Impact of teleconsultation on visual and refractive outcomes in patients undergoing laser refractive surgery during COVID-19.

Purpose: To assess the role of remote teleconsultation (TC) follow-up care following a successful and uneventful laser vision correction. Methods: The study is a retrospective, comparative analysis of patients undergoing laser vision correction at tertiary care eye hospital in Southern India. The patients were divided into two groups. The first group included patients operated on before the coronavirus disease (COVID-19) pandemic and were followed up with physical consultations during their follow-up visit (Group 1). The second group comprised patients operated on during the pandemic and had at least one remote TC during their post-operative follow-up (Group 2). Results: A total of 1088 eyes of 564 patients and 717 eyes of 372 patients were included in Group 1 and 2, respectively. The mean number of visits for the patients from Group 2 during the COVID period (2.56 +/- 0.74 days) was significantly lesser (P < 0.0001) than that of Group 1 in the pre-COVID period (3.53 +/- 1.07 days). Close to 90% of the eyes achieved an uncorrected distance visual acuity (UDVA) of 20/20 in both groups (P = 0.925). 96.50% of the eyes in Group 1 and 98.18% of the eyes in Group 2 achieved UCVA 20/25 or better (P = 0.049). Eight eyes (0.73%) in Group 1 and one eye (0.14%) in Group 2 reported a loss of 2 or more lines. However, the results were not statistically significant (P = 0.156). None of the groups had any patients who had a sight-threatening complication. Conclusion: Remote TC following refractive surgery is safe and can be effectively integrated into routine refractive practice to reduce travel to the hospital for a physical consult.

Flap amputation for long-standing post-LASIK flap dislocation with epithelial ingrowth.

A man aged 26 years presented with complaints of diminution of vision in his right eye for 1 year following a fist injury. He had a history of laser-assisted in situ keratomileusis in both eyes 5 years earlier. On examination, his uncorrected distance visual acuity (UDVA) in the right eye was 1.0 logMAR. Slit-lamp examination of the right eye revealed a superotemporal dislocation of the flap with coexisting epithelial ingrowth encroaching the pupillary area. Due to the presence of long-standing fixed flap folds, a flap amputation was performed along with removal of the epithelial ingrowth using 0.02% mitomycin C as adjunct. Postoperatively, the UDVA was 0.3 logMAR on day 1, which improved to 0.2 logMAR at 1 week. At 1 year, the UDVA was 0.2 logMAR improving to 0.1 logMAR with refraction, with minimal paracentral corneal haze and no signs of corneal ectasia.

Corneal Graft Rejection After Inactivated SARS-CoV-2 Vaccine: Case Report.

PURPOSE: Our aim was to report the case of endothelial corneal allograft rejection after inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine with an atypical presentation. METHODS: This was a case report. RESULTS: A 63-year-old woman with previous penetrating keratoplasty and laser in situ keratomileusis presented with clinical signs of endothelial corneal graft rejection 24 hours after CoronaVac (SinoVac Biotech, Beijing/China) vaccine. Slitlamp examination showed corneal edema and interface fluid accumulation. It was partially resolved after treatment with topical corticosteroids and polydimethylsiloxane. CONCLUSIONS: Corneal allograft rejection was already reported after another SARS-CoV-2 vaccine. This is the first report in the literature describing a possible association with inactivated SARS-CoV-2 vaccine and corneal allograft rejection, especially with laser in situ keratomileusis interface fluid accumulation presentation. Ophthalmologists should be aware of this potential complication.

Comparison of Wavefront-Guided Femtosecond LASIK and Optimized SMILE for Correction of Moderate-to-High Astigmatism.

PURPOSE: To compare refractive outcomes, higher order aberrations (HOAs), and the changes in contrast sensitivity after wavefront-guided femtosecond laser-assisted in situ keratomileusis (WFG LASIK) and optimized small incision lenticule extraction (SMILE) for moderate-to-high astigmatism correction. METHODS: This prospective, randomized study included 87 eyes: 40 eyes in the WFG LASIK group and 47 eyes in the SMILE group. Manual cyclotorsion compensation by marking the horizontal axis before SMILE surgery was used for optimized SMILE. Refractive diopter, aberrations, and contrast sensitivity were assessed 3 months postoperatively. The Alpins vector analysis method was used to analyze the astigmatic changes after surgery. RESULTS: There were no significant differences in the corrected distance visual acuity and refraction between the two groups after surgery. The fitted curve of surgically induced astigmatism versus target induced astigmatism was described as y = 0.9905 x + 0.0009 in the WFG LASIK group and y = 0.9672 x + 0.0026 in the SMILE group. The percentage of corneal astigmatism axis change within 5 degrees was statistically significant (chi-square test: 10.632, P = .001). HOAs increased in both the WFG LASIK and SMILE groups after surgery (t = -3.655, P = .001, t = -3.784, P = .001, respectively). However, comparison of the changes of HOAs between both groups was not significant (t = -0.565, P = .575). The improvement in contrast sensitivity in the WFG LASIK group was significantly higher than that in the SMILE group. CONCLUSIONS: WFG LASIK and optimized SMILE can achieve similar outcomes for astigmatism correction. Optimized SMILE with marking could achieve good astigmatism correction, even without an eye tracking system. [J Refract Surg. 2021;37(3):166-173.].

Quantitative shadowgraphy of aerosol and droplet creation during oscillatory motion of the microkeratome amid COVID-19 and other infectious diseases.

PURPOSE: To quantify the atomization of liquid over the cornea during flap creation using microkeratome using high-speed shadowgraphy. SETTING: Laboratory study. DESIGN: Laboratory investigational study. METHOD: In an experimental setup, flap creation was performed on enucleated goat's eyes (n = 8) mounted on a stand using One Use-Plus SBK Moria microkeratome (Moria SA) to assess the spread of aerosols and droplets using high-speed shadowgraphy. Two conditions were computed. A constant airflow assumed uniform air velocity throughout the room. A decaying jet assumed that local air velocity at the site of measurements was smaller than the exit velocity from the air duct. RESULTS: With the advancement of the microkeratome across the wet corneal surface, the atomization of a balanced salt solution was recorded on shadowgraphy. The minimum droplet size was ∼90 µm. The maximum distance traversed was ∼1.8 m and ∼1.3 m assuming a constant airflow (setting of refractive surgery theater) and decaying jet condition (setting of an operating theater with air-handling unit), respectively. CONCLUSIONS: The microkeratome-assisted LASIK flap creation seemed to cause spread of droplets. The droplet diameters and velocities did not permit the formation of aerosols. Therefore, the risk of transmission of the virus to the surgeon and surgical personnel due to the microkeratome procedure seemed to be low.