Moderator
Yousuf Khalifa, MD
Panelists
Albert Y. Cheung, MD
Olivia L. Lee, 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
Emine Esra Karaca, MD
Co-Authors
Yonca Asfuroğlu MD, FEBO, Döndü Melek Ulusoy MD, Ayça Bulut Ustael MD, Feyza Dicle Işık MD, Ozlem Evren Kemer MD
Purpose
This study aimed to compare the clinical efficacy of the Sub400 protocol and contact lens-assisted corneal crosslinking (CL-CXL) in treating keratoconus patients with thin corneas (<400 micron).
Methods
The study evaluated 22 eyes from 21 patients in the contact lens-assisted group and 49 eyes from 38 patients in the Sub400 group, with a follow-up period of 1 year. Parameters analyzed included age, gender, intraoperative central corneal thickness, UV-A duration, 1st-month demarcation line (DL) depth, pre- and postoperative 12th-month endothelial cell density (ECD), best corrected visual acuity (BCVA), and topography parameters (Kmean anterior, Kmean posterior, Kmax, central corneal thickness, thinnest corneal thickness, and astigmatism). The primary outcomes measured were the cessation of keratoconus progression at 12 months postoperatively and DL depth at 1 month.
Results
No significant differences were observed between the two groups in Kmax, Kmean, BCVA, central and thinnest corneal thickness, ECD, and topographic astigmatism changes (p > 0.05). The mean DL depth was 266.87±49.03 µm in the Sub400 group and 294.86±46.69 µm in the contact lens-assisted group, with a significant difference noted between the groups (p = 0.027). Progression occurred in 3 of 49 eyes (6.1%) in the Sub400 group and in 1 of 22 eyes (4.5%) in the contact lens-assisted group (p = 0.791).
Conclusion
We observed a deeper DL in the contact lens-assisted CXL group. The presence and depth of the demarcation line, measured one month post-treatment, indicate that both methods are safe for patients. The findings suggest that both the Sub400 protocol and CL-CXL are effective treatment options for keratoconus patients with thin corneas
Presenting Author
Anuradha Ondhia, OD
Co-Authors
Ike Ahmed FRCSC, MD, Mohammed Ghanbarnia BSc
Purpose
To assess and compare the visual and refractive outcomes of the Clareon Vivity (hydroxyethyl methacrylate) and Acrysof Vivity (phenylethyl methacrylate) IOLs following bilateral implantation in patients undergoing cataract surgery.
Methods
This is a prospective,randomized, double-masked,comparative study on adults 45+ with bilateral cataracts (graded 2 to 3). Patients must have minimum visual potential of 20/25 monocularly and otherwise clear media. Routine bilateral small incision lens removal was performed a max of 2 months apart, targeting –0.50 D in the non-dominant eye. Outcome measurements at 3-month: binocular mesopic and photopic CS without glare and mesopic CS with glare(CSV 2000); binocular target corrected and UCVA at distance, intermediate (66cn) , and near (40 cm)in photopic conditions. Further outcomes: patient reported outcomes (using QUVID© and IOLSAT©) to evaluate visual disturbances and patient satisfaction.
Results
TBD
Conclusion
TBD
Presenting Author
Ji-Eun Lee, MD
Co-Authors
Kwang Eon HAN MD, Seungahn Yang MD, So-Hyang Chung MD, PhD
Purpose
This study compared the anti-pseudomonal effects between nephrite-impregnated contact lenses (CLs) and conventional and cosmetic CLs
Methods
After inoculating the lenses with a standardized Pseudomonas aeruginosa strain, three types of contact lenses were assessed: nephrite-impregnated, conventional, and cosmetic. We performed a quantitative assessment of bacterial adhesion using viable cell count techniques. The lens surface characterization involved atomic force microscopy (AFM) and scanning electron microscopy (SEM) for detailed topographical analysis and bacterial attachment patterns. The safety evaluation in rabbits examined parameters such as corneal clarity, thickness, and endothelial cell count over time, providing a thorough assessment of biocompatibility and safety.
Results
Both conventional and cosmetic CLs (n=258±2.9×104, 368±2.2×104) showed significantly decreased number of attached bacteria when compared with those without nephrite impregnation (n=134±0.8×104, 238±2.5×104, p<0.0001, respectively). AFM and SEM revealed that P. aeruginosa was less attached to the nephrite-impregnated CLs than to the conventional and cosmetic CLs, although those with nephrite impregnation had rougher surface. In the safety test, there were no significant differences in the findings between four groups, and the clarity and stability of all corneas were preserved.
Conclusion
Nephrite may be used as a next-generation substance to reduce infectious keratitis caused by P. aeruginosa when added to CLs.
Presenting Author
John A. Hovanesian, MD, FACS
Co-Authors
Gregg Berdy MD, Robert Sorenson PhD, MD
Purpose
In patients with dry eye, this study evaluated the effect of cyclosporine 0.09% (Cequa, Sun Pharma) starting at 7 days on higher order aberrations (HOAs), corneal staining, best corrected visual acuity (BCVA), symptoms (SPEED scores), tear breakup time (TBUT), and conjunctival redness (Schulze scale).
Methods
This was a multicenter, prospective, open label, self-controlled, single group study of the efficacy of cyclosporine 0.09%in improving the above measures in patients with dry eye, defined as positive corneal staining and a reduced tear breakup time. All patients received cyclosporine 0.09% for 4 weeks and were evaluated at baseline (before treatment) and at 7, 14, and 28 days.
Results
Forty-six patients completed all visits. HOAs improved significantly from baseline to day 7 and day 28. Corneal staining improved significantlyat all time points and disappeared in 61% at day 28. BCVA improved significantly by day 28. SPEED scores, TBUT, and conjunctival injection all improved significantly at each time points compared to baseline.
Conclusion
As early as 7 days, cyclosporine 0.09% significantly improved HOAs, staining, tear breakup time, redness, and patient symptoms and may be an appropriate choice for optimizing the ocular surface rapidly.
Presenting Author
Taher K Eleiwa, MD, PhD
Co-Authors
Abdelrahman Elhusseiny MD
Purpose
To assess the efficacy and safety of topical insulin (TI) for treating neurotrophic keratopathy (NK) within one-month post-diabetic vitrectomy (DV) compared to conventional non-invasive measures.
Methods
We conducted a retrospective case-control study including all eyes that developed acute NK (stages 2 and 3) following DV between October 2020 and June 2023. The control group included NK cases managed with preservative-free lubricant eye drops and prophylactic topical antibiotics. In contrast, the study group included NK cases treated with TI [1 unit per drop] four times daily, in addition to the previously mentioned treatment. The primary outcome measure was time to epithelial healing. Secondary outcome measures included any adverse effect of TI or the need for amniotic membrane transplantation (AMT).
Results
During the study period, the TI group (19 patients, mean age 49.3 years) showed significantly faster corneal epithelial healing than controls (18 patients, mean age 52.5 years), with a mean difference of 12.16 days (P=0.001). Survival analysis revealed that 0% and 20% of TI-treated patients at NK stages 2 and 3 failed to heal, compared to 20% and 66.7% in the control group (P<0.001). Two control group eyes required AMT for progressive thinning, and three progressed to stage 3 NK but healed after switching to TI after a mean of 14 days. No adverse effects were reported in the TI-treated group.
Conclusion
Our study suggests that TI can effectively and safely promote the healing of NK after DV.
Presenting Author
Mathieu F Bakhoum, MD, PhD, ABO
Purpose
This study evaluates the efficacy of using nanopore sequencing to rapidly identify bacterial pathogens in corneal ulcers directly from tears, offering a non-invasive alternative to traditional culture methods.
Methods
In this prospective observational study, ten participants with diagnosed corneal ulcers had tear samples collected via Schirmer strips for bacterial identification using nanopore sequencing of the 16S rRNA gene. Results were compared with traditional culture methods.
Results
Nanopore sequencing detected bacterial DNA in 80% of the analyzed samples. Specifically, it identified the causative bacteria in all four samples with positive culture results. Additionally, it detected pathogens in two of the four cases where cultures were negative, and accurately identified bacteria in cases where traditional cultures were impractical due to ulcer size. This comprehensive detection underscores the method's high sensitivity and potential for identifying overlooked pathogens.
Conclusion
Sequencing of bacterial DNA directly from tears is an effective, non-invasive method to identify bacterial pathogens in corneal ulcers, providing results comparable to traditional culture methods. This technique facilitates the detection of hard-to-culture organisms, broadening our understanding of the corneal ulcers microbial landscape.
Presenting Author
Sarah Guo, MD
Co-Authors
Tara Shooshani MS, Olivia Lee MD, Cinthia Kim MD, Jose Arthur Milhomens Filho MD, Melisa Karslioglu MD, Jose Giraldo MD
Purpose
To assess corneal nerve regeneration in neurotrophic keratitis (NK), we evaluated eyes treated with recombinant human nerve growth factor (rhNGF). We correlated corneal sensation (CS) measurements (using esthesiometry) with corneal nerve density (via in vivo confocal microscopy, IVCM) and assessed the return of nerve function and structure.
Methods
Retrospective review of 17 eyes diagnosed with NK, treated with rhNGF (Cenergermin, Dompe, Milan, Italy), excluding those with transplanted corneas. CS was measured using Cochet Bonnet esthesiometer (Hilco Vision, Mansfield, MA) prior to starting eye drops. IVCM images of the central cornea were obtained using HRT3 RCM confocal microscopy (Heidelberg Engineering, Heidelberg, Germany). CS and IVCM were collected at baseline and at two, three, six, and twelve months after starting topical rhNGF. Two masked physician graders assessed ND for each IVCM scan. Simple linear regression analysis (SLR) compared CS values with ND at each time point and t-tests compared temporal changes in CS and ND.
Results
Seventeen eyes of 17 patients with various stages of NK (stage 1: n=8; stage 2: n=6; stage 3: n=3) met inclusion criteria and were seen at 74 data points. 65% of patients (n=11) were female and 35% (n=6) were male. Etiologies included herpes simplex (n=9), herpes zoster (n=3), diabetes mellitus (n=3), limbal stem cell deficiency (n=1), and anterior basement membrane dystrophy (n=1). SLR showed a significant positive relationship between CS and ND (β=0.081, 95% CI: 0.026 to 0.135, p=0.004), explaining 10.6% of CBE variance (R²=0.106). Both CS and ND significantly increased from baseline to 12 months (CS: 0.041 to 0.647, p=0.0014; ND: 1.219 to 3.188; p=0.0099).
Conclusion
Our findings show a significant positive relationship between CS and corneal ND. The regression analysis indicates that higher CS is a significant predictor of increased ND values. Both CS and ND can be used to monitor improvement during the rhNGF treatment course, which is effective in improving both the structure and function of corneal nerves.
Presenting Author
Lional Raj Daniel Raj Ponniah, MD, PhD
Purpose
Microbial keratitis can cause unilateral blindness, but the drug delivery treatment options are poor. Therefore, this study evaluated the efficacy of a novel therapeutic drug-depository contact lens (DDCL) for bacterial keratitis (BK) treatment. The lens was designed to increase the corneal lesion-antimicrobial drug interaction time.
Methods
An open-labelled randomized controlled study to compare topical antimicrobial administration and antimicrobial administration with DDCLs for treating BK. Bacterial Keratitis (BK) patients were randomized (1:1) into two groups: topical antimicrobial treatment only (Group 1) and DDCL plus antimicrobial treatment (Group 2). Both groups received 0.5 % moxifloxacin. We evaluated BK recovery, anterior chamber (AC) reactions, corneal haze and pain (on a 10-point scale) 12 hours and 1, 3, 5, and 14 days after treatment.
Results
The baseline corneal-infiltration (i.e., BK severity) values were comparable for Groups 1 (18 cases) and 2 (17cases) (P = 0.92). After 12 hours, the scores improved in both groups and continued to improve throughout the follow-up period; the improvements were more pronounced in Group 2 than in Group 1 (all P <0.05). Complete recovery occurred on Days 14 and 5 in Groups 1 and 2, respectively. Furthermore, the AC reaction was resolved by Day 3 in Group 2. The baseline pain scores were also comparable between Groups 1 and 2 (P = 0.52) and decreased throughout the follow-up period (all P <0.05); the decrease was more pronounced in Group-2
Conclusion
Novel DDCLs augment the drug-lesion interaction time by prolonging corneal antimicrobial availability, which hastens corneal healing in BK. Thus, a DDCL may decrease the antibiotic regimen and improve patient tolerance, eliminating the necessity for a loading dose.
Presenting Author
Ramy A Elbassiouny, PhD, MRCSEd
Purpose
To evaluate the role of bacteriophage impeded gel as a potential therapy for treatment of Pseudomonas aeruginosa infection in rabbit cornea and to compare it with antibiotic treatment.
Methods
This is an interventional experimental study including 40 eyes of 20 male rabbits. P. aeruginosa was injected intrastromal into the cornea to induce keratitis. The rabbits were then divided into four groups from which group A uninfected control (negative control). Group B was infected with P. aeruginosa (108 CFU/mL) and received no treatment (positive control). Group C was infected with P. aeruginosa and received phage (1010 PFU/mL) impeded in HPMC hydrogel. and Group D was infected with P. aeruginosa and received imipenem/cilastatin antibiotics (100mg/ml). Daily clinical examination was recorded. On day 12, all corneas were removed for microbiology and histopathology evaluation.
Results
The mean clinical signs score eyes treated with bacteriophage impeded gel showed evident clinical improvement from fourth to tenth day of treatment. This improvement was equivalent to that of antibiotic treatment with significant decrease in ulcer size in relation to positive control group with no significant effect on IOP. The median CFU/ml showed significant improvement on group C and D but with no statistically significant values between both groups. Histopathological examination revealed better improvement of inflammatory signs on bacteriophage impeded gel treated group equivalent to antibiotic treated group.
Conclusion
Bacteriophage impeded gel was as effective as antibiotics in the treatment of p. aeruginosa keratitis in rabbits. It may be considered for treatment of bacterial corneal ulcer.
Presenting Author
Mohammad Soleimani, MD
Purpose
Fungal and Acanthamoeba keratitis have poor prognoses and are challenging to detect early. In low-resource settings, artificial intelligence (AI) can reduce misdiagnosis in microbial keratitis (MK). This research uses AI to detect MK, differentiate bacterial, fungal, and Acanthamoeba infections, and subtype fungal keratitis via slit-lamp images.
Methods
The dataset includes 10,739 slit-lamp images, categorized into four primary classes: 2,505 images of healthy corneas, 2,008 of FK, 4,816 of bacterial keratitis, and 1,410 of Acanthamoeba keratitis (AK), sourced from 1,428 subjects. Three AI-based models employing Convolutional Neural Networks (CNN) were developed for the following purposes: first, to diagnose MK in comparison to healthy corneas; second, to differentiate among bacterial, fungal, and Acanthamoeba infections; and third, to distinguish between filamentous and yeast subtypes within the FK cases.
Results
Model 1 for diagnosing healthy corneas and MK achieved 99.01% and 99.23% accuracy, respectively with a 0.99 area under the receiver operating characteristic curve (AUC-ROC). Model 2 for differentiating bacterial, fungal, and acanthamoeba infections from each other reached accuracies of 91.91%, 79.77%, and 81.27% with AUC-ROCs of 0.88, 0.87, and 0.90, respectively. Model 3 for discriminating fungal subtypes attained an accuracy of 76.19% and 77.84% for diagnosing filamentous and yeast subtypes, respectively with an AUC-ROC of 0.78. Findings were validated using 5-fold cross-validation.
Conclusion
The developed AI-based models are promising in early and precise diagnosis of MK, enhancing the differentiation of bacterial, fungal, and acanthamoeba keratitis, and identifying fungal subtypes. These models will aid timely and appropriate treatment interventions, especially in resource-privileged populations, thus mitigate health disparities.
Presenting Author
Brent A. Kramer, MD, ABO
Co-Authors
Connor Corsini BSc
Purpose
Fungal Keratitis is a rare but devastating complication of endothelial keratoplasty procedures. The aim of this study is to evaluate the rates of fungal keratitis with and without amphotericin use in the storage media for DMEK and DSEK.
Methods
A retrospective chart review of all DMEK and DSEK cases at seven Vance Thompson Vision locations from January 2013 - July 2024 was performed, and the rate of fungal keratitis was determined. Tissue data, including the use of amphotericin in the storage media, was obtained from Dakota Lions Eye Bank, Saving Sight, CorneaGen, and Rocky Mountain Lions Eye Bank.
Results
A total of 3,421 tissue data samples were collected. 923 contained amphotericin in the storage media, while 2,498 did not. 4 fungal keratitis events were confirmed, all from tissues which did not contain amphotericin. A 2x2 contingency table was made and a qualitative Fisher's exact test gave a p=0.5796 and an odds ratio of 0.30 (95% CI: 0.016 - 5.57) after using a Haldane-Anscombe correction to account for 0 adverse events in the treatment group.
Conclusion
Although no significant difference was found in fungal keratitis post-keratoplasty with/without amphotericin, the absence of cases in the amphotericin group suggests a potential protective effect. Further investigation with larger samples is needed to determine the true impact of amphotericin on the reduction of fungal keratitis post-DMEK/DSEK.
Presenting Author
Anuja Janakiraman, MBBS, MS
Co-Authors
Lokeshwari Aruljyothi MS, DNB
Purpose
PACK -CXL with intrastromal voriconazole can be tried before resorting to therapeutic keratoplasty in severe fungal keratitis. To study the efficacy of these treatment modalities in severe fungal keratitis 1. Intrastromal Voriconazole only 2. Intrastromal voriconazole Combined with 9 mW CXL. 3. Intrastromal voriconazole Combined with 18 mW PACK-CXL
Methods
Interventional,Non randomized comparative study. INCLUSION-Patients with microbiologically proven fungal ulcers, with ulcer size>7mm, +/- hypopyon, and who were refractory to maximal medical therapy for 10 days. Exclusion- Age<18,>70 years,Perforation,endophthalmitis. METHODS-15 patients were included in each of the 3 groups. Intracameral and intrastromal voriconazole was given to all patients. Group 1 did not receive CXL, group 2 and 3 received 9mW and 18 mW CXL respectively. Postoperatively patients received antifungal treatment and followed up regularly. Resolution and scarring of ulcers were defined as positive outcomes. Progression and perforation were considered as failed outcomes
Results
More than 90 % of the patients were above 50 years of age and were diabetic. Close to 75 % of the patients had ulcer sizes above 5mm, involving 50 % stromal depth and more. 80% of the patients had hypopyon. At the end of 3 weeks,in Group 1- 7/15[46.6%] resolved with early scarring,Group 2 -8/15 [53.3%] resolved with scarring,and Group 3- 11/15 [ 73.3%] resolved with early scarring. 19 patients required Therapeutic keratoplasty- 8 from Group 1 and 7 in Group 2, 4 in Group 3. Perforation was noted in 4 out of 8 [50 % ] of the cases in Group 1 and 1 out of the 7 [14 %] cases in Group 2, whereas none of the ulcers in Group 3 perforated.
Conclusion
PACK–CXL strengthens the cornea,decreasing melts and perforations.Use of 18 mW PACK – CXL is clinically more significant than 9 mW.PACK- CXL-18 mW is promising and helps to reduce the incidence of Therapeutic keratoplasty.
Presenting Author
Faiqa B Aamir, MBBS
Co-Authors
Muhammad Ali MBBS, Chen Dun MS, Uri Soiberman MD, Martin Makary MD, Fasika Woreta MD, Divya Srikumaran MD
Purpose
Recent data highlights the sociodemographic disparities in the length of hospital stay for corneal ulcers. We aim to describe the treatment for corneal perforation, an important complication of corneal ulcers, and factors associated with worse outcomes (undergoing enucleation/ evisceration within 1 year).
Methods
100% Medicare-fee-for-service claims from 2012 to 2021 were used to identify patients aged ? 65 years with corneal perforation. Patients without 12 months of continuous enrollment in Medicare Parts A and B prior to diagnosis of corneal perforation, those with missing demographic or billing information, and those with less than 1 year of follow-up after the diagnosis of corneal perforation were excluded. The median (interquartile range, IQR) number of days between diagnosis and surgery was calculated. Multivariable logistic regression analysis was used to assess factors associated with undergoing evisceration/enucleation and represented as Odds Ratios (OR) with 95% confidence intervals (CI).
Results
Among 5,690 patients, 2,700 (47.45%) underwent keratoplasty and 837 (14.71%) underwent evisceration/enucleation with a median (IQR) of 4 (0-64) and 6 (1-31.5) days, respectively. Older patients were more likely to undergo enucleation/evisceration [OR (CI): 75-84 years: 1.75 (1.40-2.18); ? 85 years: 2.45 (1.93-3.11) vs 65-74 years] while patients with a higher median income [OR(CI): 3rd quartile: 0.75 (0.57-0.98); 4th quartile: 0.60 (0.44-0.82) vs 1st quartile] were less likely. Black patients [OR (CI): 0.72 (0.57-0.92) vs White], Northeast [OR(CI): 0.62 (0.50-0.77) vs South] and rural area residents [OR (CI): 0.69 (0.49-0.96) vs urban] were less likely to undergo keratoplasty.
Conclusion
Our data suggests that socioeconomic differences exist in the management of corneal perforations. Additional research is warranted for further exploration.
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