PURPOSE: To assess the reliability of three different Scheimpflug systems and their agreement. METHODS: Eighty-four eyes of 42 patients were examined with three Scheimpflug devices: the Galilei G2 Dual Scheimpflug Analyzer (Ziemer Ophthalmic Systems AG, Port, Switzerland), Pentacam HR system (Oculus Optikgeräte GmbH, Wetzlar, Germany), and Sirius 3D imaging system (Costruzione Strumenti Oftalmici, Florence, Italy). The central corneal thickness, maximum anterior and posterior corneal elevation, anterior radius of curvature, total higher-order aberrations, and anterior chamber depth were evaluated. Repeatability and reproducibility were evaluated using coefficients of variation and intraclass correlation coefficients. Interdevice agreement was assessed by Bland–Altman comparison analysis. RESULTS: The three Scheimpflug systems had excellent repeatability for central corneal thickness, anterior radius of curvature, and anterior chamber depth (coefficients of variation being less than 1%). Repeatability for anterior and posterior corneal evaluation was good for the Pentacam HR and Galilei G2 (coefficients of variation < 10%) and excellent for the Sirius 3D (coefficients of variation = 0). Reproducibility was excellent in the three devices, (intraclass correlation coefficient of more than 0.9). Interdevice agreement was excellent ( P > .05) for anterior radius of curvature, central corneal thickness, and anterior chamber depth, but was poor ( P < .05) for corneal elevation and higher-order aberrations. CONCLUSIONS: Reliability was good to excellent in the three devices for all measured variables. Interdevice agreement analysis suggests that measurements for anterior radius of curvature, central corneal thickness, and anterior chamber depth, but not for maximum anterior and posterior corneal elevation and total higher-order aberrations, from the Sirius 3D and Galilei G2 can be interchangeable with the Pentacam HR. [ J Refract Surg. 2014;30(9):616–621.]

We describe a novel surgical technique for pterygium removal taking advantage of the properties of amniotic membrane and limbal epithelial stem cells. A total of 10 eyes underwent pterygium excision with amniotic membrane coverage of the bare sclera and placement of pieces of limbal epithelium in a linear fashion in the affected limbal area covered by a second amniotic membrane using fibrin glue. After up to 8 months of follow-up, there were no signs of early recurrence or sight-threatening complications. The minor ipsilateral simple limbal epithelial transplantation technique for the treatment of pterygium requires less tissue than the conventional conjunctival autograft, leaving healthy conjunctiva if needed for another procedure in the future and offers the advantages of epithelial stem cells, which in the long term may reduce the rate of recurrence significantly.

To report visual, refractive, and topographic outcomes of sequential, same-day small-incision lenticule extraction and intrastromal corneal collagen crosslinking (CXL) in eyes with mild keratoconus. Institute of Ophthalmology Conde de Valenciana, Mexico City, Mexico. Prospective interventional case series. Fifteen eyes with forme fruste keratoconus and/or irregular corneas, corrected distance visual acuity 20/40 or better, stable refraction of at least 1 year, age 18 years or older, and residual corneal thickness of greater tan 400 μm before performing collagen crosslinking were studied. Patients were treated with small-incision lenticule extraction followed by intrastromal injection of riboflavin inside the pocket. Ultraviolet A light with a wavelength of 370 nm to 3 mW/cm(2) was applied for 30 minutes. Follow-up was done at 1 day, at 1 week, and at 1, 3, 6, 12, 18, and 24 months. Eight patients were included in the study. The mean age was 29.5 years ± 5.5 (SD) (range 20 to 36 years). Twenty-four months of follow-up were completed in 13 eyes, and 12 months were completed in 2 eyes. Preoperative uncorrected distance visual acuity improved from 1.6 ± 0.3 LogMAR (Snellen 20/796) to postoperative 0.12 ± 0.20 LogMAR (Snellen 20/26) and was statistically significant (P < .001). Best-corrected distance visual acuity did not change significantly (P = .186), from 0.006 ± 0.02 LogMAR (Snellen 20/20) preoperatively to 0.04 ± 0.05 LogMAR (Snellen 20/21) postoperatively, and spherical equivalent improved from -4.3 ± 1.02 preoperatively to 0.2 ± 0.66 (P < .001). Although further follow-up and larger samples are needed to fully confirm these findings, the results suggest that combined small-incision lenticule extraction and intrastromal corneal collagen crosslinking are a promising treatment option for patients for whom conventional laser refractive surgery is contraindicated. Drs. Ramirez-Miranda and Navas are consultants to Carl Zeiss Meditec. No other author has a financial or proprietary interest in any material or method mentioned.

Purpose: To analyze some of the bioethical dilemmas that may arise during the process required for corneal transplantation. Methods: We conducted a narrative review based on the available literature and the experience of cornea specialists from 3 different countries. Results: Bioethical dilemmas related to informed consent for organ and tissue donation, allocation of corneal tissues, transplant tourism, corneal tissue exportation and importation, and for-profit eye banking were analyzed and discussed. Conclusions: Around the world, the number of required corneal transplants exceeds the number of donated corneas that are available and suitable for transplantation. This shortage of corneal tissue has led to the emergence of practices that may put the 4 basic principles of bioethics at risk: autonomy, beneficence, nonmaleficence, and justice. Therefore, it has been necessary to create ethical guidelines such as the Barcelona Principles and the World Health Organization Principles of Transplantation that attempt to regulate these practices.