Fungal Keratitis Post-FemtoLASIK: A Novel Therapeutic Approach with LASIK Flap Autograft and Penetrating Keratoplasty: A Case Report.

Introduction: This case report describes a rare case of fungal keratitis following femtoLASIK. Despite targetted antifungal therapy, this case necessitated an innovative surgical approach to manage an unexpected corneal perforation. Case Presentation: A 35-year-old male presented 3 weeks post-femtoLASIK for myopic astigmatism with discomfort and reduced vision in his right eye. He was diagnosed with fungal keratitis surgery caused by Purpureocillium lilacinum and was treated with a myriad of therapy. Unfortunately, the patient developed corneal perforation during flap lift and flap bed irrigation. An innovative approach involving a tectonic autograft using a viable LASIK flap, followed by prompt penetrating keratoplasty, was utilised. Conclusion: This technique was effective and able to mitigate the progression to an open globe.

Comparison of toric intraocular lens calculation with the integrated K method and three single biometric devices.

PURPOSE: To compare astigmatic outcomes using the Integrated K method and anterior surface keratometry from 3 different biometric devices. SETTING: Lions Eye Institute, Perth, Australia. DESIGN: Retrospective case series. METHODS: Eyes of patients who underwent uneventful cataract surgery were analyzed. Predicted postoperative astigmatism was calculated for Integrated K method, IOLMaster 700, Lenstar and Pentacam. The mean centroid error in predicted postoperative refractive astigmatism (PE), mean absolute PE and percentage of eyes within 0.5 diopter (D), 0.75 D and 1 D of absolute magnitude of PE were compared. A subset analysis was done where the difference in cylinder magnitude between the 2 methods was more than 0.25 D. Spherical prediction outcomes were also analyzed. RESULTS: 241 eyes of 139 patients were included in the study. The mean centroid PE of Integrated K method (-0.07 @ 69) was significantly different from IOLMaster and Pentacam. The mean absolute PE with Integrated K method (0.33 ± 0.17) was significantly lower than all 3 devices. The percentage of eyes within 0.5 D and 0.75 D of absolute magnitude of PE was 82% and 99% for Integrated K method, 76% and 95% for IOLMaster and Lenstar, and 60% and 86% for Pentacam. In the subset analysis, the improvement in accuracy of the Integrated K method compared with a single device was greater in terms of the percentage of eyes predicted within 0.5 D. The Integrated K method did not impact the spherical prediction outcomes. CONCLUSIONS: The integrated K method is more accurate and precise than anterior surface keratometry from a single biometric device.

Comparison of three modalities of teleophthalmology delivery in regional Western Australia during the COVID-19 lock-down.

CLINICAL RELEVANCE: In conjunction with local optometry services, telehealth may be used in to provide specialist care for patients living in rural areas underserved by ophthalmology. BACKGROUND: To combat travel restrictions for specialist outreach to regional areas during the 2020 COVID-19 lockdown, Lions Outback Vision introduced three different modalities of teleophthalmology consultations; home-based telephone, hospital-based video, and optometry-based video. This study evaluated the utility of these in providing specialist care to rural patients during the pandemic. METHODS: Data from patients referred during the COVID-19 lock-down period (23 March 2020 to 5 June 2020) were analysed. If sufficient clinical information and imaging were available then ophthalmologists conducted home-based telephone consultations. If further ocular imaging or examination was required, then optometry-based video or hospital-based video were used. Data were analysed using ANOVA and two-sided t tests for continuous data and Chi Square statistics for categorical data (p < 0.05). RESULTS: Majority of the 431 consultations were conducted via home telephone (38%) or optometry-based video (37%). Indigenous patients (p = 0.014) and patients in very remote communities (p < 0.01) were more likely to receive a home-based telephone consultation. Because sufficient clinical information had already been obtained for home-based consultations, these patients were more likely to be booked for surgery than optometry (p < 0.01).Cataracts were the predominant diagnosis in optometry consults compared to hospital (p < 0.01). CONCLUSION: Primary optometry and home telephone represent a new modality for providing specialist care for patients living in very remote regions and for Indigenous patients. When appropriate clinical testing has been completed, telephone-based ophthalmology may continue to be useful for certain conditions such as waitlisting patients for cataract surgery and should continue to be funded beyond the duration of the pandemic for rural patients.

Ocular coherence tomography findings of an unusual maculopathy in retinopathy of prematurity after laser treatment.

We report the case of an infant of 26 weeks' gestational age who suddenly developed a macular lesion following laser treatment for retinopathy of prematurity (stage 3, zone II with plus disease). The appearance and subsequent resolution of the lesion was documented using serial ocular coherence tomography and fundus photography.