Cornea

Understanding of keratoconus and the resulting dramatic changes in management in recent years have given rise to treatment paradigms that would have been unrecognizable to ophthalmologists a generation ago. The new landscape features a wider range of treatment options, better diagnostic and monitoring tools, and better understanding of the underlying pathology of the disease.

A group of surgeons were faced with a suprachoroidal hemorrhage following trauma, and decided to break the ‘rules’ when tackling the case, and came out with surprisingly good results.

Findings of a retrospective case review show that eyes that underwent implantation of the Boston Type 1 keratoprosthesis had greater improvement in visual acuity than those undergoing repeat donor corneal transplantation.

The development of a bioengineered cornea may serve to provide corneas to the millions of people worldwide unable to obtain a human donor cornea.

Findings from a study undertaken at Dr Lovisolo’s practice indicate that in carefully-selected patients, a triple procedure, comprising Keraring implantation followed by accelerated CXL and topo-guided ablation can provide significant functional improvement in cases of progressive keratoconus.

An age-stratified analysis of endothelial cell count in diabetic and non-diabetic corneas found no statistically significant difference between the groups. Since diabetes may damage the inner layer of the cornea, other variables that affect cell health must also be evaluated.

Forward-looking research in drug delivery and therapies filled the sessions at this year’s meeting of the Association for Research in Vision and Ophthalmology.

Small incision lenticule extraction (SMILE), which has not yet been approved for refractive correction in the United States, may be less accurate and produce more irregular astigmatism than LASIK or PRK because of the imprecision resulting from the two incisions needed to create the lenticule. In addition, the technique for potential enhancements needs improvement. However, the treatment is promising and may stand the test of time as the technology advances.

Techniques for performing corneal collagen crosslink (CXL) are being evaluated and adapted, and at the same time, new applications are being developed.

Femtosecond lasers differ in their indications, energy delivery parameters, and hardware features. Understanding the implications of these factors will enable an objective assessment of the available technology.

Occasionally, post-cataract surgery endothelial cells don’t function well enough to keep the cornea clear, which can commonly cause corneal oedema. Here, Prof. Feinbaum describes a new treatment modality that has been designed to reduce and in most cases stop the oedema in 24–48 hours.

The FDA has approved AcuFocus’ corneal inlay product (KAMRA inlay.) The device is indicated to improve near vision by extending depth of focus in patients with presbyopia who have emmetropic refractions (+0.50 to –0.75 D).

Contrast sensitivity is a more valuable metric than many ophthalmologists realize, with applications in preoperative and postoperative management of corneal and refractive surgery patients and routine screening of patients’ quality of vision.

Keratoneuralgia, also known as “pain without stain” is primarily a clinical diagnosis made for patients with corneal pain symptoms with minimal-to-no clinical signs and minimally, if at all, relieved by conventional dry eye treatments.

Early experience with a new intrastromal corneal ring segment arc length appears to be a valuable addition to the keratoconus treatment armamentarium for one surgeon.

Endothelial keratoplasty makes it easier to follow patients with glaucoma and lowers the risk of ocular surface disease.

Immunomodulatory therapy for ocular inflammatory disease can be potent and effective, but physicians should be patient while awaiting results-and watch carefully for complications.

Autologous serum drops, amniotic membrane, and scleral lenses offer advanced options for management of persistent epithelial defects refractory to standard treatment modalities.

The rationale for epithelium-on crosslinking procedures is strong, and may ultimately make customized treatment of topographic abnormalities more attractive for therapeutic and refractive indications.

Results were encouraging from patients in a small study group receiving Bowman layer implantations to treat advanced keratoconus.

Premium IOLs can be used successfully in patients with corneal pathologies.

Peripheral melting disorders require surgical intervention when all else has failed and there is an impending risk of perforation. A peripheral C- or banana-shaped graft can restore tectonic integrity while maintaining a reasonable corneal contour to preserve vision.

The Steroids for Corneal Ulcers Trial allays some fears about using a topical corticosteroid as an adjunct to antibiotic treatment in eyes with a bacterial corneal ulcer.

Evidence for assessing the efficacy and safety of anti-vascular endothelial growth factor (VEGF) agents for treating corneal and ocular surface disease is accumulating. However, there is clearly a need for more research to define if, when, and how this therapy should be used, said Anat Galor, MD.

Pre-Descemet’s endothelial keratoplasty is a new corneal transplantation technique using a graft consisting of the pre-Descemet’s layer (Dua’s layer), Descemet’s membrane, and endothelium.

In the second of a two-part series, Arun C. Gulani, MD, reviews how to repair or prepare the cornea from any situation to present it for final corneal reshaping-straight to 20/20.

In vivo confocal microscopy has enormous potential to be used in a large number of physiological and pathological ocular conditions.

Procedure may increase near and intermediation vision without compromising stereopsis

There is no current justification for considering routine corneal crosslinking for primary prevention of postLASIK ectasia-considering the many unknowns about the efficacy and safety of combining procedures-relates one ophthalmologist.

Children and adolescents with keratoconus may have rapid progression between the ages of 8 and 19 years and immediate treatment with corneal crosslinking may stop that progression.