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Purpose: To utilize data mining for analysis of corneal transplantations (CT) in Florida from 2005-2014, segmented by demographics, geography, and transplantation technique., Methods: A retrospective, database study was performed utilizing data queried from the Healthcare and Cost Utilization Project using Current Procedural Terminology codes for lamellar keratoplasty (ALK), endothelial keratoplasty (EK), and penetrating keratoplasty (PKP). Payer status, ethnic group, age, gender, and geography (urban versus rural) was extracted from each surgical encounter and reconfigured to provide a "clean", congruous dataset for statistical analysis. This Institutional Review Board-approved study did not utilize identifiable patient information; thus, individual informed consent was not required., Results: From 2005-2014, CT (n=28,607) represented less than 1% of the total ambulatory surgeries (n=12,695,932) performed in Florida. EK volume increased while PKP and ALK volume decreased, year-over-year. Statistical significance was found between transplantation technique by sex (P<0.001) and ethnic group (P<0.001). The largest sex discrepancy was EK (59% female, 41% male). White patients underwent relatively fewer PKP than EK (71% vs. 83% of totals), while Black patients underwent relatively more PKP than EK (14% vs 6% of totals). Statistical significance was found between techniques by payer (P<0.001). Medicare was the most common payer for all techniques, but ALK and PKP had higher percentages of private insurance and self-pay. No statistical significance was found between techniques by geographic location. Corneal edema (22.4%), endothelial dystrophy (17.5%), and bullous keratopathy (10.9%) were erroneously coded as indications for ALK. Corneal scars (2.5%) and corneal opacity (1.7%) were erroneously coded as indications for EK., Conclusions: CT rates in Florida appear to overrepresent the female sex and underrepresent ethnic minorities, with propensities between PKP and African Americans, EK and female patients, and EK and Medicare reimbursement. Our study further confirms the utility of data mining for providing efficient, detailed, and practical insights into ophthalmology procedures, while highlighting the intrinsic challenges of large datasets., (Copyright © 2022. Published by Elsevier Masson SAS.)

Purpose: To compare the effectiveness of penetrating vs intrastromal femtosecond laser corneal relaxing incisions (CRIs) in reducing corneal astigmatism during cataract surgery., Settings: Baylor College of Medicine and Mercy Clinic Eye Specialists., Design: Prospective randomized study., Methods: 248 eyes from 248 patients were included. Patients were randomly assigned to undergo paired penetrating (8 mm optical zone [OZ] at 1 center and 9 mm OZ at the other) or intrastromal CRIs (8 mm OZ at both centers). The lengths of the CRIs were based on published nomograms but modified to take into account posterior corneal astigmatism. Vector analysis was performed, and net corneal changes along the CRI meridian were calculated. Multiple regression analysis was performed to assess factors contributing to net corneal changes., Results: Preoperatively, 9% to 18% of eyes had corneal astigmatism of ≤0.5 diopters (D), and 76% to 93% of eyes had postoperative refractive astigmatism of ≤0.5 D ( P < .05). Both penetrating and intrastromal CRIs produced significant mean net corneal changes along the CRI meridian (-0.49 to -1.21 D), and 71% to 84% of eyes had postoperative astigmatism vector prediction errors of ≤0.50 D. The 8 mm penetrating CRIs induced greater net corneal changes but more eyes with overcorrection than did the intrastromal and 9 mm penetrating CRIs (all P < .05). Greater net corneal changes occurred with longer CRI length, higher preoperative corneal astigmatism magnitude, and preoperative against-the-rule corneal astigmatism. Nomograms based on anterior and total corneal astigmatism are proposed., Conclusions: Both penetrating and intrastromal CRIs were effective in reducing corneal astigmatism during cataract surgery., (Copyright © 2022 Published by Wolters Kluwer on behalf of ASCRS and ESCRS.)

Objectives: To report the successful treatment of persistent corneal epithelial defects that failed to respond to alternative treatment methods using extended wear of three different rigid gas-permeable scleral lenses., Methods: Eight eyes of eight patients with persistent corneal epithelial defects were treated with Blanchard Onefit 2.0 Scleral lens, BostonSight Scleral lens, and BostonSight PROSE device and were observed for defect resolution and improvement in best-corrected visual acuity over the duration of treatment., Results: All eyes observed complete re-epithelialization with a mean time of 11.1 ± 5.5 days. At the conclusion of the treatment, visual acuity improved in all but one patient. No complications were observed during treatment., Conclusions: Scleral lenses provide the corneal epithelium with hydration, oxygen permeation, and protection from mechanical forces; thereby facilitating healing of persistent corneal epithelial defects. This case series demonstrates the successful use of continuous wear scleral lenses in a number of patients for the treatment of persistent epithelial defects refractory to other interventions., (Copyright © 2018 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.)

Purpose: To describe changes in visual acuity in patients fit with the Prosthetic Replacement of Ocular Surface Ecosystem (PROSE) with irregular corneas compared to those with ocular surface disease, as well as describe patient demographics and fitting indications for PROSE at an academic medical center., Methods: A retrospective chart review from 2010 to 2016 on a total of 825 eyes from 493 patients fitted with a PROSE lens, and grouped by etiology, either irregular cornea/dystrophy or ocular surface disease and associated sub-etiologies. We compared best corrected visual acuity (BCVA) before and after PROSE fitting., Results: The irregular cornea group (n = 262 eyes) included corneal scar (n = 57), dystrophy (n = 17), post-operative corneal irregularity (n = 70), and primary ectasia (n = 118). The OSD group included 563 eyes. For all etiologies combined, mean BCVA prior to PROSE fitting compared to after improved by 0.28 logMAR (p < .001). In the irregular cornea group, the mean BCVA improved by 0.46 logMAR (p < .001), while the improvement in BCVA for the OSD group was 0.20 logMAR (p < .001). All etiologies in the irregular cornea group demonstrated improvement in BCVA (p < .05) with the exception of post-PRK (n = 2). BCVA improvement was found for all sub-etiologies in the OSD subgroup (p < .05)., Conclusions: PROSE treatment had a positive impact on visual acuity for a wide range of corneal irregularities and ocular surface disease, suggesting that PROSE lenses may offer improvements in visual acuity without risks inherent to surgery., (Copyright © 2018 Elsevier Inc. All rights reserved.)