IntroductionThe purpose of this study was to report the first case of acute bacterial keratitis produced by methicillin-resistant Staphylococcus aureus after the implantation of two intracorneal ring segments during an uneventful procedure for treating keratoconus in a 13-year-old child.Case ReportA patient with grade III keratoconus underwent an implantation of intracorneal ring segments with no complications during the procedure. Three days later, a whitish corneal infiltrate appeared in between the union of both corneal rings. Sample cultures were positive for methicillin-resistant S. aureus (MRSA). Corneal infiltrate did not improve despite intensive topical and systemic antibiotics. Melting appeared even after the explantation of both corneal rings. Keratoplasty à chaud had to be performed to preserve the eye integrity.ConclusionsMRSA keratitis following intracorneal ring segment implantation is a rare but severe complication that can lead to a therapeutic penetrating keratoplasty to definitely cure the process.

Background The purpose of this study is to describe measurements using a newly developed modified Goldmann convex tonometer (CT) 1 year after myopic laser refractive surgery. Intraocular pressure (IOP) measurements were compared with IOP values obtained by Goldmann applanation tonometer (GAT), and Ocular Response Analyzer (ORA). Methods Prospective double-masked study performed on thirty eyes of thirty patients that underwent laser in situ keratomileusis (LASIK; n = 19) or photorefractive keratectomy (PRK; n = 11). IOP was measured before and 3 and 12 months after surgery. Intraclass correlation coefficient (ICC) and Bland-Altman plot were calculated to assess the agreement between GAT, CT, IOPg (Goldmann-correlated IOP) and IOPcc (corneal-compensated IOP) from ORA. Results Twelve months after LASIK, IOP measured with CT showed the best correlation with IOP measured with GAT before surgery (GATpre) (ICC = 0.886, 95% CI: 0.703–0.956) (15.60 ± 3.27 vs 15.80 ± 3.22; p < 0.000). However, a moderate correlation was found for IOP measured with IOPcc and CT 12 months after LASIK (ICC = 0.568, 95% CI: − 0.185 – 0.843) (15.80 ± 3.22 vs 12.87 ± 2.77; p < 0.004). Twelve months after PRK, CT showed a weak correlation (ICC = − 0.266, 95% CI: − 3.896 – 0.663), compared to GATpre (17.30 ± 3.47 vs 16.01 ± 1.45; p < 0.642), as well as poor correlation (ICC = 0.256, 95% CI: − 0.332 – 0.719) with IOPcc (17.30 ± 3.47 vs 13.38 ± 1.65; p < 0.182). Conclusions Twelve months after LASIK, IOP measured with CT strongly correlated with GAT before surgery and could therefore provide an alternative method for measuring IOP after this surgery. More studies regarding this new convex prism are needed to assess its accuracy.

this study assesses the agreement between intraocular pressure (iop) measurements taken with the Goldmann applanation tonometer (GAt) and a new experimental applanation tonometer with a convexly shaped apex (CT) after laser myopic refractive surgery. Two different CT radii (CT1 and CT2) were designed with a finite element analyser, and a prospective double masked study on 102 eyes from 102 patients was carried out. A Bland-Altman plot and intra-class correlation coefficient (ICC) were calculated to assess the agreement between GAT measurements and the measurements of both CT1 and CT2 before and after myopic laser assisted in situ keratomileusis (LASiK; n = 73) and photorefractive keratectomy (pRK; n = 29). We evaluated a subset of two subgroups (n = 36 each) for intra and interobserver (iA/ie) error. from the whole cohort, the best iop agreement was observed between GAtpre and CT1post surgery: 16.09 ± 2.92 vs 16.42 ± 2.87 (p < 0.001); ICC = 0.675 (95% CI: 0.554-0.768). In the analysis of LASiK vs PRK, GATpre and CT1post showed the highest agreement, although LASIK measurements were more accurate than pRK, as the icc = 0.718 (95% CI: 0.594-0.812) and ICC = 0.578 (95% CI: 0.182-0.795) respectively. Excellent agreement was observed for IA/IE, and there was an icc > 0.8 (95% CI) in all cases. CT1 proved more accurate in the LASIK subgroup. In conclusion, our new version of GAt could be used with post-surgery LASiK patients as a more accurate measurement device compared to the current reference tonometer. The Goldmann applanation tonometer (GAT; Haag-Streit, Switzerland) is the current reference tonometer for measuring intraocular pressure (IOP) in daily clinical practice due to its acceptably accurate measurements, reproducibility and reliability 1-4. However, GAT readings are influenced by corneal central thickness (CCT) and corneal biomechanics (CB), which vary widely among normal individuals 1,5,6. In myopic laser refractive surgery (LRS) patients, variations induced in both CCT and CB lead to differences in GAT readings. This change in IOP has been inconsistent in previous studies regardless of the type of surgery: Mardelli et al. 7 found a significant reduction of 1 ± 2.8 mmHg in IOP measurements after ablating 23 μm in photorefractive keratectomy (PRK) patients; while Duch et al. 8 found an underestimation of about 2.9 mmHg per 70 μm ablation in CCT after laser assisted in situ keratomileusis (LASIK). These IOP underestimations affect the reliability of GAT as gold standard after LASIK and PRK procedures 9-11. LASIK is one of the most frequent types of eye surgery and a total of 40 million people had this operation worldwide between 1991 and 2016 12. Moreover, the prevalence of glaucoma is 2 to 4 times higher among the myopic population 13. Thus, it is very important to obtain an accurate and real estimation of IOP in order not to miss ocular hypertension after myopic LRS. The aim of our study is to describe a new modified GAT as well as its translational application and clinical outcomes by evaluating IOP meas...

Phosphodiesterase Type 5 inhibitors have been associated in less than 10% of all consumers with both temporary and permanent visual side effects of variable severity. This prevalence increases with high doses. We report a case of bilateral structural retinal changes and visual disturbances that resolved after discontinuing phosphodiesterase Type-5 inhibitors treatment.