Cornea

One of the most memorable patients ever to walk into the office of Sonal Tuli, MD, had a fishhook protruding from his eye, which he held open with his fingers. Dr. Tuli offers some pointers based on experience from cases like these.

The same photoactivation process used in collagen cross-linking for keratoconus can kill bacteria without the need for the oxygen responsible for the biomechanical effects, potentially pointing toward better treatments for keratitis, according to Olivier Richoz, MD, PhD.

When a graft fails, surgeons have three factors to consider: the reason for the graft failure, the chances of success with a second surgery, and what has to be done differently to ensure the success of a new graft, said Francis Price Jr., MD.

A 65-year-old male with a history of congenital cataracts, bilateral cataract extraction and secondary placement of anterior chamber intraocular lenses with subsequent development of glaucoma, cicatricial conjunctivitis, dry eye and limbal stem cell deficiency presented with left eye pain and decreased vision.

Over the past few years, various diagnostics have been introduced to help clinicians identify inflammatory conditions on the ocular surface more readily and, therefore, provide treatment to patients earlier in their disease states.

2015 may be noted as a year of emergence for sustained-release drug delivery therapies for dry eye and glaucoma, according to Jonathan H. Talamo, MD, Boston.Cornea specialists have always appreciated the need to treat dry eye, “but it’s now becoming more and more appreciated and the importance of underlying dry eye and drying is so ubiquitous,” said Ernest W. Kornmehl, MD, Brookline, MA.

New research into pattern-recognition receptors is yielding promising therapies that target the specific pathogens and inflammatory pathways in keratitis, researchers said.

Ophthalmology Times is pleased to announce Amy Patel, MD, of Gavin Herbert Eye Institute, UC Irvine Health, Irvine, CA, as the winner of its 2015 Resident Writer’s Award Program, sponsored by Allergan. Dr. Patel’s winning entry is featured here.

Contact lens-assisted corneal crosslinking (CA-CXL) is a novel technique in which a riboflavin-soaked ultraviolet (UV) barrier-free soft contact lens is applied over the denuded cornea prior to UVA irradiation.

Herpes simplex virus in children is often diagnosed late or misdiagnosed, and children can experience visual loss due to complications or amblyopia.

Contact lens-Assisted corneal crosslinking (CA-CXL) is a novel technique in which a riboflavin-soaked ultraviolet (UV) barrier-free soft contact lens is applied over the denuded cornea prior to UVA irradiation. It is used to allow CXL in eyes with a thin cornea and has been associated with good results, and can be done with a standard or accelerated CXL protocol.

Understanding of keratoconus and the resulting dramatic changes in management in recent years have given rise to treatment paradigms that would have been unrecognizable to ophthalmologists a generation ago. The new landscape features a wider range of treatment options, better diagnostic and monitoring tools, and better understanding of the underlying pathology of the disease.

A group of surgeons were faced with a suprachoroidal hemorrhage following trauma, and decided to break the ‘rules’ when tackling the case, and came out with surprisingly good results.

Findings of a retrospective case review show that eyes that underwent implantation of the Boston Type 1 keratoprosthesis had greater improvement in visual acuity than those undergoing repeat donor corneal transplantation.

The development of a bioengineered cornea may serve to provide corneas to the millions of people worldwide unable to obtain a human donor cornea.

Findings from a study undertaken at Dr Lovisolo’s practice indicate that in carefully-selected patients, a triple procedure, comprising Keraring implantation followed by accelerated CXL and topo-guided ablation can provide significant functional improvement in cases of progressive keratoconus.

An age-stratified analysis of endothelial cell count in diabetic and non-diabetic corneas found no statistically significant difference between the groups. Since diabetes may damage the inner layer of the cornea, other variables that affect cell health must also be evaluated.

Forward-looking research in drug delivery and therapies filled the sessions at this year’s meeting of the Association for Research in Vision and Ophthalmology.

Small incision lenticule extraction (SMILE), which has not yet been approved for refractive correction in the United States, may be less accurate and produce more irregular astigmatism than LASIK or PRK because of the imprecision resulting from the two incisions needed to create the lenticule. In addition, the technique for potential enhancements needs improvement. However, the treatment is promising and may stand the test of time as the technology advances.

Techniques for performing corneal collagen crosslink (CXL) are being evaluated and adapted, and at the same time, new applications are being developed.

Femtosecond lasers differ in their indications, energy delivery parameters, and hardware features. Understanding the implications of these factors will enable an objective assessment of the available technology.

Occasionally, post-cataract surgery endothelial cells don’t function well enough to keep the cornea clear, which can commonly cause corneal oedema. Here, Prof. Feinbaum describes a new treatment modality that has been designed to reduce and in most cases stop the oedema in 24–48 hours.

The FDA has approved AcuFocus’ corneal inlay product (KAMRA inlay.) The device is indicated to improve near vision by extending depth of focus in patients with presbyopia who have emmetropic refractions (+0.50 to –0.75 D).

Contrast sensitivity is a more valuable metric than many ophthalmologists realize, with applications in preoperative and postoperative management of corneal and refractive surgery patients and routine screening of patients’ quality of vision.

Keratoneuralgia, also known as “pain without stain” is primarily a clinical diagnosis made for patients with corneal pain symptoms with minimal-to-no clinical signs and minimally, if at all, relieved by conventional dry eye treatments.

Early experience with a new intrastromal corneal ring segment arc length appears to be a valuable addition to the keratoconus treatment armamentarium for one surgeon.

Endothelial keratoplasty makes it easier to follow patients with glaucoma and lowers the risk of ocular surface disease.

Immunomodulatory therapy for ocular inflammatory disease can be potent and effective, but physicians should be patient while awaiting results-and watch carefully for complications.

Autologous serum drops, amniotic membrane, and scleral lenses offer advanced options for management of persistent epithelial defects refractory to standard treatment modalities.

The rationale for epithelium-on crosslinking procedures is strong, and may ultimately make customized treatment of topographic abnormalities more attractive for therapeutic and refractive indications.