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To assess the effect of corneal scar location on corneal nerve regeneration in patients with herpes simplex virus (HSV) keratitis in their affected and contralateral eyes over a 1-year period by in vivo confocal microscopy (IVCM), and to correlate these findings to corneal sensation measured by Cochet-Bonnet Esthesiometer.

Objective: To investigate the retinal changes in choroideremia (CHM) patients to determine correlations between age, structure and function. Subjects/Methods: Twenty-six eyes from 13 male CHM patients were included in this prospective longitudinal study. Participants were divided into <50-year (n= 8) and ≥50-year (n= 5) old groups. Patients were seen at baseline, 6-month, and 1-year visits. Optical coherence tomography (OCT), OCT angiography, and fundus autofluorescence were performed to measure central foveal (CFT) and subfoveal choroidal thickness (SCT), as well as areas of preserved choriocapillaris (CC), ellipsoid zone (EZ), and autofluorescence (PAF). Patients also underwent functional investigations including visual acuity (VA), contrast sensitivity (CS), colour testing, microperimetry, dark adaptometry, and handheld electroretinogram (ERG). Vision-related quality-of-life was assessed by using the NEI-VFQ-25 questionnaire. Results: Over the 1-year follow-up period, progressive loss was detected in SCT, EZ, CC, PAF, and CFT. Those ≥50-years exhibited more structural and functional defects with SCT, EZ, CC, and PAF showing strong correlation with patient age (rho≤ −0.47, p≤ 0.02). CS and VA did not change over the year, but CS was significantly correlated with age (rho= −0.63, p= 0.001). Delayed to unmeasurable dark adaptation, decreased colour discrimination and no detectable ERG activity were observed in all patients. Minimal functional deterioration was observed over one year with a general trend of slower progression in the ≥50-years group. Conclusions: Quantitative structural parameters including SCT, CC, EZ, and PAF are most useful for disease monitoring in CHM. Extended follow-up studies are required to determine longitudinal functional changes.

The diagnosis of neuropathic corneal pain (NCP) is challenging, as it is often difficult to differentiate it from conventional dry eye disease (DED). In addition to eye pain, NCP can present with similar signs and symptoms of DED. The purpose of this study is to find an objective diagnostic sign to identify patients with NCP, using in vivoconfocal microscopy (IVCM).

Purpose: Using optical coherence tomography angiography (OCTA) to investigate the area with flow in the superficial retinal vessel network (SVRN) and choriocapillaris (CC) layer among male subjects with choroideremia (CHM), female carriers, and normal controls to identify vascular changes. Patients and methods: Images of SRVN and CC layer were acquired in 9 affected males, 5 female carriers, and 14 age- and gender-matched controls using the Angiovue software of the RTVue XR Avanti. Results: The mean age was 33 years for affected male CHM patients (median 30 years), 46 years for female carriers (median 53 years), and 39 years for controls (median 38.5). Mean SRVN area±SD in subjects with CHM was 12.93±2.06 mm2, in carrier subjects 15.36±0.60 mm2, and in controls 15.30±1.35 mm2(P<0.01). The mean CC area±SD with flow was 6.97±5.26 mm2in CHM subjects, 21.65±0.17 mm2in carriers and 21.36±0.76 mm2in controls (P<0.01). SRVN and CC area with flow showed a negative correlation in CHM subjects with the age (r=−0.86; P<0.003 and r=−0.77; P<0.01, respectively). CC area with flow had a positive correlation with SRVN (r=0.83, P<0.001). Overall, visual acuity had a negative correlation with SRVN and CC area with flow (r=−0.67, P<0.001 and r=−0.57, P<0.002, respectively). Conclusions:: This is the first study to highlight changes in the SRVN in CHM subjects. OCTA detected a reduced area with flow in both retinal and choroidal circulations, and may be a useful tool for monitoring natural history and disease progression in forthcoming clinical trials.

Background/AimsTo determine the UK incidence, demographics, aetiology, management and visual outcome for children developing choroidal neovascularisation (CNV).MethodsA prospective population-based observational study of routine practice via the British Ophthalmological Surveillance Unit between January 2012 and December 2013 with subsequent 1-year follow-up in children under 16 years old with newly diagnosed CNV.ResultsTwenty-seven children with CNV were reported. The UK estimated annual incidence for those aged 16 and under was 0.21 per 100 000 (95% CI 0.133 to 0.299). The mean age was 11.1 years (SD 3.9, range 4–16). Fourteen were female. Seventy-seven per cent (22 patients) were Caucasian British. Twenty-three children (85%) had unilateral disease. The most common aetiology included inflammatory retinochoroidopathy (n=9), optic disc abnormalities (n=9) and idiopathic (n=5). Optical coherence tomography was performed in all cases and fundus fluorescein angiography in 61%. Management included observation only (n=10), anti-vascular endothelial growth factor (anti-VEGF) injection of bevacizumab (n=14) or ranibizumab (n=2), or both (n=1), and additional use of oral (n=1) and local (periocular n=2 and intravitreal n=2) steroids in five children with inflammatory retinochoroidopathy. The mean number of anti-VEGF injections was 2±1, with eight patients receiving only one injection. The mean (SD) best corrected visual acuity in LogMAR was 0.91 (0.53) at presentation and 0.74 (0.53) at 1-year follow-up (p=0.09).ConclusionThis is the first population-based prospective study of CNV in children. This is a rare disorder with a poor visual prognosis irrespective of CNV location and the use of anti-VEGF therapy.

Background/AimsTo report the clinical, histopathological and genetic features of a variant of lattice corneal dystrophy (LCD) associated with two pathogenic mutations in the transforming growth factor-B-induced (TGFBI) gene.MethodsClinical characterisation was performed by slit lamp examination and in vivo confocal microscopic imaging (IVCM). Histopathological characterisation was performed with light microscopic examination of an excised corneal button and a peripheral blood samples were collected for TGFBIscreening.ResultsA 42-year-old woman presented with progressive photophobia and decreased visual acuity in both eyes. Slit lamp examination demonstrated punctate and linear branching opacities in the mid and posterior corneal stroma, corresponding to hyper-reflective opacities noted on IVCM and amyloid deposition noted on histopathological examination of an excised corneal button. TGFBIscreening revealed two previously reported heterozygous missense mutations: c.337G>A (p.(Val113Ile)) in exon 4 and c.1673T>C (p.(Leu558Pro)) in exon 12. Screening of an affected sibling with a similar phenotype revealed that she was also heterozygous for both mutations, while screening of another sibling with punctate but not linear stromal opacities revealed that she was heterozygous for only the p.(Leu558Pro) mutation.ConclusionsThe p.(Val113Ile) mutation results in an alteration of the atypical LCD phenotype associated with the p.(Leu558Pro) mutation. This represents only the second report of the alteration of the phenotype of a TGFBIdystrophy by a second, non-homozygous pathogenic mutation, and thus provides insight into the phenotype-genotype correlation of the TGFBIdystrophies.

To evaluate outcomes of photorefractive keratectomy up to -10.00 D of myopia and -4.50 of astigmatism and to develop a predictive model for the refractive changes in the long term.

Purpose To demonstrate the surgical application of a new model of epidescemetic keratoprosthesis.Methods A 53-year-old man was referred to our center with severe alkali burns in both eyes and was treated by a combined corneal graft associated with KeraKlear implantation assisted by femtosecond laser and cataract surgery with implantation of an intraocular lens.Results After 1 month, visual acuity was 0.6 logMAR in both eyes with −2 sphere correction. Slit-lamp examination and anterior segment optical coherence tomography revealed that the device was centered in the pupil area with no infection. No sign of extrusion was detected.Conclusions The advantage of this device is that it involves nonperforating surgery, thus reducing the postoperative risk of infection and necrosis of tissue around the prosthesis. Large-scale studies with a long follow-up period are required to evaluate the outcome of use of this device.

Purpose Anterior segment optical coherence tomography (OCT) is a relevant diagnostic tool in the evaluation of corneal changes following corneal crosslinking (CXL) treatment in patients infected by a severe fungal corneal infection.Methods Two patients with severe fungal keratitis that was unresponsive to medical treatment were treated with CXL. Corneal melting was present in all cases. Anterior segment OCT showed the preoperative depth and extension of the infiltrate and the modification during the follow-up.Results Blockage of the melting was achieved in one patient and one patient developed a corneal perforation. Anterior segment OCT allowed control of the evolution of fungal infection and evaluation of the corneal tissue response to the CXL. It is also able to identify the extent and depth of the inflammation. This parameter seems more important than corneal pachymetry to ensure the safety of CXL procedures in infectious keratitis.Conclusions The different behavior of inflamed tissue with respect to UVA irradiance could be the main point to understand the different postoperative outcome.

PURPOSE:To describe the corneal appearance on confocal microscopy after AcuFocus KAMRA Inlay (AcuFocus, Inc., Irvine, CA) implantation and evaluate the visual acuity compared to the confocal microscopy data.METHODS:Twelve eyes of 12 patients implanted with one of three models of the AcuFocus KAMRA Inlay (ACI 7000, 7000T, and 7000PDT) were prospectively evaluated by confocal microscopy 6 months after implantation. Additionally, 4 eyes of 4 patients explanted during the follow-up period were evaluated.RESULTS:Among the eyes implanted, mean epithelial thickness was 54.6 ± 22 Among the eyes implanted, mean epithelial thickness was 54.6 ± 22 μm. The subbasal nerve plexus was detected in 10 patients. The corneal nerves per unit area were 2.73 ± 2.1 sprouts/mm2. The branch pattern was found in 8 patients. The mean keratocyte density value was 540 ± 210 cells/mm2. A low grade of keratocyte activation was found in all patients. Among the eyes explanted, the mean wound healing opacity was 1,092.75 ± 1,877.35 μm/pixel.CONCLUSIONS:The corneal tolerance to the KAMRA Inlay appeared to be good. The inlay modified the normal structure of the corneal layer, but it was not associated with severe complications of the eye. Keratocyte activation was the finding most associated with a negative visual outcome. Confocal microscopy can be useful to evaluate the long-term evolution of the corneal layer changes following KAMRA Inlay implantation.[[J Refract Surg.2014;30(3):172–178.]

IMPORTANCE This study confirmed the long-term outcomes of the ZB5M phakic intraocular lens (PIOL). OBJECTIVE To evaluate the potential long-term risk associated with ZB5M PIOL implantation. DESIGN, SETTING, AND PARTICIPANTS A retrospective, nonrandomized, consecutive cohort study of a total of 208 eyes implanted with ZB5M PIOLs at VISSUM Corporación Oftalmológica de Alicante between 1990 and 1996 identified through surgical records (208 eyes of 123 patients); 50 of these patients (97 eyes) had available records and follow-up. INTERVENTION ZB5M PIOL implantation. MAIN OUTCOMES AND MEASURES To evaluate the incidence and onset of each complication during the follow-up and risk factors and causes for loss of visual acuity. RESULTS Mean (SD) preoperative spherical equivalent refraction was −19.36 (6.7) diopters and at the end of follow-up, it was −1.4 (2.6) diopters. Mean (SD) best-corrected visual acuity at the preoperative visit was 0.35 (0.2) decimal and at the end of follow-up, 0.56 (0.3) decimal. Mean (SD) endothelial cell density preoperatively and at the end of follow-up was 2783 (787) cells/mm2 and 1921 (672) cells/mm2, respectively. The incidence of cataract during the follow-up was 0.010 eye-year (EY); cornea decompensation, 0.001 EY; ocular hypertension, 0.008 EY; pupil ovalization, 0.020 EY; uveitis, 0.001 EY; and retinal detachment, 0.002 EY. CONCLUSIONS AND RELEVANCE To our knowledge, this is the first study that describes the long-term outcomes and complications of ZB5M PIOLs and suggests increasing the postoperative follow-up examinations in patients older than 40 years, analyzing anterior chamber modifications, and recommends PIOL explantation in cases of an increase in the crystalline size.

PURPOSE:To evaluate the safety of the corneal inlay removal procedure and the reversibility of visual acuities, corneal topography, and corneal biomicroscopy changes in a series of cases.METHODS:Ten cases implanted with one of three versions of the AcuFocus Kamra Inlay (ACI 7000, 7000T, and 7000PDT; AcuFocus, Inc., Irvine, CA) were followed for a minimum of 6 months after corneal inlay removal.RESULTS:The reason for removal was related to subjective dissatisfaction with visual symptoms (8 of 10 patients) such as night glare, photophobia, starburst, blurry vision, and halos. One case of removal was related to inadvertent thin flap and the final case was related to insufficient near vision. Mean uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) was 0 ± 0.1 logMAR (Snellen 20/20) and 0.5 ± 0.2 logMAR (Snellen 20/40), respectively, preoperatively and 0.1 ± 0.1 logMAR (Snellen 20/25) and 0.5 ± 0.1 logMAR (Snellen 20/63), respectively, 6 months after corneal inlay removal. Mean corrected distance visual acuity (CDVA) and corrected near visual acuity (CNVA) was 0 ± 0.1 logMAR (Snellen 20/20) and 0 ± 0.1 logMAR (Snellen 20/20), respectively, preoperatively and 0 ± 0.1 logMAR (Snellen 20/20) and 0.1 ± 0.1 logMAR (Snellen 20/25), respectively, 6 months after corneal inlay removal. Mean root mean square (RMS) higher-order aberration (HOA) was 0.50 ± 0.12 (range: 0.30 to 0.70) preoperatively and 0.69 ± 0.14 (range: 0.48 to 0.95) 6 months after corneal inlay removal (The reason for removal was related to subjective dissatisfaction with visual symptoms (8 of 10 patients) such as night glare, photophobia, starburst, blurry vision, and halos. One case of removal was related to inadvertent thin flap and the final case was related to insufficient near vision. Mean uncorrected distance visual acuity (UDVA) and uncorrected near visual acuity (UNVA) was 0 ± 0.1 logMAR (Snellen 20/20) and 0.5 ± 0.2 logMAR (Snellen 20/40), respectively, preoperatively and 0.1 ± 0.1 logMAR (Snellen 20/25) and 0.5 ± 0.1 logMAR (Snellen 20/63), respectively, 6 months after corneal inlay removal. Mean corrected distance visual acuity (CDVA) and corrected near visual acuity (CNVA) was 0 ± 0.1 logMAR (Snellen 20/20) and 0 ± 0.1 logMAR (Snellen 20/20), respectively, preoperatively and 0 ± 0.1 logMAR (Snellen 20/20) and 0.1 ± 0.1 logMAR (Snellen 20/25), respectively, 6 months after corneal inlay removal. Mean root mean square (RMS) higher-order aberration (HOA) was 0.50 ± 0.12 (range: 0.30 to 0.70) preoperatively and 0.69 ± 0.14 (range: 0.48 to 0.95) 6 months after corneal inlay removal (P< .8). Weak positive correlation was found between Δt Implant-Removal (Δt I-R), RMS spherical, coma, and HOA at 6 months (Δt I-R vs RMS spherical was r = 0.2, r2= 0.5, P< .7; Δt I-R vs RMS coma was r = 0.8, r2= 0.6, P< .3; and Δt I-R vs HOA r = 0.8; r2= 0.6, P< .9).CONCLUSION:This study suggests that after removal of the corneal inlay, corneal topography and corneal aberrometry are not permanently affected. In more than 60% of patients, CNVA, CDVA, UNVA, and UDVA were similar to the preoperative value.[[J Refract Surg.2013;29(8):550–556.]