Background: This retrospective chart review compared the higher-order aberrations (HOAs) among photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) alongside changes in spherical equivalent (SEQ) and corneal shape (Q-value). Methods: Analyzing 371 myopic eyes, including 154 LASIK, 173 PRK, and 44 SMILE cases, Pentacam imaging was utilized pre-operatively and at one-year post-operative visits. Results: All procedures resulted in 100% of patients achieving an uncorrected distance visual acuity (UDVA) of 20/40 or better, with 87% of LASIK and PRK, and 91% of SMILE patients having 20/20 or better. Significant increases in HOAs were observed across all procedures (p < 0.05), correlating positively with SEQ and Q-value changes (LASIK (0.686, p < 0.05), followed by PRK (0.4503, p < 0.05), and SMILE (0.386, p < 0.05)). Vertical coma and spherical aberration (SA) were the primary factors for heightened aberration magnitude among the procedures (p < 0.05), with the largest contribution in SMILE, which is likely attributed to the centration at the corneal apex. Notably, PRK showed insignificant changes in vertical coma (−0.197 µm ± 0.0168 to −0.192 µm ± 0.0198, p = 0.78), with an increase in oblique trefoil (p < 0.05). Conclusions: These findings underscore differences in HOAs among PRK, LASIK, and SMILE, helping to guide clinicians.

Purpose: Patients with advanced keratoconus (KCN) are less likely to benefit from corneal cross-linking and may require a partial or full thickness keratoplasty. This study aimed to determine whether racial disparities exist in the clinical presentation and initial treatment recommendations for patients evaluated for KCN. Methods: A single-center retrospective review was conducted on all patients who presented to the cornea department for initial evaluation of KCN between 2018 and 2020. Patients who had undergone prior corneal procedures or surgeries were excluded. Baseline sociodemographic and clinical information was collected and stratified according to black versus non-black race. Generalized estimating equations were used to examine the association between black race and presenting corrected distance visual acuity (CDVA), presence of corneal scarring, keratometry values, Belin ABCD score, and treatment recommendations. Multivariate models were adjusted for patient demographics. Results: A total of 128 patients (251 eyes) were included in this study. In fully adjusted models, black individuals presented with significantly worse CDVA (p < 0.0001) and worse tomographic KCN staging according to the Belin ABCD criteria (p = 0.002) compared to non-blacks. Blacks were also more than four times as likely to present with a thinnest pachymetry < 400 μm (p < 0.0001) and more than three times as likely to have corneal scarring (p = 0.001). Blacks were more than seven times more likely to have keratoplasty recommended as treatment than conservative management such as corneal cross-linking or contact lenses (p = 0.004). Conclusion: Compared with their non-black counterparts, blacks presented with significantly more advanced KCN, which placed them at risk of requiring more invasive treatment plans. Future studies should investigate reasons for such late presentations and aim to mitigate disparities in the presentation and management of KCN.

Objective The objective of this study was to assess the feasibility of using an intracameral phenylephrine/ketorolac infusion during cataract surgery as a single agent to prevent postoperative pain, inflammation, and other complications. Methods A prospective, single-group feasibility study was conducted in which phenylephrine/ketorolac infusion was administered during cataract surgery and no perioperative topical drops were initially prescribed. Patients underwent optical coherence tomography, corrected distance visual acuity testing, and slit lamp biomicroscopy examination at perioperative visits, during which they also reported symptoms of pain, irritation, and/or photophobia. A goal adverse event (AE) rate was set at ≤5.0%. Results A total of 94 eyes (60 patients) were included in this study. The AE rate was 13.8% (13/94 eyes) with pain/irritation in eight eyes, cystoid macular edema (CME) in three eyes, and corneal edema in three eyes. Conclusions Based on an AE rate goal of ≤5.0%, using intraoperative, intracameral phenylephrine/ketorolac alone was not deemed a feasible alternative to current postoperative eye drop regimens in our clinical setting. However, a 13.8% AE rate is comparable to the rates of postoperative CME, corneal edema, pain, and irritation in the published literature. Thus, more research is needed to truly define this approach as inferior or non-inferior to the current standard of care.