Scleromalacia, in the form of scleral thinning, melting, and necrosis, is a potentially serious complication of pterygium excision. This study introduces a new biodegradable material, Ologen™ collagen matrix (OCM), to repair scleral thinning as an alternative to preserved scleral tissue, and evaluates the long-term outcomes of OCM for ocular surface reconstruction surgery. Two cases of possibly mitomycin C (MMC)-associated marked scleral thinning after pterygium excision with 0.02 % topical MMC for 2-weeks were included in this study. An OCM graft at the scleral thinning area and conjunctival autograft (CAU) were performed on both patients. The scleral defect size was measured and its margin was marked with a biopsy punch. The margin of the scleral thinning area was trimmed by Vannas scissors and the OCM was cut using a circular-shape biopsy punch of the same size. The OCM was sutured with a recipient scleral wall using 10–0 nylon interrupted sutures. Free CAU was harvested from the superonasal bulbar conjunctiva with a punch biopsy 1-mm larger in diameter than that of the OCM. The previously sutured OCM bed was covered with CAU and the graft was secured with 10–0 nylon interrupted sutures. Both patients were examined periodically for over two years by assessing graft thickness and surface vascularization using a slit lamp biomicroscope. Reepithelialization of the ocular surface was observed within three to six days after surgery. Ocular discomfort and inflammation ceased in both patients as the ocular surface quickly stabilized. The entire graft site remained intact and provided a good healthy ocular surface with fluorescein stain negative intact epithelium and good vascularization of grafted conjunctiva. Epithelial defects and scleral thinning did not recur in either patient over the two year follow-up period. For treatment of a possibly MMC-associated scleral necrosis following the surgical excision of the pterygium, an OCM graft with CAU is highly recommended for good clinical outcomes and low recurrence rates. With the clinical results of this study, the new biodegradable Ologen™ collagen matrix qualifies as an alternative treatment to scleral tissue for ocular surface reconstruction.

To compare clinical characteristics and antibiotic susceptibilities in patients with Pseudomonas aeruginosa (PA) and P. putida (PP) keratitis at a tertiary referral center in South Korea. Forty-nine cases of inpatients with culture-proven PA and PP keratitis were reviewed retrospectively between January 1998 and December 2017. We excluded cases of polymicrobial infection. Epidemiology, predisposing factors, clinical characteristics, antibiotic susceptibilities, and treatment outcomes were compared between the PA and PP groups. The risk factors for poor clinical outcome were evaluated on the basis of the total cohort and analyzed using multivariate logistic regression. A total of 33 eyes with PA keratitis and 16 eyes with PP keratitis were included. The mean age was 47.0 years in the PA group and 59.3 years in the PP group (p = 0.060). Differences were observed between the PA and PP groups in hypopyon (45.5% vs 6.3%, p = 0.006) and symptom duration (4.3 vs 9.5 days, p = 0.022). The most common predisposing factor for PA was wearing contact lenses (36.4%) and that for PP was corneal trauma (62.5%). No significant differences were observed in sex, previous topical steroid use, systemic disease, or duration of hospitalization between the two groups. The PA and PP groups both demonstrated good efficacy of colistin (both 100%), tobramycin (93.3%, 100%), ceftazidime (93.9%, 87.5%), and ciprofloxacin (96.6%, 87.5%). Imipenem (100% vs 81.3%, p = 0.030), piperacillin (96.6% vs 75%, p = 0.047), and ticarcillin (85% vs 0%, p < 0.001) showed significantly lower efficacy in the PP group than in the PA group. A poor clinical outcome was observed in 31.2% of the PA group and 37.5% of the PP group (p = 0.665). The risk factors for poor clinical outcome were previous ocular surface disease (odds ratio 10.79, p = 0.012) and hypopyon (odds ratio 9.02, p = 0.024). The PA group was more closely associated with younger age, wearing contact lenses, shorter symptom duration, and hypopyon, whereas the PP group was more closely associated with elderly age, corneal trauma, and decreased efficacy of the beta-lactams. Clinical outcomes were not significantly different between the two groups. Previous ocular surface disease and hypopyon were the risk factors for poor clinical outcome.

Background. The aim of this study is to analyze changing trends in isolated organisms and antibiotic resistance of bacterial keratitis (BK) over 26 years. Methods. A retrospective medical record review included 542 strains isolated from 462 BK patients between 1998 and 2023. We analyzed routinely generated in vitro antibiotic susceptibility testing results recorded in the laboratory information system and did not perform additional susceptibility testing for research purposes. The entire period was divided into two (first half: 1998–2010, 297 isolates from 255 patients; second half: 2011–2023, 245 isolates from 207 patients) and compared. Results. During the entire period, Staphylococcus spp. (32.3%) and Pseudomonas spp. (18.1%) were common isolates, and a significant increase in Acinetobacter spp. (1.3% vs. 10.6%, p < 0.001) was observed. Among Gram-positive bacteria, methicillin resistance rates remained stable between the two periods (52.6% vs. 46.7%, p = 0.525), and an increase in vancomycin-resistant Enterococci (VRE, 0% vs. 26.1%, p = 0.074) was found. Among Gram-negative bacteria (GNB), ciprofloxacin (7.5% vs. 14.4%, p = 0.108) and imipenem (2.9% vs. 6.5%, p = 0.255) resistance increased slightly, resistance to ceftazidime (8.3% vs. 8.8%, p > 0.999) was maintained, and resistance to aminoglycosides (17.8% vs. 7.2%, p = 0.010) decreased. Conclusions. Our study suggests that conventional topical fortified antibiotic eye drops (tobramycin, ceftazidime) can still be considered as an empirical treatment option for BK. However, our findings revealed a long-term trend of increasing Acinetobacter spp. and VRE, as well as a slight trend of increasing resistance to ciprofloxacin and imipenem in GNB, which may present future challenges in BK treatment.

Purpose: We compared corneal higher-order aberration (HOA) measurements between the Pentacam® HR (PC), which uses the Scheimpflug principle, and the iTraceTM aberrometer (IT), which evaluates Placido disc topography.Methods: We retrospectively analyzed 109 eyes of 87 patients without a history of ocular surface disease during the period from January 2021 to December 2022; both devices were used on the same day. We calculated the root mean square values (μm) of corneal total HOA and of the corneal 3rd- and 4th-order HOA at a pupil diameter of 4 mm. Data were compared by Bland-Altman plots for agreement analysis and Pearson correlation coefficient for correlation analysis.Results: There was no significant difference in the total HOA (p = 0.145), coma (p = 0.309), or secondary astigmatism (p = 0.080) between the PC and IT measurements; all other HOAs significantly differed between devices (p < 0.001). In the correlation analysis, the total HOA (r = 0.605, p < 0.001) and coma (r = 0.634, p < 0.001) were moderately correlated between the two devices; the other HOAs showed low degree of correlations. In the Bland-Altman plot analysis, all HOAs showed low agreement between the two devices.Conclusions: Corneal total HOA and coma measured by the two devices were significantly correlated between the two devices, but other HOAs showed significant differences in measurement and low correlations. Therefore, corneal HOA measurements cannot be interpreted interchangeably between the two devices.

Semaglutide, a glucagon-like peptide-1 receptor agonist, is increasingly used for obesity management; however, concerns have recently emerged regarding potential ocular adverse events, including nonarteritic anterior ischemic optic neuropathy (NAION). Herein, we report a case of NAION that developed after marked, rapid weight loss during semaglutide therapy in a young man with multiple vascular risk factors. A 42-year-old man presented with acute visual disturbance in the right eye after losing approximately 40 kg over 2 months while receiving semaglutide (Wegovy) for obesity treatment. The patient’s medical history included diabetes mellitus, hypertension, dyslipidemia, and a history of smoking. Ophthalmic examination revealed right optic disc edema and a corresponding inferior visual field defect. Magnetic resonance imaging and laboratory investigations revealed no other definite causes of optic neuropathy. He was diagnosed with NAION, which was temporally associated with semaglutide therapy and rapid weight reduction. Semaglutide was discontinued, and high-dose intravenous methylprednisolone was administered. At 6 months, the optic disc edema had resolved, leaving mild disc pallor, though the visual field defect persisted. Although causality cannot be established from a single case, this report highlights the need for clinical vigilance regarding optic neuropathy in patients receiving semaglutide, particularly in the setting of rapid weight loss.