Purpose. To investigate the effect of preoperative treatment and postoperative enhanced anti-inflammatory treatment on alleviating meibomian gland dysfunction (MGD) and dry eye induced by cataract surgery. Design. Prospective, randomized clinical trial. Methods. A total of 120 cataract patients with moderate obstructive-MGD were enrolled and randomized with 60:30:30 number of patients in cohorts I, II, and III, respectively: Cohort I: routine postoperative anti-inflammatory treatment; Cohort II: preoperative treatment (warming compress, lid hygiene, and anti-inflammatory treatment) and routine postoperative anti-inflammatory treatment; Cohort III: enhanced postoperative anti-inflammatory treatment. Main Outcomes Measures. All participants were examined preoperatively and postoperatively for ocular symptom score (OSS), noninvasive keratographic tear break-up time (NIKBUT), corneal fluorescein staining, Schirmer I test, lid margin, meibum quality and expressibility, and meibomian gland dropout. Results. Ocular surface disorders and MGD showed aggravated status at 1 month postoperatively in Cohort I and Cohort III, and the aggravated MGD resolved by 3 months postoperatively. At 1 month postoperatively, Cohort II and Cohort III presented high NIKBUT and low OSS, lid margin, and meibum quality and expressibility (Cohort II vs Cohort I: all P<0.001, respectively; Cohort III vs Cohort I: P=0.011, P=0.024, P=0.046, P=0.045, and P=0.012, respectively). Additionally, Cohort II had better outcomes of lid margin and meibum quality and expressibility than Cohort III at 1 month postoperatively (P=0.031, P=0.026, and P<0.001, respectively). At 3 months postoperatively, Cohort II presented a significantly higher NIKBUT than Cohort I and Cohort III (P<0.001 and P=0.001, respectively). Conclusion. Preoperative management of MGD is effective and optimal in alleviating obstructive-MGD and dry eye induced by cataract surgery.

Purpose. To investigate the pachymetry distribution of central cornea and morphologic changes in subclinical keratoconus with normal biomechanics and determine their potential benefit for the screening of very early keratoconus. Methods. This retrospective comparative study was performed in 33 clinically unaffected eyes with normal topography and biomechanics from 33 keratoconus patients with very asymmetric ectasia (VAE-NTB; Corvis Biomechanical Index defined) and 70 truly normal eyes from 70 age-matched subjects. Corneal topographic, tomographic, and biomechanical metrics were measured using Pentacam and Corvis ST. The distance and pachymetry difference between the corneal thinnest point and the apex were defined as D_TCP-Apex and DP_TCP-Apex, respectively, to evaluate the pachymetry distribution within the central cornea. The discriminatory power of metrics was analysed via the receiver operating characteristic curve. A logistic regression analysis was used to establish predictive models. Results. The parameters, D_TCP-Apex and DP_TCP-Apex, were significantly higher in VAE-NTB than those in normal eyes. For differentiating normal and VAE-NTB eyes, the Belin-Ambrósio deviation (BAD-D) showed the largest area under the curve (AUC; 0.799), followed by ARTmax (0.798), D_TCP-Apex (0.771), tomography and biomechanical index (0.760), maximum pachymetry progression index (PPImax, 0.756), DP_TCP-Apex (0.753), and back eccentricity (B_Ecc, 0.707) with no statistically significant differences among these AUCs. In the VAE-NTB group, the parameter B_Ecc was significantly and positively correlated with D_TCP-Apex (P=0.011) and DP_TCP-Apex (P=0.035), whereas the posterior elevation difference had a significant positive association with DP_TCP-Apex (P=0.042). A model using the indices D_TCP-Apex, B_Ecc, PPImax, and index of height asymmetry demonstrated the highest AUC of 0.846 with 91.43% specificity. Conclusions. Abnormal pachymetry distribution within the central cornea and subtle morphologic changes are detectable in subclinical keratoconus with normal biomechanics. This may improve VAE-NTB eyes detection.

Background: To report an unusual case of salzmann nodular degeneration (SND) in posterior keratoconus (PKC) after a corneal penetrating injury. Case presentation: A 56-year-old woman presented with a history of recurrent light sensitivity, foreign body sensation, and tears after a corneal penetrating injury 20 years ago. The patient was diagnosed with SND accompanying with PKC by slit-lamp microscope, anterior segment optical coherence tomography (OCT), and corneal tomography. A combined therapy of medication (0.1% sodium hyaluronate eye drops, recombinant bovine basic fibroblast growth factor eye drops, and 0.1% fluorometholone eye drops) and bandage contact lens could not relieve the latest episode. A phototherapeutic keratectomy (PTK) treatment (laser ablation depth: 15 μm; treatment zone: 7.5 mm) was performed to remove nodules and smooth the surface. The best spectacle-corrected visual acuity improved from 20/63 preoperatively to 20/40 postoperatively. No SND relapse and corneal ectasia were recorded at follow-up 12 months later. Conclusions: This is the first known, reported case of SND accompanying with PKC after corneal trauma. The PTK is a safe and effective option for SND with PKC.

(1) Background: To analyze the indications, graft survival, and graft failure-related risk factors of repeat penetrating keratoplasty (RPK) in children. (2) Methods: In this case series, children younger than 12 years who received RPK at Beijing Tongren Hospital were reviewed. The indications for RPK, postoperative complications, and graft survival were analyzed. The analysis of the potential variables associated with graft survival was performed using Cox proportional hazards regression. (3) Results: A total of 30 RPK eyes of 29 children were included in this study. The mean follow-up time was 26.98 ± 18.75 months. The most common indication for RPK was a vascularized corneal scar (86.67%). Postoperative complications occurred in 27 eyes (90%), including immune rejection (46.67%), epithelial defects (36.67%), and glaucoma (26.67%). About 60% of the regrafts remained clear one year after RPK, while the overall graft survival rate was 30% at the last visit. The most common cause of regraft failure was irreversible immune rejection (8/21). The significant risks of graft failure included an age of less than 60 months at surgery (p = 0.009), corneal vascularization (p = 0.018), and a postoperative epithelial defect (p = 0.037). (4) Conclusions: A vascularized corneal scar is the most common indication of RPK in children. Immune rejection is the most prevalent complication, and irreversible immune rejection always causes regraft failure.