Acute central corneal haze and thinning with atypical keratitis presentation.

A 24-year-old woman presented with a 7-day history of blurry vision, redness, and extreme pain in her right eye. She had no pertinent medical or ocular history and did not use spectacles or contacts. Uncorrected distance visual acuity (UDVA) was 20/40 in the right eye and could not be improved with refraction. Slitlamp examination revealed a 1.5 × 1.5 mm central epithelial defect with surrounding white blood cell recruitment. Confocal microscopy (Figure 1JOURNAL/jcrs/04.03/02158034-202304000-00020/figure1/v/2023-03-24T200747Z/r/image-tiff) was performed, and she was treated with chlorhexidine 0.02% drops every hour in the right eye. 2 weeks later, the cornea had completely re-epithelialized; however, persistent corneal haze, decreased visual acuity, and corneal thinning and flattening was noted. Pachymetry was 484 µm in the right eye and UDVA was 20/40 (Supplemental Figure 1, available at http://links.lww.com/JRS/A836). In the following 2 weeks, UDVA improved to 20/25. 6 months after the initial presentation, UDVA was unchanged and faint central corneal haze was noted on examination (Figure 2JOURNAL/jcrs/04.03/02158034-202304000-00020/figure2/v/2023-03-24T200747Z/r/image-tiff). Of interest, her family history is significant for her younger 16-year-old brother with 3 prior episodes of a similar type of keratitis/keratopathy over the course of 2 years in both eyes with similar central paracentral corneal haze, thinning, and flattening and similar confocal findings (Figure 3JOURNAL/jcrs/04.03/02158034-202304000-00020/figure3/v/2023-03-24T200747Z/r/image-tiff). He also was unresponsive to topical antibiotics and antivirals except topical chlorhexidine. Her brother has been our patient for the last several years prior to her first visit to our clinic. What is your diagnosis? What medical diagnostic tests, if any, would you recommend? Is this an infectious or simply an inflammatory response? Is there any genetic or familial predisposition?

Pachymetric Assessment After EpiSmart® Epithelium-on Cross-Linking for Keratoconus and Post-Surgical Ectasia.

Purpose: To assess the change in corneal pachymetry after a novel epithelium-on (EpiSmart®) corneal crosslinking procedure (CXL). Methods: Eyes treated as part of the open-label, non-controlled arm of the study "Collagen Crosslinking with Ultraviolet-A in Asymmetric Corneas" (NCT01097447) were examined at baseline, 3-, 6- and 12-months post-CXL. Thinnest pachymetry readings based on Pentacam (OCULUS GmbH, Wetzlar, Germany) were recorded. Results: A total of 101 eyes met the study inclusion criteria. Thinnest pachymetric readings at baseline averaged 451 ± 50 microns. The mean (± SD) minimum thickness was 450 ± 46 microns at 3 months, 452 ± 47 microns at 6 months, and 451 ± 48 microns at 12 months post-CXL. The changes from baseline (mean ± SE) at 3, 6, and 12 months post-CXL were -1.2 ± 1.5 microns, 0.5 ± 1.6 microns, and 0.4 ± 1.6 microns, respectively. Student's t-tests showed no statistically significant change in pachymetry from baseline for any exam period. Conclusion: This study demonstrated that, after EpiSmart® epithelium-on CXL, there was no substantial corneal thinning observable on Scheimpflug tomography out to 12 months.

Fungal Infectious Interface Keratitis Presenting 2 Years After Descemet Membrane Endothelial Keratoplasty.

PURPOSE: The purpose of this study was to describe infectious interface keratitis after Descemet membrane endothelial keratoplasty (DMEK) more than 2 years after surgery. METHODS: A case study. RESULTS: In this study, we report a case of fungal infectious interface keratitis occurring 2 years after uncomplicated Descemet membrane endothelial keratoplasty. The donor corneal rim culture at the time of surgery grew a single colony of Candida albicans/dubliniensis , but the patient was not treated with antifungals at that time. At the onset of clinical infection, more than 2 years postoperatively, the patient was treated with systemic antifungals and adjuvant intrastromal amphotericin-B injection. The patient subsequently required penetrating keratoplasty with ultimately well-preserved visual acuity. CONCLUSIONS: Fungal infectious interface keratitis (IIK) is a rare complication associated with lamellar keratoplasty. Although most common in the early postoperative period, this complication can occur several years after successful transplantation. Management may require a combination of systemic and stromal antifungal therapy. However, some patients may eventually require penetrating keratoplasty for definitive treatment.

KPI-121 1% for pain and inflammation in ocular surgery.

Pain and inflammation are common experiences following ocular surgery and, if uncontrolled, can compromise patients' vision, functioning and quality of life. Corticosteroid drugs are available to manage inflammation and discomfort but have limitations in penetrating the ocular mucus barrier to reach the target ocular tissues. KPI-121 1% (INVELTYS®) is a novel formulation of loteprednol etabonate that employs innovative proprietary technology to deliver nanoparticle-sized mucus-penetrating particles to the cornea. Results from clinical trials demonstrate that KPI-121 1% is effective and well tolerated. KPI-121 1% uses mucopenetrative technology for ophthalmic use and is the only US FDA-approved twice-daily ocular corticosteroid indicated for the treatment of inflammation and pain after ocular surgery.

Visual outcomes following optic nerve sheath fenestration via the medial transconjunctival approach.

This article determines the safety of optic nerve sheath fenestration (ONSF) for the treatment of patients with intracranial hypertension in the immediate 6-month post-operative period and its efficacy in reducing optic disk edema. Retrospective, non-comparative interventional case series. 207 eyes in 104 patients undergoing ONSF between the years 2005 and 2014. Papilledema grade based on modified Frisen scale and mean deviation of Humphrey visual field. 207 eyes of 104 patients (102 IIH, 2 IH due to dural sinus thrombosis) were included in the study. The patients were 96.1% female (N = 100) and 3.9% male (N = 4). The average patient age was 28.8 years (SD ± 9.5 years) and had a mean opening pressure of 39.85 cmH2O (SD ± 8.4 cmH2O). Mean follow-up period was 6.0 months (SD ± 5.9 months). Papilledema resolved in 76.1% of eyes at 1 week (N = 102 eyes), 75% of eyes at 1 month (N = 90 eyes), and 71% of eyes at 6 months (N = 94 eyes). Visual field comparison had a mean of the paired differences in MD at 1 week, 1 month, and 6 months of 1.59dB (P = 0.006), 2.53dB (P < 0.001), and 1.30dB (P = 0.016), respectively. ONSF is effective in reducing optic disk edema and does not cause vision loss in the 6-month post-operative period regardless of severity of IIH (as judged by elevation of opening pressure measured at pre-operative assessment).

Reduced application time for prophylactic mitomycin C in photorefractive keratectomy.

OBJECTIVE: To determine whether the duration of mitomycin C (MMC) 0.02% application affects visual outcome or the incidence of subepithelial haze in patients undergoing photorefractive keratectomy (PRK) with prophylactic administration of MMC. DESIGN: Retrospective, comparative case series. PARTICIPANTS: Two hundred sixty-nine eyes undergoing PRK. METHODS: This was a retrospective comparative case series that included 269 eyes that underwent PRK with prophylactic MMC application for 120 seconds (group 1, n = 74), 60 seconds (group 2, n = 36), or 12 seconds (group 3, n = 159). The mean preoperative spherical equivalent was -6.49 diopters (D) in group 1, -6.77 D in group 2, and -7.10 D in group 3. Photorefractive keratectomy was performed using a modified nomogram. All eyes received a single intraoperative application of MMC (0.02%) after laser ablation for the above specified durations. MAIN OUTCOME MEASURES: Best-corrected visual acuity and corneal haze score. RESULTS: Best-corrected visual acuity was 20/23 in group 1, 20/20 in group 2, and 20/21 in group 3. The mean haze score+/-standard deviation (scale, 0.00-4.00) was 0.11+/-0.31 in group 1, 0.14+/-0.28 in group 2, and 0.07+/-0.20 in group 3 throughout a mean follow-up of 31 months in group 1, 16 months in group 2, and 10 months in group 3. No eyes had a haze score of more than 1.00. CONCLUSIONS: There was no statistically significant difference in postoperative best-corrected visual acuity or haze scores among the 3 groups. Administration of prophylactic MMC 0.02% for 12 seconds after PRK seems to be equally efficacious for haze prophylaxis when compared with longer application times of 60 and 120 seconds.