Purpose: To compare transepithelial (TE) photorefractive intrastromal corneal cross-linking (PiXL) and photorefractive keratectomy (PRK) in low myopia. Setting: Monocentric study conducted in France (Purpan Hospital, Toulouse) Design: Prospective, intraindividual ethics committee-approved, comparative nonrandomized study. Methods: Myopic patients with manifest refraction spherical equivalent (MRSE) of -1.00 to -2.50 diopters (D), and cylindrical component plano to -0.75 D were included. Dominant eye underwent PRK, and non-dominant eye TE-PiXL procedure with riboflavin (Paracel ® Part 1 & 2, Avedro Inc., Waltham, MS, USA), 30 mW/cm 2 pulsed UVA irradiation centered on pupil (Mosaic™ System,Avedro Inc., Waltham, MS, USA) for 16 minutes and 40 seconds and supplemental oxygen delivery mask. The primary outcome measure was the change in MRSE. Other outcome measures were uncorrected and corrected distance visual acuity (UDVA and CDVA), mean keratometry (Km), and endothelial cell count (ECC) with a 6month follow-up. Adverse events were also assessed. Results: Nineteen patients were included. At 6 months, mean MRSE decreased by 0.72 ± 0.42 D in TE-PiXL eyes and by 1.35 ± 0.46 D in PRK eyes (P <.001). The mean change in UDVA was -0.35 ± 0.21 LogMAR in TE-PiXL eyes and -0.66 ± 0.19 LogMAR in PRK eyes (P <.001). No complications were reported. ECC and CDVA were statistically unchanged. Conclusion: PRK provided better visual and refractive outcomes than TE-PiXL. TE-PiXL however demonstrated the potential refractive effect of corneal cross-linking but with a limited magnitude of myopic correction to this point.

Introduction: Routine medical and ophthalmic care is being drastically curtailed in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Uveitis patients require particular attention because of their theoretical risk of viral infection, in the context of therapeutic immunosuppression. Areas covered: This collaborative work proposes practical management and follow-up criteria for uveitis patients in the context of the ongoing SARS-CoV-2 pandemic. Expert opinion: Management should proceed as usual when access to health care possible in patients who do not belong to a group at high risk of severe SARS-CoV-2 infection, and in uncontrolled uveitis cases. In case of reduced access to eye clinics or high risk of SARS-CoV-2 infection, patients' management should be stratified based on their clinical presentation. In non-severe uveitis cases, the use of systemic steroids should be avoided, and local steroids preferred whenever possible. In uncontrolled situations where there is real risk of permanent visual loss, high-dose intravenous steroids and/or systemic immunosuppressants and/or biotherapies can be administered depending on the severity of eye disease. Immunosuppressive therapy should not be withheld, unless the patient develops SARS-CoV2 infection.

Purpose To review management, treatment, and outcomes of patients with necrotizing herpetic retinitis (NHR) to propose an algorithm for first-line management of NHR. Methods Retrospective evaluation of a series of patients with NHR at our tertiary center between 2012 and 2021 using demographic, clinical, ophthalmologic, virological, therapeutic, and prognostic characteristics was performed. Patients were classified by NHR type: acute retinal necrosis (ARN), progressive outer retinal necrosis (PORN), cytomegalovirus (CMV) retinitis. Results Forty-one patients with NHR were included: 59% with ARN, 7% with PORN, and 34% with CMV retinitis. All patients with CMV retinitis and PORN were immunocompromised versus 21% of patients with ARN. CMV infection was found in 14 (34%) patients, varicella zoster virus infection in 14 (34%) patients, herpes simplex virus type 2 infection in 8 (20%) and type 1 infection in 5 (12%) patients. Intravenous antiviral therapy was received by 98% of patients and intravitreal antiviral injections by 90% of patients. The overall complication rate during follow-up was 83% of eyes. Most frequent complications were retinal detachment (33% eyes) and retinal break (29% eyes). Prognostic factors for poor visual outcomes were pre-existing monocular vision loss in contralateral eye among 17% of patients, bilateral NHR in 17% of patients, posterior pole involvement in 46% of eyes, and involvement > 2 retinal quadrants in 46% of eyes. Conclusions The visual prognosis of patients with NHR remains poor. Prompt investigation of immune status and presence of factors justifying intravitreal antiviral injections must be prioritized to initiate and adapt management while awaiting causative virus confirmation.