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.

Background and Clinical Significance: To report a case of bilateral sterile intraocular inflammation following intravitreal aflibercept 8 mg (Eylea HD) injections. Case Presentation: An 89-year-old woman with bilateral neovascular age-related macular degeneration (nAMD) developed blurred vision and mild ocular pain in both eyes four days after receiving aflibercept 8 mg injections in both of her eyes. Examination revealed a marked anterior chamber reaction with Descemet’s folds, 2+ vitreous cells, and 3+ vitreous haze bilaterally. Intraocular pressures were normal, and B-scan ultrasonography confirmed attached retinas with bilateral vitreous opacities. The clinical presentation initially raised concern for infectious endophthalmitis; however, the bilateral presentation, quiet conjunctivae, and prior history of sterile inflammation after aflibercept 2 mg supported a diagnosis of sterile intraocular inflammation. The patient was hospitalized and treated with intensive topical corticosteroids, antibiotics, and cycloplegics, resulting in rapid improvement and complete resolution of symptoms within four days with recovery of baseline vision. Conclusions: Intravitreal aflibercept 8 mg can be associated with bilateral sterile intraocular inflammation, even in patients who previously tolerated standard-dose aflibercept. Awareness of this potential adverse event is essential to avoid unnecessary interventions and to guide appropriate management.

Purpose: While patients with cardiovascular comorbidities are at a higher risk for the occurrence of non-arteritic anterior ischemic optic neuropathy (NAION), it is unclear whether adherence to medication results in risk reduction. The purpose of this study was to investigate whether nonadherence to medical therapy for cardiovascular morbidity correlates with a higher risk for NAION when compared to patients with strict adherence. Methods: A retrospective case-control study was conducted among members of Clalit Health Services in Israel from 2001 to 2022. For each of the 757 NAION cases, three controls (totaling 2271 patients) were matched based on birth year and sex, with a propensity score analysis employed to adjust for a range of comorbidities. A patient was deemed nonadherent with medical treatment if their purchased quantity of medication was less than 60% of the prescribed annual dosage. Mixed models were used to evaluate exposure differences, and conditional logistic regression was applied, incorporating adjustments for socioeconomic status and ethnicity, to examine the impact of medication nonadherence on NAION risk. Results: A total of 3028 patients were included in the study; 757 patients with the diagnosis of NAION and 2271 in the matched control group. The average age of NAION patients was 69 ± 9 years and 55% were male. After adjustments for socioeconomic status and ethnicity, nonadherence to calcium channel blockers (CCBs) (odds ratio [OR]: 1.33, 95% confidence interval [CI]: 1.03–1.71) and anti-arrhythmic (OR: 5.67, 95% CI: 1.89–21.2) medications emerged as significant risk factors. Similarly, nonadherence to cardioprotective medications (OR: 1.46, 95% CI: 1.23–1.74) was also identified as a significant risk factor. Conclusions: Nonadherence to treatments for cardiovascular disease, specifically to medications known to improve prognosis, is associated with a higher risk for NAION.

Objective: To investigate whether maternal diabetes during pregnancy is associated with increased risk of strabismus and refractive errors (RE) in their offspring. Methods: This retrospective cohort study utilized electronic medical records from Clalit Health Services (CHS) in Israel, 2001–2023. Births were categorized by maternal diabetes type (type 1, type 2, or gestational) or no diabetes. Mixed models compared demographics and ocular conditions, including RE and strabismus, while generalized estimating equations calculated odds ratios adjusting for confounders. Results: A total of 505 928 maternal and offspring records were analyzed. Strabismus prevalence was 496 (2.0%) in children of diabetic mothers versus 7346 (1.5%) in those of non‐diabetic mothers (odds ratio [OR] 1.29, 95% confidence interval [CI]: 1.18–1.42), and remained significant after adjustment (OR 1.40, 95% CI: 1.27–1.55). In children of mothers with HbA1c >6.5%, strabismus prevalence was 49 (2.9%) compared to 7793 (1.5%) with HbA1c ≤6.5% (adjusted OR 1.78, 95% CI: 1.30–2.43). RE prevalence was 753 (3%) among offspring of diabetic mothers versus 10 785 (2.2%) among non‐diabetic mothers (OR 1.34, 95% CI: 1.24–1.44), with maternal diabetes remaining significantly associated with RE after adjustment (OR 1.61, 95% CI: 1.48–1.74). In the HbA1c >6.5% group, RE prevalence was 71 (4.2%) versus 11 467 (2.3%) with normal HbA1c (adjusted OR 1.97, 95% CI: 1.54–2.53). Conclusion: Maternal diabetes during pregnancy is associated with strabismus and RE in the offspring, with higher risk with high HbA1c levels.