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José Manuel Benitez del Castillo,1 Thomas Kaercher,2 Khaled Mansour,3 Edward Wylegala,4 Harminder Dua5 1Universidad Complutense, Madrid, Spain; 2Augenarztpraxis, Heidelberg, Germany; 3Department of Ophthalmology, Tjongerschans Hospital, Heerenveen, the Netherlands; 4Department of Ophthalmology, Medical University of Silesia, District Railway Hospital, Katowice, Poland; 5Division of Ophthalmology and Visual Sciences, Eye ENT Centre, Queens Medical Centre, Nottingham, UKAbstract: Meibomian gland dysfunction (MGD) is widespread and has significant impact on patients’ quality of life. Eyelid hygiene is the mainstay of treatment but is unstandardized and requires commitment from the patient and encouragement from the ophthalmologist. Blephasteam® is an eyelid warming device designed to be an easy-to-use and standardized treatment for MGD. In the present study, 73 patients were treated for 21 days with twice daily Blephasteam® sessions. The primary efficacy variable, a symptomatology visual analog scale score, declined from 63.07±21.23 (mean ± standard deviation) on day 0 to 41.90±25.49 on day 21. There were also improvements in a number of secondary efficacy variables including subjective ocular symptoms and clinical signs and symptoms of MGD and dry eye, though tear film breakup time and tear osmolarity were not improved. Global efficacy was assessed as satisfactory or very satisfactory in 83.8% of cases. Patient-reported subjective ocular symptoms declined during the study, and a majority of patients rated the efficacy of Blephasteam® as satisfactory or very satisfactory. Most patients found the device comfortable and were able to continue with normal activities (reading, watching TV, using a computer) during the Blephasteam® session. No safety or tolerability issues were identified.Keywords: dry eye, Blephasteam®

The effectiveness of the correction of astigmatism depends on the accuracy of the IOL position in the lens capsule. Removal of viscoelastic from the bag and the right IOL centration have a direct impact on the effectiveness of this IOL. Intraoperative use of OCT in real time ( RESCAN 700 Zeiss) allows the evaluation of IOL in the bag position. iOCT plays role in the estimation of the distance from the posterior capsule of the lens. The use of iOCT allows to achieve an improved surgical results in patients with cataract and coexisting astigmatism. [ABSTRACT FROM AUTHOR]

Purpose The cornea is exposed to constant oxidative stress that may lead to protein homeostasis imbalance and tissue damage during aging process. The ubiquitin-proteasome pathway and the lysosomal pathway including autophagy are the major proteolytic systems to clean damaged proteins in cells. Our aim was to investigate the role of the Nrf2 and PGC-1 α, the central transcription factors of the regulation of cellular detoxification and defense against oxidative stress, in corneas of double knockout mice (Nrf2-/ PGC1 α-). Methods After fixation in 4% PFA, eyeballs were embedded in paraffin and 5 μm cross sections were cut using microtome. Tissue sections were deparaffinized, rehydrated and processed for immunostaining with primary antibodies against Beclin, HuR, p62 and LC3. Results were compared with age matching wild type controls. Results Deficiency of Nrf2 and PGC-1 α evoked accumulation of proteasomal ubiquitin and autophagy markers p62, Beclin and LC3 in one year old animals. Moreover, HuR that regulates p62 expression was highly up-regulated in the cornea epithelium. Conclusions These results suggest that Nrf2 and PGC-1 α deficiency associates with the impaired proteasomal and autophagy clearance in the corneal epithelium. This might be linked to corneal diseases, such as macular dystrophy (Kaarniranta et al., 2015). [ABSTRACT FROM AUTHOR]

Purpose To perform reconstruction of inflammatory cells infiltration in infectious keratitis. Methods First we performed in vivo confocal microscopy (HRT III, Rostock Cornea Module) in 118 patients diagnosed for the infectious keratitis (45 viral, 40 bacterial, 23 fungal, 10 amoebal). Inflammatory cytology has been analyzed according to morphology and size of cells forming infiltration. Microscopic scans were then processed with stereological software (MicroBrightField Inc, VT, USA) to track inflammatory cells within scans. Representative reconstructions of inflammatory cells infiltration has been created for each etiology of keratitis based on previous characterization of cells. Results Overall inflammatory cells densities showed no specificity for keratitis etiology, however there was clearly different participation of morphological types of cells depended on keratitis etiology. Leukocyte-like, round cells represented approximately 4.4% of inflammatory cells in viral, 91.2% in bacterial, 50.4% in fungal and 54.4% in amoebal keratitis. Rest of cells were represented by different forms of dendritic cells, which were possible to track in stereology. Conclusions In vivo analysis of corneal epithelial cytology provides useful information about keratitis etiology. Reconstruction of inflammatory cells infiltration can help to create diagnostic algorithm for infectious keratitis diagnosis. [ABSTRACT FROM AUTHOR]

Purpose To describe impact of topical preservative-free (PF) prostaglandin analogues on inflammatory response within eyelid tarsus. Methods New Zealand rabbits' eyes (n = 12 animals) were exposed to topical PF prostaglandins for 8 weeks daily. Each right eye was treated and each left eye kept as a control - topical PBS application. As eye drops we used PF tafluprost (Taflotan, Santen), PF latanoprost (Monoprost, Thea) and PF bimatoprost (Lumigan, Allergan). After 8 weeks animals were sacrificed, eyelids were post-fixed in 4% paraformaldehyde and embedded in paraffin. Tarsal sections were immunostained for macrophage-specific Iba-1 and mucin. Tissue histology was evaluated by Masson trichrome staining. Quantitative analysis of macrophages ( MFs) infiltration within tarsal: conjunctiva, stroma and glands was performed. Results PF prostaglandin treatment for 8 weeks did not affect mucin expression within analyzed tissues. Total number of MFs forming infiltration in tarsal conjunctiva of PF tafluprost group was 3.5 ± 2.5 vs 2.2 ± 1.5 cells (p > 0.05, respectively for treated vs control eye), in PF latanoprost group was 11.6 ± 9.8 vs 3.8 ± 1.8 cells (p < 0.05) and in PF bimatoprost group was 6.8 ± 5.1 vs 3.9 ± 2.5 (p = 0.05). There was significantly different intensity of MFs infiltration within tarsal conjunctiva between groups: PF latanoprost> PF bimatoprost> PF tafluprost (p < 0.05, Kruskal-Wallis test). MFs infiltration within tarsal stroma and glands was slightly increased in PF latanoprost group when compared with control (p < 0.05), however it was not significantly different from other prostaglandins (p > 0.05). Conclusions Applied PF prostaglandin analogues affected MFs infiltration within tarsus. The strongest macrophage-associated inflammatory reaction was related to PF latanoprost application, however there is a need for further analyses of other inflammatory response pathways. [ABSTRACT FROM AUTHOR]

Purpose To evaluate epithelial structure after COMET procedure in patients with congenital aniridia. Methods 17 patients (20 eyes) with congenital aniridia underwent COMET procedure. Subjects were 13 women and 4 men, in 4 patients surgery was bilateral. Indication was aniridia related Limbal Stem Cell Deficiency (LSCD).Mean follow‐up was 13 months (6 to 26). Analyzed data included OCT assisted epithelial thickness measurement and structure assessment by confocal microscopy Results Mean epithelial thickness performed in 5 different points was 52,2±14,3 µm in successful cases, 88,1±42,4 µm in failed cases with recurrent conjunctival ingrowth Conclusion Analysis of epithelial structure and thickness could be useful in postoperative care in patients with congenital aniridia after COMET procedure [ABSTRACT FROM AUTHOR]

Purpose The aim of the study was to quantify low and high order Zernike aberrations in children and youths as well as to investigate influence of fogging and cycloplegia on the refraction and aberrations measurement. Methods KR‐1W Topcon aberrometer was used to measure aberrations in refractometer and aberrometer mode. Children were examined three times. First examination in whole group was performed after fogging stimulus used once ‐ in first of three continuous measurements, second after fogging stimulus performed for each measurement and third after pharmacological cycloplegia with 1% Tropicamid. Second and third measurements were performed in selected group of children. Totally 556 schoolchildren and 74 young sportsmen aged from 6‐to‐18 years were investigated. Average age was 13.87, SD 2.29 in large group and 11.33 years, SD 2.7 in smaller group. Results We found significant differences in spherical refraction measured after pharmacological cycloplegia compared to that after fogging. Refraction after cycloplegia was more hyperopic. There were higher differences in high hyperopic children. There were no differences between fogging and cycloplegic measurements in myopes higher then ‐2.00 D.. Aberrometry has given more myopic results then refractometry. Cylinder values were almost the same. Keratometer readings were the same in all measurements conditions. We found similar levels of high order aberrations in myopic, emmetropic and hyperopic children. There was no noticeable symmetry in high order aberrations between right and left eye. Conclusion Both methods of low order aberrations measurement are similar. Optical parameters of cornea do not depend on the cycloplegic status. Low order Zernike aberrations strictly correspond to the refraction error. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the role of in vivo confocal microscopy (IVCM) in the diagnosis and treatment of infectious keratitis. Methods 24 patients with keratitis were examined by slit‐lamp biomicroscopy and IVCM (HRT). All IVCM examinations were assessed for inflammatory activity and potential etiology. After obtaining baseline cultures, patients were treated as bacterial (10), viral (5), fungal (8) or Acanthamoeba (1) related keratitis based on clinical findings and IVCM. Results Primary outcome was clinical improvement, secondary outcome was correlation between IVCM findings and final culture. In 23 cases (9 bacterial, 5 viral, 8 fungal and 1 Acanthamoeba) clnical improvement was observed within 21 days whereas 1 patient worsened. In bacterial suspected group cultures were positive in 7 cases (70%), in viral none of the cultures were positive. Despite typical clinical image and IVCM findings and clinical improvement on adequate medication in fungal and Acanthamoeba suspected groups cultures remained negative. Conclusion Our study suggests that IVCM along with clinical evaluation can be a useful tool in early diagnosis and guided treatment of patients with infectious keratitis, until definitive culture results are available. However, a prospective clinical study is recommended to further study the role of IVCM in infectious keratitis. [ABSTRACT FROM AUTHOR]

Purpose To develop chitosan hydrogel scaffolds for corneal epithelium cultures. Methods The hydrogel scaffold in the form of a membrane was obtained from chitosan‐natural linear polysaccharide derived from chitin from crustacean shells. It is anti‐bacterial, biocompatible, biologically inert, stable in the natural environment and safe for human. Chitosan films containing keratin and collagen were cross‐linked with genipin, a naturally occurring and nontoxic agent compound found in the gardenia fruit extract. Corneal epithelial cells were seeded on chitosan hydrogel scaffold and were cultivated for 14 days in standard condition using DMEM/F12HAM medium with 3T3 fibroblast co‐culture. Results Mean number of cell layers was 5,2 (3‐8). Immunostaining for cytokeratin 3 and 12,protein p63, connexin 43 was performed to confirm origin of the epithelium and presence of low differentiated cells. Conclusion Genipin crosslinked chitosan hydrogel seems to be a promising material for further clinical tests directed towards the development of implantable corneal epithelial cells [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to present the applicability of corneal confocal microscopy for the early identification and monitoring of treatment efficacy in corneal graft disease. Methods In the 45‐year‐old patient after transplantation because of keratoconus, suspected of graft rejection was performed the following tests: basic slit lamp examination, corneal scans using a Scheimpflug camera (Pentacam, OCULUS) and corneal confocal microscopy in vivo (Rostock Cornea Module Heidelberg Retina Tomograph III Engineering). The study was performed on admission and one week and two weeks after the implementation of local steroids. Results In a slit lamp examination, uncharacteristic macroscopic changes were described ‐ focal turbidity, endothelial deposits and oedema. In an examination with the Scheimpflug camera, endothelial deposits were seen as highly hiperreflective structures reaching the level of the endothelium to the posterior of the corneal stroma. These symptoms are not also unique to transplant disease. In order to search for microstructural evidence of rejection underwent corneal confocal microscopy in which visualized monomorphic intense infiltration of inflammatory cells and dendritic cells, located primarily in the area near the posterior stroma and Descemet membrane. During the steroidotherapy reduction with number of dendritc cells were observed cell infiltration set up to complete disappearance of their normal structure and appearance of the endothelium. Conclusion Corneal confocal microscopy is a useful method for early detection and monitoring of disease corneal transplant. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to show the applicability of confocal microscopy for the diagnosis of corneal graft disease in presence of masking corneal changes. Methods The examined group consisted of 12 patients with suspected corneal graft rejection, in which the local state of the cornea caused difficulties in diagnosis. 7 patients was after DALK procedure, 4 after PK, 1 after DSAEK. Local state of corneal transplant included: edema in secondary glaucoma (3 patients), inflammation with ulceration (3 patients), edema in bullous keratopathy (1 patient), edema in keratouveitis (4 patients), haze after inflammation (1 patient). We performed following procedures: slit lamp examination, scans using a Scheimpflug camera (Pentacam, OCULUS), confocal microscopy in vivo (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III). Results In a slit lamp examination, uncharacteristic macroscopic changes were described ‐ focal turbidity, endothelial deposits and edema. In an examination with the Scheimpflug camera an increased thickness and haze in the posterior stroma was reported. In order to search for microstructural evidence of rejection underwent corneal confocal microscopy which in 11/12 cases showed infiltration of dendritic cells. These cells were located at well‐defined depth (where the adhesion of the corneal transplant) and was not appearing in other parts of the cornea. Conclusion In vivo confocal microscopy is a useful method for the detection of corneal transplant disease also in presence of local changes masking rejection symptoms. This examination is characterized by high sensitivity and ranges in this study of about 92%. [ABSTRACT FROM AUTHOR]

Purpose To evaluate ocular effects of combined therapy with pegylated interferon and ribavirin in hepatitis C. Methods 18 patients (36 eyes) received combined therapy based on the presence of HCV antibodies in the serum and positive RT – PCR test results for HCV RNA. Patients were examined at baseline, months 1, 3, 6 after initiation and 6 months after completion of antiviral treatment. Primary outcome was best corrected visual acuity (BCVA) and secondary outcomes were slit lamp examination, intraocular pressure, foveal thickness, and P1 Multifocal Electroretinography(mfERG) amplitude. Results 13 patients (26 eyes) completed the study. 2 of 13 (15%) patients had exacerbation of dry eye syndrome and 2 of 13 (15%) developed retinopathy. Therapy was discontinued in patients with retinopathy with remission of retinal changes after 3 months. No significant changes in other parameters were observed. Conclusion Patients treated with PegINF‐RBV have a potential risk of ocular complications and require a regular ophthalmic examination. We suggest ocular examination and follow up protocol for patients treated with interferon‐ribavarin therapy to limit potential side effects. [ABSTRACT FROM AUTHOR]

Purpose To determine the characteristic structural corneal changes in a 22 years old patient with Hurler Scheie syndrome using confocal microscopy in vivo. Methods The study was conducted in 22 year old man with Hurler syndrome. The patient presents typical phenotype of this syndrome. Additionally the symptoms reduced by enzymatic treatment confirms the diagnosis of disease. Slit lamp examination, corneal scans using the Scheimpflug camera (Pentacam, OCULUS) and corneal confocal microscopy in vivo (Rostock Cornea Module, Heidelberg Engineering Retina Tomograph III) were performed. Results In all performed examinations the edema and loss of transparency of the cornea have been documented, but the characteristic structural changes were only demonstrated in in vivo confocal microscopy images. Abnormalities in microscopic images were described in all layers of the cornea. The tear film was found containing numerous non‐characteristic inclusions, as well as in the epithelial layer. The most common change was found in front part of corneal stroma ‐ a system of highly hyperreflected, stimulated, vacuolisated keratocytes of "honeycomb‐like" structure and a very sparse amount of stromal matrix. Posterior stroma appeared non‐characteristic hazes, presence of scarring and corrugations up to Descemet's membrane. Due to the thickness of the cornea more than 1000 microns, it was impossible to image the endothelium. Conclusion Corneal confocal microscopy in vivo, is a useful tool in the diagnosis of corneal opacities in the course of MPS Hurler. By characteristic structural features, it can be used for confirming the diagnosis. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to determine the quality of vision, refraction, and aberrations in a group of children and adolescens in selected schools of the city Siemianowice Slaskie (Southern Poland). Methods Visual quality was evaluated as visual acuity measured with two methods: OPTEC® Vision Tester and FrACT computer programme as well as contrast threshold for 30 arc min size optotypes. Refraction was determined with Topcon KR‐1W aberrometer which enables its measuring with "refractor" method or its calculation from low‐order Zernike aberrations. Results Totally 556 children aged from 8‐to‐17 years (average age 13.87, standard deviation 2.29), were investigated. Visual acuity varied within great range, but average value remained almost constant on the level slightly better that V = 5/5 (ca. ‐0.06 logMAR) in the group whithout vision problems. In the group of children with detected refraction errors (wearing glasses) average visual acuity decreased by 0.1 log units in every 5 years.There was high correlation between contrast threshold and visual acuity. We noticed an increase in the average spherical error in the amount of –0.5 D in the time interval of about 5 years. Conclusion Both methods testing visual acuity investigated by the authors are comparable and may be used as screening for children. The FrACT test for screening visual acuity and contrast is a method that would be appropriate to be used in children and teenagers in view of its similarity to computer games and its short time duration. The distribution of visual defects is comparable to that found in other screening tests on the Polish and European populations. [ABSTRACT FROM AUTHOR]

Purpose Brimonidine has proved protective effects on Retinal Ganglion Cells (in animal researches with intravitreal injection), but when used in topical application, its neuroprotective activity has not been unequivocally confirmed. A trail to evaluate potential neuroprotective effect of brimonidine on RNFL in Glaucoma patients. Methods After a retrospective analysis of 1800 patients data, we selected 98, who revealed a significant RNFL thickness loss (21 had Diabetes). We compared the rate of RFNL loss between the group of 53 patients (100 eyes) treated with brimonidine and 45 (90 eyes) treated with other drugs. Results In patients with well‐controlled intraocular pressure (IOP) there is statistically significant relationship between the use of brimonidine and loss of RNFL thickness (p <0.01) and an annual rate of RNFL loss (p=0.01). Conclusion The potentially neuroprotective effect of brimonidine depends on IOP. The higher than normal IOP will limit this potential effect. [ABSTRACT FROM AUTHOR]

Purpose The aim of this study was to show the usefullness of three different methods of Intraocular Pressure (IOP) measurements: Goldmann Applanation Tonometer, Rebound Tonometer and Ultra High‐Speed Scheimpflug Technology. Methods The examined group consisted of 96 patients, 192 eyes (63 females, 33 males of mean age 59,3±19,9 years old). IOP measurements were carried out using Goldmann Applanation Tonometer (GAT), Rebound Tonometer Icare Pro (RT) and Ultra High‐Speed Scheimpflug Technology (UHS ST) –"Corvis ST" with pachymetry which automatically took into account of central corneal thickness (CCT) correction. Additionally corneal pachymetry with Pentacam, Oculus were made to considered CCT in GAT IOP value. Statistical analysis was based on the software Statistica 10.0 PL, Statsoft, Poland. Results Mean IOP measured with GAT was 15,6±3,75 mmHg; GAT with CCT correction 15,7±3,7 mmHg; mean IOP measured with RT was 15,6±3,5 mmHg; with UHS ST 16,1±4,0 mmHg. Mean CCT measured with UHS ST was 543,7±52,7 µm; with Pentacam 547,9±54,0 µm. In comparison, there is significant difference between IOP measured with GAT and GAT+CCT, RT versus UHS ST (P<0,001) and no significant between GAT, GAT+CCT versus RT (p>0,5). Central Corneal Thickness was without differences in measurements carried out with UHS ST and Pentacam. All technics showed correlation IOP with CCT (p<0,05; r~0,3). Conclusion Applanation Tonometer and Rebound Tonometer can be equal methods of IOP measurements in contrast to Ultra High‐Speed Scheimpflug Technology which give significant different values but can be use to take accurate measurements of Central Corneal Thickness [ABSTRACT FROM AUTHOR]

Purpose To visualize intraoperative changes of corneal thickness and bubble creation process using spectral domain OCT. Methods 15 patients underwent DALK performed using "big bubble" technique. Surgeries were assisted with intraoperative spectral domain OCT imaging (The iVue from Optovue Fremont Calfornia USA). Corneal thickness was measured preoperatively, after manual pre‐cutting and after the big‐bubble creation. Results Manual pre‐cutting of corneal stroma revealed residual bed thickness of 240‐270 µm (mean 256 µm). When residual corneal bad was thicker than 250 µm, the 27G needle was used for big‐bubble creation, when it was thinner than 250 µm, 30G needle was used. After injection of an air bubble, in 11 eyes Descemet's membrane was completely separated from stroma, that was shown on OCT scans. In 4 eyes the separation was incomplete that was also clearly visible on OCT images. In one eye OCT imaging showed completely unseparated Descemet's membrane and the additional injection of air bubble was necessary to effectively create the air space between the corneal layers. Conclusion Intraoperative imaging with Spectral domain OCT provides high‐resolution imaging of cornea bed thickness including visualization of the air‐bubble formation. This technique could provide enhanced information for the corneal surgeon during lamellar procedures such a DALK. [ABSTRACT FROM AUTHOR]

Purpose To compare postoperative astigmatism outcomes of femtosecondlaser‐assisted 110°‐cut PK (FLPK) with conventional PK (PK)in keratoconus patients. Methods 62 keratoconus patients were divided into 2 groups: FLPK‐32 patients, PK‐30 patients. Procedures were done with femtosecondlaser‐assisted 110°‐cut with outer diameter of donor's cornea 8.0 mm, in conventional PK donor's graft diameter was also 8.0 mm. Postoperative astigmatism, BCVA, endothelial cell loss were evaluated. Results Follow‐up was at least 6 months. Postoperative astigmatism was lower in FLPK group (2,1±0,5D versus 4,19±1,7D in PK group, p<0.05). BCVA was respectively 0,59±0,1 and 0,55±0,1, endothelial cell loss 30,4±8,3% and 34,1±7,8% respectively. Conclusion Femtosecondlaser‐assisted surgery results in lover astigmatism level [ABSTRACT FROM AUTHOR]

Purpose Efficacy of COMET and subsequent PK in patients with limbal insufficiency combined with stromal corneal haze after corneal burns Methods 15 patients (16 eyes)who underwent corneal burns with vascular conjuctival pannus and stromal involvement underwent autologous cultivated oral mucosa epithelial transplantation. Cellular material was obtained from buccal mucosa, tripsinized, and settled on the previously prepared culture dishes. Cultures was carried on denuded amniotic membrane in presence of inactivated with mitomycin C 3T3 fibroblasts. At least 12 month after epithelium restoration patients underwent PK. Corneal surface stability and visual acuity were evaluated. Results 6 month after last step of the surgery 68,7% of eyes had transparent cornea without reccurent revascularization, 31,2 % of eyes developed vascular pannus again with vascular ingrowth on the transplanted cornea (in 2 cases visual axis was involved), in 62,5 % of eyes visual acuity increased from mean 0,01 to 0,3. Conclusion COMET combined with PK effectively improves ocular surface stability and quality of vision. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this study is to develop a method to get simple and reproducible rodent glaucoma model in rats of Wistar and Long‐Evans line. The intraocular pressure (IOP) and loss of number of retinal ganglion cells (RGCs) were measured to evaluate the success of model. Methods 20 male rats were used in this study. 7 of them were excluded because of incidence of eye inflammation. Finally 13 rats (6 Wistar rats and 7 of Long‐Evans lines with a mass about 200 g) were included. IOP was elevated by injection of polystyrene microbeads into the anterior chamber and measured by Icare TonoLab. For each rat, the right eye was treated with different combinations of polystyrene microspheres with a diameter of 6 and 1 um separately and the left eye was treated as a control. RGCs were labeled retrogradely with a fluorescent marker "FluoroGold" 5 days before euthanasia and after harvested and made slices for a counting of surviving ganglion cells. Results Mean intraocular pressure (IOP) of examined group was 24 mmHg ± 5,4. The highest IOP appeared after injection on 3rd day, and rose a bit lasting till 21st day. The mean IOP in contralateral eyes during experiment was 10,8 mmHg ± 0,5. Mean number of RGCs in eyes with elevated IOP was 3014±655 cells (semiquantitative method was used). In control group it was 4106±852 cells. In examined group values of IOP were significantly higher and number of RGCs was significantly lower according to control eyes. Conclusion"Bead model" method could be used to create rat model of glaucoma with stable increasd IOP. The different size microspheres could provide the IOP with the desired values. [ABSTRACT FROM AUTHOR]

Purpose Spatial structure of collagen lamellae of the human cornea is thought to be an important determinant of corneal rigidity. Analysis of the low‐frequency (1–107 Hz) dielectric spectra of the normal and keratoconus human cornea in the temperature range of 140‐300 K and for different hydration states were examined. Methods For the measurements, the 100 – 200 μm specimens containing the middle layers of corneal stroma were used. The 9 specimens of healthy, control corneas from Eye Bank were obtained with second microkeratom section during Ultra Thin‐DSAEK. The 12 specimens of keratoconus corneas were manually prepared from corneas removed during penetrating keratoplasty. Results Experimental results were interpreted in terms of ionic diffusion and space charge polarization according to the Sawada's theory. The new presentation of the dielectric spectra, i.e.: (delta eps'/delta ln f)*f, was used. The presented method and the Sawada's expression were applied to the analysis of the changes in spatial molecular structure of collagen fibril network in human cornea. Conclusion Fitting procedure of the theoretical function to the experimental data allowed us to determine two diffusive relaxation regions with two structural distance parameters ds, describing spatial arrangement of collagen fibrils in cornea. [ABSTRACT FROM AUTHOR]

Purpose Outcomes of patch grafts in corneal perforations and deep ulcers. Methods For the study 184 patients (follow‐up at least 6 months) were qualified: 57men and 127 women, mean age 61,7,±19,1 years. 198 procedures (112 in corneal perforations and 86 in deep ulcers) were performed. We applied grafts with diameter from 2,5 to 5 mm with oversize of 0,5 – 1 mm. Visual outcomes and corneal surface stability were analysed Results In 175 eyes we achieved stabile corneal surface, 23 grafts were failed due to graft melting. Among 175 eyes improvement of VA was achieved in 89 eyes, 58 required further procedures of penetrating keratoplasty or cataract surgery. The best visual outcomes were achieved in peripheral ulcers or perforations, central changes usually required further management or were connected with poor prognosis for good vision. 28 eyes due to dry eye, no light localization or retinal detachment (3 eyes) were disqualified to other procedures Conclusion Patch grafts are useful to restore vision and maintain corneal integrity. [ABSTRACT FROM AUTHOR]

Purpose To present results of COMET technique in corneal surface reconstruction in bilateral limbal stem cell deficiency. Methods Study group: 13 patients (17 eyes) suffering from limbal stem cell deficiency (LSCD) after chemical burns (7 eyes) or from aniridia related LSCD (10 eyes). Preoperative vision was ranged from hand movements to 0,05. Oral mucosa epithelium was collected and tripsinized. Single cells were seeded on denuded amniotic membrane. Cultures were carried in standard conditions in supplemented DMEM HAM/F12 mixture medium in presence of inactivated 3T3 fibroblasts for 8 days. Histologic examination and immunostaining for epithelial cytokeratins confirmed epithelial origin before transplantation. After superficial keratectomy carries with stratified epithelium were transplanted on the denuded corneas. Corneal surface stability was evaluated as well as visual outcomes. Results Postoperative follow‐up ranged from 6 to 12 months. 6 months after surgery 76,4 % of eyes showed stabile epithelium. In 23,5 % of eyes corneas reminded cloudy due to recurrent conjuctival neovascularization or stromal haze. All failed grafts were from ocular burns patients group. Visual acuity ranged from hand movement to 0.4. Conclusion COMET is a new method for bilateral corneal epithelial disorders offering the patient satisfactory stabilization of the corneal surface. [ABSTRACT FROM AUTHOR]

Purpose To evaluate effectiveness of soft shell cataract surgery technique on the corneal structure in group of Fuchs' dystrophy patients. Methods 24 patients (mean age 52,7±13,8), 31 eyes after phacoemulsification were examined before and 10 months after surgery. BCVA, mean central corneal thickness (CCT) and corneal endothelial cell density (CD) were evaluated. Corneal aberrations root‐mean‐square (RMS) was calculated 1 and 10 months after surgery for 4.0mm pupil. Results Corneal higher‐order aberrations (RMS) 1 month after surgery was 0,372±0,058 and 10 months after surgery was 0,345±0,076, BCVA 10 months after surgery was 0,75±0,27 (before surgery 0,32±0,28), the mean CCT was 563,37±21,42µm (before surgery 559,62±45,29µm), CD 1786,341±493,127 (before surgery 1912,783±381,963). Conclusion All patients revealed good stability and protection of the cornea confirming safety of the soft shell technique. [ABSTRACT FROM AUTHOR]

Background The purpose of this work was to study the evolving trends in techniques and indications for corneal transplantation in Poland. Methods This retrospective, descriptive analysis of corneal transplantations was performed at the Ophthalmology Department of Saint Barbara Hospital, Trauma Center, Sosnowiec, Poland, between 1988 and 2014. Structure of indications and surgery type rates over 26 years were tabulated by means of 5-year intervals. Results Between 1989 and 2014, 1762 corneal transplantations were performed, including 1375 (78%) cases of penetrating keratoplasty, 137 (8%) lamellar keratoplasty, 112 (6%) patch grafts, and 138 (8%) keratolimbal allografts. The major indications and their respective overall percentage were corneal leucoma (24%), pseudophakic/aphakic bullous keratopathy (22%), Fuchs dystrophy (13%), keratoconus (13%), re-graft (11%), keratitis (9%), and limbal stem cell deficiency (8%), with changes in relative frequency of the leading indications over the following time intervals. The number of corneal transplantations gradually increased during the years reviewed. The rates of lamellar, keratolimbal, and patch grafts have grown dynamically since 2010, reaching 20%, 17%, and 12%, respectively, of procedures performed during 2010 to 2014. Conclusions Over the past quarter of a century, there has been evolution in corneal transplantation service, from the first penetrating keratoplasty to the wide spectrum of procedures, including femtosecond laser–assisted keratoplasty. Although, since 2010, the rates of lamellar and keratolimbal allografts have grown rapidly, penetrating keratoplasty has remained the leading technique. [ABSTRACT FROM AUTHOR]

Background/aims: To evaluate efficacy, safety, pharmacokinetics (PK) and immunogenicity of SB15 versus reference aflibercept (AFL), and switching from AFL to SB15 in neovascular age-related macular degeneration (nAMD)., Design: Prospective, double-masked, randomised, phase 3 trial., Methods: Participants with nAMD were randomised 1:1 to receive SB15 (N=224 participants) or AFL (N=225). At week 32, participants either continued on SB15 (SB15/SB15, N=219) or AFL (AFL/AFL, N=108), or switched from AFL to SB15 (AFL/SB15, N=111). This manuscript reports 1-year and switching results of secondary efficacy endpoints such as changes from baseline to week 56 in best-corrected visual acuity (BCVA), central subfield thickness (CST, from internal limiting membrane (ILM) to retinal pigment epithelium), and total retinal thickness (TRT, from ILM to Bruch's membrane). Additional endpoints included safety, PK and immunogenicity., Results: Efficacy results were comparable between groups. The least squares mean (LSmean) change in BCVA from baseline to week 56 was 7.4 letters for SB15/SB15 and 7.0 letters for AFL/AFL (difference (95% CI)=0.4 (-2.5 to 3.2)). The LSmean changes from baseline to week 56 in CST and TRT were -119.2 µm and -132.4 µm for SB15/SB15 and -126.6 µm and -136.3 µm for AFL/AFL, respectively (CST: difference (95% CI)=7.4 µm (-6.11 to 20.96); TRT: difference (95% CI)=3.9 µm (-18.35 to 26.10)). Switched and non-switched participants showed similar LSmean changes in BCVA from baseline to week 56 (AFL/SB15, 7.9 letters vs AFL/AFL, 7.8 letters; difference (95% CI)=0.0 (-2.8 to 2.8)). Safety, PK and immunogenicity were comparable between groups., Conclusions: Efficacy, safety, PK and immunogenicity were comparable between SB15 and AFL and between switched and non-switched participants., Competing Interests: Competing interests: WC, IO and HJ are employed by Samsung Bioepis. Samsung Bioepis funded medical writing support and article processing charges. Additional potential conflicts of interest are listed below. SJW obtained consulting fees from Samsung Bioepis, Janssen, Novartis, Curacle, Novelty Nobility, Sometech, Rznomics and Pharmabcine, grants from Samsung Bioepis, Novelty Nobility, Novartis, Alteogen, Roche, Geneunitech, Bayer, Bio Bank Healing, and Curacle, and payments for lectures from Novartis, Bayer, and Allergan-Abbvie. He serves as equity owner of Retimark and Panolos Bioscience. SRS obtained consulting fees from Apellis, Amgen, Abbvie/Allergan, Samsung Bioepis, Biogen, Boerhinger Ingelheim, Iveric, Novartis, Roche, Bayer, Regeneron, Pfizer, Astellas, Nanoscope, Jannsen, Centervue, Optos and Heidelberg, and honoraria for lectures from Novartis, Roche, Optos, and Heidelberg. He is part of the Data Safety Monitoring/Advisory Board of Regeneron and holds leadership/fiduciary functions in ARVO and Macula Society. MB obtained honoraria for presentations by Novartis and Abbvie. He is part of the advisory board of Novartis and obtained grants for clinical trials from Iveric Bio (former Optotech), Novartis, Roche, Ophthea and Samsung Bioepis. AV obtained consulting fees and honoraria for lectures from Novartis, Roche, Pfizer, Bausch & Lomb, Zeiss, and Alcon. He also obtained support for meeting attendances by Novartis, Pfizer, Bausch & Lomb, Roche, Zeiss, Alcon, Iveric Bio, Amgen, Chengdu, Mylan, Panoptica, Formycon, Thrombogenics, Regeneron and Clearside. He is part of the Data Safety Monitoring/Advisory Board of Zeiss, Bayer, Novartis, Pfizer, and Roche. MS obtained grants from Allergan/Abbvie, Bayer and Novartis, consulting fees from Samsung Bioepis, Bayer, Novartis, Allergan/Abbvie, Roche, Alcon and Curacle, honoraria for lectures from Samsung Bioepis, Bayer, Novartis, Allergan/Abbvie, Roche, Alcon and Johnson & Johnson, and support for meeting attendances from Bayer, Allergan/Abbvie and Novartis. Min Sagong is part of the Data Safety Monitoring/Advisory board of Bayer, Novartis, and Allergan/Abbvie. JS obtained consulting fees from Abbvie and support for meeting attendances from Bayer. MV obtained consulting fees from Abbvie and Roche and support for meeting attendances from Bayer. EW obtained honoraria for lectures from Bayer, Roche, Alfa Sigma, Allergan, Zeiss and Thea, and is part of the advisory board of Allergan. SP obtained grants from Aerie, Aerpio, Allergan, Allgenesis, Apellis, Boehringer Ingelheim, Chengdu Kanghong, Clearside, EyePoint, Genentech-Roche, Ionis Pharmaceuticals, IVERIC Bio, KalVista, Kodiak Sciences, Mylan, Novartis, Oculis, Opthea, Ora, Oxurion, Regeneron, Samsung, SmileBiotek, Stealth Biotherapeutics, ThromboGenics, Xbrane Biopharma, consulting fees from AiViva, Allergan, Allgenesis, Genentech-Roche, Kala, Kodiak Sciences, Oxugenix, and RegenxBio, and support for travel expenses from EyePoint. He is part of the Data Safety Monitoring/Advisory Board of Allergan, Allgenesis Biotherapeutics, Genentech-Roche, Kodiak Sciences, and Iveric Bio and serves as equity owner and chief medical officer for Allgenesis Biotherapeutics. WC received consulting fees from Samsung Bioepis and payments for lectures from Bayer, Novartis and Chong Kun Dang., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: Aflibercept biosimilars can expand available treatment options in retinal diseases and have the potential to improve patient access to safe and effective therapy., Objective: To establish equivalence in efficacy and similarity in safety, pharmacokinetics, and immunogenicity of SB15 and reference aflibercept (AFL) in neovascular age-related macular degeneration (nAMD)., Design, Setting, and Participants: This was a randomized double-masked parallel group phase 3 trial conducted at 56 centers in 10 countries from June 2020 to March 2022, including follow-up through 56 weeks. Of 549 screened participants, 449 participants 50 years and older with treatment-naive nAMD were included and randomly assigned to SB15 (n = 224) or AFL (n = 225). Key exclusion criteria included considerable scarring, fibrosis, atrophy, and hemorrhage. This report includes results up to the end of the parallel group period at week 32. Of the 449 randomized participants, 438 (97.6%) completed week 32 follow-up., Intervention: Participants were randomized 1:1 to receive 2 mg of SB15 or AFL every 4 weeks for the first 12 weeks (3 injections), followed by dosing every 8 weeks up to week 48, with final assessments at week 56., Main Outcomes and Measures: The primary end point was the change in best-corrected visual acuity (BCVA) from baseline to week 8 with predefined equivalence margins of -3 letters to 3 letters. Other key end points were changes in BCVA and central subfield thickness up to week 32, safety, pharmacokinetics, and immunogenicity., Results: The mean (SD) age among the 449 included participants was 74.0 (8.1) years, and 250 participants (55.7%) were female. Baseline demographic characteristics and most disease characteristics were comparable between treatment groups. The least squares mean change in BCVA from baseline to week 8 in the SB15 group was equivalent to that in the AFL group (6.7 letters vs 6.6 letters, respectively; difference, 0.1 letters; 95% CI, -1.3 to 1.4). Comparable efficacy between treatment groups was maintained up to week 32 (least squares mean change from baseline in BCVA: SB15, 7.6 letters vs AFL, 6.5 letters; least squares mean change from baseline in central subfield thickness: SB15, -110.4 μm vs AFL, -115.7 μm). No clinically relevant differences were observed in the incidence of treatment-emergent adverse events (TEAEs) (SB15, 107/224 [47.8%] vs AFL, 98/224 [43.8%]) and ocular TEAEs in the study eye (SB15, 41/224 [18.3%] vs AFL, 28/224 [12.5%]). The serum concentration profiles and cumulative incidences of overall antidrug antibody positive participants were comparable., Conclusions and Relevance: In this phase 3 randomized clinical trial, SB15 and AFL showed equivalent efficacy and comparable safety, pharmacokinetics, and immunogenicity in participants with nAMD., Trial Registration: ClinicalTrials.gov Identifier: NCT04450329.

The aim of the study was to investigate oxidative stress as well as cellular protein accumulation in corneal diseases including keratoconus (KC), macular corneal dystrophy (MCD), and Fuchs endothelial corneal dystrophy (FECD) at their primary affecting sites. Corneal buttons from KC, MCD, and FECD patients, as well as healthy controls, were analyzed immunohistochemically to evaluate the presence of oxidative stress and the function of the proteostasis network. 4-Fydroxynonenal (4-HNE) was used as a marker of oxidative stress, whereas the levels of catalase and heat-shock protein 70 (HSP70) were analyzed to evaluate the response of the antioxidant defense system and molecular chaperones, respectively. Sequestosome 1 (SQSTM1) levels were determined to assess protein aggregation and the functionality of autophagic degradation. Basal epithelial cells of the KC samples showed increased levels of oxidative stress marker 4-HNE and antioxidant enzyme catalase together with elevated levels of HSP70 and accumulation of SQSTM1. Corneal stromal cells and endothelial cells from MCD and FECD samples, respectively, showed similarly increased levels of these markers. All corneal diseases showed the presence of oxidative stress and activation of the molecular chaperone response to sustain protein homeostasis. However, the accumulation of protein aggregates suggests insufficient function of the protective mechanisms to limit the oxidative damage and removal of protein aggregates via autophagy. These results suggest that oxidative stress has a role in KC, MCD, and FECD at the cellular level as a secondary outcome. Thus, antioxidant- and autophagy-targeted therapies could be included as supporting care when treating KC or corneal dystrophies.

Purpose: To compare anterior chamber depth (ACD), keratometry (K1, K2), central corneal thickness (CCT), and axial length (AL) measured by four different devices., Material and Methods: 150 eyes qualified for cataract surgery were included in the study. Four devices: IOL Master 500, OCT CASIA2, Dual Scheimpflug Analyzer Galilei G6, and Quantel Compact Touch ultrasound biometer, were compared. The agreement of measurements between the devices was evaluated by the Bland-Altman method., Results: ACD was significantly different for Ultrasound and IOL Master 3 ± 0.33 3.12 ± 0.42 respectively Interclass correlation ecoefficiency (ICC):0.69 (95% confidence interval (CI): 0.62; 0.76) p < 0.001. A significant difference was observed between Casia and IOL while measuring K1, 43.5 ± 1.7 vs. 43.61 ± 1.56 ICC:0.84 (95%CI: 0.79; 0.87) and ACD parameters 2.65 ± 0.45 vs. 3.12 ± 0.42 ICC 0.68 (95%: 0.6; 0.75) and K2 42.51 ± 1.62 vs. 44.57 ± 1.59 ICC; 0.83 (95%CI:0.78; 0.87) p < 0.001. Similarly, measurements obtained by Casia, and Galilei were also different K1 43.5 ± 1.7 ICC:0.7 (95%CI:0.62; 0.76), CCT 546.35 ± 34.75 vs. 566.73 ± 37.92 ICC:0.88 (95%CI:0.84; 0.9) p < 0.001. Differences between Galilei and IOL master were not significant p values from 0.175 to 0.999 ICC 0.8 (95%CI:0.75; 0.85) to ICC 0.94 (95%CI:0.92; 0.95)., Conclusions: The measurements obtained from Casia, and Ultrasound were significantly different and not interchangeable except for IOL master and Galilei.

Purpose: To analyse the recurrence of superficial neovascularisation after previous corneal surface reconstruction with cultivated corneal epithelial cells., Materials and Methods: Forty-eight eyes underwent autologous transplantation of cultivated corneal epithelium to treat partial or total limbal stem cell deficiency caused by chemical or thermal injury. The carrier for the epithelial sheets was a denuded amniotic membrane. Follow-up was conducted for up to 120 months. Recurrent revascularisation (measured in terms of clock hours affected) was evaluated with slit-lamp examination and the support of confocal microscopy., Results: During the long-term observation, only 7 eyes had stable epithelia with no neovascularisation from the conjunctiva. Nineteen eyes developed pathologic vessels in 1 quadrant, with additional 4 eyes developing them in 2 quadrants. Twelve patients developed subtotal or total conjunctivalisation of the corneal surface. They were referred for second cultivated epithelium transplantation (3 patients), allogenic keratolimbal transplantation (7 patients), or keratoprosthesis (2 patients). Six patients withdrew consent. The use of confocal scans of up to 100  µ m in resolution enabled the detection of pathologic microvasculature originating from the conjunctiva and the exclusion of stromal vascular ingrowth., Conclusions: Local ingrowth of the conjunctiva is a common complication after the transplantation of cultivated epithelial cells. Severe and progressive vascularisation inevitably leads to graft failure. However, if local ingrowth stops before reaching the central cornea, the treatment even with this complication can be considered a success., Competing Interests: The authors declare that they have no conflicts of interest. None of the authors has conflicts of interest with the submission., (Copyright © 2021 Dariusz Dobrowolski et al.)

Purpose: Long-term results of the patients with total LSCD, who had undergone keratolimbal allograft (KLAL) for limbal reconstruction followed by penetrating keratoplasty (PK)., Methods: The study analyzes surgical treatment of 43 eyes with severe ocular surface disorders. All subjects underwent KLAL to achieve suitable conditions for consecutive PK. Due to failures of primary treatment in 17 eyes (39%), the KLAL was repeated. PK was performed in all the patients at 9-12 months after KLAL. As a retrospective study we analyzed data from the medical records including the preoperative and postoperative best corrected visual acuity, corneal clarity, surgical outcomes and complications, postoperative intraocular pressure, graft rejection, and other comorbidities and complications., Results: The preoperative visual acuity ranged from light perception to 0.01. The final improvement of visual acuity within a gain of one or more lines with the Snellen chart, including the results of successive surgical treatments after PK, was achieved in 23 operated eyes (53%). Early graft rejection was observed in 4 eyes (9%). In 3 eyes, it was manifested as endothelial rejection, and in 1 eye, as combined endothelial and epithelial rejection. PK failure requiring repetitive PK was present in 14 eyes (32%). Phthisis bulbi developed in 6 eyes (14%). Glaucoma or ocular hypertension was reported in 25 eyes (58%). A majority were treated with up to 3 topical agents or referred for trabeculectomy in 3 cases, transscleral cyclophotocoagulation in 2 eyes, and EX-PRESS glaucoma shunt implantation in 3 cases., Conclusions: Successful KLAL carries a high risk of subsequent PK failure. Visual function remains the second aim of treatment; the primary one is to stabilize the surface., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Katarzyna Krysik et al.)

Purpose: To report on surgical approaches using amniotic membrane applications and patch grafts in corneal melting and perforations. Anatomical and functional results, including advantages and disadvantages of the interventions, will also be explored., Methods: A five-year retrospective analysis of 189 surgical treatments involving corneal melting with perforation was performed. In one evaluated treatment type, a graft of amniotic membrane, often folded one to three times, was sutured with the epithelial side facing the previously mechanically debrided corneal tissue. A larger monolayer amniotic patch was then sutured, with the epithelial side facing the top of the first membrane, to the perilimbal conjunctiva. For corneal patch grafts, the size-fitting technique of graft trephination was applied, and the donor-recipient junctions were sewn with interrupted sutures. All the procedures were evaluated, noting outcomes and complications of surgery, preoperative and postoperative visual acuities, postoperative intraocular pressures, graft rejection, and other late comorbidities and complications., Results: We performed 119 amniotic membrane applications (63%) and 70 corneal patch grafts (37%). Anatomical reconstruction of the anterior chamber was achieved in 157 eyes, of which 102 eyes (86%) received an amniotic membrane and 55 eyes (79%) were treated with the patch graft technique. In 63 eyes (33%), more than one amnion or graft treatment was necessary to close the corneal perforation., Conclusions: The success of medical and surgical management depends on the cause of corneal melting, and amniotic membrane applications often require further intervention; nevertheless, patch grafts deliver better tectonic reconstruction than amniotic membrane alone., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2020 Katarzyna Krysik et al.)

Purpose: To investigate corneal phenotype in aniridia-associated keratopathy (AAK) including its earliest manifestations, in relation to PAX6 mutational status., Methods: 46 subjects (92 eyes) with congenital aniridia from a German registry were examined using slit lamp biomicroscopy, anterior segment optical coherence tomography, contact esthesiometry and in vivo confocal microscopy. Cytogenetic analysis was conducted by Sanger sequencing of PAX6 exons and/or MLPA analysis. Measured parameters included AAK grade, distance-corrected visual acuity (DCVA), central corneal thickness (CCT), corneal sensitivity, subbasal nerve density, mature dendritic cell (DC) density and corneal epithelial phenotype., Results: 46 subjects (age range: 1-64 years) were examined, including 23 (50%) children under the age of 18. Five subjects (11.1%) with absent PAX6 coding mutation (non-PAX6 cases) had mild AAK (Grade 0-1) into the fourth decade of life and maintained corneal epithelial phenotype, greater subbasal nerve density (16.8 mm/mm 2 vs. 3.58 mm/mm 2 , P = 0.01) and better corneal sensitivity (41 ± 11 mm vs. 28 ± 12 mm, P = 0.03) relative to those with PAX6 coding mutations. In five subjects, corneal endothelial cell density ranged from 3245 to 4399 cells/mm 2 . Independent of mutational status, an increased CCT, over tenfold increased mature DC density and reduced corneal sensitivity characterized all subjects., Conclusions: PAX6 coding mutations influence AAK phenotype and progression from the earliest stages of life. A minimal keratopathy present in 100% of congenital aniridia cases is independent of the specific mutation and consists of increased corneal thickness, reduced touch sensitivity, and increased ocular surface immune activity., Competing Interests: Declaration of competing interest No conflicting relationship pertaining to this work exists for any author., (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.)

Aim: To analyse the impact of ultrasound and optical intraocular lens (IOL) calculation methods on refractive outcomes of cataract phacoemulsification performed after penetrating keratoplasty (PK) in keratoconus., Methods: Phacoemulsification cataract surgery was performed on 42 eyes of 34 patients with keratoconus who had previously undergone PK. The IOL power was determined by using both standard and corneal topography-derived keratometry using the SRK/T formula. We used two independent methods-ultrasound biometry (UB) and interferometry [optical biometry (OB)] for IOL calculation. The analysed data from medical records included demographics, medical history, best corrected visual acuity (BCVA) on Snellen charts, technique of IOL calculation and calculation formula and its impact on final refractive result., Results: BCVA ranged from 0.01 to 0.4 (mean 0.09±0.19) before surgery and ranged from 0.2 to 0.7 (mean 0.38±0.14) at 1mo and from 0.2 to 1.0 (mean 0.56±0.16) ( P <0.05) at 3mo, postoperatively. The refractive aim differed significantly from the refractive outcome in both the UB and OB groups ( P <0.05). There was no statistically significant difference in the accuracy of the two biometry methods., Conclusion: The refractive aim in keratoconus eyes post-PK is not achieved with either ultrasound or OB.

Aim: To conduct a retrospective analysis of secondary IOL implantation in patients who underwent PK with no simultaneous IOL implantation., Materials and Methods: The retrospective study of the secondary implantation of IOLs was conducted in 46 eyes that underwent a primary operation with PK and cataract/lens extraction with no IOL implantation due to capsule rupture or combining corneal or intraocular complications. The minimum period from PK was 12 months. All secondary IOL implantations were performed from January 2011 to August 2017. Aphakic postkeratoplasty patients were treated using one of the surgical techniques for secondary IOL implantation. In-the-bag IOL implantation was possible if the posterior capsule was complete. If the lens capsule remnants were sufficient to provide secure IOL support, an in-the-sulcus IOL implantation was performed. Scleral fixation was offered in eyes with extensive capsular deficiency or the presence of the vitreous body in anterior chamber. BCVA and expected and achieved refraction were evaluated; we included using two biometry devices, and results were compared., Results: The corrected distance visual acuity (CDVA) before surgery ranged from 0.1 to 0.8 (mean 0.54 ± 0.17). After secondary IOL implantation, CDVA ranged from 0.2 to 0.8 (mean 0.43 ± 0.14) at postoperative 1 month and from 0.3 to 0.9 (mean 0.55 ± 0.15) at postoperative 6 months ( p < 0.05). Comparison of the final refraction using two methods of biometry showed no statistically significant difference in the group that underwent scleral fixation of the IOL, similar to the findings for the in-the-bag and in-the-sulcus IOL implantation groups. In the scleral-fixation group, p =0.55 for the USG biometry technique and p =0.22 for the OB technique. p values for the IOL-implantation group were p =0.49 and p =0.44, respectively., Conclusion: Both implantation methods are safe for the patients. Final refraction is depending on the technique and indication to keratoplasty. Both biometry techniques deliver precise data for IOL choice.

Purpose: To report on the efficacy and safety of CO 2 laser-assisted sclerectomy surgery (CLASS) compared with trabeculectomy in primary open-angle glaucoma and exfoliative glaucoma., Methods: One hundred and thirty-one patients underwent CLASS (66 patients) or trabeculectomy (65 patients) and were followed up for 12 months. 'Complete success' was defined as intraocular pressure (IOP) between 10 and 18 mmHg and reduced by at least 30% from the baseline without medications, while 'qualified success' was compliant with the above criteria with or without the medications., Results: Comparing CLASS with trabeculectomy at 1 year, the mean IOP reduction rate was 32.6 ± 10.8% versus 40.6 ± 15.9% (p < 0.001) and the average use of medications was 1.4 ± 1.4 versus 0.7 ± 1.1 (p < 0.05). At 12 months, the complete success rate was 35% for CLASS versus 60% for trabeculectomy (p < 0.01), while the qualified success rate was 74% versus 75%, respectively, with no significant difference in qualified success rate between the groups at any time-point (p > 0.05). Compared with CLASS, patients after trabeculectomy developed a higher rate of early complications (9.1% versus 29.2%, p = 0.004), higher endothelial cell density (ECD) loss (1.4 ± 1.4% versus 6.5 ± 4.8%, p < 0.001), higher astigmatism (0.0 ± 0.1 versus 0.1 ± 0.2, p < 0.001) and significant visual acuity deterioration (0.1 ± 0.1; range 0-2 lines versus 0.4 ± 0.6; range 0-3 lines, p = 0.016)., Conclusion: Although CLASS shows a less potent hypotensive effect, it is similar to trabeculectomy in the qualified success rate and offers the reduction in medications up to 12 months. With a more attractive complications profile, CLASS may be an alternative to trabeculectomy, especially at the earlier glaucoma stage and in patients with a low ECD., (© 2018 Acta Ophthalmologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.)