Clinical outcomes of the immediate reapplication of small-incision lenticule extraction without adjusting the surgical parameters after suction loss.

This study was to analyze the clinical outcomes of immediate reapplication of small-incision lenticule extraction (SMILE) without adjusting the surgical parameters after suction loss and to compare the outcomes with contralateral eyes that underwent uneventful SMILE. A total of 74 patients who underwent uneventful SMILE in one eye (Uneventful group) and immediate reapplication of SMILE without adjusting the surgical parameters after suction loss in the contralateral eye (Suction loss group) were included. Suction loss occurred during the posterior lenticule surface cut in 39 eyes (53%) and the cap cut in 35 eyes (47%). Surgical outcomes, including visual acuity, manifest refraction, keratometry, and corneal wavefront aberrations, were evaluated at 6 months postoperatively. The mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalent were - 0.02 ± 0.07, - 0.04 ± 0.04, and - 0.10 ± 0.46 diopters (D), respectively, in the Suction loss group and - 0.02 ± 0.07, - 0.04 ± 0.05, and - 0.19 ± 0.53 D, respectively (P = 0.965, 0.519, and 0.265, respectively), in the Uneventful group. Changes between the preoperative and 6-month postoperative total corneal aberrations, spherical aberrations, and horizontal and vertical coma did not significantly differ between the Suction loss and Uneventful groups. Immediate reapplication of SMILE without adjusting the surgical parameters after suction loss resulted in good surgical outcomes that were comparable with those of uneventful SMILE.

3-month surgical outcomes of Implantable Collamer Lens implantation for myopic regression after laser vision correction surgeries: a retrospective case series.

BACKGROUND: To investigate the surgical outcomes of implantable collamer lens (ICL) implantation in eyes with residual myopia after primary laser vision correction (LVC) surgeries. METHODS: This study included patients who underwent ICL implantation and had a history of LVC surgery, including photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK). Visual acuity and refractive error were assessed pre and 3-months postoperatively and the efficacy and safety indices calculated accordingly. RESULTS: A total of 30 eyes of 17 patients were included in this study. At 3 months, the mean logMAR uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalent were - 0.03 ± 0.11 (include logMAR), - 0.04 ± 0.09 (include logMAR), and - 0.06 ± 0.33 diopters (D), respectively. The 3-month Snellen UDVA was better than 20/20 for 83% of eyes, and 97% of eyes showed an unchanged or improved CDVA after surgery. The mean efficacy and safety indices were 1.11 ± 0.22 and 1.13 ± 0.20, respectively. Further, 93 and 100% of eyes were within ±0.5 and ± 1.0 D of the attempted spherical equivalent refraction, respectively. CONCLUSIONS: ICL implantation in eyes with myopic regression after previous LVC surgery showed safe, effective, and predictable outcomes. TRIAL REGISTRATION: retrospectively registered.

Changes in ocular surface and Meibomian gland after penetrating Keratoplasty.

BACKGROUND: To acquire desirable outcomes of penetrating keratoplasty (PKP), various factors affecting graft survival, visual function, and subjective symptom should be considered. As ocular surface and meibomian gland function are associated with these factors, this study aims to investigate changes of ocular surface and meibomian gland parameters after PKP. METHODS: This retrospective case series study included 24 eyes of 24 patients who underwent penetrating keratoplasty. Examinations on lipid layer thickness (LLT), meiboscore, tear meniscus area (TMA), tear breakup time (TBUT), corneal fluorescein staining (CFS), Schirmer I test (SIT), Ocular Surface Disease Index (OSDI), and meibomian gland functions were performed before and at 1 week, 1 month, 6 months, and 12 months after surgery. RESULTS: Compared to baseline (2.9 ± 0.6 s), TBUTs were longer at 1 week (4.4 ± 0.5 s, P = 0.027) and 6 months (4.4 ± 0.5, P = 0.048) after surgery. CFS values improved from baseline (6.5 ± 1.1) to 6 months (3.5 ± 0.6, P = 0.023) and 12 months (3.3 ± 0.7, P = 0.001) after surgery. Meibum quality value worsened at 1 week and 12 months after surgery and meibomian gland expressibility value worsened at 1 week and 6 months after surgery compared to baseline. OSDI scores improved at 6 and 12 months after surgery. Meiboscore showed no change throughout the follow up period. The patients with high preoperative meiboscore had worse meibomian gland expressibility at 6 and 12 months and meibum quality at 6 months postoperatively compared to their baseline and to those of patients with low preoperative meiboscore. CONCLUSIONS: After penetrating keratoplasty, ocular surface parameters including corneal staining, TBUT, and OSDI significantly improved whereas meibomian gland parameters showed deteriorations, which was marked in patients with high preoperative meiboscore. Thus, perioperative management of MGD is recommended for patients who undergo penetrating keratoplasty, especially in patients with advanced MGD.

Customized Wavefront-Optimized Transepithelial Photorefractive Keratectomy for a Retained Lenticule Fragment After Primary SMILE.

PURPOSE: To describe the surgical outcomes after transepithelial photorefractive keratectomy (PRK) for a case of retained intrastromal lenticule fragment after small incision lenticule extraction (SMILE). METHODS: Transepithelial PRK was performed to minimize corneal irregularity and to correct residual refractive errors in a patient who had undergone failed lenticule extraction, which resulted in a refractive lenticule fragment being retained for 14 months after primary SMILE. RESULTS: At the postoperative 6-month visit, uncorrected distance visual acuity and corrected distance visual acuity improved to 20/20 and 20/20, respectively, and corneal tomography depicted normalization of the corneal surface. Corneal higher order aberrations, including coma, trefoil, and spherical aberration, were markedly reduced. CONCLUSIONS: Transepithelial PRK is a potential option for the management of a retained lenticule fragment after primary SMILE. [J Refract Surg. 2020;36(6):395-399.].

Clinical outcomes of immediate transepithelial photorefractive keratectomy after suction loss during small-incision lenticule extraction.

PURPOSE: To investigate the surgical outcomes of immediate transepithelial photorefractive keratectomy (PRK) after suction loss during small-incision lenticule extraction (SMILE) and compare the outcomes with those of uneventful SMILE. SETTING: Eyereum Eye Clinic, Seoul, South Korea. DESIGN: Retrospective case series. METHODS: This study included 24 eyes of 12 patients who had uneventful SMILE in one eye and immediate transepithelial PRK after the development of suction loss during the lenticule cut in the contralateral eye. Visual acuity assessments, manifest refraction, and measurements of corneal wavefront aberrations were performed preoperatively and 6 months postoperatively. RESULTS: At 6 months, the mean uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalent were -0.04 ± 0.05, -0.09 ± 0.05, and -0.02 ± 0.24 diopter (D), respectively, in the transepithelial PRK group and -0.10 ± 0.07, -0.06 ± 0.07, and -0.04 ± 0.17 D, respectively (P = .036, P = .109, and P = .671, respectively), in the uneventful SMILE group. The 6-month Snellen UDVA was better than 20/20 for 11 (92%) and 12 (100%) of eyes in the transepithelial PRK and uneventful SMILE groups, respectively. All 24 eyes showed unchanged or improved CDVA and a significant increase in the total corneal higher-order aberrations postoperatively. Corneal spherical aberrations exhibited a significant postoperative increase only in the transepithelial PRK group. CONCLUSIONS: Immediate transepithelial PRK after early suction loss during SMILE might be safe and effective, with refractive outcomes that are comparable with those after uneventful SMILE.

Comparing Dry Eye Disease After Small Incision Lenticule Extraction and Laser Subepithelial Keratomileusis.

PURPOSE: To compare dry eye disease parameters between small incision lenticule extraction (SMILE) and laser subepithelial keratomileusis (LASEK). METHODS: This prospective, nonrandomized study included 39 eyes of 39 patients who underwent SMILE (n = 19) and LASEK (n = 20). Dry eye disease parameters included Ocular Surface Disease Index (OSDI), tear breakup time, Schirmer I test (SIT) value, corneal esthesiometry result, tear meniscus area, meibomian gland evaluation result, lipid layer thickness, and blink rate. Evaluations were performed before surgery and at 1 and 6 months after surgery. RESULTS: Compared with the LASEK group, the SMILE group showed lower corneal esthesiometry values at 1 month and higher OSDI scores and lower SIT values at 6 months after surgery. The SMILE group showed significantly higher OSDI scores at 1 and 6 months after surgery than before, but significantly lower OSDI scores at 6 months than at 1 month after surgery. Both groups showed significantly decreased corneal sensitivity at 1 month after surgery, which increased to the preoperative level 6 months after surgery. The change in OSDI scores at 1 month after surgery positively correlated with changes in the total and partial blink rates, whereas the change in corneal sensitivity at 1 month after surgery negatively correlated with the total and partial blink rates. CONCLUSIONS: Both SMILE and LASEK groups showed temporary decreases in corneal sensitivity, which recovered to baseline levels. Although subjective symptoms worsened after SMILE, SIT values improved after LASEK. Compared with SMILE, LASEK yielded better results regarding subjective symptoms, tear production, and corneal sensitivity.

Decentration measurements using Placido corneal tangential curvature topography and Scheimpflug tomography pachymetry difference maps after small-incision lenticule extraction.

PURPOSE: To assess the agreement of decentration measurements between tangential curvature topography and tomography pachymetry difference maps after a small-incision lenticule extraction (SMILE) procedure. SETTING: Yonsei University College of Medicine and Eyereum Eye Clinic, Seoul, South Korea. DESIGN: Retrospective case series. METHODS: Decentrations and pupillary offset (angle κ) were analyzed and compared using two different methods. A difference map of the tangential curvature was generated with a Placido corneal topographer (Keratron Scout) and a pachymetry difference map was generated with a Scheimpflug tomographer (Pentacam) for each eye, using preoperative and 3-month postoperative scans. Decentrations were also compared using a vector difference plot for the two maps. RESULTS: The study comprised 155 eyes (155 patients). The magnitude of decentration was 0.27 mm ± 0.17 (SD) (range 0.02 to 0.88 mm) with the tangential curvature difference maps and 0.26 ± 0.20 mm (range 0.00 to 0.91 mm) with the pachymetry difference maps, showing no significant difference in the arithmetic values of decentration (P = .124). However, the vector difference in pupillary offset between preoperative and postoperative measurements from the pachymetry difference map significantly correlated with the magnitude of vector differences of decentration between the two maps (P = .007). The vector difference plot also showed a wide distribution spread to all 4 quadrants, demonstrating a lack of agreement. CONCLUSIONS: Although there was no significant difference between the scalar magnitude of decentration with the tangential topography difference maps and tomography pachymetry difference maps, the vector differences did not agree and increasing error was present with increasing differences in pupillary offset in the pachymetry difference maps.

Comparison of objective accommodation in phakic and pseudophakic eyes between age groups.

PURPOSE: To compare objective accommodation of phakic and pseudophakic eyes between two different age groups. METHODS: Eighty-three eyes (83 participants aged ≥ 40 years) with a visual acuity of 20/25 or better, and refractive error < spherical - 1.0 diopters (D) and cylindrical 1.0 D, were included. Forty-four patients had undergone phacoemulsification and monofocal intraocular lens implantation and were examined 6 months post-surgery. Participants were divided into groups 1 (pseudophakic, age < 60 years), 2 (pseudophakic, ≥ 60 years), 3 (phakic, < 60 years), and 4 (phakic, ≥ 60 years). Objective accommodation and pupil diameter to 2.0- and 3.0-D stimuli were measured with a binocular open-field autorefractor. RESULTS: The mean objective accommodation was 0.29 ± 0.47 D, 0.01 ± 0.21 D, 1.00 ± 0.88 D, and 0.01 ± 0.13 to a 2.0-D stimulus, and 0.26 ± 0.51 D, - 0.06 ± 0.21 D, 1.42 ± 1.21 D, and - 0.06 ± 0.21 to a 3.0-D stimulus in groups 1, 2, 3, and 4, respectively. For both stimuli, the values in group 1 exceeded those in groups 2 and 4, and were smaller than those in group 3, while the values in group 3 exceeded those in groups 2 and 4. The mean pupillary diameter was - 0.5 ± 0.8 mm, - 0.3 ± 0.8 mm, - 0.6 ± 0.5 mm, and - 0.6 ± 0.9 mm to a 2.0-D stimulus, and - 0.6 ± 0.8 mm, - 0.6 ± 0.8 mm, - 0.9 ± 0.5 mm, and - 1.0 ± 1.1 mm to a 3.0-D stimulus in groups 1, 2, 3, and 4, respectively. There was significant correlation between objective accommodation and changes of pupil size for both stimuli. CONCLUSION: Age seems to play a role in objective accommodation among relatively young pseudophakic patients.

Preloaded and non-preloaded intraocular lens delivery system and characteristics: human and porcine eyes trial.

AIM: To compare characteristics of preloaded and non-preloaded intraocular lens (IOL) delivery systems during IOL delivery procedures. METHODS: Total 101 human eyes were included in this prospective observational case series. Delivery characteristics of 5 types of IOLs including iSert250 NC60 (NC60), EnVista MX60 (MX60), AcrySof IQ SN60WF (SN60WF), TECNIS ZCB00 (ZCB00), and TECNIS PCB00 (PCB00) were investigated. NC60 and PCB00 were injected via preloaded delivery systems and other IOLs were injected via non-preloaded systems. In the human trial, time taken from IOL loading to completion of implantation was measured in all eyes undergoing conventional cataract surgery. Using 4 excised porcine eyes, dynamics of ophthalmic viscosurgical device (OVD) between an IOL injector and a porcine eye was analyzed using fluorescein sodium-stained OVD. RESULTS: The average time for IOL implantation was 22.0s for NC60, 43.2s for MX60, 32.3s for SN60WF, 41.4s for ZCB00, and 14.6s for PCB00 respectively. The number of cases with IOL manipulation with a second instrument was 6 for MX60, 2 for ZCB00, 0 for SN60WF, NC60, and PCB00. Amount of OVD pushed into a porcine eye was smaller with a preloaded system than with non-preloaded systems. CONCLUSION: IOL delivery with preloaded systems is faster and more predictable. Moreover, a preloaded delivery system shows relatively less OVD pushed into a porcine eye than non-preloaded systems.

A Case Report of the Intravascular Fasciitis of a Neck Vein Mimicking Intravascular Tumorous Conditions.

Intravascular fasciitis is a rare variant of nodular fasciitis, which can be easily misdiagnosed as a tumorous condition. We had a patient with an intravenous mass of a neck vein, and surgical excision was successful. Although all preoperative imaging studies and intraoperative pathologic reports suggested certain tumorous conditions as differential diagnosis results, the final diagnosis confirmed that it was an intravascular fasciitis based on its fibromixoid tissues with the proliferation of spindle cells and positive immunohistochemical staining for smooth muscle actin. Unless a physician has an insight of the disease or a suspicion to initiate running differential markers, it may be confused with other intravascular lesions and cause unnecessary radical surgery. Here we report our experience with a patient having this rare vascular disease.

Lower incidence of contrast-induced nephropathy in patients undergoing fluorescent angiography.

BACKGROUND: To evaluate the incidence and risk factors of contrast-induced nephropathy (CIN) in patients undergoing fluorescein angiography (FA). METHODS: One hundred sixty patients who underwent FA as a part of ophthalmic examination and had serum creatinine (SCr) results within 24 h before FA and within 72 h after FA between 2005 and 2013 at a tertiary medical center were included. According to baseline SCr levels, the subjects were divided into low-risk group (<1.5 mg/dL), intermediate-risk group (1.5-2.0 mg/dL), and high-risk group (>2.0 mg/dL) for CIN development. The CIN incidence, and changes in renal function defined by SCr levels and estimated glomerular filtration rate (eGFR) were evaluated. Demographics and comorbidities were analyzed to investigate an association with CIN development. RESULTS: Of 160 patients, 91 were males (56.9%). The mean age was 52.46 ± 17.81 years. Two (1.3%) patients developed CIN after FA, whose SCr levels returned to normal within 10 days without hemodialysis. Overall, there were no changes before and after FA in SCr level (1.52 ± 1.31 mg/dL vs. 1.51 ± 1.28 mg/dL, respectively; p = 0.93) and eGFR (67.02 ± 36.62 mL/min/1.73 m2 vs. 66.41 ± 36.54 mL/min/1.73 m2, respectively; p = 0.54). SCr level and eGFR remained unchanged after FA in low-risk and intermediate-risk groups. In high-risk group, eGFR remined unchanged, but SCr level decreased after FA (from 3.64 ± 1.59 mg/dL to 3.53 ± 1.60 mg/dL; p = 0.04). Basline SCr and cormorbidities did not predict CIN development. CONCLUSIONS: Acute renal function deterioration was not evident in patients undergoing FA regardless of baseline renal function and comorbidities.

Clinical Outcomes of an Optimized Prolate Ablation Procedure for Correcting Residual Refractive Errors Following Laser Surgery.

PURPOSE: The purpose of this study was to investigate the clinical efficacy of an optimized prolate ablation procedure for correcting residual refractive errors following laser surgery. METHODS: We analyzed 24 eyes of 15 patients who underwent an optimized prolate ablation procedure for the correction of residual refractive errors following laser in situ keratomileusis, laser-assisted subepithelial keratectomy, or photorefractive keratectomy surgeries. Preoperative ophthalmic examinations were performed, and uncorrected distance visual acuity, corrected distance visual acuity, manifest refraction values (sphere, cylinder, and spherical equivalent), point spread function, modulation transfer function, corneal asphericity (Q value), ocular aberrations, and corneal haze measurements were obtained postoperatively at 1, 3, and 6 months. RESULTS: Uncorrected distance visual acuity improved and refractive errors decreased significantly at 1, 3, and 6 months postoperatively. Total coma aberration increased at 3 and 6 months postoperatively, while changes in all other aberrations were not statistically significant. Similarly, no significant changes in point spread function were detected, but modulation transfer function increased significantly at the postoperative time points measured. CONCLUSIONS: The optimized prolate ablation procedure was effective in terms of improving visual acuity and objective visual performance for the correction of persistent refractive errors following laser surgery.

Retinal pigment epithelium wound healing after traumatic choroidal rupture.

PURPOSE: The aim of this study was to investigate wound healing in the retinal pigment epithelium (RPE) after traumatic indirect choroidal rupture using fundus autofluorescence (FAF) and spectral-domain optical coherence tomography (SD-OCT). METHODS: A total of 14 eyes of 14 patients with traumatic indirect choroidal rupture were included. Baseline and last follow-up FAF images were compared to evaluate the extent of RPE healing after choroidal rupture, and associated morphologic characteristics were examined by SD-OCT. RESULTS: The size of the RPE lesion was reduced in five eyes. The change occurred in the fovea in four eyes and in the macula in three eyes. The change was noted in both the fovea and the macula in two eyes; in these cases, the changes were more prominent in the fovea than in the macula. Extra-macular lesions and lesions with deep choroidal involvement did not show any reduction in size. Choroidal neovascularization (CNV) developed in seven eyes. There was no extra-macular CNV. CONCLUSION: Retinal pigment epithelium (RPE) wound healing after traumatic choroidal rupture is affected by location and extent of the lesion.

Fundus autofluorescence findings in central serous chorioretinopathy using two different confocal scanning laser ophthalmoscopes: correlation with functional and structural status.

PURPOSE: To compare autofluorescence (AF) findings using wide-field (Optomap) and conventional (HRA-AF) confocal scanning laser ophthalmoscopy (cSLO) systems in patients with central serous chorioretinopathy (CSC), and to investigate the correlations between AF findings and functional and anatomical status. METHODS: Optical coherence tomography (OCT) and AF images were compared in 73 eyes with serous retinal detachment (SRD) (group A) and 30 eyes without SRD (group B). We evaluated AF findings from the SRD region, atrophic area, and foveola. Correlations between AF findings and outer retinal abnormalities in OCT and visual acuity (VA) were analyzed. RESULTS: Optomap-AF was more effective than HRA-AF in identifying the margins of a detached area (P = 0.001) in group A, and for monitoring mild outer retinal damage (P = 0.041) in group B. The foveolar AF grades in both instruments were significantly correlated with VA and central foveal thickness (CFT) in both group A (Optomap, VA r s = 0.33, P = 0.012; CFT r s = -0.38, P = 0.002; HRA, VA r s = 0.62, P < 0.001; CFT r s = -0.70, P < 0.001) and group B (Optomap, VA r s = 0.71, P < 0.001, CFT r s = -0.78, P < 0.001; HRA, VA r s = 0.40, P = 0.026, CFT r s = -0.40, P = 0.030). CONCLUSIONS: Optomap-AF was found to be advantageous for monitoring subretinal status in eyes with SRD, and more accurately reflected mild outer retinal changes in eyes without SRD. Foveolar AF grades of both imaging modalities were significantly correlated with functional and anatomical status.

Anti-Vascular Endothelial Growth Factor with Gas for Submacular Hemorrhage.

PURPOSE: To investigate the treatment outcome of pneumatic displacement and intravitreal anti-vascular endothelial growth factor (VEGF) for submacular hemorrhage (SMH) from exudative age-related macular degeneration (AMD). METHODS: Best-corrected visual acuity (BCVA) and central foveal thickness (CFT) were measured at baseline and at 1, 3, and 6 months after initial treatment in 72 eyes of 72 patients treated with a combination of pneumatic displacement and anti-VEGF injection for SMH from exudative AMD. RESULTS: Best-corrected visual acuity and CFT showed significant improvement from baseline during the 6-month follow-up period (logarithm of the minimum angle of resolution BCVA from 1.80 to 1.00, CFT from 886 to 383 µm, p < 0.001, respectively). The decrease in subretinal hemorrhage was greater than that in subretinal pigment epithelial hemorrhage at 1 month after initial treatment (p < 0.001). In eyes with symptoms for less than 30 days, higher reflectivity of hemorrhage on optical coherence tomography and higher CFT were associated with lower BCVA after 6 months of treatment (reflectivity B = 0.335, p = 0.007; CFT B = 0.001, p = 0.003). CONCLUSIONS: The combination of pneumatic displacement and intravitreal anti-VEGF is a useful treatment option for SMH secondary to AMD. Higher baseline CFT and higher reflectivity of hemorrhage were associated with lower BCVA 6 months after initial treatment.

Influence of visual acuity on suicidal ideation, suicide attempts and depression in South Korea.

BACKGROUND: To assess the influence of visual acuity (VA) on suicidal ideation, suicide attempts and depression. METHODS: From 2008 to 2012, a total of 28 919 nationally representative participants aged 19 years or older in the Korea National Health and Nutrition Examination Survey underwent additional ophthalmological examinations by the Korean Ophthalmologic Society. Associations between best corrected VA in the better-seeing eye based on decimal fraction and mental health were identified using multivariable logistic regression analysis after adjusting for possible biopsychosocial confounders. Self-reported mental health (suicidal ideation, suicide attempt and depression), Euro Quality of Life-Visual Analog Scale and counselling experience were evaluated by direct interviews. A nomogram for risk of suicidal ideation was generated. RESULTS: By multivariable logistic regression analysis, low VA was significantly associated with suicidal ideation and suicide attempt but not depression. Participants with a VA of no light perception to 0.2 had a nearly twofold and threefold increased risk of suicidal ideation (adjusted OR, 1.85; 95% CI 1.04 to 3.27) and suicidal attempt (adjusted OR, 3.44; 95% CI 0.92 to 12.79), compared with participants with a VA of 1.0. Sociodemographic disparities, including age and socioeconomic status, existed for suicidal ideation, suicidal attempt and depression. Euro Quality of Life-Visual Analog Scale significantly decreased as VA decreased and was lower in participants who attempted suicide. CONCLUSIONS: Low VA was associated with the occurrence of suicidal ideation or a suicide attempt. Ophthalmologists should embrace their responsibility to help reduce suicidality and prevent suicides in patients with low VA by encouraging them to seek psychiatric care.

Pigment epithelial tears after ranibizumab injection in polypoidal choroidal vasculopathy and typical age-related macular degeneration.

PURPOSE: The purpose of the study was to compare the rates and characteristics of retinal pigment epithelial (RPE) tears between typical exudative age-related macular degeneration (tAMD) and polypoidal choroidal vasculopathy (PCV) after injection of intravitreal ranibizumab (IVR). METHODS: In total, 836 eyes from 784 patients with exudative AMD treated with IVR were analyzed. The presence, type, size, and height of pigment epithelial detachment (PED) in OCT before injection were evaluated, and the occurrence rate of RPE tears within three months of injection between tAMD and PCV was compared. RESULTS: In total, 515 eyes (61.6 %) had tAMD and 321 eyes (38.4 %) were diagnosed as PCV. RPE tears developed in 18 eyes (3.5 %) in the tAMD group, while only two eyes (0.62 %) were associated with PCV (p = 0.009, Chi-square test). Eleven of the eighteen eyes with RPE tears in tAMD had fibrovascular PED with contractile neovascular tissue under the surface of the RPE and a cleft at baseline. Two eyes with RPE tears in PCV showed large hemorrhagic PED before presenting with an RPE tear. CONCLUSIONS: RPE tears after IVR were significantly less common in PCV than in tAMD. The different characteristics of RPE tears between the two disease entities suggest differences in the pathogenesis underlying the event.

Management of long-standing partially torn and flipped laser in situ keratomileusis flaps.

UNLABELLED: We describe 2 cases of traumatized and torn laser in situ keratomileusis (LASIK) flaps, partially flipped anteriorly or posteriorly, fixed for 8 months or 4 months, and accompanied by epithelial ingrowth. The 2 patients had had uneventful bilateral LASIK 6 years and 1 year before the trauma. In Case 1, the anteriorly flipped flap was removed with transepithelial phototherapeutic keratectomy. Next, mitomycin-C 0.04% was applied for 30 seconds. In Case 2, the portion of the flap that was flipped posteriorly and buried under the remaining intact LASIK flap was restored to its original normal position and epithelial ingrowth was removed mechanically with a microcurette. Irrigation with 20% ethanol was performed to inhibit the recurrence of interfacial epithelial ingrowth. The stretched amniotic membrane overlay over the cornea and sclera was sutured tightly to the episclera as the biologic pressure patch for the inhibition of epithelial re-ingrowth. Good visual acuity was restored in both cases. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Effects of topical loteprednol etabonate on tear cytokines and clinical outcomes in moderate and severe meibomian gland dysfunction: randomized clinical trial.

PURPOSE: To assess tear cytokine levels and clinical outcomes in moderate and severe meibomian gland dysfunction (MGD) after 2 months of treatment with topical loteprednol etabonate and eyelid scrubs with warm compresses vs eyelid scrubs with warm compresses alone. DESIGN: Randomized controlled trial. METHODS: Patients with moderate and severe MGD were randomized into 2 groups: topical loteprednol etabonate and eyelid scrubs with warm compresses (Group I, 34 eyes) or eyelid scrubs with warm compresses (Group II, 36 eyes). We evaluated cytokine levels, tear film break-up time (TBUT), corneal and conjunctival fluorescein staining, biomicroscopic examination of lid margins and meibomian glands, and the Ocular Surface Disease Index before initiating treatment and 1 month and 2 months after treatment. RESULTS: There were significant decreases in the levels of interleukin (IL)-6, IL-8, and IL-1ß in Group I, and IL-6 and IL-8 in Group II. Moreover, the observed decreases of these cytokines in Group I were attributed to a remarkable decrease between treatment and 1 month after treatment. In Group I, there were improvements in all of the clinical outcomes, with prominent improvement in TBUT, corneal and conjunctival fluorescein staining, and meibum quality after 1 month of treatment, compared with Group II. An improvement in meibomian gland expressibility and MGD stage reduction were more remarkable in Group I. CONCLUSIONS: Topical loteprednol etabonate and eyelid scrubs with warm compresses were tolerated and efficacious for the treatment of moderate and severe MGD. We suggest that such beneficial effects could manifest after 1 month.