Five-year results of a prospective, randomised, contralateral eye trial of corneal crosslinking for keratoconus.

BACKGROUND: Few studies have evaluated corneal crosslinking (CXL) in a prospective, randomised fashion. This study aimed to determine the efficacy and safety of CXL to reduce the progression of keratoconus. METHODS: Prospective, unmasked, randomised, contralateral eye controlled trial at a tertiary eye centre. PARTICIPANTS: Individuals with bilateral progressive keratoconus. One eye from each subject was randomised to CXL and the contralateral, untreated eye acted as the control. PRIMARY OUTCOME MEASURE: change in maximum keratometry. SECONDARY OUTCOME MEASURES: uncorrected distance visual acuity, spectacle corrected distance visual acuity, spherical equivalent refraction, simulated keratometry, corneal astigmatism, minimum pachymetry and complications. RESULTS: Thirty-eight individuals (mean age 21.1 ± 6.7 years) were enrolled with one eye treated with CXL. At 5 years, there was a mean decrease in maximum keratometry of treated eyes (-1.45 ± 2.25 D) compared to an increase among the controls (1.71 ± 2.46 D; p < 0.001). There were significant differences between the treated and control groups in the mean change of Steep SimK (-1.07 ± 1.22 vs. 0.96 ± 1.97 D; p < 0.001), Flat SimK (-0.61 ± 1.34 vs. 0.43 ± 1.12 D; p < 0.001), corneal astigmatism (-0.45 ± 1.31 vs. 0.63 ± 1.52 D; p < 0.01) and minimum pachymetry (-32.49 ± 26.32 vs. -13.57 ± 24.11 µm; p < 0.01). Complications included sterile infiltrates (n = 2), microbial keratitis (n = 1), persistent corneal haze/scarring at 5 years (n = 4) and loss of ≥2 lines of corrected distance visual acuity (n = 3). CONCLUSIONS: CXL is an effective and relatively safe intervention to halt or reduce the progression of keratoconus in the majority of eyes for at least 5 years.

Rubeola keratitis emergence during a recent measles outbreak in New Zealand.

INTRODUCTION Measles is a highly contagious disease caused by the rubeola virus. It can result in ocular complications such as conjunctivitis and keratitis, which will be encountered in general practice. Cases usually resolve without sequelae, but may progress to corneal perforation if left untreated. AIM We present two cases of rubeola keratitis secondary to measles infection. METHODS This report is about a retrospective review of data from two patients who presented to the eye department with rubeola keratitis in the midst of the recent measles outbreak in New Zealand. RESULTS Both patients presented with decreased visual acuity approximately 2 weeks after being diagnosed with measles. One of them was unvaccinated, whereas the other had no documentation of previous vaccination. Both were healthy and immunocompetent individuals. There was no evidence of corneal perforation or retinopathy on examination. Both patients regained their baseline visual acuity after treatment with fluorometholone eye drops. DISCUSSION Despite the existence of a safe and effective vaccine, there were more than 2000 cases of measles in the recent outbreak in New Zealand. The lack of vaccination is one of the primary causes of rubeola keratitis. These cases highlight the effects of measles infection from an ophthalmology perspective and reinforce the paramount importance of getting vaccinated.

Retrobulbar hemorrhage after sub-Tenon's anesthesia.

We present a case of retrobulbar hemorrhage complicating sub-Tenon's anesthesia in a patient receiving oral anticoagulants. To our knowledge, this has been described only once in the literature.