Anterior Segment Changes in Patients With Glaucoma Following Cataract Surgery.

This prospective observational study investigates the impact of cataract surgery on anterior segment parameters in nonglaucomatous and primary open-angle glaucoma (POAG) eyes, utilizing anterior segment optical coherence tomography (AS-OCT). The study involved 42 Caucasian patients, divided into a control group and a POAG group. Comprehensive ophthalmic examinations were performed along with AS-OCT imaging and biometry preoperatively, as well as on one day, one week, and one month following cataract surgery. The results showed significant post-operative changes in anterior chamber depth (ACD) and angle width in both groups, suggesting that cataract surgery may influence the structural parameters associated with glaucoma risk and management. Specifically, a marked increase in ACD and improvement in angle-opening distances were observed, highlighting the potential of cataract extraction to alter intraocular fluid dynamics favorably. Despite these changes, the study noted an initial spike in increased intraocular pressure (IOP) in POAG patients immediately post-operative, which stabilized during follow-up. For the control group, IOP showed gradually reducing IOP values in the follow-up visits. The findings underscore the role of advanced imaging technologies in understanding glaucoma's pathophysiology and the potential benefits of cataract surgery in glaucoma patients. The study advocates for further research with a larger, more diverse patient population and extended follow-up to explore the long-term implications of cataract surgery on glaucoma dynamics, emphasizing the importance of personalized management and treatment strategies particularly for glaucoma patients.

Multiorganism, drug-resistant keratitis treated by corneal crosslinking.

PURPOSE: To describe a case of multiorganism, drug-resistant keratitis that responded well to corneal crosslinking (CXL) treatment. METHODS: A 52-year-old man presented to our institute with a 2-month ocular history of infectious keratitis in his right eye, on topical antibacterial, antifungal, and antiprotozoan treatment, and complained of increase in pain, discomfort, and visual deterioration. Slit-lamp examination revealed advanced infectious keratitis (extensive deep corneal infiltrate with perineuritis). Cultural and molecular analysis of obtained corneal specimens demonstrated combined fungal and Acanthamoeba infection; confocal microscopy confirmed Acanthamoeba infection. Intense targeted topical antifungal and antiprotozoan treatment was initiated immediately and 1 month later CXL was performed due to drug resistance of the infection. RESULTS: Two weeks after CXL treatment, the corneal findings had deteriorated, while a corneal abscess was formed and extended at almost half of the cornea. This was gradually limited and the corneal infiltrate and abscess were eventually decreased. In addition, the symptoms improved. CONCLUSIONS: Corneal crosslinking could be an effective therapy in the management of advanced infectious keratitis unresponsive to conventional medical treatment.

Pupil response to tropicamide following corneal crosslinking.

PURPOSE: To evaluate the effect of corneal crosslinking (CXL) with ultraviolet A (UVA) irradiation on pupil response to tropicamide 0.5% instillation. METHODS: This prospective interventional study enrolled 17 patients (19 eyes) with progressive keratoconus who underwent CXL with UVA irradiation. Central corneal thickness (CCT) was evaluated with the use of anterior segment optical coherence tomography (Visante OCT 3.0). Pupil diameter was measured with the use of Colvard infrared pupillometer before the instillation of tropicamide 0.5% and after the instillation of tropicamide every 5 minutes for total duration of 30 minutes. Corneal epithelial integrity was examined with the use of fluorescein dye staining. Measurements were performed 1 day preoperatively and 1 month postoperatively, with emphasis on simulating the same light conditions regarding the pupil measurements. RESULTS: No intraoperative or postoperative complications were observed in any of the patients. Mean CCT decreased significantly (p<0.001) 1 month postoperatively. Mean postoperative pupil size did not change significantly at any time point compared to the mean preoperative measurements. CONCLUSIONS: The CXL procedure seems not to impair effectiveness of topical drugs, using pupil size measurements after tropicamide 0.5% instillation.

Corneal stromal demarcation line determined with anterior segment optical coherence tomography following a very high intensity corneal collagen cross-linking protocol.

PURPOSE: To evaluate corneal stromal demarcation line depth after very high intensity (18 mW/cm) ultraviolet-A irradiation for a 5-minute corneal collagen cross-linking (CXL) protocol with the use of anterior segment optical coherence tomography. METHODS: This prospective interventional study enrolled 14 patients (18 eyes) with progressive keratoconus who underwent CXL with an ultraviolet-A irradiation intensity of 18 mW/cm for 5 minutes. One month postoperatively, corneal stromal demarcation line depth was measured with the use of anterior segment optical coherence tomography by 2 independent observers. The rate of reepithelialization and endothelial cell density at a 3-month follow-up period were also evaluated. RESULTS: No intraoperative or postoperative complications were observed in any of the patients. No statistically significant difference between the 2 observers' measurements was observed (P = 0.989). Mean corneal stromal demarcation line depth was 223 ± 32 µm (range, 159-265 µm). The mean endothelial cell density decreased from 2714 ± 174 preoperatively to 2671 ± 192 at 3 months postoperatively; however, this decrease was not statistically significant (P = 0.221). CONCLUSIONS: Corneal stromal demarcation line depth after a very high intensity 5-minute CXL protocol seems to be shallower than the standard Dresden protocol.

Excessive Corneal Flattening and Thinning After Corneal Cross-linking: Single-Case Report With 5-Year Follow-up.

PURPOSE: To present a case of significant progressive corneal flattening and thinning after corneal cross-linking (CXL), with 5 years of follow-up. METHODS: Case report. RESULTS: A 23-year-old woman presented with bilateral progressive keratoconus and received CXL treatment (Dresden protocol) for both eyes in March 2009. The patient has demonstrated gradual significant corneal thinning (from a preoperative value of 464 µm to 243 µm) and progressive flattening (+11.1-diopter change in spherical equivalent) in her right eye, over a 5-year period. The fellow eye remained stable during the same postoperative period. CONCLUSIONS: This is the first case report of significant progressive corneal flattening and thinning after undergoing CXL treatment for progressive keratoconus.