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Purpose: To compare haze and refractive outcomes in patients undergoing combined accelerated corneal cross-linking (A-CXL) and selective wavefront-guided transepithelial photorefractive keratectomy (WG-transPRK) without mitomycin C (MMC) versus those undergoing A-CXL. Methods: This prospective study analyzed 95 eyes (86 patients) with progressive keratoconus from October 2018 to October 2022. The first group underwent CXL combined with corneal or ocular WG-transPRK (CXL+PRK, n = 52), targeting higher order aberrations (HOAs). The second underwent CXL only (n = 43), both following the same accelerated CXL protocol without MMC on the SCHWIND Amaris laser platform (SCHWIND eye-tech-solutions). Baseline and postoperative evaluations (1, 3, 6, and 12 months) included uncorrected (UDVA) and corrected (CDVA) distance visual acuity, manifest refraction, tomography, corneal HOAs, and optical coherence tomography (OCT) scans. A patented machine learning algorithm objectively detected and quantified stromal haze on OCT scans in grayscale units. Results: In both groups, anterior corneal haze reflectivity and subepithelial haze peaked at 3 months postoperatively, then progressively decreased at 6 and 12 months. Haze did not differ between groups at any time point. By 12 months, CDVA increased by 2.5 lines in the CXL+PRK group (P <.001) and by 0.7 lines in the CXL group (P =.10), and maximum keratometry decreased from 51.70 ± 5.10 to 47.90 ± 7.90 diopters (D) (CXL+PRK group) (P <.001) and from 51.20 ± 5.10 to 50.30 ± 4.60 D (CXL group) (P =.004). Corneal HOAs decreased in both groups but more in the CXL+PRK group. Conclusions: Combining CXL with WG-transPRK without MMC does not result in increased haze when compared to A-CXL alone. This combined approach achieves greater improvements in visual, topographic, and aberrometric parameters. [J Refract Surg. 2024;40(9):e583–e594.] [ABSTRACT FROM AUTHOR]

Purpose: To describe a patient who developed major topographical changes mimicking post-laser in situ keratomileusis (LASIK) ectasia during breast cancer treatment with tamoxifen. Methods: Case report and literature review. Results: A 36-year-old woman who had had 10 years of stable vision after LASIK surgery was diagnosed as having breast cancer 6 months before presentation. As therapy, the patient received tamoxifen, a selective estrogen receptor modulator. After the initiation of therapy, the patient experienced rapidly decreasing vision in her left eye. Assessment of corneal tomography showed marked steepening with irregular astigmatism, leading to the diagnosis of postoperative ectasia in the left eye. After 3 months of treatment with tamoxifen, the anterior cornea showed marked flattening again and improvement of corrected distance visual acuity, both of which were maintained at the 6-month follow-up visit. Conclusions: Serum estrogen level changes during breast cancer treatment may induce major topographical changes, mimicking postoperative ectasia after LASIK. [Journal of Refractive Surgery Case Reports. 2024;4(1):e20–e23.] [ABSTRACT FROM AUTHOR]

This document is an editorial published in Frontiers in Pharmacology titled "Research and advances on medication for corneal diseases and surgery." The aim of this research topic is to gather the latest developments in medication for challenging corneal diseases and surgeries. The editorial highlights the use of corneal cross-linking (CXL) as an emerging technology for improving corneal biomechanics and treating corneal ectasias. It also discusses the antimicrobial function of CXL, known as photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL), and its potential for treating infectious keratitis. Additionally, the editorial mentions the development of topical medications for corneal neovascularization and corneal endothelial disease. Overall, this research topic provides valuable insights into the advancements in medication for various corneal diseases. [Extracted from the article]

Background: As a key element of ocular accommodation, the inherent mechanical stiffness gradient and the gradient refractive index (GRIN) of the crystalline lens determine its deformability and optical functionality. Quantifying the GRIN profile and deformation characteristics in the lens has the potential to improve the diagnosis and follow-up of lenticular disorders and guide refractive interventions in the future., Methods: Here, we present a type of optical coherence elastography able to examine the mechanical characteristics of the human crystalline lens and the GRIN distribution in vivo. The concept is demonstrated in a case series of 12 persons through lens displacement and strain measurements in an age-mixed group of human subjects in response to an external (ambient pressure modulation) and an intrinsic (micro-fluctuations of accommodation) mechanical deformation stimulus., Results: Here we show an excellent agreement between the high-resolution strain map retrieved during steady-state micro-fluctuations and earlier reports on lens stiffness in the cortex and nucleus suggesting a 2.0 to 2.3 times stiffer cortex than the nucleus in young lenses and a 1.0 to 7.0 times stiffer nucleus than the cortex in the old lenses., Conclusions: Optical coherence tomography is suitable to quantify the internal stiffness and refractive index distribution of the crystalline lens in vivo and thus might contribute to reveal its inner working mechanism. Our methodology provides new routes for ophthalmic pre-surgical examinations and basic research., (© 2024. The Author(s).)