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Purpose: Establishing the reliability of a new method to check the mean retinal and choroidal reflectivity and using it to find retinal and choroid changes in amblyopia., Methods: Design: Retrospective case-control. Population: 28 subjects of which 10 were healthy controls (20 eyes): 8 with refractive errors, 1 with strabismus, and 1 with both. 18 patients with unilateral amblyopia included: 7 anisometropic, 6 isoametropic, 1 strabismic, and 4 combined. Mean participants' age: 13.77 years ± 10.28. Observation procedures: SD-OCT and ImageJ. Main outcome measure: mean reflectivity of retinal and choroid layers. Amblyopic, fellow, and healthy eyes were compared., Results: The method of measuring reflectivity is good to excellent reliability for all regions of interest except the fourth. The mean reflectivity of the choriocapillaris and Sattler's layer in amblyopic eyes were significantly lower than in healthy eyes (p = 0.003 and p = 0.008 respectively). The RNFL reflectivity was lower than that of fellow eyes (p = 0.025). Post-hoc pairwise comparisons showed statistically significant differences between amblyopic and healthy eyes for choriocapillaris (p = 0.018) and Sattler's (p = 0.035), and between amblyopic and fellow eyes for RNFL (p = 0.039)., Conclusion: A decrease in reflectivity of the choriocapillaris and Sattler's in amblyopic compared to healthy eyes, and a decrease in reflectivity of the RNFL in the amblyopic compared to fellow eyes, indicate that the pathophysiology is partly peripheral and might be bilateral., Competing Interests: The authors have declared that no competing interests exist.

Purpose: To evaluate the efficacy of simultaneous laser in situ keratomileusis (LASIK) and small-aperture corneal inlay (KAMRA; AcuFocus, Inc) implantation in hyperopic presbyopic eyes at 5 years postoperatively., Methods: This was a retrospective single-center study of patients with hyperopia and presbyopia who underwent simultaneous LASIK and corneal inlay implantation by two experienced refractive surgeons. These patients were regularly observed for 5 years and evaluated with serial corneal tomographies and refractive assessments for uncorrected near visual acuity (UNVA), uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), distance-corrected near visual acuity (DCNVA), and manifest refraction spherical equivalent (MRSE)., Results: Twenty-four eyes of 24 patients were included. Mean age was 53.63 ± 4.11 years (range: 47 to 63 years) and mean preoperative MRSE was +1.52 ± 0.64 diopters (D) (range: +0.50 to +3.00 D). UNVA was 0.04 ± 0.06 logMAR at 1 month and 0.02 ± 0.05 logMAR (J1+ equivalent) at 5 years postoperatively. In comparison, preoperative DCNVA was 0.44 ± 0.20 (J5/J6 equivalent) (P < .001). At 5 years postoperatively, UDVA was 0.16 ± 0.18 logMAR (20/30 Snellen equivalent), and 23 of 24 eyes (95.8%) had UNVA of J3 or better. Two eyes (8.3%) lost one line of CDVA. One corneal inlay needed readjustment but none were explanted. Eight eyes (25%) developed regression in UNVA with hyperopic shift, which responded to a 3- to 4-month course of topical steroids, with 3 eyes showing patchy haze on the undersurface of the corneal inlay., Conclusions: Simultaneous LASIK and KAMRA inlay implantation, evaluated for 5 years postoperatively, shows some efficacy and predictability in improving UDVA and UNVA in hyperopic presbyopic eyes. However, late-onset regression with hyperopic shift, possible loss of CDVA, and occasional haze remain challenges. [J Refract Surg. 2020;36(8):498-505.]., (Copyright 2020, SLACK Incorporated.)

Objective: To report the 15-year trend in ophthalmic presentations to the emergency department (ED) at the only medical center in Lebanon that provides 24-hour ophthalmologic care., Methods: Retrospective review of 1967 patients presenting to the ED with eye-related complaints between September 1997 and August 1998 and between September 2012 and August 2013. Diagnoses were classified into 4 categories according to the International Society of Ocular Trauma and include penetrating eye injuries, nonpenetrating eye trauma, nontraumatic ophthalmic emergencies, and nontraumatic, nonurgent ophthalmic conditions., Results: One thousand sixty eye-related presentations out of 39,158 total ED visits (2.71%) presented in 1997 compared to 907 out of 46,363 in 2012 (1.96%). Penetrating and nonpenetrating eye emergencies decreased between 1997 and 2012 (7.17% to 4.19%, p = 0.003 and 52.64% to 29.00%, p < 0.001, resp.) while nonurgent cases increased from 30.19% to 53.47% ( p < 0.001). 57% of patients were covered by third-party guarantors in 1997 versus 73% in 2012., Conclusion: Our results demonstrate a significant increase in nonurgent cases in parallel with the proportion of third-party payers, an issue to be addressed by public health policies and proper resource allocation. A detailed nationwide review is needed to make solid recommendations for the management of ophthalmologic presentations in the ED.

Purpose: To evaluate the epithelial erosion incidence and refractive results in myopic eyes undergoing single-step transepithelial photorefractive keratectomy (TransPRK) compared with alcohol-assisted photorefractive keratectomy (PRK)., Methods: This was a retrospective nonrandomized comparative study conducted at the American University of Beirut Medical Center. A total of 189 eyes that had undergone single-step transepithelial PRK (TransPRK) were compared with 189 matched eyes that had undergone alcohol-assisted PRK over a follow-up of 1 year. The incidence and symptoms of epithelial erosion were evaluated in both treatment groups using a post hoc questionnaire administered to patients selected in the study. Visual and refractive outcomes, including vector analysis of astigmatism, and corneal higher-order aberrations were also compared at 1-year postoperatively., Results: Baseline characteristics were similar between 2 groups (P > 0.05). A slight difference was detected at 12-month follow-up in the refractive cylinder (P = 0.02) and difference vector (P = 0.01) between eyes that had undergone TransPRK versus alcohol-assisted PRK. All other visual and refractive outcomes were similar at 12-month follow-up between both groups. Of note, 9.9% of patients with alcohol-assisted PRK (10/101) reported to the clinic because of tearing and stabbing sensation within 1 week after contact lens removal as opposed to 1% (1/100) of the TransPRK group (P = 0.0097). Subclinical recurrent epithelial erosion symptoms occurred more frequently in alcohol-assisted PRK: soreness to touch, sharp pains, and eyelid sticking occurred in 26.0% versus 6.6%, 32.5% versus 7.9%, and 26.0% versus 6.6% among the patients who were treated with alcohol-assisted PRK versus those who were treated with TransPRK, respectively (P ≤ 0.002)., Conclusions: Single-step TransPRK for myopic eyes yields refractive results similar to those of alcohol-assisted PRK but shows a lesser incidence of early postoperative epithelial erosions and subsequent subclinical recurrent erosions.

Purpose: To assess central corneal thickness (CCT) and corneal haze in keratoconus eyes following corneal cross-linking (CXL)., Design: Prospective noncomparative case series., Methods: Forty patients (44 eyes) with keratoconus that had serial evaluation for CCT, following CXL, using high-definition optical coherence tomography (HD-OCT), ultrasound pachymetry (USP), and dual Scheimpflug tomography. CCT was measured at baseline, then at 2 weeks and 1, 3, 6, and 12 months postoperatively., Results: The mean baseline CCT measurements were 470.02 μm, 469.79 μm, and 466.66 μm using the HD-OCT, the USP, and dual Scheimpflug tomography, respectively (P = .91). Following CXL, the mean CCT measurements by dual Scheimpflug, at all follow-up periods, were lower compared to mean baseline reading (P < .003). The mean CCT measurements by the HD-OCT and USP were similar to baseline readings except for the thicker readings at the 2-week follow-up visit. Overall, the mean CCT obtained by the USP was similar to that obtained by the HD-OCT throughout the 12-month period. However, the mean CCT measurements obtained by dual Scheimpflug tomography were statistically and clinically significantly lower than those obtained by both HD-OCT and USP at all follow-up visits., Conclusions: USP and HD-OCT showed better agreement in CCT readings at all visits, and may better estimate the true CCT following CXL as compared to dual Scheimpflug tomography. The lower mean CCT post-CXL as measured by the latter seems to be correlated with the amount of haze that develops after cross-linking., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Great discrepancies are often encountered between the distance fixation and the near-fixation esodeviations and exodeviations. They are all attributed to either anomalies of the AC/A ratio or anomalies of the fusional convergence or divergence amplitudes. We report a case with pseudoconvergence insufficiency and another one with pseudoaccommodative convergence excess. In both cases, conv./div. excess and insufficiency were erroneously attributed to anomalies of the AC/A ratio or to anomalies of the fusional amplitudes. Our purpose is to show that numerous factors, other than anomalies in the AC/A ratio or anomalies in the fusional conv. or divergence amplitudes, can contaminate either the distance or the near deviations. This results in significant discrepancies between the distance and the near deviations despite a normal AC/A ratio and normal fusional amplitudes, leading to erroneous diagnoses and inappropriate treatment models.

Purpose. To discuss an unusual presentation of ocular toxocariasis. Methods. Case report. Results. A 40-year-old woman presented with decreased vision in the left eye with a long history of recurrent red eye from uveitis. Eosinophilia and positive ELISA titers for Toxocara canis favored the diagnosis of ocular toxocariasis. Over 3 months, an anterior scleral mass had a rapid growth raising the possibility of medulloepithelioma, which rarely can mimic uveitic syndromes. Surgical plan changed from local excision to enucleation. Histopathology demonstrated a large homogeneous mass of chronic inflammatory cells with inflammation of the overlying thinned out sclera, medial rectus insertion, and limbal cornea. The triad of peripheral granuloma, eosinophilia, and positive blood serology established the diagnosis of ocular toxocariasis. Conclusions. Ocular toxocariasis can mimic ocular malignancy such as medulloepithelioma in adults and rarely presents as an anterior scleral mass.