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Purpose: Evaluation of safety and efficacy of topical ocular SAF312 (Libvatrep) in post-photorefractive keratectomy (PRK) pain., Methods: In this placebo (vehicle)-controlled, participant- and investigator-masked study, 40 participants were randomized (1:1) to two treatment sequences in a bilateral PRK crossover design (SAF312 2.5% followed by vehicle [or vice versa], one eye drop, four times daily for 72 hours after PRK). Primary endpoints were visual analog scale (VAS) pain scores at 6 hours after first drop of study drug and average VAS scores over 0 to 12 hours postoperatively. Secondary endpoints included postoperative oral rescue medication (ORM) use and adverse events (AEs)., Results: All 40 participants completed the study. Both primary endpoints were met; mean difference in VAS pain scores between SAF312- and vehicle-treated eyes was -11.13 (P = 0.005, -25%) at 6 hours postoperatively and -8.56 (P = 0.017, -22%) over 0 to 12 hours. Mean VAS pain scores with SAF312 were consistently lower than with vehicle from 1 hour postoperatively up to 30 hours (P ≤ 0.10 observed in 8/11 time points). Less ORM was taken with SAF312 up to 0 to 72 hours postoperatively, with a trend of fewer participants taking ORM at 0 to 24 hours postoperatively with SAF312 versus vehicle. No serious AEs were reported. All ocular AEs were mild and transient, and none were drug related. SAF312-treated eyes showed no delay in wound healing and had a lower grade 4 conjunctival hyperemia 24 hours postoperatively versus vehicle-treated eyes., Conclusions: SAF312 was well tolerated and effective in reducing ocular pain post-PRK., Translational Relevance: Topical SAF312 presents a new therapeutic option for patients undergoing PRK.

Selective suture removal following corneal transplant surgery can facilitate the reduction of astigmatism. We present concepts concerning astigmatism analysis after keratoplasty related to suture compression by reviewing keratoscopy, slit-lamp biomicroscopy, and retinoscopy findings. Keratoscopy observations indicating tight sutures include peripheral indentation of the keratoscope rings, individual keratoscope ring images between tight sutures, and decentration of the corneal apex away from a tight suture. The utilization of the Van Loenen keratoscope at the slit-lamp in "dynamic keratoscopy" allows the surgeon to readily recognize these findings and also proves useful intraoperatively. Slit-lamp biomicroscope observations indicative of tight sutures include a doughnut of tissue compression, Kaye's epithelial white dots, and epithelial or endothelial stress lines. Retinoscopy observations demonstrate that tight sutures induce astigmatism with the narrowest side of the retinoscopy beam pointing directly toward the tightest suture. Astigmatism management plays a major role in the future success of ophthalmology and needs to be increasingly integrated into the practice of the general ophthalmologist.

We administered 4 g of azlocillin sodium intravenously to 24 patients scheduled to undergo elective intraocular surgery and collected specimens of serum, tears, and aqueous humor from zero to six hours after infusion for assay by high-pressure liquid chromatography. We found that azlocillin is distributed into tears and penetrates into the aqueous humor of human volunteers with noninflamed eyes after a single intravenous dose. Levels of 4.17 micrograms/ml and 4.44 micrograms/ml were achieved in tears and aqueous humor, respectively.