Importance:Characterizing individual ocular symptom trajectories following laser-assisted in situ keratomileusis (LASIK) and photorefractive keratectomy (PRK) may provide a longitudinal, patient-centered perspective on postoperative recovery and help identify patients at risk of prolonged symptom courses. Objective:To characterize longitudinal ocular symptom trajectories after refractive surgery, describe associated symptom descriptors over time, and identify baseline factors associated with pain trajectories. Design, Setting, and Participants:This prospective, multicenter cohort study was conducted at 2 academic ophthalmology centers in the US from April 2021 to July 2025. Adults undergoing bilateral LASIK or PRK were enrolled and evaluated preoperatively and at postoperative day 1 (POD 1) and months 3 (POM 3) and 6 (POM 6). Participants eligible for refractive surgery were included. Exclusion criteria included pregnancy, corneal abnormality (scar, ectasia, corneal surgery), eye diseases that could confound ocular pain (glaucoma, herpetic eye disease), and age younger than 18 years. Main Outcomes and Measures:Ocular pain intensity measured using numerical rating scale (NRS; 0-10) at baseline, POD 1, POM 3, and POM 6. Clinically relevant pain was defined as an NRS score of 3 or greater. Trajectories were classified based on clinically relevant pain presence across time points; baseline demographic, clinical, surgical, and ocular surface factors were evaluated as associated factors. Results:Among 326 participants with complete pain data (mean [SD] age, 34.3 [7.9] years; 196 [60.1%] female), pain trajectories were heterogeneous. No clinically relevant pain was observed in 94 participants (28.8%), pain at POD 1 only in 143 participants (43.9%), and prolonged pain (at POM 3 or POM 6) in 59 participants (18.1%); 30 participants had uncommon pain trajectories. Prolonged pain was independently associated with PRK (vs LASIK: odds ratio [OR], 2.73; 95% CI, 1.29-5.77) and several preoperative factors, including lubricating drop use (OR, 2.41; 95% CI, 1.17-4.96), chronic low back pain (OR, 2.45; 95% CI, 1.14-5.25), and greater ocular symptom burden (5-Item Dry Eye Questionnaire score: OR, 1.11; 95% CI, 1.01-1.22). The presence of corneal staining at 6 months after surgery was associated with lower odds of prolonged pain (OR, 0.79; 95% CI, 0.64-0.97). Conclusions and Relevance:In this cohort study, postoperative ocular symptom trajectories after refractive surgery followed distinct longitudinal patterns, suggesting these trajectories may have been associated with specific baseline factors. This trajectory-based, symptom-specific approach may provide clinically relevant insight into patient recovery and may improve risk stratification, counseling, and targeted perioperative management, but further corroboration is warranted.

Purpose:To train and validate a convolutional neural network (CNN) to detect the history of laser-assisted in situ keratomileusis (LASIK) surgeries using corneal optical coherence tomography (OCT) maps. Methods:Five corneal OCT maps (pachymetry, epithelial thickness, posterior mean curvature, anterior axial power, and anterior stroma reflectance) were utilized as the input of a lightweight CNN model. OCT scans of healthy volunteers and patients who had undergone myopic or hyperopic LASIK were included. Repeated fivefold cross-validation was used to train and evaluate the proposed CNN. In addition, a separate group of post-LASIK participants, who were not included in the cross-validation, was used for out-of-sample testing to assess the CNN model performance. Results:In the cross-validation, the proposed CNN model achieved an overall balanced accuracy of 90.2% ± 3.6% with 93.5% ± 5.2% sensitivity and 97.8% ± 1.7% area under the receiver operating characteristic curve (AUC) in detecting myopic LASIK and 90.2% ± 5.8% sensitivity and 98.2% ± 1.9% AUC in identifying the hyperopic LASIK. In the out-of-sample test, all eyes were classified correctively. Conclusions:The lightweight CNN model with corneal OCT maps provides a useful tool for detecting LASIK history. Translational Relevance:Artificial intelligence-assisted OCT may offer better management for patients with LASIK history who need cataract surgeries.

center dot PURPOSE: To develop and validate a deep learning (DL) model to differentiate ocular surface squamous neoplasia (OSSN) from pterygium and pinguecula using high- resolution anterior segment optical coherence tomography (AS-OCT). center dot DESIGN: Retrospective Diagnostic Accuracy Study. center dot METHODS: Setting : Single-center. Study Population : All eyes with a clinical or biopsy- proven diagnosis of OSSN, pterygium, or pinguecula that received AS-OCT imaging. Procedures : Imaging data was extracted from Optovue AS-OCT (Fremont, CA) and patients' clinical or biopsy- proven diagnoses were collected from electronic medical records. A DL classification model was developed using two methodologies: (1) a masked autoencoder was trained with unlabeled data from 105,859 AS-OCT images of 5746 eyes and (2) a Vision Transformer supervised model coupled to the autoencoder used labeled data for finetuning a binary classifier (OSSN vs non-OSSN lesions). A sample of 2022 AS-OCT images from 523 eyes (427 patients) were classified by expert graders into "OSSN or suspicious for OSSN" and "pterygium or pinguecula." The algorithm's diagnostic performance was evaluated in a separate test sample using 566 scans (62 eyes, 48 patients) with biopsy-proven OSSN and compared with expert clinicians who were masked to the diagnosis. Analysis was conducted at the scan-level for both the DL model and expert clinicians, who were not provided with clinical images or supporting clinical data. MAIN OUTCOME: Diagnostic performance of expert clinicians and the DL model in identifying OSSN on ASOCT scans. center dot RESULTS: The DL model had an accuracy of 90.3% (95% confidence intervals [CI]: 87.5%-92.6%), with sensitivity of 86.4% (95% CI: 81.4%-90.4%) and specificity of 93.2% (95% CI: 89.9%-95.7%) compared to the biopsy-proven diagnosis. Expert graders had a lower sensitivity 69.8% (95% CI: 63.6%-75.5%) and slightly higher specificity 98.5% (95% CI: 96.4%-99.5%) than the DL model. The area under the receiver operating characteristic curve for the DL model was 0.945 (95% CI: 0.918-0.972) and significantly greater than expert graders (area under the receiver operating characteristic curve = 0.688, P < .001). center dot CONCLUSIONS: A DL model applied to AS-OCT scans demonstrated high accuracy, sensitivity, and specificity in differentiating OSSN from pterygium and pinguecula. Interestingly, the model had comparable diagnostic performance to expert clinicians in this study and shows promise for enhancing clinical decision-making. Further research is warranted to explore the integration of this artificial intelligence-driven approach in routine screening and diagnostic protocols for OSSN. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

High-quality evidence regarding suppressive valacyclovir treatment in herpes zoster ophthalmicus (HZO) is necessary to guide care. To determine whether suppressive valacyclovir compared with placebo delays the occurrence of new or worsening stromal keratitis (SK), endothelial keratitis (EK), iritis, or dendriform epithelial keratitis (DEK) during 12 months of treatment and if treatment benefit persisted at 18 months (secondary end point). The Zoster Eye Disease Study (ZEDS) was a randomized clinical trial conducted in 95 sites from November 2017 to June 2024. Immunocompetent, nonpregnant adults with a history of an HZO rash, documented active keratitis or iritis within 1 year, and an estimated glomerular filtration rate of 45 mL/min/1.73 m2 or greater were eligible. After determined to be eligible, participants were randomized in 4 strata: age at onset (<60 years vs ≥60 years) and disease duration (<6 months vs ≥6 months). A total of 12 months of double-masked daily valacyclovir, 1000 mg, or placebo. The primary outcome was time to first occurrence within 12 months of new or worsening SK, EK, iritis, or DEK. A total of 527 participants (median [IQR] age, 60 [50-68] years; 266 female [50.5%]; 266 in the valacyclovir group; 261 in the placebo group) were randomized in 4 strata; 481 completed 12 months, and 460 completed 18 months. Data were analyzed by intention to treat. At 12 months, primary end points occurred in 86 participants (33%) assigned to placebo and 74 (28%) assigned to valacyclovir, and at 18 months in 104 participants (40%) assigned to placebo and 86 (32%) assigned to valacyclovir. The hazard ratio (HR) of the primary end point at 12 months was 0.77 for participants taking valacyclovir vs placebo (HR, 0.77; adjusted 95% CI, 0.56-1.05; P = .09) and 0.73 at the secondary end point at 18 months (HR, 0.73; adjusted 95% CI, 0.55-0.97; P = .03). There was a reduction of multiple other secondary end points at 12 months (HR, 0.70; 95% CI, 0.52-0.95; P = .02) and 18 months (HR, 0.72; 95% CI, 0.55-0.95; P = .02). Although the primary outcome did not show a benefit of suppressive valacyclovir treatment, secondary study outcomes showed treatment superiority at the 18-month end point and reduced number of multiple episodes of keratitis or iritis at both 12 and 18 months. These results support consideration of 1 year of suppressive valacyclovir treatment for HZO. ClinicalTrials.gov Identifier: NCT03134196

PURPOSE: Data on vaccine-associated corneal transplant rejections are limited. We examined the association between graft rejection and vaccination. DESIGN: Matched case-control METHODS: We used electronic health records to identify corneal transplant recipients between January 2008 and August 2022 at Kaiser Permanente Southern California. Cases were transplant recipients who experienced a graft rejection (outcome) during the study period. Randomly selected controls who did not experience a corneal graft rejection at their matched cases' index date (rejection date) were matched in a 3:1 ratio to cases. For controls, index date was determined by adding the number of days between transplant and graft rejection of their matched case to the control's transplant date. RESULTS: The study included 601 cases and 1803 matched controls (mean age 66 years [s.d. 17.0], 52% female, 47% non-Hispanic white). Twenty-three% of cases and 22% of controls received >= 1 vaccinations within 12 weeks prior to the index date. The adjusted odds ratio (aOR) for vaccination in the 12 weeks prior to index date, comparing cases to controls was 1.17 (95% CI: 0.91, 1.50]). The aOR was 1.09 (0.84, 1.43) for 1 vaccination, 1.53 (0.90, 2.61) for 2 vaccinations, and 1.79 (0.55, 5.57) for >= 3 vaccinations. The aOR was 1.60 (0.81, 3.14) for mRNA vaccines, and 1.19 (0.80, 1.78) for adjuvanted/high dose vaccines. CONCLUSIONS: We found no evidence to suggest an association between vaccination and graft rejection. Our findings provide support for the completion of recommended vaccinations for corneal transplant recipients, without significantly increasing the risk of graft rejection.

PURPOSE:Landolt ring-shaped epithelial keratopathy is a corneal disease that has only been reported in 11 Japanese patients in 2014. 1 We describe the first case of Landolt ring-shaped epithelial keratopathy in the United States in a patient of European background. METHODS:This is a single case report with longitudinal care. RESULTS:A 35-year-old White patient presented with a history of ocular burning, photophobia, and decreased vision. Corneal examination showed bilateral and asymmetric microcystic lesions in a unique Landolt ring (or the letter "C") shape, distributed randomly in the epithelium. Confocal microscopy revealed cellular ballooning and hyperreflective opacities in the basal layer of the corneal epithelium. The patient has had multiple recurrences of her symptoms year-round, each lasting 4 to 8 days. Topical treatment with cyclosporine, steroids, and lubrication resolved her symptoms but without complete resolution of signs on examination. CONCLUSIONS:Our patient's clinical signs and symptoms are similar to those described previously in 11 Japanese patients. However, unlike those patients, our patient demonstrates symptomatic response to topical treatment, no seasonal association to her condition, and to date, incomplete resolution of her disease after more than 2 years. This case highlights that Landolt ring-shaped epithelial keratopathy, a novel corneal disease of unclear origin, has relevance outside of the Japanese population.

Background/aimsTo examine demographic and clinical factors associated with ocular pain 1 day after refractive surgery.MethodsProspective study of individuals undergoing refractive surgery. Participants rated their ocular pain on a 0–10 numerical rating scale (NRS) presurgery and 1 day after surgery. Presurgery, participants completed questionnaires on demographics, comorbidities, medications and dry eye and ocular pain symptoms; and an anaesthetised Schirmer test was performed. Acute ocular pain 1 day after surgery was defined as an NRS score of worst pain since surgery ≥3 and this group was compared with individuals with NRS scores<3.Results251 individuals underwent refractive surgery (89% laser-assisted in situ keratomileusis, n=222; 11% PRK, n=29). Mean age was 35±8 years (range 19 to 60); 60% (n=150) self-identified as female, 80% (n=203) as White, and 36% (n=89) as Hispanic. Thirteen (5%) individuals reported ocular pain (NRS ≥3) prior to surgery and 67% (n=168) reported ocular pain 1 day after surgery (nine individuals had pain at both time points). Factors that were associated with pain 1 day after surgery included Hispanic ethnicity (adjusted relative risk (aRR) 1.42, 95% CI 1.21 to 1.68, p<0.001) and the presence of eye pain presurgery (aRR 1.10, 95% CI 1.02 to 1.18, p=0.02).ConclusionA majority of individuals report moderate or greater pain within 24 hours of refractive surgery. Hispanic ethnicity and eye pain prior to surgery were associated with self-reported acute postsurgical pain.

Abstract Background Vaccination is recommended for prevention of infectious diseases. For individuals with a history of corneal transplantation, however, there are concerns that vaccination may trigger allograft rejection through elevated immune activity. The association between vaccination and graft rejection remains unclear. Methods We conducted a nested case-control study to evaluate the association between graft rejection and vaccination in corneal transplant recipients at Kaiser Permanente Southern California (KPSC) between January 2008 and August 2022. We identified all KPSC members who received a corneal transplant during the study period, with no history of prior transplant or rejection. Cases were those who experienced a graft rejection during the study period and eligible controls were those who had not experienced a rejection at the time of a given case. Controls were randomly selected via risk-set sampling and matched in a 3:1 ratio to cases on age, sex, and transplant date (±12 weeks). Index date was the date of rejection for cases. For controls, index date was determined by adding the number of days between transplant and rejection of the matched case to the control’s transplant date. We performed multivariable conditional logistic regression to compare the odds of vaccination (all types) in the 12 weeks prior to the index date in cases and controls, while adjusting for potential confounders. Results Our study included 601 corneal transplant recipients with rejection (cases), and 1,803 matched controls. The overall cohort was 48% female and 47% white, with a mean age of 66 years (s.d. 17) (Table 1). A total of 136 (23%) cases and 373 (21%) controls received vaccination within 12 weeks of the index date (adjusted odds ratio 1.17, 95% CI: 0.91, 1.50) (Table 2).Table 1.Characteristics of corneal transplant recipients who experienced graft rejection (cases) and who did not experience graft rejection (controls), Kaiser Permanente Southern California, 01/01/2008 - 08/31/2022. a Defined in the 12 months prior to index date unless otherwise indicated b Defined in the 12 weeks prior to index date c HIV/AIDS, leukemia, lymphoma, congenital immunodeficiencies, asplenia/hypospenia, or organ transplant at any time prior to index date, or immunosuppressant medication used during 12 weeks prior to index date d Includes dexamethasone, fluorometholone, loteprednol, difluprednate, prednisolone, methylprednisolone, and prednisone.Table 2.Vaccination among corneal transplant recipients who experienced graft rejection (cases) and who did not experience graft rejection (controls), Kaiser Permanente Southern California, 01/01/2008 - 08/31/2022. a Adjusted for race/ethnicity, Charlson comorbidity score, immunocompromised status, corneal transplant type, oral/ocular steroids received 12 weeks prior to index date (yes/no), non-index vaccinations received 12 weeks prior to index date (yes/no), and medical center and area. Conclusion We did not find evidence of an elevated risk of graft rejection associated with vaccination given in the 12 weeks prior to the index date. Although our study is the largest study examining the association between corneal transplant rejection and vaccination to our knowledge, this study may be underpowered to detect a minimal increase in risk. Our findings provide support for completion of recommended vaccinations for patients who are planning or have received a corneal transplant. Disclosures Jennifer H. Ku, PhD MPH, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support Julia Tubert, MPH, Moderna: Grant/Research Support|Pfizer: Grant/Research Support Yi Luo, PhD, GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Kevin L. Winthrop, MD, MPH, AN2: Advisor/Consultant|AN2: Grant/Research Support|Insmed: Advisor/Consultant|Insmed: Grant/Research Support|Insmed: This study was funded by Insmed Inc.|Paratek: Advisor/Consultant|Paratek: Grant/Research Support|Red Hill Biopharma: Advisor/Consultant|Red Hill Biopharma: Board Member|Red Hill Biopharma: Grant/Research Support|Renovion: Advisor/Consultant|Renovion: Grant/Research Support|Spero: Advisor/Consultant|Spero: Grant/Research Support Divya Srikumaran, MD, Alcon: Advisor/Consultant|Claris Biotherpeautics: Grant/Research Support Ana Florea, PhD MPH, Gilead: Grant/Research Support|GlaxoSmithKline: Grant/Research Support|Moderna: Grant/Research Support|Pfizer: Grant/Research Support Hung Fu Tseng, PhD MPH, GSK: Grant/Research Support|Moderna: Grant/Research Support

Purpose: The aim of this study was to describe a case of corneal involvement as an early manifestation of ocular disease in the 2022 human mpox (monkeypox) virus outbreak. Methods: This is a single case report with longitudinal care. Results: A 47-year-old immunocompetent man presented with viral conjunctivitis before development of skin lesions or systemic symptoms. Subsequently, he developed membranous keratoconjunctivitis and a corneal epithelial defect. Orthopoxvirus-positive polymerase chain reaction test from his ocular surface was positive. The epithelial defect did not heal with conservative treatment but was successfully treated with amniotic membrane transplantation over 8 days. Reduced corneal sensation was noted after epithelial healing, and polymerase chain reaction from the ocular surface remained positive at 17 days from symptom onset, with slowly recovering conjunctivitis at 21 days. Continued membrane formation required repeated removal but significantly improved with topical corticosteroid treatment after epithelial healing by 29 days of symptom onset. Corneal sensation normalized by 87 days from symptom onset at which time symblepharon were noted but PCR testing from the ocular surface was negative. Conclusions: Early corneal involvement of human monkeypox virus is possible. Transient corneal hypoesthesia may be due to acute inflammation. Chronic inflammatory changes can result in symblepharon. These findings have potential implications in patient care and corneal donation.

PURPOSE:The purpose of this study was to report a rare case of cyclodialysis cleft after secondary intraocular lens (IOL) placement using the Yamane flanged intrascleral haptic fixation technique.METHODS:This study is an observational case report.RESULTS:A 74-year-old man with an ocular history of spontaneously dislocated IOL and subsequent anterior chamber IOL (ACIOL) placement presented with monocular diplopia secondary to ACIOL subluxation. The patient underwent explantation of the subluxed ACIOL and placement of a scleral-fixated IOL using the Yamane technique. The postoperative course was complicated by persistent hypotony, prompting ultrasound biomicroscopy, which revealed a cyclodialysis cleft adjacent to one of the externalized IOL haptics. The haptic was discovered in the involved supraciliary space while performing direct cyclopexy. The cyclodialysis cleft closed with return to physiologic intraocular pressure.CONCLUSIONS:Cyclodialysis cleft formation is a possible complication of scleral IOL fixation and should be suspected in cases of prolonged postoperative hypotony. Extended longitudinal tracking of the needle and haptic through the supraciliary space may be one mechanism for cyclodialysis cleft formation in the Yamane technique.

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A middle-aged patient with a remote history of bilateral juvenile cataracts after posterior chamber intraocular lens placement (PCIOL) presented with decreased vision in the right eye for several months. Examination was notable for a superonasal area of pigmentation with elevation of the conjunctiva and an inferotemporally subluxed PCIOL in the right eye. What would you do next?

Purpose COVID-19 vaccines are currently undergoing long-term safety monitoring, including for ocular side effects. Uveitis following vaccination has been described previously with other vaccines and warrants evaluation for COVID-19 vaccines, especially given their widespread use.Case Reports We present two cases of patients who developed anterior uveitis following the Moderna COVID-19 vaccine, as reported to the National Registry for Drug-Induced Ocular Side Effects. We also summarize reports of anterior uveitis following COVID-19 vaccination as reported to the World Health Organization global database of individual case safety reports.Conclusions Based on the temporal pattern of ocular inflammation following vaccine delivery in these cases, an association may be present between uveitis and COVID-19 vaccination. Further investigation to explore this association is warranted to guide patient care.

Purpose: To describe the intraoperative and early postoperative complications using preloaded Descemet membrane endothelial keratoplasty (DMEK) grafts with intraocular injection of the graft in Optisol-GS and omission of trypan blue restaining. Methods: This is a retrospective case series of 132 consecutive eyes with Fuchs endothelial dystrophy or endothelial failure who underwent DMEK using preloaded donor tissue prepared as previously described. The graft was not restained with trypan blue by the surgeon, and Optisol-GS was injected with the graft into the eye instead of being rinsed from the injector. Early postoperative complications (0-8 wk) including intraoperative fibrin formation, intraocular inflammation, elevated intraocular pressure, partial graft detachment requiring rebubble, and early graft failure were recorded. Results: No eyes developed intraoperative fibrin formation or postoperative inflammation (such as toxic anterior segment syndrome) or elevated intraocular pressure. For eyes with Fuchs corneal dystrophy, our rebubble rate was 21% (22/106 eyes). Early graft failure was noted in 2% (3/132 eyes), which is similar to previous reports. Conclusions: Our results suggest that injection of Optisol-GS into the anterior chamber during DMEK graft injection does not lead to increases in intraoperative or early postoperative complications. Trypan blue restaining is not necessary for intraoperative visualization. This simplification can reduce graft manipulation and save time and resources for this procedure.

PURPOSETo map and measure the depths of corneal neovascularization (NV) using 3-dimensional optical coherence tomography angiography (OCTA) at 2 different wavelengths.METHODSCorneal NV of varying severity, distribution, and underlying etiology was examined. Average NV depth and vessel density were measured using 840-nm spectral-domain OCTA and 1050-nm swept-source OCTA. The OCTA results were compared with clinical slit-lamp estimation of NV depth.RESULTSTwelve eyes with corneal NV from 12 patients were imaged with OCTA. Clinically "superficial," "midstromal," and "deep" cases had an average vessel depth of 23%, 39%, and 66% on 1050-nm OCTA, respectively. Average vessel depth on OCTA followed a statistically significant ordinal trend according to the clinical classification of vessel depth (Jonckheere-Terpstra test, P < 0.001). In 8 cases where both 840-nm OCTA and 1050-nm OCTA were acquired, there was excellent agreement in the mean vessel depth between the 2 systems (concordance correlation coefficient = 0.94, P < 0.001). The average vessel density measured by 840-nm OCTA was higher (average 1.6-fold) than that measured by 1050-nm OCTA.CONCLUSIONSCorneal OCTA was able to map corneal NV in 3 dimensions and measure vessel depth and density. The depth of corneal NV varied between different pathologies in a manner consistent with previous pathologic studies. The measured vessel density appeared to be affected by the interscan time, which affects blood flow velocity sensitivity, and the wavelength, which affects the ability to penetrate through opacity. These findings suggest possible clinical applications of OCTA for the diagnosis of corneal pathology and quantitative monitoring of therapeutic response in patients with corneal NV.