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Background: This study aims to investigate the knowledge, attitudes, and practices (KAP) regarding keratopathy among diabetic patients. Methods: A web-based cross-sectional study was conducted between May 26, 2023, and September 18, 2023, at Yantai Shan Hospital and Yantai Yuhuangding Hospital. Demographic information and KAP were assessed through the distribution of questionnaires. Results: Among the 521 participants, average knowledge, attitude, and practice scores were 6.11 ± 4.53, 27.61 ± 4.41, and 37.25 ± 5.21, respectively. Path analysis revealed a significant association between attitude and knowledge (β = 0.416, P < 0.001), and practice(β = 0.683, P < 0.001). Multivariate logistic regression indicated that attitude score (OR = 1.288, 95%CI: 1.203–1.379, P < 0.001), higher monthly incomes(> 10000 RMB) (OR = 3.494, 95%CI: 1.104–11.055, P = 0.033), higher self-rated control levels(4 and 5 points) (OR = 3.729, 95%CI: 1.687–8.243, P = 0.001 and OR = 3.801, 95%CI: 1.560–9.261, P = 0.003 respectively) and family history of ophthalmic diseases (OR = 0.297, 95%CI: 0.115–0.762, P = 0.012) were independently associated with proactive practice. Conclusion: Diabetic patients demonstrated inadequate knowledge, moderately positive attitudes, and reasonably proactive practices concerning keratopathy. The study emphasizes the impact of attitude on practice, influenced by knowledge and other factors such as self-rated blood sugar control and family history of ophthalmic diseases. [ABSTRACT FROM AUTHOR]

Background: There is scarcity of data on the incidence and factors associated with the occurrence of ocular lesions in critically ill children. Aim: Test the applicability and utility of an ocular assessment scale and to identify risk factors of ocular lesions. Study Design: Prospective observational study. A tertiary care medical‐surgical Paediatric Intensive Care Unit. 194 children without previous ocular disease who stayed in the Paediatric Intensive Care Unit for more than 48 h. An ocular lesions risk scale was designed including risk factors lagophthalmos, eye dryness, conjunctival hyperemia, slow blinking, intubation, sedation, relaxation, face mask and hemodynamic instability. Patients were classified as high‐, medium‐, and low‐risk patients. Corneal lesions were examined by fluorescein staining according to their risk and were confirmed by an ophthalmologist. Results: 76 patients were examined with fluorescein staining. Thirty‐two ocular lesions were detected by nursing staff, 26 confirmed by the ophthalmologist. 53.6% of the high‐risk patients developed a corneal lesion. Univariate analysis revealed an association between ocular damage and all factors included in the scale, except for face mask. In the multivariate analysis, ocular lesions were associated with lagophthalmos, hyperemia, invasive mechanical ventilation and inotropic support. Conclusions: The scale was useful to detect corneal lesions in critically ill children. The identification of risk factors will enable the development of measures to reduce the incidence of ocular lesions. Relevance for Clinical Practice: A new, non‐validated scale allowed staff to detect eye injuries, study this problem and improve future prevention. [ABSTRACT FROM AUTHOR]

Abstract Background This study aims to investigate the knowledge, attitudes, and practices (KAP) regarding keratopathy among diabetic patients. Methods A web-based cross-sectional study was conducted between May 26, 2023, and September 18, 2023, at Yantai Shan Hospital and Yantai Yuhuangding Hospital. Demographic information and KAP were assessed through the distribution of questionnaires. Results Among the 521 participants, average knowledge, attitude, and practice scores were 6.11 ± 4.53, 27.61 ± 4.41, and 37.25 ± 5.21, respectively. Path analysis revealed a significant association between attitude and knowledge (β = 0.416, P 10000 RMB) (OR = 3.494, 95%CI: 1.104–11.055, P = 0.033), higher self-rated control levels(4 and 5 points) (OR = 3.729, 95%CI: 1.687–8.243, P = 0.001 and OR = 3.801, 95%CI: 1.560–9.261, P = 0.003 respectively) and family history of ophthalmic diseases (OR = 0.297, 95%CI: 0.115–0.762, P = 0.012) were independently associated with proactive practice. Conclusion Diabetic patients demonstrated inadequate knowledge, moderately positive attitudes, and reasonably proactive practices concerning keratopathy. The study emphasizes the impact of attitude on practice, influenced by knowledge and other factors such as self-rated blood sugar control and family history of ophthalmic diseases.

Purpose To review the existing literature to evaluate the utility of insulin eye drops as a treatment for neurotrophic-related epithelial defects. Methods A comprehensive literature search of Medline, Embase, and Web of Science and additional manual searches were conducted using relevant keywords. All articles published from January 2005 to January 2024 were examined. Studies on the use of topical insulin drops in neurotrophic epithelial defects were included. Results A total of 16 articles were found relevant to be discussed in the review. All included patients had neurotrophic-related epithelial defects ranging from 3.8 mm2 to 144 mm2. After treatment with topical insulin, most of the epithelial defects showed a complete epithelialization. Various concentrations and types of insulin were used. The studies also varied in the type of vehicle used in the preparation of insulin drops. Two randomized controlled trials demonstrated that topical insulin drops were more effective than conventional treatment with artificial tears or autologous serum. All included studies, except for two, reported the absence of local or systemic side effects. Conclusions Topical insulin is a promising and effective (adjuvant) treatment for neurotrophic keratopathy. It facilitates the healing of neurotrophic epithelial defects and offers many advantages over the current treatment options; insulin is widely available and it is relatively inexpensive. Topical insulin drops do not affect systemic blood glucose levels and are well tolerated. However, further investigation is needed.

The occurrence and development of ophthalmic diseases are related to the dysfunction of eye tissues. Ubiquitin is an important form of protein post-translational modification, which plays an essential role in the occurrence and development of diseases through specific modification of target proteins. Ubiquitination governs a variety of intracellular signal transduction processes, including proteasome degradation, DNA damage repair, and cell cycle progression. Studies have found that ubiquitin can play a role in eye diseases such as cataracts, glaucoma, keratopathy, retinopathy, and eye tumors. In this paper, the role of protein ubiquitination in eye diseases was reviewed. [ABSTRACT FROM AUTHOR]

Copyright of Current Retina Journal / Güncel Retina Dergisi is the property of Anadolu Kitabevi Basim Yayim Medikal Turizm Kirtasiye Tic. Ltd. Sti. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Congenital aniridia is a rare ocular disorder characterized by the partial or complete absence of iris tissue. Although the classic form is associated with a range of ocular abnormalities, including foveal and optic nerve hypoplasia, nystagmus, and cataracts, it is the onset of glaucoma, cataracts, and keratopathy that most significantly impair vision in affected patients. Typically caused by mutations in the PAX6 gene, which encodes the paired box protein Pax-6, aniridia can also be associated with systemic conditions such as WAGR syndrome. This study emphasizes the importance of comprehensive ophthalmic examination and genetic testing in diagnosing and managing aniridia, particularly when associated with systemic conditions. Multidisciplinary management and regular follow-up are essential to monitor for potential complications, including Wilms' tumor, ensuring optimal care for affected patients.

Purpose: This study reports a case of Crohn's disease-associated keratopathy that progressed with disease activity. Observations: A 29-year-old man diagnosed with Crohn's disease and receiving systemic adalimumab therapy, presented with an irregular epithelial surface, superior corneal opacity, subepithelial infiltration, pannus with new vessel ingrowth, and punctate epithelial erosions in both corneas. Changes in ophthalmological findings were checked during regular outpatient follow-ups. We also compared the stool calprotectin values obtained at a gastrointestinal clinic during the course of keratopathy. By analyzing the trend of fecal calprotectin levels in this patient, we found that keratopathy worsened as fecal calprotectin levels increased. Corneal neovascularization and infiltration improved as the fecal calprotectin levels decreased. Conclusions and importance: The mechanism of Crohn's disease-associated keratopathy has not been identified but appears to be related to the autoimmune mechanism of Crohn's disease. Managing Crohn's activity by referring to the gastroenterology department should be considered to relieve Crohn's disease-associated keratopathy.

Background: Ocular involvement in autoimmune bullous dermatoses (AIBD) remains underappreciated. Objectives: The objective was to study the prevalence and characteristics of ocular involvement in patients with AIBD. Methods: The medical records of 25 patients (males: females 11:14) aged between 27 and 85 years (mean ± standard deviation = 44.9 ± 15.6 years) with AIBD were analyzed retrospectively for clinico-epidemiological attributes and the presence of ocular abnormalities. Results: There were 20 (80%) pemphigus patients, of which most were pemphigus vulgaris (PV, n = 14) and pemphigus foliaceus (PF, n = 6). Other 5 (20%) patients included bullous pemphigoid (BP, n = 4) and cicatricial pemphigoid (CP, n = 1). Seventeen (68%) patients comprising 11 (78.6%) of PV, 3 (50%) of PF, 2 (50%) of BP, and 1 (100%) of CP had 27 ocular abnormalities. Erosions of lid margins (n = 3, 27.3%), blepharitis with meibomitis (n = 1, 9.1%), chalazion (n = 1, 9.1%), and conjunctival vesicles over bulbar conjunctivae (n = 2, 18.2%), conjunctivitis (PV = 5, 45.5%, PF = 1, 33.3%), and symblepharon and keratoconjunctivitis sicca in one (9.1%) patient each, respectively, were major ocular manifestations in pemphigus. Entropion with trichiasis, shallow fornices, and corneal opacities were major abnormalities in patients with BP (n = 2, 100%) and CP (n = 1, 100%). Conclusion: Ocular comorbidities vary in prevalence and severity between subtypes of AIBD. These are mainly from complications of ocular surface disease predominantly affecting the anterior segment of the eye. They are more severe in patients with CP compared to others. The study is limited by a single-center, retrospective-study design, a small number of patients in each group for stratification, and long-term follow-up.

Background/Objectives: Aniridia-associated keratopathy (AAK) is a potentially vision-threatening pathology in congenital aniridia, for which both the underlying etiopathogenesis and effective treatment remain unclear. Methods:This prospective study was conducted to assess and compare the short-term outcome after superficial keratectomy (SK) alone or in a combination with an amniotic membrane transplantation (AMT). Here, 76 eyes were enrolled in 76 patients with grade 4 AAK. In all eyes, in order to assess preoperatively the efficiency of the limbal epithelial stem cells (LESC), the presence of corneal epithelial cells in confocal microscopy was established. The analyses included: best corrected visual acuity (BCVA), the stage of AAK and the number of corneal quadrants involved in corneal neovascularization (CNV). Results: Six months after surgery, the mean BCVA was 0.05 and ranged from 0.002 up to 0.1 in both groups. Improvement in BCVA occurred in 94.29% patients when *SK alone* was performed, and in 92.68% when in combination with AMT. There were no statistically significant differences in the effect of therapy depending on the type of surgery, regarding BCVA, stage of AAK and the number of quadrants with CNV. Conclusions: SK alone is an effective procedure in short outcomes limited to six months for advanced AAK in association with LESC partial efficiency. [ABSTRACT FROM AUTHOR]

Background/Aim: Hidradenitis suppurativa (HS) is linked to immune dysregulation and systemic inflammation. While previous studies indicate a higher prevalence of ocular manifestations in HS, the specific risk of keratopathy and keratitis remains unclear. The primary aim of this study was to assess the risk of keratitis and keratopathy in individuals with HS. Patients and Methods: In this retrospective cohort study conducted with data from the TriNetX database, 53,716 patients with HS were matched to an equivalent number of non-HS controls using propensity score matching. The study covered the period from January 1st, 2005, to December 31st, 2017. Hazard ratios and their respective 95% confidence intervals (CIs), were computed to evaluate the occurrences of keratitis and keratopathy over a 5-year duration in patients with HS, compared to non-HS controls. Results: HS was associated with a 1.52 times higher risk of keratitis over a 5-year period (95%CI=1.24- 1.86) and a 1.47 times higher risk of keratopathy (95%CI=1.18-1.84). These risks remained consistent in sensitivity analyses. The elevated risk of keratitis was observed across both sexes. However, the risk of keratopathy was significantly higher in women with HS (HR=1.61, 95%CI=1.24-2.10) and individuals aged 18-64 years (HR=1.32, 95%CI=1.04-1.68). Conclusion: HS was linked to an elevated risk of both keratitis and keratopathy over a 5-year period. Ophthalmologic manifestations are recommended to be considered in HS standard care. [ABSTRACT FROM AUTHOR]

Diabetes mellitus, the most prevalent endocrine disorder, not only impacts the retina but also significantly involves the ocular surface. Diabetes contributes to the development of dry eye disease and induces morphological and functional corneal alterations, particularly affecting nerves and epithelial cells. These changes manifest as epithelial defects, reduced sensitivity, and delayed wound healing, collectively encapsulated in the context of diabetic keratopathy. In advanced stages of this condition, the progression to corneal ulcers and scarring further unfolds, eventually leading to corneal opacities. This critical complication hampers vision and carries the potential for irreversible visual loss. The primary objective of this review article is to offer a comprehensive overview of the pathomechanisms underlying diabetic keratopathy. Emphasis is placed on exploring the redox molecular pathways responsible for the aberrant structural changes observed in the cornea and tear film during diabetes. Additionally, we provide insights into the latest experimental findings concerning potential treatments targeting oxidative stress. This endeavor aims to enhance our understanding of the intricate interplay between diabetes and ocular complications, offering valuable perspectives for future therapeutic interventions. [ABSTRACT FROM AUTHOR]

Purpose: To review the prevalence and describe the characteristics, of cases with late-onset intracorneal ring segments (ICRS) keratopathy in a multicenter study. Methods: A retrospective multicentric case-series study was performed in a specialized keratoconus service, from Buenos Aires, Argentina. An electronic clinical chart from patients with ICRS keratopathy between January 1999 and January 2019 was reviewed. We included cases with late-onset distal-apical ICRS keratopathy, which was defined as a persistent corneal lesion developed 12 months or later after implantation, located over, around, or closer to the ICRS. All the surgeries were performed by a manual corneal tunnel creation technique. Samples were taken to rule out infectious etiology. Results: From 5217 eyes that underwent ICRS implantation, 13 cases (0.24%) were detected. The keratopathy onset was 72 ± 42.98 months (29–133) after ICRS implantation. Cultures were negative in all cases. An ICRS exchange was made for five cases in stage I and four in stage II. Four cases presented with partial ICRS extrusion in stage III. ICRS exchange was possible in two of them and a penetration keratoplasty was necessary for the rest. All cases remained stable 1 year after surgical procedures. Conclusions: A late-onset distal-apical ICRS keratopathy was detected with low prevalence (0.24%) in a large sample. It was classified into three stages according to its severity. Different treatments were selected for each stage, obtaining stable results 1 year after treatment. [ABSTRACT FROM AUTHOR]

It is considered, that one of the main directions of treatment of adenovirus conjunctivitis is the appointment of interferon alpha-2b in combination with diphenhydramine, which until recently was provided by the only original drug. In 2020, the first generic drug, Interferon-Oftalmo, would be registered in Russia.The purpose: to evaluate and compare the efficacy, safety and tolerability of treatment of patients with keratopathy against the background of adenovirus keratoconjunctivitis with Interferon-Oftalmo and Oftalmoferon.Material and methods. The comparative analysis included completed cases of treatment of 51 patients (102 eyes) aged 18–75 years with clinical signs of keratopathy against the background of epidemic adenoviral keratoconjunctivitis. Patients of the first group (n = 27, 54 eyes) on the background of tear replacement therapy received eight instillations of the drug Interferon-Ophthalmo, the second (n = 24, 48 eyes) received Oftalmoferon. The observation period was 15 days. Treatment efficacy was assessed based on a quantitative analysis of the dynamics of clinical symptoms of inflammation and the state of the cornea, the severity of subjective manifestations of ocular surface xerosis using the ocular surface damage index (OSDI), as well as the stability of the tear film. Safety and tolerability were also evaluated.Results. Against the background of complex therapy, which included the instillation of Interferon-Ophthalmo or Oftalmoferon, all patients showed comparable dynamics in the relief of the inflammatory process and keratopathy. This was expressed in a statistically significant decrease in the severity of foreign body sensation, lacrimation, itching, eyelid edema, conjunctival edema and hyperemia, follicular reaction, conjunctival hemorrhages, punctate keratopathy, subepithelial infiltrates in the cornea. In both groups, there was a steady downward trend in OSDI against the background of an increase in the stability of the tear film and an increase in maximally corrected visual acuity. The safety and tolerability profile of the drugs was assessed as comparably favorable.Conclusion. The inclusion of the drug Interferon-Oftalmo in the complex therapy of adenoviral epidemic keratoconjunctivitis allows us to expect a comparable effect on the course of the disease compared to the original drug Oftalmoferon.

Congenital aniridia is a panocular disorder that is typically characterized by iris hypoplasia and aniridia-associated keratopathy (AAK). AAK results in the progressive loss of corneal transparency and thereby loss of vision. Currently, there is no approved therapy to delay or prevent its progression, and clinical management is challenging because of phenotypic variability and high risk of complications after interventions; however, new insights into the molecular pathogenesis of AAK may help improve its management. Here, we review the current understanding about the pathogenesis and management of AAK. We highlight the biological mechanisms involved in AAK development with the aim to develop future treatment options, including surgical, pharmacological, cell therapies, and gene therapies. [ABSTRACT FROM AUTHOR]

Two dogs presented with bilateral pattern-forming corneal opacity. Treatment with topical immunosuppressants was initiated after a complete ophthalmic examination. The response to treatment was assessed by analyzing serial images using slit-lamp biomicroscopy and spectral domain optical coherence tomography (SD-OCT). Both dogs responded to topical immunosuppressants; however, the lesions recurred once the treatment was abated or withdrawn. The most effective immunosuppressant in both dogs was 0.03% tacrolimus ointment. Early and continuous treatment with topical immunosuppressants may be necessary to improve corneal clarity and prevent scarring. SD-OCT could provide useful structural information regarding presumed immune-mediated keratitis and aid in monitoring treatment response. [ABSTRACT FROM AUTHOR]

Abstract Background To compare and contrast morpho-volumetric features between Down syndrome (DS) cornea and non-DS keratoconic cornea by three-dimensional (3D) modelling. Methods Forty-three subjects (43 eyes) with DS and 99 patients matching their age and sex (99 eyes) with keratoconus (KC) were included in this single-center cross-sectional study. Main outcome measures were high-order aberrations (HOA), central corneal thickness (CCT), spherical equivalent refraction, and morpho-volumetric parameters established using a 3D corneal model, such as deviation of anterior and posterior corneal apices (Dapexant/Dapexpost) and minimum thickness points (Dmctant/Dmctpost) from corneal vertex, areas of the anterior and posterior surfaces (Aant/Apost), sagittal area passing through the anterior and posterior corneal apices (Aapexant/Aapexpost) and minimum thickness point (Amctpost) and corneal volume of the complete cornea (Vtotal). Results Age, gender, spherical equivalent refraction, CCT and Vtotal were similar between the net on-DS KC and DS groups (P > 0.05), while non-DS KC group had higher HOA than the DS group (P

Diabetes mellitus, the most prevalent endocrine disorder, not only impacts the retina but also significantly involves the ocular surface. Diabetes contributes to the development of dry eye disease and induces morphological and functional corneal alterations, particularly affecting nerves and epithelial cells. These changes manifest as epithelial defects, reduced sensitivity, and delayed wound healing, collectively encapsulated in the context of diabetic keratopathy. In advanced stages of this condition, the progression to corneal ulcers and scarring further unfolds, eventually leading to corneal opacities. This critical complication hampers vision and carries the potential for irreversible visual loss. The primary objective of this review article is to offer a comprehensive overview of the pathomechanisms underlying diabetic keratopathy. Emphasis is placed on exploring the redox molecular pathways responsible for the aberrant structural changes observed in the cornea and tear film during diabetes. Additionally, we provide insights into the latest experimental findings concerning potential treatments targeting oxidative stress. This endeavor aims to enhance our understanding of the intricate interplay between diabetes and ocular complications, offering valuable perspectives for future therapeutic interventions.

Abstract Purpose To report the clinical characteristics of 13 cases of noninfectious corneal ulceration related to lacrimal drainage pathway disease. Methods Medical records of 13 patients with lacrimal drainage pathway disease-associated keratopathy who were examined at Ehime University Hospital between April 2007 and December 2021 were analyzed. Results The predisposing lacrimal drainage pathway diseases for corneal ulceration were chronic dacryocystitis in seven patients and lacrimal canaliculitis in six patients. The corneal ulcers were located at the peripheral cornea in 10 patients and the paracentral cornea in three patients. All patients indicated few cellular infiltrations of the ulcerated area at the slit-lamp examination. Corneal perforation was found in seven patients. The primary identified organisms were Streptococcus spp. in chronic dacryocystitis and Actinomycetes spp. in lacrimal canaliculitis. All patients showed rapid healing of the epithelial defects after treatment of the lacrimal drainage pathway disease. The mean time elapsed between treatment of the lacrimal drainage pathway disease and re-epithelialization of corneal ulcer was 14.5 ± 4.8 days. Conclusion Lacrimal drainage pathway disease-associated keratopathy may be characterized by peripheral corneal ulcer with few cellular infiltrations, occasionally leading to corneal perforation. Treatment of the lacrimal drainage pathway disease could be the most effective treatment for lacrimal drainage pathway disease-associated keratopathy.

A 36-year-old patient presented with a complaint of an extensive “white scar” in his right eye without pain after silicone oil presence in the vitreous cavity for 12 years. Slit-lamp microscopy revealed extensive corneal leukoplakia and mild limbus neovascularization. Anterior segment optical coherence tomography revealed marked eccentric thickening of the subepithelium and normal thickness of the stroma. We proceeded with silicone oil removal and intraocular and anterior chamber lavage at first, followed by epithelial lesion excision combined with amniotic membrane transplantation 3 months later. The patient was satisfied with the clear cornea appearance.

The term STODS (Surgical Temporary Ocular Discomfort Syndrome) has been coined to describe the ocular surface perturbations induced by surgery. As one of the most important refractive elements of the eye, Guided Ocular Surface and Lid Disease (GOLD) optimization is fundamental to success in achieving refractive outcomes and mitigating STODS. Effective GOLD optimization and the prevention/treatment of STODS requires an understanding of the molecular, cellular, and anatomic factors that influence ocular surface microenvironment and the associated perturbations induced by surgical intervention. By reviewing the current understanding of STODS etiologies, we will attempt to outline a rationale for a tailored GOLD optimization depending on the ocular surgical insult. With a bench-to-bedside approach, we will highlight clinical examples of effective GOLD perioperative optimization that can mitigate STODS' deleterious effect on preoperative imaging and postoperative healing. [ABSTRACT FROM AUTHOR]

Abstract Background Evaluate outcomes and identify prognostic factors in congenital aniridia. Methods Retrospective interventional case series of patients with congenital aniridia treated between 2012–2020. Ocular examination and surgical details were collected. Surgical failure was defined as disease progression or need for additional surgery for same/related indication. Kaplan–Meier survival curves, Wilcoxon test, and univariate and multivariate linear regression analyses were performed. Results Ninety-four patients with congenital aniridia presented at median 19.0 years. Two-thirds of patients underwent ≥ 1intraocular surgery, with average of 1.7 ± 2.3 surgeries/eye. At final follow-up (median 4.0 years), 45% of eyes had undergone lensectomy. Aphakic eyes showed worse visual acuity (VA) than phakic or pseudophakic eyes. Glaucoma affected 52% of eyes, of which half required IOP-lowering surgery. Glaucoma drainage devices showed the highest success rate (71%) at 14.2 ± 15.4 years of follow-up. Keratopathy affected 65% of eyes and one-third underwent corneal surgery. Keratoprosthesis had the longest survival rates at 10-years (64% with 95% CI [32,84]). LogMAR VA at presentation and final follow-up were not statistically different. Half of patients were legally blind at final follow-up. Final VA was associated with presenting VA, glaucoma diagnosis, and cataract or keratopathy at presentation. Penetrating keratoplasty and keratoprosthesis implantation correlated with worse BCVA. Conclusions Most aniridic patients in this large US-based cohort underwent at least 1 intraocular surgery. Cataract, glaucoma, and keratopathy were associated with worse VA and are important prognostic factors to consider when managing congenital aniridia.

A 47-year-old patient status post uncomplicated bilateral LASIK treatment presented with interlamellar stromal keratopathy induced by viscoelastic material during cataract surgery, decreasing her vision to CF (count fingers) postoperatively. After recognition, the viscoelastic material was removed by interface irrigation. The keratopathy improved by postoperative day 1 and resolved by 6 weeks with best-corrected visual acuity being 20/30. We conclude that viscoelastic-induced stromal keratopathy requires correct recognition in order to undertake appropriate management.

Abstract In an open‐label, controlled study of nitisinone in alkaptonuria (SONIA 2), patients were advised to lower dietary protein intake to reduce serum tyrosine (s‐Tyr) levels and the risk of keratopathy. A body weight increase was observed in the nitisinone‐treated patients but not in the control group. To investigate the effectiveness and consequence of protein restriction in patients with alkaptonuria, a post‐hoc analysis of SONIA 2 was performed. One hundred and thirty‐eight patients were randomised (nitisinone: n = 69, controls: n = 69). Comparison of baseline and Month 12 data on 24‐h urinary excretion of HGA (u‐HGA24) and urea (u‐urea24, used as an approximate protein intake measure), tyrosine and body weight were performed using paired t tests. Comparisons of data between groups were made using 2‐sample t tests. We found that u‐urea24 decreased more in nitisinone‐treated than controls. The study centre with lowest average s‐Tyr and u‐urea24 (nitisinone arm) at Month 12 also had lowest keratopathy incidence (3.1%), while the centre with highest values showed the highest (14.6%). S‐Tyr was generally high in those with keratopathy, but those without keratopathy had similar elevated values. A similar pattern across centres was seen for body weight changes, with a statistically significant weight increase in nitisinone‐treated patients at centres with lower u‐urea24 values. Therefore, in nitisinone‐treated patients, protein restriction led to increased body weight but may also have lowered the risk of developing keratopathies. If introduced, a protein‐restricted diet should be supervised by a dietician and, when appropriate, include amino acid supplements deficient in tyrosine and phenylalanine, to avoid malnutrition and undesired weight increase.

Antipsychotics are widely used in psychiatric practice for treating schizophrenia, bipolar disorder, and other diseases, including those treated off-label. They manifest many adverse effects, including ophthalmic ones. Some of these effects, such as persistent mydriasis, cycloplegia, extraocular muscle dystonia, and visual hypersensitivity attacks are reversible, since they disappear after dose reduction or drug withdrawal. Yet other side effects, such as cataracts, corneal edema, acute angle closure glaucoma and retinopathy are threatening for sight and may lead to permanent visual acuity decline and even blindness. The review provides data on the incidence of ocular side effects (both typical and atypical) of multiple antipsychotics, their clinical manifestations, pathogenesis and treatment. Eye examination is recommended for patients taking antipsychotics in the early periods of treatment and then twice a year. The psychiatrists need to know about the adverse effects of individual drugs whilst the ophthalmologists should be aware of their semiotics, pathogenesis and treatment, since timely diagnosis and treatment of pathological changes, together with antipsychotic therapy modification, prevent the development of severe and irreversible visual impairment in the majority of cases.

INTRODUCTION: The most common eye injury during and after general anesthesia is corneal abrasion which can occur at any time after anesthesia and even up to 24 h after it. The aim of this study was to investigate the incidence and factors associated with corneal injury in patients undergoing nonocular surgery. METHODS: This was a descriptive cross-sectional study. A total of 170 patients, who were admitted to the operating room and met the inclusion criteria, were selected through simple nonprobability sampling. Data collection forms were used in order to assess the incidence of corneal injury and its related risk factors. The National Eye Institute scale with fluorescein paper and cobalt blue light by slit lamp were utilized to examine exposure keratopathy. RESULTS: Overall, the results showed that the incidence of keratopathy immediately after eye care removal was found to be 64.7% in the operating room, 65.9% in the recovery room, and 41.2% in 24 h after the surgery. Smokers' patients and drug abusers under general anesthesia underwent endotracheal intubation, received more opioids preoperatively, and had more perioperative bleeding and fluid intake. Moreover, in patients who had received more oxygen flow in the recovery room; the rate of keratopathy was higher. CONCLUSION: Smoking, drug usage, and receiving endotracheal intubation are the risk factors of keratopathy. Therefore, for high-risk patients and procedures, it is indispensable to both obtain preoperative information and take intraoperative precautions in order to prevent eye injuries. Future studies are needed to demonstrate these finding.

What is Known and Objective: Toxic corneal epitheliopathies are common, but the majority are probably so mild that they are subclinical. Clinically significant epithelial keratopathy can occur following a single drop of topical expired carboxymethylcellulose sodium eye drops. Case Summary: This case presents A 34‐year‐old female who presented to the emergency department with a history of severe ocular pain and reduced vision after bilateral instillation of expired eye drops. Both eyes were diagnosed with toxic epithelial keratopathy. The presenting best corrected visual acuity (BCVA) was 20/100 in the right eye and 20/300 in the left eye. The BCVA at last follow‐up was 20/20 in both eyes. What is New and Conclusion: The safe use and storage of ophthalmic drugs, including their use before the expiration date, should be reinforced to patients by all healthcare practitioners to avoid complications such as toxic keratopathy. [ABSTRACT FROM AUTHOR]

Copyright of Hungarian Medical Journal / Orvosi Hetilap is the property of Akademiai Kiado and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: To review the existing literature to evaluate the utility of insulin eye drops as a treatment for neurotrophic-related epithelial defects., Methods: A comprehensive literature search of Medline, Embase, and Web of Science and additional manual searches were conducted using relevant keywords. All articles published from January 2005 to January 2024 were examined. Studies on the use of topical insulin drops in neurotrophic epithelial defects were included., Results: A total of 16 articles were found relevant to be discussed in the review. All included patients had neurotrophic-related epithelial defects ranging from 3.8 mm 2 to 144 mm 2 . After treatment with topical insulin, most of the epithelial defects showed a complete epithelialization. Various concentrations and types of insulin were used. The studies also varied in the type of vehicle used in the preparation of insulin drops. Two randomized controlled trials demonstrated that topical insulin drops were more effective than conventional treatment with artificial tears or autologous serum. All included studies, except for two, reported the absence of local or systemic side effects., Conclusions: Topical insulin is a promising and effective (adjuvant) treatment for neurotrophic keratopathy. It facilitates the healing of neurotrophic epithelial defects and offers many advantages over the current treatment options; insulin is widely available and it is relatively inexpensive. Topical insulin drops do not affect systemic blood glucose levels and are well tolerated. However, further investigation is needed., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Current Ophthalmology.)

Purpose: This study reports a case of Crohn's disease-associated keratopathy that progressed with disease activity., Observations: A 29-year-old man diagnosed with Crohn's disease and receiving systemic adalimumab therapy, presented with an irregular epithelial surface, superior corneal opacity, subepithelial infiltration, pannus with new vessel ingrowth, and punctate epithelial erosions in both corneas. Changes in ophthalmological findings were checked during regular outpatient follow-ups. We also compared the stool calprotectin values obtained at a gastrointestinal clinic during the course of keratopathy. By analyzing the trend of fecal calprotectin levels in this patient, we found that keratopathy worsened as fecal calprotectin levels increased. Corneal neovascularization and infiltration improved as the fecal calprotectin levels decreased., Conclusions and Importance: The mechanism of Crohn's disease-associated keratopathy has not been identified but appears to be related to the autoimmune mechanism of Crohn's disease. Managing Crohn's activity by referring to the gastroenterology department should be considered to relieve Crohn's disease-associated keratopathy., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. There are no financial interests/personal relationships for this article., (© 2024 The Authors. Published by Elsevier Inc.)

Background-Aim: PAX6 is a key regulator of eye development and epithelial homeostasis in the cornea. When deficient, chronic corneal inflammation, neovascularization and limbal stem cell deficiency can occur. Here we investigated the potential of duloxetine, a generic serotonin reuptake inhibitor that can upregulate PAX6 in vitro, for its in vivo activity in the context of corneal inflammation., Methods: Duloxetine tolerance was tested in a human limbal stem cell line and isogenic CRISPR-knockout PAX6 +/- cells. C57BL/6-Wildtype mice were administered duloxetine eye drops at concentrations of 1 μM - 2 mM and tested for toxicity and corneal PAX6 expression. In LPS-induced corneal inflammation in mice, duloxetine's effect on PAX6 expression, corneal opacification and inflammatory responses were evaluated by in vivo corneal imaging, immunostaining, and whole-transcriptome microarray analysis., Results: No toxicity was observed in vitro for duloxetine concentrations up to 10μΜ. In vivo, duloxetine drops were well-tolerated up to 50 μM. Duloxetine drops at 10μΜ significantly upregulated PAX6 protein levels in the cornea by 30 % within 2 days. In the LPS model, duloxetine resulted in a sustained 33 % PAX6 protein upregulation in the cornea at 7 days, and in reduced opacity within 2 days, accompanied by a significant dampening of IL-17A signaling, neutrophil degranulation, microglial activation, macrophage markers, and MMP expression, despite non-significant changes in total inflammatory cell infiltration., Conclusion: Short-term administration of a repurposed generic drug, duloxetine, upregulates PAX6 protein levels in the cornea of mice and exerts an anti-inflammatory activity by dampening innate immune responses., Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

The term fatty keratopathy is used to describe the phenomenon of fat deposition caused by corneal neovascularization, which will severely affect the eye’s beauty and vision. The purpose of this study was to establish a New Zealand white rabbit animal model of fatty keratopathy, that is, the establishment of an animal model of fatty keratopathy. The goal was achieved by the combination of a corneal neovascularization animal model and a hyperlipidemia animal model. Two groups were created according to the experimental sequence. The first group initially induced a corneal neovascularization pattern and later induced a hyperlipidemia pattern, and the second group followed the opposite sequence. The results of the two groups showed that all the significant crystalline deposits of the cornea were visible. So the animal models of fatty keratopathy were successfully established in both groups.

Purpose: To characterize the ocular toxicity of an antibody-drug conjugate (ADC), depatuxizumab mafodotin (Depatux-m), in nonclinical species and to evaluate the effects of drug-antibody ratios (DARs), variations of the ADC construct, and potential methods for mitigation of the corneal toxicity. Depatux-m contains the potent cytotoxic agent monomethyl auristatin F as the ADC payload. Methods: Depatux-m was administered intravenously to cynomolgus monkeys at doses up to 30 mg/kg and to mice up to 100 mg/kg. Ocular toxicity was evaluated by clinical ophthalmic examinations and histopathology. Potential mitigation was tested through agents to block target engagement and multiple topical ophthalmic treatments (antioxidant, vasoconstrictor, tear stimulant). Results: Effects primarily involved corneal epithelium and were dose-dependent with respect to onset, severity, and time to reversal in both monkeys and mice. On slit lamp biomicroscopy, the initial effect in monkeys was superficial multifocal punctate opacities (granularity), which migrated axially and were followed by pigmentation and multifocal punctate fluorescein staining. Microscopically, findings were characterized by single-cell necrosis, pigmentation, disordered basilar layer, and thinning of the corneal epithelium. Increased toxicity was associated with a higher DAR or more stably attached linker. Treatment with agents to block target engagement did not affect toxicity, and none of the topical treatments was successful. Conclusions: The corneal findings observed were similar to the effects described in clinical trials with Depatux-m and other ADCs. Collectively, these studies and available literature support the hypothesis that ADC-mediated toxicity is driven primarily by mechanism of action of the payload. [ABSTRACT FROM AUTHOR]

Purpose: To report the clinical characteristics of 13 cases of noninfectious corneal ulceration related to lacrimal drainage pathway disease.Methods: Medical records of 13 patients with lacrimal drainage pathway disease-associated keratopathy who were examined at Ehime University Hospital between April 2007 and December 2021 were analyzed.Results: The predisposing lacrimal drainage pathway diseases for corneal ulceration were chronic dacryocystitis in seven patients and lacrimal canaliculitis in six patients. The corneal ulcers were located at the peripheral cornea in 10 patients and the paracentral cornea in three patients. All patients indicated few cellular infiltrations of the ulcerated area at the slit-lamp examination. Corneal perforation was found in seven patients. The primary identified organisms were Streptococcus spp. in chronic dacryocystitis and Actinomycetes spp. in lacrimal canaliculitis. All patients showed rapid healing of the epithelial defects after treatment of the lacrimal drainage pathway disease. The mean time elapsed between treatment of the lacrimal drainage pathway disease and re-epithelialization of corneal ulcer was 14.5 ± 4.8 days.Conclusion: Lacrimal drainage pathway disease-associated keratopathy may be characterized by peripheral corneal ulcer with few cellular infiltrations, occasionally leading to corneal perforation. Treatment of the lacrimal drainage pathway disease could be the most effective treatment for lacrimal drainage pathway disease-associated keratopathy. [ABSTRACT FROM AUTHOR]

Nitisinone (NIT) causes tyrosinaemia and corneal keratopathy (KP), especially in men. However, the adaptation within the phenylalanine (PHE)/tyrosine (TYR) catabolic pathway during KP is not understood. The objective of this study is to assess potential differences in the PHE/TYR pathway during KP and the influence of gender in NIT-induced tyrosinaemia in alkaptonuria (AKU). Samples of serum and 24 h urine collected from patients treated with NIT during a 4-year randomized study in NIT vs. no-treatment controls (SONIA 2; Suitability Of Nitisinone In Alkaptonuria 2; EudraCT no. 2013-001633-41) at months 3 (V2), 12 (V3), 24 (V4), 36 (V5) and 48 (V6) were included in these analyses. Homogentisic acid (HGA), TYR, PHE, hydroxyphenylpyruvate (HPPA), hydroxyphenyllactate (HPLA) and sNIT were analysed at all time-points in serum and urine in the NIT-group. All statistical analyses were post hoc. Keratopathy occurred in 10 out of 69 AKU patients, eight of them male. Thirty-five sampling points (serum and 24 h urine) were analysed in patients experiencing KP and 272 in those with no-KP (NKP) during NIT therapy. The KP group had a lower HPLA/TYR ratio and a higher TYR/PHE ratio compared with the NKP group (p < 0.05 for both). There were 24, 45, 100 and 207 sampling points (serum and 24 h urine) in the NIT group which were pre-NIT female, pre-NIT male, NIT female and NIT male, respectively. The PHE/TYR ratio and the HPLA/TYR ratio were lower in males (p < 0.001 and p < 0.01, respectively). In the KP group and in the male group during NIT therapy, adaptive responses to minimise TYR formation were impaired compared to NKP group and females, respectively. [ABSTRACT FROM AUTHOR]

Background & Objective: Delayed mustard gas keratopathy (DMGK) is the main chronic outcome in eye-chemical injured patients. The aim of this study was the histopathological evaluation of mustard-exposed cornea after more than 30 years. Methods: Fourteen corneas after Lamellar keratoplasty were evaluated in this study. Corneal tissues were prepared by histologic methods and stained by H&E. Results: The main histopathological findings in these cases were the presence of severe stromal edema and corneal scar. In the sections with visible superficial epithelium, subepithelial bullae formation was observed. Focal or diffuse disruption of Bowman's membrane and replacement with fibrosis were also seen. There was no evidence of stromal vascularization and inflammation in all specimens. Conclusion: After more than 30 years, an extensive corneal scar is seen in sulfur mustard exposed patients. Scar tissue without vascularization and fibroblastic proliferation is the main finding in the sulfur mustard exposed cornea. This pathology result is different from other scars. No evidence of inflammation or immune cell infiltration should be considered in managing DMGK. [ABSTRACT FROM AUTHOR]

A headache is characterized as a craniofacial pain that may derive from any involvement of the structure of the head, neck or cranial cavity. It may be associated with any pathology, negatively affecting the quality of life of the individuals afflicted by it. We present the case of a woman with bilateral lipid keratopathy associated with a headache of a moderate to severe intensity, refractory to treatment with non-steroidal antiinflammatory drugs, treated with lidocaine 1% injections in supraorbital and infraorbital nerves. A clear improvement was observed in visual symptoms and headache with a decrease in symptom frequency, duration and intensity. The improvement lasted over 6 months, which positively impacted the patient's quality of life. The treatment was well tolerated and no adverse effects were observed. In this case, local injections of lidocaine showed a favorable outcome. Well-designed studies should be conducted to elucidate the role of LA for this condition. [ABSTRACT FROM AUTHOR]

Diabetic corneal alterations, such as delayed epithelial wound healing, edema, recurrent erosions, neuropathy/loss of sensitivity, and tear film changes are frequent but underdiagnosed complications of both type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus. The disease affects corneal epithelium, corneal nerves, tear film, and to a lesser extent, endothelium, and also conjunctiva. These abnormalities may appear or become exacerbated following trauma, as well as various surgeries including retinal, cataract or refractive. The focus of the review is on mechanisms of diabetic corneal abnormalities, available animal, tissue and organ culture models, and emerging treatments. Changes of basement membrane structure and wound healing rates, the role of various proteinases, advanced glycation end products (AGEs), abnormal growth and motility factors (including opioid, epidermal, and hepatocyte growth factors) are analyzed. Experimental therapeutics under development, including topical naltrexone, insulin, inhibitors of aldose reductase, and AGEs, as well as emerging gene and cell therapies are discussed in detail.

Purpose: We report a case of corneal verticillata in a patient who had been taking raloxifene for a prolonged period. To our knowledge, this is the first case report of an ocular side effect of raloxifene. Observations: A 69-year-old female patient presented to our clinic for her routine eye check-up. On slit-lamp examination, whorl-like subepithelial deposits were observed in the bilateral corneas. She was diagnosed with corneal verticillata (vortex keratopathy) caused by raloxifene. A follow-up evaluation was conducted after discontinuation of the drug; however, the corneal opacity did not improve. Conclusions and importance: Patients with corneal verticillata should be asked regarding any intake of raloxifene for osteoporosis, as it may cause corneal verticillata.

Diabetes mellitus(DM)is a chronic metabolic disease characterized by sustained hyperglycemia, which can cause systemic macrovascular, microvascular and nervous system complications. The eye is one of the main organs affected by this disease. The ocular complications of DM include DR, however, non-retinal complications are also contained. This review provides an overview of the non-retinal eye diseases associated with DM, including diabetic keratopathy, dry eye, iridocyclitis, glaucoma, cataract, refractive error, optic neuropathy, iridocyclitis, asteroid hyalosis and so on. These ocular diseases may also lead to vision loss and should be taken seriously in diabetic patients.

Background: Evaluate outcomes and identify prognostic factors in congenital aniridia.Methods: Retrospective interventional case series of patients with congenital aniridia treated between 2012-2020. Ocular examination and surgical details were collected. Surgical failure was defined as disease progression or need for additional surgery for same/related indication. Kaplan-Meier survival curves, Wilcoxon test, and univariate and multivariate linear regression analyses were performed.Results: Ninety-four patients with congenital aniridia presented at median 19.0 years. Two-thirds of patients underwent ≥ 1intraocular surgery, with average of 1.7 ± 2.3 surgeries/eye. At final follow-up (median 4.0 years), 45% of eyes had undergone lensectomy. Aphakic eyes showed worse visual acuity (VA) than phakic or pseudophakic eyes. Glaucoma affected 52% of eyes, of which half required IOP-lowering surgery. Glaucoma drainage devices showed the highest success rate (71%) at 14.2 ± 15.4 years of follow-up. Keratopathy affected 65% of eyes and one-third underwent corneal surgery. Keratoprosthesis had the longest survival rates at 10-years (64% with 95% CI [32,84]). LogMAR VA at presentation and final follow-up were not statistically different. Half of patients were legally blind at final follow-up. Final VA was associated with presenting VA, glaucoma diagnosis, and cataract or keratopathy at presentation. Penetrating keratoplasty and keratoprosthesis implantation correlated with worse BCVA.Conclusions: Most aniridic patients in this large US-based cohort underwent at least 1 intraocular surgery. Cataract, glaucoma, and keratopathy were associated with worse VA and are important prognostic factors to consider when managing congenital aniridia. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The most common eye injury during and after general anesthesia is corneal abrasion which can occur at any time after anesthesia and even up to 24 h after it. The aim of this study was to investigate the incidence and factors associated with corneal injury in patients undergoing nonocular surgery. METHODS: This was a descriptive cross-sectional study. A total of 170 patients, who were admitted to the operating room and met the inclusion criteria, were selected through simple nonprobability sampling. Data collection forms were used in order to assess the incidence of corneal injury and its related risk factors. The National Eye Institute scale with fluorescein paper and cobalt blue light by slit lamp were utilized to examine exposure keratopathy. RESULTS: Overall, the results showed that the incidence of keratopathy immediately after eye care removal was found to be 64.7% in the operating room, 65.9% in the recovery room, and 41.2% in 24 h after the surgery. Smokers' patients and drug abusers under general anesthesia underwent endotracheal intubation, received more opioids preoperatively, and had more perioperative bleeding and fluid intake. Moreover, in patients who had received more oxygen flow in the recovery room; the rate of keratopathy was higher. CONCLUSION: Smoking, drug usage, and receiving endotracheal intubation are the risk factors of keratopathy. Therefore, for high-risk patients and procedures, it is indispensable to both obtain preoperative information and take intraoperative precautions in order to prevent eye injuries. Future studies are needed to demonstrate these finding. [ABSTRACT FROM AUTHOR]

Aniridia is a familial or sporadic disorder affecting not only the iris but also the cornea, angle structures, lens, optic nerve, and fovea. This disorder may be associated with many other systemic abnormalities such as urogenital malignancies. We report a family of aniridia with different clinical spectrum of features.

OBJECTIVES: The objective of this study is to describe complications associated with the use of two types of silicone oil (SO) (1000 centistokes [cs] and 5000 cs) in vitreoretinal surgery in Oman. MATERIALS AND METHODS: This is a retrospective descriptive study on all patients who underwent vitreoretinal surgeries in which SO injection or removal was done. The study was conducted at Sultan Qaboos University Hospital between January 1, 2010, and December 31, 2017. Demographic data, lens status of the eye at the time of SO injection, type of SO used (1000 cs or 5000 cs), and complications associated with SO were collected. RESULTS: A total of 107 eyes of 103 patients were included in the study. SO 1000 cs was used in 66 eyes and SO 5000 cs was used in 41 eyes. A total of 29 eyes (27%) developed SO-related complications, which included SO emulsification in 14 eyes (13.1%), raised intraocular pressure (IOP) >21 mmHg in 19 eyes (17.8%), and band keratopathy in 4 eyes (3.7%). SO emulsification was seen in eight eyes (12.1%) in whom SO 1000 cs was used and in five eyes (12.2%) in whom SO 5000 cs (P = 1.000). CONCLUSION: SO was found to be a relatively safe adjunct in vitreoretinal surgery. SO-related complications such as SO emulsification, raised IOP, and band keratopathy were observed in less than one-third of study eyes. No difference was noted in emulsification rate between SO 1000 cs and SO 5000 cs. Further studies with larger sample size and longer follow-up period are warranted.

Issues: Use of crack cocaine and associated medical complications persists globally. Some reports in medical literature describe a sight‐threatening condition commonly referred to as 'crack eye' or 'crack eye syndrome'. The purpose of this review is to describe what is known about crack eye from case reports in peer‐reviewed literature. Approach: A structured search was completed in MEDLINE, TOXLINE, EMBASE, PsychInfo, Scopus and Biomed Central, to collect case reports and case series on corneal complications attributed to crack cocaine smoking. Key Findings: Of 111 articles screened, 11 contained case reports or series. Thirty individual cases of 'crack eye' were reported. The majority (63%) of cases had bilateral involvement; 83% of all cases with microbial culture results had corneal infections. Aggressive treatment caused an improvement in 95% of all cases and 23% of all cases were lost to follow up. Of those who received treatment for corneal complications associated with crack cocaine, 22% remained with significant visual impairment (hand motions only) in the affected eye. Implications: Clinicians should consider crack cocaine involvement in patients presenting with corneal disease without known predisposing factors, and elicit comprehensive drug histories to prevent a reduction in visual acuity. Conclusion: Corneal complications of crack cocaine smoking are caused by a number of synergistic factors, including direct toxicity of crack cocaine vapours to surface cells, impairment of neurogenic support to corneal epithelial integrity, desiccation of the eye surface due to diminished blinking reflex, low level chemical burns and mechanical denudement of surface cells through eye rubbing. [ABSTRACT FROM AUTHOR]

A 47-year-old patient status post uncomplicated bilateral LASIK treatment presented with interlamellar stromal keratopathy induced by viscoelastic material during cataract surgery, decreasing her vision to CF (count fingers) postoperatively. After recognition, the viscoelastic material was removed by interface irrigation. The keratopathy improved by postoperative day 1 and resolved by 6 weeks with best-corrected visual acuity being 20/30. We conclude that viscoelastic-induced stromal keratopathy requires correct recognition in order to undertake appropriate management. [ABSTRACT FROM AUTHOR]

Abstract Background Intravitreal methotrexate has been proven to be an effective treatment method for vitreoretinal lymphoma. However, keratopathy occurs as the major side effect during treatment in most cases. The purpose of this study is to describe the characteristics of primary central nervous system lymphoma (PCNSL) with intraocular involvement and to attempt to reduce the incidence of keratopathy caused by intravitreal methotrexate. Methods The medical records of 22 PCNSL patients with intraocular involvement (33 eyes) were reviewed. Patients were divided into two groups. Group A (22 eyes) received the induction-consolidation-maintenance regimen, which consisted of intravitreal methotrexate injection at a dosage of 400 μg/0.1 ml twice a week for the first four weeks, weekly for the following eight weeks, and then monthly for the last nine months. Patients with a poor systemic condition were assigned to Group B (8 eyes), who were started on the treatment protocol described above and switched directly to monthly injection (9 months) when ocular remission was achieved. Results Blurred vision (31%) and floaters (25%) were common presenting symptoms. Vitritis was the most common clinical sign and was present in 29 eyes (90%) on B-ultrasound examination. Diagnosis was made by 25G-pars plana vitrectomy, and most diagnoses were diffuse large B-cell lymphoma. Ocular remission was achieved after 8.2 (SD = 4.6) injections of methotrexate. The mean VA (visual acuity) was improved from LogMAR 0.65 to 0.3 (P = 0.002). Keratopathy was observed in 21 eyes (66%) after an average of 8.2 (SD = 2.3) injections. With a reduced injection frequency, the incidence of keratopathy was lowered from 86.4% (Group A) to 25.0% (Group B) without ocular recurrence during follow-up. Conclusions Intravitreal methotrexate is a safe, effective and flexible treatment for PCNSL patients with intraocular involvement. Keratopathy is the most common adverse effect and can be controlled by reducing the injection frequency.

Purpose. To evaluate the efficiency of the complex treatment of Descemet’s membrane detachment.Material and methods. In case of failure of therapeutic methods of treatment of induced keratopathy, a 65-year patient underwent an optical coherence tomography of the anterior segment, and a total detachment of the Descemet’s membrane was detected. The injection of sterile air was performed into the anterior chamber of the patient and the transepithelial puncture of the cornea was carried out in order to drain the fluid located between the Descemet’s membrane and the posterior surface of the corneal stroma.Results. The patient underwent pneumopexy of the Descemet’s membrane with transepithelial puncture of the cornea in order to drain the fluid located between the Descemet’s membrane and the posterior surface of the corneal stroma associated with the standard keratoplastic and anti-inflammatory therapy. The postoperative period was without complications. During the examination a week later, a complete absence of subjective symptoms (pain, lacrimation, foreign body sensation, photophobia) was revealed, objectively the edema of all corneal layers was significantly reduced. The visual acuity of the operated eye increased from 0.05 n/c to 1.0.Conclusion. In case of total detachment of the Descemet’s membrane the application of thee sterile air injection into the anterior chamber with the transepithelial puncture of the cornea in order to drain the fluid between the Descemet’s membrane and the posterior surface of the corneal stroma, leads to its complete attachment, an arrest of the corneal syndrome and an improvement of visual acuity.