Eric Donnenfeld

Laser in situ keratomileusis for correction of myopia and astigmatism after penetrating keratoplasty.

PURPOSEnTo determine the safety and effectiveness of laser in situ keratomileusis (LASIK) for visual rehabilitation of residual myopia and astigmatism after penetrating keratoplasty.nnnDESIGNnProspective, noncomparative case series.nnnPARTICIPANTSnLASIK was performed on 23 eyes of 22 patients unable to wear glasses or contact lenses after penetrating keratoplasty due to anisometropia, high astigmatism, and/or contact lens-intolerance.nnnMETHODSnAll patients underwent LASIK for visual rehabilitation after penetrating keratoplasty. Uncorrected visual acuity and best spectacle-corrected visual acuity, degree of anisometropia, and corneal transplant integrity were recorded before surgery, as well as at 1 month, 3 months, 6 months, and 12 months after LASIK surgery.nnnRESULTSnThe mean spherical equivalent before surgery was -7.58+/-4.42 diopters (D), which was reduced to -1.09+/-2.01 D, -0.79+/-1.84 D, -0.77+/-1.25 D, and -1.57+/-1.20 D, respectively, at 1, 3, 6, and 12 months after LASIK. The mean cylinder before surgery was 3.64+/-1.72 D, which was reduced to 1.98+/-1.15 D, 1.64+/-1.14 D, 1.48+/-0.92 D, and 1.29+/-1.04 D, respectively, at 1, 3, 6, and 12 months after LASIK. Spherical equivalent anisometropia was reduced from a mean of 6.88+/-4.4 D to 1.42+/-1.05 D at the final examination. Best-corrected visual acuity remained the same or improved in 21 of 23 eyes and decreased by 1 and 3 lines in 2 patients. There were no surgical flap or corneal transplant complications.nnnCONCLUSIONSnLASIK is a viable treatment alternative for myopia and astigmatism after penetrating keratoplasty in patients who are contact lens-intolerant. LASIK is more effective in treating myopia than astigmatism after penetrating keratoplasty.

Topical cyclosporine A 0.5% as a possible new treatment for superior limbic keratoconjunctivitis

PURPOSEnTo report the early success of the use of topical cyclosporine A 0.5% drops to treat Theodores superior limbic keratoconjunctivitis (SLK).nnnDESIGNnA retrospective noncomparative case series.nnnPARTICIPANTSnFive patients diagnosed with SLK.nnnINTERVENTIONnAll five patients were treated with topical cyclosporine A 0.5% drops as primary or adjunctive therapy after treatment failure in some of prednisolone acetate 1% drops and topical silver nitrate 0.5% application. Topical cyclosporine A 0.5% drops were used four times a day in both eyes.nnnMAIN OUTCOME MEASURESnResolution of symptoms (foreign body sensation and irritation) and signs (rose bengal staining, tarsal papillary reaction, and injection).nnnRESULTSnAll five patients had long-term (6 months to 3 years) improvement of irritation and foreign body sensation, as well as improvement of injection and filamentary keratitis. Aside from burning on instillation, there were no complications related to this therapy.nnnCONCLUSIONSnTopical cyclosporine A 0.5% is helpful as primary or adjunctive therapy for SLK. It may also be used as a maintenance drug to prevent recurrence. Further study may delineate the specific role and treatment parameters for the use of topical cyclosporine A 0.5% in the treatment of SLK.

Microbial keratitis trends following refractive surgery: Results of the ASCRS infectious keratitis survey and comparisons with prior ASCRS surveys of infectious keratitis following keratorefractive procedures

&NA; In 2008, the American Society of Cataract and Refractive Surgery (ASCRS) surveyed its 9121 United States and international members to evaluate the changing trends and incidence, culture results, treatment, and visual outcomes of infectious keratitis following keratorefractive procedures worldwide. This paper presents and analyzes the results with comparisons to the data in surveys conducted in 2001 and 2004. Nineteen infections were reported by 14 surgeons who had performed an estimated 20u2009941 keratorefractive procedures, an incidence of 1 infection in every 1102 procedures. Sixteen cases presented in the first postoperative week, 1 case during the second week, 1 case between the second and fourth weeks, and 1 case at 1 month or later. The 16 cases that presented in the first week were diagnosed at initial presentation. The most common organism cultured was methicillin‐resistant Staphylococcus aureus (MRSA). Microbial keratitis following refractive surgery is an increasingly recognized sight‐threatening complication. Financial Disclosure: No author has a financial or proprietary interest in any material or method mentioned. Additional disclosures are found after the text.

An update on the use of ophthalmic ketorolac tromethamine 0.4

Ketorolac tromethamine 0.4% ophthalmic solution, a recent reformulation of the original ketorolac tromethamine 0.5% solution, is indicated for the reduction of ocular pain and burning/stinging following cataract and refractive surgery. Studies have demonstrated that ketorolac tromethamine 0.4% has equivalent efficacy to ketorolac tromethamine 0.5% in reducing postsurgical inflammation and controlling pain. Several studies have demonstrated that, as well as reducing pain and ocular inflammation, ketorolac tromethamine 0.4% effectively treats cystoid macular oedema, inhibits miosis and may prevent cystoid macular oedema when used both pre- and postoperatively. Ketorolac tromethamine 0.4% is a versatile agent and is effective when used as either monotherapy or as an adjunct therapy to steroids.

The Prospective Health Assessment of Cataract Patients’ Ocular Surface (PHACO) study: the effect of dry eye

Purpose To determine the incidence and severity of dry eye as determined by the International Task Force (ITF) scale in patients being screened for cataract surgery. Patients and methods This was a prospective, multi-center, observational study of 136 patients, at least 55 years of age, who were scheduled to undergo cataract surgery. The primary outcome measure was the incidence of dry eye as evaluated by grade on the ITF scale and secondary outcome measures include tear break-up time (TBUT), ocular surface disease index score, corneal staining with fluorescein, conjunctival staining with lissamine green, and a patient questionnaire to evaluate symptoms of dry eye. Results Mean patient age was 70.7 years. A total of 73.5% of patients were Caucasian and 50% were female. Almost 60% had never complained of a foreign body sensation; only 13% complained of a foreign body sensation half or most of the time. The majority of patients (62.9%) had a TBUT ≤5 seconds, 77% of eyes had positive corneal staining and 50% of the eyes had positive central corneal staining. Eighteen percent had Schirmer’s score with anesthesia ≤5 mm. Conclusion The incidence of dry eye in patients scheduled to undergo cataract surgery in a real-world setting is higher than anticipated.

Dexamethasone Intracameral Drug-Delivery Suspension for Inflammation Associated with Cataract Surgery: A Randomized, Placebo-Controlled, Phase III Trial

PURPOSEnTo evaluate the safety and efficacy of an anterior chamber intracameral dexamethasone drug-delivery suspension (IBI-10090; DEXYCU; Icon Bioscience Inc., Newark, CA) that provides medication for up to 21 days with a single application in treating postoperative inflammation in patients undergoing cataract surgery.nnnDESIGNnProspective, randomized, double-masked, multicenter trial.nnnPARTICIPANTSnPatients with preoperative best-corrected visual acuity of 20/30 to 20/200 undergoing unilateral cataract surgery by phacoemulsification were randomized to receive IBI-10090 or placebo.nnnMETHODSnThree hundred ninety-four patients were randomized 1:2:2 to receive 5-μl injections of placebo or 5-μl injections of 342 or 517 μg IBI-10090 dexamethasone drug delivery suspension injected into the anterior chamber at the conclusion of cataract surgery. Patients were followed for 90 days after surgery.nnnMAIN OUTCOME MEASURESnPrimary outcome was anterior chamber cell (ACC) clearing (ACC score of 0) in the study eye at postoperative day (POD) 8. Secondary outcome measures were anterior chamber flare and ACC plus flare clearing in the study eye. Ocular and nonocular adverse events were assessed.nnnRESULTSnAnterior chamber cell clearing at POD 8 was achieved in 25.0% of eyes in the placebo group and in 63.1% and 66.0% of eyes in the 342- and 517-μg treatment groups, respectively (P < 0.001). Anterior chamber flare clearing at POD 8 was achieved by 63.8% of eyes in the placebo group and in 92.4% and 89.1% of eyes in the 342- and 517-μg IBI-10090 treatment groups, respectively (P < 0.001). Anterior chamber cell plus flare clearing at POD 8 was achieved in 33.8% of eyes receiving placebo and in 63.1% and 67.3% of eyes receiving 342- and 517-μg IBI-10090, respectively (P < 0.001). Adverse events among the 3 groups were similar, and no serious ocular adverse events were reported up to PODxa090.nnnCONCLUSIONSnThe IBI-10090 dexamethasone drug-delivery suspension placed in the anterior chamber after cataract surgery at concentrations of 342 and 517 μg was safe and effective in treating inflammation occurring after cataract surgery and may be an alternative to corticosteroid drop installation in this patient population.

Visual and keratometric outcomes of keratoconus patients after sequential corneal crosslinking and topography-guided surface ablation: Early United States experience

PURPOSEnTo evaluate a sequential treatment algorithm for visual and keratometric improvement in keratoconus patients after corneal crosslinking (CXL) followed by topography-guided photorefractive keratectomy (PRK).nnnSETTINGnOphthalmic Consultants of Long Island, Garden City, New York, USA.nnnDESIGNnRetrospective case series.nnnMETHODSnThis study reviewed patients with keratoconus who had CXL followed by custom topography-guided PRK between April 2016 and December 2016. The following data were collected at baseline, the time of CXL, and 3xa0months and 6xa0months after PRK: uncorrected (UDVA) and corrected (CDVA) distance visual acuities, keratometric astigmatism, spherical equivalent, maximum and mean keratometry readings, and corneal thickness at the cone apex. Demographic data, age at time of CXL and PRK, and time elapsed between CXL and PRK were analyzed for significance and a correlation with visual and astigmatic outcomes.nnnRESULTSnThe study comprised 56 patients (62 eyes), 34 who had both topographic and refractive treatment and 28 patients who had treatment of topographic irregularities only. The mean age was 38.08xa0yearsxa0±xa013.07 (SD) at CXL and 40.33xa0±xa013.44xa0years at topography-guided PRK. Six months after PRK, there was a significant improvement in UDVA and CDVA in the refractive group (20/60 and 20/30, respectively) versus the nonrefractive group (20/100 and 20/40, respectively). Ninety-three percent of eyes that had refractive treatment had 20/40 or better CDVA. There were no significant adverse events in any case.nnnCONCLUSIONSnThe data support the use of refractive treatment in addition to topographic treatment for visual improvement in patients with keratoconus having CXL and PRK.

Randomized prospective evaluation of the wound integrity of primary clear corneal incisions made with a femtosecond laser versus a manual keratome

PURPOSEnTo compare the wound integrity of femtosecond laser-assisted 110-degree reverse side-cut clear corneal incisions (CCIs) with femtosecond laser-assisted 70-degree forward side-cut and manual CCIs in patients having cataract surgery.nnnSETTINGnIsland Eye Surgicenter, Carle Place, New York, USA.nnnDESIGNnProspective case series.nnnMETHODSnPatients having cataract surgery were randomized into 3 treatment groups as follows: Group A had 110-degree femtosecond reverse side-cut CCIs, Group B had 70-degree femtosecond forward side-cut CCIs, Group C had manual CCIs. At the conclusion of surgery, the integrity of the CCI was measured by raising intraocular pressure (IOP) until the CCI began to leak. Postoperatively, the CCIs were assessed for wound leakage at 1xa0day, 2xa0weeks, and 1xa0month.nnnRESULTSnThe study comprised 45 patients (45 eyes, 15 in each treatment group). The mean IOP at which CCIs leaked (in response to anterior chamber balanced salt solution irrigation) was statistically significantly higher in Group A (28.20xa0mm Hgxa0±xa011.69 [SD]) than in Group B (15.07xa0±xa010.64xa0mm Hg; Pxa0=xa0.005) and Group C (9.93xa0±xa09.90xa0mm Hg; Pxa0<xa0.001). At 1xa0day postoperatively, the Seidel test with pressure showed no leakage in any of the Group A eyes; however, 53% of eyes in Group B and 87% in Group C showed wound leakage.nnnCONCLUSIONnThe femtosecond laser-created reverse side-cut CCIs required significantly higher IOP intraoperatively before leaking and resulted in better wound integrity with significantly less wound leakage postoperatively than laser-created forward side-cut or manual CCIs.

Safety of IBI-10090 for inflammation associated with cataract surgery: Phase 3 multicenter study

PURPOSEnTo compare the safety and efficacy of IBI-10090 anterior chamber intracameral dexamethasone drug-delivery suspension (Dexycu) with those of prednisolone acetate 1.0% ophthalmic drops in treating inflammation after cataract surgery.nnnSETTINGnEleven centers in the United States.nnnDESIGNnProspective randomized open-label multicenter trial.nnnMETHODSnPatients were randomized 2:1 to receive a 5xa0μL injection of 517xa0μg IBI-10090 in the anterior eye chamber or topical prednisolone 1.0% drops (1 drop 4 times daily for 3xa0weeks). The postoperative follow-up was 90xa0days. The primary outcome was safety, evaluated by the incidence and severity of adverse events. Exploratory measures were anterior chamber cell, anterior chamber flare, and anterior chamber cell-flare clearing.nnnRESULTSnOne hundred twenty-six IBI-10090 patients and 55 prednisolone patients were included in the safety analysis. Two serious adverse events unrelated to treatment were reported. The decrease in endothelial cell density was not significantly different between groups. The most common adverse events were increased intraocular pressure (11.1%), iritis (6.3%), and systemic (7.9% IBI-10090 group; 10.9% prednisolone group). By 8xa0days postoperatively, 51.6% of IBI-10090 eyes and 50.9% of prednisolone eyes had anterior chamber cell clearing; more than 98% of eyes had clearing at 90xa0days. The anterior chamber flare and anterior chamber cell-flare clearing results were similar. Of IBI-10090 patients, 68.7% strongly agreed that not having to use eyedrops was very convenient; 39.2% using prednisolone 1.0% strongly stated they would have preferred dropless therapy.nnnCONCLUSIONnThe safety and efficacy of IBI-10090 and prednisolone 1.0% were similar, with IBI-10090 preferred over drops.

Safety and tolerability of lifitegrast ophthalmic solution 5.0%: Pooled analysis of five randomized controlled trials in dry eye disease

Purpose: Characterize the safety and tolerability of lifitegrast ophthalmic solution 5.0% for the treatment of dry eye disease. Methods: Pooled data from five randomized controlled trials were analyzed. Key inclusion criteria were adults with dry eye disease (Schirmer tear test score ⩾1 and ⩽10u2009mm, eye dryness score ⩾40 (visual analog scale 0–100), corneal staining score ⩾2.0 (0–4 scale)). Participants were randomized to lifitegrast ophthalmic solution 5.0% or placebo twice daily for 84 or 360u2009days. Treatment-emergent adverse events and drop comfort scores were assessed. Results: Overall, 2464 participants (lifitegrast, nu2009=u20091287; placebo, nu2009=u20091177) were included. Ocular treatment-emergent adverse events occurring in >5% in either group were instillation site irritation (lifitegrast, 15.2%; placebo, 2.8%), instillation site reaction (lifitegrast, 12.3%; placebo, 2.3%), and instillation site pain (lifitegrast, 9.8%; placebo, 2.1%); the most common (>u20095%) nonocular treatment-emergent adverse event was dysgeusia (lifitegrast, 14.5%; placebo, 0.3%). The majority of treatment-emergent adverse events were mild to moderate in severity. Discontinuation due to treatment-emergent adverse events occurred in 7.0% (lifitegrast) versus 2.6% (placebo) of participants (ocular: 5.5% vs 1.5%; nonocular: 1.9% vs 1.1%). Drop comfort scores with lifitegrast improved within 3u2009min of instillation and the score at 3u2009min improved across visits (12-week trials (both eyes, day 84 vs 0): 2.0 vs 3.3; SONATA (day 360 vs 0): right eye, 1.2 vs 1.7; left eye, 1.2 vs 1.8). Conclusion: Lifitegrast ophthalmic solution 5.0% appeared to be safe and well tolerated for the treatment of dry eye disease. Drop comfort with lifitegrast improved within 3u2009min of instillation.