Topic: Topical nonsteroidal anti-inflammatory drugs (NSAIDs) for management of pain in patients after photorefractive keratectomy (PRK). Clinical Relevance: Pain after PRK is a major concern for both patients and surgeons. Although evidence supports the use of NSAIDs postoperatively, no consensus exists regarding the preferred regimen. The study aimed to compare the efficacy and safety of different topical NSAIDs. Methods: This study was prospectively registered with PROSPERO (ID: CRD42023417651). A systematic search of electronic databases was performed, for randomized controlled trials reporting topical NSAIDs' outcomes of corneal re-epithelization, rescue analgesics intake, and pain in days 0 to 3 after PRK (postoperative days [PODs] 0 to 3). Studies were graded for risk of bias. Data were extracted, and standardized mean differences (SMDs) were evaluated in a network meta-analysis in accordance with the Cochrane's guidelines, to which a frequentist approach model was fitted. Transitivity was assessed using the net split method. Treatment effectiveness was ranked using forest plots based on comparison with placebo. P-scores (P) and league tables were used to examine combined direct and indirect comparisons. Results: Of 1540 studies identified, 27 were included. These encompassed 2286 patients across 11 countries, evaluating 7 distinct topical NSAIDs. At POD0, ketorolac (P 0.764), flurbiprofen (P 0.763), and bromfenac (P 0.717) were the most efficient drugs overall and displayed significantly lower pain scores than placebo. Other than that, flurbiprofen held the highest rank for reported pain throughout, significantly outperforming placebo on POD1 (P 0.874, SMD −1.19, 95% CI −1.86 to −0.52), POD2 (P 0.882, SMD −1.05, 95% CI −1.82 to −0.27), and POD3 (P 0.939, SMD −1.14, 95% CI −2.1 to −0.18). Other NSAIDs were significantly better than placebo only on POD1 and POD0. Rescue analgesic intake analysis favored indomethacin (P 0.834, SMD −0.8, 95% CI −1.33 to −0.27), ketorolac, and diclofenac. Compared with placebo, re-epithelization was slowed to different significances with all NSAIDs but flurbiprofen (P 0.991, SMD −0.7, 95% CI −1.38 to −0.03). Conclusions: Flurbiprofen was favorable in pain scores on typically painful postoperative days and re-epithelization times. However, analgesics intake, a more objective outcome, suggested superiority of other NSAIDs. Inconsistencies may be explained by the small sample size. For clinical interpretation, NSAID effect sizes should be taken into consideration.

Background/Objectives: To compare the visual and refractive outcomes of myopic patients undergoing high astigmatic photorefractive keratectomy (PRK) surgery with and without pupillary decentration of treatment. Methods: In this retrospective study, we reviewed the medical records of myopic patients who underwent PRK surgery for high astigmatism (>3 diopters [D]) between January 2013 and December 2023. The patients were divided into two groups based on whether the surgeon applied pupillary decentration during surgery. Preoperative, intraoperative, and postoperative parameters were compared between the groups. Adjustments were made to account for differences in baseline characteristics and intraoperative parameters. Results: Overall, the study included 575 eyes from 414 patients, of which 79 eyes were treated with pupil decentration. The pupil-decentered group exhibited significantly preoperative higher myopia (subjective spherical equivalent (SEQ) of −5.30 ± 3.12 D vs. −4.26 ± 2.45 D, p < 0.001) and subjective sphere (−3.40 ± 3.13 D vs. −2.31 ± 2.49 D, p < 0.001). Visual and refractive outcomes, including uncorrected visual acuity (UCVA) of logMAR 0.11 ± 0.77 vs. 0.09 ± 0.72 (p = 0.302), best-corrected visual acuity (BCVA) of 0.07 ± 0.92 vs. 0.07 ± 0.82 (p = 0.982), SEQ (−0.33 ± 0.93 vs. −0.19 ± 0.60D, p = 0.094), sphere (0.02 ± 0.98 vs. 0.15 ± 0.67 D, p = 0.142), cylinder (−0.71 ± 0.48 vs. −0.70 ± 0.55 D, p = 0.894), safety index (1.07 ± 0.27 vs. 1.12 ± 0.31, p = 0.236), and efficacy index (0.99 ± 0.31 vs. 1.07 ± 0.35, p = 0.065), showed no significant differences between the two groups. Postoperative outcomes remained comparable after adjusting for baseline and intraoperative parameters. Conclusions: Our findings suggest that, in myopic patients undergoing high-astigmatic PRK surgery, pupil decentration does not lead to superior postoperative visual and refractive outcomes. This highlights that, in this scenario, surgeons can preserve the efficacy and safety of the procedure even without applying pupil decentration.

Purpose: To evaluate real-world visual and refractive outcomes in the Diabetes Mellitus (DM) population. DM may impair corneal healing and neurosensory function, often serving as a relative contraindication for laser vision correction (LVC). This study evaluated visual and refractive outcomes of photorefractive keratectomy (PRK) and laser-assisted in situ keratomileusis (LASIK) in adults with controlled DM compared to healthy controls and compared the two techniques within the diabetic cohort. Setting: Care Vision Laser Center, Tel Aviv, Israel. Design: Retrospective comparative study. Methods: This retrospective study (2013–2024) included consecutive primary PRK or LASIK procedures in adults with controlled DM (HbA1c <8.0%, no worse than mild NPDR, no diabetic macular edema) and healthy controls. Eyes were propensity-matched on baseline characteristics. Outcomes included refractive and visual measures and complications (retreatment, dry eye, glare, infectious keratitis, haze, epithelial ingrowth, DLK). Results: After matching, 784 myopic PRK eyes (158 DM), 471 myopic LASIK eyes (96 DM), 123 myopic DM eyes (86 PRK; 37 LASIK), and 611 hyperopic LASIK eyes (31 DM) were analyzed. Mean follow-up was approximately 3–5 months. Generalized Estimating Equations (GEE)-adjusted analyses showed no significant differences in visual, refractive, or complication outcomes between DM and controls for myopic PRK or LASIK. Within the diabetic population, PRK and LASIK outcomes were comparable. Hyperopic LASIK outcomes were similar, though DM patients showed a higher retreatment rate. Conclusions: In carefully selected adults with controlled DM, both PRK and LASIK yielded comparable safety and visual outcomes to controls. These findings suggest LVC is viable for this population and that current guidelines may be overly conservative.

Purpose: To review the efficacy and safety of oral doxycycline antibiotics versus topical macrolides in the treatment of meibomian gland dysfunction (MGD). Design: Systematic review and meta‐analysis. Methods: A comprehensive search of PubMed, Scopus, Embase, and ClinicalTrials.gov through December 2024 identified randomised controlled trials (RCTs) comparing oral tetracyclines with topical macrolides for MGD. Eligible studies reported outcomes related to tear film stability, meibomian gland function, ocular surface health, or symptom severity. Data extraction followed PRISMA guidelines and risk of bias was assessed using Cochrane methods. Results: Among 3699 publications (1964–2024), six RCTs from distinct locations (374 patients) met inclusion criteria, describing only topical azithromycin and oral doxycycline. Treatment regimens were comparable: one month of topical azithromycin (1–1.5%, once to four times daily) versus three to 8 weeks of oral doxycycline (100–200 mg daily). Both treatments significantly improved MGD signs and symptoms. In pooled analyses, topical azithromycin showed superiority in reducing tear debris (odds ratio [OR], 0.33; 95% confidence interval [CI], 0.15–0.74); however, while the total symptoms score favoured azithromycin, the result was borderline (OR, 0.62; 95% CI, 0.38–1.00) and sensitivity‐dependent. Subgroup analysis showed doxycycline was superior for corneal fluorescein staining (standardised mean difference [SMD], 0.64; 95% CI, 0.22–1.05), whereas 1% azithromycin was superior for tear breakup time (mean difference [MD], −1.40; 95% CI, −2.20 to −0.60) and dropout‐causing adverse events (risk ratio [RR], 0.07; 95% CI, 0.01–0.49). Conclusions: Both topical azithromycin and oral doxycycline are effective for MGD management. Topical azithromycin demonstrated a more favourable safety profile and may represent a useful therapeutic option, particularly for patients with low tolerance to systemic medications. However, further high‐quality studies are needed to strengthen the evidence base.