accelerated corneal collagen cross-linking in pediatric keratoconus.

PURPOSE: To evaluate the long term visual, refractive, and corneal tomographic outcomes of epithelium-off accelerated corneal collagen cross-linking (ACXL) in the management of pediatric keratoconus (KC). METHODS: This retrospective study included patients under 18 years old with progressive KC who underwent ACXL between 2012 and 2019 at Dicle University Hospital. Complete ophthalmic examination was performed including uncorrected distance visual acuity (UDVA), best spectacle-corrected distance visual acuity (CDVA), manifest refraction, and corneal tomography. Evaluations were performed preoperatively and at 6 months intervals postoperatively. RESULTS: Forty-nine eyes of 49 patients were included in the study. The mean age of patients at the time of ACXL was 14.2 ± 1.8 (range: 9.5-17.3) years. Mean follow up was 4.61 ± 1.90 (range: 2.0-8.1) years. The mean LogMAR UDVA improved from 0.94 ± 0.41 to 0.81 ± 0.43, 0.69 ± 0.41, and 0.67 ± 0.33 after 1, 3, and 5 years respectively (p = 0.001). The mean LogMAR CDVA improved from 0.58 ± 0.36 to 0.46 ± 0.31, 0.34 ± 0.23, and 0.39 ± 0.27 after 1, 3, and 5 years respectively (p = 0.015). The mean refractive cylinder improved significantly from 6.01 ± 2.07 diopters (D) to 5.46 ± 1.87, 5.38 ± 2.18, and 5.02 ± 2.31 D after 1, 3, and 5 years respectively (p = 0.005). As compared to preoperative values, steep keratometry and maximum keratometry were not significantly different (p = 0.805 and 0.448, respectively) following ACXL, while flat keratometry significantly improved after ACXL (p = 0.012). Although central corneal thicknesses decreased significantly (p = 0.029), the decrease in thinnest corneal thickness was not statistically significant (p = 0.205). CONCLUSION: Epithelium-off ACXL seems to be effective for halting KC progression with long term clinical benefits in pediatric patients.