Higher-order aberrations and visual quality after incision lenticule extraction surgery with intraoperative angle kappa adjustments between small and large kappa patients: A 2-year follow-up.

Purpose: To evaluate the postoperative visual outcomes, that is, corneal higher-order aberrations (HOAs) and visual quality, of patients with an angle kappa greater than 0.30 mm who underwent angle kappa adjustment during small-incision lenticule extraction (SMILE) 2 years after surgery compared to eyes with an angle kappa less than 0.30 mm. Methods: This was a retrospective study and included 12 patients from October 2019 to December 2019 who underwent the SMILE procedure for correction of myopia and myopic astigmatism and had one eye with a large kappa angle and another eye with a small kappa angle. Twenty-four months after surgery, an optical quality analysis system (OQAS II; Visiometrics, Terrassa, Spain) was used to measure the modulation transfer function cutoff frequency (MTFcutoff), Strehl2D ratio, and objective scatter index (OSI). HOAs were measured with a Tracey iTrace Visual Function Analyzer (Tracey version 6.1.0; Tracey Technologies, Houston, TX, USA). Assessment of subjective visual quality was achieved using the quality of vision (QOV) questionnaire. Results: At 24 months postoperatively, the mean spherical equivalent (SE) refraction was - 0.32 ± 0.40 and - 0.31 ± 0.35 in the S-kappa group (kappa <0.3 mm) and the L-kappa group (kappa ≥0.3 mm), respectively (P > 0.05). The mean OSI was 0.73 ± 0.32 and 0.81 ± 0.47, respectively (P > 0.05). There was no significant difference in MTFcutoff and Strehl2D ratio between the two groups (P > 0.05). Total HOA, coma, spherical, trefoil, and secondary astigmatism were not significantly different (P > 0.05) between the two groups. Conclusion: Adjustment of angle kappa during SMILE helps reduce the decentration, results in less HOAs, and promotes visual quality. It provides a reliable method to optimize the treatment concentration in SMILE.

Herpetic Keratitis Following Corneal Crosslinking for Keratoconus: A Case Series.

Background: Corneal crosslinking is widely applied to enhance corneal biomechanical properties and delay the progression of keratoconus. The surgical procedure and application of ultraviolet A irradiation (UVA) during corneal crosslinking have been recognized to induce the reactivation of simplex herpes virus (HSV) but are rarely reported and poorly analyzed. Case Presentation: We report the first case series of herpetic keratitis in 4 keratoconus patients undertaking corneal crosslinking, who were all clinically diagnosed at routine follow-up visits 3 days to 1 month after the surgery. Different from the typical new onset of secondary herpetic keratitis that mainly presents with epithelial lesions and severe eye pain, these patients all presented with stromal infiltrates and were generally asymptomatic except for vision blurring in 2 patients. All patients responded well to antiviral therapy, topical steroids, and epithelial nourishment medication, leaving corneal macula or nebula at the last follow-up visit. Conclusion: Close follow-up is essential and the most effective way to diagnose herpetic keratitis after corneal crosslinking due to the lack of subjective symptoms. The prophylactic use of antiviral therapy on asymptomatic patients is controversial and should be evaluated based on long-term prognosis.

Case report: A case of corneal deposits between binocular descemet membrane and corneal endothelial layer after small-incision lenticule extraction (SMILE) followed by HPV vaccine.

Background: Deposits located between the Descemet memberane and the corneal endothelial layer in both eyes has not yet been reported after SMILE. Case report: Grayish white fine deposits was found between the Descemet memberane and the corneal endothelial layer in both eyes of the patient's cornea, and no other abnormalities were observed in the anterior and posterior segments of patient's eyes with ophthalmic examination instrument. However, the visual acuity of patient remained unchanged. Significantly, the patient had a sister who had undergone the same procedure a year earlier without any complications. After careful questioning, we learned that the patient received the 9-valent human papillomavirus (HPV) vaccine on the third post-operative day without any other special experiences. We performed immunological examination and genetic testing on the patient. The results of immunological examination of patient showed no obvious abnormality, which was consistent with the routine trend after vaccination. In particular, a homozygous variation of the ARSG gene was found in the patient and her sister. Conclusion: There are two possible causes of corneal changes in patients. The first is IGA elevation caused by vaccination, deposited in the cornea. Second, the ARSG gene mutation of the patient leads to a potential congenital corneal dystrophy, and clinical manifestations occur under the stimulation of the vaccine.