The Coronavirus disease 2019 (COVID-19) pandemic is an ongoing healthcare crisis that continues its worldwide spread. Ophthalmologists are at high risk of acquiring and transmitting the virus. Telemedicine platforms have evolved and may play an important role in attenuating this risk. For patients, these platforms provide the possibility of clinic consultation without the concerns of a clinic visit. We aimed to assess the utilization of telemedicine by oculoplastics specialists worldwide during the COVID-19 pandemic. A 13-item survey was distributed internationally to practicing oculoplastic surgeons. Collected data included demographics, clinical practice variables and perceptions regarding telemedicine. Significance of associations and single survey items was evaluated by Chi-squared and z-score of proportions tests, respectively. The questionnaire was completed by 70 oculoplastic surgeons (54.3% male, mean age 47.3 years, median experience 10 years) from eight countries, practicing in various clinical settings (50.0% hospitals, 45.7% private clinics, 4.3% community clinics). Most respondents reported telemedicine to be an effective tool for oculoplastic consultations (67.1%, p = 0.004), while only 12.8% (p < 0.00001) had incorporated this modality into clinical practice prior to the pandemic. Even though a vast majority (98.6%) of participants had limited outpatient activity, most (55.7%) felt unprotected from the virus. Telemedicine had been incorporated by 70.5% (p = 0.001) of respondents during the COVID-19 pandemic, whereas most (57.1%) predicted continued use of the modality. Telemedicine can be effectively and rapidly incorporated into the clinical practice of oculoplastic surgeons during the COVID-19 pandemic. Further research into the most effective utilization of these platforms appears warranted.

Purpose: To report the intraoperative performance and postoperative outcomes of crystalline lens removal and in-the-bag intraocular lens (IOL) implantation with scleral-bag fixation by means of capsular tension segments (CTSs) and a capsular tension ring (CTR) in patients with a subluxated lens. Setting: Department of Ophthalmology, Shaare-Zedek Medical Center, Jerusalem, Israel. Design: Retrospective, consecutive case series. Methods: This study included patients with subluxated crystalline lens who underwent lensectomy or cataract extraction using an anterior chamber maintainer (ACM), a CTR, transscleral capsular-bag fixation by polytetrafluoroethylene suture with 2 CTSs, and in-the-bag IOL implantation. Outcome measures included intra- and postoperative complications, corrected distance visual acuity (CDVA), target and postoperative refraction, and IOL tilt. Results: 17 eyes (9 patients) were included, with a mean follow-up of 22.06 ± 14.88 months. There was a significant improvement in mean logMAR CDVA (P < .001), with 15 eyes (88.24%) achieving a Snellen CDVA of 20/30 or better and all eyes achieving 20/40 or better. The mean refractive spherical-equivalent prediction error was 0.07 ± 1.10 diopters (D), with 10 (58.82%) and 15 (88.24%) of eyes within ±0.50 D and 1.00 D, respectively, from the intended refraction. The mean horizontal and vertical tilts were 1.9 ± 2.6 degrees and 2.6 ± 2.1 degrees, respectively. No complications were observed except for 1 case of an intraoperative posterior-capsular tear. Conclusions: A comprehensive surgical approach for scleral-bag fixation that combines the use of an ACM, CTR, polytetrafluoroethylene sutures, 2 CTSs with in-the-bag IOL implantation, offers an effective strategy for achieving favorable visual outcomes and a low incidence of complications in patients with subluxated crystalline lenses.

Purpose: To report a case of late-onset interface fluid syndrome (IFS) after laser-assisted in situ keratomileusis (LASIK). Methods: A 94-year-old man was referred for evaluation because of persistent corneal edema 10 days after Descemet Stripping Automated Endothelial Keratoplasty (DSAEK) for pseudophakic bullous keratopathy. Results: After an uneventful DSAEK, the patient was treated with topical antibiotics and steroids. On presentation, a well positioned and oriented DSAEK graft was observed in the right eye, yet the cornea was edematous. Applanation tonometry was normal. Anterior-segment optical coherence tomography (AS-OCT) revealed a LASIK flap with a fluid cleft beneath it. Requery confirmed that LASIK was performed 21 years ago. Topical steroids were stopped, and after 2 weeks, the cornea was clear, and AS-OCT revealed complete resolution of the interface fluid. Conclusions: Even decades later, IFS should be considered as a source of corneal edema in patients after LASIK. Monitoring these patients with AS-OCT is recommended.

Background: Anterior blepharitis (AB) is a chronic eyelid inflammation with no definitive cure. Objectives: To assess the safety and efficacy of a 1% povidone-iodine (PVI) ophthalmic solution lid scrub compared to formulated eyelid wipes in treating AB. Design: A prospective, randomized, controlled, observer-masked, paired-eye trial. Methods: Sixty-three AB patients were randomly assigned to a 30-day treatment in which one eye underwent a daily lid scrub with 1% PVI solution (1% PVI group), while the fellow eye was treated with formulated eyelid wipes (control group). Clinical outcomes, such as blepharitis signs, tear breakup time, and corneal staining, were evaluated at study enrollment and exit visits. Symptom assessments utilized the visual analog scale (VAS) per eye and the ocular surface disease index (OSDI) questionnaire. Results: Fifty-two patients (mean age 62.3 years, 53.8% females) completed the treatment, while seven patients were lost to follow-up, three were non-compliant, and one sustained an eye trauma. After 30 days, both the 1% PVI and control groups exhibited significant improvements in symptoms, blepharitis signs, and corneal staining (p < 0.05). The 1% PVI scrubs were equally effective as eyelid wipes in most outcomes (p = 0.480) and superior in alleviating eyelid erythema (p = 0.007). Only the 1% PVI group showed a positive correlation between OSDI and VAS score improvements (r (52) = 0.353, p = 0.01). No adverse events related to either treatment modality were reported. Conclusions: A 1% PVI solution is an effective, safe, and well-tolerated treatment option for AB and is superior to formulated eyelid wipes in several subjective and objective measures.

Purpose: To demonstrate the noninferiority in antimicrobial effectiveness of thrice-repeated applications of 1% povidone–iodine (PI) compared with a single application of 5% PI on the ocular surface in vivo and to evaluate potential toxicity of PI to the corneal epithelium. Setting: Department of Ophthalmology, Shaare Zedek Medical Center, Jerusalem, Israel. Design: Prospective, randomized, double-blind study. Methods: Patients randomly received either a single application of 5% PI or repeated irrigations of 1% PI on the ocular surface preoperatively. Bacterial colony counts were quantitatively analyzed by taking standardized conjunctival swabs before and after irrigation, and differences in bacterial colony counts were compared between the 2 groups. The presence of superficial punctate keratopathy was evaluated in all patients by the National Eye Institute grading system. Results: The study comprised 102 eyes of 102 patients. Both 1% and 5% PI yielded a marked decrease in bacterial colonies compared with before application (P < .001). The repeated application of 1% PI showed a significantly lower bacterial count compared with the single application of 5% PI (P < .05) and resulted in significantly less damage to the corneal epithelium compared with a single 5% PI application (P < .001). Conclusions: Preoperative repeated applications of 1% PI effectively eradicated ocular surface bacteria equal to that of 5% PI with a less deleterious effect on the corneal epithelium. Our findings suggest that 1% PI may be a promising alternative to 5% PI.