Recommendations for ophthalmologic practice during the easing of COVID-19 control measures

In the context of the COVID-19 pandemic, this paper provides recommendations for medical eye care during the easing of control measures after lockdown. The guidelines presented are based on a literature review and consensus among all Spanish Ophthalmology Societies regarding protection measures recommended for the ophthalmologic care of patients with or without confirmed COVID-19 in outpatient, inpatient, emergency and surgery settings. We recommend that all measures be adapted to the circumstances and availability of personal protective equipment at each centre and also highlight the need to periodically update recommendations as we may need to readopt more restrictive measures depending on the local epidemiology of the virus. These guidelines are designed to avoid the transmission of SARS-CoV-2 among both patients and healthcare staff as we gradually return to normal medical practice, to prevent postoperative complications and try to reduce possible deficiencies in the diagnosis, treatment and follow-up of the ophthalmic diseases. With this update (5th) the Spanish Society of Ophthalmology is placed as one of the major ophthalmology societies providing periodic and systematized recommendations for ophthalmic care during the COVID-19 pandemic

Long-term evaluation of eyes with central corneal thickness <400 µm following laser in situ keratomileusis

Mohammad Reza Djodeyre,1 Jaime Beltran,2 Julio Ortega-Usobiaga,3 Felix Gonzalez-Lopez,4 Ana Isabel Ruiz-Rizaldos,1 Julio Baviera2 1Department of Refractive Surgery, Clinica Baviera, Zaragoza, 2Department of Refractive Surgery, Clinica Baviera, Valencia, 3Department of Research and Development, Clinica Baviera, Bilbao, 4Department of Refractive Surgery, Clinica Baviera, Madrid, Spain Purpose: To study long-term refractive and visual outcomes of laser in situ keratomileusis (LASIK) in eyes with a postoperative thin central cornea.  Methods: In this retrospective observational case series, we studied 282 myopic eyes with a normal preoperative topographic pattern and postoperative thin corneas (<400 µm) that had at least 3 years of follow-up after LASIK in three private clinics. The main outcome measures were safety, efficacy, predictability, percent tissue altered, and complications.  Results: The mean postoperative central corneal thickness was 392.05 µm (range: 363.00–399.00 µm). After a mean follow-up of 6.89±2.35 years (standard deviation), the safety index was 1.17, the efficacy index was 0.94, and predictability (±1.00 diopter [D]) was 73.49. The mean residual stromal bed thickness was 317.34±13.75 µm (range: 275–356 µm), the mean flap thickness was 74.76±13.57 µm (range: 55–124 µm), and the mean percent tissue altered was 37.12%±3.62% (range: 27.25%–49.26%). No major complications were recorded.  Conclusion: LASIK with a resultant central cornea thickness <400 µm seems to be effective, safe, and predictable provided that preoperative topography is normal and the residual stromal bed thickness is >275 µm. Keywords: LASIK, thin, cornea, ectasia, myopia, pachymetry, topograph