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 compare the visual and refractive outcomes of breastfeeding versus non-breastfeeding women who underwent photorefractive keratectomy (PRK) surgery. Methods: In this retrospective study, medical files of women who underwent PRK surgery between January 2013 and December 2023 were reviewed. The patients were divided into two groups: women who reported breastfeeding during their screening examination and women who did not. Pre-, intra-, and post-operative parameters were compared between the groups. Results: The study included 12,843 eyes from 6,567 women, with 550 eyes from breastfeeding women. Time from screening to surgery was similar between groups (159.5 ± 412.5 vs. 142.8 ± 390.6 days, P = 0.331). Breastfeeding women were older (28.7 ± 4.8 vs. 25.6 ± 6.7 years, P < 0.001), had shorter follow-up (61.0 ± 72.9 vs. 70.6 ± 84.0 days, P = 0.008), higher keratometry (44.78 ± 1.49 vs. 44.55 ± 1.54 D, P < 0.001), worse myopia (SEQ −5.31 ± 2.54 vs. −4.65 ± 2.45 D, P < 0.001), and worse uncorrected visual acuity (UCVA: 1.3 ± 1.1 vs. 1.22 ± 1.05, P = 0.006) and best corrected visual acuity (BCVA: 0.04 ± 1.0 vs. 0.03 ± 1.0, P = 0.02). Postoperative UCVA (0.03 ± 0.85 vs. 0.04 ± 0.8) and BCVA (0.03 ± 0.89 vs. 0.03 ± 0.85) were similar. Breastfeeding was not linked to higher retreatment rates (P = 0.79). Multivariate analysis found no significant differences. Conclusion: Women who reported breastfeeding on average 5 months prior to surgery achieved visual and refractive outcomes comparable to non-breastfeeding women. PRK appears to deliver satisfactory results within the early postoperative period assessed in this study. Nevertheless, these exploratory findings do not establish long-term refractive stability and should not be interpreted as supporting a change in standard clinical counseling during lactation.

Purpose: To determine whether documented preoperative systemic isotretinoin exposure affects LASIK and PRK outcomes and complications. Setting: Care Vision Laser Center, Tel Aviv, Israel. Design: Retrospective comparative cohort study. Methods: Consecutive primary myopic LASIK and PRK procedures (January 2013 to June 2024), excluding retreated and monovision eyes, were reviewed. Exposure was ascertained from clinical notes and a preoperative medication questionnaire; patients whose exposure began after surgery were excluded. Exposed patients were propensity-score matched 1:4 to controls on age, sex, year of surgery, and preoperative spherical equivalent (SEQ), cylinder, and central corneal thickness. Outcomes were uncorrected (UDVA) and corrected (CDVA) distance visual acuity, SEQ, efficacy and safety indices, and documented complications. Results: Fifty patients (95 eyes) had documented preoperative exposure (LASIK, 11 patients/19 eyes; PRK, 39/76), matched to 200 control patients (388 eyes). The cessation-to-surgery interval was quantifiable in 39 patients (median, 95 days); 11 were operated 2 to 12 days after documented active use. No preoperative, intraoperative, or postoperative parameter differed between groups. Postoperative UDVA was 20/20 in both groups after LASIK and 20/22 versus 20/21 after PRK (adjusted difference, 0.015 logMAR; 95% CI, −0.016 to 0.045; P=0.35). No exposed eye lost a line of CDVA, documented complications did not differ, and outcomes did not vary across cessation strata. Conclusions: Outcomes of LASIK and PRK were comparable between eyes with documented preoperative isotretinoin exposure and matched unexposed eyes across all cessation intervals observed, including surgery within days of documented use. These preliminary findings warrant prospective confirmation with ocular-surface endpoints.

Purpose: CLCN2 is a gene that encodes the voltage-gated chloride channel protein 2 in the human brain and eyes. While mutations in this gene have been associated with leukoencephalopathy as well as ocular manifestations including optic neuropathy and choroidopathy, here we report for the first time a case of severe proliferative retinopathy in a patient with CLCN2 mutation. Observations: A 12-year-old girl with Familial Mediterranean Fever (FMF) was referred due to blurred vision in both eyes. Ophthalmoscopic examination revealed mild vitreous hemorrhage, large neovascularization at the disc (NVD), extensive neovascularization along the arcades (i.e., NVE; neovascularization elsewhere), retinal arteriolar narrowing, silver sheathing of the veins and preretinal hemorrhages. Fluorescein angiography (FA) demonstrated prominent leakage from multiple large NVEs. A thorough and multidisciplinary evaluation ruled out metabolic, thrombotic, infectious, inflammatory, or autoimmune etiologies. Notably, however, brain magnetic resonance imaging (MRI) revealed leukodystrophy yet poorly correlated with her clinical manifestation. Strikingly, whole exome sequencing uncovered a homozygous mutation in the CLCN2 gene. She was treated with intravitreal injections of the anti-vascular endothelial growth factor (VEGF) antibody Bevacizumab and laser pan-retinal photocoagulation (PRP) with partial response. Conclusions: This case suggests that CLCN2 mutation may possess a key role in an aggressive form of proliferative retinopathy with partial response to anti-VEGF therapy. We hypothesize that the potential underlying mechanism involves astrocyte dysfunction and retinal blood barrier disruption. Noteworthy, a comprehensive approach is unequivocally significant in evaluating such cases of proliferative retinopathy with unclear etiology to establish a diagnosis and management strategy.

Purpose: To evaluate the differences in hyperopic laser assisted in situ keratomileusis (LASIK) results between small, medium, and large cyclorotational angle degrees. Methods: This retrospective study included consecutive patients who underwent hyperopic LASIK between 2012 and 2023 at Care-Vision Laser Centers, Israel. Patients were divided into three groups according to their cyclorotation angle magnitude. A comparison of baseline and intraoperative parameters was performed. Refractive and visual outcomes were assessed, including Efficacy and safety indexes, and an Alpins vector analysis was performed. Multiple linear regression was performed to identify the effect of potential confounders. Results: Overall, 621 eyes of 428 patients were included. Mean age was 44.5 ± 12.6 years and 52.7% were female. Analysis indicated no significant differences in any of the visual and refractive outcomes including the calculated indexes. Alpins vector analysis showed no significant differences between the groups in any of the vectors either in size or magnitude, nor were there significant differences in the Alpins calculated indicators. Multi-linear regression for potential confounders suggested the preoperative axis had significant confounding association only with a null effect (β < 0.01, p = 0.03) on the Alpins index of success. Conclusions: Cyclorotational angle magnitude did not significantly impact visual or refractive outcomes in hyperopic LASIK performed using modern excimer laser systems with cyclorotation correction abilities. These findings suggest limited clinical relevance of cyclorotation degree in LASIK outcomes in this context, with other factors potentially playing a more significant role in surgical planning.