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Background/Objectives: To report the cosmetic, clinical, and visual outcomes of a combined surgical approach for treating a corneal/limbal dermoid using excision and a three-layered amniotic membrane graft with fibrin glue. Methods: An 18-year-old female presented with impaired vision and ocular discomfort caused by a prominent dome-shaped limbal congenital dermoid on the inferotemporal cornea, resulting in a significant aesthetic concern. A full assessment, including refraction, best-corrected visual acuity (BCVA), corneal topography, aberrometry and anterior segment OCT (AS-OCT) was conducted to plan the surgical approach. The dermoid was excised under peribulbar anaesthesia using manual lamellar dissection, followed by the application of 0.02% Mitomycin C and a multilayered amniotic membrane graft with fibrin glue. A bandage contact lens was applied and removed after three weeks, with postoperative treatment including topical antibiotics and steroids. Follow-ups were conducted on day 1, at 1 week, 3 weeks, 2 months, 6 months, 1 year, and 2 years. Results: Histopathological examination confirmed the mesoblastic nature of the lesion. Significant improvements in BCVA and ocular symptoms were observed. Corneal topography showed ocular surface regularization with reduction of high order aberrations and point spread function. AS-OCT showed complete integration of the amniotic membrane, with full epithelial coverage of the defect. The healing process was uneventful and the ocular surface remained stable throughout the entire follow-up, without complications or recurrence. Conclusions: This approach of dermoid excision, multilayered amniotic membrane and fibrin glue restored vision effectively, with notable improvements in ocular surface and cosmetic outcomes, without recurrence over two years. [ABSTRACT FROM AUTHOR]

Background: This study aims to evaluate the repeatability of the Pentacam HR, comparing two different measurement modes (50-cornea fine and 25-3D scan) in patients affected by keratoconus. Methods: Multicenter retrospective study, conducted at Eye Clinic of the ASST-Spedali Civili-University of Brescia, Italy, and St. Paul's Eye Unit, Royal Liverpool University Hospital, United Kingdom. A total of 72 eyes from 72 patients with keratoconus underwent six consecutive measurements, three using the 25-3D scan mode and three with the 50-Cornea fine mode. Measurements were made by one single observer, using the Scheimpflug corneal tomographer camera (Pentacam HR, Oculus, Wetzlar, Germany). Repeatability was assessed using the within-subject SD (Sw) statistic from a two-way analysis of variance. Results: Both measurement modes had excellent repeatability. The interclass coefficient correlation (ICC) was excellent (>0.9) in all the parameters evaluated, apart from anterior and posterior astigmatic axes and posterior astigmatism (ICC > 0.8) and index of height asymmetry (IHA) (ICC < 0.6). However, in 18 of 29 parameters, the ICC was higher in case of 25-3D scan. Repeatability limit for Kmax was 1.00D in 25-3D scan mode and 1.02D in case of 50-cornea fine. Conclusions: 25-3D scan may be preferable to 50-Cornea fine, in view of having slightly higher ICC in case of patients with keratoconus. Repeatability limits reported may be helpful in clinical practice for assessing the progression of keratoconus. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to evaluate the effect of a surgical technique for managing post-penetrating keratoplasty (PK) ectasia complicated by late endothelial failure (LEF). Methods: A single-center pilot case series was conducted regarding consecutive patients affected by post-PK ectasia with late graft failure. Using a microkeratome, a single donor cornea was dissected to prepare a two-piece graft, comprising a larger anterior lamella made up of anterior stroma and a smaller posterior lamella made up of posterior stroma, Descemet's membrane, and endothelium. The two lamellae were then positioned on the appropriately prepared recipient cornea. The technique was applied to 15 patients between 2022 and 2023, and data were retrospectively collected from preoperative evaluations and at 1, 6, and 12 months, post-operatively. At each visit, patients underwent standard clinical evaluation, corneal topography, and endothelial cell density evaluation, and visual acuity was measured using a LogMAR chart. Results: The technique restored normal corneal curvature and achieved a clear graft in all patients, leading to the resolution of preoperative ectasia and improved corneal pachymetry. At the one-year follow-up, the average K was reduced from 51.1 ± 4.5 D to 43.5 ± 1.1 D; the best corrected visual acuity (BCVA) was improved from 1.1 ± 0.4 to 0.3 ± 0.2 LogMAR; the central corneal thickness was reduced from 629 ± 39 μm to 532 ± 45 µm; and the endothelial cell density was 1926 ± 199 cells/mm2. None of the patients developed severe complications. Conclusions: The two-piece manual mushroom PK may represent an effective technique for managing complex post-PK ectasia cases combined with endothelial decompensation. [ABSTRACT FROM AUTHOR]

Background: To analyse the effect of suprachoroidal injection (SChI) of triamcinolone acetonide (TA) on macular thickness (CRT), ectopic inner foveal layer thickness (EIFL-T) and best corrected visual acuity (BCVA) in pseudophakic patients undergoing vitrectomy for epiretinal membrane (iERM) compared to intravitreal injection of TA (IVTA). Methods: Prospective matched comparison of patients undergoing vitrectomy for Govetto stage 3 and 4 iERM. 25 eyes receiving IVTA (G-1) were compared to 23 eyes receiving SChI-TA (G-2) during vitrectomy. Primary outcome was change in BCVA, CRT, EIFL-T before surgery and 1, 3 and 6 months after surgery. Secondary outcome was the incidence of cystoid macular edema (CME). Results: Six months after surgery, G2 had a greater mean reduction in CRT (−222 µm vs −131 µm) and EIFL-T (−200 µm vs −104 µm) than G1. BCVA improved more in G2 than in G1 (p = 0.02). Foveal depression reformed in 43% of cases in G-2 and 16% of cases in G-1. Incidence of postoperative CME was 16% in G-1 and 4.3% in G-2. Conclusions: During vitrectomy for iERM, SChI-TA was more effective than IVTA in reducing CRT and EIFL-T and improving BCVA. SChI-TA was effective in preventing postoperative CME. SChI-TA treatment was safe and reproducible and did not affect postoperative IOP. Trial registration NP6289—June 18th, 2024 (retrospectively registered). [ABSTRACT FROM AUTHOR]

Purpose: To investigate the potential improvement in visual acuity and subjective perception of image quality in patients with keratoconus using non‐orthogonal correction (NOC) cylinder trial lenses where the steep and flat power meridians are set at angles less or greater than 90°. Methods: A set of NOC plano/cylindrical trial lenses, where the axes between the power meridians were set at a range of non‐orthogonal angles, were used to refract 18 participants with keratoconus in whom 23 eyes were used for testing. Corneal elevation data were processed by bespoke MATLAB code from Pentacam Scheimpflug tomographer scans. Each participant first underwent subjective refraction using standard orthogonal cylinder trial lenses, and the monocular best‐corrected visual acuity (BCVA, logMAR) was recorded for each eye. They then underwent a second subjective refraction using NOC cylinder trial lenses created for the study and completed a questionnaire to elicit their subjective appraisal of letter clarity and ghosting. Results: Fourteen (61%) eyes demonstrated an increase in objective BCVA with the NOC versus the orthogonal correction; seven (30%) eyes showed no change and in two (9%) eyes, the BCVA was slightly worse. Further, 87% and 79% experienced an increase in letter clarity and a reduction in ghosting, respectively, independent of changes in BCVA. The majority of non‐orthogonal angles were in the range of 80°–85°, and it was possible to refine the cylinder and axis of the NOC further compared with the orthogonal correction. All but one of the participants said they would be interested in trying non‐orthogonal spectacles if the opportunity arose. Conclusions: Correcting irregular astigmatism in keratoconic individuals with non‐orthogonal spectacle correction may provide benefit in terms of increased visual acuity, improvements in letter clarity and a reduction of ghosting effects. This type of correction has the potential to improve the overall quality of life for patients with keratoconus. [ABSTRACT FROM AUTHOR]

Purpose: To compare the aberrometric profile of the Artisan Aphakia lens (Opthec BV) and transscleral plug FIL-SSF lens (Soleko) and to assess the impact of tilt and decentration on their optical performance. Methods: This retrospective observational study was conducted at Azienda Ospedaliera Universitaria Careggi, Florence, Italy, with a consecutive cohort of aphakic eyes undergoing secondary lens implantation with an Artisan or FIL-SSF lens. Wavefront analysis was performed using a pyramidal wavefront-based aberrometer (Osiris-T; CSO). Tilt and decentration were calculated using anterior segment optical coherence tomography (MS-39; CSO). Results: The study included 47 eyes from 45 patients: 24 eyes in the FIL-SSF group and 23 eyes in the Artisan group. Decentration was 0.39 ± 0.14 mm in the FIL-SSF group and 0.51 ± 0.16 mm in the Artisan group (P =.02). The mean tilt value was 6.6 ± 2.35 degrees in the FIL-SSF group and 5.9 ± 1.86 degrees in the Artisan group (P =.13). Internal higher order aberrations (HOAs) were 0.23 ± 0.07 μm in the FIL-SSF group and 0.29 ± 0.13 μm in the Artisan group (P =.02). The point spread function (PSF) Strehl ratio was 0.12 ± 0.05 in the FIL-SSF group and 0.10 ± 0.04 (P =.11) in the Artisan group. The PSF Strehl ratio without lower order aberration (PSFw2) was 0.28 ± 0.12 in the FIL-SSF group and 0.23 ± 0.09 in the Artisan group (P =.01). Conclusions: The Artisan and FIL-SSF lenses provide comparable optical performance in terms of the PSF Strehl ratio. However, the Artisan lens appears to be more susceptible to decentration, which may result in increased higher order aberrations and a consequently lower PSFw2 Strehl ratio. [J Refract Surg. 2024;40(12):e926–e933.] [ABSTRACT FROM AUTHOR]