Purpose To describe the efficacy and safety of topography-guided trans-epithelial no-touch photorefractive keratectomy (PRK) for the correction of highly irregular astigmatism after penetrating keratoplasty (PK). Patients and Methods A prospective study was conducted on 12 eyes of 12 patients affected by highly irregular astigmatism after PK for keratoconus. Each patient underwent a single-step topography-guided trans-epithelial ablation (CIPTA ® 2 software, iVis Technologies). Corneal topography data as well as uncorrected (UDVA) and corrected distance visual acuity (CDVA) and spherical equivalent (SEQ) were collected preoperatively (T0) and at 1 (T1), 3 (T2) and 12 (T3) months after surgery. Results Mean UDVA and CDVA significantly improved, respectively, from 1.22±0.17 and 0.18±0.03LogMAR at T0 to 0.63±0.17 (CI 95%, P<0.001) and 0.04±0.03LogMAR at T3 (CI 95%, P<0.001). Mean SEQ significantly decreased from −3.75±1.32 to –1.60±1.32D (CI 95%, P<0.02). Mean subjective refractive astigmatism (SRAST) and mean keratometry astigmatism (SimK) significantly decreased, respectively, from 7.83±0.98 and 8.10±1.48D to 2.83±0.98 and 5.29±1.48D (CI 95%, P<0.001). Corneal Morphological Irregularity index (CMI) significantly decreased from 62.76±7.26 µm to 23.24±7.26 µm (CI 95%, P<0.001). Apart from a single episode of graft rejection 5 days after ablation, successfully reverted with topical steroids, no other complications were noted. A mild corneal haze was observed in two eyes (16.7%) at 3 months post-PRK, and no regression was observed at 12 months. Conclusion Our study demonstrates the safety and long-term effectiveness of a trans-epithelial topography-guided ablation in the treatment of post-PK highly irregular astigmatism.

Background: Vogt–Koyanagi–Harada (VKH) disease is a form of uveitis that is rare in Western countries. The aim of this study was to report on the long-term real-life treatment and prognosis of VKH in Italy. Methods: The clinical features, complications, and final visual acuity were retrospectively evaluated in 38 patients with VKH (mean follow-up: 120 months) globally, according to oral or intravenous corticosteroid treatment at onset and subsequent immunosuppressive therapy. Results: The mean final visual acuity was 0.13 ± 0.4 logMAR, which was a significant increase from the baseline (p < 0.0001). The patients who received intravenous rather than oral corticosteroids relapsed less (p = 0.026), with fewer relapses/patient/month of follow-up (p < 0.0001), and showed less frequent sunset glow fundus (33.3% versus 55%) and more relapse-free cases after induction therapy (p = 0.007). Delayed immunosuppressive therapy (median: 180 days from the onset of symptoms) reduced the rate of sunset glow fundus. The onset of sunset glow fundus was associated with a worse final visual acuity (p = 0.006). Conclusion: The long-term prognosis of VKH is quite good. Intravenous corticosteroids given at the onset of VKH are more effective than oral corticosteroids. Even if it is not given immediately after symptoms onset, immunosuppressive therapy is able to reduce the incidence of sunset glow fundus and to improve the final visual prognosis.

No abstract