In this cross-sectional, retrospective analysis of a single-provider outpatient clinic across multiple satellites, consecutive patients returning for intravitreal injections (IVIs) of anti-vascular endothelial growth factor or corticosteroids were identified as "delayed" or "undelayed" during a six-week study interval during the COVID-19 pandemic to determine secondary effects of the closure period on injection-based retina care and outcomes. A "delayed" encounter was defined as having a follow-up interval exceeding 33% of the recommended cycle. Patients seen for IVIs during the corresponding six-week interval a year previously were identified for study as pre-COVID-19 controls. Main outcome measures included best-corrected visual acuity (BCVA) and optical coherence tomography (OCT) assessment based on findings of intraretinal or subretinal fluid consistent with new or recurrent neovascular events.

The study included 183 eyes of 144 patients who underwent IVI-based care from June 18, 2020, through August 7, 2020, compared to 193 eyes of 154 patients injected during the corresponding interval one year before. There were 62 eyes of 46 patients seen in the study period later than scheduled (among 144 patients of 183 eyes in total), which represented a larger proportion of delayed patients compared to the previous year (31.9% vs. 14.9%). Considering the patterns from the control group, the attributed delay due to COVID-19 was 15.0% of patients. The delayed return eyes had a greater decline in BCVA (three letters), higher rates of worsened OCT results (48%) and prompted reduction in previously prescribed injection intervals.

Researchers wrote that the unintended consequence of delayed care of patients on established care regimens should be anticipated, and mitigate strategies considered if similar restrictions are mandated in the future.

Major studies demonstrating the inhibition of myopia in children and juveniles by low-dose atropine eye drops provide little information on the manufacturing process and the exact composition of the atropine dilutions. However, corneal penetration might significantly vary depending on preservatives such as benzalkonium chloride (BAC) and the atropine concentration. Since there is a tradeoff between side effects, stability and optimal effects of atropine on myopia, it is important to gain better knowledge about intraocular atropine concentrations. Researchers performed an ex vivo study to determine corneal penetration for different formulations. Atropine drops (0.01%) of different formulations were obtained from pharmacies and applied to the cornea of freshly enucleated pig eyes. After 10 minutes, a sample of aqueous humor was taken, and atropine concentrations were determined following liquid-liquid extraction followed by high-performance liquid chromatography-tandem mass spectrometry (LC-MS/MS).

The variability that originated from variations in applied drop size exceeded the differences between preserved and preservative-free formulations. The atropine concentration in the anterior chamber measured after 10 minutes was only 3.8 × 10-8 of its concentration in the applied eye drops, corresponding to 502.4 pM.

Researchers reported that the preservative did not facilitate corneal penetration, at least ex vivo. They added that, in the aqueous humor of children's eyes, similar concentrations, including higher variability, may be expected in the lower therapeutic window of pharmacodynamic action.

A total of 31 eyes of 31 glaucoma patients were studied to investigate the use of preoperative steroid drops in glaucoma patients undergoing trabeculectomy for ocular surface disease. Only glaucoma patients who had been using at least three topical intraocular pressure-lowering medications for longer than six months were included. All patients were treated with loteprednol etabonate ophthalmic suspension 0.5% four times per day for one week before trabeculectomy. Data from baseline (day of surgery) and the follow-up visit (two weeks after surgery) were included. All patients underwent a detailed ophthalmologic exam. Ocular surface disease was evaluated using the Ocular Surface Disease Index questionnaire and clinical measures, including tear breakup time, conjunctival hyperemia, and biomicroscopy to detect the presence or absence of keratitis. Ocular Surface Disease Index scores greater than 13 indicated a clinically relevant presence of ocular surface disease. In addition, all patients underwent keratograph analysis. The comparison of ocular surface disease before and after trabeculectomy was assessed using a paired test.

The mean age of the glaucoma patients was 69.90 ± 10.77 years. The average visual acuity was 0.40 ± 0.34 logMAR. The overall Ocular Surface Disease Index prevalence rate was 27.20 ± 17.56 units. Clinical assessment revealed no significant difference in bulbar redness, breakup time or keratitis before and after surgery. Keratograph analysis showed that the only two parameters that were significantly different before and after trabeculectomy were the bulbar redness by keratograph (BR-K) and the average noninvasive tear breakup time. Patients presented more conjunctival hyperemia and shorter noninvasive tear breakup time after trabeculectomy compared with before surgery.

Investigators wrote that the study not only confirmed the high prevalence of clinical findings of ocular surface disease in glaucoma patients but also revealed new objective parameters measured by keratograph analysis. Apart from using loteprednol etabonate ophthalmic suspension 0.5% one week before the surgery, the sample demonstrated a worsening of conjunctival hyperemia (bulbar redness by keratograph) and also a shorter noninvasive tear breakup time postoperatively.