Preliminary results up to 1 year postoperatively indicate the efficacy of I-CXL in stabilizing the progression of this degenerative disease combined with significant improvement of CDVA. I-CXL, which spares the corneal epithelium, has the potential to become a valid alternative for halting the progression of keratoconus while reducing postoperative patient pain, risk of infection, and treatment time in select patients; however, the relative efficacy of this technique compared to standard epithelium-off techniques remains to be determined.

The 1-year outcomes suggest that I-CXL might be comparable to S-CXL in stabilizing the progression of the degenerative ectatic disease. Additionally, quicker improvement of functional parameters was reported in the I-CXL group. [J Refract Surg. 2016;32(10):672-678.].

PURPOSE: To assess the long-term efficacy and safety of epithelium-off corneal cross-linking according to the Dresden protocol (S-CXL) in progressive keratoconus. METHODS: Patients treated with S-CXL from April 2006 to January 2010 at Humanitas Clinical and Research Center, Rozzano, Italy, who completed at least 10 years of follow-up were included. Corrected distance visual acuity (CDVA), refraction, and corneal topography and tomography with Pentacam (OCULUS Optikgeräte GmbH) were evaluated at baseline and 10+ years after the procedure. The definition of progression after S-CXL was two of the following three criteria: increase of “A” value, increase of “B” value, or decrease of minimum thickness evaluated with the ABCD progression display above 95% CI for the post-CXL population. RESULTS: Twenty-seven eyes of 22 patients were included. At a mean of 11 years of follow-up (maximum 13 years), S-CXL was able to maintain CDVA and induce significant regularization of the corneal surface as demonstrated by a significant decrease of the central keratoconus index ( P = .035) and a decrease of anterior curvature (“A” value) starting from 2.54 ± 2.46, which reduced to 1.14 ± 1.60 ( P = .005) at 10+ years of follow-up. Two of 27 eyes included showed significant progression after S-CXL (7.4%). CONCLUSIONS: S-CXL was confirmed to be a safe and effective treatment for progressive keratoconus with a failure rate of 7.4% at up to 13 years of follow-up. The authors suggest the use of a combined progression system that evaluates anterior and posterior curvature and with thickness map together with the knowledge of the noise level of the testing system. [ J Refract Surg . 2020;36(12):838–843.]

BackgroundThe purpose of this retrospective follow-up study is to evaluate the prevalence of patients with thyroid eye disease presenting with apparent unilateral proptosis and determine the occurrence of exophthalmos in contralateral non-proptotic eye over the time. Associated features with this event were evaluated.MethodsA cohort of 655 consecutive patients affected by thyroid eye disease with a minimum follow-up of 10 years was reviewed. Exophthalmos was assessed by using both Hertel exophthalmometer and computed tomography (CT). The influence of age, gender, hormonal status and of different therapies such as corticosteroids, radiotherapy and surgical decompression on this disease progression was evaluated.ResultsA total of 89 patients (13.5%) (95% confidence interval [CI] 15%-10%) had clinical evidence of unilateral exophthalmos at the first visit. Among these, 13 patients (14%) (95% CI 22%-7%) developed subsequent contralateral exophthalmos. The increase of protrusion ranged from 2 to 7 mm (mean of 4.2). The time of onset varied from 6 months to 7 years (mean time: 29 months). Smoking status, young age and surgical decompression are significantly associated with development of contralateral proptosis (p< .05).ConclusionsAsymmetric thyroid eye disease with the appearance of unilateral exophthalmos at the initial examination is a fairly frequent event, while subsequent contralateral proptosis occurs less commonly. However, physicians should be aware that young patients, particularly if smokers, undergoing orbital decompression in one eye may need further surgery on contralateral side over time.

Purpose: To evaluate the correlation between changes in maximum keratometry (Kmax) and ABC values from the ABCD Progression Display (Pentacam) in progressive keratoconus (KC) and to evaluate whether the ABC changes were able to detect progression earlier than Kmax. Setting: Humanitas Clinical and Research Center, Rozzano, Milan, Italy. Design: Retrospective study. Methods: Kmax, ABC values, and thinnest point (ThCT) were recorded at the day of corneal crosslinking (CXL) (T0) and previous follow-up (T-1). In patients without earlier progression in Kmax, follow-up examination (T-2) was used to determine whether any of the ABC parameters reached statistical significance for progression. Results: Seventy-six eyes of 63 patients scheduled for CXL with documented progression (Kmax increase of >1.00 diopter) were included. There was a significant, albeit moderate, correlation between the change in Kmax between T0 and T-1 and the change in both A (ρ = 0.391) and B values (ρ = 0.339). There was no significant correlation between the change in Kmax between T0 and T-1 and the change in either C or ThCT. In patients with T-2 examinations, 16 (51.6%) of 31 patients showed a statistically significant change on the ABCD progression display that was not detected with Kmax. Conclusions: This study showed a significant, but moderate, correlation between the change in Kmax and the change in A and B values in progressive KC. Moreover, more than half of the cases showed documented progression earlier with the ABCD progression display than that detected by standard Kmax changes. This study suggests possible changes in progression criteria to allow for earlier intervention.

Endocytoscopy provides real-time histological images in vivo, with clear visualization of cellular details and features of dysplasia in colorectal ACF.

Botulinum toxin therapy for blepharospasm can provide long-lasting relief and reduction of spasms in the majority of patients. This therapy has the advantages of being safe, simple, and repeatable.

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