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PURPOSE: To compare the accuracy of the Barrett Integrated K (IK) toric calculator with the standard Barrett toric calculator. METHODS: Consecutive patients who underwent cataract extraction with implantation of a toric intraocular lens at the Rabin Medical Center, Israel, were reviewed. Errors in predicted postoperative refractive astigmatism were calculated for the Barrett toric calculator using biometry measurements only and with the IK tool using biometry and tomography. Both methods were assessed with predicted and measured posterior corneal astigmatism (PPCA and MPCA, respectively). RESULTS: The study included 73 eyes of 59 patients. The mean centroid prediction error using PPCA (0.08 ± 0.80 D @ 78°) was significantly different compared with MPCA (0.07 ± 0.80 D @ 48°, P = .016). In addition, a significant difference between IK-PPCA (0.06 ± 0.80 D @ 80°) and IK-MPCA (0.05 ± 0.80 D @ 38°) was found ( P = .023). The median absolute prediction error ranged from 0.55 D using IK-PPCA to 0.60 D using PPCA, with no significant differences between the four calculation versions. No significant differences were found between the calculators in the predictability rates within ±0.50, ±0.75, and ±1.00 D. Analysis of one eye of each patient showed similar results. CONCLUSIONS: The IK calculator yielded comparable outcomes to the standard Barrett calculator. Although differences in the mean centroid errors were found, they were clinically insignificant and predominantly seen in the axis of the predicted astigmatism error. These minor differences were mainly attributed to the incorporation of the MPCA in the calculation. [ J Refract Surg . 2022;38(9):565–571.]

To evaluate the sensitivity and specificity of the ABCD progression display for keratoconus progression.Data was collected from patients that underwent at least two Pentacam assessments 6 months apart. Sensitivity and specificity were calculated for the ABCD progression display. Progression was defined by criterion 1: change in two ABCD parameters above 80% confidence interval (CI) or criterion 2: change in one ABCD parameter above 95%CI. Receiver operating characteristic analysis compared the area under the curve (AUC) of all ABCD parameter combinations.Thirty eyes were evaluated over a median time of 10.3 months. Progression by criterion 1 resulted in a sensitivity of 61.9% and specificity of 88.9%. Progression by criterion 2 resulted in higher sensitivity (80.9%) and specificity (100%). Pairwise comparisons of the ROC curves show that the AUC achieved by criterion 2 was significantly higher than criterion 1 (0.905 vs. 0.754, p = 0.0332). Evaluation of all ABCD combinations with a significant change of 80% or 95% CI did not show superiority over criterion 1 or 2 regarding progression detection. The D parameter had a very low AUC (0.5-0.556).The ABCD progression display can assess keratoconus progression with high sensitivity and specificity, thus assisting the patients' decision-making process. The D parameter did not contribute to the sensitivity or specificity of this classification.

To assess the number of recruits for military service in the Israeli Defense Force (IDF) who underwent refractive surgery prior to enlistment and examine whether the procedure affected their ability to accomplish combat training.Medical records of IDF recruits.Retrospective analysis of medical records of recruits with ametropia who underwent or did not undergo refractive surgery prior to enlistment.Recruits were categorized into ametropes and recruits who underwent refractive surgery. Fitness and assignment to combat units and completion status of combat training were compared between the two groups.The study included 334,688 (182,969 males, 151,719 females) ametropes of which 5231 (4753 males, 478 females) underwent refractive surgery prior to recruitment. Refractive surgery prevalence increased from 9/1000 ametropes in 2005 to 18.5/1000 ametropes in 2018 (r = 0.912, p 0.001); 2643 of the operated recruits (50.5%) had their surgery at the age of 17-18. Dropout rates from combat training were significantly lower in the refractive surgery group during the study period (1.68% vs. 6.14%, respectively, p 0.001). Soldiers in the operated group were more frequently referred to ophthalmologists than those in the ametropes group and less frequently referred to optometrists.The prevalence of refractive surgery in IDF recruits has increased substantially during the last decade with more of them applying to combat units. Refractive surgery opened new possibilities for recruits who were unfit for combat duty prior to surgery and did not appear to impair the chances of successfully completing combat training.

To present the outcomes of attempts to salvage total graft detachment following Descemet's membrane endothelial keratoplasty (DMEK).A search of the electronic medical records of two tertiary medical centers for all patients who underwent DMEK yielded six cases of postoperative total graft detachment (2.54%). Graft salvage was attempted in all cases using repeated intracameral graft staining, unfolding, and reattachment to the stroma under 20% hexafluoride gas.In all cases, a free-floating totally detached graft was identified in the anterior chamber shortly after surgery. Salvage surgery resulted in a central, well-oriented, and fully attached graft. In three cases, the primary graft failed, and in two, the corneas cleared at first but failed after 2 months and 1 year respectively. In one case, the cornea remained clear during 1 year of follow-up but had a very low endothelial cell density.Reattachment of fully detached DMEK graft is technically possible, but graft manipulation during the primary and secondary operations is likely to damage the endothelial cells, resulting in primary or early graft failure. If graft salvage is attempted, the probability of primary or early graft failure should be discussed with the patient, and expectations should be tempered accordingly.ZIEL: Präsentation der Ergebnisse der Rettungsversuche nach vollständiger Transplantatablösung nach Descemet-Membran-Transplantation (Descemetʼs membrane endothelial keratoplasty – DMEK-Methode).Datenbankrecherche des Rabin Medical Center und des Rambam Medical Center in Israel für alle Patienten, die zwischen Januar 2015 und Januar 2020 eine Hornhauttransplantation erhielten, wobei bei 236 Patienten eine DMEK durchgeführt wurde, in 6 Fällen wurde eine vollständige Transplantatablösung beobachtet (2,54%). Die Rettung des Transplantats wurde mit erneuter intrakameraler Transplantatfärbung, -entfaltung und erneuter Anheftung an das Stroma mit 20% Hexafluoridgas versucht.In allen Fällen konnte in der Vorderkammer ein komplett abgelöstes Transplantat kurz nach der Operation gefunden werden. Mit der Revisionsoperation gelang es in allen Fällen, ein zentriertes, richtig orientiertes, total angebrachtes Transplantat wiederherzustellen. In 3 Fällen ist die Hornhaut nach der Revisionsoperation nicht aufgeklart. In 2 Fällen waren die Hornhäute zuerst klar, aber das Transplantat versagte nach 2 Monaten und 1 Jahr. In einem Fall war die Hornhaut 1 Jahr lang klar, hatte dann aber eine sehr niedrige Endothelzelldichte.Das erneute Anbringen eines frei schwimmenden DMEK-Transplantats nach vollständiger Ablösung ist technisch möglich, aber die Manipulation des Transplantats während der primären und sekundären Operation kann die Endothelzellen beschädigen, was zu einem primären oder frühen Versagen des Transplantats führt. Wenn eine Transplantatrettung versucht wird, sollte die Wahrscheinlichkeit eines primären oder frühen Transplantatversagens mit dem Patienten besprochen und seine Erwartungen entsprechend relativiert werden.

Purpose: To examine the clinical outcomes, efficacy, safety, and predictability of transepithelial photorefractive keratectomy (Trans-PRK) operations performed on the day of the first screening visit in comparison with operations scheduled at a following appointment. Methods: Data of consecutive patients with myopia of various degrees, who underwent Trans-PRK, were retrospectively analyzed. Findings were compared between patients who underwent Trans-PRK on the same day of first consultation to patients that underwent surgery at subsequent visits, following initial consultation on a different day. Results: The study included 599 eyes treated on the initial visit day and 1936 eyes treated on a subsequent visit. Mean final spherical equivalent was close to emmetropia in both groups ( p = 0.183). Efficacy indices were 0.928 ± 0.192 in the initial-visit group and 0.945 ± 0.163 in the second-visit group ( p = 0.152). Safety indices were 0.954 ± 0.156 and 0.955 ± 0.151 ( p = 0.707), respectively. No differences between the groups were seen in uncorrected visual acuity (UDVA) of ⩾20/20, ⩾20/25, and ⩾20/32. Only the sub-analysis of patients reaching UDVA of 20/40 or better was slightly lower in the first-visit (95.5%) compared with the second-visit group (97.9%, p = 0.001). Results of attempted correction within ±0.50 D were: 63.3% and 69.0%, respectively ( p = 0.009). Complications profiles in the two groups were comparable. Conclusions: Trans-PRK completed on the day of the first screening appointment demonstrated a similar safety outcome compared with subsequent-visits procedures, and slightly lower, yet comparable, results regarding efficacy and predictability.

To compare keratometry data between the handheld Retinomax K-plus 3 and the table-mounted IOLMaster 700. Healthy adult volunteers were prospectively recruited to the study. All participants underwent 3 consecutive keratometry measurements using the Retinomax K-plus 3 and a single biometry assessment using the IOLMaster 700. Differences between the Retinomax K-plus 3 and the IOLMaster 700 were assessed using Wilcoxon test for paired samples, Spearman correlation, Bland–Altman and mountain plots. Twenty-eight healthy subjects with a median age of 37 years (interquartile range (IQR) 28–44 years) were included in the study. The median mean keratometry (mean K) reading was higher using the Retinomax K-plus 3 (44.04D; IQR 42.96–45.61D) compared to the IOLMaster 700 (43.78D; IQR 43.22–44.90D, p

The study aimed to examine the effect of cataract extraction on ophthalmologists’ ability to detect pseudoexfoliation (PXF) syndrome. A total of 31 patients admitted for elective cataract surgery were enrolled in this prospective comparative study. Prior to surgery, patients underwent slit-lamp examination and gonioscopy conducted by experienced glaucoma specialists. Subsequently, patients were re-examined by a different glaucoma specialist and comprehensive ophthalmologists. Pre-operatively, 12 patients were diagnosed with PXF on the basis of a Sampaolesi line (100%), anterior capsular deposits (83%), and pupillary ruff deposits (50%). The remaining 19 patients acted as controls. All patients were re-examined 10–46 months post-operatively. Of the 12 patients with PXF, 10 (83%) were correctly diagnosed post-operatively by glaucoma specialists and 8 (66%) by comprehensive ophthalmologists. There was no statistically significant difference in PXF diagnosis. However, detection of anterior capsular deposits (p = 0.02), Sampaolesi lines (p = 0.04), and pupillary ruff deposits (p = 0.01) were significantly lower post-operatively. Diagnosis of PXF is challenging in pseudophakic patients as the anterior capsule is removed during cataract extraction. Therefore, PXF diagnosis in pseudophakic patients relies mainly on the presence of deposits at other anatomical sites, and careful attention to these signs is required. Glaucoma specialists may be more likely than comprehensive ophthalmologists to detect PXF in pseudophakic patients.

Purpose To assess the accuracy of the Kane formula for intraocualr lens (IOL) power calculation in comparison with established formulas in the elderly population. Setting Shiley Eye Institute, University of California San Diego, USA. Design Retrospective cohort. Methods Retrospective data from 90 patients (90 eyes) aged 75 years or older who underwent uneventful cataract surgery with SN60WF intraocular lens (IOL) implantation were evaluated. The first operated eyes of patients with final corrected distance visual acuity 20/40 or better and axial length 22 to 26 mm were included. Prediction errors were calculated for Barrett Universal (BU) II, Haigis, Hoffer Q, Holladay 1, Kane, and SRK/T formulas. A subgroup analysis based on age (75-84 and ≥85 years old) was performed. Results Use of both BUII and Kane formulas resulted in the highest percentage of eyes with prediction errors within ±0.50 diopters (D) (72% each) and significantly higher than Hoffer Q, Holladay 1, and SRK/T (P = .001). Rates of predictability within ±0.25 D and ±1.00 D were 31% to 38% and 87% to 92%, respectively, with no significant differences between formulas. No statistically significant difference was seen between formulas in the median absolute error. These tendencies remained consistent in both age groups when analyzed separately. Subgroup analysis showed better predictability of all formulas in the younger age group. Conclusions To the authors' knowledge, this is the first study evaluating the Kane formula exclusively in the elderly population. The Kane formula was found to be of equal accuracy to the BUII and superior to the Hoffer Q, Holladay 1, and SRK/T formulas. Very elderly patients might have reduced refractive precision using all formulas.

Purpose To evaluate whether punching Descemet membrane endothelial keratoplasty (DMEK) corneal grafts onto a contact lens scaffold reduces endothelial cell loss at the graft margin in comparison to punching the graft directly onto the donor stroma. Methods DMEK grafts were prepared using 2 different methods after peeling the graft from the stroma: punching onto a contact lens and punching onto the donor stroma. The grafts were then evaluated for the width of Descemet membrane devoid of endothelial cells in the peripheral ring, measured at 4 points at the graft margin. Results Our study included 6 grafts, harvested from 3 donors aged 66.3 ± 5.1 years. Grafts prepared on a contact lens scaffolding had more of their Descemet membrane margin populated by endothelial cells than did grafts that were punched directly onto the donor stroma (total denuded area: 0.06 ± 0.08 mm vs. 1.17 ± 0.02 mm, P = 0.018; maximal width of denuded area: 59.6 ± 28.4 μm vs. 100.2 ± 59.7 μm, P = 0.07). Donor grafts on contact lens had approximately 2.5% more endothelial cells available for transplantation (2425 cells/mm vs. 2367 cells/mm). Graft preparation time did not significantly differ between the methods (6.4 ± 0.49 vs. 9.8 ± 3.7 minutes, P = 0.46). Conclusions Punching DMEK grafts onto a contact lens reduces endothelial loss at the grafts' margins and may prolong their survival.

Purpose To describe the clinical characteristics and treatment of spontaneous Descemet membrane (DM) detachment occurring decades after penetrating keratoplasty (PK). Methods A multicenter interventional case series design was used. We reviewed the medical records of 4 patients with a history of PK presenting with spontaneous DM detachment at 3 university hospitals in Israel and an ocular surgery institute in The Netherlands in 2016 to 2019. Patient demographic and clinical data, postoperative best corrected visual acuity, findings on preoperative and postoperative anterior segment optical coherence tomography (AS-OCT), and graft survival were recorded. Results Patients were aged 46 to 50 years. All had undergone PK for keratoconus 20 to 26 years previously. Patients presented within 18 to 180 days of onset of visual disturbance. Symptoms included sudden painless visual loss (2 patients), gradual visual loss and foreign body sensation (1 patients), and visual loss not otherwise specified (1 patient). Slit-lamp examination showed corneal edema, and AS-OCT showed DM detachment of variable extent. In 2 patients, the initial diagnosis was graft rejection and failure. Treatment consisted of anterior chamber injection of air (n = 3) or 20% SF6 (n = 1). In 3 patients, the DM reattached and the cornea regained its clarity. The fourth patient had persistent DM detachment that required repeated PK. Conclusions Spontaneous DM detachment can mimic late graft failure in patients after PK. If diagnosed early, DM reattachment may be performed by air/gas injection, avoiding repeated keratoplasty. Eyes with presumed late penetrating graft rejection or failure should be examined by AS-OCT to exclude DM detachment.

Purpose To evaluate the effect of a single subconjunctival aflibercept injection on formed corneal neovascularization. Methods A prospective clinical trial, conducted at a single tertiary medical center. Included were consecutive patients with corneal pathologies complicated by corneal neovascularization, who were candidates for anti-vascular endothelial growth factor treatment at the discretion of a cornea specialist. A single subconjunctival injection of 0.08 mL of Aflibercept (Eylea 25 mg/mL) was administered near the limbus in proximity to the areas of maximal pathological neovascularization. Follow-up visits were scheduled on days 7, 30, 60, and 90 following injection. Best-corrected visual acuity (BCVA), intraocular pressure, slitlamp examination, digital cornea photography, specular microscopy, and anterior-segment optical coherence tomography were documented at each visit. The images were graded by a masked observer for density, extent, and centricity of corneal vascularization. Results Six eyes of six patients were analyzed. No clinically significant ocular or systemic adverse events were documented. No change was noted in extent, density, or centricity of corneal blood vessels at seven, 30, and 90 days after injection (P>0.1 for all time point comparisons, Friedman test). Best-corrected visual acuity fluctuated insignificantly in 5/6 patients during follow-up time, and objective but not subjective improvement of BCVA was noted in one patient with no concurrent change of neovascularization. The recruitment has therefore halted prematurely. Conclusions A single subconjunctival aflibercept injection seems to be well tolerated. However, it is ineffective for regressing formed corneal neovascularization.

Purpose: To compare corneal endothelium parameters taken by two common noncontact specular microscopes in healthy subjects. Methods: Healthy participants visiting the outpatient eye clinic at the Rabin Medical Center, Petah Tikva, Israel, were recruited prospectively. All participants underwent three consecutive corneal endothelial cell photographs with both the Konan-Noncon Robo SP-6000 and the Tomey EM-3000 specular microscopes. Endothelial cell density (ECD) was evaluated using the manual center technique in both machines. Bland-Altman graphs were used to assess the agreement between the devices, and intraclass correlation coefficient (ICC) served to assess intraobserver variability for each device. Results: Recruited were 49 healthy subjects with a mean age of 48.9 +/- 15.6 years, 49 right eyes were included. The mean ECD was comparable between the Tomey EM-3000 and the Konan-Noncon Robo SP-6000 (2,713.2 +/- 242.4 vs. 2,700.8 +/- 300.5 cells/mm(2), respectively, P=0.47) with a mean difference of 12.4 cells/mm(2) (0.67%), a mean ECD absolute difference of 93.3 cells/mm(2), and low 95% limits of agreement of -222.0 to +246.9 cells/mm(2). A folded empirical distribution function curve showed that all differences fell within 525.4 cells/mm(2), centered around a median of 13.3 cells/mm(2). Intraclass correlation coefficient was high for both the Konan-Noncon Robo SP-6000 (0.93, 95% confidence interval [CI]: 0.89-0.95) and the Tomey EM-3000 (0.88, 95% CI: 0.82-0.93). Conclusions: The difference in endothelial cell measurements between the Konan SP-6000 and the Tomey EM-3000 specular microscopes through the center and the L-count analyzing techniques, respectively, is clinically small and not statistically significant. Nevertheless, caution should be taken when used interchangeably because ECD difference between the two machines can be as high as 525.4 cells/mm(2).

Objectives Our aim is to evaluate the safety, efficacy, predictability, and clinical outcome of femtosecond laser-assisted in situ keratomileusis (FS-LASIK) procedures performed on the day of the initial consultation relative to procedures performed at subsequent visits. Methods A retrospective cohort study design was used. The study group included patients with myopia of different severities who were treated with FS-LASIK in 2013 through 2014 in an optical outpatient clinic of a large private medical service. Inclusion criteria were at least 18 years of age, a stable refraction for 12 months, no history of autoimmune disease, ocular surgery, or eye disease, and complete medical records. Background, clinical, and outcome data were collected from the patient files. Results Femtosecond laser-assisted in situ keratomileusis was performed in 80 patients (160 eyes) at the first visit and 361 patients (719 eyes) at a subsequent visit. The mean±SD spherical equivalent (SE) refraction before surgery was -3.74±2.03 D in the first-visit group and -3.73±1.87 D in the subsequent-visit group (P=0.99). Efficacy index values were 0.97±0.15 in the first-visit group and 0.98±0.13 in the subsequent-visit group (P=0.92), and corresponding safety index values were 0.99±0.15 and 0.99±0.12 (P=0.81). The final SE measured -0.09±0.58 D in the first-visit group and -0.19±0.55 D in the subsequent-visit group (P=0.05). Types and rates of complications were similar in the two groups. Conclusions There is no significant difference in the results of refractive surgery with FS-LASIK between procedures performed at the initial or subsequent visits. In both conditions, FS-LASIK surgery is associated with excellent safety, efficacy, and predictability profiles.

Eye trauma is an unfortunate and often preventable cause of vision loss. Confetti cannons are common causes of injury. Awareness of ocular hazards of confetti cannons remains low because of limited reports describing ophthalmic injuries following their use.To describe outcomes of ocular trauma caused by confetti cannons and to increase recognition of their ocular risks.A retrospective analysis was conducted of eye injuries caused by confetti cannons presenting to a single medical center between 2016 and 2020. Data collected included age, gender, eye injured, ocular damage, visual outcome, and details of surgeries performed.Overall, six consecutive patients (2 males, mean age 19.5 ± 9.74 years) were identified and studied. In all patients only one eye was injured (3 right eyes) during a private celebration, most commonly (n=5) to a bystander while in the vicinity of a cannon operated by someone else. Most common eye injuries included corneal erosion (n=4), traumatic hyphema (n=4), and retinal edema (n=3). Mean initial logMAR visual acuity in the injured eye was 0.73 ± 0.18, improving to 0.25 ± 0.16 at the final visit (P = 0.125). Two patients underwent eye surgery due to their trauma: one to repair globe penetration and another to undergo intravitreal injection of tissue plasminogen activator and C3F8 for submacular hemorrhage, followed 8 months later by intravitreal bevacizumab injection for choroidal neovascularization.Confetti cannons pose hazards that can cause severe ocular trauma resulting in permanent vision loss. Increasing awareness of device hazards is necessary to prevent eye injuries.

To describe the first clinical implantation of the CorNeat™ keratoprosthesis, which utilizes a polymeric scaffold for biointegration within ocular tissue.The CorNeat keratoprosthesis was implanted in the right eye of a patient with bilateral corneal opacification and neovascularization secondary to multiple failed grafts. The following surgical technique was used: 360 degree peritomy; epithelial scraping and corneal marking; pre-placement of three corneo-scleral sutures through the implant; central trephination using a 7 mm trephine and host cornea removal; keratoprosthesis placement and sutures tightening while fitting the corneal edge into the posterior groove of the CorNeat keratoprosthesis; and repositioning of the conjunctiva over the implant skirt and fixation with sutures and Fibrin sealant.Twelve months postoperatively visual acuity improved to 1/16 from hand movement. The keratoprosthesis was properly positioned. Tactile intraocular pressure was assessed as normal. Regional, mostly nasal, conjunctival retraction of 4-5 mm over the nano-fibre skirt was seen throughout follow-up. The anterior chamber was quiet and well-formed. No other postoperative complications were observed.This initial case may imply a potential breakthrough in the treatment of corneal disease not amenable to standard corneal transplant. Long follow-up and additional implantations are desired to prove the long-term safety and efficacy of this device.

To compare the effect of three commonly prescribed anti-inflammatory eye drops on corneal epithelial cells in vitro.Three different lines of human corneal epithelial cells were tested: primary cells cultured from donor tissue, commercially available primary cells, and immortalized cells. Cells were seeded on 96-well plates and treated with the following eye drops: cyclosporine 0.05%, lifitegrast 5%, and tacrolimus 0.03% or 0.1%. Exposure times tested were 30 seconds, 1 minute, 2 minutes, 1 hour, 2 hours, 4 hours, and 24 hours. Brightfield images and viability assays were analyzed 48 to 72 hours after the initiation of treatments. At least five replicates were tested per drug and time exposure.Commercially obtained primary cells showed reduced viability following 1 hour with tacrolimus 0.1% (8%; P = 0.043%) and 4 hours with tacrolimus 0.03% (17%; P = 0.042%). Lifitegrast exposure reduced primary cell viability after 4 hours (10%; P = 0.042). Cell viability in primary cells was not deleteriously affected following exposure to cyclosporine for up to 4 hours. A similar trend was observed in both primary cells cultured from donor tissue and immortalized human corneal epithelial cells, demonstrating greater decreases in cell viability in tacrolimus compared to lifitegrast and cyclosporine. Light microscopy imaging for analysis of cell morphology and confluence supported the results.Tacrolimus showed the highest impact on corneal epithelium survival in vitro, and cyclosporine proved the most protective.Comparing anti-inflammatory eye drops on corneal epithelial cells in vitro may inform eye drop selection and development for clinical purposes.

To compare the biomechanical properties of the unilateral operated corneas in patients who had undergone Descemet membrane endothelial keratoplasty (DMEK) for pseudophakic bullous keratopathy (PBK) with those of the contralateral normal corneas. This was a retrospective cohort study conducted at university hospitals (Department of Ophthalmology, Rabin Medical Center, Petach Tikva, Israel, and S. Fyodorov Eye Microsurgery State Institution, Moscow, Russia). Forty eyes of 20 patients who underwent DMEK for unilateral PBK 3.5 to 36 months ago and with normal fellow eyes were included in the study. An ocular response analyzer was used to measure the corneal biomechanical properties in the operated and normal fellow eyes. The main outcome measures were corneal hysteresis (CH) and corneal resistance factor (CRF). The mean CH (8.4 ± 1.5 mmHg vs. 8.2 ± 1.5 mmHg, P = 0.707) and the mean CRF (8.7 ± 1.6 mmHg vs. 8.3 ± 1.6 mmHg, P = 0.419) values did not show any statistically significant difference between the operated and the normal fellow eyes. In our study, the corneas that underwent DMEK for PBK showed normal values for biomechanical parameters. These findings support the previous studies that have reported near complete visual, functional, and ultra-structural rehabilitation of the corneas following DMEK.

Aim: To compare the efficacy of aflibercept (Eylea®), a potent antivascular endothelial growth factor (VEGF) agent, with betamethasone (Celestone®) and placebo for the treatment of formed corneal neovascularization in a rabbit model. Methods: A central corneal chemical burn was created in the right eye of 24 New Zealand albino rabbits. Four weeks later, the rabbits were randomly divided into 4 equal groups for subconjunctival injection of aflibercept, betamethasone, aflibercept+ betamethasone, or saline (control). Digital photographs taken at weekly intervals were rated by 2 masked observers for extent, centricity, and density of corneal neovascularization according to a predefined scale. The percentage of corneal surface involved by neovascularization was quantified by image analysis software (Fiji-J). The change in corneal neovascularization from treatment administration (4 weeks after injury) to 4 weeks later (8 weeks after injury) was assessed. The rabbits were then euthanized, and their eyes were enucleated and processed for histopathological and immunofluorescence studies. Results: There was no significant difference in the change in corneal neovascularization after treatment among the 4 groups according to the digital images (p > 0.15) or histological evaluation with hematoxylin and eosin (p > 0.08). On immunofluorescence assay, a lower VEGF concentration was observed in all treatment groups compared to the control group. Conclusions: In this rabbit model, corneal neovascularization induced by chemical burn failed to regress with treatment with aflibercept, betamethasone, or their combination.

To validate the effectiveness of the multi-metric D-index by Pentacam in detecting keratoconus (KC) progression.This was a retrospective study of KC patients at the Rabin Medical Center, Petah Tikva, Israel, during 2016-2018 with at least two corneal tomography examinations six months apart. Agreement between clinical diagnosis of progression (1.5D increase in mean keratometric value, 1D increase in Kmax, a 5% decrease in central corneal thickness (CCT), worsening of visual acuity by more than one line, or deterioration of manifest corneal astigmatism 1.5D) and the D-index was evaluated. Receiver operating characteristic (ROC) analysis was used to find the D-index's optimal cutoff value to show progression.We included KC eyes in the stable group (N = 7) and the progression group (N = 54). Patient demographics and tomographic parameters at baseline were similar between the groups. The D-index change was significantly higher in the progression group than in the stable group (median + 1 and 0.0, respectively, p = 0.024). Based on the ROC analysis, the optimal D-index cutoff change within at least six months was 0.32 (59.3% sensitivity and 100% specificity (area under the curve [AUC] = 0.771, Youden = 0.592). Subjects with a D-index change above this value had a 21.1-fold increase in odds for corneal ectasia progression requiring CXL (OR: 21.1, 95%CI 1.17-398.8, p = 0.038).The multi-metric D-index can serve as a clinically feasible parameter to detect KC progression and guide patients' referral for further interventions.

Purpose: To evaluated Descemet’s membrane endothelial keratoplasty (DMEK) outcomes in young and old graft recipients.Materials and Methods: Data of 164 surgeries with a median age of 76 years (inte...

To assess the outcomes of Descemet membrane endothelial keratoplasty (DMEK) in patients with ocular hypotony after glaucoma surgery.retrospective case series.Setting: Multicenter retrospective case series.Hypotonic eyes with prior glaucoma surgery that underwent DMEK between January 2013 and July 2019 in Israel (2 centers) and Canada (1 center).Pre/postoperative corrected distance visual acuity, complications, 3- to 6-month endothelial cell loss, and intraocular pressure (IOP).The study included 11 DMEK procedures performed in 10 eyes of 4 males and 6 females aged 65-84 years. Indications for DMEK included 7 cases of pseudophakic bullous keratopathy, 2 cases of failed DMEK, and 1 case of failed Descemet stripping automated endothelial keratoplasty. All patients had at least 1 previous trabeculectomy operation. One patient had 2 trabeculectomy procedures and 1 tube placement procedure. Two patients had 1 previous trabeculectomy and 1 tube placement procedure. The corrected distance visual acuity improved significantly from 1.52 ± 0.68 logarithm of minimal angle of resolution preoperatively to 0.49 ± 0.32 logarithm of minimal angle of resolution 3 months postoperatively (P.001). Rebubbling occurred in 3 of 11 procedures (27%). Endothelial cell loss 6-12 months postoperatively was 60% ± 16% (range, 41%-89%). At the last follow-up visit, 6 of 11 (54%) of the grafts were clear. The remaining 5 grafts failed at 1-4 years postoperatively. The preoperative IOP was 5.1 ± 1.6 mm Hg (range, 1-7 mm Hg). In all but one patient, the postoperative IOP did not increase to more than 13 mm Hg. In 2 cases, the IOP decreased from 5 and 7 mm Hg preoperatively to 1 mm Hg 1 year postoperatively.DMEK is a valid procedure for the treatment of corneal edema in hypotonic eyes after glaucoma procedures. These eyes benefit from improvement in vision after DMEK.

The coronavirus disease-2019 (COVID-19) pandemic presented a major medical management challenge to ophthalmology departments throughout Israel.To examine the managerial challenges, actions taken, and insights of directors of ophthalmology departments in Israel during the COVID-19 pandemic.We conducted a cross sectional survey of directors of ophthalmology departments during the COVID-19 pandemic while the Israeli population was quarantined.All 21 directors answered the survey. The majority of the COVID-19 admissions were located in the center of Israel (53%) and Jerusalem (30%). E-communication took a central role in coping with the pandemic with 80% of the directors satisfied with this form of communication; 75% reported a reduction in clinical and surgery volume of at least 25%, and 40% reported reallocations of manpower. Most of the medical staff used gloves, a face shield, disposable robe, and a mask with no uniformity across departments. Cross satisfaction was noted regarding a hospital's ability to equip the departments. Lack of preparation for post-pandemic era was reported by all directors, but one (95%). Directors sought guidelines and uniformity regarding outpatient referral to the hospital (p = 0.035).Guidelines via safe digital platforms aid in management decisions and uniformity across departments. Advanced preparation is needed to prevent adverse clinical outcomes and to maintain treatment continuum. Our results can be used to guide and help improve the preparedness of ophthalmology departments during COVID-19 and for future pandemics.

To compare keratometry data between the handheld Retinomax K-plus 3 and the table-mounted IOLMaster 700.Healthy adult volunteers were prospectively recruited to the study. All participants underwent 3 consecutive keratometry measurements using the Retinomax K-plus 3 and a single biometry assessment using the IOLMaster 700. Differences between the Retinomax K-plus 3 and the IOLMaster 700 were assessed using Wilcoxon test for paired samples, Spearman correlation, Bland-Altman and mountain plots.Twenty-eight healthy subjects with a median age of 37 years (interquartile range (IQR) 28-44 years) were included in the study. The median mean keratometry (mean K) reading was higher using the Retinomax K-plus 3 (44.04D; IQR 42.96-45.61D) compared to the IOLMaster 700 (43.78D; IQR 43.22-44.90D, p 0.01), with a mean difference of 0.18D (95% confidence interval (CI) 0.11-0.23D). Mean K readings were highly correlated between the 2 devices (r = 0.995, p 0.01). Bland-Altman plots showed 95% limits of agreement between -0.14D and 0.49D. Frequency histogram of mean K reading differences between the Retinomax K-plus 3 and the IOLMaster 700 showed that 56% of cases were between ± 0.2D, 93% of cases were between ± 0.4D and all cases were between ± 0.5D. Mean corneal astigmatism measurement was higher using the Retinomax K-plus 3 (1.01 ± 0.40D) compared to the IOLMaster 700 (0.77 ± 0.36D), with a mean difference of 0.23 ± 0.37D (p 0.01) between the devices.A good agreement exists between the Retinomax K-plus 3 and the IOLMaster 700 regarding keratometry readings. This enables cataract surgeons to safely use the Retinomax K-plus 3 device when indicated.

Introduction: The purpose of this study was to compare the outcomes of transepithelial photorefractive keratectomy (Trans-PRK) with femtosecond laser assisted in situ keratomileusis (FS-LASIK) for the correction of low to moderate myopia. Methods: A retrospective cohort study design was used. The study group included patients with myopia less than −6.0 D, with or without concomitant astigmatism under 2.0 D, who were treated with FS-LASIK or Trans-PRK in 2013 through 2014. Background, clinical and outcome data were collected from the patient files. A comparison between eyes treated with FS-LASIK or Trans-PRK was performed. Results: The Trans-PRK group was comprised of 1793 eyes and the FS-LASIK group of 666 eyes. Mean ± SD spherical equivalent (SE) refraction prior to surgery was −3.43 ± 1.27 D in the Trans-PRK group and −3.18 ± 1.34 D in the FS-LASIK group ( p Conclusions: Both Trans-PRK and FS-LASIK demonstrated excellent results, mostly comparable with the current literature. FS-LASIK achieved better results than Trans-PRK surgery in the efficacy and safety parameters.

Purpose: To compare the outcomes of femtosecond laser assisted in situ keratomileusis (FS-LASIK) with transepithelial photorefractive keratectomy (T-PRK) for the correction of high-grade astigmatism. Methods: Medical records of patients with astigmatism of 2 diopters (D) or higher, who were treated with FS-LASIK or T-PRK in 2013 through 2014 at a private practice laser clinic, were retrospectively analyzed. Efficacy, safety, predictability and vector analysis of astigmatism correction were compared between the treatment groups. Results: The study included 93 eyes treated with FS-LASIK and 186 eyes treated with T-PRK. No significant differences in postoperative spherical equivalent (−0.10 ± 0.7 D and −0.11 ± 0.7 D, respectively, p = 0.958) and postoperative refractive astigmatism (0.79 ± 0.54 D and 0.82 ± 0.63 D, respectively, p = 0.685) were demonstrated. A significant advantage of FS-LASIK over T-PRK was seen for the efficacy (1.00 ± 0.18 and 0.86 ± 0.22, respectively, p Conclusion: Both procedures demonstrated desirable post-operative SE outcomes for high-grade astigmatism correction. However, FS-LASIK achieved better results than T-PRK in the efficacy and safety parameters.

Purpose: To compare changes in anterior segment parameters following ExPRESS Mini Glaucoma Shunt surgery vs. trabeculectomy using the Pentacam rotating Scheimpflug camera. Methods: In this prospective, comparative study, 27 patients with glaucoma treated at the Rabin Medical Center from 2009 to 2013 were enrolled in this prospective comparative study: 19 participants (19 eyes) underwent ExPRESS shunt implantation and 12 (13 eyes) underwent trabeculectomy. Changes in anterior chamber parameters at postoperative day 1 and postoperative month 3 were evaluated on Scheimpflug images. Results: Intraocular pressure decreased significantly from baseline in both groups. The decrease in both groups was similar at postoperative month 3 (p=0.82). ExPRESS surgery caused a transient increase in posterior corneal astigmatism (p=0.008) and a transient decrease in anterior chamber depth (p=0.016) and volume (p=0.006) on postoperative day 1. At postoperative month 3, these parameters were no longer statistically significant (p=0.65, p=0.51, and p=0.57 respectively). Trabeculectomy caused a transient increase in anterior and posterior corneal astigmatism on postoperative day 1 (p=0.003 and p=0.005, respectively), which were not evident at postoperative month 3 (p=1.0 and p=1.0, respectively). At postoperative month 3, both ExPRESS and trabeculectomy showed similar changes in anterior chamber parameters. Conclusions: Both ExPRESS mini glaucoma implant and trabeculectomy significantly decreased intraocular pressure and had transient effects on anterior segment parameters, with minor differences between the methods. RESUMO Objetivo: Comparar as alterações nos parâmetros do segmento anterior após a cirurgia ExPRESS Mini Glaucoma Shunt vs. trabeculectomia usando a câmera Scheimpflug Pentacam rotativa. Métodos: Neste estudo comparativo prospectivo, 27 pacientes com glaucoma tratados no Centro Médico Rabin de 2009 a 2013 foram incluídos neste estudo comparativo prospectivo: 19 participantes (19 olhos) foram submetidos ao implante de derivação ExPRESS e 12 (13 olhos) foram submetidos à trabeculectomia. Alterações nos parâmetros da câmara anterior no dia 1 e em 3 meses de pós-operatório foram avaliadas pelas imagens de Scheimpflug. Resultados: A pressão intraocular diminuiu significativamente em relação aos valores iniciais nos dois grupos. A diminuição nos dois grupos foi semelhante no 3º mês pós-operatório (p=0,82). A cirurgia com ExPRESS causou um aumento temporário do astigmatismo posterior da córnea (p=0,008) e uma diminuição temporária da profundidade da câmara anterior (p=0,016) e do volume (p=0,006) no primeiro dia do pós-operatório. Ao final de três meses, esses parâmetros não foram mais estatisticamente significativos (p=0,065, p=0,51 e p=0,57, respectivamente). A trabeculectomia causou um aumento temporário do astigmatismo anterior e posterior da córnea no primeiro dia do pós-operatório (p=0,003 e p=0,005, respectivamente), mas isso não foi observado ao final de 3 meses (p=1,0 e p=1,0, respectivamente). Após 3 meses, tanto o EXPRESS quanto a trabeculectomia mostraram alterações semelhantes nos parâmetros da câmara anterior. Conclusões: O implante ExPRESS Mini para glaucoma e a trabeculectomia diminuíram significativamente a pressão intraocular e tiveram efeitos temporários nos parâmetros do segmento anterior, com pequenas diferenças entre os métodos.

Purpose To evaluate the intraoperative use of ultrasound biomicroscopy (UBM) during Descemet's membrane endothelial keratoplasty (DMEK) to determine graft's orientation. Methods Prospective interventional study of eight eyes of seven patients who underwent DMEK. Following the identification of correct graft orientation using 'Blue cannula tip' sign during DMEK surgery, UBM was used to ascertain graft's orientation. The rate of successful DMEK graft orientation determined by the UBM was registered and verified postoperatively by anterior segment-optical coherence tomography (OCT). Intra- and postoperative complications, postoperative clearance of the cornea, corrected distance visual acuity and endothelial cell loss were also noted. Results The study included five males and two females aged 54-82 years with corneal oedema due to Pseudophakic bullous keratopathy (n = 5), Fuchs' endothelial dystrophy (n = 2). In all cases, the technique allowed proper determination of the graft's orientation. In one case, 'blue cannula tip' sign showed correct orientation while UBM identified an upside-down graft. The graft was inverted in the anterior chamber using fluid jets, and repeat 'blue cannula tip' sign and UBM examination both showed correct orientation. In all cases, postoperative anterior segment-OCT demonstrated correct graft orientation. Conclusions Use of intraoperative UBM to determine graft orientation during DMEK correlated with proper graft orientation, as was verified postoperatively by anterior segment-OCT. The use of UBM can be particularly helpful in cases of poor graft visibility due to opaque corneal stroma, pigment or blood in the anterior chamber during surgery, or when the blue tint of the graft fades rapidly, which may preclude proper determination of graft's orientation.

Purpose To describe the ghost Descemet's membrane endothelial keratoplasty (DMEK) technique that allows for real-time evaluation of DMEK graft orientation, location, and folding status within the anterior chamber, by simple observation at the surgical microscope. Methods This is a retrospective case series done in a university hospital. The study included 10 patients who underwent ghost DMEK surgery because of corneal endothelial insufficiency for Fuchs' endothelial dystrophy (N = 5), pseudophakic bullous keratopathy (N = 2), and failed previous posterior lamellar keratoplasty (N = 3). Cases were reviewed for feasibility of graft preparation, intra- and postoperative complications, postoperative clearing of the cornea, corrected distance visual acuity, and endothelial cell loss. Results All graft preparations were uneventful. The circular staining was readily apparent and did not fade away during surgery. Graft orientation and folding status were determined using only direct observation through the operating microscope. Complications included one intraoperative hyphema, one graft detachment requiring rebubbling, and one pupillary block on the first postoperative day, which was resolved surgically. At last visit, 8 of 10 eyes had visual acuity of 6/12 or better and 7 of 10 eyes had visual acuity of 6/8.5 or better. Mean cell loss rates 1 to 3 months postoperatively were 48% ± 17% (range, 22%-71%). All corneas were clear by the first to second postoperative month. Mean follow-up time was 3 months (range, 1-8 months). Conclusions Peripheral staining of DMEK grafts (ghost DMEK) is a simple and effective method for graft visualization in the anterior chamber, obviating the need for trypan blue staining and other techniques and devices currently used for the identification of graft orientation and folding status, thus simplifying and shortening surgery.

The aim of the study was to examine the outcomes of transepithelial photorefractive keratectomy (Trans-PRK) and Femtosecond Laser-assisted in situ keratomileusis (Z-LASIK) for the correction of high myopia. A retrospective cohort study design was used. The study group included 792 eyes with high-grade myopia (− 6.0 diopters or higher) or high-grade myopia with astigmatism that were treated with Z-LASIK or Trans-PRK in 2013 through 2014 in an optical outpatient clinic of a large private medical service. The Trans-PRK group comprised of 674 eyes with a spherical equivalent (SE) of − 7.87 ± 1.46 and the Z-LASIK group comprised of 118 eyes with a SE of − 7.19 ± 0.81 (P

BACKGROUND In this study, we examined a novel variant of 'big-bubble' deep anterior lamellar keratoplasty using trypan-blue-stained viscoelastic device for the creation of a pre-descemetic bubble. METHODS Ten corneoscleral rims were mounted on an artificial anterior chamber (AC). The AC was filled with air through a limbal paracentesis. A Melles' triangulated spatula was inserted through the paracentesis, with its tip penetrating the AC, was then slightly retracted and pushed into the deep stroma above the roof of the paracentesis. A mixture of trypan blue and viscoelastic device (Healon, Abbott Medical Optics, Abbott Park, Illinois) was injected into this intra-stromal pocket using a 27-G cannula to create a pre-descemetic separation bubble. Bubble type and visualization of dyed viscoelastic device were noted. The method was later employed in three cases. RESULTS In all 10 corneoscleral rims, the technique successfully created a visible pre-descemetic (type 1) bubble that could be expanded up to the predicted diameter of trephination. Subsequent trephination and the removal of corneal stroma were uneventful. In two out of four clinical cases, a type 1 bubble was created, while in two others, visco-dissection failed and dyed viscoelastic was seen in the AC. CONCLUSIONS The presented technique holds promise of being a relatively easy to perform, predictable and well-controlled alternative for achieving a type 1 bubble during deep anterior lamellar keratoplasty surgery. The trypan-blue-stained viscoelastic device facilitates proper visualization and control of the separation bubble and assists in identifying the penetrance to the separation bubble prior to removal of the stromal cap.

Descemet’s membrane endothelial keratoplasty (DMEK) involves removal of the recipient’s Descemet membrane (DM) prior to transplanting the donor’s DM. When using balanced salt solution (BSS) or ophthalmic viscosurgical devices (OVDs), visualization of the host’s DM during its stripping may be inadequate and may result in Descemet remnants and could lead to sub-optimal surgical results. Previous articles described excellent visualization when utilizing air injection but this requires repeated air injection into the anterior chamber (AC). We present a pilot study that compares different techniques under which DM stripping can be performed: with continuous automated air infusion, with manual air infusion, and with BSS. We retrospectively compared video footage of DM stripping with BSS, with continuous air and with manual injection of air into the AC to determine DM stripping duration and the number of times the surgeon had to insert and retrieve a surgical instrument from the AC. Thirty videos of 10 consecutive cases of the three DM stripping techniques were evaluated. DM stripping duration was 3.26 (±1.32), 3.92 (±1.2) and 12.9 (±3.98) minutes for BSS, continuous air flow, and manual air injection, respectively. Frequency of instrument retrieval (FIR) was 3.6 (±1.71), 1.5 (±0.71) and 15.1 (±3.28) for BSS, continuous air flow, and manual air injection, respectively. Continuous air flow and BSS were both statistically different than manual air injection into the AC (p

Corneal melting with perforation is a severe ophthalmic complication of autoimmune disorders such as rheumatoid arthritis. It requires urgent medical management in order to maintain the integrity of the globe and preserve vision. Treating this complication by penetrating keratoplasty is problematic due to the high rate of recurrence of corneal melting as well as other complications. We describe the use of a tectonic fresh-tissue corneolimbal covering graft. An interventional case series including three patients that presented to our tertiary center between 2000 and 2015 with corneal melting and perforation, secondary to rheumatoid arthritis. Emergency surgery included suturing of a 13.00- to 13.50-mm full-thickness fresh-tissue corneolimbal covering graft to the patient’s posterior limbal zone. The corneolimbal graft maintained the integrity of the cornea in all cases, by sealing the perforation and promoting the creation of a fibrovascular scar at the area of corneal melting. There were no complications, recurrences of host corneal melting, or perforation during the follow-up period. Fresh-tissue full-thickness corneolimbal grafts may be used to cover emergency corneal melting and perforations secondary to rheumatoid arthritis.

AimTo identify risk factors for the development of dupilumab-induced ocular surface disease (DIOSD) in adult patients with atopic dermatitis (AD) and describe outcomes of treatment.MethodsA retrospective institutional cohort study performed at the Rabin Medical Center, Petach Tikva, Israel. Adult patients with AD who received dupilumab from March 2018 to June 2019 were included. Demographics, AD severity scores, blood IgE levels, previous atopic keratoconjunctivitis (AKC), dermatological response to dupilumab, ophthalmological evaluation and treatment were noted. Univariate and multivariate analyses were used to identify risk factors for DIOSD.ResultsSixteen of 37 patients who were included in the study (43%) had new or exacerbated symptoms of ocular surface disease starting at 2 weeks following the first treatment. Three patients reported transient dry eye sensation which lasted 2 weeks; nine patients reported chronic dry eye sensation, and four patients (25%) had marked blepharoconjunctivitis. The presence of severe AD was the strongest predictor of DIOSD. Not a single patient with moderate AD had DIOSD. In multivariate analysis, prior AKC was a risk factor for DIOSD (R2=15.78, OR=23.28, p=0.005) while a family history of atopy was protective of DIOSD (R2=6.22, OR=0.13, p=0.05). All four patients with blepharoconjunctivitis had resolution of signs, and symptoms within days of starting periocular 0.03%–0.1% tacrolimus ointment.ConclusionsDIOSD is common in patients with AD receiving dupilumab. While most cases are mild, some patients can develop blepharoconjunctivitis which responds well to tacrolimus ointment. AD severity, and previous AKC are risk factors for DIOSD.

To describe the clinical outcomes of using C3F8 as a tamponade agent for the attachment of partially detached Descemet membrane endothelial keratoplasty (DMEK) grafts after failure of previous rebubbling attempts.Interventional case series. We reviewed the medical records of all DMEK surgeries performed at Rabin Medical Center (Petach Tikva, Israel) between January 2016 and December 2018 in which 10% C3F8 tamponade was used for graft reattachments. Patient demographic details, indication for surgery, early postoperative endothelial cell loss, postoperative visual acuity, intraoperative and postoperative complications as well as graft survival were noted.Five patients were included in this case series. Indications for DMEK were pseudophakic bullous keratopathy (n = 3), failed penetrating graft (n = 1), and Fuchs endothelial dystrophy (n = 1). In 4 of 5 cases, SF6 tamponade was used at the end of the initial DMEK surgery. In 1 case, air tamponade was used. In all cases, partial graft detachment was seen 1 to 2 weeks postoperatively, and anterior chamber rebubbling was performed using 20% SF6 gas. A second C3F8-assisted rebubbling was performed 10 to 70 days after the primary DMEK surgery. In all cases, complete graft attachment was achieved, and the corneas cleared. Early endothelial cell loss rates averaged at 44% ± 26% (range 20%-74%). One case which had a previous trabeculectomy with chronic preoperative and postoperative hypotony had failed 6 months after surgery. All the other grafts were clear at last visit.Tamponade using nonexpansile 10% C3F8 gas can attach partially detached DMEK grafts after the failure of previous air- or SF6-assisted rebubbling attempts.

Previous studies demonstrated the potential pathogenic relationship between infestation of the eyelashes by the parasite Demodex and chronic blepharitis, whereas other studies did not demonstrate such relations and concluded that Demodex is a normal eyelid flora.This study examines the prevalence of Demodex in patients with blepharitis compared to a healthy control group in Israel, in order to further explore and establish its pathogenic role in cases of chronic blepharitis.A case-control study was conducted including 110 participants: 60 patients with chronic blepharitis attending a tertiary medical center and 50 subjects with no signs of blepharitis. Six to eight eyelashes were epilated from each participant and studied microscopically for the presence of Demodex by a blinded examiner. Fluorescein stain was added to the "clean" samples in order to reduce the false negative results.Demodex were identified on the eyelashes of 44 patients with blepharitis (73.3%) and 20 controls (40%) (p0.001). After adjusting for age, blepharitis was still a significant risk factor for the presence of Demodex (OR=2.96, CI 95% 1.2-7.3).This study supports previous studies demonstrating pathogenic relationship between Demodex infestation of the eyelashes to chronic blepharitis. The authors recommend epilating 6-8 lashes of patients with blepharitis for microscopic identification of these parasites. Fluorescein stain may have a limited role in the recognition of Demodex in parasite free samples.

PURPOSE: To assess Descemet’s membrane endothelial keratoplasty (DMEK) without performing a peripheral iridotomy (PI) prior to or during surgery (“PI-less DMEK”). MATERIALS AND METHODS: This retrospective study included consecutive patients that underwent PI-less DMEK by a single surgeon (E.L) between February 2016 and February 2017 at the Rabin Medical Center, a Tertiary Hospital. Intraoperative and postoperative complications were assessed. RESULTS: Thirty-one patients, mean age 75.9 ± 7.9 years with 58.1% female were included. Leading indications for surgery were pseudophakic bullous keratopathy (18/31) and Fuchs’ endothelial dystrophy (9/31). Preoperative best-corrected distance visual acuity was 1.13 ± 0.59 logMAR (~6/80 Snellen). For 12/31 that had postoperative endothelial cell count measurements, cell loss was 49 ± 20%. Intraoperative complications included anterior chamber (AC) hyphema during graft insertion requiring reinsertion (n = 1), and minor hyphema from the main corneal incision (n = 1). Partial slit lamp gas evacuation was performed in all patients 1.5 h postoperatively. Postoperative complications included partial graft detachment requiring rebubbling (n = 5), self-resolving minimal peripheral graft detachment (n = 5), uncontrolled intraocular hypertension requiring trabeculectomy in a patient with a history of medically controlled glaucoma (n = 1), postoperative cystoid macular edema that resolved medically (n = 1) and graft failure 5 months postoperatively (n = 1). No patients developed pupillary block. Excluding graft failure (n = 1), preoperative amblyopia (n = 2) and premature loss to follow-up (n = 1), final corrected distance visual acuity was 0.18 ± 0.14 logMAR (~20/30 Snellen) with 44.4% reaching 6/7.5 (Snellen) or more. CONCLUSIONS: PI-Less DMEK is a safe, technically easy, and effective modification that avoids the time and complications associated with performing a PI before or during surgery.

PURPOSE We aimed to evaluate the efficacy of subconjunctival aflibercept, a vascular endothelial growth factor trap compound, for the treatment of corneal neovascularization in a rat model. METHODS Chemical burn was produced in the central cornea of 31 male Sprague-Dawley rats. Animals were randomized to receive treatment with subconjunctival injection of 0.08 mL aflibercept (25 mg/mL), 0.05 mL bevacizumab (25 mg/mL), or 0.05 mL physiologic saline. Corneal neovascularization was evaluated on postinjury days 1, 3, 7, 9, and 13 by corneal photographs. The rats were killed on day 21 and samples were collected for histological and flat-mount immunofluorescence analyses. RESULTS In all rats, vascular sprouting began on day 3, reached maximum density on days 7-9, and spontaneously regressed thereafter. Mean burn area in the central cornea comprised ∼15% of the total corneal area. The aflibercept group had a significantly smaller relative area of neovascularization than both control group (P < 0.05, 12.27 ± 9.91, 29.66 ± 9.96 days 7) and bevacizumab group (P < 0.05, 12.27 ± 9.91, 21.27 ± 8.19 days 7 and 15.5 ± 10.25, 32.38 ± 9.44 days 9; Mann-Whitney test). On histological study, hematoxylin and eosin staining revealed blood vessels extending to the central cornea in the control and bevacizumab groups and limited to the periphery in the aflibercept group. Immunofluorescence study with an endothelial marker revealed a smaller area of staining in the aflibercept group. CONCLUSIONS Aflibercept effectively inhibits corneal neovascularization in a rat model of chemical burn-induced neovascularization and warrants further study for potential use in humans.

The problem of bacterial infections in general, and in medical devices in particular, has led to extensive research to produce antibacterial coatings. The current research presents a unique technique for imparting antibacterial properties to contact lenses. The coating consists of nanoparticles of zinc-doped copper oxide. In the coating process, active nanoparticles are formed and immediately deposited onto the surface of the contact lens. The coating thus formed is homogeneous and stable, without leaching of the nanoparticles. The antibacterial activity was evaluated against Gram-positive and Gram-negative bacteria. The optimization of the coating process has led to a smaller particle size and good antibacterial activity.

This work examined the antibacterial and physical effects of a novel Zn-CuO nanocoating applied on a silicone hydrogel contact lens. Zn-CuO coating of PureVision balafilcon-A soft contact lenses (Bausch&Lomb, Rochester, NY) was performed by sonochemical deposition using a high-intensity ultrasonic horn. Non-coated PureVision lenses served as a control in all experiments. Adhesion assays for P. aerueginosa and S. epidermidis to the coated lenses were performed to identify the minimal coating concentration which still possessed antibacterial activity. Lens water content, oxygen transfer light transfer, leaching, and electron microscopy studies were performed using this concentration. Coated lenses showed 3–5 log reductions in adhesion of both species. The lowest tested coating concentration of 0.02 wt% led to a log reduction of 3.25 ± 1.25 of P. aeruginosa CFU/lens (P = 0.007) and a log reduction of 4.37 ± 0.75 of S. epidermidis (p = 0.0007). Using this coating concentration, water content (36%, 33.6%), oxygen transfer (87.22 ± 10.96, 92.18 ± 2.38, × 10−11(cm2/s)(mlO2)/(ml × mmHg)), p = 0.12), and light transfer properties did not differ significantly between the coated and the control contact lenses. In the range of 380–780 nm wavelength, the coated lenses transmitted 96.47 ± 1.52% while the control lenses transmitted 97.36 ± 1.35%. The corresponding values for the range of 300–380 nm wavelength were 79.343 ± 8.754 and 80.169 ± 1.35. Leaching studies for 0.5 mM coated lenses have demonstrated the excellent stability of the coating with the release of only 0.005% of the coating after 1 week of exposure to the test solution. Sonochemical-assisted nanocoating of contact lenses showed significant and consistent antibacterial activity while preserving the basic properties of a silicone hydrogel contact lens.

PURPOSE To evaluate the efficacy of corneal collagen cross-linking (CXL) with photoactivated riboflavin (PACK-CXL) as primary therapy for Staphylococcus aureus-induced corneal ulcers in a rabbit model. METHODS The right eye of 40 rabbits was inoculated with S. aureus to induce formation of central corneal ulcers (day 1). The ulcer was examined on day 5, and rabbits were randomly assigned to 4 groups-group A: no treatment (control); group B: topical antibiotic treatment (cefazolin 50 mg/mL, garamycin 14 mg/mL drops, chloramphenicol 5% ointment every 2 hours); group C: PACK-CXL; group D: PACK-CXL + topical antibiotics. Follow-up by biomicroscopy was performed on day 5 and then every week for 1 month. The main outcome measures included infiltrates or the scar diameter, time to healing, time to full epithelialization, and a change in corneal thickness. RESULTS After 1 month of treatment, group C ulcers had the smallest mean scar diameter (8.8 mm), followed by groups D (11.2 mm), B (13.0 mm), and A (24.5 mm) (P = 0.011). Group C had the shortest mean healing time (15.5 days), followed by groups D (17.2 days), B (19.7 days), and A (21.8 days). Analysis of relative reduction in the infiltrate size from day 5 yielded better results for groups C (P = 0.039) and D (P = 0.034) than those of group B. CONCLUSIONS We demonstrate a beneficial effect of PACK-CXL as primary treatment, either as stand-alone or as an adjuvant to antimicrobial therapy.