Effect of autologous serum after amniotic membrane transplantation for persistent corneal ulcers.

AIM: To investigate the effect of adding autologous serum eye drops to the postoperative regime after amniotic membrane transplantation for severe persistent corneal ulcers. METHODS: Forty eyes of 40 patients with persistent corneal ulcers were randomly assigned to artificial tears (sodium hyaluronate 0.2%, ATs group, n=20) or autologous serum eye drops (ASEDs, n=20) following treatment with amniotic membrane transplantation. Digital slit lamp images were acquired from all patients before and 30d post treatment. The area with fibrovascular tissue was calculated using Image J. Central corneal sensitivity was assessed by Cochet-Bonnet aesthesiometry before and one month after treatment. Scar tissue transparency was assessed with a novel optical densitometry. RESULTS: Mean age of patients was 61.65±16.47y and 57.3±19.11y in the ATs group and ASEDs group, respectively. Twenty-two male and 18 female patients were included in the study. The improvement in visual acuity was significantly greater in the ASEDs group (0.14±0.04) than the ATs (0.08±0.04; P=0.00046). Cochet-Bonnet aesthesiometry improved significantly after treatment with a similar rate between groups. There were no statistically significant differences in the area of postoperative fibrovascular tissue between the two groups (P=0.082). The success rate in the two groups was similar. The difference in densitometry between the ATs and ASEDs group was statistically significant (P=0.042) with greater reduction from baseline in the ASEDS group. CONCLUSION: Autologous serum eye drops can lead to better visual acuity, more stable results and improved densitometry and should be considered in the postoperative care following amniotic membrane transplantation.

Retropupillary Iris-fixated versus Sutured Scleral-fixated Intraocular Lenses.

Aim: To compare the anatomical and functional results and patient satisfaction following retropupillary implantation of Artisan Aphakia iris-fixated intraocular lens (rAAIF) and sutured scleral fixated intraocular lens (SFIOL). Subjects and methods: We presented a prospective double-arm non-blinded study. Forty-one eyes with acquired aphakia, no age-related macular degeneration, no previous keratoplasty, no combined procedures, no AC reaction (cells, fibrin), normal intraocular pressure, no history of endothelial corneal dystrophy in relatives or fellow eye were included. Indications, complications, corrected distance visual acuity (CDVA), endothelial cell density (ECD), and patient satisfaction score were assessed. Results: Retropupillary AAIF was implanted in 21 (51.22%) eyes and SFIOL in 20 (48.78%) eyes. The most common indication was complicated cataract surgery in 18 cases (43.90%), followed by trauma in 16 (39.02%), and spontaneous dislocation in 7 (17.07%). No difference between rAAIF and SFIOL in terms of sex, laterality (χ=0.13, p=0.72), indications (χ=0.78, p=0.68), previous ocular history, and comorbidities was observed. The complications and the visual outcomes at 6 months postoperatively were similar between the two groups (p=0.95 and p=0.321, respectively). The ECD loss in the two groups was also similar (p=0.89). The patient satisfaction score was 58.67±8.80 in the rAAIF and 56.69±11.50 in the SFIOL group, which was statistically similar (p=0.764). Conclusion: Retropupillary AAIF and SFIOL showed similar results concerning visual acuity, endothelial cell loss, and patient satisfaction. Careful preoperative individual assessment is required to have optimal results with either technique. Abbreviations: AAIF = Artisan Aphakia iris-fixated intraocular lens, rAAIF = retropupillary Artisan Aphakia iris-fixated intraocular lens, CDVA = corrected distance visual acuity, ECD = endothelial cell density, IOL = intraocular lens, SD = standard deviation, SFIOL = scleral fixated intraocular lens.

Finegoldia magna and Mucorales molds co-infection in a severe case of SARS-CoV-2 disease.

INTRODUCTION: Rhino-orbito-cerebral mucormycosis has been reported as a sequela after coronavirus disease in immunocompromised patients with poorly controlled diabetes mellitus. Most cases have been identified in India, with only 19 reported elsewhere. METHODOLOGY: We herein report the results of clinical, imaging, microbiological, and histopathological studies in an immunocompetent 67-year-old male with rhino-orbital infection by Finegoldia magna and Mucorales molds following severe SARS-CoV-2 disease associated with new-onset decompensated diabetes mellitus. RESULTS: Microbiological and histological studies confirmed the presence of both Mucorales molds and Finegoldia magna, which was successfully treated with antibiotics and a specific anti-fungal agent (Posaconazole). CONCLUSIONS: Careful multidisciplinary follow-up of patients treated for severe SARS-CoV-2 disease is necessary for the timely diagnosis of complications such as uncontrolled diabetes mellitus and opportunistic infections.

Presbyopia correction with a new Extended Depth of Focus Intraocular Lens.

Extended depth of focus intraocular lenses (EDoF IOLs) offer an expanded number of modalities for simultaneous cataract and presbyopia treatment. The objective of the current study was to assess clinical outcomes with a new mono-EDoF intraocular lens and to analyze the effect of different parameters on postoperative results. The inclusion criteria were defined as uneventful cataract surgery, no history of concomitant ocular disease, implantation of ZOE Primus-HD lens. Parameters from IOL Master 500 were analyzed. The main outcome measures were postoperative uncorrected distance (UDVA) and intermediate (UIVA) visual acuity. The study included 39 eyes of 37 patients (15 males and 22 females) with a mean age of 73.59±7.71. Postoperatively, the UDVA improved to 0.84±0.16 (p<0.001) and UIVA was 0.86±0.14. There was no correlation between K1, K2 and IOL power with both postoperative UDVA and IDVA. Moreover, there was no statistically significant difference between UDVA and UIVA between patients with mean K value over or under 44.0D (p=0.204 and p=0.817, respectively). The results of a multinomial logistic regression analysis for the predictive value of the factors K1, K2 and IOL power demonstrated no statistical significance, except for UIVA with a significant influence of IOL power (p=0.024) in patients with less than 0.9 Snellen visual acuity. The implantation of the new mono-EDoF ZOE Primus-HD lens led to improvement in both UDVA and UIVA. Patients with keratometry values less than 44.0D could still benefit from the mono-EDoF lenses. Further studies including wavefront aberrometry are needed to study the interaction between corneal aberrations and EDoF IOLs. Abbreviations: IOL = Intraocular lens, UDVA = Uncorrected distance visual acuity, UIVA = Uncorrected intermediate visual acuity, D = Diopters, EDoF = Enhanced Depth of Focus, MF IOL = Multifocal intraocular lens, AUC = area under the curve.

Epithelial Flap Corneal Cross-linking.

PURPOSE: To compare standard epithelium-off corneal cross-linking (standard Epi-Off CXL) to corneal cross-linking with an epithelial flap (Epi-Flap CXL). METHODS: Patients who had undergone sequential bilateral CXL for progressive keratoconus were included in this comparative interventional case series. One eye was treated with the Epi-Off CXL technique and the fellow eye with the Epi-Flap CXL technique. Postoperative pain was measured using the Verbal Rating Scale and corneal densitometry using a Scheimpflug camera. Sex, age, corrected distance visual acuity, keratometry, and corneal thickness were also recorded. RESULTS: Twenty-four eyes of 12 patients with keratoconus with a mean age of 27.15 ± 5.15 years were included. The Verbal Rating Scale scores were significantly lower in patients who had Epi-Flap CXL on the first (1.00 [interquartile range (IQR): 0.00 to 1.00] vs 3.00 [IQR: 3.00 to 3.75], P = .01) and third (0.00 [IQR: 0.00 to 1.00] vs 1.00 [IQR: 0.00 to 1.00], P = .01) postoperative day compared to the Epi-Off CXL group. No pain was observed in both groups after the third day. After 12 months, the Epi-Flap CXL group showed significantly less anterior corneal haze (measured as corneal densitometry) compared to the patients treated with Epi-Off CXL (P = .01). Both groups demonstrated stability of keratometry and corneal thickness at 12 months after CXL (P < .01). CONCLUSIONS: Epi-Flap CXL is associated with less postoperative pain and anterior stromal haze in patients undergoing CXL for progressive keratoconus with no loss of efficacy. [J Refract Surg. 2021;37(11):741-745.].

A New Surgical Technique to Deliver Riboflavin Beneath Corneal Epithelium: The Corneal Cross-Linking Epi-Pocket.

PURPOSE: To describe a new technique to deliver riboflavin into the corneal stroma during Corneal Cross-Linking (CXL) without the removal of corneal epithelium. METHODS: Keratoconus patients underwent CXL for progressive keratoconus. Riboflavin was delivered by manually creating an epithelial pocket (CXL Epi-Pocket). Verbal rating scale was recorded postoperatively. Best-corrected visual acuity, keratometric indices, corneal thickness and corneal densitometry were recorded at baseline and at 12-month follow-up. RESULTS: Eighteen eyes of 18 patients were included in the study. At a 12-month follow-up, best-corrected visual acuity, K1, K2 and densitometry values were stable. Maximum keratometry (Kmax) reduced from 55.31 ± 6.21 (SD) to 52.34d ± 4.12d (SD) (P value = 0.032). the thinnest point went from 441 ± 21.18 (SD) to 425.4 ±â€Š19.02 (SD) um (P value = 0.041). The verbal rating scale at 1, 2 and 3 days postoperatively were 1.76 ±â€Š0.19 (SD), 1.02 ±â€Š0.51 (SD) and 0.28 ±â€Š0.14 (SD). CONCLUSIONS: CXL Epi-Pocket is able to deliver riboflavin to halt the progression of keratoconus at a 12-month follow-up.

Influence of Corneal Visualization Scheimpflug Technology Tonometry on Intraocular Pressure.

Purpose: To investigate the effect of Corneal Visualization Scheimpflug Technology tonometry (CST) on intraocular pressure (IOP). Design: Cohort study. Participants: Patients with and without primary open-angle glaucoma (POAG) were included. Methods: Intraocular pressure was measured using the Icare rebound tonometer (ICRT; Icare Finland Oy) and the biomechanically corrected IOP (bIOP) using the CST. Intraocular pressure was measured at baseline with ICRT, followed by a CST measurement in one eye with the fellow eye acting as a control. Icare measurements were repeated at 10 seconds and 1, 2, 4, 8, 15, 30, and 60 minutes in both eyes. The ratio of test eye IOP to fellow eye IOP was used to control for intrasubject variation. Main Outcome Measures: Intraocular pressure change following Corneal Visualization Scheimflug Technology tonometry. Results: Forty participants (mean age, 54.09 ± 20.08 years) were included comprising 20 patients with POAG and 20 patients with no ocular abnormalities other than cataract. Mean central corneal thickness was similar in those without POAG (547.4 ± 55.05 µm) and with POAG (520.22 ± 37.59 µm; P = 0.14). No significant change was found in IOP measured with the ICRT in the fellow eye versus the 1-hour period in either the healthy (P = 0.87) or POAG (P = 0.92) group. Significant changes were found in IOP after CST measurement for both healthy (P < 0.01) and glaucomatous (P < 0.01) eyes. After the CST measurement, the IOP reduced continuously from a mean of 13.75 mmHg to 10.84 mmHg at 4 minutes for healthy eyes and from 13.28 mmHg to 11.11 mmHg at 8 minutes for glaucomatous eyes before approaching (83% for healthy eyes and 92% POAG eyes) the pre-CST measurement at 1 hour. Conclusions: Corneal Visualization Scheimpflug Technology tonometry causes a significant reduction in IOP in both glaucomatous and healthy eyes that lasts for at least 1 hour afterward.