Given the increasing global demand for ophthalmologic care and the anticipated shortage of ophthalmology professionals, innovative solutions are essential for optimizing health care delivery. Digital health technologies offer promising opportunities to efficiently manage high patient volumes. Cataract surgery, with its established safety profile and routine postoperative care, provides an ideal setting for implementing such innovations. Structured clinical questions have proven effective in identifying patients requiring further assessment, supporting the feasibility of follow-up through telephone consultations. To further extend this approach, artificial intelligence-based follow-up systems may offer an opportunity to automate these interactions, reduce clinician workload, and streamline care pathways. The aim of the study is to assess the clinical safety and effectiveness of an artificial intelligence-based follow-up call system (Dora-NL1) in identifying patients who require further assessment after cataract surgery in the Netherlands. This prospective single-center study was conducted at the University Eye Clinic Maastricht, the Netherlands. Adult patients who underwent uncomplicated cataract surgery were eligible to participate. All patients received a Dora-NL1 follow-up telephone call at 1 and 4 weeks postoperatively in addition to standard care (a clinician-led telephone consultation at week 1 and an in-person hospital visit at week 4). The Dora-NL1 calls used a standard conversational flow to evaluate symptoms and recommend a clinical outcome. The recommended outcomes of Dora-NL1 were based on the symptoms reported by the patient. Clinical safety and accuracy were assessed by comparing Dora-NL1 outcomes to blinded clinician assessments of recorded calls and to standard postoperative care. Patient-reported usability was measured using the Telehealth Usability Questionnaire and Net Promoter Score. A total of 105 patients with a mean age of 72 (SD 7) years were included in the analysis. Dora-NL1 demonstrated high agreement with clinician-supervised calls, with symptom evaluation accuracy ranging from 89% to 99% (κ=0.390-0.947) and care management decision accuracy between 83% and 88% (κ=0.640-0.753). At week 1, Dora-NL1 showed a sensitivity of 100% and a specificity of 42% compared to standard clinician-led telephone consultations with no missed clinical concerns. At week 4, compared to the in-person follow-up, Dora-NL1 failed to identify 4 (4.1%) patients who required unexpected management changes, including 3 with asymptomatic complications detected only via slit lamp examination and 1 with complaints in the nonoperated eye. Patients rated Dora-NL1 positively, with Net Promoter Scores of +13.5 and +12.6 at week 1 and 4, respectively. The Telehealth Usability Questionnaire was completed by 98 patients, yielding a mean score of 3.19 (SD 1.13) on a 5-point scale, highlighting its simplicity, ease of use, and audibility. Dora-NL1 is a safe and effective tool for automated postoperative screening following cataract surgery. It offers a safe alternative to clinician-led telephone consultations in routine cases but cannot fully replace in-person examinations.

PURPOSE:The purpose is to study the change in the contact of the IOL with the posterior capsule using intraoperative SD-OCT before and after implantation of the CTR post implantation of the IOL in the capsular bag. METHODS:A total of 51 eyes of 51 patients with senile immature cataract underwent topical phacoemulsification procedure with implantation of an extended depth of focus intraocular lens by a single experienced surgeon. The Rescan 700 SD-OCT system was used for intraoperative imaging. These patients were imaged using intraoperative SD-OCT after implantation of the IOL and before and after implantation of appropriate size of CTR. The vertical height between posterior surface of the lens capsule and the posterior surface of the IOL was measured and compared across 3 CTR sizes. RESULTS:The vertical height between the posterior surface of the lens capsule and the posterior surface of the IOL reduced significantly post CTR implantation (P value < 0.001) in all three groups. The change in height after CTR implantation was seen highest with the CTR size 13 mm and lowest with CTR size 11 mm. CONCLUSION:Significant improvement of contact between the IOL and the posterior capsule was shown after implantation of the CTR. Larger the size CTR, more the contact of the IOL with the bag was shown.

Purpose: To evaluate the symptoms, etiology and treatment of patient dissatisfaction after extended depth-of-focus (EDOF) intraocular lens (IOL) implantation. Setting: University Eye Clinic, Maastricht University Medical Center, the Netherlands Design: Retrospective case series. Methods: For this study, all medical records of patients who received an EDOF IOL from July 2020 to July 2022 were reviewed. Patients were included if they had reported any dissatisfaction after surgery. The main outcome parameters were reasons for dissatisfaction (subjective complaints) and the presumed etiology of the complaints. Results: Out of 202 patients (354 eyes) who underwent EDOF IOL implantation, 83 eyes (22.8%) of 52 dissatisfied patients were included. Blurred vision was the predominant complaint, reported in 78 eyes (94%). Photic phenomena were reported in 21 eyes (25.3%), with 16 eyes (76.2%) experiencing coexisting blurred vision. The major etiologies for dissatisfaction in this cohort were residual ametropia (51.8%), dry eye disease (26.5%), and posterior capsular opacification (12.0%). Treatments were administered to 85.5% of the eyes, including interventions such as artificial tears, spectacles, or refractive surgery enhancement. A small number of patients (n=12; 5.9%) remained dissatisfied despite intervention. Conclusion: Based on this real-world data study, dissatisfaction following EDOF IOL implantation can be effectively identified and treated in most cases.

Acanthamoeba keratitis (AK) is a sight-threatening corneal infection that is challenging to diagnose and treat due to the resistance of Acanthamoeba to standard antimicrobial agents. Current detection methods have limitations. This study aimed to develop and validate a sensitive viability PCR (v-PCR) assay using a photoreactive dye to distinguish viable from non-viable Acanthamoeba for rapid identification of viable Acanthamoeba trophozoites and cysts. Propidium monoazide (PMAxx) was used as a photoreactive dye. Mixtures containing decreasing percentages of viable Acanthamoeba, including reference strains Acanthamoeba polyphaga trophozoites and cysts, Acanthamoeba castellanii trophozoites, and Acanthamoeba castellanii trophozoites from a clinical sample, were prepared. Disinfectant efficacy against Acanthamoeba was also assessed. Samples were divided into PMAxx-treated and non-PMAxx-treated parts, and v-PCR assay was applied to both. The difference in viable Acanthamoeba was determined by subtracting the cycle threshold (Ct) value of the PMAxx-treated sample from the non-PMAxx-treated sample. Mixtures with decreasing concentrations of viable Acanthamoeba trophozoites and cysts showed increasingly lower delta Ct values as the percentage of viable Acanthamoeba decreased, as expected. This relationship was observed across all tested samples. Menicon Progent effectively eliminated A. polyphaga trophozoites and cysts, while propamidine, chlorhexidine, or their combination resulted in approximately 2-log reductions in A. polyphaga trophozoites and cysts. In the current study, a rapid v-PCR assay was developed that can distinguish between viable and non-viable Acanthamoeba, for both trophozoites and cysts, across multiple species. The presence of viable Acanthamoeba, as determined by v-PCR, allows monitoring of treatment response and efficacy in AK.IMPORTANCEThe development of a sensitive viability PCR (v-PCR) assay using propidium monoazide (PMAxx) as a photoreactive dye marks a significant advancement in the diagnosis and treatment of Acanthamoeba keratitis (AK), a severe corneal infection notorious for its resistance to conventional antimicrobials. This innovative assay offers a rapid and accurate method to distinguish viable from non-viable Acanthamoeba trophozoites and cysts, addressing a critical need in the field. By effectively distinguishing between viable and non-viable Acanthamoeba, this test enables monitoring of treatment response and efficacy, essential for guiding clinical interventions in AK cases. The successful validation of this v-PCR assay across various Acanthamoeba species and its ability to assess disinfectant efficacy further underline its potential as a valuable tool for improving diagnostic precision and therapeutic outcomes in the treatment of AK.

To evaluate the association of postoperative IOL tilt and decentration and corrected distance visual acuity (CDVA) by performing analyses using IOLMaster700 data and custom-developed software. University Eye Clinic Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands. This case series included patients after cataract surgery who underwent SS-OCT scans using the IOLMaster700 with custom-developed software for tilt and decentration analyses. The outcomes based on our custom-developed software were conducted along the pupillary axis (PA) and corneal topographic axis (CTA). Associations between tilt, decentration and CDVA were evaluated. A total of 168 eyes (168 patients) were analyzed. The maximum observed IOL tilt was 9.54° along the CTA and 3.69° along the PA. Maximum decentration reached 2.22 mm (CTA) and 2.17 mm (PA). Mean tilt was 1.21 ± 0.69° (PA) and 4.87 ± 1.52° (CTA), while mean decentration was 0.27 ± 0.25 mm (PA) and 0.27 ± 0.26 mm (CTA). Regression analyses showed no statistically significant associations between tilt or decentration and CDVA, irrespective of the reference axis used. For tilt along the PA, the regression coefficient (B) was 0.004 (95 What is new?

Purpose: To compare the safety of a standardized, commercially available intracameral combination of mydriatics and anesthetic (ICMA) with a reference topical mydriatic regimen for cataract surgery. Patients and Methods: The safety results from two international, randomized, controlled clinical studies were combined to compare ICMA at the beginning of cataract surgery (ICMA group) to the reference topical mydriatic regimen (reference group). Data were collected on ocular and systemic adverse events, corneal and anterior chamber examination, endothelial cell density, retinal thickness and visual acuity. Analysis was performed on a pooled safety set from both studies, preoperatively and up to 1 month postoperatively. Results: 342 patients received ICMA and 318 the reference topical regimen. Ocular adverse events were reported in 17.0% of patients in the ICMA group and 18.6% in the reference group. No difference was shown between groups in endothelial cell density (2208 +/- 498 cells/mm2 for ICMA group versus 2241 +/- 513 cells/mm2 for the reference group; p=0.547) and retinal thickness (change from baseline less than 50 mu m in 94.7% versus 95.0% of patients, respectively) at 1 month postoperatively. At 1-day post-surgery, less patients in the ICMA group had moderate or severe (Grades 2 and 3) superficial punctate corneal staining (3.9% versus 7.0% for the reference group; p=0.064). Postoperatively, some ocular symptoms were also less frequently reported in the ICMA group. Bestcorrected visual acuity increased in 96.0% of patients in the ICMA group and 95.8% in the reference group at 1 month. Conclusion: ICMA injection at the beginning of cataract surgery was demonstrated to be safe and may also provide perioperative and postoperative advantages over the standard topical mydriatic regimen.

PurposeWe describe a patient after customized crosslinking (CXL) for progressive keratoconus who developed corneal edema with spontaneous resolution.ObservationsA 24-year-old male with progressive keratoconus of the left eye underwent a customized CXL procedure with a total energy of 10 J/cm2 for 16.4 minutes. Preoperative corrected distance visual acuity (CDVA) was 20/30 with a maximum keratometry (K)-value of 58.6 diopter (D) and the thinnest point measured 414 μm. The preoperative endothelial cell density (ECD) was 2414 cells/mm2. During treatment, corneal thickness was 325 μm after epithelial debridement and 375 μm after the application of 0.1% riboflavin containing HPMC. After the treatment, antibiotic and steroid drops were prescribed for 5 days and 3 weeks, respectively. At the 1-month post-CXL visit the patient had no complaints, visual acuity and clinical examination showed no irregularities. At the 4-months post-CXL visit the patient complained of blurry vision. The CDVA was 20/100 and slit-lamp examination showed microcystic corneal edema. The corneal thickness at the thinnest point measured 440 μm. One month later the edema had resolved spontaneously and CDVA had restored to 20/25. Corneal thickness at the thinnest point measured 415 μm, the ECD was 1514 cells/mm2 and confocal microscopy showed normal structural changes in the anterior stroma after CXL, with the demarcation line located at a depth of 414 μm, just above the corneal endothelium.Conclusions and ImportanceWe report a case of corneal edema following customized CXL with endothelial cell loss that resolved spontaneously. We recommend either adhering to a minimal stromal thickness of 400 μm before administering UV-A irradiation, using a contact lens or adjusting the irradiation to prevent this complication.

Purpose: To assess the effect of change in ocular spherical aberration (SA) with adaptive optics on visual acuity (VA) at different defocus after implantation of extended depth-of-focus (EDOF) and enhanced monofocal intraocular lenses (IOLs). Settings: Narayana Nethralaya Eye Hospital, Bangalore, India. Design: Prospective, longitudinal, observational. Methods: 80 eyes (40 patients) that had cataract surgery were included in the study. 40 eyes were implanted with Eyhance EDOF IOLs and the remaining with Vivity EDOF IOLs. Baseline ocular aberrations were measured with a visual adaptive optics aberrometer, then the optimal SA was determined by increasing it in steps of −0.01 μm up to −0.1 μm until the maximum improvement in near distance VA was observed for a given eye. Then the defocus curve for each eye was measured after modifying the ocular SA by magnitude equal to optimal SA. Results: Most of the eyes accepted a negative induced SA of −0.05 μm (Eyhance group: 67.6%; Vivity group, 45.2%). In the Eyhance group (dominant eyes), VA improved at −2 diopters (D) (P < .02) only and degraded at 0 D, +0.5 D, and +1 D defocus (P < .05). In the Vivity group, the VA remained unchanged at all defocus (P > .05). In the Eyhance group (nondominant eyes), VA improved at −3.5 D defocus only and degraded at +1.5 D and +2 D defocus (P < .05). In the Vivity group, VA improved at −2.5 D defocus (P < .05) only. Conclusions: A negative induced SA of −0.05 μm in implanted eyes was optimal for a slight improvement in distance-corrected near and intermediate VA without any significant decrease in baseline distance-corrected VA.

Motivation: Preclinical research suggests an ocular glymphatic system similar to the cerebral system, driven by intraocular pressure (IOP). However, human studies are scarce. Goal(s): To explore the eye-brain connection by investigating tear total-tau as a potential early marker of cerebral glymphatics and consider the link between IOP (driver of ocular glymphatics) and impaired cerebral waste clearance. Approach: MRI-visible PVS were scored on 7T images and related to IOP and tear total-tau. Results: Higher tear total-tau and lower IOP were associated with more PVS, implying a connection to impaired cerebral waste clearance and aligning with the potential presence of a human ocular glymphatic system. Impact: Our exploratory results suggest that higher tear-tau and a reduced driving force of ocular waste clearance are connected to impaired cerebral waste clearance. Thereby, this study bridges the gap between the potential human ocular glymphatic system and cerebral waste clearance.

PURPOSE: To compare the prediction accuracy of toric intraocular lens calculations using estimated vs measured posterior corneal astigmatism (PCA). DESIGN: Retrospective case series. center dot METHODS: A total of 110 eyes of 110 patients with uncomplicated toric intraocular lens implantation were included in this study. Predicted postoperative refractive astigmatism was calculated with the Barrett Toric Calculator using the estimated PCA (E-PCA), the measured IOLMaster 700 PCA (I-PCA), and the measured Pentacam PCA (P-PCA). Refractive astigmatism prediction errors (RA-PEs), including their trimmed (tr-) centroid (mean vector), spread (precision), tr-mean absolute RAPE (accuracy), and percentage within a certain threshold, were determined using vector analysis and compared between groups. SETTING: University Eye Clinic, Maastricht University Medical Center + , the Netherlands. RESULTS: The tr-centroid RA-PEs of the E-PCA (0.02 diopter [D] at 82.2 degrees), the I-PCA (0.08 D at 35.5 degrees), and the P-PCA (0.09 D at 69.1 degrees) were significantly different from each other ( P < .01), but not significantly different from zero ( P = .75, P = .05, and P = .05, respectively). The E-PCA had the best precision (tr-mean 0.40 D), which was not significantly lower than the I-PCA (0.42 D, P = .53) and P-PCA (0.43 D, P = .06). The EPCA also had the best accuracy (0.40 D), which was not significantly different from the I-PCA (0.42 D, P = .26) and significantly better than the P-PCA (0.44 D, P < .01). The precision and accuracy of the I-PCA did not significantly differ from those of the P-PCA. There were no statistically significant differences in the percentage of eyes within a certain absolute RA -PE threshold. CONCLUSIONS: The Barrett Toric Calculator using the E-PCA, I-PCA, or P-PCA showed a comparable prediction of postoperative refractive astigmatism in standard clinical practice. (Am J Ophthalmol 2024;262: 107113. (c) 2023 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ ))

Impaired cerebral waste clearance (i.e., glymphatics) is evident in aging and neurodegenerative disorders, such as Alzheimer's disease, where an impaired waste clearance system could be related to the accumulation of pathological proteins (e.g., tau). One marker of impaired cerebral clearance is the abundance of enlarged perivascular spaces (PVS). Preclinical studies propose a similar clearance system in the eye, driven by intraocular pressure (IOP). This cross-sectional pilot study explores the link between ocular and cerebral waste clearance by examining the association between MRI-visible PVS, tear fluid total-tau, and IOP. Thirty cognitively healthy participants, all aged over 55 years, underwent 7 Tesla MRI, with PVS visually rated in the centrum semiovale (CSO) and basal ganglia. Tear fluid was collected using paper Schirmer's strips and analyzed for total-tau using enzyme-linked immunosorbent assay. IOP was measured using non-contact tonometry. Partial Spearman's correlation coefficients of eye and brain markers were calculated, adjusted for age, sex, tear fluid-wetting length, and hemispheric region of interest volume. Higher CSO PVS scores in the left and right hemisphere were associated with higher levels of tear fluid totaltau. Higher CSO PVS scores in both hemispheres were related to lower ipsilateral IOP. The exploratory results suggest that higher tear fluid total-tau and a reduced driving force of ocular waste clearance are connected to impaired cerebral waste clearance in cognitive healthy individuals. This study connects the potential ocular glymphatic system to the cerebral waste clearance system. Clarifying waste clearance biology and validating eye biomarkers for cerebral waste clearance could provide treatment targets and diagnostic opportunities for neurological diseases.

PURPOSE:To study change in the contact of intraocular lens (IOL) with the posterior capsule with respect to the vertical versus horizontal orientation of the haptic-optic junction of the IOL using intraoperative spectral domain optical coherence tomography (SD-OCT). METHODS:Fifty eyes of 50 patients with senile immature cataract underwent topical phacoemulsification procedure with implantation of a monofocal IOL by a single experienced surgeon. The Rescan 700 SD-OCT system was used for intraoperative imaging. These patients were imaged using intraoperative SD-OCT after implantation of IOL, with the haptics oriented horizontally and then vertically. RESULTS:The vertical height between the posterior surface of the lens capsule and the posterior surface of IOL reduced significantly when the haptics were oriented vertically compared to horizontal orientation. This difference was found on analyzing both vertical as well as horizontal axis scans. CONCLUSION:We found a greater contact between the posterior capsule and the posterior surface of IOL, with the haptic optic junction of the IOL oriented vertically. This study also suggests the need for newer toric IOL designs which allow vertical orientation of haptics, leading to better contact between IOL and the bag.

Abstract Background Epidemiological and toxicological studies indicate that increased exposure to air pollutants can lead to neurodegenerative diseases. To further confirm this relationship, we evaluated the association between exposure to ambient air pollutants and corneal nerve measures as a surrogate for neurodegeneration, using corneal confocal microscopy. Methods We used population-based observational cross-sectional data from The Maastricht Study including N = 3635 participants (mean age 59.3 years, 51.6% were women, and 19.9% had type 2 diabetes) living in the Maastricht area. Using the Geoscience and hEalth Cohort COnsortium (GECCO) data we linked the yearly average exposure levels of ambient air pollutants at home address-level [particulate matter with diameters of ≤ 2.5 µm (PM2.5), and ≤ 10.0 µm (PM10), nitrogen dioxide (NO2), and elemental carbon (EC)]. We used linear regression analysis to study the associations between Z-score for ambient air pollutants concentrations (PM2.5, PM10, NO2, and EC) and Z-score for individual corneal nerve measures (corneal nerve bifurcation density, corneal nerve density, corneal nerve length, and fractal dimension). Results After adjustment for potential confounders (age, sex, level of education, glucose metabolism status, corneal confocal microscopy lag time, inclusion year of participants, smoking status, and alcohol consumption), higher Z-scores for PM2.5 and PM10 were associated with lower Z-scores for corneal nerve bifurcation density, nerve density, nerve length, and nerve fractal dimension [stβ (95% CI): PM2.5 -0.10 (-0.14; -0.05), -0.04 (-0.09; 0.01), -0.11 (-0.16; -0.06), -0.20 (-0.24; -0.15); and PM10 -0.08 (-0.13; -0.03), -0.04 (-0.09; 0.01), -0.08 (-0.13; -0.04), -0.17 (-0.21; -0.12)], respectively. No associations were found between NO2 and EC and corneal nerve measures. Conclusions Our population-based study demonstrated that exposure to higher levels of PM2.5 and PM10 are associated with higher levels of corneal neurodegeneration, estimated from lower corneal nerve measures. Our results suggest that air pollution may be a determinant for neurodegeneration assessed in the cornea and may impact the ocular surface health as well.

An induced cylinder and spherical power after implantation with an extended depth of focus (EDOF) and enhanced monofocal intraocular lens (IOL) could improve distance, intermediate (60 cm) and near (40 cm) visual acuity (VA). In this prospective study, forty eyes with Eyhance EDOF IOL (Johnson and Johnson, USA) and 40 eyes with Vivity EDOF IOL (Alcon Laboratories Inc. USA) were included. Induced cylinder (applied to non-dominant eye) in steps of + 0.25D were used and then VA was measured monocularly (only non-dominant eye). Similarly, induced sphere (applied to non-dominant eye) in steps of + 0.25D were used and then VA was measured monocularly (only non-dominant eye). The above methods were repeated for the dominant eye as well. Then, binocular defocus curve for each patient was obtained by inducing optimal sphere and cylinder (one at a time in front of the non-dominant eye only). In both IOL groups, induced cylinder and sphere independently led to significant improvement in near and distance vision (p < 0.05). Induced sphere binocularly caused a greater decrease (similar to 0.1 LogMAR) in distance VA compared to induced cylinder but this was not clinically significant. Most patients accepted an induced cylinder of +1.0 to +1.5D in both IOL groups. Induced cylinder and sphere caused a favourable improvement in near and intermediate VA after surgery in both IOL groups without a significant drop in distance VA.

PURPOSE. Keratoconus is characterized by the progressive thinning of the cornea, which leads to a cone-like appearance of the eye over time. Although conventionally defined as a noninflammatory condition, a number of recent studies have associated keratoconus (KC) with allergic conjunctivitis (AC) based on clinical parameters. This study aimed to consolidate this association by performing a proteomic analysis of tear fluid from patients with keratoconus and/or allergic conjunctivitis. METHODS. Of 51 patients, 17 were diagnosed with KC, 17 were diagnosed with AC, and 17 were diagnosed with both KC and AC (combined). Nine of 34 patients with KC had a progressive form of the disease. Tear fluid samples (n = 51, one eye per patient) were collected by the Schirmer's strips. Tear proteins were extracted from the Schirmer's strips. Proteomic profiling of 384 inflammatory proteins was assessed by a multiplex proximity extension assay (Olink Explore 384 Inflammation Panel I). RESULTS. A total of 384 inflammatory proteins were measured. Two hundred seventytwo of the 384 proteins passed stringent data cleaning and were compared among the patient groups. Compared to the 2 other groups, LGALS9 was upregulated uniquely in KC, whereas FGF19, PDGFB, HPCAL1, OSM, and FCAR were downregulated in KC. Similarly, TNFRSF4 and CCL13 were specifically upregulated in AC, whereas ectodysplasin A receptor (EDAR) was uniquely downregulated in AC. CONCLUSIONS. High-throughput proteomic profiling of tear fluid confirms the association between KC and AC on a molecular level and raise the importance of redefining KC as an inflammatory condition.

Purpose of review The aim of this study was to present an overview of recent publications and opinions in the field of same-day bilateral cataract surgery. Recent findings A Cochrane review was published comparing immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) with regard to safety outcomes, costs and cost-effectiveness. In addition, several large database studies provided more information on incidences of rare complications such as unilateral and bilateral endophthalmitis rates. Summary Recently available evidence showed that ISBCS is an effective and cost-effective alternative to DSBCS. Nonetheless, additional (randomized) registry studies, randomized controlled trials and cost-effectiveness studies are needed to evaluate bilateral endophthalmitis rates, refractive outcomes and cost-effectiveness of ISBCS compared with DSBCS.

Purpose: The aim of this study was to analyze real-world practice patterns and graft survival after corneal transplantation for infectious keratitis in the Netherlands. Methods: All consecutive keratoplasties for infectious keratitis registered in the Netherlands Organ Transplant Registry were included. Graft survival was analyzed using Kaplan–Meier survival curves with Cox regression to compare the 3 most common pathogens with subgroup analysis for type and reason of transplantation, sex, and graft size. Multivariable analysis was performed using the same explanatory factors. Results: Between 2007 and 2017, 1111 keratoplasties for infectious keratitis were registered in the Netherlands Organ Transplant Registry. The most common pathogens were viruses (n = 437), bacteria (n = 271), and Acanthamoeba (n = 121). Human leukocyte antigen (HLA) matching did not provide a significant survival benefit, whereas emergency procedures showed worse graft survival [hazard ratio (HR) = 0.40, P = 0.120; HR = 2.73, P < 0.001, respectively]. Graft size >8.5 mm was significantly worse than graft size 8.5 mm (HR = 2.062, P = 0.010). In therapeutic keratoplasty, graft survival was significantly worse for Acanthamoeba than viral keratitis (HR = 2.36, P = 0.008). In the multivariable model, adjusting for graft size, type, and reason for transplantation, viral and bacterial keratitis did not differ significantly in graft survival, and Acanthamoeba showed a significantly worse prognosis (vs. viral keratitis, HR = 2.30, P < 0.001; bacterial keratitis, HR = 2.65, P < 0.001). Conclusions: Viral keratitis was the most common indication for transplantation, followed by bacterial and Acanthamoeba keratitis. HLA matching did not offer protection over elective non-HLA–matched procedures, whereas emergency procedures and grafts sized >8.5 mm showed poor survival. In optical keratoplasty, survival is high for all pathogens, whereas in therapeutic keratoplasty Acanthamoeba shows poor outcome.

Purpose: To validate the Easee web-based tool for the assessment of visual acuity in patients who underwent cataract surgery. Setting: University Eye Clinic Maastricht, Maastricht, the Netherlands. Design: Prospective method comparison study. Methods: Subjects aged between 18 and 69 years who underwent cataract surgery on 1 or both eyes at the Maastricht University Medical Center+ were eligible to participate in this study. The uncorrected (UDVA) and corrected distance visual acuity (CDVA) assessments were performed using the web-based tool (index test) and conventional ETDRS and Snellen charts (reference tests). The outcomes of the different tests were expressed in logMAR, and a difference of <0.15 logMAR was considered clinically acceptable. Results: 46 subjects with 75 operated eyes were included in this study. The difference of the UDVA between the web-based tool and ETDRS or Snellen was −0.05 ± 0.10 logMAR (P < .001 [0.15; −0.26]) and −0.04 ± 0.15 logMAR (P = .018 [0.24; −0.33]), respectively. For the CDVA, these differences were −0.04 ± 0.08 logMAR (P < .001 [0.13; −0.21]) and −0.07 ± 0.10 logMAR (P < .001 [0.13; −0.27]), respectively. The Pearson correlation coefficients between the web-based tool and ETDRS were maximally 0.94 and compared with Snellen 0.92. In total, 73% to 88% of the visual acuity measurement differences were within 0.15 logMAR. Conclusions: The web-based tool was validated for the assessment of visual acuity in patients who underwent cataract surgery and showed clinically acceptable outcomes in up to 88% of patients. Most of the participants had a positive attitude toward the web-based tool, which requires basic digital skills.

Abstract Tear fluid forms a potential source for biomarker identification, and can be minimal invasively collected via Schirmer strips. The lack of knowledge on the processing of Schirmer strips however complicates the analysis and between-study comparisons. We studied two different pre-processing methods, specifically the use of punches of the strip versus elution of the strip in PBS buffer. Tear fluid filled Schirmer strips were collected from 5 healthy participants, and divided into two halves over the length of the strip. In either part, punches or eluates were obtained from 4 different locations, from the first part touching the eye (head) to the end, to assess the protein distribution along the strips. The levels of 92 inflammatory proteins were measured in the punches/eluates using Olink Target 96. The punch method yielded higher protein detectability compared to the elution method (76% vs 66%; p ≤ 0.001). However, 3 out of 5 punches from the head failed quality control. Protein levels over the remaining parts of the strips were similar. Based on our findings we encourage using the punch method of any part of the strip except the head with Olink Target 96 or other suitable techniques.