This retrospective chart review of three scleral contact lens (ScCL) wearers presenting for sudden onset pain and blurred reported three cases of acute corneal edema occurring decades after penetrating keratoplasty (PK) for keratoconus. Data extracted included clinical presentation, year and reason for PK, ocular medications and comorbidities, contact lens wearing history; and results of any ancillary testing available including corneal topography, anterior segment optical coherence tomography (OCT) and specular microscopy surrounding the event; treatment and outcomes of intervention. The number of PK eyes fit with ScCLs in the author's practice was determined to estimate the prevalence of this event.

The three patients each had a longstanding PK for keratoconus performed between 33 and 35 years prior to presentation and recurrent ectasia. Each patient presented with an acute, painful eye and reduced vision either three days, four months or nine years after refitting into ScCLs. Each eye had well-demarcated focal microcystic epithelial and stromal edema within the graft and crossing the wound margin onto the host cornea. Although a definitive break or detachment of Descemet's membrane was not visualized, the presentations suggested these were episodes of acute hydrops.

Longstanding PKs with recurrent ectasia and acute focal edema suggestive of corneal hydrops was demonstrated in this case series of ScCL wearers. Researchers wrote that, although similar events have occurred as part of the natural history of post-PK corneas for keratoconus, the proximity of ScCL refitting to two of the events suggested some association.

In this retrospective, observational cohort study using healthcare claims data from a US nationwide managed care network between January 1, 2006 and December 31, 2016, which included enrollees ≥40 years old with primary open-angle glaucoma with or without a diagnosis of nonexudative AMD at the index date, researchers assessed whether ocular antihypertensives were associated with development and progression of age-related macular degeneration (AMD). Hazard ratios (HR) for developing AMD or progressing from nonexudative to exudative AMD with exposure to ocular antihypertensive medications were analyzed.

Of 132,963 eligible enrollees, 118,174 (87.5%) had no diagnosis of AMD at baseline, while 14,789 (12.5%) had a diagnosis of nonexudative AMD. Prostaglandin analog exposure had a decreased hazard of AMD development among individuals without baseline disease (HR, 0.90), while topical alpha2-agonist exposure demonstrated an increased hazard of AMD development (HR, 1.08). Among patients with baseline nonexudative AMD, topical carbonic anhydrase inhibitor exposure was associated with a decreased hazard of progressing to exudative disease (HR, 0.84), while topical alpha2-agonists had increased hazard (HR, 1.17).

Researchers reported that certain ocular antihypertensive medications may be associated with development or progression of AMD. They added that their role in AMD pathogenesis should be better understood as they are considered for therapeutics in this disease.

Investigators compared lens comfort and dry eye (DE) symptoms of DE scleral lens (SL) wearers’ fit with polyethylene glycol (PEG)-based surface-treated and untreated SLs. Dry eye signs, comfortable SL wearing time (WT), vision quality and lens-related ocular surface changes were also assessed. Twenty-one SL wearers with DE and SL discomfort were enrolled in a double-masked crossover study. Participants were randomized to wear untreated or PEG (Tangible Hydra-PEG, Tangible Science) surface-treated SL of the same parameters first for 30 days. Lens comfort, DE symptoms and ocular surface assessments were measured at baseline, after the first test period and after the crossover. Comfortable lens WT and frequency of foggy vision were recorded. Comparisons were assessed using paired T tests or Wilcoxon signed-rank tests.

Polyethylene glycol-treated SL wear resulted in significantly improved lens comfort, DE symptoms, corneal sodium fluorescein staining, temporal conjunctival lissamine green staining, lid wiper epitheliopathy, conjunctival papillae, frequency of foggy vision, tear break-up time (TBUT) and comfortable lens WT compared with untreated wear. No significant changes were found between treated and untreated lens wear for TBUT over the SL and nasal conjunctival lissamine green staining.

Investigators wrote that polyethylene glycol surface-treated SLs provided improved comfort, reduced DE symptoms and reduced ocular surface compromise compared with untreated SLs for participants with DE.