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Background: Post-traumatic corneal wounds that require suturing are quite common; they reduce corneal transparency and cause corneal distortion, leading to corneal astigmatism and higher-order aberrations. Excimer laser treatment can be a potentially beneficial intervention for such wounds. The observation aimed to evaluate the effectiveness of topography-guided custom ablation treatment (TCAT) in patients with corneal injuries. Methods: This observation included three patients with corneal penetrating trauma (full-thickness corneal scar) and one patient with corneal blunt trauma, i.e., a non-penetrating injury with corneal laceration (partial-thickness corneal scar). This cohort study was conducted from July 2021 to August 2023. After first-stage treatment (stabilization of the post-traumatic visual defect confirmed by refraction and topography examination, corneal healing, and improvement of the corneal scar), the patients underwent the second-stage treatment, i.e., TCAT with a 20 to 45 s application of mitomycin C solution to avoid haze induction. After TCAT, the uncorrected distance visual acuity (UDVA) and best-corrected distance visual acuity (BCVA) were measured. Refractive astigmatism was assessed using autorefractometry. Topographic astigmatism was analyzed using corneal topography and pachymetry. The root mean square (RMS) of the higher-order aberration was calculated using Zernike coefficients. The patients’ corneal healing and refractive changes were monitored. Results: All patients were monitored for corneal healing and refractive changes and underwent the same second-stage treatment, which utilized TCAT to regularize the corneal surface and reduce higher-order aberrations (HOAs). The UDVA of patients 1, 2, 3 and 4 improved by 3, 7.5, 4 and 6 rows (Snellen chart), respectively. The resultant UDVA was 1.0, 0.9, 0.7 and 1.2, while BCVA was 1.0, 1.2, 1.0, and 1.5, respectively. Conclusions: TCAT regularized the patients’ corneal surfaces and reduced HOAs. We, therefore, conclude that TCAT may be a beneficial second-stage treatment for corneal trauma-induced astigmatism. Full article

Background—The COVID-19 pandemic has changed our standard practices: operating rooms were only available for functional emergencies and outpatient visits were drastically reduced in favor of telemedicine. Aim: To report the personalized “one-shot” surgery using absorbable 10-0 Vicryl (V10-0) or polyglactin 910 monofilament in mechanical corneal injuries from February 2020 to December 2021. Methods—Prospective case series with at least 12-months’ follow-up, in a French university hospital. Among the overall population of open or closed-globe emergencies (n = 40), non-penetrating corneal lamellar lacerations (long axis > 2 mm) in zone 1 (OTC group) were treated with V10-0 suture(s) (n = 10), replacing traditional non-absorbable 10-0 nylon suture(s) or medical options in first line. The outpatient visits were performed on day (D)10, month (M)2, M6 then every six months. One interim visit by phone teleconsultation was scheduled between D10 and M2, and other(s) as needed. The main outcome was best-corrected visual acuity (BCVA) at M6. Secondary outcomes included mainly corneal astigmatism (CA) at M6 complications. Results—Among the ten corneal wounds, there were three children (30%), eight domestic accidents (80%), three eyes with metallic foreign bodies (30%), four open-globe injuries (40%), and nine eyes that received high-speed projectiles or sharp objects (90%). The complete V10-0 suture(s) absorption occurred in all eyes between D10 and M2. At M6, mean far and near BCVA decreased from 0.680 ± 0.753 and 0.490 ± 0.338 preoperatively to 0.050 ± 0.071 and 0.220 ± 0.063 logMAR (p = 0.019 and p = 0.025 respectively), mean CA decreased from 4.82 ± 3.86 preoperatively to 1.15 ± 0.66 diopters (p = 0.008). BCVA and CA were unchanged thereafter. No serious adverse event nor repeated surgery occurred. The mean number of teleconsultations was 1.20 ± 0.63 without an additional nonscheduled outpatient visit. Conclusions—The absorbable V10-0 sutures might be a safe and effective alternative for eligible corneal wounds, while reducing the number of outpatient visits, especially for children (no suture removal). The COVID-19 pandemic highlighted that they are ideally suited to logistical challenges. Full article