A Foldable Nonpenetrating Keratoprosthesis: Medium to Long-Term Clinical Results in Patients with Corneal Blindness due to Noninflammatory Anterior Cornea Disease.

PURPOSE: To report the medium to long-term safety and performance outcomes of the KeraKlear nonpenetrating artificial cornea (KeraKlear) as the primary procedure in patients with corneal blindness due to noninflammatory anterior cornea disease. METHODS: Fifteen patients with corneal blindness (preoperative visual acuity [VA] of ≥20/200) due to a non-inflammatory anterior corneal condition were included in this prospective, single-center study. Preoperative diagnoses included corneal scars, keratoconus, and corneal dystrophies. Diseased corneas were implanted with the KeraKlear (KeraMed Inc., Irvine, California, USA) by a single surgeon (JMV) using a femtosecond laser to create all incisions. Participants were followed up with for as long as 64 months. Uncorrected Snellen VA and postoperative complications were recorded. RESULTS: The average age at the time of surgery was 49.6 years old and 67% of patients were female. The patients experienced an average improvement in uncorrected Snellen VA of 7.6 lines (-1.17 logMAR). Average uncorrected vision at the last visit was 20/100 (0.73 logMAR), and median uncorrected vision at the last visit was 20/70 (0.54 logMAR). One patient experienced extrusion of the KeraKlear due to infection. There were no cases of glaucoma, retroprosthetic membrane, or endophthalmitis, the three most common complications of penetrating keratoprostheses (KPro). CONCLUSIONS: Medium and long-term outcomes of the KeraKlear indicate that this device is a viable alternative to corneal transplantation as a primary procedure in patients with non-inflammatory causes of corneal blindness, especially when corneal tissue is not available. The KeraKlear does not penetrate into the anterior chamber, and therefore, is less susceptible to the most common complications of penetrating KPro including endophthalmitis, glaucoma, and retroprosthetic membrane. The KeraKlear also has a comparable or improved adverse event rate compared to penetrating keratoplasty

The Efficacy and Safety Profile of Netarsudil 0.02% in Glaucoma Treatment: Real-World Outcomes

Introduction: More effective glaucoma medications are necessary as medication intolerance and non-adherence remain problematic. Netarsudil is a newly FDA-approved Rho kinase inhibitor. We hypothesize that netarsudil will safely reduce intraocular pressure (IOP) compared to baseline even while other glaucoma medications are used. Methods: This retrospective observational study was conducted on glaucoma patients seen at the Wills Eye Hospital Glaucoma Service who received netarsudil 0.02% between March and September of 2018. Intraocular pressure (IOP, via Goldmann applanation tonometry) and best corrected visual acuity (BCVA, via Snellen visual acuity charts) comparisons between baseline and 1- and 3-month follow-up visits were performed using Student’s t-tests. Results: This study included 172 eyes of 108 patients. Compared to baseline, a mean±SD decrease in IOP of 3.67±4.91 and 3.91±4.83 mmHg was noted at 1- and 3-month follow-up visits, respectively (both p\u3c0.001). No statistically significant difference in IOP change between patients on ≥3 and \u3c3 glaucoma medications at month 1 was observed (p=0.667). Conjunctival hyperemia was the most common side effect at months 1 and 3 (15.7% and 23.0% of patients, respectively). Blurred vision was reported at 1- and 3-month follow-up (5.8% and 8.0% of patients, respectively), but no significant difference in BCVA was observed (p= 0.723 and 0.611, respectively). Discussion: With a mild side effect profile, netarsudil yielded a significant IOP reduction in glaucoma patients, including significant reductions in patients on ≥3 medications. Given its efficacy and unique mechanism of action, earlier-line use of netarsudil may be considered

Use of infant donor tissue in endothelial keratoplasty

Majid Moshirfar,1 Yichieh Shiuey,2 Carlton Robert Fenzl3 1Department of Ophthalmology, Francis I Proctor Foundation, University of California San Francisco, San Francisco, CA, USA; 2Palo Alto Medical Foundation, Sunnyvale, CA, USA; 3John A Moran Eye Center, University of Utah, Salt Lake City, UT, USA We have read with great interest the recent article by Kobayashi et al describing endothelial keratoplasty using infant donor tissue.1 This is a fine case report describing the use of infant donor tissue as a viable source when performing non-Descemet stripping automated endothelial keratoplasty (nDSAEK). Descemet stripping automated endothelial keratoplasty (DSAEK) and nDSAEK seem to be the only currently accepted forms of keratoplasty for which donor tissue under the age of 2 years is acceptable. When used to perform penetrating keratoplasty, it is known that infantile grafts behave in an ectatic fashion.2,3 This is likely due to their more elastic properties. Tissue preparation in Descemet membrane endothelial keratoplasty (DMEK) proves to be too difficult given the strength of adhesion of Descemet membrane to the overlying stroma.1 Read the original article&nbsp

Peripheral ulcerative keratitis after cataract surgery in a patient with ocular cicatricial pemphigoid

Purpose: To describe a case of peripheral ulcerative keratitis (PUK) that developed in the immediate postoperative period after uncomplicated cataract surgery in a patient with ocular cicatricial pemphigoid. Methods: Single interventional case report. An elderly white woman with stable ocular cicatricial pemphigoid underwent an uncomplicated clear corneal phacoemulsification procedure in the left eye. In the immediate postoperative period, PUK developed adjacent to the corneal wound in the left eye. Results: The PUK was successfully treated with a bandage contact lens to the left eye, optimizing the ocular surface with punctal plugs and topical and systemic steroid therapy. After a 7-week course of tapering topical and systemic steroids, the PUK completely resolved. There was no further flare-up over a 12-month period. Conclusions: PUK can develop after clear corneal cataract surgery in patients with stable ocular cicatricial pemphigoid. Perioperative immunosuppression should be considered to minimize the chance of PUK developing in such case

Physician Executive Leadership (PEL): Expanding Medical School Leadership and Management Education

Today’s doctors are expected to fulfill many roles, and yet, traditional medical education does not include the following: Interdisciplinary teamwork Leadership skills Management and business techniques Financial knowledge Quality improvement Information technology Systems based approaches Physician Executive Leadership (PEL) was founded in 2013 at Jefferson’s Sidney Kimmel Medical School to directly address gaps in medical education The PEL curriculum is both student run and student led, informed by student demand and feedback Students can complete the curriculum at the standard level of commitment or be more engaged to earn Distinction The PEL curriculum is centered around six pillars: Applied Leadership Care Quality & Experience Health Finance Health Policy Entrepreneurship & Innovation Law & Ethics Programming includes: Guest lectures (large and small groups) Student run journal, The Diagnostic PEL Plus, a s tructured capstone program focused on management/leadership, with Jefferson lecturers outside SKMC and industry lecturers Funded summer internship of up to $1,500; self directed student projects focused on innovatio

Acute diplopia after glabellar hyaluronic acid filler injection

Purpose: Blindness is a well-known complication of filler injection in the glabellar region. Acute diplopia from filler injection without vision loss is a rare complication that typically results in clinical ophthalmoplegia which can have permanent sequelae. Here, we describe a patient who presented with acute diplopia with grossly intact full extraocular motility after glabella hyaluronic acid filler injection that resolved after 1 month. Observations: A previously healthy 43-year-old woman underwent her first hyaluronic acid injection in the glabella and developed immediate binocular double vision with severe pain and skin mottling above her right eyebrow and central forehead. Hyaluronidase injections, nitroglycerin paste, and aspirin were immediately administered. On exam, there was significant skin mottling over the glabella, extending to the forehead and nose with a small incomitant horizontal and vertical misalignment. No changes to her vision were observed and extraocular motility was grossly full. The rest of her exam was unremarkable. Over the course of the following month, the patient's diplopia resolved, but she developed skin necrosis and scarring. Conclusions: Importance: Proper knowledge of facial and periocular anatomy is critical for practitioners to safely perform filler injections and manage potential complications. Patients should be counseled about the potential rare risks of these elective procedures