Ocular Surface Changes in Patients with Thyroid Eye Disease: An Observational Clinical Study.

BACKGROUND: This study aimed to compare ocular surface parameter changes in active and inactive thyroid eye disease (TED) patients and controls. METHODS: This is an observational clinical study that included 60 eyes divided into three groups following clinical activity score (CAS) assessment. The first group (Group A) comprised 20 eyes with active TED (CAS score ≥3/7), while the second group (Group B) comprised 20 eyes with inactive TED (CAS score <3/7) and the third group (Group C) comprised 20 eyes of controls without dry eye manifestations. The palpebral fissure height, degree of proptosis, degree of lagophthalmos, ocular surface disease index (OSDI), Schirmer test without anesthesia, corneal fluorescein staining (CFS), non-invasive tear break-up time (NITBUT), tear meniscus height (TMH), lipid layer thickness (LLT), meiboscore, meibomian gland dysfunction (MGD), and thyroid antibodies were assessed and data were compared between study participants. RESULTS: The mean OSDI was 40.0 ±5.80 in Group A, which significantly differed from Group B with a mean of 26.5 ±5.10 (p=0.02). There were significant differences between the two groups regarding palpebral fissure height (p=0.02), amount of proptosis (p=0.008), and degree of lagophthalmos (p=0.001). Similarly, active TED patients had more decreased tear secretion than inactive TED patients (p=0.012). Moreover, active TED patients showed a significant increase in Meibomian gland loss areas in both upper and lower eyelids compared with inactive TED patients (p=0.001). Corneal fluorescein staining also revealed a statistically significant difference between the studied groups (p=0.0001). CONCLUSION: This study showed differences regarding ocular surface parameter changes between both active and inactive TED and compared to controls. Further studies are needed to confirm these results.

The 7-Year Outcomes of Epithelium-Off Corneal Cross-linking in Progressive Keratoconus.

PURPOSE: To evaluate the clinical results of epitheliumoff corneal cross-linking (CXL) during a 7-year follow-up. METHODS: This retrospective, non-randomized, single-center interventional study enrolled 34 consecutive eyes of 24 patients with progressive keratoconus undergoing CXL surgery with epithelium removal. Visual, refractive, corneal topographic, pachymetric, and anterior segment changes were evaluated at 1, 3, and 7 years after surgery. RESULTS: Significant reduction of refraction was observed at 1 year postoperatively (P ≤ .006), with an additional significant reduction between the 1- and 3-year postoperative visits (P ≤ .002) and no significant changes afterward (P ≥ .156). Regarding corrected distance visual acuity (CDVA), a significant improvement was detected at 1 year after surgery (P < .001), with an additional improvement between 1 and 3 years postoperatively (P = .001), and no significant changes at the end of the follow-up (P = .518). Significant corneal flattening was observed at 1, 3, and 7 years after surgery (P ≤ .041). Likewise, a significant central thinning was observed at 1 year postoperatively (P < .001), with no significant changes afterward (P ≥ .112). Anterior maximum elevation only changed significantly between 1 and 3 years after surgery (P = .002), whereas the posterior maximum elevation changed significantly at all time points of the follow-up (P ≤ .034). No significant changes with surgery in anterior segment volume (P ≥ .377) and anterior chamber depth (P ≥ .142) were detected. CONCLUSIONS: The effect of epithelium-off CXL in progressive keratoconus is maintained 7 years after surgery. Long-term corneal changes after this procedure may be influenced by an age-related corneal stiffening process. [J Refract Surg. 2018;34(3):181-186.].

Comparative Analysis of the Clinical Outcomes of SMILE and Wavefront-Guided LASIK in Low and Moderate Myopia.

PURPOSE: To compare the clinical outcomes of small incision lenticule extraction (SMILE) and wavefront-guided LASIK (WFG LASIK) in eyes with low and moderate myopia. METHODS: This was a prospective, comparative study enrolling 110 eyes with low and moderate myopia (spherical equivalent ≤ 6.00 diopters [D]). Two groups were differentiated according to the surgical technique used: the WFG LASIK group included 51 eyes (51 patients) undergoing WFG LASIK using the STAR S4IR excimer laser and the iDesign aberrometer (Abbott Medical Optics, Abbott Park, IL) and the SMILE group included 59 eyes (59 patients) undergoing SMILE with the VisuMax platform (Carl Zeiss Meditec, Jena, Germany). Visual, refractive, aberrometric, and contrast sensitivity outcomes were evaluated during a 6-month follow-up. RESULTS: Mean efficacy index was 0.92 ± 0.11 and 1.12 ± 0.17 in the SMILE and WFG LASIK groups, respectively (P < .001). Postoperative spherical equivalent was within ±0.50 D in 81.54% and 98% of eyes in the SMILE and WFG LASIK groups (P < .001), and postoperative cylinder was 0.50 or below in 84.7% and 100% of eyes, respectively (P = .038). Mean safety index was 0.98 ± 0.08 and 1.20 ± 0.14 in the SMILE and WFG LASIK groups (P < .001), with losses of lines of corrected distance visual acuity in 6.8% and 0.0% of eyes, respectively. Higher increase in higher order (P < .001) and coma (P < .001) root mean square and higher decrease in contrast sensitivity for 6, 12, and 18 cycles/degree (P ≤ .001) were observed after SMILE. CONCLUSIONS: SMILE and WFG LASIK are efficacious and safe procedures for the correction of low and moderate myopia, but WFG LASIK allows a more predictable outcome and better aberrometric control. [J Refract Surg. 2017;33(5):298-304.].

Evaluation of a toric implantable collamer lens after corneal collagen crosslinking in treatment of early-stage keratoconus: 3-year follow-up.

PURPOSE: The aim of this study was to assess the predictability, efficacy, safety, and stability in patients who received a toric implantable collamer lens (TICL) after collagen crosslinking in early-stage keratoconus. METHODS: This prospective interventional case series study was conducted at the Alexandria Main University hospitals, University of Alexandria, Egypt. Sixteen eyes underwent implantation of a TICL (STAAR Surgical Inc) after crosslinking. The mean spherical refraction was -5.98 ± 4.39 diopters (D) (range, -0.50 to -14.50 D), and the mean cylinder was -4.91 ± 1.51 D (range, -2.50 to -7.75 D). Uncorrected distance visual acuity (UDVA), manifest and cycloplegic refraction, corrected distance visual acuity (CDVA), vault, intraocular pressure, and endothelial cell count (using specular microscopy) were evaluated during a 3-year follow-up. RESULTS: The mean Snellen decimal CDVA improved from 0.56 ± 0.13 (range, 0.40-0.80) preoperatively to 0.89 ± 0.17 (range, 0.60-1.20) at 3 years of the follow-up (P < 0.0001). The mean UDVA also improved significantly from 0.63 ± 0.14 before ICL implantation to 0.88 ± 0.18 after 3 years of the follow-up (P < 0.001). At 3 years, the mean spherical and cylindrical manifest refractions were 0.00 ± 0.18 D and -0.05 ± 0.14 D, respectively. At the end of the follow-up, the vault was 509.75 ± 141.47 µm (range, 320-900) and the intraocular pressure was 11.94 ± 1.12 mm Hg. No complications occurred during the surgical procedures. No eye needed explantation or repositioning of the TICL. The endothelial cell count loss after 3 years was -8.98%. CONCLUSIONS: Correction of spherical and cylindrical refractive errors in keratoconic eyes by TICL implantation 12 months after crosslinking gave significantly promising outcomes, particularly in the astigmatic component of refraction.