Concomitant Bandage Contact Lens, Oral Nicergoline, and Topical Autologous Serum for Severe Neurotrophic Keratitis.

BACKGROUND: To report the outcomes of using the combination of oral nicergoline, autologous serum, and contact lens to enhance corneal epithelization in neurotrophic keratitis and to discuss the clinical potential of this management. METHODS: This was a prospective consecutive case series study of eight patients treated for neurotrophic keratitis at the "Conde de Valenciana" Institute of Ophthalmology. Oral nicergoline, autologous serum, and bandage contact lens were initiated at the same time, immediately after stage 3 diagnosis keratitis was confirmed clinically, and until corneal epithelialization was achieved or eminent corneal perforation was seen. In patients where diabetes was a cause, glycosylate hemoglobin was measured to asses metabolic control. Corneal esthesiometry and corrected distance visual acuity were assessed before and after treatment. RESULTS: This study included eight eyes of eight patients (5 men [62.5%], average age 57±17.9 years). All patients completed at least 1 month of follow-up after nicergoline and contact lens suspension. Of the eight eyes, no one had positive culture growth and complete epithelial healing was achieved in all cases. Half of patients had diabetes and had a poor metabolic control. Corneal sensitivity improved in all eyes almost 2 centimeters in Cochet-Bonnet esthesiometry ( P= 0.01). In addition, final visual acuity gains were obtained ( P= 0.100). CONCLUSIONS: The combination of oral nicergoline, autologous serum, and bandage contact lens simultaneously could be an alternative in the management of stage 3 neurotrophic keratitis when conventional medical treatment has no improvement of corneal epithelization.

Submicroscopic deletions at 13q32.1 cause congenital microcoria.

Congenital microcoria (MCOR) is a rare autosomal-dominant disorder characterized by inability of the iris to dilate owing to absence of dilator pupillae muscle. So far, a dozen MCOR-affected families have been reported worldwide. By using whole-genome oligonucleotide array CGH, we have identified deletions at 13q32.1 segregating with MCOR in six families originating from France, Japan, and Mexico. Breakpoint sequence analyses showed nonrecurrent deletions in 5/6 families. The deletions varied from 35 kbp to 80 kbp in size, but invariably encompassed or interrupted only two genes: TGDS encoding the TDP-glucose 4,6-dehydratase and GPR180 encoding the G protein-coupled receptor 180, also known as intimal thickness-related receptor (ITR). Unlike TGDS which has no known function in muscle cells, GPR180 is involved in the regulation of smooth muscle cell growth. The identification of a null GPR180 mutation segregating over two generations with iridocorneal angle dysgenesis, which can be regarded as a MCOR endophenotype, is consistent with the view that deletions of this gene, with or without the loss of elements regulating the expression of neighboring genes, are the cause of MCOR.

Pemphigus: An Ophthalmological Review.

OBJECTIVE: To describe the epidemiology, etiology, pathogenesis, clinical characteristics, and management of pemphigus, with an emphasis on ocular involvement. METHODS: Literature review. RESULTS: Pemphigus is an autoimmune epithelial blistering disease of the skin and mucous membranes. The typical pathological finding is acantholysis of the epidermis that leads to blister formation. Immunofluorescence techniques show autoantibody deposition on the epidermal intercellular substance. Although a genetic background is necessary, environmental factors are crucial for the onset and perpetuation of the disease. Exposure to some drugs, toxic agents, and foods and associations with other autoimmune diseases and lymphoproliferative conditions should be assessed. Generally, the skin is the most commonly affected tissue. Ocular involvement might be present and exhibit a clinical course that is independent of skin compromise. Visual function may be affected depending on the severity of the presentation. In untreated cases, mortality is high because of bacterial sepsis and hydroelectrolyte imbalance. A multidisciplinary approach should be used involving a dermatologist, ophthalmologist, and immunologist. Immunosuppressive agents are the mainstay of treatment; corticosteroids typically with azathioprine or mycophenolate mofetil are the drugs of choice. Surgical treatment of trichiasis and malposition of the eyelids and tectonic procedures for corneal perforation are sometimes required in very severe and recalcitrant cases. CONCLUSIONS: Pemphigus is a potential life- and sight-threatening disease. Understanding the disease facilitates the adequate assessment of the modifiable factors and the prompt initiation of immunotherapy. Ocular involvement can develop in patients with pemphigus. Adequate ophthalmological care is needed, in particular, prevention of infections, scarring, and corneal perforation.

Epidemiology and Outcomes of Kocuria Keratitis.

OBJECTIVE: To determine the characteristics of infectious keratitis caused by Kocuria spp. METHODS: Retrospective case series. Information included demographic data, medical history, risk factors associated with infectious keratitis, clinical characteristics, microbiological results and drug sensitivity, clinical course, management, and visual outcomes. RESULTS: Eight patients were included (7 females and 1 male; mean age, 66.2 years; age range, 42-84 years). All patients presented risk factors for infectious complications, such as filamentous keratitis, dry eye, blepharitis, and persistent corneal edema. In all cases, ulcers were classified as severe. The infection resolved with medical treatment in one eye only. One case was treated with amniotic membrane graft. Two patients required keratoplasty (lamellar and penetrating), and one case needed sclerokeratoplasty. In three cases, the keratitis was severe enough to require evisceration. The final visual acuity ranged from 20/25 to no light perception. CONCLUSIONS: Bacterial keratitis by Kocuria spp. is a rare infection that may have an unexpected clinical course and possible serious outcomes. This pathogen should be considered in patients with unusual clinical course. Local or systemic immune compromise in the genesis of the disease must also be taken into account, and ophthalmologists should be more suspicious in this vulnerable group of patients.

Multifocal toric intraocular lens implantation for forme fruste and stable keratoconus.

PURPOSE: To describe the results of multifocal toric intraocular lens implantation in two patients (one with forme fruste keratoconus and the other with frank but stable keratoconus). METHODS: A 50-year-old woman with forme fruste keratoconus and positive family history of keratoconus and a 42-year-old man with frank keratoconus underwent corneal collagen cross-linking. Uncorrected distance visual acuity was 20/800 in the right eye and 20/400 in the left eye and 20/400 in the right eye and 20/100 in the left eye, respectively. Refractive lens exchange was performed using multifocal toric intraocular lenses in both cases. RESULTS: After phacoemulsification, uncorrected distance visual acuity, corrected distance visual acuity, binocular uncorrected distance visual acuity was 20/25 and 20/30 in cases 1 and 2, respectively, and residual refraction was within 0.5 diopters of emmetropia in both cases. Patients were subjectively satisfied. CONCLUSIONS: Presbyopic treatment options are scarce for patients with keratoconus and multifocal toric intraocular lenses may be useful in selected cases.

Repeatability, reproducibility, and agreement between three different Scheimpflug systems in measuring corneal and anterior segment biometry.

PURPOSE: To assess the reliability of three different Scheimpflug systems and their agreement. METHODS: Eighty-four eyes of 42 patients were examined with three Scheimpflug devices: the Galilei G2 Dual Scheimpflug Analyzer (Ziemer Ophthalmic Systems AG, Port, Switzerland), Pentacam HR system (Oculus Optikgerate GmbH, Wetzlar, Germany), and Sirius 3D imaging system (Costruzione Strumenti Oftalmici, Florence, Italy). The central corneal thickness, maximum anterior and posterior corneal elevation, anterior radius of curvature, total higher-order aberrations, and anterior chamber depth were evaluated. Repeatability and re-producibility were evaluated using coefficients of variation and intraclass correlation coefficients. Interdevice agreement was assessed by Bland-Altman comparison analysis. RESULTS: The three Scheimpflug systems had excellent repeatability for central corneal thickness, anterior radius of curvature, and anterior chamber depth (coefficients of variation being less than 1%). Repeatability for anterior and posterior corneal evaluation was good for the Pentacam HR and Galilei G2 (coefficients of variation < 10%) and excellent for the Sirius 3D (coefficients of variation = 0). Reproducibility was excellent in the three devices, (intraclass correlation coefficient of more than 0.9). Interdevice agreement was excellent (P > .05) for anterior radius of curvature, central corneal thickness, and anterior chamber depth, but was poor (P < .05) for corneal elevation and higher-order aberrations. CONCLUSIONS: Reliability was good to excellent in the three devices for all measured variables. Interdevice agreement analysis suggests that measurements for anterior radius of curvature, central corneal thickness, and anterior chamber depth, but not for maximum anterior and posterior corneal elevation and total higher-order aberrations, from the Sirius 3D and Galilei G2 can be interchangeable with the Pentacam HR.

TGFBI, CHST6, and GSN gene analysis in Mexican patients with stromal corneal dystrophies.

OBJECTIVES: The purpose of our study was to describe the results of molecular screening of TGFBI, CHST6, and GSN genes in a group of Mexican patients with different stromal corneal dystrophies (CD). MATERIAL AND METHODS: A total of 16 CD Mexican patients pertaining to nine different pedigrees were subjected to a complete ophthalmological investigation. A clinical diagnosis of lattice CD was performed in 10 patients from five pedigrees. Three patients from two pedigrees were diagnosed with granular CD type 2, two patients with unrelated probands had Finnish-type corneal amyloidosis, and one patient had macular CD. Genetic analysis included DNA isolation from blood leukocytes and polymerase chain reaction (PCR) amplification and direct nucleotide sequencing of TGFBI, CHST6, and GSN genes. RESULTS: Seven lattice CD patients from four unrelated families had an identical p.H626R mutation in TGFBI, three patients from a single lattice CD family carried a p.R124C substitution in TGFBI, and a granular type 2 CD pedigree was demonstrated to carry a heterozygous TGFBI p.M619K substitution. A patient having Finnish-type corneal amyloidosis had a p.D187N mutation in GSN. Finally, molecular analysis of CHST6 in a patient with macular CD disclosed the presence of a homozygous p.Y110C change. CONCLUSIONS: This study improves the knowledge of the genetic features of Mexican patients with corneal stromal dystrophies by identifying mutations in the TGFBI, CHST6, and GSN genes. Genetic screening of larger samples of patients from distinct ethnic groups would be of great importance for a better understanding of the mutational spectrum of stromal CD.

Long-term refractive outcomes of posterior chamber phakic (spheric and toric implantable collamer lens) intraocular lens implantation.

To report the long-term refractive outcomes, safety, predictability, efficacy and complications of 349 eyes treated with posterior chamber phakic intraocular lenses (pIOLs). A retrospective review of consecutive clinical cases of patients who underwent spheric implantable collamer lens (ICL) and toric ICL (TICL) implantation. The study included 349 eyes of 216 patients with sphere between +8 to -24 diopters (D) and 0 to -6.5 D of astigmatism. Statistical analysis was performed to identify differences between preoperative and postoperative refractive outcomes. Main outcome measures were preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), spherical and cylindrical errors and spherical equivalent and significant postoperative complications. 194 eyes were treated with TICL and 155 eyes with ICL. The mean age of the patients was 29 ± 6.7 years. The mean preoperative sphere was -10.35 ± 5.1 D (+8 to -24) and the postoperative sphere was -0.09 ± 1.06 D (+3.25 to -6.5), p < 0.001. Preoperative cylinder was -2.63 ± 1.44 (0 to -6.5 D) and postoperative cylinder was -0.97 ± 0.89 D (0 to -3.5), p < 0.001. The preoperative mean spherical equivalent was -11.6 ± 5.12 D (+7.875 to -25.625) and postoperative spherical equivalent was -0.52 ± 1.03 (+2.25 to -6.75), p < 0.001. The mean preoperative UDVA was 1.72 ± 0.49 and postoperative UDVA was 0.23 ± 0.22, p < 0.001. The mean preoperative CDVA was 0.21 ± 0.17 and postoperative CDVA was 0.12 ± 0.138, p < 0.001. The implantation of posterior chamber pIOLs is a safe, predictable and effective strategy to manage refractive errors during long-term follow-up.

Neurotrophic keratopathy: General features and new therapies.

Neurotrophic keratopathy is an uncommon degenerative corneal disorder characterized by compromised corneal sensory innervation resulting in the formation of epithelial defects and nonhealing corneal ulcers. Various treatment modalities are available to stabilize disease progression, improve patient well-being, and prevent vision loss. For eligible patients, medical and surgical reinnervation have emerged as pioneering therapies, holding promise for better management. We present a comprehensive review of the disorder, providing an update relevant to ophthalmologists on pathogenesis, diagnosis, treatment options, and novel therapies targeting pathophysiological pathways.

Comparison of posterior corneal imaging before and after LASIK using dual rotating scheimpflug and scanning slit-beam corneal tomography systems.

PURPOSE: To compare the maximum posterior elevation (MPE) measurements before and after LASIK using a dual rotating Scheimpflug (DRS) imaging system (Galilei, Ziemer Ophthalmic Systems, Port, Switzerland) and a scanning slit-beam (SSB) imaging system (Orbscan IIz, Bausch & Lomb, Rochester, NY). METHODS: This retrospective study included 78 eyes from 78 patients who underwent myopic LASIK. Preoperative and postoperative data collected included anterior and posterior best-fit sphere radius and axial curvature readings, posterior central elevation (PCE), and MPE relative to a best-fit sphere using a 7.8-mm region of interest. Data were compared using paired t test analysis. RESULTS: Mean preoperative PCE (5.06 ± 2.29 µm with the DRS system and 12.78 ± 6.90 µm with the SSB system) and MPE (4.87 ± 4 µm with the DRS system and 15.44 ± 9.78 µm with the SSB system) were statistically different (P < .001). Mean postoperative PCE (4.55 ± 2.34 µm with the DRS system and 20.59 ± 8.11 µm with the SSB system) and MPE (4.90 ± 3.35 µm with the DRS system and 24.95 ± 10.15 µm with the SSB system) were statistically different (P < .001). The difference between preoperative and postoperative MPE measurements by DRS was not statistically significant (P = .953), whereas the difference measured by SSB was statistically significant (P < .001). CONCLUSIONS: The consistency of DRS measurements suggests that the posterior surface of the cornea does not change appreciably after keratorefractive surgery and is imaged more accurately using DRS compared with SSB. The DRS system affords confidence in interpreting data that are useful for discerning morphologic abnormalities of the cornea, both before and after keratorefractive surgery.

Clinical and microbiological profile of infectious keratitis in children.

BACKGROUND: Infectious keratitis is a sight-threatening condition for children. The purpose of this study was to describe the clinical profile, risk factors and microbiological profile of infectious keratitis in children. METHODS: Retrospective review of clinical records of patients under 16 years of age with history of microbial keratitis seen at a tertiary referral center. Clinical characteristics, risk factors, visual and surgical outcomes as well as the microbiological profile are analyzed. RESULTS: Forty-one eyes of 41 patients. Mean age was 8.7 years. Time between the onset of symptoms and ophthalmological examination was 12.7 days. Predisposing factors were found in 78%; ocular trauma was the most common (25%). Visual acuity equal or worse than 20/200 at admission correlated positively with a poorer visual outcome, p=0.002. Positivity of cultures was 34%. Gram-positive bacteria were isolated in 78.5%; Staphylococcus epidermidis (28.6%) was the most common microorganism. CONCLUSIONS: Our study emphasizes the importance of a prompt diagnosis and treatment of infectious corneal ulcers in children. Trauma and contact lenses were the main predisposing factors. Gram-positive organisms were isolated in the vast majority of cases and visual outcomes are usually poor.

Comparison of mini-simple limbal epithelial transplantation and conjunctival-limbal autograft for the treatment of primary pterygium: a randomised controlled trial.

PURPOSE: The purpose of this double-masked, parallel randomised controlled trial was to compare the recurrence rate and other outcomes between conjunctival-limbal autograft (CLAu) and mini-simple limbal epithelial transplantation (mini-SLET) after excision of pterygium. METHODS: Eligibility criteria for participants was the presence of a primary nasal pterygium extending equally to or greater than two millimetres on the cornea on its horizontal axis from the nasal limbus. The participants were allocated into two groups (CLAu and mini-SLET) using simple randomisation with a table of random numbers. Participants and the outcome assessor were masked to the intervention. The study protocol is listed and available on https://clinicaltrials.gov (Identifier: NCT03363282). RESULTS: A total of 61 eyes were enrolled in the study, 33 underwent CLAu (group 1) and 28 mini-SLET (group 2), all eyes were analysed in each group. At 2, 3, 6 and 12 months the CLAu group exhibited a recurrence of 0%, 6.1%, 8.1% and 8.1%, while the mini-SLET exhibited a recurrence of 0%, 17.9%, 50% and 53.5% (p<0.05). There were no intraoperative or postoperative complications in either of the two groups. CONCLUSION: The findings of this study suggest that mini-SLET has a higher recurrence rate and provides no advantage over CLAu in the treatment of primary pterygium.

Use of Amniotic Membrane Transplant and Deep Anterior Keratoplasty in a Patient with Bilateral Acanthamoeba Infectious Keratitis: A Case Report.

The aim of this study was to report a case with the use of amniotic membrane transplant and deep anterior keratoplasty in a patient with bilateral Acanthamoeba infectious keratitis as a treatment. A 20-year-old male presented with bilateral Acanthamoeba keratitis (AK) who was initially diagnosed with herpetic keratitis receiving full antiviral and corticosteroid topical treatment without any improvement. Corneal biopsy was performed to confirm the suspected diagnosis, and Acanthamoeba stromal cysts were identified in the sample. Treatment was initiated with 0.02% chlorhexidine, 0.1% propamidine isethionate, neomycin, and tropicamide/phenylephrine. Symptoms and clinical improvement were achieved between the 8th and 10th weeks, so corticosteroids were initiated. Treatment was continued until we observed a poor response in the left eye; therefore, an epithelial scraping and amniotic membrane placement were performed. Lately, the right eye underwent a deep anterior lamellar keratoplasty. A challenging case of bilateral AK managed with topical medications, amniotic membrane, and corneal keratoplasty. The earlier the disease is diagnosed, the better the outcome. If the diagnosis is delayed, the amoebas have penetrated deep into the corneal stroma, and successful therapy becomes difficult. A surgical option can be an early solution with a good prognosis for these cases.

Cogan syndrome: a case report and review of the literature.

Cogan syndrome is a rare disease whose etiology is still undetermined. It typically affects men and women between the second and fourth decade of life. We report a case of Cogan syndrome with ocular and audio-vestibular involvement as a systemic manifestation in a 31-year-old woman.

Delayed-onset pressure-induced interlamellar stromal keratitis (PISK) and interface epithelial ingrowth 10 years after laser-assisted in situ keratomileusis.

Purpose: To report a case of pressure-induced interlamellar stromal keratitis (PISK) 10 years after laser assisted in situ keratomileusis (LASIK). Observations: A case of a 36-year-old man who underwent LASIK and presented with PISK 10 years later. Before presenting to our department he consulted elsewhere for red eye, decreased visual acuity, foreign body sensation, and pain on the RE for 1 week. He was then prescribed topical prednisolone six times per day and was lost to follow-up. On examination and after 1 month of continuous use of steroids uncorrected distance visual acuity (UCDV) was 20/400 in the right eye (RE) and 20/20 in the left eye (LE). Best corrected visual acuity was 20/80 on the RE. The Goldmann intraocular pressure (IOP) was 26 and 17 mmHg in the RE and LE, respectively. Slit lamp biomicroscopy revealed fluid in the interface and epithelial ingrowth. Fundoscopic examination results were normal in both eyes. Treatment was initiated with topical brimonidine tartrate 0.2%, timolol 0.5%, and dorzolamide 2.0% BID. Once the pressure was controlled the patient was scheduled for mechanical debridement of the epithelial ingrowth with significant improvement of UCVA (20/25). Conclusions: Refractive surgeons should be aware of PISK as a potential complication of LASIK even years after the procedure. Intraocular pressure can be misleading, and diligent and careful examination are key to diagnosis and treatment of this potentially blinding complication.

Importance and use of corneal biomechanics and its diagnostic utility.

The study of corneal biomechanics has become relevant in recent years due to its possible applications in the diagnosis, management, and treatment of various diseases such as glaucoma, keratorefractive surgery and different corneal diseases. The clinical biomechanical investigation has become of great importance in the setting of refractive surgery to identify patients at higher risk of developing iatrogenic ectasia. This review focuses on two of the technologies available for clinical use, the Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, NY, USA) and the Corvis ST (Oculus Optikgergäte GmbH, Wetzlar, Germany). Both are non-contact tonometers that provided a clinical evaluation of corneal biomechanics. The fundamentals and main parameters of each device are described, as well as their use in eye surgery and the corneal biomechanical behavior in eye diseases. Finally, we will discuss the more recent Brillouin microscopy biomechanical analysis, and the integration Scheimpflug-based corneal tomography and biomechanical data with artificial intelligence to increase accuracy to detect risk of ectasia.

El estudio de la biomecánica corneal ha cobrado relevancia en los últimos años debido a sus posibles aplicaciones en el diagnóstico, el manejo y el tratamiento de diversas enfermedades, como glaucoma, cirugía queratorrefractiva y diferentes enfermedades corneales. La investigación de la biomecánica corneal es de mucha importancia en el contexto de cirugía refractiva, pues podría identificar pacientes en riesgo de desarrollar una ectasia corneal iatrogénica. Esta revisión se centra en dos de las tecnologías disponibles para uso clínico: el Ocular Response Analyzer (Reichert Ophthalmic Instruments, Buffalo, NY, EE. UU.) y el Corvis ST (Oculus Optikgergäte GmbH, Wetzlar, Alemania). Ambos son tonómetros de no contacto que proporcionan una evaluación clínica de la biomecánica corneal. Se describen los fundamentos y los principales parámetros de cada dispositivo, así como su uso en cirugía ocular y el comportamiento biomecánico corneal en las enfermedades oculares. Finalmente, se mencionan los dispositivos más recientes de análisis biomecánico, como la microscopía de Brillouin, así como la integración de los datos biomecánicos y topográficos basados en Scheimpflug con la inteligencia artificial para aumentar la precisión en la detección del riesgo de ectasias.

Adjuvant Topical Interferon Alpha 2b for the Treatment of Monkeypox Ocular Manifestations.

PURPOSE: The aim of this study was to report a case of ocular Mpox that responded favorably to treatment with topical interferon and oral doxycycline. METHODS: This is a case report of a previously healthy 24-year-old woman who developed a pustular rash, headache, fever, arthralgia, sore throat, and asthenia 3 weeks before attending to our clinic. Her main complaint at the moment of the visit was pain, photophobia, foreign body sensation, blurred vision, red eye, and discharge on the left eye. The slit-lamp examination of the left eye showed severe conjunctival hyperemia associated with tarsal follicles, 360 degrees ciliary injection, diffuse corneal epithelial edema with white linear epithelial infiltrates, pigmented and nonpigmented keratic precipitates, and two 1-mm peripheral corneal ulcers with white infiltrates, associated with positive fluorescein staining. Anterior chamber cellularity and flare were mildly present. RESULTS: Mpox with ocular manifestations diagnosis was confirmed by real-time quantitative reverse transcription polymerase chain reaction assay (qRT-PCR) testing; samples were taken from corneal, conjunctival, and nasopharynx swab as well as a skin scab. Topical interferon alpha 2b 1 MIU/mL every 6 hours for 1 month and oral doxycycline 100 mg BID were administered along with other medications with consequent decrease of inflammation and malaise symptoms 1 week later, associated with uncorrected visual acuity improvement. CONCLUSIONS: Alternative and efficacious treatment options for Mpox ocular manifestations are needed to prevent further disease progression and sequelae in countries with no access to the gold-standard therapy. Topical interferon alpha 2b and oral doxycycline have shown adequate response as shown with this patient.

Implantable collamer lenses after intracorneal ring segments for keratoconus.

To report the clinical characteristics and visual outcomes of patients with keratoconus treated with posterior chamber phakic intraocular lenses after implantation of intracorneal ring segments (ICRS). This retrospective study included 11 eyes of eight patients diagnosed with keratoconus treated with ICRS and posterior chamber phakic intraocular lenses. The preoperative and postoperative uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), preoperative and postoperative keratometric data, manifest refraction and spherical equivalent were recorded. No complications were observed. At 38.18 ± 18.7 months of follow-up, the mean spherical error was -0.06 ± 0.46 D (+0.75 to -0.75 D) and cylindrical error of -1.22 ± 0.65 D (-0.25 to -1.5 D). The preoperative spherical equivalent was -10.52 ± 5.88 D (-3.12 to -22.75 D) and the postoperative spherical equivalent was -0.68 ± 0.45 D (0 to -1.25 D), p < 0.001. The preoperative and postoperative UDVA were 1.31 ± 0.37 logMAR (mean 20/400 Snellen, 0.69-1.77 logMAR) and 0.14 ± 0.04 (mean 20/30 Snellen, 0.09-0.47 logMAR), with a p value <0.001. The preoperative and postoperative CDVA were 0.289 ± 0.14 logMAR (mean 20/40 Snellen, 0-0.477 logMAR) and 0.16 ± 0.08 (mean 20/25 Snellen, 0.09-0.39 logMAR), with a p value of 0.007. Combined treatment of keratoconus with ICRS and posterior chamber phakic intraocular lenses was a safe and effective procedure for high refractive errors induced by keratoconus in these selected patients.

Optical coherence tomography findings of cyanoacrylate glue patch in corneal perforations.

Purpose: To report a cases series of corneal perforations treated with cyanoacrylate glue patch (CGP) assessed with optical coherence tomography for monitoring corneal status in long-term follow-up examinations. Observations: CPG was successfully used as primary treatment in three cases of corneal perforations. Spontaneous loosening or dislodging of the CPG did not occur in the follow-up. Anterior segment optical coherence tomography (AS-OCT) was performed to monitor wound healing at the site of perforation before considering the CGP removal. The presence of normal epithelium layer beneath the glue patch and stromal regeneration tissue were confirmed by AS-OCT, and glue patch was safely removed. Conclusions and importance: The area of healing tissue beneath the CGP may not be easy to evaluate using the slit-lamp microscopy alone. AS-OCT is a useful tool in the assessment of corneal healing tissue in the presence of cyanoacrylate glue patch.

Safety and efficacy of pilocarpine, cevimeline, and diquafosol compared to artificial tears for the treatment of dry eye: protocol for a systematic review.

BACKGROUND: Dry eye disease (DED) is a condition that compromises the ocular surface and affects millions of people around the world. In recent years, a scheme has been proposed for the treatment of DED, with the use of artificial tear being the mainstay of treatment. In this scheme, the use of secretagogues is suggested as part of the treatment for patients with moderate to severe affectation. With this systematic review, we aim to evaluate the effectiveness and safety of secretagogues for DED. METHODS: Electronic databases will be searched; we will include randomized controlled trials that compare secretagogues and artificial tears. Study inclusion will not be restricted on the basis of language or publication status. We will use Google Translate to assess studies written in languages other than English and Spanish. Identification, evaluation, data extraction, and assessment of risk of bias will be conducted by two authors of the review, a third review author will resolve any disagreement. The outcomes will be the ocular surface disease index score, tear film break-up time, Schirmer test score, VRQoL Score, and tear film osmolarity. We will use the Cochrane Collaboration Risk of Bias 2 (RoB 2) tool for assessing the risk of bias of the included studies. Based on the heterogeneity of the included studies, we will combine the findings in a meta-analysis using a fixed effect model if heterogeneity ≤ 50% or a random effect model if heterogeneity > 50%. If we deem meta-analysis as inappropriate, we will document the reasons and report findings from the individual studies narratively. DISCUSSION: Based on the evidence obtained, we will evaluate the effect of pilocarpine, cevimeline, and diquafosol and compare it to artificial tears on multiple outcome measures. This systematic review aims to determine the efficacy and safety of the secretagogues pilocarpine, cevimeline, and diquafosol to help clinicians in the decision-making process. TRIAL REGISTRATION: PROSPERO CRD42020218407 .