Randomized Controlled Trial Comparing Everting Sutures with a Lateral Tarsal Strip for Involutional Lower Eyelid Entropion.

INTRODUCTION: To compare the anatomical and functional outcome and changes in the quality of life (QoL) over time of the lateral tarsal strip (LTS) versus the Quickert everting sutures (ES) for the repair of primary involutional lower eyelid entropion. METHODS: Forty-five patients (54 eyes) with primary involutional lower eyelid entropion were recruited in a prospective randomized clinical trial over 3-year period. Twenty-six eyes were randomized to the LTS technique and 28 to the ES procedure. Primary outcome was the anatomical correction of the eyelid at the final assessment in 1 year. Secondary outcomes were function and symptoms assessment with a QoL questionnaire at 6 months. Fisher's exact test was used for the statistical analysis of success rate and gender study and Mann-Whitney U test and logistic regression analysis were used for age study. The Wilcoxon and Mann-Whitney U tests were used for the analysis of the National Eye Institute Visual Functioning Questionnaire-25 (NEI VFQ-25). RESULTS: At the 6-month follow-up, 25 eyes (96.2%) of the LTS group and 20 (71.4%) of the ES group had favorable outcome (P = 0.025). There were one and eight eyes, respectively, with early recurrence. At the final 12-month evaluation, 23 eyes (88.5%) in the LTS group and 16 eyes (57.1%) in the ES group were successful. Three (11.5%) and 12 (42.9%) eyes respectively showed postoperative recurrence. There was a statistically significant difference between the two groups (P = 0.015) for the primary outcome, whereas age and gender did not influence success. The NEI VFQ-25 showed statistically significant subjective improvement from baseline in most categories of the QoL. No significant difference between the two procedures was detected at 6 months. CONCLUSION: This study suggests that the LTS procedure has a superior surgical success rate and reduction of symptoms compared with the ES for the repair of involutional lower eyelid entropion. Both procedures showed similar improvement of the postoperative QoL. TRIAL REGISTRATION: International Clinical Trials Registry Platform identifier: ACTRN12616000620426.

Corneal collagen cross-linking for progressive keratoconus in pediatric patients: a feasibility study.

PURPOSE: To evaluate the outcomes of corneal collagen cross-linking (CXL) in pediatric patients with bilateral progressive keratoconus. METHODS: This retrospective case series included four pediatric patients (eight eyes) with progressive keratoconus aged 14.0±2.2 years (range: 11 to 16 years). All eyes underwent CXL in accordance with the standard Dresden protocol. Pre- and 1-, 12-, 24-, and 36-month postoperative examinations included corneal thickness at the thinnest point (using a topographic system), corneal topographic evaluation (flat and steep meridian keratometry [K1 and K2]), refraction, and visual acuity. RESULTS: All patients completed 36-month follow-up. No intra- or postoperative complications were observed. Stabilization of K1 and K2 was demonstrated in all cases throughout follow-up (from the first postoperative interval), while visual acuity improved in six eyes and remained stable in the remaining two eyes. Manifest refraction remained stable, and corneal thickness decreased at the first postoperative month with gradual return to preoperative values during follow-up. CONCLUSIONS: Preliminary data of four pediatric patients with moderate keratoconus show feasibility of treatment by CXL in these select patients with no intra- or postoperative complications over 3-year follow-up.

Intraocular pressure measurements after corneal collagen crosslinking with riboflavin and ultraviolet A in eyes with keratoconus.

PURPOSE: To determine the possible effect of corneal collagen crosslinking (CXL) with riboflavin and ultraviolet A (UVA) on intraocular pressure (IOP) measurements by Goldmann applanation tonometry (GAT). SETTING: Institute of Vision and Optics, Faculty of Medicine, University of Crete, Heraklion, Crete, Greece. DESIGN: Prospective case series. METHODS: This noncomparative study measured IOP by GAT before CXL and 6 months and 12 months after CXL. RESULTS: The study evaluated 55 eyes (55 patients). There was a statistically significant increase in the measured IOP 6 months and 12 months after CXL (both P<.001). The mean measured IOP was 9.95 mm Hg ± 3.01 (SD) before CXL, 11.40 ± 2.89 mm Hg at 6 months, and 11.35 ± 3.38 mm Hg at 12 months. The change in IOP measurements at both postoperative examinations was not correlated with patient age, preoperative pachymetry, or preoperative keratometry readings. CONCLUSION: After riboflavin-UVA CXL in eyes with keratoconus, there was a significant increase in IOP measured by GAT that was probably caused by an increase in corneal rigidity.