Background To compare the outcomes of two different protocols of accelerated corneal crosslinking (CXL) on visual, corneal high order aberrations (HOA) and topographic parameters in patients with progressive keratoconus. Methods In this prospective comparative study, sixty-six eyes of 66 patients with progressive keratoconus were divided into two groups; 37 eyes in Group 1 received 18 mW/cm 2 for five minutes, and 29 eyes in Group 2 were treated with 9 mW/cm 2 for 10 min. The uncorrected distant visual acuity (UCVA), best-corrected distant visual acuity (BCVA), corneal HOAs and topography parameters were measured preoperatively and postoperatively at the end of 12 months. The data for the two groups were compared statistically. Results The mean UCVA and BCVA were significantly improved at the postoperative 12 months compared with the preoperative values in both groups (P < 0.05 for all). A significant improvement in corneal HOAs was observed in both groups (P < 0.05 for all). The change in corneal coma value was significantly higher in Group 2 (P < 0.05). The change in keratometric values K1, K2, AvgK and maximum keratometry (AKf) were significantly higher in Group 2 (P < 0.05 for all). The regression model showed that the most important factor predicting the change in AKf was the type of CXL (β = − 0.482, P = 0.005). Conclusions Accelerated CXL using 10 min of UVA irradiance at 9 mW/cm 2 showed better topographic improvements and coma values than five minutes of UVA irradiance at 18 mW/cm 2 independent of keratoconus severity.

Purpose: To compare the long-term safety, efficacy, and complications of small-incision lenticule extraction (SMILE) and flexible iris-fixated anterior chamber phakic intraocular lens (pIOL) implantation for the treatment of high myopia. Setting: University of Health Science Turkey, Beyoğlu Eye Training and Research Hospital, İstanbul, Turkey. Design: Retrospective comparative case series. Methods: Data of patients who underwent SMILE or pIOL (Artiflex) implantation for myopia were retrospectively reviewed. Only patients with preoperative manifest refraction spherical equivalent from −6.00 to −10.00 diopters (D) were included in the study. Results: There were 47 eyes of 32 patients in the SMILE group and 52 eyes of 29 patients in the pIOL group. The mean postoperative follow-up was 63.75 ± 18.40 months in the SMILE group and 65.38 ± 16.22 months in the p-IOL group (P = .71). At 6 years postoperatively, refractive predictability was slightly better in the pIOL group, and the percentages of eyes within ±0.50 D of the attempted correction were 77% and 83% in the SMILE and pIOL groups, respectively. Although mean uncorrected distance visual acuity was comparable (SMILE, 0.12 ± 0.06 logarithm of the minimum angle of resolution [logMAR]; p-IOL, 0.09 ± 0.05 logMAR), the safety indices (1.08 ± 0.22 vs 1.11 ± 0.20; P = .02) and the efficacy indices (0.92 ± 0.24 vs 1.11 ± 0.22; P = .03) were statistically significantly higher after pIOL implantation. Despite a mean of 11.09% of the endothelial cell being lost at 6 years after pIOL implantation, no pIOL was explanted due to endothelial cell loss. Conclusions: In this comparative and long-term study, iris-fixated anterior chamber pIOL implantation for high myopic correction showed slightly better safety and efficacy profiles but with statistically significant endothelial cell loss.

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Purpose: The aim is to report long-term graft survival rates, clinical outcomes of Descemet membrane endothelial keratoplasty (DMEK).Methods: In this study 150 eyes, that underwent DMEK whether for Fuchs endothelial corneal dystrophy (FECD) or for bullous keratopathy (BK), surveilled for 7 years at 6 time-points to evaluate graft survival rates and clinical outcomes of post-corneal transplantation.Results: Overall, the estimated survival probability of 95% con dence interval at 7 years of post-DMEK was 0.58 (0.72-0.77) and the survival probabilities of eyes operated for FECD (0.53) were higher than eyes operated for BK (0.42) (Log Rank 26.87, [p=0.197]). Post-transplant eyes with FECD achieved better visual acuity levels than eyes with BK (p=0.006). Primary graft failure occurred in 11.3% eyes. Secondary graft failure rate was 9.3%, and allograft rejection rate was 4.7%.Conclusion: Although DMEK is effective, safe in long-term, visual results and graft survival rates are better in cases with FECD.

PEX material can cause decrease in tear film secretion and disturb tear film stability. There is no effect of PEX-induced dry eye on CCT. Lower CCT values in the eyes with PEX material may be a result of decrease in corneal stromal cell density. Moreover, higher CCT values may be because of decreased endothelial cells in PEX glaucoma patients.

SIGNIFICANCE After epithelium-off crosslinking (CXL), epithelial closure time and post-operative pain are an important issue in terms of possible complications and patient comfort. We report a prospective randomized study about the use of autologous serum eye drops after CXL. PURPOSE This study aims to evaluate the effect of autologous serum eye drops on epithelial healing and post-operative pain after CXL. METHODS Sixty patients diagnosed as having progressive keratoconus and treated with accelerated CXL (9 mW/cm2 for 10 minutes) randomly received 20% autologous serum eye drops (autologous serum group, n = 30) or artificial tears (control group, n = 30). Patients were evaluated every day after the surgery, and the day of epithelial closure was recorded. All patients were asked to report the maximum pain level using the Wong-Baker FACES Pain Rating Scale at the end of each day until the epithelial closure was completed. The change in topographic parameters and haze were recorded at 6 months. RESULTS The mean epithelial closure time was significantly lower in the autologous serum group than in the control group (2.37 ± 0.49 and 2.67 ± 0.47 days, respectively; P = .02). There was a statistically significant difference between the pain scores in the first and second days of surgery between the two groups (first-day autologous serum autologous serum group: 2.80 ± 0.66 and control group: 3.50 ± 0.82, P = .01; second-day autologous serum group: 1.73 ± 0.69 and control group: 2.20 ± 0.76, P = .02). Pre-operative and post-operative topographic parameters and haze at 6 months were similar between the two groups (P > .05 for all). CONCLUSIONS Use of autologous serum eye drops after CXL accelerates epithelial healing and reduces post-operative pain. Shortening the duration of epithelial closure would be beneficial in reducing possible complications and increasing patient comfort.

Purpose: The present study aimed to report the outcomes of patients with progressive keratoconus who were treated via accelerated crosslinking (CXL) 6 months earlier and to determine the factors that promoted improved visual acuity after treatment. Methods: This retrospective study included 35 eyes of 34 patients with progres sive keratoconus who underwent CXL. Topographical measurements were obtained preoperatively and in the first, third, and sixth months postoperatively using a rotating Scheimpflug camera. The uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), flat keratometry (K) value (K1), steep K value (K2), average K value (avgK), topographic cylindrical value (Cyl), apical keratoscopy front (AKf ), apical keratoscopy back (AKb), symmetry index front (SIf ), symmetry index back (SIb), and thinnest point of the cornea (ThkMin) were recorded. Results: At the 6-month follow-up, the mean UCVA and BCVA values were improved, and the K values remained stable. Statistically significant decreases in AKf (p=0.04) and the thinnest point of the cornea (p=0.001) and a statistically significant increase in AKb (p=0.01) were observed. A correlation analysis revealed that the preoperative BCVA, UCVA, K1, K2, avgK, AKf, and AKb values significantly affected visual acuity at the 6-month follow-up. Conclusions: Accelerated CXL is an effective treatment for the prevention or even reversal of keratoconus progression. The preoperative K values and apexes of the anterior and posterior cornea were found to affect visual acuity at 6 months after accelerated CXL. Both AKb steepening and AKf flattening appear to be important factors in the stabilization of keratometric values and improvement of visual outcomes.

PurposeThe aim of this study was to investigate the possibility of a relationship between corneal biomechanical properties and different grades of dermatochalasis.Patients and methodsPatients were assigned to four groups according to the severity of their dermatochalasis: normal (Group 1), mild (Group 2), moderate (Group 3), and severe (Group 4). An Ocular Response Analyzer device was used to measure corneal hysteresis (CH), corneal resistance factor (CRF), and corneal-compensated intraocular pressure (IOPcc).ResultsWe found no significant differences in the mean values of the CH, CRF, and IOPcc of all groups (P=0.75, P=0.93, and P=0.11, respectively). However, CH and IOPcc were negatively correlated in Group 1, Group 2, and Group 3 patients (P=0.013, r=−0.49; P=0.015, r=−0.52; and P=0.011, r=−0.47, respectively), but this correlation was not apparent in the Group 4 patients (P=0.57, r=0.12). CRF and IOPcc were correlated, but only in Group 4 (P=0.001, r=0.66).ConclusionSevere dermatochalasis was associated with altered corneal biomechanical properties. Some of the important visual consequences of dermatochalasis and related diseases (such as floppy eyelid syndrome) can be understood by considering corneal biomechanical alterations.