Accelerated Corneal Collagen Cross-Linking Protocols for Progressive Keratoconus: Systematic Review and Meta-analysis.

PURPOSE: The aim of this study was to compare the outcomes of 18 mW/cm 2 (5 minutes) versus 9 mW/cm 2 (10 minutes) accelerated corneal collagen cross-linking protocols in patients with progressive keratoconus. METHODS: A systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, and electronic information was searched to identify studies comparing the outcomes of 5- versus 10-minute protocols in patients with progressive keratoconus. Mean changes in uncorrected visual acuity, best-corrected visual acuity, cylinder (diopters), thinnest corneal thickness, corneal keratometry values (K1 and K2), corneal high-order aberration (HOA), spherical aberration, coma, and trefoil were the primary outcome measures. Secondary outcome measures included the mean change in central corneal thickness and postoperative complications. Random effects modeling was used for the analysis. RESULTS: Four studies that enrolled 329 eyes were included. The 10-minute protocol had significantly improved outcomes compared with the 5-minute protocol for the mean changes in K1 and K2 ( P < 0.00001), corneal total HOA ( P = 0.0002), and corneal coma ( P = 0.00001). However, no statistically significant differences were found between the 2 protocols in uncorrected visual acuity, best-corrected visual acuity, cylinder, thinnest corneal thickness, spherical aberration, or trefoil. The 5-minute protocol was associated with a significantly lower mean change in the central corneal thickness for secondary outcomes. In addition, no significant differences were found between the 2 protocols for postoperative complications. CONCLUSIONS: The 10-minute protocol had better K1, K2, and HOA outcomes than the 5-minute protocol, but no statistically significant differences in the other outcomes.

Intermediate-term Visual Outcomes and Complications of Type 1 Boston Keratoprosthesis With and Without Glaucoma Surgery.

PURPOSE: Glaucoma is a cause of comorbidity in patients receiving the Boston keratoprosthesis (KPro). The aim of this study was to report the outcomes of the Boston KPro with or without glaucoma surgery. METHODS: This was a retrospective single-center cohort study. Patients who underwent Boston KPro from March 2009 to February 2019 were included. One eye per patient (the first surgery) was included in this study. Patients were classified into 2 groups: KPro only (group 1) and KPro with any form of glaucoma procedure (group 2). Main outcome measures were Best-corrected visual acuity (BCVA), functional success (BCVA 20/200 or better), anatomical success (retention of KPro at the last follow-up), and complications. RESULTS: Seventy-one eyes were included: 27 eyes (38%) in group 1 and 44 (62%) in group 2. There was no statistically significant difference in BCVA between groups 1 and 2 at each time point. Of the eyes in group 1, 11% lost light perception vision and 4.5% in group 2 ( P = 0.293). There was no difference in anatomical success with 70% in group 1 and 77% in group 2 ( P = 0.703) at the last follow-up, with a median failure time of 18 months. The functional success was 48% for group 1 and 50% for group 2 ( P = 0.541). CONCLUSIONS: Eyes undergoing KPro with glaucoma surgery before or at the same time carry a similar functional and anatomical success to eyes without glaucoma surgery.

Aqueous penetration of topical tacrolimus.

PURPOSE: To evaluate the penetration of topical tacrolimus 0.05% into the aqueous humor. OBSERVATIONS: A total of four patients scheduled for routine cataract surgery were included prospectively. We excluded patients with corneal pathology or ocular surface diseases. Topical tacrolimus 0.05% was compounded at our facility. It was dosed every 1 min for 5 min an hour before the aqueous was sampled. Aqueous samples were collected at the time of cataract surgery and were subjected to detection of presence and level of tacrolimus. There were 2 male and 2 female patients. The age range was 58-73 years with a mean age of 66 years. Tacrolimus was detected in the aqueous humor in all patients. The concentration of tacrolimus in the aqueous ranged from 2.6 to 5.6 ng/ml (mean 4.15 ± 1.18 ng/ml). In all patients, the aqueous tacrolimus concentration was greater than the minimal therapeutic level. The study was registered at clinicaltrials.gov (registration number is NCT02794610). CONCLUSIONS AND IMPORTANCE: Tacrolimus was detected in the aqueous humor following topical application. Topical tacrolimus may be a promising steroid-sparing modality for the treatment of anterior uveitis.

Sutureless superficial anterior lamellar keratoplasty for recurrent corneal haze after repeat excimer laser surface ablation.

BACKGROUND/AIMS: To evaluate the 5-year outcomes of sutureless superficial anterior lamellar keratoplasty (SALK) in the treatment of surface ablation-related corneal haze recurring after phototherapeutic keratectomy (PTK). METHODS: Prospective interventional study at a tertiary referral centre in Forli, Italy. Ten consecutive eyes with corneal haze following photorefractive keratectomy, recurring after treatment with PTK with or without mitomycin C, undergoing sutureless SALK. Sutureless SALK was performed using a microkeratome in donor and recipient. MAIN OUTCOME MEASURES: best spectacle-corrected visual acuity (BSCVA), surgically induced astigmatism (SIA), rate of recurrence and complications. RESULTS: There were no intraoperative complications and there was no recurrence of haze in any eye postoperatively. BSCVA showed significant improvement at all postoperative time points. Mean preoperative visual acuity improved from 0.46 logMAR units (SD=0.12) to 0.12 (SD=0.12, p=0.0001) at 5 years. At 6 months, SIA was 2.50±1.04 with no further significant change at 5 years (2.53±1.39, p=0.95). There was no significant change in mean spherical equivalent and no significant difference between preoperative and postoperative astigmatism vector values at 5 years. CONCLUSIONS: Sutureless SALK provides a useful treatment option in patients with recurrent haze after excimer laser treatment. It can eliminate haze recurrence for at least a period of 5 years and can improve BSCVA, although there may be significant SIA.

Incidence of Endophthalmitis after Intravitreal Bevacizumab using Aliquots Prepared On-site in 2 Operating Rooms in Kuwait.

PURPOSE: To report the incidence of endophthalmitis after intravitreal injection of bevacizumab and the outcomes of treatment of endophthalmitis at two centers in Kuwait. SUBJECTS AND METHODS: The aliquots of bevacizumab were prepared under aseptic precautions and administered in the operating theater on the same day at both centers. All patients received antibiotic drops after injection of bevacizumab. Data were collected on the number of cases that received intravitreal bevacizumab (IVB) and those that developed endophthalmitis were identified at the two centers. All cases of endophthalmitis received an intravitreal antibiotic injection and additional treatments as warranted. Data were collected on the outcomes of endophthalmitis treatment. RESULTS: There were 5 cases of endophthalmitis among a total of 5429 injections (0.09%: Confidence interval: 0.084-0.1). The incidence was 3 cases among 4690 (0.06%) and 2 cases among 739 injections (0.027%) at each center, respectively (P = 0.08). Four cases of endophthalmitis were culture-positive and organisms isolated were, coagulase negative Staphylococcus in 2 cases, Staphylococcus lugdunensis and Streptococcus pneumoniae in 1 case each. The final visual acuity was better than pre-IVB in 3 cases, same as pre-IVB in 1 case and worse in 1 case with streptococcal infection. No eyes developed phthisis bulbi or required enucleation. CONCLUSIONS: The incidence of endophthalmitis after intravitreal injection of bevacizumab using aliquots prepared in the operating room is comparable to other studies. There were no clusters of endophthalmitis cases.