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Gonorrhea keratoconjunctivitis is a sight-threatening condition that requires hospitalization and systemic antibiotic therapy. We report a case of a 47-year-old man suffering from gonococcal conjunctivitis with progressive corneal involvement despite three days of appropriate topical and intravenous antibacterial therapy. The patient received adjuvant treatment with 5% topical povidone-iodine, which had an immediate beneficial effect. One day after the application, the patient showed a resolution of severe exudative discharge with improvement in epithelial defects and thinning. By hospital day seven, the corneal defect and thinning had both resolved. Povidone-iodine may be a low-cost, safe, and potentially effective adjuvant therapy for refractory gonococcal keratoconjunctivitis in adult individuals unresponsive to standard-of-care antibiotic therapy after 72 hours of treatment. However, there is no evidence to support povidone-iodine as a standalone treatment for gonococcal conjunctivitis. Further research with a greater number of patients is needed to determine its true utility.

Background/Objectives: Although both the MEL90 (Carl Zeiss Meditec AG, Jena, Germany) and WaveLight EX500 (Alcon Laboratories, Inc., Fort Worth, TX, USA) are two widely used excimer lasers, comparisons between the two remain limited. This study evaluates visual and refractive outcomes from the U.S. Food and Drug Administration (FDA) premarket approval trials of these platforms in the treatment of myopia with and without astigmatism, hyperopia with and without astigmatism, and mixed astigmatism. Methods: Clinical outcomes from FDA premarket approval trials were compared between the recently approved MEL90 and the WaveLight (now termed EX500) excimer lasers. Results: A total of 714 eyes (358 patients) from MEL90 and 1353 eyes (706 patients) from EX500 were analyzed up to 6 months postoperatively. In the hyperopia/hyperopic astigmatism cohort, the EX500 demonstrated greater efficacy relative to MEL90, with more eyes achieving a postoperative uncorrected distance visual acuity (UDVA) of 20/20 or better (48.6% vs. 68.7%, respectively; p < 0.001). In both the MEL90 and EX500, at least 85% of eyes with myopia/myopic astigmatism and 68% with mixed astigmatism achieved a postoperative UDVA of 20/20 or better. For all refractive cohorts, more than 95% of eyes achieved a UDVA of 20/40 or better at 6 months (all p > 0.05). The EX500 was more likely to demonstrate an improvement of more than two lines of UDVA compared to baseline CDVA (all p < 0.05). In contrast, the MEL90 showed greater predictability of spherical equivalent within ±0.50 D and ±1.00 D for the hyperopia/hyperopic astigmatism cohort (both p = 0.007), as well as within ±0.50 D for the myopia/myopic astigmatism cohort (p < 0.001). Postoperatively, both platforms were associated with decreased glare and halos, although findings were variable in the EX500 mixed astigmatism cohort. Conclusions: Both excimer lasers demonstrated safe and effective outcomes that exceed the threshold set by the FDA.

Purpose: To determine the magnitude of higher order aberrations (HOAs) induced from light delivery device treatments after implantation of a light adjustable lens (LAL; RxSight). Methods: Patients who underwent cataract surgery or refractive lens exchange with LAL implantation in a private practice were included in this retrospective, consecutive chart review. The iTrace (Tracey Technologies) was used to measure corneal, internal, and total HOAs before each adjustment and lock-in visit at a 3-mm entrance pupil size. HOAs were also measured after the final lock-in visit. Overall and individual HOAs that were induced throughout the course of the LAL treatments were measured. Subgroup analysis was performed analyzing number of adjustments, distance versus near target, spherical aberration induced, target proximity, and history of refractive surgery. Results: This study included 56 eyes from 32 patients. The mean induction of total HOAs (combined corneal and internal aberrations) was −0.005 μm (standard deviation = 0.071). No induced total HOAs were greater than 0.3 μm. The 32 eyes that had undergone prior refractive surgery were found to have a statistically significant increase in induced HOAs compared to the 24 eyes without prior refractive surgery (P = .02). No other statistically significant differences were detected during subgroup analysis. Conclusions: This study suggests that LAL treatments do not induce a clinically significant amount of HOAs. However, eyes that have previously undergone refractive surgery may be more likely to have a greater magnitude of HOAs induced by light delivery device treatments.

Light-adjustable lenses (LALs) allow for visual acuity (VA) adjustment after cataract surgery, using ultraviolet (UV) light therapy. UV-induced cystoid macular edema (CME) is not well documented. We report the first case of bilateral CME after UV light therapy with LAL. An 81-year-old woman underwent uncomplicated staged bilateral cataract extraction with LAL implantation. Two days after the second UV light adjustment, she had bilateral decreased VA and a new-onset bilateral CME. UV treatments were halted, and she was started on topical nonsteroidal anti-inflammatory drug (NSAID) therapy and prednisolone. CME completely resolved within three weeks following onset. Topical NSAID and prednisone drops were continued until the completion of all light treatments, followed by a slow taper over one month. We hypothesize that UV light can contribute to CME via multiple mechanisms, including UV-activated macromer byproducts, direct UV-induced injury, or ultraviolet B (UVB) disrupting the blood-aqueous barrier. Clinicians should be aware of this complication and maintain a low threshold for deferring light therapy and initiating topical treatment.