Background: Contact lens-assisted corneal cross-linking can be used to treat keratoconus in patients with thin corneas under measuring less than 400 µm. This study compares the long-term clinical and tomographic outcomes between accelerated corneal cross-linking (A-CXL) and accelerated contact lens-assisted corneal cross-linking (A-CACXL). Methods: Patients who underwent either A-CXL or A-CACXL protocol due to progressive keratoconus were enrolled in this retrospective cohort study conducted between January 2015 and December 2018. The control group (patients with minimum corneal thickness of at least 400 µm, comprising 32 eyes of from 32 patients) was treated with A-CXL, whereas the treatment group (patients that had minimum corneal thickness after epithelial removal below 400 µm; 30 eyes of from 30 patients) underwent the A-CACXL protocol. Clinical and tomographic data were obtained from a 3-year follow-up period. Results: At 3 years, both groups represented a significant gain in best-corrected visual acuity (from 0.32 to 0.18 LogMAR units for A-CXL, p = 0.001; from 0.51 to 0.33 LogMAR units for A-CACXL, p = 0.037). Furthermore, postoperative tomographic parameters (Kmax, Kmean, or corneal astigmatism) were comparable between the two protocols. Progression of keratoconus was halted among 87% of eyes in the A-CXL group and among 73% of eyes in the A-CACXL group (p = 0.2). Conclusions: A-CACXL treatment is an effective and safe option for patients with keratoconus and thin corneas, yielding long term outcomes comparable to those of A-CXL treatment for patients with a minimum corneal thickness of 400 µm following a 3-year follow-up.

Introduction: Staphylococcus-related marginal keratitis is an inflammation of the corneal periphery characterized by the presence of stromal infiltrates and blepharoconjunctivitis. Conventional treatment consists of antibiotics and corticosteroid eye drops, and recurrence is prevalent upon treatment cessation. In this case report, we present a 1-year follow-up of the results of a novel therapeutic approach for recurrent marginal keratitis using a combination of chlorhexidine and vancomycin eye drops. Case Presentation: A 34-year-old male presented with an 8-year history of recurrent staphylococcus-related marginal keratitis in his right eye, consisting of 5 acute episodes, which under a conventional treatment regimen resolved within 10–14 days. During the follow-up of his right eye, an inflammation in his left eye developed as well. Treatment with a combination of chlorhexidine at 0.02% and vancomycin at 50 mg/mL eye drops brought rapid resolution of the acute inflammation with preservation of the effect for at least 1 year. Conclusions: A combination of chlorhexidine and vancomycin eye drops may provide an effective treatment for marginal keratitis. It demonstrated rapid improvement and maintained long-term stability, with disease control observed throughout 1-year follow-up.

To compare the efficacy of two topical NSAID eye drops, Bromfenac and Nepafenac, in reducing postoperative pain following transepithelial photorefractive keratectomy (t-PRK). A total of 119 patients undergoing bilateral t-PRK were divided into three groups: Nepafenac (n = 40), Bromfenac (n = 40), or control (n = 39). Nepafenac 0.1% three times daily or Bromfenac 0.07% twice daily, initiated two days preoperatively and continued for three days postoperatively. The control group received systemic paracetamol (500 mg) and ibuprofen (150 mg) tablets as needed. Overall, both Nepafenac and Bromfenac groups showed significantly lower mean pain levels compared with control group (mean difference = -2.77; 95% CI: -3.63 to - 1.91; p < 0.001, and mean difference = -2.22; 95% CI: -3.01 to -1.43; p < 0.001, respectively). Bromfenac was significantly superior to control only on days 1, 3, and 4. No statistically significant difference in mean pain levels was observed between Bromfenac and Nepafenac groups (mean difference = -0.55; 95% CI: -1.45 to 0.35; p = 0.234). While Nepafenac showed better early symptom control in pain and discomfort (stinging, tearing and light sensitivity), particularly in the first two postoperative days, Bromfenac had a better effect on ocular discomfort in the later postoperative phase on days 4 and 5. Both demonstrated comparable overall tolerability compared to the control. Both Nepafenac and Bromfenac significantly reduced postoperative pain following t-PRK compared to systemic analgesia. These findings support the use of topical NSAIDs in optimizing post-PRK pain management.