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.

Background. To analyze the therapeutic effects of corneal debridement combined with intrastromal voriconazole in recalcitrant fungal keratitis. Methods. This is a retrospective study. Fourteen patients with recalcitrant fungal keratitis were treated by corneal debridement combined with intrastromal voriconazole (50 μg/0.1 ml). This paper reviews and analyzes the patients’ basic state, surgical intervention, medicinal treatment, and outcomes. Results. The mean sizes of infiltration and ulcer were (5.54 ± 1.32)mm and (3.46 ± 1.03)mm, respectively, and the mean depth was (315.43 ± 57.72)μm. Twelve of the patients had satellite lesion, and 2 suffered hypopyon. After intrastromal voriconazole, the size of infiltration decreased significantly to (4.32 ± 1.10)mm (P<0.001), but there was no significant change in ulcer size ((3.36 ± 0.92)mm, P=0.082). Thirteen patients were cured after corneal debridement. The mean healing time was (15.38 ± 7.38) days. Excluding one cured patient with optic nerve atrophy and one patient for whom the treatment failed, the mean best-corrected visual acuity after healing was (0.23 ± 0.18)LogMAR, a significant improvement compared to pretreatment (0.87 ± 0.57(LogMAR), P=0.01). The mean corneal astigmatism was (1.3 ± 1.6)D of 12 cured patients after healing and (1.0 ± 0.7)D at final follow-up, and there was no significant difference (P=0.374). Conclusions. Corneal debridement combined with intrastromal voriconazole is a secure and effective treatment for recalcitrant fungal keratitis.

(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.