Objectives: To analyze the outcomes and complications of Descemet‘s membrane endothelial keratoplasty (DMEK) performed without prophylactic peripheral iridotomy (PI). Methods: Design: Retrospective study. Setting: Institutional, tertiary care eye hospital. Study Population: All patients who underwent DMEK or DMEK combined with phacoemulsification (DMEK triple) for Fuchs endothelial dystrophy, using a standardized protocol between August 2016 and July 2021, were included. Previous glaucoma surgery, laser PI, aphakia, or complicated pseudophakia were excluded. Main outcome measures: Primary outcomes: Incidence of pupillary block (PB). Secondary outcomes: Graft detachment (GD), rebubbling rates, uncorrected (UCDVA) and best corrected logMAR distance visual acuity (BCDVA), and endothelial cell loss (ECL) at six months. Data were analyzed using the chi-square test and stepwise backward regression analysis. Results: 104 eyes of 72 patients were included. Four eyes (3.8%) developed PB; in two of these cases, standard protocol was not followed. Overall minor GD occurred in 43.2% (n = 45); significant GD was present only in 7 eyes (6.6%). Overall slit lamp rebubbling rate was 30% (n = 35), though only four patients were rebubbled in theatre (3.8%). PB, GD, and rebubbling rates did not vary with the surgeon, surgery, or tamponade (air or SF6 gas). UCDVA, BCDVA, and ECL at 6 months were 0.29 $\pm$ 0.31, 0.20 $\pm$ 0.28, and 40.46 $\pm$ 20.36%, respectively. Conclusions: Compared to previously reported outcomes of DMEK with PI, our results of PI less DMEK using a standardized protocol have a similar incidence of pupillary block, graft detachment, and rebubbling, with comparable visual acuity and endothelial cell loss.

Objectives: The aim of this study was to evaluate changes in corneal topography, wavefront aberrations, and densitometry after superficial keratectomy (SK) for Salzmann nodular degeneration (SND). Methods: This was an observational retrospective study. Pre- and post-operative data, including best spectacle-corrected visual acuity (BCVA), refraction, and Pentacam^® topography scans, were analysed. Changes in keratometry (K), wavefront aberrations, and corneal optical densitometry (COD) were evaluated. Results: A total of 21 eyes of 17 patients who underwent SK for SND were included. At an average follow-up of 6.3 ± 4.4 months, there was a significant reduction in RMS (root mean square) values for total wavefront aberrations after surgery (mean reduction: −3.89 ± 4.08 μm, p = 0.001), lower-order aberrations (mean reduction: −3.47 ± 3.52 μm, p = 0.001), and higher-order aberrations (mean: −0.42 ± 0.58 μm, p < 0.001). There was a significant improvement in BCVA (mean change: 0.27 ± 0.31 logMAR, p < 0.001) and spherical equivalent (mean change: −2.09 ± 2.73 D, p = 0.002), and a reduction in refractive cylinder (mean reduction: −0.85 ± 1.14 D, p = 0.008). There was a significant reduction in corneal astigmatism (mean reduction 1.04 ± 2.88 D; p = 0.041), and an increase in flat keratometry (mean change 1.46 ± 3.10 D; p = 0.029). Lastly, there was a significant decrease in total COD values in all zones except for the central 2 mm (p < 0.05) and in the overall total 12 mm cornea (p = 0.035). Conclusions: SK for SND resulted in better visual acuity and potentially improved quality as suggested by the reduction in corneal aberrations and improvement in corneal regularity and transparency.

To the Editor I read with interest the assessment of the environmental impact of the face-to-face (FTF) vs virtual annual meeting of the American Academy of Ophthalmology (AAO) by McClintic and Stashevsky.¹ Measuring and understanding our individual carbon footprints is imperative to begin the journey to carbon neutral by the second half of this century, as highlighted in the Paris Agreement from the UN Climate Change Conference in 2015. However, I believe that to develop a true understanding of the benefits, or otherwise, of FTF vs virtual meetings, then a full comparative analysis of the 2 meeting types should be considered.