The degradation of the small-angle domain of the point-spread function after DSEK suggests that aberrations contribute to decreased visual acuity after DSEK. The poorer optical properties of the eye with older recipient age after DSEK can be attributed to the retained host cornea.

Purpose To determine whole eye high-order aberrations (HOAs) in pseudophakic eyes after Descemet stripping endothelial keratoplasty (DSEK) for Fuchs dystrophy, and to establish relationships between graft thickness, HOAs, and visual acuity. Design Cross-sectional study. Methods Whole eye HOAs were measured in pseudophakic eyes at intervals through 24 months after DSEK, and in otherwise healthy pseudophakic control eyes implanted with the same type of spherical intraocular lens. Wavefront errors were assessed by a Hartmann-Shack aberrometer over a 4 mm-diameter optical zone. In DSEK eyes, central graft thickness and stromal graft folds were measured by using confocal microscopy in vivo, and best-corrected visual acuity (BCVA) was determined by the electronic Early Treatment of Diabetic Retinopathy Study method. Results Total HOAs at 24 months after DSEK (0.28 ± 0.11 μm, mean ± SD, n=17) were higher than those in pseudophakic controls (0.16 ± 0.07 μm, n=25, p<0.001); specifically, trefoil and quadrafoil were higher after DSEK. At 24 months, total HOAs (r= 0.69, p<0.001) and graft folds (r= 0.41, p= 0.02) were correlated with central graft thickness, and BCVA was correlated with total HOAs (r= 0.39, p=0.01) but not with graft thickness (r= −0.24, p= 0.20, n=27). Conclusions Whole eye HOAs are higher after DSEK compared to untreated corneas. Thicker grafts are associated with increased HOAs and more graft folds, suggesting that the donor lenticule contributes, in part, to the wavefront errors. Although BCVA is weakly related to total HOAs after DSEK, it is not related to graft thickness.

Although effective and generally well tolerated in the treatment of sinusitis, fluoroquinolone antibiotics may produce adverse effects of arthralgia and/or myalgia.

PurposeTo describe three cases of keratitis following Selective Laser Trabeculoplasty (SLT).ObservationsThree females with a history of glaucoma presented with corneal edema, keratitis (endothelial, epithelial) and decreased visual acuity shortly after SLT. There was variable resolution of symptoms after starting treatment with oral antiherpetics and topical steroids.Conclusions and importanceWith the increase in usage of SLT as a treatment for glaucoma and subsequent reports of keratitis, it is imperative for ophthalmic surgeons to be aware of herpes simplex as a possible risk factor. Prompt treatment with antivirals and steroids can potentially prevent scarring and permanent damage to the cornea.

We report the case of a young man who presented with bilateral third nerve palsies without pupillary involvement. Brain MRI demonstrated lesions in the region of the oculomotor nerves, and further evaluation led to the diagnosis of multiple sclerosis. Our case documents a rare initial clinical presentation of this demyelinating disease.