Epithelial Flap Corneal Cross-linking.

PURPOSE: To compare standard epithelium-off corneal cross-linking (standard Epi-Off CXL) to corneal cross-linking with an epithelial flap (Epi-Flap CXL). METHODS: Patients who had undergone sequential bilateral CXL for progressive keratoconus were included in this comparative interventional case series. One eye was treated with the Epi-Off CXL technique and the fellow eye with the Epi-Flap CXL technique. Postoperative pain was measured using the Verbal Rating Scale and corneal densitometry using a Scheimpflug camera. Sex, age, corrected distance visual acuity, keratometry, and corneal thickness were also recorded. RESULTS: Twenty-four eyes of 12 patients with keratoconus with a mean age of 27.15 ± 5.15 years were included. The Verbal Rating Scale scores were significantly lower in patients who had Epi-Flap CXL on the first (1.00 [interquartile range (IQR): 0.00 to 1.00] vs 3.00 [IQR: 3.00 to 3.75], P = .01) and third (0.00 [IQR: 0.00 to 1.00] vs 1.00 [IQR: 0.00 to 1.00], P = .01) postoperative day compared to the Epi-Off CXL group. No pain was observed in both groups after the third day. After 12 months, the Epi-Flap CXL group showed significantly less anterior corneal haze (measured as corneal densitometry) compared to the patients treated with Epi-Off CXL (P = .01). Both groups demonstrated stability of keratometry and corneal thickness at 12 months after CXL (P < .01). CONCLUSIONS: Epi-Flap CXL is associated with less postoperative pain and anterior stromal haze in patients undergoing CXL for progressive keratoconus with no loss of efficacy. [J Refract Surg. 2021;37(11):741-745.].

Plug the pit: a surgical technique for optic disc pit.

Purpose: To present a recently described surgical technique for the treatment of optic disc pit (ODP) and evaluate its outcomes. Methods: A patient presented with refractory serous macular detachment and secondary full thickness macular hole associated with ODP, for which he had already undergone pars-plana vitrectomy with internal limiting membrane peeling and autologous serum application over the optic disc pit. A recently described surgical technique was carried out to treat this case. In this procedure, a silicone punctal plug was used to close the ODP. The macular hole was closed with a human amniotic membrane graft. Endotamponade was carried out with 1000cs silicone oil. Results: Postoperatively, the serous macular detachment subsided and the punctal plug and amniotic membrane graft were in situ. Patient's visual acuity improved from counting fingers to 6/38 at one year postoperative. Conclusion: This technique appears to be safe and effective in resolving long standing serous macular detachment associated with ODP, which was refractory to the conventional intervention. However, more cases and longer follow-ups are needed to affirm the safety and efficacy of this recently described procedure.