OBJECTIVE: To evaluate the predictive value of anterior segment optical coherence tomography (AS-OCT) for postoperative corneal edema in cataract patients.
METHODS: A retrospective cohort study of 144 cataract patients from December 2020 to December 2021 was conducted. Patients were divided into edema eyes (84 cases) and observation (60 cases) group based on postoperative corneal edema occurrence. Relevant indicators were compared between groups. Logistic regression identified risk factors for postoperative corneal edema. Receiver operating characteristic curves evaluated the predictive value.
RESULTS: The edema eyes group had significantly higher postoperative central corneal thickness (CCT) and lower postoperative endothelial cell density (ECD) than the observation group (P < 0.05). The edema eyes group also had significantly lower preoperative ECD, anterior chamber depth (ACD), anterior chamber angle (ACA), and preoperative lens position (LP) than the observation group (P < 0.05). Logistic regression analysis showed that preoperative ECD, ACD, ACA, and LP were independent risk factors for postoperative corneal edema (P < 0.05), all of which also showed good predictive value for postoperative corneal edema, with areas under the curve (AUCs) of 0.854, 0.812, 0.791, and 0.778, respectively, under the ROC curve analysis.
CONCLUSIONS: AS-OCT can provide useful information for predicting postoperative corneal edema in cataract patients. Preoperative ECD, preoperative ACD, preoperative ACA, and preoperative LP are important parameters that can be measured by AS-OCT and used as risk factors for postoperative corneal edema.

OBJECTIVE: Autostereoscopic displays have become increasingly common, but their impact on ocular dimensions remains unknown. We sought to identify changes in the crystalline lens dimensions induced by autostereoscopic three-dimensional (3D) viewing.
METHODS: Forty young adults (age: 22.6 ± 2.0 years, male/female: 15/25) were consecutively enrolled and randomly divided into two groups (3D and two-dimensional [2D] viewing groups) to watch a 30-min movie clip displayed in 3D or 2D mode on a tablet computer. The lens thickness (LT), diameter, curvature, decentration and tilt were measured with anterior segment optical coherence tomography under both non-accommodating (static) and accommodating conditions.
RESULTS: In the static condition, the LT decreased by 0.03 ± 0.03 mm (p < 0.001) and the anterior radius of curvature (ARC) increased by 0.49 ± 0.59 mm (p = 0.001) post-3D viewing. In contrast, following 2D viewing, the ARC decreased by 0.23 ± 0.25 mm (p = 0.001). Additionally, the increase in the steep ARC post-3D viewing was greater in high-myopic eyes than low to moderate myopic eyes (p = 0.04). When comparing the accommodative with the static (non-accommodative) condition, for 3D viewing the lens decentration decreased (-0.03 ± 0.05 mm, p = 0.02); while for 2D viewing, the posterior curvature radius (-0.14 ± 0.20 mm, p = 0.006) and diameter (-0.13 ± 0.20 mm, p = 0.01) decreased.
CONCLUSIONS: Viewing with the autostereoscopic 3D tablet could temporally decrease the thickness and curvature of the lens under non-accommodating conditions. However, its long-term effect requires further exploration.

Objective: The purpose of this study was to report a case of herpes simplex virus-1 (HSV-1) keratitis misdiagnosed as fungal keratitis due to its clinical presentation being similar to that of fungal keratitis, ultimately diagnosed by NGS. Patients and Methods: A 59-year-old male presented with reduced vision in the right eye, combined with a history of trauma with vegetative matter. The corneal ulcer was accompanied with feathery infiltration, satellite lesion, and endothelial plaques. In vivo confocal microscopy (IVCM) showed hyper-reflective linear, thin, and branching interlocking structures. Fungal keratitis was diagnosed. Voriconazole 100 mg orally daily, topical tobramycin and 1% voriconazole were initiated empirically right away. The condition was aggravated and penetrating keratoplasty was performed. Anterior segment optical coherence tomography (AS-OCT) demonstrated the presence of plaques with a clear boundary between plaques and endothelium, resembling the AS-OCT images observed in cases of viral keratitis. Next-generation sequencing (NGS) further detected HSV-1 deoxyribonucleic acid, and no fungal component was found. Antifungal agents were discontinued and antiviral treatments were added. Results: We successfully treated a patient with HSV-1 keratitis who was misdiagnosed due to clinical features and IVCM findings similar to fungal keratitis. The patient\'s infection was controlled. At 2 years after surgery, the cornea recovered well. Conclusions: HSV-1 keratitis with atypical clinical presentation can be easily misdiagnosed. This case report emphasizes the importance of NGS in diagnosing the pathogens of keratitis.

OBJECTIVE: To report the use of anterior segment optical coherence tomography (AS-OCT) for superficial keratectomy (SK) in anterior corneal opacity.
METHODS: The characteristics of 43 eyes (39 patients) with various lesions responsible for anterior corneal opacity were included in this retrospective non-comparative study. AS-OCT was performed on all eyes before surgery. The thickness of corneal opacity and the underlying healthy stroma were measured. SK was performed on each individual.
RESULTS: Four types of anterior corneal opacity were evaluated, including corneal degeneration (26/43), Reis-Bücklers corneal dystrophy (8/43), alkali burn (1/43) and corneal tumors (8/43). Based on AS-OCT images, all eyes showed abnormal hyper-reflective signals in the superficial cornea to less than one-third of the normal corneal thickness in the deepest corneal opacity. All 43 eyes underwent an SK procedure. In addition, 1 eye with alkali burns and 7 eyes with corneal tumors were combined with amniotic membrane transplantation. All eyes restored transparency without significant complications.
CONCLUSIONS: AS-OCT is a valuable method for objective preoperative and noninvasive assessments of anterior corneal opacities and is useful for guiding SK.

Primary angle closure glaucoma is a visually debilitating disease that is under-detected worldwide. Many of the challenges in managing primary angle closure disease (PACD) are related to the lack of convenient and precise tools for clinic-based disease assessment and monitoring. Artificial intelligence (AI)- assisted tools to detect and assess PACD have proliferated in recent years with encouraging results. Machine learning (ML) algorithms that utilize clinical data have been developed to categorize angle closure eyes by disease mechanism. Other ML algorithms that utilize image data have demonstrated good performance in detecting angle closure. Nonetheless, deep learning (DL) algorithms trained directly on image data generally outperformed traditional ML algorithms in detecting PACD, were able to accurately differentiate between angle status (open, narrow, closed), and automated the measurement of quantitative parameters. However, more work is required to expand the capabilities of these AI algorithms and for deployment into real-world practice settings. This includes the need for real-world evaluation, establishing the use case for different algorithms, and evaluating the feasibility of deployment while considering other clinical, economic, social, and policy-related factors.

Purpose: To compare the refractive efficacy and morphological changes in the cornea following a novel biphasic higher fluence transepithelial corneal crosslinking (BI-TE-CXL) and transepithelial corneal crosslinking (TE-CXL) in adults keratoconus.Methods: Patients with progressive keratoconus who required corneal crosslinking were assigned to the BI-TE-CXL group (32 eyes, phase 1: 7.2 J/cm2 for 5 min and 20 s of pulsed-light exposure, KXL, Glaukos-Avedro; phase 2: 3.6 J/cm2 for 6 min and 40 s of continuous light exposure at the front curvature apex with a 6 mm diameter light spot, UVX-2000, IROC) or the TE-CXL group (32 eyes, uniform 7.2 J/cm2 for 5 min and 20 s of pulsed-light exposure, KXL, Glaukos-Avedro). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), corneal fluorescein staining (CFS), corneal topography, anterior segment optical coherence tomography (AS-OCT), and in vivo corneal confocal microscopy (IVCM) were performed 3, 6, 12 and 24 months after surgery.Results: The CFS scores in the BI-TE-CXL group were significantly higher than those in the TE-CXL group on the first two days after surgery (p < 0.001). The Kmax (at 12 and 24 months) and CDVA (logMAR) were significantly lower in the BI-TE-CXL group than those in the TE-CXL group (p < 0.05). The corneal demarcation line under AS-OCT was visible in 81.3% of patients in the BI-TE-CXL group and 15.6% in the TE-CXL group. The depth of the demarcation line under IVCM was significantly deeper in the BI-TE-CXL group (248.3 ± 25.0 μm) than that of the TE-CXL group (136.5 ± 15.6 μm) in the central cornea (p < 0.001). The cross-linked collagen structures in the central cornea were still present after 12 months in the BI-TE-CXL group. No significant difference in sub-basal nerve density between the two groups (p > 0.05).Conclusions: Following BI-TE-CXL, CDVA was significantly improved, accompanied by deeper demarcation line depth and persistent crosslinked structures in the central corneal stroma.

OBJECTIVE: To evaluate the viability and precision of measuring the distance from the limbus to extraocular muscle insertion using anterior segment optical coherence tomography (AS-OCT) and panoramic ultrasound biomicroscopy (UBM) before and after strabismus surgery.
METHODS: We recruited primary strabismus patients and measured the limbus-insertion distance by AS-OCT and UBM preoperatively, 2 weeks, and 1, 3, and 6 months postoperatively. Values were also measured using callipers intraoperatively before and after the planned procedures. Preoperative AS-OCT and UBM values were compared to intraoperative calliper measurements as the gold standard. Postoperative AS-OCT and UBM values were compared to the new postoperative limbus-insertion distance. The limit of agreement deemed clinically acceptable was defined as 1 mm.
RESULTS: A total of 85 horizontal muscles of 40 patients, including 48 lateral rectus muscles and 37 medial rectus muscles, were analysed. Primary muscles could be successfully detected by AS-OCT (95%) and UBM (100%). At 2 weeks and 1, 3, and 6 months postoperatively, the new rectus muscle attachment site detection rate by AS-OCT was 6%, 32%, 80%, and 89%, respectively, and that by UBM was 24%, 60%, 85%, and 93%, respectively. The Bland-Altman plots revealed better consistency in pairs of AS-OCT, UBM, and calliper measurements of primary muscles than postoperative muscles. For primary muscles, 89% of AS-OCT measurements fell within the permissible range of surgical measurements (1 mm), but this dropped to 67% at 6 months postoperatively (P < 0.001). The accuracy of UBM measurements of primary muscles was 81%, and this decreased to 59% at 6 months postoperatively (P = 0.001).
CONCLUSIONS: AS-OCT and UBM performed well in terms of imaging primary horizontal rectus muscles, but showed decreased accuracy and reproducibility in postoperative muscle measures.

UNASSIGNED: The purpose of this study was to investigate the in vivo morphologic features of the cornea in patients with unilateral posterior interstitial keratitis.
UNASSIGNED: Seven eyes of 7 patients with unilateral posterior interstitial keratitis were examined by slit-lamp biomicroscopy, anterior segment optical coherence tomography (AS-OCT), and in vivo confocal microscopy (IVCM). The imaging features of the cornea were evaluated and analyzed.
UNASSIGNED: By slit-lamp examination, the posterior corneal stromal opacities were observed in all 7 eyes, and deep neovascularization in 4 eyes. The posterior stromal opacities showed higher reflectivity with an intact overlying epithelium by AS-OCT and did not invade the Bowman\'s layer in all cases. IVCM revealed highly reflective dispersed microdots, needle-shaped bodies, and increased reflectivity of keratocytes in the lesion site in all patients. Active Langerhans cells and an attenuated subbasal nerve plexus were observed in 5 eyes. After treatment, the active Langerhans cells disappeared; however, highly reflective microdots and needle-shaped bodies remained.
UNASSIGNED: The three-dimensional evaluation of slit-lamp biomicroscopy, AS-OCT, and IVCM may help in the early diagnosis of patients with posterior interstitial keratitis.

OBJECTIVE: To compare long-term real-world outcomes of corneal thickness (CT) alterations in proliferative diabetic retinopathy (PDR) patients treated with panretinal photocoagulation (PRP) and intravitreal conbercept (IVC).
METHODS: This retrospective study included 69 eyes of 69 patients with PDR (42 PRP and 27 IVC). Full corneal thickness (FCT), corneal epithelial thickness (CET) and corneal stromal thickness (CST) measured by anterior segment optical coherence tomography at baseline were compared between groups. These CT changes at last follow-up from baseline were also compared between groups and within each group.
RESULTS: During a mean follow-up of more than two years, the IVC group demonstrated a significantly increased corneal thickness from baseline compared to the PRP group in some areas (PRP vs. IVC: FCT 0-2 mm: -0.59 ± 9.31 vs. 5.59 ± 9.23 μm, p = 0.009; CST 0-2 mm: -2.05 ± 8.79 vs. 3.48 ± 7.52 μm, p = 0.015; CST 2-5 mm: -1.78 ± 13.27 vs. 5.68 ± 14.53 μm, p = 0.046). In within-group comparisons, a significantly increased FCT from baseline was found in the 0-2 mm area in the IVC group (p = 0.004), but no significant change was observed in the PRP group (p = 0.691). For CET changes, a significantly increased CT was observed in the 0-2 mm, 2-5 mm and 5-7 mm areas in both groups respectively (all p < 0.05). Regarding CST, an increased CT was found in the 0-2 mm area in the IVC group (p = 0.037), while a decreased trend was observed in 0-2 mm and 2-5 mm areas in the PRP group (all p > 0.05).
CONCLUSIONS: When using PRP or IVC in the long-term management of PDR, CT changes should be considered. This may provide evidence for corneal protection during PDR treatment.

A 36-year-old patient presented with a complaint of an extensive \"white scar\" in his right eye without pain after silicone oil presence in the vitreous cavity for 12 years. Slit-lamp microscopy revealed extensive corneal leukoplakia and mild limbus neovascularization. Anterior segment optical coherence tomography revealed marked eccentric thickening of the subepithelium and normal thickness of the stroma. We proceeded with silicone oil removal and intraocular and anterior chamber lavage at first, followed by epithelial lesion excision combined with amniotic membrane transplantation 3 months later. The patient was satisfied with the clear cornea appearance.