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Our aim was to report the case of endothelial corneal allograft rejection after inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine with an atypical presentation.This was a case report.A 63-year-old woman with previous penetrating keratoplasty and laser in situ keratomileusis presented with clinical signs of endothelial corneal graft rejection 24 hours after CoronaVac (SinoVac Biotech, Beijing/China) vaccine. Slitlamp examination showed corneal edema and interface fluid accumulation. It was partially resolved after treatment with topical corticosteroids and polydimethylsiloxane.Corneal allograft rejection was already reported after another SARS-CoV-2 vaccine. This is the first report in the literature describing a possible association with inactivated SARS-CoV-2 vaccine and corneal allograft rejection, especially with laser in situ keratomileusis interface fluid accumulation presentation. Ophthalmologists should be aware of this potential complication.

PURPOSE To evaluate the clinical outcomes after implantation of a new 320°-arc length Ferrara intrastromal corneal ring segment (320-ICRS) in eyes of patients with keratoconus. METHODS A multicentric nonrandomized study was conducted in which a new 320-ICRS was placed in 138 eyes of 130 patients with keratoconus. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), keratometry, corneal volume, asphericity, lines of vision gain/loss, and vectorial analysis were assessed preoperatively and at the final follow-up visit after the procedure. RESULTS The mean follow-up time was 6.2 ± 3.3 (SD) months (range 3-12 months). Mean UDVA improved from 20/250 to 20/60. Mean CDVA improved from 20/100 to 20/40. Mean Q improved from -1.12 ± 0.49 preoperatively to -0.28 ± 0.51 postoperatively (P < 0.001). Mean corneal volume increased from 56.2 ± 4.28 mm preoperatively to 57.6 ± 4.74 postoperatively (P < 0.001). Mean Km reduced from 53.3 ± 5.5 D preoperatively to 47.8 ± 4.6 D postoperatively (P < 0.001). The change in UDVA, CDVA, and topographic astigmatism was statistically significant (P < 0.0001). CONCLUSIONS The 320-ICRS can efficiently and safely improve visual acuity in keratoconus, modifying the corneal shape to a more physiologic, aspheric shape.

Purpose. To evaluate the additional benefits of amniotic membrane transplantation (AMT) when combined with conjunctival limbal autograft (CLAU) in the treatment of chronic chemical burns. Methods. Thirty eyes of 30 rabbits underwent a chemical burn to create limbal deficiency. Forty-five days later, the animals were randomized into three groups of 10 rabbits each. Eyes from group 1 were treated with CLAU, group 2 underwent CLAU and AMT, and group 3 served as control without surgery. Corneal vascularization and opacity were documented with external photographs at postoperative days 30, 60, and 90. The rabbits were killed 3 months after surgery, and their corneas divided into two halves. One half was prepared for hematoxylin-eosin and periodic acid–Schiff staining and the other for frozen sections and immunostaining with AM3 (to MUC 5AC mucin) and AE5 (to K3 keratin). Final clinical outcome was also scored using external photographs at the last follow-up examination. Results. After chemical burn, all groups showed similar degrees of conjunctivalization. After transplantation, corneal vascularization was worse in controls at 60 and 90 days (p < 0.001). At 30 days, eyes from group 1 had less corneal opacity (p < 0.05). At 90 days, corneal opacity was worse in controls but the same in groups 1 and 2 (p < 0.05). At the same time, limbal deficiency was significantly worse in controls (p < 0.05) but similar between groups 1 and 2. Corneal phenotype was present in 70% of the eyes in group 1, 50% in group 2, but in 10% of the controls. Clinical success with clear corneas was significantly more common in groups 1 and 2 when compared with controls (p < 0.001). Conclusions. CLAU is effective in treating limbal deficiency. The concurrent AMT does not add benefits in this rabbit model of chemical burns.

A computerized topographic analysis system was used to evaluate corneal changes after strabismus surgery in eight eyes of five patients with Graves' disease. All patients underwent inferior rectus muscle recession; three eyes also had medial rectus recession. Corneal topographic analysis revealed that, postoperatively, corneas steepened inferiorly and inferotemporally at 1.5 mm from corneal apex (p less than 0.05). The opposite effect was observed in the superior quadrant (average flattening of 1.20 +/- 0.32 D at 1.5 mm from corneal apex, and 1.08 +/- 0.39 D at 3.0 mm from corneal apex; p less than 0.05). Superotemporally, the cornea flattened by an average of 0.65 +/- 0.26 D at 3.0 mm from corneal apex, and superonasally 0.72 +/- 0.19 D at 3.0 mm from corneal apex (p less than 0.05). Central, nasal, and temporal cornea did not show statistically significant changes. Spherical equivalent did not change significantly after surgery. The amount of restriction and upgaze measured preoperatively was correlated weakly with inferior corneal steepening (r2 = 0.44; p = 0.046). These results are indicative that corneal topography may be influenced by strabismus surgery for Graves' disease through alteration of extraocular muscle tension or intraocular pressure.

Corneal scarring as a consequence of bacterial keratitis is an important cause of visual loss and a major indication for penetrating keratoplasty. Anti-inflammatory agents might be useful in this condition for limiting corneal damage, but benefit from adjunctive anti-inflammatory therapy has never been demonstrated. In this limited pilot study, we compared the effect on clinical outcome of treating Pseudomonas keratitis in guinea pigs with prednisolone (a corticosteroid), flurbiprofen (a cyclo-oxygenase inhibitor), nordihydroguaiaretic acid (a lipoxygenase inhibitor), and a leukotriene antagonist, SKF104353 [R-(R*, S*)]-beta-[(2-carboxyethyl) thio-alpha-hydroxy-2-(8-phenyloctyl) benzenepropanoic acid, zinc salt]. None of the anti-inflammatory agents prevented sterilization of ulcers with antibiotic (ofloxacin) therapy. Therapy with the leukotriene antagonist appeared to reduce infiltrate size more quickly and produce a more rapid reduction in lesion size, but the differences were not statistically significant. Sample size calculations suggest that very large numbers of animals would be required to prove efficacy. The role of anti-inflammatory agents in reducing the stromal destruction caused by bacterial keratitis remains controversial.

Recurrence of Pseudomonas keratitis during treatment with corticosteroids has been reported previously in humans. Rabbits with keratitis due to Pseudomonas aeruginosa or Streptococcus pneumoniae were treated with antibiotics and either vehicle, methylprednisolone acetate, flurbiprofen, or nordihydroguaiaretic acid (NDGA). Cultures performed after 7 days were negative, and antibiotics were discontinued. Two weeks later, Pseudomonas keratitis recurred in 6 of 7 (85.7%) steroid-treated rabbits, 1 of 8 (12.5%) flurbiprofen-treated rabbits, 1 of 8 (12.5%) NDGA-treated rabbits, and none of 8 vehicle-treated rabbits. None of the 31 rabbits infected with Streptococcus pneumoniae experienced recurrence. These data confirm the clinical observation that Pseudomonas keratitis may recur if antibiotic therapy is discontinued and corticosteroids are administered; the risk of recurrence appears to be much less with nonsteroidal antiinflammatory agents.

Replacement of the entire anterior segment of the eye is a very ambitious and complex endeavor and it is not known whether the retina remains functional when the anterior structures have been removed. We used routine histo-pathologic evaluation and electroretinographic measurements to determine the structural and functional status of rabbit retinas following surgical removal of the internal anterior structures (iris, ciliary body, and lens) and replacement of the vitreous with silicone oil. In some cases, we were able to record both a scotopic and a photopic electroretinographic response as long as 15 weeks after complete removal of the internal anterior segment structures. Although many hurdles remain and more efficacious surgical techniques and biomaterials need to be developed, our results suggest that, in the rabbit, the retina may continue to function in the absence of critical anterior segment structures.