Eyeworld

In the journal Systemic supplemental oxygen therapy during accelerated corneal collagen crosslinking for progressive keratoconus: a randomized clinical trial Amir Faramarzi, MD, Kiana Hassanpour, MD, Baharan Rahmani, MD, Shahin Yazdani, MD, Bahareh Kheiri, MsC, Mohammad-Mehdi Sadoughi, MD The effect of systemic supplemental oxygen during accelerated corneal crosslinking for progressive keratoconus was evaluated in this random- ized clinical trial. Nineteen eyes in the OA-CXL group received systemic oxygen at 5 liters/minute for 10 minutes while undergoing acceler- ated crosslinking (9 mW/cm 2 for 10 minutes). Fourteen eyes had the same crosslinking protocol without the supplemental oxygen (A-CXL group). Fourteen eyes had the conventional Dresden crosslinking protocol (C-CXL group). Visual acuity, keratometry, corneal hysteresis, and corneal resistance factor were measured preop and at 6 months postop. The authors reported a greater K max reduction in the OA-CXL group compared to the other groups. The corneal resistance factor was increased significantly from baseline in the OA-CXL group. The investi- gators concluded that accelerated crosslinking is superior when coupled with supplemental oxygen compared to an accelerated protocol alone or the conventional protocol. Visual outcomes after cataract surgery: topical NSAID prophylaxis compared with prednisolone Neal Shorstein, MD, James Carolan, MD, Liyan Liu, MSc, Stacey Alexeeff, PhD, Laura Amsden, MSW, Lisa Herrinton, PhD Visual outcomes in patients without a history of macular edema fol- lowing cataract surgery using topical NSAIDs with prednisolone were compared with prednisolone use alone. The retrospective cohort study included data obtained from a Kaiser Permanente Northern Califor- nia EHR from June 1, 2010, through May 31, 2015; 42% of patients received topical prednisolone alone and 58% received the NSAID-pred- nisolone topical combination. The investigators found the average with- in-person change in BCVA from preop to postop measurements was the same in the two groups, but the group that received the combination treatment was more likely to achieve a 20/20 or better BCVA. This was a small statistically significant association, the authors wrote. Realtime imaging of airflow patterns and impact of infection control measures in ophthalmic practice: a pandemic perspective Samaresh Srivastava, DNB, Vaishali Vasavada, MS, Abhay Vasavada, MS, Aditya Sudhalkar, MS, Abhishek Kothari, MS, Shail Vasavada, DO Exhaled airflow patterns in a clinical scenario and the impact of enact- ed infection control practices and room air circulation were evaluated in this experimental study conducted amid the pandemic. Ten patients were observed with Schlieren imaging documenting exhaled airflow patterns with and without an N95 mask and with and without face shields. Recordings were taken with and without air conditioning on. The investigators observed a forward stream of exhaled air from the patient's mouth and nose during all respiratory activities, but use of an N95 mask reduced the intensity and forward transmission of air. Taping the mask was found to reduce leakage of air from the nasal bridge. Face shields blocked forward flow of exhaled air. A forceful, direct draft of air over the surgeon's working area reduced and diverted exhaled air away from the surgeon's breathing area, the investigators reported. Results of thin cap SMILE Suphi Taneri, MD, Samuel Arba-Mosquera, PhD, Anika Rost, MSc, Caroline Hansson, MSc, H. Burkhard Dick, MD A chart review of 102 eyes of 51 patients set out to evaluate a thin cap—120 µm vs. 100 µm—in SMILE for correction of myopia or myopic astigmatism. At 3 months postop, eyes with a 120 µm cap were under corrected in spherical equivalent refraction compared to eyes that had SMILE with a 100 µm cap, however, it wasn't statistically significant. Postop cylinder difference was also not statistically significant between the two cap thicknesses. Other factors such as visual acuity, ease of lenticule separation, and adverse events were similar between the two groups. Suction time was shorter when the cap was 100 µm, and it also resulted in a thicker postop central residual stroma (20±15 µm thicker). The researchers concluded that a 100 µm cap thickness was safe without a nomogram adjustment. They also concluded that after suction loss a second docking with a 100 µm cap and larger optical zone could allow SMILE to proceed. A Phase IV clinical study to evaluate the effects of an intracameral combined mydriatic and anesthetic agent and standard topical mydriatics and anesthet- ics on the ocular surface after cataract surgery Spyridoula Souki, MD, Béatrice Cochener, MD, Marc Labetoulle, MD, José Luis Güell, MD Intracameral and topical combined mydriatic and anesthetic agents were compared in this Phase 4 open-label, randomized, single-center study that involved 50 patients having sequential cataract surgery in both eyes. Patients were randomized to receive either intracameral Mydrane/Fydrane (tropicamide/phenylephrine/lidocaine, Thea Phar- maceuticals) and a topical anesthetic eye drop in one eye or just topical versions (control). Patients received the opposite treatment in their second eye surgery. There was not a statistically significant difference in corneal or conjunctival surface staining from baseline to day 1 postop in either group. There were fewer epithelial alterations on postop day 1 in the combination eyes, in addition to less frequent folliculopapillary reaction, and other ocular symptoms were fewer and milder. The length of the procedure in eyes that received intracameral Mydrane/Fydrane was shorter, and patient and surgeon satisfaction was greater when eyes received this option as well. Five-year long-term outcomes of intrastromal corneal ring segment implantation using the manual technique for keratoconus management Jorge Vasco Costa, MD, Tiago Monteiro, MD, Nuno Franqueira, MD, Fernando Faria-Correia, MD, Jose Alfonso, MD, Fernando Vaz, MD This retrospective cohort study included 124 eyes that had intrastromal corneal ring segments (ICRS) implanted using a manual technique. UDVA, CDVA, subjective refraction, keratometry, aberrometry, and pachymetry were evaluated preop and 6 months, 1 year, and 5 years postop. Secondary analysis compared two subgroups of patients, those younger than 30 years and those 30 years and older. At 5 years, UDVA and CDVA improved significantly and there was a significant decrease in spherical equivalent, refractive cylinder, and all topography val- ues. There was not any regression during the follow-up period. In the subgroup comparison, the results were similar and stable in all areas, except in minimum pachymetry value change over time. JULY 2021 | EYEWORLD | 65

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