Corneal endothelial safety following subconjunctival and intrastromal injection of bevacizumab for corneal neovascularization.

The purpose of this study is to determine the effect on endothelial cell density and morphology of combined subconjunctival and intracorneal injection of bevacizumab for the treatment of corneal neovascularization (NV). The charts and specular microscopy images of ten consecutive patients with corneal NV, who received combined subconjunctival+intracorneal injections of bevacizumab were reviewed. Patients received three injections of bevacizumab 25 mg/mL (1.25 mg/0.05 mL subconjunctival and 1.25 mg/0.05 mL intrastromal) 4-6 weeks apart. Endothelial cell counts (ECCs) and morphological changes were assessed by non-contact specular microscopy performed at baseline, 1 month after each injection and at 3 and 6 months after the last injection. There were no significant changes in ECCs (p = 0.663), coefficient of variation (p = 0.076), percentage of hexagonal cells (p = 0.931) or mean corneal thickness (p = 0.462) from pre-injection values to the 6-month follow-up values. There were no intraoperative or postoperative complications. In our series, the use of combined subconjunctival and intracorneal bevacizumab did not cause any decrease in ECCs or morphological alterations up to 6 months after the last of three injections. Further studies are required to confirm long-term safety in a larger sample population with longer follow-up, as well as the ideal dose, route of administration and frequency of bevacizumab administration.

Secondary intraocular lens interventions: predisposing factors, indications and coincident procedures.

To evaluate the predisposing factors, indications and coincident procedures in patients requiring a secondary intraocular lens (IOL)-related intervention. We reviewed data on 183 consecutive secondary IOL-related procedures. Information collected included demographics, predisposing factors, IOL status, indication for surgery, coincident procedures, and final IOL location and fixation method. Of the 183 procedures performed, 73 were secondary IOL implantations, 68 were IOL exchanges and 42 were IOL repositionings. Predisposing factors were found in 88.6 % of the cases, the most common being complicated cataract surgery (39.8 %) followed by trauma (20.2 %). The most common indications for surgery in the anterior chamber IOL and posterior chamber IOL groups were pseudophakic bullous keratopathy ± failed graft (77.2 %) and subluxated IOL (57.53 %), respectively. A malpositioned or subluxated lens was found in 47.86 % of all pseudophakic eyes. A simultaneous procedure was performed in 67 % of cases, anterior vitrectomy being the most common (43.7 %), followed by keratoplasty (35 %). Secondary IOL-related interventions were associated with predisposing factors, complicated cataract surgery being the most common. Patients implanted with anterior chamber IOLs seemed to have a more complicated course requiring more complex secondary surgeries and associated procedures.

Shifting trends in bacterial keratitis in Toronto: an 11-year review.

OBJECTIVE: To review the distribution, current trends, and resistance patterns of bacterial keratitis isolates in Toronto over the last 11 years. DESIGN: Retrospective, observational, case series. PARTICIPANTS: Microbiology records of suspected bacterial keratitis cases that underwent a diagnostic corneal scraping and cultures from January 1, 2000, through December 31, 2010, were reviewed. METHODS: Culture results and antibiotic sensitivity profiles were reviewed and analyzed. MAIN OUTCOME MEASURES: Distribution of the main isolated pathogens as well as in vitro laboratory minimum inhibitory concentration testing results to identify resistance patterns. RESULTS: A total of 1701 consecutive corneal scrapings were taken during the 11 years of the study. A pathogen was recovered in 977 samples (57.4%), with bacterial keratitis accounting for 897 of the positive cultures (91.8%). The total number of Gram-positive and Gram-negative isolates was 684 and 213, respectively. We identified a decreasing trend in Gram-positive isolates (P = 0.016). The most common isolate overall was coagulase-negative Staphylococcus (CNS) and the most common Gram-negative bacteria isolated was Pseudomonas aeruginosa. Methicillin-resistant Staphylococcus aureus (MRSA) was present in 1.3% of the S aureus isolates, whereas methicillin-resistant CNS (MRCNS) was present in 43.1% of the CNS isolates. There was a trend toward increasing laboratory resistance to methicillin from 28% during the first 4 years of the study to 38.8% for the last 3 years (P = 0.133). When analyzing the sensitivities of MRSA and MRCNS isolates to other antibiotics, there was resistance to cefazolin and sensitivity to vancomycin in all isolates, whereas resistance to other antibiotics was variable. CONCLUSIONS: There was a significant decrease in the percentage of Gram-positive microorganisms over time. The sensitivity of Gram-negative isolates to tested antimicrobials was >97% response for all the reported antibiotics; this was not the case for Gram-positive isolates, in which resistance to the antibiotics was more common. Methicillin-resistant organisms accounted for 29.1% of all Gram-positive cultures in our series, suggesting that the empiric use of vancomycin in the setting of severe suspected bacterial keratitis may be justified.

Intraocular lenses for presbyopia correction: past, present, and future.

PURPOSE OF REVIEW: To discuss the development of presbyopia-correcting intraocular lenses (IOLs), what we have learned since their introduction a few decades ago, what are the options currently on the market, and where the technology is heading in the future. RECENT FINDINGS: Multifocal and accommodating IOLs have gone through several modifications to improve distance, intermediate and near vision compared to their predecessors. These modifications have also targeted unwanted side-effects such as glare and halos in the multifocal lenses and inconsistent near-vision results in the accommodating IOLs and although the results have improved, they are far from perfect. Therefore, careful patient selection for each of these technologies is crucial for success and patient satisfaction. SUMMARY: Presbyopia correction remains a great challenge in cataract and refractive surgery. In this article, we review the development of presbyopia-correcting IOLs, starting from the simple, two-zone, multifocal, refractive models introduced 2 decades ago, the current Food and Drug Administration (FDA) approved multifocal and accommodating lenses as well as those undergoing FDA trials and take a look into developing technologies that may be available to us in the future.

Factors associated with early detection of choroidal neovascularization in age-related macular degeneration in the clinic setting.

BACKGROUND: Delayed diagnosis of choroidal neovas cularization (CNV) in age-related macular degeneration (AMD) adversely affects visual outcome. OBJECTIVES: To identify factors associated with early detection of CNV in the clinic setting. METHODS: Demographic and clinical data and lesion characteristics were retrospectively collected from 76 consecutive AMD patients who had a history of CNV in one eye and presented with CNV in the second eye. These data were evaluated for association with visual acuity (VA) at the time of presentation. RESULTS: Better VA was associated with a history of CNV in the fellow eye (P < 0.0001), adherence to follow-up every 4 months (P = 0.015), younger age (P = 0.03), smaller lesion (P < 0.0001), and non-subfoveal location (P = 0.048). VA of the fellow eye did not correlate with VA at presentation with CNV. CONCLUSIONS: These data suggest that patients' experience of CNV, regardless of VA, facilitates early diagnosis in the fellow eye. Adherence to follow-up in the routine clinic setting also facilitates early detection of CNV.

Combined topical and intracameral anesthesia for Descemet's stripping automated endothelial keratoplasty.

To evaluate the use of combined topical and intracameral anesthesia for Descemet's stripping automated keratoplasty (DSAEK). This was a retrospective comparative cohort analysis consisting of 10 eyes in 10 consecutive patients undergoing DSAEK surgery with combined topical and intracameral anesthesia. These cases were compared with 21 randomly selected controls during the same time period undergoing DSAEK surgery performed under retrobulbar anesthesia. Incidence of intraoperative and postoperative complications, and endothelial cell counts were compared. In all cases, DSAEK was completed without intraoperative complications. All patients tolerated the procedure well. There were 6 cases of postoperative graft dislocation requiring rebubbling, and no cases of primary failure or endophthalmitis. No significant difference in endothelial cell counts was found at final follow-up. Short-term results suggest that combined topical and intracameral anesthesia is as safe and effective for DSAEK in cooperative patients when compared to retrobulbar anesthesia. It may thereby be an alternative anesthetic modality for patients in whom retrobulbar or peribulbar anesthesia may be risky or contraindicated.

Multiple XEN Gel Stents for Refractory Pediatric Glaucoma.

Although trabeculotomy and goniotomy are currently the mainstay of surgical management for congenital glaucoma, XEN Gel Stent (Allergan) implantation and other microinvasive glaucoma surgery technologies may offer the advantage of having a lower risk of postoperative complications than conventional techniques. A 10-year-old boy presented with aphakic glaucoma in his left eye secondary to previous cataract surgery. Intraocular pressure (IOP) in the left eye at initial presentation was 31 mm Hg with maximal tolerated medical therapy. Surgical history included tube shunt, shunt revision, and subsequent shunt removal. Shunt surgery and revision had been unsuccessful at achieving target IOP. The patient underwent two treatments of micro-pulse transscleral laser therapy that failed to achieve target IOP. At this time, an open conjunctiva ab externo superior XEN Gel Stent (Allergan) was implanted. Within 1 month of surgery, conjunctival dehiscence and contraction occurred. Following this, ab interno inferonasal air-ophthalmic viscosurgical device XEN Gel Stent implantation was performed. In the 6 months following the second XEN Gel Stent, IOP in the left eye was stable at 6 to 8 mm Hg. This report describes the effective use of a XEN Gel Stent implant in the management of congenital glaucoma, while also highlighting a complication. Further studies are required to determine the comparative outcomes of this technique with conventional surgical management. [J Pediatr Ophthalmol Strabismus. 2022;59(1):e11-e14.].

Gabapentin for postoperative pain after photorefractive keratectomy: a prospective, randomized, double-blind, placebo-controlled trial.

PURPOSE: To determine whether treatment with oral gabapentin reduces postoperative pain after photorefractive keratectomy (PRK). METHODS: This prospective, randomized, double-blind, placebo-controlled study comprised 40 patients scheduled for bilateral PRK. Exclusion criteria were previous refractive surgery; diseases that could affect epithelial healing; use of antihistamines, nonsteroidal anti-inflammatory drugs, or steroids; and use of mitomycin C during PRK. Patients were divided into two groups: 20 patients received gabapentin capsules (300 mg) and 20 patients received identical placebo capsules. Visual acuity, slit-lamp examination, and a 12-question, 10-point visual numerical scale questionnaire were evaluated at each postoperative follow-up. Main outcome measures were the severity of pain at each follow-up and during the previous 24 hours. Secondary outcome measures were maximum and minimum severity of pain, healing time, uncorrected distance visual acuity, and the rating of other symptoms and potential side effects. RESULTS: The gabapentin group had less pain during the first 72 hours (P=.024 to .001). A significant difference in favor of gabapentin was found for the first 48 hours regarding minimum pain severity (P=.005 and .01 for 24 and 48 hours, respectively) and for the first 72 hours for maximum pain severity (P=.014, .007, and .001 for 24, 48, and 72 hours, respectively). No significant differences were observed for side effects, symptoms, or healing time except discomfort in favor of gabapentin during the first 24 hours (P=.043). CONCLUSIONS: Gabapentin significantly reduced postoperative pain after PRK compared to placebo, with no increase in reported side effects.

Correction of astigmatism after cataract surgery using the light adjustable lens: a 1-year follow-up pilot study.

PURPOSE: The management of preoperative and residual astigmatism is critical to obtain optimized uncorrected visual acuity. The aim of this study was to determine whether residual astigmatism could be precisely corrected postoperatively using the Light Adjustable Lens (LAL, Calhoun Vision Inc) and to determine the stability of the adjusted refraction. METHODS: Ten eyes of 10 patients with cataract and corneal astigmatism between 1.00 and 2.00 diopters (D) were included. After standard phacoemulsification and implantation of the LAL, adjustment and lock-in procedures were completed. Before adjustment and 2 weeks, 6 months, and 1 year after lock-in, a full ophthalmic examination including uncorrected distance acuity (UDVA) and corrected distance visual acuity (CDVA), autorefraction, and manifest refraction was performed. RESULTS: All surgeries, adjustments, and lock-in procedures were performed with no complications. All eyes achieved ±0.50 D of the targeted cylindrical adjustment. Mean spherical equivalent refraction was 0.03±0.84 D before adjustment and -0.06±0.25 D at final follow-up. The cylinder axis remained the same in 60% of eyes and all eyes were stable within 10° rotation at 12-month follow-up. Seven of 10 eyes achieved UDVA of 20/25 or better whereas all eyes achieved UDVA of 20/32 or better. Corrected distance visual acuity remained stable in all eyes. CONCLUSIONS: In this pilot study, the LAL proved to be an efficient, predictable, and stable method of managing astigmatism in cataract patients.

Treatment of Severe Infectious Keratitis With Scleral Contact Lenses as a Reservoir of Moxifloxacin 0.5.

PURPOSE: To report the outcomes of using scleral contact lenses as antibiotic reservoirs as a therapeutic approach in a case series of severe infectious keratitis and to discuss the clinical potential. METHODS: This was a prospective consecutive case series study of 12 eyes treated for infectious keratitis at the "Conde de Valenciana" Institute of Ophthalmology. A scleral lens (SL) filled with 0.5% moxifloxacin was used as a reservoir and replaced every 24 hours until epithelization was complete or the culture report and/or antibiogram demonstrated either a microorganism not susceptible to or resistant to moxifloxacin. RESULTS: The study included 12 eyes of 12 patients (7 women; 58.33%; average age of 63 ± 20.11 years). All patients completed at least 1 month of follow-up. Patients had a diagnosis of infectious keratitis, and the SL was fitted on initial consultation. Of the 12 eyes, 7 had culture-positive bacterial infection, 2 eyes were mycotic, and 3 eyes had no culture growth. In 3 eyes, SL was discontinued because of the lack of response (one eye) and to the presence of mycotic infection (2 eyes). All infections resolved favorably at the final follow-up. CONCLUSIONS: The use of SLs could be an alternative for antibiotic impregnation and treatment of infectious keratitis. No complications or side effects were observed related to the use of the scleral contact lens as a reservoir for the antibiotic. This treatment modality could offer a comfortable treatment for the patient, ensuring good impregnation and maintenance of antibiotic concentrations during the 24-hour wear periods.

Cool Crosslinking: Riboflavin at 4°C for Pain Management After Crosslinking for Keratoconus Patients, A Randomized Clinical Trial.

PURPOSE: To explore corneal cooling as a method of pain management in corneal-accelerated collagen cross-linking. METHODS: This was a prospective and interventional randomized clinical trial registered in the National Institutes of Health Clinical Trials through the identifier NCT030760770. The research was conducted at the Institute of Ophthalmology "Conde de Valenciana." A total of 98 patients were randomly assigned to one of the following 2 groups: cold riboflavin (4°C) group or control group (riboflavin at room temperature). The inclusion criteria were patients of any sex, older than 18 years of age with keratoconus diagnosis who needed management with cross-linking in both eyes because of the evidence of progression. The exclusion criteria were patients who had cross-linking without epithelial debridement, unilateral cross-linking, or any other ocular pathologies besides keratoconus and any cognitive incapacity that would make the understanding of the pain test difficult. The main outcome measures were pain, tearing, photophobia, foreign body sensation, and irritation. RESULTS: At 2 hours post-op, pain in the case and control groups was 3.80 ± 3.00 and 8.08 ± 2.21 (P < 0.05), tearing was 1.56 ± 1.96 and 8.29 ± 2.42 (P < 0.05), photophobia was 5.44 ± 3.57 and 7.83 ± 2.64 (P < 0.05), foreign body sensation was 2.20 ± 2.78 and 6.54 ± 2.73 (P < 0.05), and irritation was 3.48 ± 2.98 and 6.79 ± 3.00 (P < 0.05), respectively. A statistical significant difference was maintained in pain values on day 1 (2.79 ± 3.09 and 4.91 ± 3.27 [P < 0.05]), 2 (2.54 ± 2.41 and 4.00 ± 2.43 [P < 0.05]), and 4 (0.45 ± 0.76 and 1.22 ± 1.67 [P < 0.05]). CONCLUSIONS: This study demonstrated that pain and associated symptoms decreased significantly in the riboflavin 4°C group.

Limbal stem cell deficiency after topical mitomycin C therapy for primary acquired melanosis with atypia.

PURPOSE: To describe the incidence, characteristics, risk factors, and clinical outcome of limbal stem cell deficiency (LSCD) resulting from topical treatment with mitomycin C (MMC) for primary acquired melanosis (PAM) with atypia. DESIGN: Retrospective, observational case series. PARTICIPANTS: Patients with LSCD who had been managed with topical MMC for PAM with atypia at the Ocular Oncology Service at the Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel, between 2000 and 2007. METHODS: Retrospective chart review of all patients with PAM with atypia was performed. Impression cytologic analysis of the corneal and conjunctival epithelium was performed in patients suspected of having LSCD. MAIN OUTCOME MEASURES: Evaluation of risk factors for LSCD, including demographic characteristics, MMC dosage, and length of treatment; and clinical and visual outcome of patients diagnosed with LSCD. RESULTS: Limbal stem cell deficiency was identified in 5 (23.8%) of 21 patients. The mean age+/-standard deviation of the 5 patients was 61.8+/-12.7 years compared with 43.7+/-16.1 years in patients in whom this complication did not develop (P = 0.025). Longer treatment periods of MMC were noted in eyes in which LSCD developed (78.4+/-24.8 days) compared with eyes without LSCD (37.7+/-3.1 days; P = 0.07). In 3 patients, spontaneous partial resolution of the LSCD was noted. CONCLUSIONS: High-dose topical MMC for PAM with atypia may be associated with a relatively high incidence of LSCD. Mitomycin C concentration and treatment regimen should be reevaluated to improve the safety of this treatment protocol.

Usher syndrome associated with Fuchs' heterochromic uveitis.

BACKGROUND: The purpose of this study is to report two new cases of Usher syndrome associated with Fuchs' heterochromic uveitis (FHU), to confirm our previous observation of the association between FHU and retinitis pigmentosa (RP), and to evaluate if FHU is particularly associated with Usher syndrome. METHODS: Retrospective medical record review of all new RP cases at Hadassah Medical Center between the years 2000 and 2007, review of our previously published data, and a meta-analysis of published relevant articles in peer reviewed journals. RESULTS: During the time frame of the study we diagnosed 58 new cases of RP, of whom one male and one female had the typical findings of FHU, and both had Usher syndrome type II. The difference in the occurrence of FHU between the 616 controls and the patients with RP was significant (p = 0.0073, Fisher's exact test). In our combined data, FHU occurred only in two types of RP; RP simplex with an incidence of 0.57%, and Usher syndrome with an incidence of 13.5%. This difference between the incidence of FHU in patients with Usher syndrome and other types of RP was significant (p < 0.0001, Fisher's exact test). Adding up these two cases with what is already published in the literature makes up a total of 17 RP patients with coexisting FHU. CONCLUSIONS: This study confirms the association between FHU and RP; and a particularly stronger association with Usher syndrome type II. Although infectious agents seem to play a role, the cause for this significant correlation is still unclear.

Pain Management in Corneal Collagen Crosslinking for Keratoconus: A Comparative Case Series.

Purpose: To compare management of postoperative pain after corneal collagen crosslinking (CXL) with oral gabapentin or ketorolac. Methods: Prospective interventional comparative case series in a single center. Patients undergoing epithelium-off (epi-off) or epithelium-on (epi-on) techniques performed by a single surgeon for progressive keratoconus were enrolled and randomly assigned to the ketorolac (10-mg tablets every 8 h) or the gabapentin (300-mg capsules every 8 h) group and instructed to take the medication for the first 3 postoperative days. Using a numeric scale of pain, scores were assessed for current pain (at the time of applying the questionnaire), and average pain over the preceding 24 h. Eye symptoms and systemic adverse events related to oral medication were also assessed. Results: Thirty-seven patients were included, with 22 (10 epi-on and 12 epi-off) assigned to the ketorolac group and 15 (7 epi-on and 8 epi-off) to the gabapentin group. No statistically significant differences were noted on the pain scale between groups at any point of the study, in the median pain scores of patients at the time of applying the questionnaire, nor in the severity of pain during the 24-h period before the assessment. Also, no differences were found among groups for the eye symptoms and the systemic adverse events. The median regression analysis showed no effect of the type of surgery or gender in the severity of pain. Conclusions: Both oral ketorolac and oral gabapentin can be used with similar results for pain and symptomatic control after epi-on or epi-off CXL procedures.

Association of complement factor H Y402H polymorphism with phenotype of neovascular age related macular degeneration in Israel.

PURPOSE: The Tyr402His variant of complement factor H (CFH) is associated with age-related macular degeneration (AMD) in several populations. Our aim was to evaluate if this single nucleotide polymorphism (SNP) is associated with AMD in the Israeli population and see if it underlies heterogeneity in clinical manifestation and responses to photodynamic therapy (PDT), which characterize neovascular AMD (NVAMD). METHODS: Genotyping for the Tyr402His variant was performed in 240 NVAMD patients (78.1+/-7 age range) and 118 controls (70.8+/-8.2 age range). Genotyping was correlated with clinical characteristics and treatment parameters in sequential 131 NVAMD patients who underwent PDT. RESULTS: TheTyr402His coding allele was associated with NVAMD in the Israeli population: odds ratio (OR)=1.9; 95% confidence interval (CI)=1.3-2.6; p=0.0002. Homozygosity for this variant was associated with an OR of 3.4 (95% CI: 1.7-6.8) for having AMD. There was no association among this SNP and age of onset of NVAMD, gender, neovascular lesion size, initial or final visual acuity, and number of PDT sessions required. CONCLUSIONS: In accordance with findings from the majority of previous study populations, the Tyr402His variant of CFH is associated with NVAMD in Israel. However, heterogeneity in clinical manifestations of NVAMD and in its response to PDT is not underlined by this CFH variant and may be accounted for by other genetic and environmental factors.

Anterior segment optical coherence tomography angle and vault analysis after toric and non-toric implantable collamer lens V4c implantation in patients with high myopia.

OBJECTIVE: To assess anterior segment changes, including iridocorneal angle and vault, after toric and non-toric implantable collamer lens (ICL) V4c (STAAR Surgical AG) implantation under different lighting conditions. METHODS: Longitudinal, prospective, case series. Patients with high myopia (>6 dioptres) underwent toric and non-toric ICL V4c implantation. Optical coherence tomography measurements were taken under different lighting conditions preoperatively and at 1 week and 1, 6 and 12 months of follow-up. RESULTS: Seventy-six eyes of 42 patients underwent ICL V4c implantation. Mean age was 27.4 years (±5.14 years, range 20 to 39 years). The average iridocorneal angle showed a statistically significant decrease (p<0.05) in all mesopic, scotopic and photopic conditions after 1 week of surgery compared with the preoperative measurements; in mesopic conditions, it decreased 14.1°, in photopic conditions 14.8° and scotopic conditions 13.2°. The angle measurement had a statistically significant change only in mesopic conditions (p=0.01) over the 1-year follow-up. The average vault under mesopic conditions was 0.661±0.21 mm at week 1. The vault measurement change was statistically significant over the 1-year follow-up in mesopic conditions (p=0.01). Refractive results showed a significant improvement in both uncorrected and corrected distance visual acuity (p<0.001). CONCLUSION: There is a significant reduction in the iridocorneal angle after ICL V4c implantation. Furthermore, there is a change under mesopic conditions in both the iridocorneal angle and vault during long-term follow-up.

Bacterial Keratitis in Toronto: A 16-Year Review of the Microorganisms Isolated and the Resistance Patterns Observed.

PURPOSE: To review the incidence, distribution, current trends, and resistance patterns of bacterial keratitis isolates in Toronto over the past 16 years. METHODS: Microbiology records of suspected bacterial keratitis that underwent a diagnostic corneal scraping and cultures from January 1, 2000, through December 31, 2015, were retrospectively reviewed. The distribution of the main isolated pathogens and in vitro laboratory minimum inhibitory concentration testing results were used to identify resistance patterns. RESULTS: A total of 2330 corneal scrapings were taken over 16 years. A pathogen was recovered in 1335 samples (57.3%), with bacterial keratitis accounting for 1189 of the positive cultures (86.0% of all isolates). The total number of gram-positive and gram-negative isolates was 963 and 324, respectively. Coagulase-negative Staphylococcus and Pseudomonas aeruginosa were the most common gram-positive and gram-negative bacteria isolates, respectively. A decreasing trend in the number of isolates in gram-positive bacteria (P = 0.01), specifically among Staphylococcus aureus (P < 0.0001) and Streptococcus species (P = 0.005), was identified. When analyzing the susceptibilities of gram-positive and gram-negative isolates, an increasing trend in antibiotic resistance was observed in erythromycin (P = 0.018), ceftazidime (P = 0.046), and piperacillin/tazobactam (P = 0.005). The susceptibility of tested gram-positive microorganisms to vancomycin was 99.6%. CONCLUSIONS: There has been a decreasing trend in the number of isolates in gram-positive microorganisms over the past 16 years. An increasing trend in resistance for various antibiotics against gram-negative and gram-positive isolates was identified. High susceptibility to vancomycin reinforced the empirical use of fortified tobramycin and vancomycin in the initial management of severe bacterial keratitis.

Long-term Outcomes of Pediatric Penetrating Keratoplasty for Herpes Simplex Virus Keratitis.

PURPOSE: To analyze the characteristics and long-term outcomes of patients that underwent pediatric penetrating keratoplasty (PPK) for herpes simplex virus (HSV) keratitis. DESIGN: Retrospective, interventional, consecutive case series. METHODS: Observational report of outcomes and findings for 9 patients with history of HSV keratitis that underwent PPK and were followed in a single institution. Difference between the median preoperative and final best-corrected visual acuity (BCVA) was assessed and the outcomes are reported. RESULTS: We included 9 eyes; median age at the moment of the PPK was 14 years. The median initial BCVA was 20/400 (range 20/60 to hand motion) and final was 20/50 (range 20/30 to 20/400) (P < .05). Follow-up was a median of 94 months. Complications in these patients included glaucoma (1), graft rejection (1), recurrence of disease (1), and amblyopia (3). No graft failures were present. CONCLUSION: The long-term outcomes with PPK for HSV keratitis in children provide improvement in BCVA when not compromised by amblyopia.

Trans-epithelial accelerated corneal cross-linking for keratoconus in children.

The aim of the study is to evaluate the safety and efficacy of trans-epithelial accelerated corneal cross-linking (TE-ACXL) in children with progressive keratoconus. Retrospective, case-series of 23 eyes of 14 children who underwent TE-ACXL. Evaluations were performed at baseline and 1, 3, 6, 12 and 18mo postoperatively. Mean follow-up time of 23.82±3.15mo and mean age was 13.7±1.4y (range 11 to 16y). Mean preoperative uncorrected distance visual acuity changed from 0.92±0.45 logMAR (20/160) to 0.71±0.40 logMAR (20/100) (P=0.001). Mean keratometry (Km) changed from 53.87± 6.03 to 53.00±5.81 (P=0.001). Pachymetry did not have significant changes at last follow-up (P=0.30). The mean preoperative sphere was -5.58±2.48 and -4.89±4.66 D (P=0.11) at last follow-up; refractive cylinder from -5.58±2.48 to -5.02±2.23 (P=0.046). In conclusion, tomographic and refractive stability are shown in over 91% of eyes with pediatric progressive keratoconus who underwent TE-ACXL.