Short-term topical use of ketorolac prior to femtosecond laser-assisted cataract surgery seems to induce significantly less pupillary miosis in comparison to eyes that did not receive NSAID pretreatment. NSAID use is advised prior to femtosecond laser-assisted cataract surgery to minimize pupil miosis-related surgical difficulties or complications during cataract extraction. [J Refract Surg. 2017;33(4):230-234.].

Purpose To disclose, using an ex vivo study, the histopathological mechanism behind the in vivo thickening of the Endothelium/Descemet’s membrane complex (En/DM) observed in rejected corneal grafts (RCGs). Methods Descemet’s membrane (DM), endothelium (En), and retrocorneal membranes (RCM) make up the total En/DM thickness. These layers are non-differentiable by HD-OCT; therefore, the source of the thickening is unclear from an in vivo perspective. A retrospective ex vivo study (from September 2015 to December 2015) was conducted to measure the thicknesses of DM, En, and RCM in 54 corneal specimens (31 RCGs and 23 controls) using light microscopy. Controls were globes with posterior melanoma without corneal involvement. Results There were 54 corneas examined ex vivo with mean age 58.1 ± 12.2 in controls and 51.7 ± 27.9 years in rejected corneal grafts. The ex vivo study uncovered the histopathological mechanism of En/DM thickening to be secondary to significant thickening (p<0.001) of DM (6.5 ± 2.4 μm) in rejected corneal grafts compared to controls (3.9 ± 1.5 μm). Conclusions Our ex vivo study shows Descemet’s membrane is responsible for the thickening of the En/DM in RCGs observed in vivo by HD-OCT and not the endothelium or retrocorneal membrane.

Background Hypochlorous acid has both anti-microbial and wound healing properties with a growing role for use in pre-procedural care on the face. Objectives To compare the antiseptic property of 0.01% hypochlorous solution (HA), 5% povidone iodine (PI), 4% chlorhexidine (CHG) and 70% isopropyl alcohol (IPA) antiseptic on facial skin. Methods A prospective single-center clinical trial. Results A total of 21 participants were recruited. Bacterial growth was seen in CHG (10%), IPA (71%), PI (81%) and HA (95%) of specimens (p &lt; 0.001). CHG had less growth when compared to HA (p = &lt;0.001), IPA (p = &lt;0.001) and PI (p = &lt;0.001). No difference in bacterial growth was seen between HA and IPA (p = 0.063) or HA and PI (p = 0.25). Significant differences in mono-microbial and poly-microbial growth was seen between HA and IPA (p = 0.046) and HA and CHG (p= &lt; 0.001). Staphylococcus epidermidis grew less frequently in CHG (10%), followed by IPA (29%), PI (71%) and HA (71%). Staphylococcus capitis grew less frequently in CHG (0%), followed by PI (14%), HA (24%) and IPA (29%). Conclusions CHG reduced the bacterial growth compared to HA, PI, and IPA. However, HA, PI and IPA had insignificant differences in bactericidal effects. Our study provides a supporting role of HA to be considered as an antiseptic.

In vitro studies of HA 0.01% were observed to have equal or more efficacious antiseptic properties compared with IPA, CHG, and PI. Future studies will be needed to investigate its role in periocular use.

Purpose To assess aqueous humor concentration of prostaglandin E2 (PGE2) after capsulotomy creation using a femtosecond laser (FLAC) in patients pretreated with short-term topical ketorolac versus patients without pretreatment. Methods This prospective study comprised consecutive patients scheduled to undergo cataract surgery using a femtosecond laser platform to perform only capsulotomies. An identical protocol for preoperative mydriasis was used for all the eyes included in the study, while aqueous humor was extracted from the anterior chamber of all patients immediately after the initial side port incision. ELISA was performed to quantify aqueous humor PGE2. The patients were divided into 2 groups; in group 1, the patients received short-term topical ketorolac preoperatively, while the patients in group 2 did not receive NSAID pretreatment. Results Twenty eyes of 20 patients were included in the study (10 eyes in each group). Mean concentration of aqueous humor PGE2 after FLAC was 392.16 ± 162.00 pg/ml and 622.63 ± 331.84 pg/ml for groups 1 and 2, respectively. A statistically significant difference in aqueous humor PGE2 concentration between the two groups (p < 0.05) was demonstrated, with the eyes that received ketorolac pretreatment demonstrating a lower concentration of PGE2. Conclusion Short-term topical use of ketorolac prior to FLAC seems to prevent excessive release of PGE2 in the anterior chamber of the eyes that received NSAID pretreatment when compared to the eyes that did not receive NSAIDs preoperatively.

There was no statistically significant difference in pain scores or surgical outcomes in patients receiving frontal nerve block compared with those receiving subconjunctival injection during CMMR surgery.

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