Outcome indicators for cross linking in pediatric keratoconus.

Purpose: To evaluate the predictive factors for successful corneal collagen cross-linking (CXL) in pediatric patients with Keratoconus (KC). Methods: This retrospective study was conducted using a prospectively built database. Patients (18 years old or younger) underwent CXL for KC between 2007 and 2017, with a 1-year follow-up period or longer. The outcomes included changes in Kmax (delta [Δ] Kmax = Kmaxlast - Kmaxpre) and LogMAR visual acuity (ΔLogMAR = LogMARlast - LogMARpre).The effects of CXL type (accelerated or non-accelerated), demographics (age, sex, background of ocular allergy, ethnicity), preoperative LogMAR visual acuity, maximal corneal power (Kmax), pachymetry (CCTpre), refractive cylinder, and follow-up (FU) time on the outcomes were analyzed. Results: One hundred thirty-one eyes of 110 children were included (mean age, 16 ± 2 years; range, 10-18 years). Kmax and LogMAR improved from baseline to last visit: from 53.81 D ± 6.39 D to 52.31 D ± 6.06 D (p < 0.001) and from 0.27 ± 0.23 LogMAR units to 0.23 ± 0.19 LogMAR units (p = 0.005), respectively. A negative ΔKmax (meaning corneal flattening) was associated with a long FU, low CCTpre, high Kmaxpre, high LogMARpre, and non-accelerated CXL on univariate analysis. High Kmaxpre and non-accelerated CXL were associated with negative ΔKmax in the multivariate analysis.A negative ΔLogMAR (meaning vision improvement) was associated with a high LogMARpre in univariate analysis. Conclusion: CXL is an effective treatment option in pediatric patients with KC. Our results showed that the non-accelerated treatment was more effective than the accelerated treatment. Corneas with advanced disease had a greater effect on CXL.

Predicting factors for the efficacy of cross-linking for keratoconus.

PURPOSE: To evaluate predictors for success in corneal crosslinking (CXL) for keratoconus in a large cohort and extended follow-up. DESIGN: A retrospective study based on a prospectively built database. METHODS: Participants underwent CXL for keratoconus from 2007 to 2018. Statistical analysis was performed for patients with at least 1-year follow-up. We analyzed effects of CXL type (Epithelium-on or Epithelium-off and Accelerated (9mW/cm2@10min) or Standard (3mW/cm2@30min)) and pre-operative factors including age, gender, baseline LogMAR visual acuity (LogMARpre), maximal corneal power (Kmaxpre), pachymetry, refractive and topographic cylinders, spherical equivalent (SEpre), mean corneal power (MeanK) and follow-up time on outcome measures. The outcome measures were the final change of Kmax (Delta Kmax) and the final change in LogMAR visual acuity (Delta LogMAR). A more negative Delta Kmax or Delta LogMAR represents a favorable effect of crosslinking. RESULTS: 517 eyes had Kmax results, and 385 eyes had LogMAR results with more than one year follow-up. These eyes were included in the study. The mean follow-up time was 2.29 years. Mean Kmax decreased from 54.07±5.99 diopters to 52.84±5.66 diopters (p<0.001), and Mean LogMAR decreased from 0.28±0.20 to 0.25±0.21 (p<0.001). Non-accelerated epithelium-off CXL resulted in greater flattening of Kmax when compared with other protocols. Visual acuity improvement was similar when comparing different CXL protocols. Multivariate analysis showed four factors associated with negative Delta Kmax: high Kmaxpre, high SEpre, high MeanKpre, and non-accelerated procedure. Multivariate analysis showed three factors associated with negative Delta LogMAR: high LogMARpre, high SEpre, and Low MeanKpre. After excluding corneas with Kmaxpre >65 D or Pachymetry<400 microns, multivariate analysis showed that high Kmaxpre, high SEpre, and non-accelerated CXL were associated with negative Delta Kmax while high LogMARpre and high SEpre were associated with negative Delta LogMAR. CONCLUSION: CXL for keratoconus is a highly effective treatment, as evident by its effects on the outcome measures: Delta Kmax and Delta LogMAR. CXL was more successful in eyes with high Kmaxpre, high SEpre, and high LogMARpre, which express disease severity. The non-accelerated epithelium-off protocol was associated with greater flattening of corneal curvature but did not show a better effect on visual acuity as compared to the other CXL protocols.

The prevalence of corneal abnormalities in first-degree relatives of patients with keratoconus: a prospective case-control study.

PURPOSE: Although there is a high prevalence of keratoconus in the Middle East including Israel, limited data is available describing first-degree relatives of patients with sporadic keratoconus (KC) using Scheimpflug imaging. The purpose of this study is to accurately phenotype first-degree relatives of patients with sporadic KC in Israel using corneal tomography, which may help determine the genetic aetiology of KC. METHODS: First-degree relatives (N = 56) of 16 KC probands participated in this prospective case-control study. Healthy controls (N = 96) were from a previous study. Autorefraction, visual acuity, slit lamp biomicroscopy, retinoscopy, subjective refraction and Scheimpflug imaging (CSO Sirius Topographer) of keratoconus patients and their first-degree relatives were evaluated. The worse eye was used for KC and KC suspects. The main outcome measure was prevalence of abnormal corneal topography and tomography parameters, which was compared between first-degree relatives vs controls. p values < 0.05 were considered significant. RESULTS: KC (N = 2) or KC suspect (N = 8) was diagnosed in 18% (95% CI 8-28%) of the first-degree relatives. At least one abnormal corneal parameter was evident in 34% of first-degree relatives, while this was significantly lower for controls (14%, χ2(1,N = 152)  = 8.8, p = 0.01). Qualitative analysis showed KC first-degree relatives had significantly more abnormal anterior corneal topography patterns than controls (34% vs 17%, χ2(1,N = 152)  = 5.9, p = 0.02). For first-degree relatives, sex was not a factor influencing prevalence of corneal abnormalities (18% for both men and women, χ2(1,N = 56)  = 0.0, p = 1.0). A significant correlation was found for first-degree relatives between age and most corneal parameters, while this was not evident for the control group. CONCLUSIONS AND RELEVANCE: Eye care practitioners should consider first-degree relatives of patients with KC at moderate risk for the disease and/or corneal abnormalities.

Predictive factors for efficacy and safety in refractive surgery for myopia.

PURPOSE: To evaluate the predictive factors for safety and efficacy in laser refractive surgery for myopia. SETTING: A singular refractive surgery center, at a University-affiliated tertiary medical center. DESIGN: Retrospective cohort study. METHODS: Study population-A total 8,775 eyes having laser refractive laser procedures for myopia (in4,623 patients). Observation procedures-Using a prospective database of refractive procedures performed over the span of 13 years, variables such as gender, age, type of surgery, date of surgery, pre-operative corneal thickness and Spherical Equivalent (SEQ) were evaluated. Main outcome measures-Proportion of patients with Safety index higher than 0.85 and Efficacy index higher than 0.80. RESULTS: 91.9% and 86.0% of all evaluated eyes were above the safety and efficacy cut-off levels, respectively. Younger age was significantly correlated with safety and efficacy indices above the cut-off levels (p<0.001). Male gender was significantly correlated with efficacy above the cut-off level (p<0.001). Myopic eyes with lower SEQ were associated with both safety (p = 0.002) and efficacy (p<0.001) indices above the cut-offs. The surgical procedure was found to significantly affect the outcome only using univariate analysis: Safety was higher in Photorefractive Keratectomy (PRK), while Efficacy was higher in Laser Assisted In Situ Keratomileusis (LASIK) (p<0.001, respectively) but no difference was found using multivariate analysis. Safety index above the cut-off level increased over the years (p<0.001). CONCLUSIONS: Efficacy in refractive surgery for myopia is correlated with younger age, male gender and low myopia. Safety is correlated with younger age, low myopia and increases over the years. Multivariate analysis found no differences between PRK and LASIK regarding safety and efficacy.

Risk factors and incidence of ocular hypertension after penetrating keratoplasty.

PURPOSE: Ocular hypertension is a potentially serious complication after penetrating keratoplasty (PKP). Our objective is to determine the risk factors, incidence, patient characteristics, response to pressure-lowering medical therapy, and graft outcome associated with elevation of intraocular pressure after PKP. METHODS: One hundred forty-six consecutive eyes that had PKP between June 2001 and June 2003 were operated and managed at Hadassah-Hebrew University Medical Center. Chart review was performed seeking preoperative and postoperative data on risk factors for ocular hypertension after PKP. Univariate and logistic regression analysis were performed to identify significant risk factors. RESULTS: After surgery, 70 eyes (47.9%) had at least 1 period of ocular hypertension, with a mean intraocular pressure (IOP) of 27.15±5.66 mm Hg. Ocular hypertension appeared after a mean postoperative period of 70.3±15.8 days, and continued for an average period of 15.6±2.0 days. In 35 eyes (23.9%), a second episode of IOP elevation was noted 212.2±46.8 days after the surgery. Logistic regression analysis revealed that preexisting glaucoma (P=0.009) and an additional surgical procedure combined with PKP (P=0.007) were the main factors predicting ocular hypertension after PKP. In 11 eyes (7.53%) the topical pressure-lowering therapy failed, and they required glaucoma filtering surgery. CONCLUSIONS: The incidence of ocular hypertension after PKP is high, and at least 1 episode of high IOP was noted in almost half of our patients. A history of preexisting glaucoma and an additional surgical procedure combined with PKP were found to be significant factors predicting the occurrence of ocular hypertension.

Scleral contact lenses for visual rehabilitation after penetrating keratoplasty: long term outcomes.

PURPOSE: To evaluate the success rate of highly gas permeable scleral contact lenses (SCL) for visual rehabilitation after penetrating keratoplasty (PK), over a period of up to 9 years. METHODS: A total database of 31 consecutive patient fitted with SCL between January 2004 and December 2009 was retrospectively reviewed. Demographic data, etiology prior to lens fitting, visual outcomes, follow up time and complications were analyzed. RESULTS: All eyes were fitted due to inadequate spectacle-corrected vision after successful penetrating keratoplasty or failure of other contact lens modalities. Out of 31 patients fitted, 28 (33 eyes) continue to wear SCL for periods between 0.5 and 8.8 years. The mean duration of follow-up after contact lens fitting was 5.2 ± 2.2 years. The mean age of corneal graft was 17.6 ± 11.4 years (range 4.3-42), and the mean interval between PK and initial contact lens fitting was 12.2 ± 10.7 years (range 0.7-36.0). The average steepest keratometry of our cohort was 55.0 ± 7.5 diopter (D) and the refractive astigmatism was 8.0 ± 4.4 D. The mean contact lens corrected visual acuity (BCVAcl) was 0.78 ± 0.25 (range 0.3-1.2). Twenty-three (82%) patients achieved a functional vision of 0.5 or more. During the studied period, ten (30.0%) eyes presented at least one graft rejection episode and two eyes (6%) had an episode of microbial keratitis. Corneal transplants of 20 years or more show a higher rate of refits due to ectasia recurrence. CONCLUSIONS: Scleral lenses should be considered as lens of choice in eyes with complex corneal geometry, as besides visual rehabilitation, their use may delay or prevent further surgical involvement.

Silicone hydrogel mini-scleral contact lenses in early stage after corneal collagen cross-linking for keratoconus: a retrospective case series.

BACKGROUND: The aim was to the evaluate performance of a novel silicone hydrogel mini-scleral contact lens (SHmS) for optical correction of keratoconus in the early stages after the corneal collagen cross-linking procedure (CXL). METHODS: We retrospectively analysed the visual acuity improvement and corneal adaptation in the first 10 eyes of nine patients fitted with SHmS lenses one to 3.5 months after corneal collagen cross-linking. The lenses were designed to rest over the patients' sclera and peri-limbal cornea and vault the central cornea with minimal support over it. Visual acuities with manifest refraction and contact lenses, refractive and topographical values (Kmin and Kmax) were evaluated on lens dispensing and after six month of lens wearing. Ocular physiological responses were evaluated using the Institute of Eye Research (IER) grading scales. RESULTS: SHmS fitting was performed 2.1 ± 0.97 (SD) months after collagen cross-linking. Mean follow up was 10.9 ± 4.41 months (range six to 18 months). Mean decimal visual acuity with SHmS was 0.66 ± 0.22 (approximately 6/9 Snellen fraction, range 0.3 to 0.1) or 0.75 ± 0.14 (approximately 6/8.1, range 0.5 to 1.0), when omitting two amblyopic eyes. Nine (90 per cent) eyes were successfully fitted, that is, able to wear the lenses for 10 hours per day or longer. Mean wearing time was 11.7 hours (range six to 14) per day. No corneal neovascularisation or papillary reaction was found in all fitted eyes. CONCLUSIONS: SHmS contact lenses provide successful visual rehabilitation shortly after corneal collagen cross-linking. This new soft contact lens design with scleral fixation and minimal apical touch was demonstrated to be safe shortly after collagen cross-linking, as the avoidance of contact with the treated zone minimises contact lens influence on corneal recovery.

LASIK correction of vision in adults with unilateral amblyopia.

PURPOSE: to evaluate the effects of laser refractive surgery in adult patients with mild to moderate amblyopia due to anisometropic myopia. METHODS: a retrospective review of 30 patients (60 eyes) with unilateral amblyopia (corrected distance visual acuity [CDVA] 0.6 or worse) who underwent simultaneous bilateral laser vision correction using the Technolas 217z excimer laser (Bausch & Lomb) was performed. Mean patient age was 31.03 ± 10.05 years (range: 18 to 53 years). Visual outcomes in the amblyopic eye were compared with those in the fellow nonamblyopic control eye of the same patient. RESULTS: mean preoperative CDVA improved in amblyopic eyes from 0.50 ± 0.13 to 0.57 ± 0.20 postoperatively (average gain of 0.075 ± 0.14; P=.007) and improved from 0.92 ± 0.12 preoperatively to 0.93±0.15 after surgery (mean gain of 0.013 ± 0.14; P=.603) in the fellow nonamblyopic eyes. The safety index was significantly greater in the amblyopic eyes compared with the nonamblyopic fellow eyes (1.15 ± 0.30 vs 1.02 ± 0.15, P=.035), therefore, no difference was noted in efficacy (P=.913). Five of 30 eyes with mild to moderate amblyopia gained 2 to 4 lines of CDVA. CONCLUSIONS: laser refractive surgery for myopic correction was found to be safe and effective in eyes with mild to moderate amblyopia.

Limbal stem cell deficiency after topical mitomycin C therapy for primary acquired melanosis with atypia.

PURPOSE: To describe the incidence, characteristics, risk factors, and clinical outcome of limbal stem cell deficiency (LSCD) resulting from topical treatment with mitomycin C (MMC) for primary acquired melanosis (PAM) with atypia. DESIGN: Retrospective, observational case series. PARTICIPANTS: Patients with LSCD who had been managed with topical MMC for PAM with atypia at the Ocular Oncology Service at the Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel, between 2000 and 2007. METHODS: Retrospective chart review of all patients with PAM with atypia was performed. Impression cytologic analysis of the corneal and conjunctival epithelium was performed in patients suspected of having LSCD. MAIN OUTCOME MEASURES: Evaluation of risk factors for LSCD, including demographic characteristics, MMC dosage, and length of treatment; and clinical and visual outcome of patients diagnosed with LSCD. RESULTS: Limbal stem cell deficiency was identified in 5 (23.8%) of 21 patients. The mean age+/-standard deviation of the 5 patients was 61.8+/-12.7 years compared with 43.7+/-16.1 years in patients in whom this complication did not develop (P = 0.025). Longer treatment periods of MMC were noted in eyes in which LSCD developed (78.4+/-24.8 days) compared with eyes without LSCD (37.7+/-3.1 days; P = 0.07). In 3 patients, spontaneous partial resolution of the LSCD was noted. CONCLUSIONS: High-dose topical MMC for PAM with atypia may be associated with a relatively high incidence of LSCD. Mitomycin C concentration and treatment regimen should be reevaluated to improve the safety of this treatment protocol.

Quantitative assessment of bandage soft contact lens wear immediately after LASIK.

PURPOSE: To evaluate the efficacy and tolerability of overnight bandage soft contact lenses applied immediately after LASIK. METHODS: Bandage soft contact lenses were applied immediately following bilateral simultaneous LASIK in 161 consecutive patients. Signs and symptoms associated with contact lens wear were prospectively recorded at 1 hour, 4 hours, and the following morning, using a standardized questionnaire. Contact lenses were removed at 1 hour if patients were symptomatic of intolerance. If no signs of contact lens intolerance appeared at 1 hour, the lenses were removed the following morning. No contact lenses were applied in 61 patients after LASIK. RESULTS: One hour after the procedure, contact lenses were removed from 47 patients due to intolerance. In these patients, contact lens removal was associated with a significant decrease of the total score the next morning (0.31±0.55) compared to 1 hour (5.65±1.60, P<.0001). A similar decrease of the total score was noted in those patients who tolerated the contact lenses (0.20±0.52 vs 1.30±1.78) and those in whom the contact lenses were not applied (0.76±1.19 vs 3.24±1.93). Mucoid discharge at the lid margins was noted in 52.6% of patients and mild corneal edema was noted in 28.8% of patients with bandage soft contact lenses at 12 to 18 hours. CONCLUSIONS: Bandage soft contact lens application after LASIK is associated with significant reduction of symptoms during the immediate postoperative period. However, removal of these lenses may be necessary shortly after the procedure.

Methylprednisolone delivery to the back of the eye using hydrogel iontophoresis.

AIM: The aim of this study was to evaluate methylprednisolone penetration into ocular structures after low-current trans-scleral hydrogel iontophoresis, as compared with the common intravenous (i.v.) treatment. METHODS: Methylprednisolone hemisuccinate (MPH) iontophoresis was studied in rabbits, using drug-loaded hydrogels mounted on a portable iontophoretic device. Cathodal iontophoresis of 2.6 mA/cm(2) was applied for 5 min at two opposite sites on the sclera or for 10 min at the same site. Ocular drug levels were determined 2 h after iontophoretic treatment, then compared to mock iontophoresis and i.v. infusion of 10 mg/kg methylprednisolone. RESULTS: Significantly higher methylprednisolone levels were found in ocular tissues after iontophoresis, compared with the control groups, except for the sclera concentrations, which were similar to the concentrations achieved after mock iontophoresis. Two (2) h after the trans-scleral iontophoretic treatment, 178.59 +/- 21.63 microg/g, 6.74 +/- 2.38 microg/ml, and 2.71 +/- 0.57 microg/mL were found in the retina, aqueous humor, and vitreous, respectively. No significant differences were found between one or two site treatments of trans-scleral iontophoresis. Nondetectable concentrations were found 2 h after the i.v. infusion of 10 mg/kg of methylprednisolone in all evaluated ocular tissues and fluids. CONCLUSIONS: A short, low-current noninvasive iontophoretic treatment, using methylprednisolone-loaded hydrogels, has potential clinical value in treating ocular inflammatory diseases.

In vitro and in vivo evaluation of carboplatin delivery to the eye using hydrogel-iontophoresis.

PURPOSE: To investigate in vitro and in vivo hydrogel-iontophoresis delivery of carboplatin to the eye. METHODS: Iontophoresis was applied on agar gels resembling the eye using different current intensities and durations. Transscleral iontophoresis was performed on healthy rabbits, applying 0, 1, and 3 mA current for 10 min. RESULTS: Similar drug concentrations were obtained in all experimental groups, in in vitro and in vivo studies, regardless of the iontophoretic current applied. A 20-mm penetration depth was found for carboplatin at the agar model. High drug levels were found at the sclera and retina, while lower levels were found at ocular fluids. CONCLUSION: Carboplatin-iontophoretic application at the above conditions does not have an obvious advantage over passive penetration due to high diffusion properties and insufficient molecular charge. Passive carboplatin diffusion from loaded hydrogels inserted in the lower cul-de-sac should be further investigated as a potential clinical treatment for intraocular retinoblastoma.

Charged nanoparticles delivery to the eye using hydrogel iontophoresis.

Ocular iontophoresis has been investigated for many years as a non-invasive technique for enhancing ionized drug penetration through ocular tissues. In this study we assessed the penetration of charged fluorescent nanoparticles into rabbit eyes using hydrogel iontophoresis. Particle distribution into ocular tissues and penetration efficiency of negative nanoparticles compared with positive nanoparticles was also evaluated. Cathodal and anodal iontophoretic administrations were performed using polyacrylic hydrogels loaded with charged nanoparticle suspension (20-45 nm), applying a current intensity of 1.5 mA for 5 min onto the cornea and sclera. At pre-set time points post treatment, eyes were dissected and tissues were evaluated for fluorescence intensity. Strong fluorescence evidence was observed at anterior and posterior ocular tissues. Negative particle distribution profile revealed fast uptake into the outer ocular tissues, within 30 min post treatment, followed by particle migration into the inner tissues up to 12 h post treatment. The positively charged particles demonstrated better penetration abilities into inner ocular tissues compared to the negatively charge particles. This work provides an opening for the development of a new ocular therapeutic pathway using iontophoresis of extended release drug-loaded charged nanoparticles.

Methotrexate delivery to the eye using transscleral hydrogel iontophoresis.

PURPOSE: To evaluate methotrexate penetration and distribution profile in ocular structures after short low current transscleral hydrogel iontophoresis. METHODS: Methotrexate iontophoresis was studied in rabbits using drug-loaded hydrogels mounted on a portable iontophoretic device. Drug distribution profile was evaluated 2, 4, and 8 hours after iontophoretic treatment of 1.6 mA/cm2 for 4 min. Ocular drug levels were also determined two hours after iontophoretic treatment of 5 mA/cm2, compared to mock iontophoresis and intravitreal injection of methotrexate. RESULTS: Therapeutic drug levels were maintained for at least 8 h at the sclera and retina and for 2 h at the aqueous humor following the iontophoretic treatment. After increasing the current density, a twice-higher concentration was achieved at the vitreous and 8 to 20 time higher concentrations at the retina and sclera. CONCLUSIONS: A short low current non-invasive iontophoretic treatment using methotrexate-loaded hydrogels has a potential clinical value in treating ocular inflammatory diseases and intraocular lymphoma.

Early transient visual acuity loss after LASIK due to steroid-induced elevation of intraocular pressure.

PURPOSE: To report the clinical course of early transient reduction of uncorrected visual acuity (UCVA) after LASIK surgery resulting from steroid-induced elevation of intraocular pressure (IOP). METHODS: Twenty-nine eyes of 15 patients who received topical corticosteroids after uneventful myopic LASIK surgery and had a decrease in UCVA within the first 3 weeks were evaluated retrospectively. RESULTS: Intraocular pressure increased by 4 to 30 mmHg from preoperative to postoperative days 4 to 20. Twenty-seven of 29 eyes had a decrease in UCVA and/or best spectacle-corrected visual acuity (BSCVA). All eyes, except one, had edema without evidence of inflammation in the interface or the remainder of the cornea. Discontinuation of topical corticosteroids and application of anti-glaucoma medications resulted in a decrease of IOP to normal levels, reduction or disappearance of the edema, and recovery of BSCVA. CONCLUSIONS: Early onset steroid-induced elevation of IOP after LASIK may cause corneal edema and a sudden decrease in UCVA. Rapid diagnosis and treatment can control IOP and recover the visual loss.

Iontophoretic treatment of experimental pseudomonas keratitis in rabbit eyes using gentamicin-loaded hydrogels.

PURPOSE: To evaluate the efficacy of iontophoresis using a hydrogel probe containing gentamicin for the treatment of Pseudomonas keratitis in the rabbit cornea. METHODS: Five groups (Groups 1-5) of 8 rabbits each were infected by injecting Pseudomonas aeruginosa into their corneas. Three dosings of corneal iontophoresis were performed, at intervals of 3.5 hours, using soft disposable gentamicin-loaded hydroxyethyl methacrylate hydrogel discs mounted on a portable iontophoretic device. Groups 1 and 2 were treated with corneal iontophoresis for 60 seconds and a current of 0.5 and 0.2 mA. Groups 3 and 4 were treated with hydrogel loaded with 0.9% NaCl solution, using a current of 0.2 mA and mock iontophoresis. Group 5 was treated with eye drops of 1.4% gentamicin every hour for 8 hours. One and a half hours after the last treatment, the animals were killed, and the corneas were excised and cultured for P. aeruginosa count after 24-hour incubation. RESULTS: After iontophoretic treatment of gentamicin with a current of 0.5 mA (Group 1), the logarithmic value of Pseudomonas colony-forming units (CFUs) was 2.96 +/- 0.45. After lower current iontophoretic treatment (Group 2), the logarithmic Pseudomonas count was 5.25 +/- 0.54 CFUs. At the control groups (Groups 3-5), the Pseudomonas counts were found to be much higher, 7.62 +/- 0.28, 7.22 +/- 0.29, and 6.29 +/- 0.45 CFUs, respectively. CONCLUSION: A short iontophoretic treatment using gentamicin-loaded hydrogels has potential clinical value in treating corneal infections.

Conjunctival autografting combined with low-dose mitomycin C for prevention of primary pterygium recurrence.

PURPOSE: To compare the clinical outcome of pterygium surgery combining intraoperative mitomycin C (MMC) with a free conjunctival autograft, with three other methods of pterygium surgery, including intraoperative MMC alone, conjunctival autograft alone, and bare sclera without adjunctive treatment. DESIGN: Interventional, randomized and in part nonrandomized, prospective, comparative study. METHODS: setting: A university medical center department of ophthalmology. STUDY POPULATION: One hundred and twenty patients underwent pterygium excision surgery. These patients were divided into four treatment groups. INTERVENTION: In group 1 (30 patients), MMC, 0.2 mg/ml, was applied for three minutes. In group 2 (30 patients), conjunctival autografting was performed. Group 3 (30 patients) received sodium chloride 0.9% only, and group 4 (30 patients) underwent conjunctival autografting combined with one minute application of MMC, 0.2 mg/ml. MAIN OUTCOME MEASURE: Recurrence rates and complications. RESULTS: Pterygium recurred in two patients (6.6%) in group 1, in four patients (13.3%) in group 2, in 14 patients (46.6%) in group 3, and in none of the patients in group 4. chi(2) analysis revealed a significantly lower recurrence rate in group 4 compared with group 2 (P = .038) and with group 3 (P < .0001). Epithelialization of the wounds was complete within 14 days of surgery. No complications were demonstrated in any of the study groups except for one case of minor melting of the flap in group 4. CONCLUSIONS: This study indicates that pterygium excision with a free conjunctival autograft combined with intraoperative low-dose MMC is a safe and effective technique in pterygium surgery.

Two cases of pneumococcal keratitis following myopic LASIK.

PURPOSE: To report two cases of pneumococcal keratitis after LASIK. METHODS: Retrospective interventional small case series of two patients who underwent bilateral LASIK for myopia and developed pneumococcal keratitis after surgery. This complication was encountered 2 days after surgery in one eye in both cases. The corneal flap was lifted, and irrigation and cultures from the stromal bed performed. Topical and subconjunctival antibiotics were started. RESULTS: Culture revealed Streptococcus pneumoniae in both cases. The infiltrates responded well to treatment. One year after the procedure, uncorrected visual acuity is > 20/40 in both cases. CONCLUSIONS: Pneumococcal keratitis can complicate LASIK. Patients should be informed of this potential complication, as prompt treatment is crucial.