Moderator
Ramy A Elbassiouny, PhD, MRCSEd
Panelists
Masih U Ahmed, MD, ABO
Marisa Schoen, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
John W Josephson, MD, ABO
Co-Authors
Karanveer Saini BA
Purpose
To evaluate infection control protocols for office-based surgery (OBS) suites compared to other surgical settings. The objective is to provide insights and practical recommendations that can be adopted by other OBS centers.
Methods
A retrospective analysis of our OBS center�s infection control protocols on 1,300 cases with surgical streaming. Procedures included cataract surgery, pterygiums, blepharoplasty, CTAK, Intacs, CXL, and other anterior segment procedures. Critical protocols included preoperative administration of antibiotic eye drops, cleansing of the eye and surgical site with betadine, and the use of sterile technique throughout the procedure. Data on patient outcomes, infection rates, and any complications was collected and analyzed to assess the effectiveness of these protocols.
Results
Over a two-year period, all 1,300 surgeries had a zero-infection rate, with no reported cases of endophthalmitis or other surgical site infections. These results match or exceed safety outcomes in other settings. A large contributor to our infection control is patient education. Patient were given guidelines for cleaning their eye after the surgery and given set schedules to take post-operative drops.
Conclusion
The implementation of infection control protocols is critical to maintaining a zero-infection rate in an OBS setting. These findings highlight that OBS facilities adhere to the same ophthalmic safety standards, protocols, sterility, and infection control as an ASC or HOPD.
Presenting Author
Alexander I. Movshovich, MD, ABO
Co-Authors
Alexey Gokadze MBBS, Vladimir Ilnitskiy MBA, BA
Purpose
To comprehensively assess results of 72 cases of Keratopigmentation (KTP) assisted with Femto Second Laser performed on patients after previously performed LASIK.
Methods
This is a four-year retrospective analysis of 72 patients, who underwent KTP assisted with Femto Second Laser after LASIK performed 1-20 years before KTP. In these series female was 81%, male -19%. Age distribution 23 to 61 y.o. Intracorneal channel was formed by a femtosecond laser (Visumax 500), using modified Intracorneal Ring protocol. Pigment of choice (Biochromaeyes Biotic Focea France) was introduced into the channel with special instruments. All procedures were video/photo registered. Patients received a questionnaire, depicting the post operative course.
Results
One case was aborted. 3 cases with minor lifting of the flap were completed. All patients were reexamined the next day; 19 followed in 3 -24 months; 8 had pigment under the flap on OCT, (5 biomicroscopically not apparent. 3 had pigment beyond the channel without vision change). 25 patients responded to the questionnaire: 71% felt the recovery was easy, 86% - didn�t have night vision change, 37% - didn�t have dryness, 35% had new dryness (half resolved over 6 months,, full recovery within a month in 85%, 20% had minor light sensitivity after 1 month. 95% of reexamined patients maintained uncorrected vision. 100% retained preoperative best-corrected vision
Conclusion
� KTP is more challenging after LASIK and requires special instruments and technique. � Uncorrected visual acuity remained the same in 95%. � There was no change in night vision in 85% � There is a higher rate of side effects in the eyes after LASIK � New dryness appeared in 25% and preexisting dryness exacerbated in 23%
Presenting Author
Sam Garg, MD, ABO
Co-Authors
Christina Fleming BSc, Noelia Kunzevitzky PhD, Roger Goldberg MD, MBA, Jeffrey Goldberg MD, PhD, William Culbertson MD
Purpose
To evaluate the safety of a single intracameral injection of magnetic human corneal endothelial cells (EO2002) with and without endothelial brushing (EB) or Descemet stripping (DS) in subjects with corneal endothelial dysfunction. Secondary objectives assessed best-corrected visual acuity (BCVA) and central corneal thickness (CCT).
Methods
Prospective study of 42 eyes receiving an injection of EO2002 followed by brief placement of an external magnetic patch, allowing rapid return to normal activities. The first 21 subjects were enrolled in an open-label, dose-escalating study design across four doses (50k, 150k, 500k, or 1M cells; Group 1). Of those, 9 subjects received EO2002 with EB or DS, and 12 subjects received EO2002 injection without surgery. The next 21 subjects (Group 2) were enrolled in a randomized, double-masked study across three doses (150k, 500k, or 1M cells). CCT was assessed by ultrasound pachymetry and anterior segment OCT, and BCVA was tested by ETDRS.
Results
All 42 planned subjects were successfully enrolled and treated with EO2002. Amongst all subjects in data collected to date, there were no product-related serious adverse events and no significant IOP elevation or inflammation. In Group 1, subjects that underwent EB or DS experienced a slower recovery than the non-surgical, cell-injection-only arm. Additional unmasked data on Group 2 subjects� outcomes will be presented.
Conclusion
Magnetic corneal endothelial cell therapy is safe and demonstrates strong evidence of efficacy. Patients with corneal edema who are candidates for endothelial keratoplasty now have a minimally invasive alternative that can be done in the clinic with a short recovery time.
Presenting Author
Zhanyu Su, MD
Co-Authors
Kangjun Li MD, Yuexi Chen PhD, Jianing Gu MSc
Purpose
This study explores the ex-vivo release characteristics and biocompatibility of decellularized corneal stromal lenticule lenses (dfLENs) as scaffolds for delivering the immunosuppressant drug rapamycin (RAPA).
Methods
dfLENs were prepared through decellularization using hypertonic saline and nucleases. RAPA, dissolved in deep eutectic solvents (DESs), was loaded into these dfLENs. High-performance liquid chromatography (HPLC) analyzed the release kinetics of RAPA from dfLENs. Co-cultivation with corneal stromal cells assessed the biocompatibility of the drug-loaded lenses. The mechanical properties were evaluated using uniaxial tensile tests to measure stress-strain and calculate the modulus of elasticity at physiological maximum strain. Transparency was quantified using a multifunctional spectrophotometer.
Results
Ex-vivo studies showed rapid release of RAPA within the first week, with 58.1 � 13.2% released on the first day and 78.6 � 10.6% by the seventh day, continuing through the 21st day. Lenses loaded with 3% RAPA concentration inhibited cell growth, while those with concentrations below 1% showed no cytotoxicity and high biocompatibility. The modulus of elasticity of the drug-loaded lenses was 8.76 � 2.13 at 0.03 physiological maximum strain, superior to that of corneal stromal lenses (4.83 � 2.95, P < 0.05). There was no significant difference in transparency between the drug-loaded lenses and both normal lenticules and dfLENs.
Conclusion
The dfLENs can release the drug RAPA for at least 21 days ex-vivo, display excellent biocompatibility, and maintain transparency, with superior biomechanical properties. These dfLENs are promising as drug carriers, and the development of RAPA-loaded dLENs has potential clinical applications for anti-inflammatory and anti-immune rejection therapies.
Presenting Author
Imane Tarib, MD
Co-Authors
Ellen Koo MD, Sarah Pajek MA, BSc, Andrea Santiago Leon MD
Purpose
To evaluate progression of corneal opacities in patients using topical Losartan by using analyzing changes in corneal densitometry throughout the course of the treatment.
Methods
We conducted a prospective study involving all patients presenting with corneal scars or haze at our facility who were treated with topical Losartan, administered six times daily, and followed for a minimum of six months. Slit lamp photographs and corneal densitometry measurements were taken for all patients. We analyzed the changes in densitometry values within the areas of corneal opacity.
Results
We included 14 patients in this prospective study. Seven eyes have completed the course of 6 months of treatment with imaging pre and post-treatment available. Indications ranged from post-LASIK scar/haze, post-HSV keratitis scar, post-fungal keratitis scar. Two patients did not have visual improvement, the remaining had an average of 2 lines of visual acuity improvement. Mean total densitometry pre-Losartan was 38.5% and pos-Losatran 38.4%.
Conclusion
Corneal Densitometry is a great objective tool to assess improvement in corneal scar. It is helpful for patient education as well as treatment follow-up. Larger studies with longer follow-up are necessary to assess statically significant improvement in corneal densitometry after use of Losartan eye drops for corneal haze and scarring.
Presenting Author
Rachana P Shah, MBBS, MS
Co-Authors
Ritika Mukhija MBBS, MD, FRCOphth, Mayank Nanavaty DO, MBBS, FRCOphth
Purpose
To study corneal epithelial thickness changes in both affected and fellow eyes of patients with post-traumatic recurrent corneal erosion (RCE) and compare these with healthy age-matched controls.
Methods
This is a retrospective observational study. Patient with traumatic RCE during a 3-year period were included. Corneal epithelial thickness data was obtained from high-resolution spectral domain OCT (Solix, Haag-Streit, Germany) at the follow-up visit in cornea clinic when the erosion had healed. Data was recorded for affected (Group 1) and fellow eye (Group 2) and also for healthy age- matched controls (Group 3). Comparison was made between the two and epithelial maps of healthy age matched controls. Primary outcome measure was �E- SD� which indicates variation in epithelial thickness (ET). Secondary outcome measures were central ET (ET_C), minimum ET (ET_min) and maximum ET (ET_max).
Results
30 cases and 15 age-matched healthy controls were included. Those with pre-existing corneal dystrophies were excluded. E-SD was 4.53�2.01 �m, 2.83�1.19 �m and 1.75�0.49 �m in Groups 1, 2, and 3 respectively and showed statistically significant difference (P<0.01). et_c,="" et_min="" and="" et_max="" were="" 56.63�7.36="" �m,="" 55.23�9.42="" �m="" and="" 65.43�11.17="" �m="" in="" group="" 1;="" 49.33�6.44="" �m,="" 46.1�6.15="" �m,="" and="" 62.26�9.33="" �m="" in="" group="" 2;="" and="" 54.8�9.86="" �m,="" 62.27�9.97="" �m,="" and="" 52.89�2.47="" �m="" in="" group="" 3.="" no="" significant="" differences="" were="" found="" for="" et_c="" and="" et_min="" (p="0.07" &="" p="0.08)," but="" et_max="" differed="" significantly="" (p="0.03);" with="" significant="" difference="" between="" groups="" 1="" &="" 3="" (p="0.01)" and="" 2="" &="" 3="" (p="0.05)after" a="" post="" hoc="">
Conclusion
We report epithelial thickness changes for the first time in traumatic recurrent corneal erosion. Maximum epithelial thickness and variation were highest in affected eyes, but even fellow eyes had significantly higher values than controls. This may indicate a predisposition to RCE post-trauma. Prospective studies are needed to explore this further.
Presenting Author
Daniela E. Gomez-Elizondo, MD
Co-Authors
Erik Navas Villar MD, Nora Robledo OD, Ivonne Curiel Arce MD, Arturo Chayet MD
Purpose
This study aims to obtain the corneal epithelial thickness mapping in healthy patients at three different times throughout the day, using anterior segment swept-source OCT.
Methods
This prospective study enrolled 25 patients (50 eyes) undergoing routine eye exams. Patients with dry eye symptoms were excluded. Epithelial corneal thickness was measured using anterior segment swept-source optical coherence tomography at 8 AM, 1 PM, and 6 PM daily. Statistical analysis was performed to evaluate the changes in epithelial thickness across the different times of the day and to determine the significance of any observed variations.
Results
Twenty-five healthy patients (50 eyes) were enrolled, including 21 females and 4 males, with a mean age of 33.08 � 10.13 years. K1 was 42.89 � 1.36 D at 8 AM and 42.92 � 1.35 D at 6 PM (p = 0.1). K2 was 44.16 � 1.53 D at 8 AM and 44.18 � 1.50 D at 6 PM (p = 0.464). The mean superior epithelial thickness was 48.95 � 4.51 �m at 8 AM and 47.09 � 3.18 �m at 6 PM, with a mean difference of 1.86 �m (p < 0.001). Inferior epithelial thickness was 51.68 � 4.44 �m at 8 AM and 50.68 � 3.53 �m at 6 PM, with a mean difference of 1.0 �m (p = 0.001). The difference between the superior and inferior quadrants was statistically significant at both 8 AM (-2.06 �m, p < 0.001) and 6 PM (-2.89 �m, p < 0.001).
Conclusion
There was a statistically significant difference in epithelial thickness between the superior and inferior quadrants. No difference in keratometry was observed throughout the day. Epithelial thickness decreased during the day, particularly in the superior quadrant, with a mean reduction of 1.86 �m.
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