Intraoperative variability of corneal epithelium thickness in photorefractive keratectomy.

PURPOSE: To evaluate the intraoperative central corneal epithelial thickness (ET) as measured by optical coherence pachymetry (OCP) in myopic eyes undergoing alcohol-assisted photorefractive keratectomy (PRK). METHODS: A retrospective review of patients who underwent alcohol-assisted PRK was performed. Data were abstracted on age, gender, contact lens (CL) wear, preoperative refractive errors, keratometry, topographic and ultrasonic pachymetry, and intraoperative OCP measurements before and after epithelium removal. The central ET was calculated by subtracting OCP measurement after epithelium removal from the OCP measurement prior to epithelium removal. RESULTS: The study comprised of 162 consecutive eyes from 81 patients. Mean age was 26.73 ± 6.47 years, 50.6% were males. CL was used in 92 eyes (56.8%). The mean sphere and spherical equivalent were -3.60 ± 1.84 D and -3.26 ± 1.85D, respectively. The mean intraoperative ET was 58.22 ± 17.53 µm (range, 15-121µm). Fifty-five percent of the eyes had an ET measurement above or below the range of 40-60µm. ET was significantly higher in the second operated eye compared to the first operated eye (p = 0.006), and an association was found to CL-wear (p = 0.03). There was no significant difference in thickness between genders (p = 0.62), and no correlation to patient age (p = 0.45, rp = 0.06), refractive errors (p > 0.30,rp=-0.07-0.08), nor keratometry(p > 0.80, rp=-0.01- (-0.02)). CONCLUSION: The intraoperative assessment of ET in alcohol-assisted PRK showed a high variability of the central corneal epithelium, with a significant difference between the first and second operated eyes. This difference may have implications when the epithelium is not included in the surgical planning in surface ablation.

Corneal cross-linking for treatment of keratoconus relapse in post-keratoplasty eyes.

PURPOSE: Keratoconus relapse after penetrating keratoplasty is a rare condition that may result in severe visual deterioration and corneal graft thinning. Therefore, treatment to stabilize the cornea should be considered. The purpose of this study was to evaluate the safety and efficacy of Corneal Cross-Linking (CXL) in eyes with relapse of keratoconus after penetrating keratoplasty for keratoconus. MATERIALS AND METHODS: A retrospective review of eyes that developed keratoconus relapse following a penetrating keratoplasty and treated with CXL. The main outcome measures were change in maximal keratometry (Kmax), best-corrected distance visual acuity (BCVA), thinnest corneal thickness (TCT) and central corneal thickness (CCT), and complications. RESULTS: We identified 10 consecutive eyes of 9 patients. Preoperative median BCVA before the CXL and 1 year after the CXL procedure remained stable (p = 0.68). The median (IQR) of Kmax improved from 63.2 (24.9) D before the CXL procedure to 62.2 (27.1) D at 1 year postoperatively (P = 0.028). Median TCT and CCT also remained with no significant change 1 year after CXL. No complications were noted following the procedure. CONCLUSION: CXL in eyes with keratoconus relapse after keratoplasty is a safe and effective procedure enabling not only visual stabilization but also might bring keratometry improvement. Routine follow-up after keratoplasty should be performed for early detection of keratoconus relapse and CXL is timely advised when such a relapse is documented.

Safety of cataract surgery in patients treated with the new oral anticoagulants (NOACs).

PURPOSE: To evaluate the safety of phacoemulsification of cataract in patients taking new oral anticoagulants (NOACs). METHODS: In a prospective case series, consecutive patients on NOACs (dabigatran, rivaroxaban, or apixaban) who were referred for uncomplicated cataract surgery to the eye institute underwent a thorough ophthalmological and hematological evaluation. Rivaroxaban and apixaban anti-factor Xa tests, and diluted thrombin time for dabigatran, were used for monitoring anticoagulation levels in blood. Blood was drawn for these tests just prior to surgery and at a peak level of the drug at about 4 h post-surgery (2 h after the drug was given). All surgeries were videotaped and patients were examined at 1 and 7 days after the operation. The main outcome measures included assessment of intra-operative, postoperative ocular bleeding, and other related complications. RESULTS: Thirty-five eyes of 25 unrelated patients ranging in age from 63 to 92 years (mean 77.6 years) underwent phacoemulsification. Intra-operative bleeding was observed in 5 eyes from the conjunctiva or limbus at the main incision site. No intraocular bleeding occurred. No hemorrhagic complications were observed during the 1-week follow-up. According to anti-factor Xa levels prior to surgery and following surgery, 85% of the patients were on therapeutic levels of NOACs. CONCLUSIONS: Clear corneal incision phacoemulsification performed under topical anesthesia can be safely performed in simple cases of cataract without discontinuing NOAC treatment.

Predictability of Biometry in Patients Undergoing Cataract Surgery.

PURPOSE: To compare measurements of axial length (AL), anterior chamber depth (ACD), keratometry (K), and the refractive predictability of the Aladdin and IOLMaster biometry devices in cataract surgery patients. METHODS: A retrospective observational study of eyes undergoing cataract surgery. Data were retrieved on AL, ACD, and K measurements obtained by the Aladdin and the IOLMaster. Furthermore, the postoperative refractive prediction errors were compared between the devices. RESULTS: The study included 127 consecutive eyes of 127 patients undergoing cataract surgery. Mean measurements of AL were not significantly different between the Aladdin (24.18 ± 1.89 mm) and IOLMaster (24.18 ± 1.89 mm) (p = 0.792). Mean K measurements were different between Aladdin (43.84 ± 1.56 D) and IOLMaster (43.97 ± 1.61 D) (p < 0.001). For AL, Aladdin measurements correlated strongly with IOLMaster measurements (r = 0.9997). For K, Aladdin measurements correlated strongly with IOLMaster measurements (r = 0.9912). Fifty-eight of the 127 eyes underwent cataract surgery with a monofocal intraocular lens. For these, mean absolute error (MAE) in predicting refraction relative to the measured postoperative refraction differed between Aladdin (MAE = 0.54 ± 0.40D) and IOLMaster (MAE = 0.49 ± 0.41D) (p = 0.001). After adjustment for the systematic difference in K measurements, the difference in MAE was no longer significant (p = 0.601). The ACD measurements did not differ significantly (p = 0.873) and were well correlated (r = 0.8327). CONCLUSIONS: A very good correlation was found in AL, K, and ACD measurements between the Aladdin biometer and the IOLMaster. Minimal adjustment for the constant difference in keratometry measurements matched the refractive predictability of both devices.

[Corneal collagen cross-linking novel technique for prevention of keratoconus progression: results after one-year at the Sheba Medical Center].

BACKGROUND: Keratoconus is a progressive corneal degenerative disease that appears in young adults and causes progressive myopia and irregular astigmatism affecting visual acuity. The quality of life may be severely impaired in these young adults. Corneal Collagen Cross-Linking (CXL) is a novel technique aimed at stopping disease progression. OBJECTIVE: To evaluate the refractive and topographic outcome 12 months after CXL treatment in patients with progressive keratoconus. METHODS: In this retrospective case series, 15 eyes of 14 patients with progressive keratoconus were treated with standard CXL. Patients were assessed preoperatively, at week 1 and at months 1, 3, 6, and 12 after treatment. Outcome measures included best-corrected visual acuity (BCVA) refraction, biomicroscopy and fundus examination, corneal topography and pachymetry. RESULTS: Comparing the preoperative data with 12 months postoperative results, we observed stabilization of the average keratometry values 51.2 to 50.67 (diopters), P = 0.605. The BCVA values remained stable 0.47 to 0.57 (decimal point) P = 0.6626. CONCLUSION: Our series of patients with progressive keratoconus supports the effect of crosslinking to prevent disease progression. Regularization of the corneal keratometry values and minor improvement of the visual acuity may be additional benefits of this procedure.

Pharmacokinetics of bevacizumab after topical and intravitreal administration in human eyes.

BACKGROUND: Topical bevacizumab is a potential treatment modality for corneal neovascularization, and several recent studies have demonstrated its efficacy. No previous study of the pharmacokinetics of topical bevacizumab has been performed in human eyes. The purpose of this study is to investigate the pharmacokinetics of topical administration of bevacizumab in human eyes, and also to compare the pharmacokinetics of intravitreal bevacizumab injections with previously reported data. METHODS: Twenty-two (22 eyes) were included in this study, and divided into four groups: eight patients received topical bevacizumab and aqueous samples were obtained 1 hour later during cataract extraction surgery (group 1), eight patients received topical bevacizumab and vitreous samples were obtained 1 day later during pars-plana vitrectomy (PPV) (group 2), three patients received intravitreal bevacizumab and vitreous samples were obtained during PPV (group 3). Vitreous samples from three patients who received no bevacizumab served as controls (group 4). All samples underwent enzyme-linked immunosorbent assay to detect bevacizumab. RESULTS: No bevacizumab was detected in the aqueous or vitreous of any topically treated eyes. The mean vitreal half-life for intravitreally injected bevacizumab was 4.9 days in four non-vitrectomized eyes and 0.66 days in one previously vitrectomized eye. CONCLUSIONS: Topically administered bevacizumab does not penetrate the cornea into the anterior chamber and vitreous cavity, indicating that topical use for treating corneal neovascularization has minimal risk of intraocular penetration and adverse events related to intraocular vascular endothelial growth factor inhibition. The half-life following intravitreal bevacizumab injection measured in this study is comparable to that of previous reports, and includes the first demonstration of a significantly reduced half-life following intravitreal injection in a previously vitrectomized eye.

Topical bevacizumab for neovascular glaucoma: a pilot study.

BACKGROUND/AIMS: Bevacizumab (Avastin), an anti-vascular endothelial growth factor drug, has been successfully used in recent years to treat ocular pathologies, mostly by intravitreal administration. The aim of this study was to investigate the safety and efficacy of topically applied bevacizumab for the treatment of neovascular glaucoma (NVG). METHODS: Patients with NVG were treated with topical bevacizumab (25 mg/ml) 4 times daily during 2 weeks. The following parameters were evaluated at baseline and on days 3, 7 and 14: visual acuity, slit-lamp examination, intraocular pressure (IOP), heart rate and systemic blood pressure. Iris neovascularization was documented using slit-lamp color photos at baseline and on day 14. RESULTS: Eight eyes of 8 patients with NVG were evaluated. After the 2-week treatment, mean IOP was lowered from 34.9 mm Hg (SD 12.8) at baseline to 28.8 mm Hg (SD 9.9) on day 14, representing a mean reduction of 6.1 mm Hg (17.5%). Three patients had clinical regression of their iris neovascularization. Ocular adverse events were transient and included mild upper eyelid swelling, mild exacerbation of superficial punctate keratitis and mild corneal epithelial bullae in an already edematous cornea. There were no serious systemic adverse events. CONCLUSIONS: Topical application of bevacizumab may lower IOP and result in regression of neovascularization in patients with NVG.

Ex Vivo Histological Analysis of Corneas with Manually Implanted Intracorneal Stromal Ring Segments.

Backgrond: Intracorneal ring segments (ICRSs) are utilized to correct refractive changes impacting visual acuity, commonly implanted via femtosecond laser but can also inserted manually. Corneal deposits alongside the ICRS channels are seen commonly. Methods: This study explores the histological characteristics of corneal deposits following manual ICRS implantation, comparing them to previously published articles describing femtosecond laser-assisted cases. Results: This is a retrospective analysis of three cases involving manual ICRS implantation, accumulation of whitish deposits and later explanation of the corneas due to penetrating keratoplasty (PKP). Patient demographics, ocular history, and surgical details were collected. Histological analysis employed Hematoxylin and Eosin (H&E) and Masson's trichrome staining. Whitish deposits along ICRS tracts were observed in all cases, with minimal fibroblastic transformation of keratocytes adjacent to the segments. Comparing these cases of manual to femtosecond laser-assisted ICRS implantation, in most cases, similar deposits were identified, indicating the deposits' association with the stromal tissue reaction to the ring segment and not to the surgical technique. Conclusions: This study contributes insights into the histopathology of manually implanted ICRS, emphasizing the shared nature of deposits in both insertion methods. The findings highlight the link between deposits and the stromal tissue reaction to the ring segment, irrespective of the insertion technique.

Intraoperative Assessment of the Stromal Ablation in Photorefractive Keratectomy.

Purpose: To evaluate the difference between planned and measured central ablation depth (CAD) and compare the first and second operated eye in simultaneous bilateral myopic alcohol-assisted PRK. Methods: A retrospective review of patients was performed. Demographic and preoperative data was abstracted. Intraoperative assessment included environmental data, laser-planned algorithm of ablation (L-CAD), and optical coherence pachymetry (OCP) measurements. The true stromal ablation depth (O-CAD) was calculated by subtracting the immediate post-ablation OCP measurement from the OCP measurement before laser ablation. Deviation in pachymetry (DP) between O-CAD and L-CAD was also assessed. Results: The study comprised 140 eyes from 70 consecutive patients. The mean age was 26.91 ± 6.52 years, and 57.1% were females. O-CAD was significantly correlated to preoperative refractive errors and intraoperative laser settings. DP was not correlated to any of the pre- or intraoperative parameters. L-CAD showed a significant underestimation as compared to O-CAD (67.87 ± 25.42 µm and 77.05 ± 30.79 µm, respectively, p < 0.001), which was shown in 74.3% of the cases. A moderate agreement between the two methods was noted, with a mean deviation of 17%. This difference was maintained for each eye individually (p < 0.001). In addition, DP was significantly higher in the first operated eye as compared to the second operated eye (11.97 ± 16.3 µm and 6.38 ± 19.3 µm respectively, p = 0.04). Conclusion: The intraoperative assessment of stromal ablation showed significantly higher central ablation depth values compared to the laser-planned ablation algorithm. The deviation in pachymetry was higher in the first, compared to the second, operated eye. Awareness is warranted as to the discrepancy between preoperative planning and intraoperative assessment.

Topical tacrolimus for the management of acute allergic conjunctivitis in a mouse model.

BACKGROUND: Acute allergic conjunctivitis is a constantly challenging condition that often requires steroids for effective management. Alternative treatment options are needed due to the potential side effects of steroids. Tacrolimus has been used for vernal/atopic conjunctivitis. The aim of our study was to investigate the therapeutic effect of topical administration of 0.03 % tacrolimus (eye drops or ointment) in comparison to 0.1 % dexamethasone in a mouse model of acute allergic conjunctivitis. METHODS: BALB/c mice were sensitized by an intraperitoneal injection of 10 µg/0.2 ml ovalbumin (OVA) absorbed on ALUM (2.0 mg) on days 1 and 8. They were challenged by topical instillation of 2 µl of 15 % OVA (absorbed in 10 % glycerol) twice daily, on days 15-21. Treatment was administered twice daily on days 17-21. Mice were randomly assigned topical treatment groups: Group 1, 0.1 % dexamethasone drops; Group 2, 0.03 % tacrolimus drops; Group 3, 0.03 % tacrolimus ointment; Group 4 PBS drops (control). On day 22 all mice underwent clinical evaluation, blood sampling for IgE levels, and conjunctivas were removed for eosinophil counting. RESULTS: IgE and OVA-specific IgE levels were similar among all groups, demonstrating induction of allergic reaction in all mice. Significantly lower clinical scores were found among all treated groups as compared to controls (P < 0.001), while no significant difference was found among the three treatment groups (P > 0.05). Conjunctival eosinophil counts were significantly lower in Group 1 (P < 0.05) as compared to the other groups. CONCLUSIONS: The clinical efficacy of topical 0.03 % tacrolimus was similar to 0.1 % dexamethasone for acute allergic conjunctivitis.

High-dose topical bevacizumab for corneal neovascularization.

BACKGROUND/AIMS: Bevacizumab (Avastin), an anti-vascular endothelial growth factor drug, has been successfully used in the recent years to treat ocular pathologies, mostly by intravitreal administration. The aim of the current study was to assess the off-label topical use of high-dose bevacizumab for the treatment of corneal neovascularization. METHODS: Seventeen eyes of 17 patients with corneal neovascularization secondary to various pathologies were included. The patients were treated with topical bevacizumab (25 mg/ml) 4 times daily for 2 weeks. The following parameters were evaluated at baseline and on days 3, 7 and 14: visual acuity, slit-lamp examination, intraocular pressure, heart rate and blood pressure. Color photos were obtained at baseline and on day 14. RESULTS: Eleven eyes (65%) demonstrated regression of corneal neovascularization and/or clearing of corneal opacification. Adverse ocular events were mild and transient, and included eyelid swelling/chalazion and superficial punctate keratitis. CONCLUSION: Treatment with high-dose topical bevacizumab (25 mg/ml) was effective for corneal neovascularization in nearly two thirds of the eyes treated. Adverse ocular side effects were mild and transient.

Wearing time as a measure of success of scleral lenses for patients with irregular astigmatism.

OBJECTIVES: To evaluate the visual correction and clinical performance with scleral contact lenses (CL) for the visual rehabilitation of irregular astigmatism and to report the effect of brief wearing breaks on the wearing time and success rate. METHODS: A retrospective review was performed on consecutive patients who were fitted with scleral CL because of irregular astigmatism following failure of other optical corrections. Visual acuity (VA) and wearing times were abstracted. RESULTS: The 97 consecutive identified patients (155 eyes) were divided according to the diagnosis: (1) keratoconus (105 eyes; 67.7%), (2) postpenetrating keratoplasty (PK) (28 eyes; 18.1%); (3) multiple diagnoses (22 eyes; 14.2%)-postradial keratotomy, keratoglobus, pellucid marginal degeneration, PK with aphakia, and iatrogenic ectasia. The mean follow-up was 34.9 ± 18.5 months (range, 2-71 months). There was a significant increase in best VA-scleral when compared with the previous best VA-prescleral (P<0.001). The best VA-scleral was similar in the 3 groups (P>0.5). Patients who took brief breaks every 4 to 5 continuous wearing hours had a significantly higher success rate (P<0.001) among all diagnosis groups. The success rate in wearing time in the keratoconus group was significantly higher than in the PK group (P<0.001). Twenty-six patients (27%) discontinued to wear scleral lenses. CONCLUSION: Scleral lenses can be used successfully for visual rehabilitation and management of irregular astigmatism from various causative factors. The daily wearing time was significantly improved by taking brief breaks for replenishing the CL.

Safety and Efficacy of Repeated Corneal Collagen Crosslinking in Progressive Keratoconus.

PURPOSE: Keratoconus is a progressive visually impairing disorder. Despite the beneficial effects of epithelial off-crosslinking (CXL) on the stabilization of keratoconus, progression may still occur. We report the efficacy and safety of a repeated CXL for significant progression of keratoconus after a single CXL procedure. METHODS: This retrospective study includes patients diagnosed with progressive keratoconus who were previously treated with CXL and underwent repeated CXL. Demographic, clinical, and surgical data were retrieved and analyzed. RESULTS: Ten consecutive eyes of nine patients who developed progressive keratoconus after CXL were identified. The mean age at diagnosis of keratoconus was 20.2 ± 6.0 years. The post-repeated CXL follow-up period was 2.1 ± 1.3 years. The mean best corrected visual acuity (BCVA) remained stable throughout the follow-up period. The mean Kmax at baseline was 60.4 ± 3.6 D. Before the repeated CXL, Kmax progressed significantly ( P = 0.018) and was 62.2 ± 6.3 D, and at the last follow-up, the value decreased significantly ( P = 0.037) and was 60.3 ± 6.4 D. The mean minimal pachymetry was 464.0 ± 27.0 µ at base line. Before the repeated CXL, minimal pachymetry was significantly lower ( P = 0.018), and after the repeated CXL, the minimal pachymetry was stable ( P = 0.2). No intra- or postoperative complications were noted. CONCLUSIONS: Repeated CXL is a safe and effective treatment option when failure of the initial CXL is diagnosed, even in young patients. This procedure may prevent visual deterioration and a potential need for keratoplasty.

Gender related trends among Israeli ophthalmologists professional career and personal life performance.

BACKGROUND: Gender-diversity trends in ophthalmology in Israel have not been studied despite a high proportion of female ophthalmologists. Our purpose was to evaluate gender-related trends in ophthalmology professional career and personal life performance in early and advanced careers in Israel. METHODS: A survey based on a nationwide voluntary anonymous web questionnaire was distributed to the members of the Israeli Ophthalmological Society. The questionnaire included questions referring to professional career and personal life performance. Gender differences were analyzed. RESULTS: Out of 252 respondents, 116 (46%) were women, with a mean age of 47.97 + -11.3 and 53.18 + -12.4 (P = 0.01) years, respectively. Marital status, post-residency fellowship performance or duration, an additional academic degree, academic appointments, and managerial positions were similar between genders. Fellowship predominance of males was found in cornea/cataract/refractive and of females in strabismus, pediatric ophthalmology, and neuro-ophthalmology (P < 0.01, P = 0.032, respectively). Men had significantly more publications and appointments in peer review journals and work hours (P = 0.04 and P = 0.02, P = 0.027, respectively). Both genders responded similarly regarding work satisfaction, combination between family life and work. More women felt inequity during and post-residency in clinical (P = 0.011, P = 0.001, respectively) and surgical work (P = 0.001, P = 0.035, respectively). More women experienced inappropriate remarks from patients and sexual harassment (P = 0.001, P < 0.001, respectively), and supported the need for affirmative action (P < 0.0001). CONCLUSIONS: Several gender disparities were found among ophthalmologists in Israel, including subspecialties distributions, publications, appointments in peer review journals, working hours, work inequity sense, harassment events, and support the need for affirmative action.

Staphylolysin is an effective therapeutic agent for Staphylococcus aureus experimental keratitis.

BACKGROUND: Therapy of S. aureus keratitis is increasingly challenging due to emerging resistant strains. Staphylolysin (LasA protease) is a staphylolytic endopeptidase secreted by Pseudomonas aeruginosa. The purpose of the current study was to study the effect of treatment with staphylolysin on experimental keratitis caused by various Staphylococcus aureus strains. METHODS: The therapeutic effect was studied in a keratitis model induced in rabbits by intrastromal injections of 10(3) S. aureus cells of three different methicillin-resistant S. aureus (MRSA) strains and one methicillin-susceptible S. aureus strain (MSSA). Topical treatment with either staphylolysin or bovine serum albumin (BSA; control) was applied every half hour for 5 h, starting at 4 h after infection. Corneas were removed for bacterial quantification. Histopathological analysis was performed on MSSA-infected rabbits, killed at either one or 84 h after completion of treatment and on uninfected eyes 1 h after treatment termination. RESULTS: The number of bacteria in the staphylolysin-treated corneas was significantly reduced in all infections with the four S. aureus strains studied as compared to controls: the staphylolysin-treated eyes infected with MRSA strains were either completely sterilized or showed a 3-4 orders of magnitude decrease in the number of cfu/cornea (p = 0.004 to 0.005); all of the staphylolysin-treated MSSA-infected eyes were sterile. Histopathological analysis of the methicillin-sensitive (MSSA) strain-infected eyes at 84 h after completion of treatment showed moderate inflammation in the staphylolysin-treated eyes as compared with extensive abscess formation in the control group. The uninfected corneas showed only mild stromal edema in both the staphylolysin and BSA-treated groups. CONCLUSIONS: Staphylolysin provided long-lasting protection against several strains of S. aureus, evident by both its strong anti-bacterial activity and beneficial histopathological results of treatment.

Repeated Femtosecond Laser-Assisted Astigmatic Keratotomies in Post-Keratoplasty Eyes.

Visual rehabilitation after a keratoplasty is often compromised due to high amounts of residual astigmatism. Femtosecond laser-assisted astigmatic keratotomy (FLAK) is gaining popularity in decreasing this astigmatism. Though one set of two incisions suffices in most cases, sometimes the treatment proves insufficient and additional treatment is required. This case series evaluates the outcomes in patients who underwent two consecutive FLAK sets to correct post-keratoplasty residual astigmatism. All repeated FLAK cases performed on post-keratoplasty eyes were reviewed in a high-volume clinic as a non-comparative retrospective case series. The data extracted include the procedure parameters, time between procedures, refraction including sphere, astigmatism, spherical equivalent (SE), and uncorrected and best-spectacle-corrected distance visual acuity (UDVA, BSDVA, respectively). Eleven eyes of eleven patients aged 25.5 ± 10 treated with more than one FLAK procedure were identified. The average follow-up time was 6 months after the first FLAK and 24 ± 10 months after the second. The second FLAK was performed six months after the first. The preoperative mean astigmatism was -9.59 ± 2.36 D. At the final follow-up, the mean astigmatism decreased to -5.38 ± 1.79 D (p = 0.001). Repeated FLAK procedures achieved a significant and stable reduction of astigmatism in post-keratoplasty eyes. This procedure shows safety and effectivity in these complex eyes and may prevent the need for a further keratoplasty.

Acute cataract development in a 43-year-old woman after an ultrasound eyelid-tightening procedure.

PURPOSE: The purpose of this article is to describe a severe side effect presentation of a bilateral cataract after treatment with intense focused ultrasound (IFUS) and subsequent uneventful cataract surgery. OBSERVATIONS: A 43-year-old woman presented to the emergency room with decreased visual acuity several hours after undergoing an eyelid-tightening procedure using IFUS. The patient's vision was decreased (R>L), a result of an acute cataract, which had an unusual appearance and consistency. Several weeks later, visual acuity had decreased further in the right eye to 20/400 and the patient underwent uneventful laser-assisted cataract surgery with intraocular lens implantation, which resulted in full visual recovery. CONCLUSIONS AND IMPORTANCE: This case emphasizes the need for particular attention to possible side effects resulting from periocular IFUS, including severe ocular impact requiring surgical intervention.

The effect of the glycemic control on the aqueous humor glucose levels in diabetic patients undergoing elective cataract surgery.

PURPOSE: Aqueous humor glucose levels play a role in the anterior segment disorders' pathophysiology, mainly in diabetics. Our purpose was to evaluate the ratio of aqueous humor glucose levels to blood glucose levels in diabetics and to evaluate the correlation between this ratio and blood glycated hemoglobin (HbA1c) levels. METHODS: This prospective study was performed in Sheba Medical Center during 2016-2018. The study included type 2 diabetic patients admitted for elective cataract surgery. Blood glucose levels were measured immediately before surgery. HbA1c was obtained within 3 months preoperatively. At the beginning of surgery, 0.05-0.1 mL aqueous humor was drawn. Main outcome measures were aqueous humor glucose/blood glucose ratio and the correlation between HbA1c and aqueous humor glucose/blood glucose ratio. RESULTS: Thirty-seven patients (mean age 75.2 ± 11.2 years) were recruited. The average aqueous humor glucose/blood glucose ratio was 0.69 ± 0.20. A significant positive correlation was found between aqueous humor and blood glucose levels, Pearson coefficient constant R = 0.63 (p < 0.01), and specifically stronger among older patients R = 0.89 (p < 0.01), females R = 0.74 (p < 0.01), patients with short-term disease (<10 years) R = 0.80 (p < 0.01), and patients treated with oral anti-diabetic treatment R = 0.74 (p < 0.01). A significant strong positive correlation was found between HbA1c levels and aqueous humor glucose/blood glucose ratio R = 0.62 (p < 0.01), and specifically stronger among older patients R = 0.82 (p < 0.01), males R = 0.70 (p < 0.01), patients with prolonged disease (⩾10 years) R = 0.540 (p < 0.05), and patients treated with oral anti-diabetic treatment R = 0.62 (p < 0.01). CONCLUSION: A significant strong correlation was found between aqueous humor glucose levels and blood glucose levels. Poor glycemic control was strongly correlated with an increased ratio, reflecting an increased anterior chamber's glucose permeability. Older age group was found to have stronger correlation of poor glycemic control with this ratio.

Treatment of dry eye syndrome with orally administered CF101: data from a phase 2 clinical trial.

OBJECTIVE: To explore the safety and efficacy of CF101, an A(3) adenosine receptor agonist, in patients with moderate to severe dry eye syndrome. DESIGN: Phase 2, multicenter, randomized, double-masked, placebo-controlled, parallel-group study. PARTICIPANTS: Sixty-eight patients completed the study, 35 patients in the placebo group and 33 patients in the CF101 group. INTERVENTION: Patients were treated orally with either 1 mg CF101 pills or matching vehicle-filled placebo pills, given twice daily for 12 weeks, followed by a 2-week posttreatment observation. MAIN OUTCOME MEASURES: An improvement of more than 25% over baseline at week 12 in one of the following parameters: (1) tear break-up time (BUT); (2) superficial punctate keratitis assessed by fluorescein staining results; and (3) Schirmer tear test 1 results. Clinical laboratory safety tests, ophthalmic examinations, intraocular pressure (IOP) measurements, electrocardiographic evaluations, vital sign measurements, and monitoring of adverse events. RESULTS: A statistically significant increase in the proportion of patients who achieved more than 25% improvement in the corneal staining and in the clearance of corneal staining was noted between the CF101-treated group and the placebo group. Treatment with CF101 resulted in a statistically significant improvement in the mean change from baseline at week 12 of the corneal staining, BUT, and tear meniscus (TM) height in the CF101-treated group. CF101 was well tolerated and exhibited an excellent safety profile with no serious adverse events. A statistically significant decrease from baseline was observed in the IOP of the CF101-treated group in comparison with the placebo group. CONCLUSIONS: CF101, given orally, induced a statistically significant improvement in the corneal staining and an improvement in the BUT and TM in patients with moderate to severe dry eye syndrome. The drug was very well tolerated. These data and the anti-inflammatory characteristic of CF101 support further study of the drug as a potential treatment for the signs and symptoms of dry eye syndrome. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.