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We propose a fully-automatic deep learning-based algorithm for segmentation of ocular structures and microbial keratitis (MK) biomarkers on slit-lamp photography (SLP) images. The dataset consisted of SLP images from 133 eyes with manual annotations by a physician, P1. A modified region-based convolutional neural network, SLIT-Net, was developed and trained using P1’s annotations to identify and segment four pathological regions of interest (ROIs) on diffuse white light images (stromal infiltrate (SI), hypopyon, white blood cell (WBC) border, corneal edema border), one pathological ROI on diffuse blue light images (epithelial defect (ED)), and two non-pathological ROIs on all images (corneal limbus, light reflexes). To assess inter-reader variability, 75 eyes were manually annotated for pathological ROIs by a second physician, P2. Performance was evaluated using the Dice similarity coefficient (DSC) and Hausdorff distance (HD). Using seven-fold cross-validation, the DSC of the algorithm (as compared to P1) for all ROIs was good (range: 0.62 – 0.95) on all 133 eyes. For the subset of 75 eyes with manual annotations by P2, the DSC for pathological ROIs ranged from 0.69 – 0.85 (SLIT-Net) vs. 0.37 – 0.92 (P2). DSCs for SLIT-Net were not significantly different than P2 for segmenting hypopyons (p > 0.05) and higher than P2 for WBCs (p < 0.001) and edema (p < 0.001). DSCs were higher for P2 for segmenting SIs (p < 0.001) and EDs (p < 0.001). HDs were lower for P2 for segmenting SIs (p = 0.005) and EDs (p < 0.001) and not significantly different for hypopyons (p > 0.05), WBCs (p > 0.05), and edema (p > 0.05). This prototype fully-automatic algorithm to segment MK biomarkers on SLP images performed to expectations on an exploratory dataset and holds promise for quantification of corneal physiology and pathology.

Purpose To evaluate the recipient factors associated with graft detachment in the subsequent eye of patients who underwent sequential Descemet membrane endothelial keratoplasty (DMEK). Methods A retrospective, consecutive case series with 158 eyes of 79 patients who underwent DMEK surgeries in both eyes between October 2013 and April 2019 for treatment of Fuchs endothelial dystrophy. The main outcome measure was the presence of graft detachment (any amount of detachment) at postoperative 1 week in the subsequent eye. Preoperative, intraoperative, and postoperative factors were evaluated for association with graft detachment. Results Of 79 patients (158 eyes) with a mean follow-up of 11.7 ± 8.4 months, 18 patients (36 eyes) developed graft detachment in both eyes 1 week postoperatively. The risk of detachment in the subsequent eye was increased when the first eye had any amount of detachment [odds ratio = 2.8; 95% confidence interval (CI) = 1.1-7.3; P = 0.037]. When the first eye had a clinically significant detachment (>30% detached), the risk of detachment occurring in the subsequent eye was greater (odds ratio = 15.7; 95% CI = 1.8-134.5; P = 0.012). This risk of graft detachment in the subsequent eye increased 33% for every 5% increase in the detachment percentage in the first eye (odds ratio = 1.3; 95% CI = 1.1-1.6; P = 0.008). Conclusions The presence of graft detachment after DMEK increases the risk of graft detachment in subsequent DMEK in the contralateral eye. Modification in perioperative care and surgical technique in the contralateral eye, such as a larger gas bubble, use of SF6 20%, and combining cataract surgery, may be needed when graft detachment occurs after DMEK in the first eye.

Purpose of review As keratoconus is a chronic disease affecting young people, vision-related quality of life is often significantly impaired in patients with this disease. However, successful management of keratoconus, including visual rehabilitation strategies, can improve quality of life in these patients. This review will describe clinical approaches that improve vision-related quality of life in patients with stable keratoconus. Recent findings Several types of contact lenses including scleral lenses have been used successfully to manage keratoconus. Eyes with severe keratoconus, even those in which fitting with other types of lenses is challenging, can be successfully fitted with scleral lenses. Although laser ablative procedures, such as photorefractive keratectomy (PRK) have been traditionally contraindicated in patients diagnosed with or suspected of having keratoconus, PRK has been attempted to partially correct refractive errors in keratoconus. Although phototherapeutic keratectomy and radial keratotomy have been reported to be used in eyes with keratoconus, effectiveness and safety results have varied. Implantation of phakic intraocular lenses and intraocular lenses, including toric intraocular lenses, which primarily correct regular astigmatism, with cataract extraction or refractive lens exchange can improve vision-related quality of life in patients with keratoconus by significantly reducing cylinder while improving uncorrected visual acuity. Summary Appropriate selection and application of treatment options based on consideration of multiple factors will help patients with keratoconus, improving their vision-related quality of life and delaying or avoiding keratoplasty.

Purpose To evaluate visual outcome and patient satisfaction following implantation of multifocal intraocular lenses (IOLs) with a +1.5 diopters (D) addition compared with monofocal IOLs. Methods This prospective, nonrandomized, comparative case series involved 48 eyes (24 patients) who underwent cataract surgery with implantation of low-power-added multifocal IOLs (LS313-MF15; multifocal group) and 48 eyes (24 patients) with conventional monofocal IOLs (CTS204; monofocal group). Visual acuity (VA), defocus curves, refraction, contrast sensitivity, glare, ocular optical quality, and scores in questionnaire were assessed 6 months postoperatively. Results Uncorrected VA at intermediate and near distance tended to be better in the multifocal group, with significant differences at 50 cm (P=0.03). The defocus curve showed significantly different VA at vergences of -1.5 and -2.0 D (P=0.02 and P=0.03, respectively). Results of postoperative refraction, contrast sensitivity, glare, and optical quality were similar (P>0.05), although coma-like aberration was higher in the multifocal group (P=0.04). Despite of similar levels of visual disturbances (P>0.05), disturbances in activities and spectacle use at intermediate working distance were significantly less frequent in the multifocal group (P=0.03 and P=0.04, respectively). Multifocal group showed significantly greater overall satisfaction (P=0.02). Conclusions Low-power-added multifocal IOLs yielded better intermediate and near vision without increasing optical phenomena compared with monofocal IOLs.

Purpose To assess variability in corneal ulcer measurements between ophthalmologists and reduce clinician-dependent variability using semiautomated segmentation of the ulcer from photographs. Methods Three ophthalmologists measured 50 patients' eyes for epithelial defects (EDs) and the stromal infiltrate (SI) size using slit-lamp (SL) calipers. SL photographs were obtained. An algorithm was developed for semiautomatic segmenting of the ED and SI in the photographs. Semiautomatic segmentation was repeated 3 times by different users (2 ophthalmologists and 1 trainee). Clinically significant variability was assessed with intraclass correlation coefficients (ICCs) and the percentage of pairwise measurements differing by ≥0.5 mm. Semiautomatic segmentation measurements were compared with manual delineation of the image by a corneal specialist (gold standard) using Dice similarity coefficients. Results Ophthalmologists' reliability in measurements by SL calipers had an ICC from 0.84 to 0.88 between examiners. Measurements by semiautomatic segmentation had an ICC from 0.96 to 0.98. SL measures of ulcers by clinical versus semiautomatic segmentation measures differed by ≥0.5 mm in 24% to 38% versus 8% to 28% (ED height); 30% to 52% versus 12% to 34% (ED width); 26% to 38% versus 10% to 32% (SI height); and 38% to 58% versus 14% to 34% (SI width), respectively. Average Dice similarity coefficients between manual and repeated semiautomatic segmentation ranged from 0.83 to 0.86 for the ED and 0.78 to 0.83 for the SI. Conclusions Variability exists when measuring corneal ulcers, even among ophthalmologists. Photography and computerized methods for quantifying the ulcer size could reduce variability while remaining accurate and impact quantitative measurement endpoints.

To report results of multifocal intraocular lens (IOL) implantation in 2 patients with refractive error and presbyopia after previous radial keratotomy (RK). A refractive multifocal IOL with rotational asymmetry (LS313-MF30; Oculentis, Berlin, Germany) was implanted. The first patient was a 60-year-old man with myopia who underwent unilateral RK 20 years before. His uncorrected distance visual acuity (UDVA) was 20/400, and his distance corrected near vision was J9 in both eyes. Six months after bilateral surgery, his binocular UDVA and uncorrected near visual acuity (UNVA) improved to 20/20 and J1, respectively, although he experienced diurnal fluctuation. The second patient was a 55-year-old woman with hyperopia who underwent bilateral RK 18 years before. Uncorrected distance visual acuity was 20/25 in both eyes, but UNVA was between J9 and J10. Three months after unilateral surgery, UDVA and UNVA of the postsurgical eye improved to 20/20 and J1, respectively. Neither patient reported any significant photic phenomena, and both were satisfied with the results of treatment. The desirable clinical outcomes and levels of satisfaction expressed by these patients indicate that surgery using this particular multifocal IOL may benefit presbyopic patients with previous RK. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially.

A state of limbal stem cell deficiency (LSCD) can be secondary to a number of etiologies, resulting in either a reduction in the total number of limbal stem cells or an abnormality in stem cell function. Initially, the epithelium becomes irregular and hazy; however, this condition may progress to persistent corneal epithelial defects, stromal scarring, ulceration, and even perforation. Since LSCD secondary to a variety of etiologies may be reversible, and various factors are prognostic of disease progression, timely diagnosis is important. This review will describe current knowledge of diagnostic techniques for LSCD and understanding of epithelial stem cell function.Conjunctivalization, regarded as the most reliable clinical finding diagnostically, can be identified as late staining of epithelium with fluorescein. While identifying loss of the palisades of Vogt by slit-lamp examination, can provide a high suspicion of LSCD, but this is not diagnostic. Impression cytology is a simple, noninvasive technique that aids in the diagnosis of LSCD, but a negative result also cannot rule out the diagnosis. Recent findings have also shown that imaging techniques including in-vivo confocal microscope and optical coherent tomography can also aid in diagnosing LSCD; however, several challenges remain before these techniques become standard diagnostic methods in clinical practice. Meanwhile, determination of the absence of limbal epithelial crypts and focal stromal projections using image reconstruction techniques may assist in the diagnosis of LSCD. Furthermore, histologic markers may help not only to improve sensitivity and specificity of conventional techniques in diagnosis of LSCD, but also to identify human limbal stem cells and determine their number and function in LSCD.Efforts to develop and improve techniques for diagnosing LSCD are ongoing. Increased knowledge of limbal stem cells and components of their niches may not only help in understanding the pathogenesis of LSCD but may improve its diagnosis, thereby ameliorating the prognosis of patients with this devastating disease.

OBJECTIVES To evaluate the clinical outcomes of patients with limbal stem cell deficiency (LSCD) who were fitted with the Prosthetic Replacement of the Ocular Surface Ecosystem (PROSE) scleral device. METHODS In this retrospective, interventional case series, we reviewed the charts of 31 eyes of 19 consecutive patients clinically diagnosed with LSCD who were evaluated for the PROSE device. Clinical data were reviewed before PROSE evaluation and at the last available follow-up. The main outcomes measures were best-corrected distance visual acuity (CDVA) and modified ocular involvement score (OIS), graded using a previously described system for corneal findings. RESULTS Corrected distance visual acuity improved from 0.86±0.50 logarithm of the minimal angle of resolution (Snellen equivalent, 20/145) at baseline to 0.46±0.44 (Snellen equivalent, 20/58) with PROSE at the last follow-up (mean, 25.1±18.0 months; P

High myopia, generally defined as an axial length longer than 26.0 mm or myopia greater than −6.0 diopters (D), is a commonly encountered comorbidity in cataract patients. The prevalence of high myopia in the general population has been reported to range from 2 to 5 %, but it may be as high as 10–21 % especially in ethnic Asians and younger persons [1–5]. In addition, high myopia is strongly associated with increased rates of nuclear and posterior subcapsular cataract [6, 7].

Corneal diseases may limit surgical techniques during cataract surgery and may lead to undesirable surgical results. Furthermore, cataract surgery may contribute to the progression of preexisting corneal diseases [1]. Preoperative identification of corneal morbidity and appropriate perioperative management, including relevant surgical techniques, are essential for surgery to have optimal outcomes.

Posterior polar cataract is a large disc-shaped opacity resulting from persistent hyperplastic primary vitreous progress to degeneration of posterior subcapsular cortex and opacification. Mittendolf dot which is a remnant of a hyaloid vessel, on the posterior surface of the lens does not cause visual disturbance, however, can present thin lens capsular thickness which easily breaks during cataract surgery (Fig. 6.1).

Making a surgery plan in patients with cataract and glaucoma is important, because surgeons’ choice of surgeries affects longevity of patients’ vision. With the development of small incisional cataract surgery and antimetabolite therapy, the success of combined cataract and filtering surgery or cataract surgery alone has been improved a lot (Tables 5.1 and 5.2).

Lens dislocation is caused by trauma, hereditary, or spontaneous. If the patient has serious blunt injury to the operating eye, we have to be prepared for lens dislocation during surgery even if we cannot find any defect of zonules or displacement of crystalline lens.

Cataract formation is the most common complication of pars plana vitrectomy (PPV), with the incidence of new or progressive lens opacity after vitrectomy being as high as 80 % within 2 years [1, 2]. Patients with cataract after PPV are at a high risk of intraoperative and postoperative complications due to anatomical differences between the vitrectomized and unoperated ones. Several factors must be considered before, during and after surgery to achieve successful outcomes in these patients.

Improvements in instrumentation and surgical techniques have enhanced patient expectations for surgical outcomes. Presbyopia, which results from a loss of accommodation, is considered the main reason for dissatisfaction after conventional cataract surgery, and remains a significant challenge for ophthalmologists.

The incidence of intraocular lens (IOL) dislocation is increasing as with the changes in surgeons’ preference to newer IOL designs, introduction of soft IOLs and increased number of pseudophakic population in these years. Late decenteration is more frequently found in cases with uveitis cataract, pseudoexfoliation syndrome, and previous vitrectomy. Since capsule fibrosis and shrinkage is more prominent when silicon IOL material is used than other PMMA or acrylic material, I tried to find the difference in incidence of late IOL dislocation between IOLs made of different materials. Although we could not find the diffierence in the incidence between the eyes with different material, I believe it safer not to use IOLs inducing serious capsule contraction when weak zonules are noticed.

Eyes smaller than normal (axial length less than 20.5 mm) can be classified into two categories according to anterior chamber depth: those with microphthalmos (short anterior chamber depth) and those with high axial hyperopia (normal anterior chamber depth) [1]. Eyes with short anterior chamber depth and normal axial length are classified as having relative anterior microphthalmos (Fig. 13.1) [2]. Depending on the presence or absence of an accompanying anatomic malformation in the anterior or posterior segment of the eye, eyes with microphthalmos may be subdivided further into those with simple microphthalmos (or nanophthalmos) and complex microphthalmos [3]. In the latter, microphthalmos is accompanied by anatomic malformations, including chorioretinal colobomas, persistent hyperplastic primary vitreous, and retinal dysplasia [3]. Phacoemulsification of these eyes and implantation of intraocular lenses (IOLs) are challenging, with high risks of intraoperative and postoperative complications such as zonular dehiscence, severe uveitis, uveal effusion, cystoid macular edema and aqueous misdirection. Furthermore, the risk of complications increases in proportion to the reduction in axial length [4]. Recent developments in phacoemulsification and devices used for IOL implantation have overcome these challenges, resulting in satisfactory clinical outcomes [4–6].

Purpose An oral antineoplastic drug, S-1, is known to be more effective with less toxicity and fewer gastrointestinal side effects than the conventional intravenous 5-fluorouracil. We report a case of limbal stem cell deficiency that occurred in a patient receiving chemotherapy using S-1 alone for gastric cancer. Case Report A 65-year-old woman with symptoms of grittiness and epiphora in both eyes for several months was referred to the ophthalmology clinic. She had been receiving S-1 orally after total gastrectomy for advanced gastric cancer. Slit lamp examination revealed an irregular hazy corneal epithelium in both eyes that extended to the center of the cornea overlying the pupil and showed late staining with fluorescein dye. Palisades of Vogt at the superior limbus were absent in both eyes. Best-corrected distance vision was 20/50 in both eyes with all other structures of the anterior and posterior segment unremarkable including a patent lacrimal drainage system. There was no change in the corneal lesions of either eye despite 3 months of topical therapy. The lesions did resolve in 4 months after discontinuation of S-1 therapy owing to acute renal failure. Conclusions Early detection of this adverse reaction before significant visual loss through regular follow-up appears to be important in patients receiving S-1 therapy.

Background This case report describes a patient with chronic unilateral chemosis, likely due to treatment with amlodipine besylate. Case presentation A 52-year-old man visited the clinic with symptoms of foreign body sensation and puffiness in his right eye, which had persisted for 4 months. There were no other symptoms, such as itching and pain, in his right eye and no specific symptoms in his left eye. He had been treated for hypertension and hyperlipidemia for the previous 5 months with once daily amlodipine besylate/atorvastatin (Caduet) and candesartan cilexetil (Atacand). Examination revealed marked swelling of the inferior bulbar conjunctiva in the right eye. Evaluation revealed no specific causes for the longstanding chemosis. A change of medication to telmisartan/hydrochlorothiazide (Micardis Plus) without amlodipine besylate resulted in significant improvements in his symptoms after 1 month and complete remission after 8 months. Conclusion Prior to invasive evaluation including biopsy, specific drugs should be considered as possible causes of idiopathic longstanding conjunctival chemosis.

Excavated optic disk anomalies, such as morning glory disk anomaly, peripapillary staphyloma, and optic disk coloboma, are rare. 1 Contractile movement of a given lesion is even rarer. Only 4 patients with morning glory disk anomalies accompanied by contractile movement have been reported. 2-5 We offer a computerized analysis of the contraction, observable on a video recording of a patient with this disorder, with an explanation of the possible pathogenesis of the disorder.

This was a report about a pseudophakic patient who experienced isolated total aniridia without damage to other intraocular structures following blunt trauma to the eye. This patient had a history of uneventful cataract surgery using a small clear corneal incision (CCI). This 71-year-old male presented at our clinic with glare in his left eye. He reported that he had fallen down while drunk and struck his left eye against a stone on the road 15 days earlier. He had undergone cataract surgery on his left eye nine months before the accident at another eye clinic. Slit-lamp examination showed total aniridia in his left eye, but there was no hyphema or cells in the anterior chamber. The intraocular lens in his left eye was stable, without decentration, dislocation, or zonular dehiscence and remained in an intact capsular bag. Review of the medical records from the surgical clinic at which he had undergone cataract surgery indicated no specific findings for any intraocular structure including the iris. He had previously undergone an uneventful phacoemulsification for his left eye through a 2.2 mm CCI, followed by the implantation of a single piece acrylic intraocular lens inside an intact capsular bag. This report showed that small-sized CCIs can be opened postoperatively by trauma and that this can result in isolated total aniridia without damage to other intraocular structures.

Purpose To evaluate the amount of intraocular lens (IOL) decentration and refractive changes after cataract surgery using posterior continuous curvilinear capsulorrhexis (PCCC). Design Prospective comparative case series. Participants We included 86 eyes of 77 patients who had cataract surgery using PCCC (the PCCC group), and 79 eyes of 68 patients treated without PCCC (the control group). Methods Foldable IOLs with polymethylmethacrylate haptics (VA-60BB, Hoya Corporation, Tokyo, Japan) were implanted in both groups. The best-corrected visual acuity (BCVA) was assessed. Automated refractokeratometry, Scheimpflug imaging (Pentacam; Oculus, Wetzlar, Germany), and slit-lamp photography with retroillumination were performed at each follow-up visit over 6 months. The axial shift of each IOL was measured as the distance between the corneal endothelium and the anterior surface of the IOL on Scheimpflug images. The horizontal shift was assessed as the distance between the geometric center of the IOL and the centers of the pupil and the limbus. Main Outcome Measures Best-corrected visual acuity, horizontal and axial shift of the IOL, and automated refraction. Results There was no difference between the 2 groups in the mean BCVA before surgery and at any postoperative follow-up. The mean horizontal shift of the IOL after 6 months was 0.25±0.14 mm for the pupil and 0.31±0.17 mm for the limbus in the PCCC group ( P = 0.315), and 0.26±0.09 mm and 0.31±0.13 mm, respectively, in the control group ( P = 0.115). These were not different from the measurement on the postoperative day 1 ( P = 0.515, P = 0.263, P = 0.421, and P = 0.875, respectively). At each follow-up visit over 6 months, there was no difference in the horizontal shift between the 2 groups ( P >0.05). The IOL shifted insignificantly in the PCCC group (−0.08±0.24 mm anterior shift), but the shift was significant in the control group (−0.42±0.27 mm anterior shift; P = 0.009). The mean postoperative refractive shift 6 months after surgery compared with refraction on the first day after surgery was −0.16±0.67 diopter (D) in the PCCC group and −0.60±0.70 D in the control group ( P = 0.042). Conclusions During cataract surgery, PCCC is useful to stabilize and minimize postoperative refractive changes. The IOL displacement attributable to capsular contraction is less when cataract surgery involves PCCC. Financial Disclosure(s) The authors have no proprietary or commercial interest in any of the materials discussed in this article.

Purpose To compare the efficacy and safety of iris fixation with scleral fixation in surgical repositioning of dislocated intraocular lenses (IOLs). Design Retrospective, consecutive, comparative interventional case series. Methods setting: Referral hospital. study population: Seventy-eight consecutive patients who underwent surgical repositioning of dislocated intraocular lenses using suturing to the sclera or iris. intervention: Forty-four eyes of 44 patients underwent scleral fixation and 35 eyes of 34 patients underwent iris fixation of dislocated intraocular lenses. main outcome measures: Visual acuity, refractive stability, operation time, and perioperative complications, including recurrence of IOL dislocation. Results Corrected distance visual acuity (CDVA) improved significantly 1 month postoperatively in both groups ( P P = .040) but not in the iris fixation ( P = .058) group. The amount of refractive error significantly diminished 1 day after surgery ( P = .028 in the scleral fixation and P = .046 in the iris fixation group). For the astigmatic components, Jackson crossed cylinders equivalent to conventional cylinders of positive power at axes of 0 degrees ( J0 ) and 45 degrees ( J45 ), J45 differed significantly in the scleral fixation and iris fixation groups ( P = .009), whereas J0 was similar ( P > .05). Operation time was significantly shorter ( P = .0007), while immediate postoperative inflammation was significantly more severe ( P = .001), in the iris fixation than in the scleral fixation group. Recurrence rates were similar ( P > .05), but the mean time to recurrence was significantly shorter in the iris fixation than in the scleral fixation group ( P = .031). Conclusions Iris fixation and scleral fixation techniques had similar efficacy in the repositioning of dislocated intraocular lenses. Although operation time was shorter for iris fixation, it had several disadvantages, including induced astigmatism, immediate postoperative inflammation, earlier recurrence, and less stable refraction.

Conjunctivochalasis is defined as redundant, loose, nonedematous, inferior bulbar conjunctiva interposed between the globe and the lower eyelid [1], occurring in patients with ocular irritation, epiphora, blurred vision, dry eye, and subconjunctival hemorrhage [1-3]. First-line treatments include topical preservative-free artificial tears, steroids, and antihistamines, with surgery as necessary if symptoms do not resolve. The primary surgical method consists of crescent-shaped resection and re-approximation of redundant inferior bulbar conjunctiva [1]; several studies have demonstrated the general efficacy of this method [2,4]. However, this approach has several limitations, resulting in the development of modified surgical techniques, including amniotic membrane graft transplantation [5,6], scleral fixation of the redundant conjunctiva with stitches [7], and superficial cauterization using bipolar devices [8]. More recently, a surgical approach using a high-frequency radiowave electrosurgical unit was described [9]. This method minimizes heat dissipation and resultant cellular alteration, reducing postoperative pain and scar formation and facilitating wound healing [10,11]. These authors reported that this electrosurgical system produced successful results in conjunctivochalasis, with a shorter operative time but comparable clinical outcomes to standard surgical methods. However, in practice, these investigators often encountered complaints of early postoperative pain in electrocauterized patients who had conjunctival epithelial defects in the electrocauterized area in the early postoperative days. We hypothesized that, despite good clinical outcomes, the high temperatures generated by the electrosurgical unit may induce greater than anticipated thermal damage in the subconjunctival tissue and overlying epithelial cells, inducing an inflammatory response. Therefore, we compared postoperative inflammation in an experimental conjunctivoplasty model utilizing high frequency radiowave electrocauterization with a procedure using simple excision and suturing.

Purpose: This retrospective observational case series of fifty-one consecutive patients referred to the eye clinic with acute-stage Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) from 1995 to 2011 examines the effect of early treatment with a systemic corticosteroid or intravenous immunoglobulin (IVIG) on the ocular outcomes in patients with SJS or TEN. Methods: All patients were classified by age (≤18 years vs. >18 years) and analyzed by treatment modality and early intervention with systemic corticosteroids (≤5 days), IVIG (≤6 days), or amniotic membrane graft transplantation (AMT) (≤15 days). The main outcomes were best-corrected visual acuity (BCVA) in logarithm of the minimum angle of resolution (logMAR) and ocular involvement scores (OIS, 0-12), which were calculated based on the presence of superficial punctate keratitis, epithelial defect, conjunctivalization, neovascularization, corneal opacity, keratinization, hyperemia, symblepharon, trichiasis, mucocutaneous junction involvement, meibomian gland involvement, and punctal damage. Results: The mean logMAR and OIS scores at the initial visit were not significantly different in the pediatric group (logMAR = 0.44, OIS = 2.76, n = 17) or the adult group (logMAR = 0.60, OIS = 2.21, n = 34). At the final follow-up, the logMAR and OIS had improved significantly in the adult group (p = 0.0002, p = 0.023, respectively), but not in the pediatric group. Early intervention with IVIG or corticosteroids significantly improved the mean BCVA and OIS in the adult group (p = 0.043 and p = 0.024, respectively for IVIG; p = 0.002 and p = 0.034, respectively for corticosteroid). AMT was found to be associated with a significantly improved BCVA or OIS in the late treatment group or the group with a better initial OIS (p = 0.043 and p = 0.043, respectively for BCVA; p = 0.042 and p = 0.041, respectively for OIS). Conclusions: Our findings suggest that patients with SJS or TEN who are aged 18 years or less have poorer ocular outcomes than older patients and that early treatment with steroid or immunoglobulin therapy improves ocular outcomes.

Purpose To compare the effect of using fibrin glue or 10-0 nylon sutures on the clinical outcome of patients undergoing pterygium excision and conjunctival autografting. Methods We retrospectively reviewed the medical records of 52 eyes from 46 patients who underwent pterygium excision and conjunctival autografting and were followed up for more than 3 months. The operation duration, postoperative inflammation, complications, and recurrence rates were compared between groups of 20 patients (22 eyes) for whom fibrin glue was used (fibrin glue group) and 26 patients (30 eyes) for whom suturing was performed with 10-0 nylon (suture group) in pterygium excision and conjunctival autografting. Results The operation duration was 27.71 (5.22) minutes in the fibrin glue group and 43.30 (8.18) minutes in the suture group (p = 0.000). Seven days after the operation, the fibrin glue group showed milder conjunctival inflammation than the suture group (p = 0.000). Postoperative complications and corneal recurrence rates were not statistically different between the two groups. Conclusions The use of fibrin glue in pterygium excision with conjunctival autografting is likely to be a more effective, safer procedure than suturing.

Purpose: To report a case of complete recovery within 1 day of cortical blindness associated with electroconvulsive therapy (ECT). Case summary: A 15-year-old girl, who had no ophthalmologic disease, complained of bilateral visual loss immediately after ECT. At the first ophthalmologic examination, best corrected visual acuity was 0.03 in both eyes. Findings of anterior segment and fundus, movement of external ocular muscles, and pupillary light reflex were normal. Visual field examination showed generalized reduction of sensitivity and increased fixation loss in both eyes. Optical coherence tomography revealed no abnormalities. Electroretinography was normal, and a slightly prolonged latency of P100 was noted in the right and left flash visual evoked potentials. Without any specific treatment, the patient's vision improved gradually after 18 hours of ECT and was recovered completely, with vision of 1.0 in both eyes the next day. There were no abnormalities in visual evoked potentials or the visual field. Conclusions: Transient visual loss can occur after ECT, because of cortical blindness by transient cerebral ischemia, and can be recovered completely without specific treatment.