Postoperative supine position after primary Descemet-stripping automated endothelial keratoplasty reduces graft detachment rate.

OBJECTIVE: To characterize the association between prolonged supine postoperative positioning of patients undergoing Descemet-stripping automated endothelial keratoplasty (DSAEK) and graft dislocation rate. METHODS: In this retrospective cohort study, medical records of patients who underwent uncomplicated DSAEK surgery at Yitzhak Shamir Medical Center between 2010 and 2019 were reviewed. Nursing documentation of patients' adherence to supine positioning during the postoperative hospitalization period was collected. A patient was considered compliant if he or she was documented as cooperative with supine positioning throughout the first 24 hours. RESULTS: A total of 170 eyes of 138 patients were found eligible. Main indications for surgery were pseudophakic bullous keratopathy (50.6%), previous graft failure (25.9%), and Fuch's endothelial dystrophy (FED; 20.6%). Twelve surgeries were combined with cataract extraction. Postoperative graft detachment occurred in 26 eyes (15.3%) after an average period of 1 day (range, 0-20 days). Compliance with supine positioning was documented in 84.1% (n = 143 patients). Noncompliance rates during the first 24 hours in the detached and nondetached groups were 26.9% (n = 7) and 14.4% (n = 20), respectively; after adjustment for possible confounders, the odds ratio (OR) was 1.44 (p = 0.249). Graft dislocation was observed in 13.3% (19 of 143) and 25.9% (7 of 27) of cooperative and noncooperative patients, respectively (p = 0.17). Subanalysis of 120 eyes with either BPK or FED for which it was the first transplantation demonstrated a protective effect of supine positioning (OR 3.42, confidence interval 1.095-10.700; p = 0.034). Findings for both groups remained unchanged in multivariate analysis. CONCLUSIONS: We found a statistically significant protective effect of 24 hours of postoperative supine positioning against graft detachment after DSAEK in eyes with no prior transplantations.

Corneal Cross-Linking in Pediatric Patients: Evaluating Treated and Untreated Eyes-5-Year Follow-Up Results.

PURPOSE: To evaluate the long-term results of corneal collagen cross-linking (CXL) for treatment of pediatric keratoconus and the long-term outcomes of the fellow untreated keratoconic eye in patients younger than 18 years old. METHODS: A retrospective case analysis was performed on 88 eyes of 44 patients aged 18 years or younger, with keratoconus, who underwent CXL in at least 1 eye. Follow-up measurements, for the treated and untreated eye pair, taken up to 5 years after treatment, were compared with baseline values. Parameters included uncorrected distance visual acuity (UCDVA), best spectacle-corrected distance visual acuity (BCDVA), manifest refraction, pachymetry, and corneal topography and tomography. RESULTS: Mean age of patients was 15.6 ± 2.1 years. For the treated eyes, during all years of follow-up, UCDVA improved significantly (from 0.83 ± 0.30 to 0.72 ± 0.28 logMAR; P = 0.01). Improvement in BCDVA was not statistically significant (from 0.28 ± 0.19 to 0.23 ± 0.15 logMAR; P = 0.06). The manifest cylinder showed a significant reduction (from 5.8 ± 3.6 to 4.3 ± 2.5 diopters; P = 0.006). There was no significant change in maximum keratometry. Average keratometry and corneal thickness reduced significantly (P = 0.009 and P = 0.002, respectively). Five patients had very mild corneal haze after CXL. For the fellow untreated eyes-during 5 years of follow-up, UCDVA showed a slight decrease that was not statistically significant. BCDVA, average keratometry, and maximum keratometry remained stable. CONCLUSIONS: Our long-term follow-up study suggests that CXL is a safe procedure in the pediatric age, and there is no urgency in treating pediatric patients with keratoconus without proof of progression.

Accuracy and feasibility of axial length measurements by a new optical low-coherence reflectometry-based device in eyes with posterior subcapsular cataract.

PURPOSE: To evaluate the feasibility and accuracy of measuring axial length (AL) by a new optical low-coherence reflectometry (OLCR)-based device in eyes with central posterior subcapsular cataract (PSC). SETTING: Department of Ophthalmology, Assaf-Harofeh Medical Center, Zerifin, Israel. DESIGN: Retrospective case series. METHODS: Consecutive cases of patients who had uneventful cataract surgery and whose preoperative AL measurements were not feasible with the partial coherence interferometry (PCI) device because of a central PSC were assessed. Preoperative AL was measured by the OLCR device and immersion ultrasound (US). Preoperative results were compared with the postoperative AL measurements obtained by the PCI. RESULTS: Twenty-seven patients (27 eyes) were enrolled in the study. The median difference between the OLCR and the PCI AL measurements (0.07 mm) was lower than the median difference between the US and the PCI AL measurements (0.13 mm) (P = .016). The ranges of the limits of agreement were 0.15 mm between OLCR and PCI, and 0.88 mm between US and PCI. The proportion of eyes with an AL difference of less than 0.1 mm was significantly higher between the OLCR and the PCI devices (24 eyes [88.9%]) than between the US and the PCI devices (9 eyes [33.3%]) (P = .001). CONCLUSIONS: The OLCR-based device successfully measured the preoperative AL in all eyes with central PSC for which preoperative PCI scans were not feasible. These measurements had a high level of agreement with the postoperative AL measurements obtained by the PCI device.

NHS Gene Mutations in Ashkenazi Jewish Families with Nance-Horan Syndrome.

PURPOSE: To describe ocular and extraocular abnormalities in two Ashkenazi Jewish families with infantile cataract and X-linked inheritance, and to identify their underlying mutations. METHODS: Seven affected members were recruited. Medical history, clinical findings, and biometric measurements were recorded. Mutation analysis of the Nance-Horan syndrome (NHS) gene was performed by direct sequencing of polymerase chain reaction-amplified exons. RESULTS: An unusual anterior Y-sutural cataract was documented in the affected male proband. Other clinical features among examined patients included microcorneas, long and narrow faces, and current or previous dental anomalies. A nonsense mutation was identified in each family, including a previously described 742 C>T, p.(Arg248*) mutation in Family A, and a novel mutation 2915 C>A, p.(Ser972*) in Family B. CONCLUSIONS: Our study expands the repertoire of NHS mutations and the related phenotype, including newly described anterior Y-sutural cataract and dental findings.

Reversibility of retinal ischemia due to central retinal artery occlusion by hyperbaric oxygen.

PURPOSE: Ischemic retinal damage can be reversed by hyperbaric oxygen therapy (HBOT) as long as irreversible infarction damage has not developed. However, the time window till irreversible damage develops is still unknown. The study aim was to evaluate the effect of HBOT and determine possible markers for irreversible retinal damage. MATERIALS AND METHODS: Retrospective analysis of 225 patients treated with HBOT for central retinal artery occlusion (CRAO) in 1999-2015. One hundred and twenty-eight patients fulfilled inclusion/exclusion criteria: age >18 years, symptoms <20 hours, and best-corrected visual acuity (BCVA) <0.5 logMAR. RESULTS: Time delay from symptoms to treatment was 7.8±3.8 hours. The BCVA was significantly improved after HBOT, from 2.14±0.50 to 1.61±0.78 (P<0.0001). The proportion of patients with clinically meaningful visual improvement was significantly higher in patients without cherry-red spot (CRS) compared to patients with CRS at presentation (86.0% vs 57.6%, P<0.0001). The percentage of patients with final BCVA better than 1.0 was also significantly higher in patients without CRS vs patients with CRS at presentation (61.0% vs 7.1%, P<0.0001). There was no correlation between CRS and the time from symptoms. HBOT was found to be safe, and only 5.5% of patients had minor, reversible, adverse events. CONCLUSION: HBOT is an effective treatment for non-arteritic CRAO as long as CRS has not formed. The fundus findings, rather than the time delay, should be used as a marker for irreversible damage.

Macular Corneal Dystrophy and Posterior Corneal Abnormalities.

PURPOSE: This study reports the presentation of 2 families with macular corneal dystrophy (MCD). The aim of this study was to show whether ultrasound biomicroscopy (UBM) can, based on posterior changes of the cornea in MCD, assist in the choice of surgery, either anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK), compared with optical coherence tomography (OCT) and Scheimpflug. METHODS: Six patients with MCD were examined for their best-corrected visual acuity, slit-lamp, OCT, UBM, and Scheimpflug findings. Blood samples for DNA and exons of the CHST6 gene were screened for mutations. RESULTS: All 6 patients showed typical MCD signs at the slit lamp. Corneal transplantation was required in 2 patients in both eyes. Recurrence of MCD was observed in 2 eyes after the DALK procedure (patient A5, age 48 years, right eye and B1, 51 years, left eye), whereas the 2 eyes after PK (patient A5, age 48 years, left eye and patient B1, 51 years, right eye) remained clear (for 10 years of follow-up in patient A5 and 4 years in patient B1). In 2 patients (A1 and A3), corneal thinning could be evaluated by OCT. In 3 patients (A2, 3, and 4), UBM disclosed deeper pathologies including opacities, loss of continuity, and focal protrusions of the posterior cornea, which were not evident by other devices. In family A, a novel mutation was identified. CONCLUSIONS: Our UBM examination of MCD shows alterations of the cornea's posterior layer and confirms the known clinical and histological findings of MCD that PK represents the therapy of choice, contrary to DALK. The novel CHST6 mutation shows the heterogeneity of MCD.

Ocular anterior segment changes in pregnancy.

PURPOSE: To evaluate the changes occurring in the cornea, anterior segment anatomy, and intraocular pressure (IOP) in pregnant women. SETTING: Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin, Israel. DESIGN: Prospective single-center comparative study. METHODS: The Ocular Response Analyzer dynamic bidirectional applanation device and the Pentacam HR Scheimpflug imaging system were used to obtain data on the anterior eye segments of healthy pregnant and nonpregnant women. RESULTS: Sixty pregnant and 60 nonpregnant women were enrolled. The Goldmann-correlated IOP and corneal-compensated IOP were significantly lower in the pregnant group (mean 10.96 mm Hg versus 12.97 mm Hg, P<.001; and 10.97 mm Hg versus 13.16 mm Hg, P<.001, respectively). The corneal front steep keratometry value was statistically significantly higher in the pregnant group (44.81 diopters [D] versus 44.1 D, P=.039). No significant difference was found in corneal hysteresis, the corneal resistance factor, corneal posterior curvature, central corneal thickness and volume, anterior chamber depth and volume, or iridocorneal angle. CONCLUSIONS: Pregnancy was associated with greater corneal curvature and lower IOP. Further studies should be performed to learn whether these alterations result from changes in corneal biomechanical properties during pregnancy. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Corneal collagen cross-linking for the treatment of progressive keratoconus: 3-year prospective outcome.

OBJECTIVE: To assess the long-term effects of treatment of progressive keratoconus with ultraviolet A-riboflavin collagen cross-linking (CXL). DESIGN: This was a prospective clinical study. PARTICIPANTS: Seventeen eyes of 17 patients with progressive keratoconus were treated with CXL. METHODS: Patients were examined preoperatively, at week 1, months 1, 3, 6, 9, 12, 24, and 36 after treatment. We assessed uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA), refraction, biomicroscopy and fundus appearance, intraocular pressure, endothelial cell density (ECD), corneal topography, minimal corneal thickness (MCT), macular optical coherence tomography, axial length, and corneal biomechanics with the ocular response analyzer. RESULTS: Comparing the 36-month time point results with pretreatment values, we found that UCVA and BSCVA were unchanged. Steepest meridian keratometry (D) and mean cylinder (D) did not show significant change compared with pretreatment values but showed a slight increase as compared with the 24-month time point (53.9 vs 51.7 vs 52.5, and 10.5 vs 8.1 vs 9.2 before, at 24 months, and at 36 months, respectively). Axial length (mm) showed an elongation trend throughout the follow-up period (24.56 vs 24.61 [p = 0.04] vs 24.71 [p = 0.05], before, at 24 months, and at 36 months, respectively). No significant change was observed in ECD, corneal hysteresis and corneal resistance factor, MCT, or foveal thickness. CONCLUSIONS: Three-year results after CXL show stable visual acuity, stable corneal thickness, and stable corneal biomechanical parameters. The decreasing trend in keratometry values that was observed during the first 2 years after CXL was no longer evident. Longer follow-up is needed to decide whether it is a first sign of loss of achieved stability and resumption of keratoconus progression.

Riboflavin/UVA photochemical therapy for severe infectious keratitis.

PURPOSE: To describe the antibacterial activity of treatment with riboflavin and ultraviolet A light (UVA) in cases of severe infectious keratitis. METHODS: A retrospective analysis was performed of an interventional case series in which 6 eyes of 6 patients with severe infectious keratitis, all of whom were refractive to multidrug conventional therapy, were treated with riboflavin/UVA. The procedure was conducted according to the standardized protocol of corneal collagen crosslinking (CXL) for keratoconus. Best spectacle-corrected visual acuity and clinical outcomes were evaluated before and during the follow-up period. RESULTS: Five of the 6 patients showed rapid reduction in symptoms and decreased infiltrate size after riboflavin/UVA photochemical therapy. Signs of infection and inflammation mostly resolved within 1 to 2 weeks after the treatment. Despite this therapy, one patient continued to deteriorate, and penetrating keratoplasty was performed. CONCLUSIONS: The adjunctive use of riboflavin/UVA photochemical therapy has a positive effect on refractory infectious keratitis. The treatment seems to be safe and effective and should be considered as part of the first-line therapy in severe cases of infectious keratitis.

Results of cataract surgery with Z-flex hydrophilic acrylic toric IOL.

PURPOSE: To report the outcome of cataract surgery with implantation of the Z-flex 690TA hydrophilic acrylic toric intraocular lens (IOL).
 METHODS: We enrolled consecutive patients who had 1.75 D or more of preexisting corneal astigmatism. Patients had cataract extraction surgery with implantation of a Z-flex 690TA toric IOL (Medicontur, Hungary). Refractive outcomes, keratometry, correction ratio (CR), and error of magnitude (EM) were evaluated. RESULTS: Nineteen eyes of 13 patients were evaluated. Mean follow-up time was 4.3 ± 2.3 months. Mean preoperative keratometric astigmatism was 3.05 ± 0.74 D. Mean postoperative deviation from the anticipated spherical equivalent was +0.23 ± 0.39 D, with 100% of eyes achieving a spherical equivalent within ± 1.00 D of the target refraction. Mean deviation from the anticipated refractive cylinder was 0.46 ± 0.47 D. Mean IOL misalignment was 5.67 ± 6.45 degrees. Mean CR was 1.02 ± 0.22, and the mean EM was -0.09 ± 0.55 D. CONCLUSION: The Z-flex 690TA hydrophilic acrylic toric IOL implantation was safe, effective, and predictable in correcting corneal astigmatism during cataract surgery.

Use of amphoteric rinsing solution for treatment of ocular tissues exposed to nitrogen mustard.

PURPOSE: Ocular exposure to mustard agents may cause severe and prolonged injury to the anterior segment tissues. Effective decontamination of the external eye surface after exposure is of paramount importance. The purpose of the present study was to assess the effectiveness of Diphoterine rinsing solution (DRS) in reducing ocular damage after exposure to nitrogen mustard (NM) and to compare it with normal saline solution. METHODS: One eye of 16 New Zealand albino rabbits was exposed to 2% NM. Immediate thorough irrigation was performed with either 500 ml of DRS (treated group) or with 500 ml of normal saline (control group). The magnitude of ocular injury and response to treatment were assessed by examiners masked to the treatment assignment during 22 days following the exposure. RESULTS: Immediate ocular irrigation with DRS was more effective compared with saline in reducing corneal, iris and anterior chamber injury. In the DRS-treated group, the corneal opacity and corneal neovascularization were less severe, and development of iris atrophy was delayed. Intraocular pressure (mmHg) was better maintained when compared to the control group (day 7 24.3 versus 14.8, p = 0.003; day 12 28 versus 15, p = 0.003; day 22 33.5 versus 21.8, p = 0.014, respectively). Systemic oxidative stress associated with exposure to NM was significantly higher in the saline-treated group than in DRS-treated group (p < 0.011). CONCLUSIONS: The findings of this study indicate the effectiveness of DRS in reducing of NM-induced ocular injuries. Its use should be considered as an immediate treatment modality following exposure to mustard agents to reduce potential ocular injury.

Repeatability of the Sirius imaging system and agreement with the Pentacam HR.

PURPOSE: To assess measurement repeatability of corneal curvature, minimal corneal thickness, and anterior chamber depth obtained with the Sirius imaging system (Costruzioni Strumenti Oftalmici) and to assess its agreement with the Pentacam HR imaging system (Oculus Optikgeräte GmbH). METHODS: Healthy individuals were prospectively recruited. To assess repeatability, eight consecutive measurements were performed in the right eye of healthy individuals with the Sirius. A single measurement was then performed consecutively with both systems. The anterior and posterior corneal radii (antR and posR, respectively), anterior chamber depth, and minimal corneal thickness were evaluated. Repeatability of Sirius was evaluated by calculating coefficients of variation (CoV). Agreement between Sirius and Pentacam was assessed by calculating 95% limits of agreement (LoA) and plotting Bland-Altman graphs. RESULTS: Forty-five eyes from individuals (21 men, 24 women) aged 20 to 61 years were evaluated. The mean CoV was 0.37% and 1.32% for antR and posR at 3 mm, respectively, and 0.36% and 1.28% for antR and posR at 7 mm, respectively. For anterior chamber depth and minimal corneal thickness, the CoV was 0.56% and 1.69%, respectively. Calculated 95% LoA were -0.1 to 0.12 mm (mean difference: 0.018 mm) and -0.54 to 0.33 mm (mean difference: 0.1 mm) for antR and posR at 3 mm, respectively. For anterior chamber depth, 95% LoA was -0.23 to 0.09 mm (mean difference: 0.068 mm) and -9.61 to 33.44 µm (mean difference: 11.91 µm) for minimal corneal thickness. CONCLUSIONS: The Sirius showed good to excellent repeatability for all measured parameters. Agreement analysis suggests that Sirius and Pentacam should not be used interchangeably.

Characterization and comparison of the 10-2 SITA-standard and fast algorithms.

PURPOSE: To compare the 10-2 SITA-standard and SITA-fast visual field programs in patients with glaucoma. METHODS: We enrolled 26 patients with open angle glaucoma with involvement of at least one paracentral location on 24-2 SITA-standard field test. Each subject performed 10-2 SITA-standard and SITA-fast tests. Within 2 months this sequence of tests was repeated. RESULTS: SITA-fast was 30% shorter than SITA-standard (5.5 ± 1.1 vs 7.9 ± 1.1 minutes, P < 0.001). Mean MD was statistically significantly higher for SITA-standard compared with SITA-fast at first visit (Δ = 0.3 dB, P = 0.017) but not second visit. Inter-visit difference in MD or in number of depressed points was not significant for both programs. Bland-Altman analysis showed that clinically significant variations can exist in individual instances between the 2 programs and between repeat tests with the same program. CONCLUSIONS: The 10-2 SITA-fast algorithm is significantly shorter than SITA-standard. The two programs have similar long-term variability. Average same-visit between-program and same-program between-visit sensitivity results were similar for the study population, but clinically significant variability was observed for some individual test pairs. Group inter- and intra-program test results may be comparable, but in the management of the individual patient field change should be verified by repeat testing.

Clinical and corneal biomechanical changes after collagen cross-linking with riboflavin and UV irradiation in patients with progressive keratoconus: results after 2 years of follow-up.

PURPOSE: To assess the biomechanical and keratometric effects and the safety of treatment of progressive keratoconus with UV-riboflavin collagen cross-linking (CXL). METHODS: This is a prospective clinical controlled study. Fourteen eyes of 14 patients with progressive keratoconus were treated with CXL after corneal deepithelization. Patients were assessed preoperatively, at week 1 and at months 1, 3, 6, 9, 12, and 24 after treatment. We measured uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) (logarithm of the minimum angle of resolution), refraction, biomicroscopy and fundus examination, intraocular pressure, axial length, endothelial cell density, corneal topography, minimal corneal thickness, macular optical coherence tomography, and corneal biomechanics with the ocular response analyzer. RESULTS: Comparing the preoperative results with 24-month postoperative results, we observed significant improvement in BCVA (0.21 ± 0.1 to 0.14 ± 0.1, P = 0.002) and stability in UCVA (0.62 ± 0.5 and 0.81 ± 0.49, P = 0.475). We observed a significant decrease in steepest-meridian keratometry (diopters) (53.9 ± 5.9 to 51.5 ± 5.4, P = 0.001) and in mean cylinder (diopters) (10.2 ± 4.1 to 8.1 ± 3.4, P = 0.001). Significant elongation of the eyes was observed, from 24.39 ± 1.7 mm to 24.71 ± 1.9 mm (P = 0.007). No significant change was observed in mean simulated keratometry, minimal corneal thickness, endothelial cell density, corneal hysteresis, and corneal resistance factor or foveal thickness. CONCLUSIONS: Two years after CXL, the observation of stable UCVA, improved BCVA, and reduced keratometry suggests stabilization in progression of keratoconus. Unchanged corneal thickness, endothelial cell density, and foveal thickness suggest the long-term safety of this procedure. The observed increase in axial length and stability in corneal biomechanical parameters measured with the ocular response analyzer require further study for verification and explanation.

Angle closure in Caucasians--a pilot, general ophthalmology clinic-based study.

PURPOSE: To assess the rate of clinically significant angle closure in a predominantly Caucasian, clinic-based population, and consequently find out whether gonioscopy should be included in the routine ophthalmic examination. METHODS: Patients aged ≥40 years with hyperopia ≥1 D were consecutively recruited in a community general ophthalmology clinic. Detailed darkroom gonioscopy was done, and primary angle closure was diagnosed if there was iridotrabecular apposition >180 degrees not secondary to an identifiable ocular disorder. Biometric parameters were measured and compared between the eyes with and without angle closure. RESULTS: Eighty-four eyes from 84 patients (aged 61.3±8.9 y) were enrolled. There were 52 female (62%) and 32 male. Fourteen patients (16.7%) were diagnosed with angle closure. A statistically significant difference was observed between the eyes with and without angle closure in mean axial length (22.07±0.72 vs. 22.61±0.97, P=0.028), anterior chamber depth (ACD) (2.45±0.33 vs. 2.89±0.32, P<0.001), and lens thickness (4.97±0.3 vs. 4.62±0.4, P=0.002). Degree of hyperopia was marginally significant (3.13±2.3 vs. 2.45±1.5, P=0.09). In a logistic regression model, only ACD remained statistically significantly different (P=0.016). We tested the ability of ACD to distinguish eyes with angle closure. The area under the receiver operating characteristic curve was 0.824; using a cutoff ACD value of 2.65 mm, sensitivity was 0.786 with a specificity of 0.812. CONCLUSIONS: Clinically significant angle closure, mandating close follow-up or preventive procedures, may be more common in Caucasians than currently thought. We recommend that gonioscopy should be included in the routine ophthalmic examination of all adults with hyperopia.

Variations in corneal biomechanical parameters and central corneal thickness during the menstrual cycle.

PURPOSE: To assess variations in the biomechanical properties and central corneal thickness (CCT) throughout the female menstrual cycle. SETTING: Department of Ophthalmology, Assaf Harofeh Medical Center, Zerifin Israel. DESIGN: Case series. METHODS: Young healthy women were prospectively recruited. Every participant was assessed at the beginning of the menstrual cycle, at ovulation, and at the end of the cycle. At every time point, corneal hysteresis (CH) and the corneal resistance factor (CRF) were measured with the Ocular Response Analyzer and the CCT was measured with an ultrasonic pachymeter. RESULTS: Twenty-two eyes of 22 women (mean age 19.5 years ± 1.5 [SD]) were included. The CH was statistically significantly decreased at ovulation (10.1 mm Hg) compared with the beginning (11.1 mm Hg, P<.001) and the end (11.4 mm Hg, P<.001) of the cycle. The CRF was also significantly decreased at ovulation (9.8 mm Hg) compared with the beginning (10.6 mm Hg, P<.001) and the end (10.5 mm Hg, P<.001) of the cycle. The central cornea was thinnest at the beginning (535 µm) and statistically significantly thicker at ovulation (542 µm, P<.001) and at the end of the menstrual cycle (543 µm, P<.001). CONCLUSIONS: The CCT and biomechanical parameters significantly varied during the menstrual cycle. The CH and CRF were temporarily decreased at ovulation. The cornea was thinnest at the beginning and thicker at ovulation and at the end of the cycle. Such corneal changes may be important to consider during screening of candidates for laser refractive surgery.

Balloon catheter dilatation versus probing as primary treatment for congenital dacryostenosis.

AIM: To compare the success rate of balloon catheter dilatation of the nasolacrimal duct with probing and irrigation as primary treatment for congenital dacryostenosis. METHODS: Charts of all children who were operated on for the first time for congenital dacryostenosis during the years 2004 to 2006 were analysed and the outcomes compared. Surgical success was defined as absence of epiphora and mucous discharge, and of increased tear lake, at the last visit. RESULTS: 68 children (114 eyes) underwent balloon catheter dilatation and 37 children (60 eyes) had probing. Children who had balloon dilatation were significantly older: mean age 55.98±113.6 (range 9.0-728.0) months as opposed to 18.5±6.5 (range 7.0-60.0) months, p<0.01). After a mean follow-up time of 15.4 (range 4-32) months, 102 of 114 eyes were defined as successfully treated following balloon catheter dilatation (89.5% success rate) compared with 52 of 60 eyes following probing (86.7% success rate, p=0.581). Five of six patients (80%) in which the #00 probe could only hardly be inserted into the nasolacrimal duct because of firm bone resistance failed in the probing group, as opposed to only 2/10 (20%) in the balloon catheter group (p=0.03). CONCLUSION: Children who had balloon catheter dilatation had a slightly better success rate than those who had probing; however, this difference was statistically significant only for patients who had a relatively narrow nasolacrimal bone duct.

Topical anesthetic abuse keratitis secondary to floppy eyelid syndrome.

PURPOSE: To report the diagnosis and management of a patient with chronic ophthalmic topical anesthetic abuse and floppy eyelid syndrome. METHODS: We describe the case of a 47-year-old man suffering from persistent bilateral ocular irritation and chronic corneal erosions. RESULTS: The patient was hospitalized in our ophthalmology department and underwent thorough ophthalmic, systemic, and psychiatric evaluation. Chronic topical anesthetic abuse was discovered. Removal of abused drops and copious lubricating treatment lead to partial improvement further permitting diagnosis of floppy eyelid syndrome. Definitive surgical treatment by horizontal eyelid tightening combined with continuous lubrication resulted in remission of symptoms. CONCLUSIONS: Uncommon conditions may coexist in 1 patient. In this case, floppy eyelid syndrome resulted in topical anesthetic abuse. Ophthalmologists should keep both these conditions in mind when treating patients with otherwise unexplained chronic persistent corneal erosions.

Goldmann applanation tonometry versus ocular response analyzer for intraocular pressure measurements in keratoconic eyes.

PURPOSE: To compare intraocular pressure (IOP) measurements obtained with the Goldmann applanation tonometer (GAT) and the ocular response analyzer (ORA) in patients with keratoconus (KC) and analyze their dependence on ocular anatomic parameters. METHODS: Patients with KC were recruited prospectively. IOP was measured using GAT and ORA. The ORA provided a Goldmann correlated IOP (IOPg) and a corneal correlated IOP (IOPcc). Assessment of refractive status, visual acuity, axial length, corneal topography, and pachymetry was done. RESULTS: Fifty-nine eyes of 59 patients with KC (39 men, 20 women; mean age: 27.8 +/- 6.8 years) were included. The differences in mean IOP values between GAT (10.9 +/- 2.0 mm Hg) and IOPg (9.5 +/- 2.8 mm Hg) and between GAT and IOPcc (13.3 +/- 2.5 mm Hg) were statistically significant (all P < 0.001). Both pressure measurements provided by the ORA showed significant correlation with corneal curvature. No significant effect of corneal thickness on any of the pressures was observed. CONCLUSIONS: IOP measurements taken with GAT and ORA in keratoconic eyes were significantly different. Although IOPcc was significantly higher, IOPg was significantly lower than GAT IOP. Unlike GAT measurements, ORA readings seemed to be affected mainly by corneal curvature. As a result of described differences, we suggest these devices should not be used interchangeably but rather in a complementary fashion to assess IOP in keratoconic eyes.

Treatment of dry eye syndrome with orally administered CF101: data from a phase 2 clinical trial.

OBJECTIVE: To explore the safety and efficacy of CF101, an A(3) adenosine receptor agonist, in patients with moderate to severe dry eye syndrome. DESIGN: Phase 2, multicenter, randomized, double-masked, placebo-controlled, parallel-group study. PARTICIPANTS: Sixty-eight patients completed the study, 35 patients in the placebo group and 33 patients in the CF101 group. INTERVENTION: Patients were treated orally with either 1 mg CF101 pills or matching vehicle-filled placebo pills, given twice daily for 12 weeks, followed by a 2-week posttreatment observation. MAIN OUTCOME MEASURES: An improvement of more than 25% over baseline at week 12 in one of the following parameters: (1) tear break-up time (BUT); (2) superficial punctate keratitis assessed by fluorescein staining results; and (3) Schirmer tear test 1 results. Clinical laboratory safety tests, ophthalmic examinations, intraocular pressure (IOP) measurements, electrocardiographic evaluations, vital sign measurements, and monitoring of adverse events. RESULTS: A statistically significant increase in the proportion of patients who achieved more than 25% improvement in the corneal staining and in the clearance of corneal staining was noted between the CF101-treated group and the placebo group. Treatment with CF101 resulted in a statistically significant improvement in the mean change from baseline at week 12 of the corneal staining, BUT, and tear meniscus (TM) height in the CF101-treated group. CF101 was well tolerated and exhibited an excellent safety profile with no serious adverse events. A statistically significant decrease from baseline was observed in the IOP of the CF101-treated group in comparison with the placebo group. CONCLUSIONS: CF101, given orally, induced a statistically significant improvement in the corneal staining and an improvement in the BUT and TM in patients with moderate to severe dry eye syndrome. The drug was very well tolerated. These data and the anti-inflammatory characteristic of CF101 support further study of the drug as a potential treatment for the signs and symptoms of dry eye syndrome. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found after the references.