To describe a patient with scleral dellen after pterygium excision with intraoperative mitomycin C. Case report and MEDLINE review of the medical literature on scleral dellen after bare sclera technique. A 48-year-old man had a left nasal pterygium excised by the bare sclera technique with intraoperative mitomycin C. Eight days after surgery, the patient noticed a small black spot in the bare sclera area with mild irritation. Slit-lamp examination revealed a focal area of extreme thinning, centered on the nonepithelialized bare sclera, surrounded by edematous conjunctiva. The ciliary body was visible through the thin and dry scleral lesion. After topical lubricant therapy, the scleral lesion appeared normal thickness and white in color 3 days later. Therapy was continued until the sclera epithelialized. Scleral dellen is an early postoperative complication of bare sclera technique owing to delayed conjunctival wound closure. Hydration of the thinned sclera will rapidly thicken it. However, medical therapy should be continued until the surrounding conjunctiva has flattened and the sclera has epithelialized. Surgical wound closure is an alternative management and may be the way to prevent scleral dellen formation after bare sclera technique. All patients after bare sclera surgery should be followed up until the conjunctival wound has healed. If delayed healing is found, frequent artificial tears, patching, or surgical intervention is necessary.

Dry eye disease (DED) is a multifactorial disease that causes ocular discomfort and visual impairment on a damaged ocular surface. Lifitegrast, a novel T-cell integrin antagonist, was approved in the United States in July 2016 as a 5% (50 mg/mL) ophthalmic solution for DED management. Currently, no meta-analysis and systemic review based on relevant studies have been conducted. This study aimed to evaluate the efficacy and safety of lifitegrast in patients with DED. We systematically searched Embase, Medline, PubMed, and Web of Science for randomized controlled trials (RCTs) and nonrandomized studies evaluating lifitegrast effects on symptomatic DED. Then, inferior corneal staining score, total corneal staining score (TCSS), nasal lissamine staining score (NLSS), total lissamine staining score, ocular discomfort score (ODS), eye discomfort score (visual analog scale (VAS) score), eye dryness score (EDS), ocular surface disease index score (OSDI-S), and tear break-up time (TBUT) were assessed. Clinical global impression and safety profiles were also evaluated. The studies were pooled in a random-effects model. We included five RCTs, one case–control study, and four longitudinal or retrospective studies, comprising 3197 participants. In the meta-analysis, lifitegrast was superior to the placebo because it improved TCSS, NLSS, TBUT, ODS, eye discomfort score, EDS, and OSDI-Sin DED. However, lifitegrast showed higher risks for ocular and non-ocular treatment-emergent adverse events (TEAEs) overall or at a mild or moderate level. Nonetheless, its incidence of adverse events slightly differed from that in the placebo, especially instillation site discomforts and dysgeusia, thereby considered safe and tolerable. Claims of withdrawal during follow-up caused by TEAEs were extremely rare. Lifitegrast improves DED, although dysgeusia, installation site pain, and irritation may be a concern for some. Overall, most of the adverse events are tolerable. Lifitegrast can alleviate refractory DED and improves patients’ quality of life.

Purpose: To evaluate the clinical outcomes of posterior sub-Tenon (PST) injection of triamcinolone acetonide (TA) in the early treatment of severe cystoid macular edema (CME) in central retinal vein occlusion (CRVO). Methods: In a noncomparative, prospective study, 18 eyes of 18 patients with severe CME (central macular thickness, CMT >450 μm) secondary to recent-onset CRVO (the onset of symptoms ≤4 weeks) and a decrease in visual acuity (≤80 letters of Early Treatment Diabetic Retinopathy Study [ETDRS] scores, 20/50) were included. PST injection of 40 mg of TA was given under topic anesthesia. All patients received three biweekly injections and were evaluated at baseline and at 1 day, 1, 2, 4, 6, and 8 weeks, and 3, 6, and 9 months after injection. The main outcome measures were ETDRS scores, CMT, intraocular pressure (IOP), cataract progression, and frequency of complications. Results: The mean age of the 18 patients was 61.17 years (range, 24–81 years) and the mean duration of symptoms was 15.28 days (range, 9–28 days). Eight eyes were diagnosed with ischemic CRVO and 10 eyes with nonischemic CRVO. Mean baseline ETDRS visual acuity (VA) score was 36.89 ± 18.22 in all affected eye. There was a significant improvement in VA at 1, 3, 6, and 9 months of follow-up. The mean VA at these time points were 46.61 ± 20.21, 58.11 ± 22.19, 59.39 ± 22.98, and 58.67 ± 23.27 (all P < 0.001), respectively. Both nonischemic and ischemic eyes benefited with a statistically significant VA improvement at each time point. A comparison of the gain in VA between two subgroups was not significant at 1 and 3 months (P > 0.05), but was statistically significant at 6 and 9 months (P = 0.009 and 0.008, respectively). VA gain of 10 or more letters was found in all nonischemic eyes (10/10) and 3 ischemic eyes (3/8) at the 9-month follow-up. Two ischemic eyes were found to have no gain of letters in VA at the 9-month follow-up. The mean baseline CMT for all eyes was 566 ± 42 μm. There was a 29% reduction with a mean CMT of 404 ± 49 μm (P < 0.001) at 1 month, 51% reduction with a mean CMT of 278 ± 40 μm (P < 0.001) at 3 months, 61% reduction with a mean CMT of 222 ± 56 μm (P < 0.001) at 6 months, and 63% reduction with a mean CMT of 210 ± 30 μm (P < 0.001) at 9 months. Both nonischemic and ischemic eyes demonstrated a statistically significant reduction in CMT (all P < 0.001). A comparison of the reduction in CMT between these two subgroups was not significant at each visit (all P > 0.05). For both subgroups, there was no statistically significant difference in IOP change at baseline, 1 week, 1, 3, 6, and 9 months of follow-up. Only two patients required topic antiglaucoma drops for elevated IOP. Three patients developed a recurrence of CME accompanied with visual decrease. No cataract progression or other complications were observed. Conclusions: PST injection of TA is effective in reversing CME and improving visual acuity in recent-onset CRVO in the first 9 months. Patients with nonischemic CRVO may respond more favorably than patients with ischemic CRVO. Early treatment may be better for visual improvement before longstanding macular edema results in irreversible photoreceptor damage. Further study with longer follow-up period is necessary.

Myopia is a highly prevalent refractive disorder. We investigated the effect of diacerein on monocular form deprivation (MFD) in hamsters as a possible therapeutic intervention. Diacerein is an anthraquinone derivative drug whose active metabolite is rhein. Diacerein or atropine was applied to the MFD hamsters, and their refractive error and axial length were measured after 21 days. The refractive error (control: −0.91 ± 0.023, atropine: −0.3 ± 0.08, and diacerein: −0.27 ± 0.07 D) and axial length (control: 0.401 ± 0.017, atropine: 0.326 ± 0.017, and diacerein: 0.334 ± 0.016 mm) showed statistically significant differences between control, atropine‐treated, and diacerein‐treated MFD eyes. Furthermore, we determined the level of transforming growth factor‐beta‐ (TGF‐) β1, matrix metalloproteinase‐ (MMP‐) 2, type I collagen, interleukin‐ (IL‐) 6, IL‐8, and monocyte chemoattractant protein‐ (MCP‐) 1 in the retina. Atropine and diacerein suppressed levels of the myopia‐related TGF‐β1 and MMP‐2 while increasing type I collagen expression. They also inhibited the interleukin IL‐6, IL‐8, and MCP‐1 levels. Diacerein reduced the IL‐6, IL‐8, and MCP‐1 expression in ARPE‐19 cells. Furthermore, diacerein inhibited inflammation by attenuating the phosphorylation of protein kinase B (AKT) and nuclear factor kappa‐light‐chain‐enhancer of activated B (NF‐κB) pathway. This suggests that diacerein has a therapeutic effect on myopia and is a potential treatment option.

Purpose: To identify optical coherence tomography (OCT) biomarkers that may predict functional and anatomical outcomes in diabetic macular edema (DME) patients treated with intravitreal dexamethasone (DEX) implant.Materials and Methods: Sixty-four eyes from 50 patients with DME were enrolled. Best-corrected visual acuity (BCVA) and OCT biomarkers including central retinal thickness (CRT), subretinal fluid (SRF), intraretinal cysts (IRC), ellipsoid zone disruption (EZD), disorganization of retinal inner layers (DRIL), hard exudate (HE), hyperreflective foci (HRF), epiretinal membrane (ERM), and vitreomacular interface (VMI) changes were evaluated at baseline and at 3, 6, and 12 months after treatment. Multiple logistic analysis was performed to evaluate each OCT biomarker as a predictive factor for functional and anatomical improvement at the end of treatment.Results: The presence of SRF at baseline was associated with a favorable outcome, with CRT improving by more than 100 μm after treatment from multivariate logistic regression analysis [odds ratio 6.16 (1.75–21.6)]. In addition, baseline SRF predicted a greater CRT improvement from multiple regression analysis (model R-square 0.11, p = 0.006). The reduction of DRIL, SRF, LONLC, IRC, and EZD were correlated with better CRT improvement (more than 100 μm) (P < 0.05). SRF and EZD recovery can also predict better visual prognosis (P < 0.05).Conclusion: OCT biomarkers can be used to predict who may benefit the most after DEX treatment. We suggest that the DEX implant should be considered as a first line treatment in DME patients with SRF.