Visual impairment from corneal stromal disease affects millions worldwide. We describe a cell-free engineered corneal tissue, bioengineered porcine construct, double crosslinked (BPCDX) and a minimally invasive surgical method for its implantation. In a pilot feasibility study in India and Iran (clinicaltrials.gov no. NCT04653922), we implanted BPCDX in 20 advanced keratoconus subjects to reshape the native corneal stroma without removing existing tissue or using sutures. During 24 months of follow-up, no adverse event was observed. We document improvements in corneal thickness (mean increase of 209 ± 18 µm in India, 285 ± 99 µm in Iran), maximum keratometry (mean decrease of 13.9 ± 7.9 D in India and 11.2 ± 8.9 D in Iran) and visual acuity (to a mean contact-lens-corrected acuity of 20/26 in India and spectacle-corrected acuity of 20/58 in Iran). Fourteen of 14 initially blind subjects had a final mean best-corrected vision (spectacle or contact lens) of 20/36 and restored tolerance to contact lens wear. This work demonstrates restoration of vision using an approach that is potentially equally effective, safer, simpler and more broadly available than donor cornea transplantation.

Torticollis can arise from nonocular (usually musculoskeletal) and ocular conditions. Some facial asymmetries are correlated with a history of early onset ocular torticollis supported by the presence of torticollis on reviewing childhood photographs. When present in an adult, this type of facial asymmetry with an origin of ocular torticollis should help to confirm the chronicity of the defect and prevent unnecessary neurologic evaluation in patients with an uncertain history. Assessment of facial asymmetry consists of a patient history, physical examination, and medical imaging. Medical imaging and facial morphometry are helpful for objective diagnosis and measurement of the facial asymmetry, as well as for treatment planning. The facial asymmetry in congenital superior oblique palsy is typically manifested by midfacial hemihypoplasia on the side opposite the palsied muscle, with deviation of the nose and mouth toward the hypoplastic side. Correcting torticollis through strabismus surgery before a critical developmental age may prevent the development of irreversible facial asymmetry. Mild facial asymmetry associated with congenital torticollis has been reported to resolve with continued growth after early surgery, but if asymmetry is severe or is not treated in the appropriate time, it might remain even with continued growth after surgery.

Aim and Background:This study was designed to compare four standard procedures, for determining the monocular accommodative amplitudes.Materials and Methods:Fifty-two students participated in this analytical-descriptive study. Accommodative amplitudes were measured using four common clinical techniques, namely: Push-up, push-down, minus lens, and modified push-up.Results:The highest amplitude was obtained using the push-up method (11.21 ± 1.85 D), while the minus lens technique gave the lowest finding (9.31 ± 1.61 D). A repeated-measures Analysis of Variance (ANOVA) showed a significant difference between these methods (P < 0.05), further analysis showed that this difference was only between the minus lens and other the three methods (the push-up (P < 0.001), the push-down (P < 0.001) and the modified push-up (P < 0.001)). The highest and the lowest mean difference was related to the push-up with the minus lens, and the push-down with the modified push-up, while the highest and the lowest 95% limits of agreement were related to the push-up with the modified push-up and the push-up with the push-down methods. There was almost a perfect agreement between the push-up and the push-down method, whereas, a poor agreement was present between the modified push-up and the minus lens technique, and a fair agreement existed between the other pairs.Conclusions:The quick and easy assessment of the amplitude using the push-up and the push-down methods compared to other methods, and the obtained perfect agreement between these two methods can further emphasize their use as a routine procedure in the clinic, especially if a combination of the two techniques is used to offset their slight over- and underestimation.