New Drugs, New Toxicities: Side Effects of New and Emerging Breast Cancer Therapies.

With the rapid introduction of novel breast cancer therapies, recognizing and managing side effects is essential to maintain adherence and improve outcomes. As novel oral endocrine therapies and combination strategies including targeted agents have prolonged progression and in some cases disease-free survival, early recognition and appropriate management of these toxicities is critical to optimize quality of life. Dermatologic adverse events are frequently associated with novel breast cancer therapies including immune checkpoint inhibitors (ICIs), targeted therapies, and antibody-drug conjugates (ADCs).

Lysophosphatidic acid receptor 3 (LPAR3) regulates ocular surface chloride transport via calcium signaling.

Dry eye is a multifactorial disease associated with impaired tear film homeostasis, damaging the ocular surface epithelium. Lysophosphatidic acid receptors (LPARs) are G-protein coupled receptors involved in Ca and cAMP signaling via PLC and adenylyl cyclase activation. LPAR activation is involved in cell proliferation and wound healing in human corneal epithelial cells (HCECs) and in neuropathic pain.

Bilateral Light-Adjustable Lens Implantation in a Patient With 50-Cut Radial Keratotomy.

Purpose: To report a case of Light Adjustable Lens (LAL, RxSight, Aliso Viejo, CA) implantation in a patient with bilateral 50-cut radial keratotomy (RK) and discuss related preoperative, intraoperative, and postoperative considerations.

Methods: A 78-year-old patient with history of bilateral 50-cut RK underwent phacoemulsification with implantation of LALs in both eyes one month apart. Although LAL technology was not approved specifically for addressing limitations in intraocular lens calculation post-RK due to corneal topography irregularity, the patient opted for this lens due to its ability to make post-operative adjustments to its refractive power.

Multimodal Imaging of Posterior Corneal Opacities in Multicentric Osteolysis Nodulosis and Arthropathy (MONA).

Purpose: Multicentric osteolysis nodulosis and arthropathy (MONA) syndrome is a rare autosomal recessive skeletal dysplasia. Caused by mutations in the matrix metalloproteinase 2 gene () on chromosome 16q12, this syndrome has infrequently been associated with ophthalmic manifestations. Corneal opacities have been reported but not described or documented in detail.

Calcium-sensing receptor (CaSR) modulates ocular surface chloride transport and its inhibition promotes ocular surface hydration.

Purpose: Ocular surface hydration is critical for eye health and its impairment can lead to dry eye disease. Extracellular calcium-sensing receptor (CaSR) is regulator of ion transport in epithelial cells expressing cystic fibrosis transmembrane conductance regulator (CFTR) Cl channel. CFTR is also a major ion channel in ocular surface epithelia, however the roles of CaSR in ocular surface are not well studied.

Incidence and Mitigation of Corneal Pseudomicrocysts Induced by Antibody-Drug Conjugates (ADCs).

Purpose Of Review: This study is to highlight the incidence of corneal pseudomicrocysts in FDA-approved antibody-drug conjugates (ADCs), and success of preventive therapies for pseudomicrocysts and related ocular surface adverse events (AEs).

Recent Findings: ADCs are an emerging class of selective cancer therapies that consist of a potent cytotoxin connected to a monoclonal antibody (mAb) that targets antigens expressed on malignant cells. Currently, there are 11 FDA-approved ADCs with over 164 in clinical trials.

Integrating Internship Into Ophthalmology Residency: Assessment of a National Survey and Structured Microsurgical Curriculum.

Objective: To report the results of a national survey soliciting residency programs' microsurgical curricula for ophthalmology interns, and the efficacy of a single institution's intern microsurgical wet lab curriculum.

Design: Mixed methods study including a national survey and a prospective trial.

Setting: Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.

Keratoconus Diagnosis and Treatment: Recent Advances and Future Directions.

Keratoconus is a disorder characterized by progressive corneal thinning and steepening that may result in significant visual impairment secondary to high astigmatism, corneal scarring, or even corneal perforation. Early detection and screening of keratoconus are essential for effective management and treatment. Several screening methods, such as corneal topography and tomography, corneal biomechanics, and genetic testing, are being developed to detect keratoconus at an early stage.

Ocular Surface Ion Transport and Dry Eye Disease.

Purpose Of Review: To review the role of ocular surface epithelial (corneal and conjunctival) ion transporters in the pathogenesis and treatment of dry eye disease (DED).

Recent Findings: Currently, anti-inflammatory agents are the mainstay of DED treatment, though there are several agents in development that target ion transport proteins on the ocular surface, acting by pro-secretory or anti-absorptive mechanisms to increase the tear fluid Film volume. Activation or inhibition of selected ion transporters can alter tear fluid osmolality, driving water transport onto the ocular surface via osmosis.

Parental Keratoconus Literacy: A Socioeconomic Perspective.

Purpose: To assess the impact of parental socioeconomic status and keratoconus literacy on pediatric eye rubbing and keratoconus severity.

Methods: In this mixed-methods study, pediatric keratoconus patients (age ≤ 18 years) were retrospectively identified. Sociodemographic and clinical characteristics were extracted from the electronic medical record (EMR).

Trends in Corneal Topography and Tomography Imaging for Keratoconus Management.

Purpose: To describe trends in the use of corneal topography and tomography for the management of keratoconus patients at a single academic institution and to identify how these trends may be associated with different procedural interventions.

Patients And Methods: In this retrospective cohort study, keratoconus patients treated from 2012 to 2019 were identified. The electronic health record was reviewed for the presence of corneal topography or tomography imaging completed within seven days of the first visit and the highest level of intervention at the first and most recent visit.

Socioeconomic Correlates of Keratoconus Severity and Progression.

Purpose: The purpose of this study was to investigate the social determinants of health for keratoconus.

Methods: In this retrospective cohort study of patients with keratoconus, the electronic health record was reviewed for keratometry, treatments received, clinical comorbidities, and social characteristics. Outcomes included severe keratoconus at presentation (steep keratometry ≥52 diopters), disease progression (≥0.

Resident-performed immediate sequential bilateral cataract surgery during the COVID-19 pandemic.

Purpose: To assess visual outcomes and patient satisfaction for senior resident-performed immediate sequential bilateral cataract surgery (ISBCS) versus delayed sequential bilateral cataract surgery (DSBCS) during the COVID-19 pandemic, when minimizing healthcare-related exposures for patients and providers are paramount.

Methods: This was a pilot retrospective cohort study of all ISBCS and DSBCS patients who underwent senior resident-performed cataract surgery from May to September 2020 at a single academic institution. Outcome measures were final corrected distance visual acuity (CDVA), final manifest refraction (MRx), intraoperative and postoperative complications rates, total number of visits, and patient satisfaction assessed postoperatively by telephone questionnaire.

Ocular Surface Potential Difference Measured in Human Subjects to Study Ocular Surface Ion Transport.

Purpose: The epithelium lining the ocular surface, which includes corneal and conjunctival epithelia, expresses the prosecretory chloride channel cystic fibrosis transmembrane conductance regulator (CFTR) and the proabsorptive epithelial sodium channel (ENaC). Here, methodology was established to measure the millivolt (mV) potential differences at the ocular surface, called ocular surface potential difference (OSPD), in human subjects produced by ion transport.

Methods: OSPD was measured in human subjects in which a fluid-filled measuring electrode contacted a fluid pool created by eversion of the lateral lower eyelid, with a reference electrode placed subcutaneously in the forearm.

Remote corneal suturing wet lab: microsurgical education during the COVID-19 pandemic.

Purpose: To study the feasibility and efficacy of a new remote wet lab for microsurgical education using a corneal suturing task.

Setting: Department of Ophthalmology, University of California San Francisco, San Francisco, California, USA.

Design: Prospective randomized controlled study.

Nanomolar Potency Aminophenyltriazine CFTR Activator Reverses Corneal Epithelial Injury in a Mouse Model of Dry Eye.

Dry eye disorders are a major health care burden. We previously reported the identification of -methyl--phenyl-6-(2,2,3,3-tetrafluoropropoxy)-1,3,5-triazine-2,4-diamine [cystic fibrosis transmembrane conductance regulator (CFTR)-K267], which activated human wild-type CFTR chloride conductance with EC ∼ 30 nM. Here, we report evidence for CFTR-K267 efficacy in an experimental mouse model of dry eye using a human compatible ophthalmic vehicle.

Corneal Collagen Cross-Linking Under General Anesthesia for Pediatric Patients With Keratoconus and Developmental Delay.

Purpose: To report the clinical characteristics and outcomes of pediatric patients with keratoconus (KCN) who underwent corneal collagen cross-linking (CXL) under general anesthesia for developmental delay or inability to cooperate with topical anesthesia.

Methods: In this retrospective case series, we reviewed the medical charts of pediatric patients with KCN who had CXL under general anesthesia from January 2018 to April 2019. Baseline disease characteristics of patients with and without developmental delay were compared using the Pearson χ test and the t test.

Influence of corneal diameter on surgically induced astigmatism in small-incision cataract surgery.

Objective: Clear corneal incisions (CCI) in cataract surgery create a variable amount of surgically induced astigmatism (SIA). As refractive outcomes become increasingly important, it is necessary to understand factors that impact SIA and refractive surprises. In this study, we evaluate the effect of horizontal corneal diameter (white-to-white, WTW) on SIA in 2.

Hyphema from Iris Melanocytoma.

Using multimodal imaging, we demonstrate a classic iris melanocytoma presenting with recurrent, spontaneous hyphema in a young female patient. The patient has been observed without tumor growth. Hyphema has not been previously reported to occur with iris melanocytoma.