PURPOSE: To describe penetrating keratoplasty with sutureless membrane artificial endothelial replacement technique (PK-SMART), a surgical procedure that allows for combined penetrating keratoplasty (PK) and EndoArt (End...PURPOSE: To describe penetrating keratoplasty with sutureless membrane artificial endothelial replacement technique (PK-SMART), a surgical procedure that allows for combined penetrating keratoplasty (PK) and EndoArt (EndoArt, EyeYon Medical, Israel) implantation in high-risk eyes for graft failure. METHODS: Three consecutive patients with failed PK and a history of multiple ocular surgeries underwent repeat PK combined with implantation of a synthetic endothelial replacement membrane. The implant was positioned within a stromal lamellar pocket of the donor cornea before graft transplantation, without the need for transcorneal sutures or postoperative gas tamponade. Outcome measures included corrected distance visual acuity (CDVA), graft clarity, central corneal thickness, and device adherence. RESULTS: At 6 months, all corneal grafts were clear with complete EndoArt adhesion. Preoperative CDVA ranged from light perception to hand motion in 2 eyes. Postoperative CDVA improved to hand motion, 20/400, and 20/100, respectively. Central corneal thickness decreased in all patients, from 803 to 578 μm, from 975 to 587 μm, and from 761 to 548 μm. No postoperative complications were observed, including implant detachment requiring rebubbling. CONCLUSIONS: PK-SMART simultaneously addresses stromal opacities through PK and endothelial dysfunction through artificial endothelial replacement. The technique is suited for complex, high-risk eyes in which standalone EndoArt implantation cannot resolve stromal opacities and is associated with a high risk of device detachment. Central corneal clarity was restored in all our patients, with quantifiable improvements in visual function. Larger studies with extended follow-up will be required to confirm the long-term safety and efficacy of this procedure.
PURPOSE: To investigate an association between inflammatory bowel disease and keratoconus. CLINICAL RELEVANCE: Keratoconus can be difficult to diagnose early, and because of its progressive nature, early treatment is ben...PURPOSE: To investigate an association between inflammatory bowel disease and keratoconus. CLINICAL RELEVANCE: Keratoconus can be difficult to diagnose early, and because of its progressive nature, early treatment is beneficial to preserving vision. Understanding potential associations of systemic disease with keratoconus may aid the development of screening protocols and guide early management decisions. METHODS: Our search of 5 key databases (PubMed, Ovid Medline, Scopus, Web of Science, and Embase) was conducted on October 16, 2024. The selected papers were categorized as patient studies or genetic association studies for analysis. The primary outcome was odds ratio. Meta-analysis and test of assumptions was conducted on patient studies. Bias assessments were conducted using Q-GENIE and ROBINS-E. RESULTS: Our search yielded 299 publication titles, of which 9 were included in our systematic review and 3 were incorporated into the meta-analysis. The aggregate odds ratio of patient-focused studies was 1.39 (95% confidence interval: 0.82-2.37). In the 4 studies investigating Crohn disease, there was no significant causal association (all P-values >0.05). All 5 genetic association studies demonstrated a genetic association between either inflammatory bowel disease (as a collective) and/or ulcerative colitis and keratoconus. CONCLUSIONS: The literature demonstrated a genetic association between ulcerative colitis and keratoconus. This association has not been consistently replicated in patient-focused studies.
PURPOSE: Meibomian gland dysfunction (MGD) can occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). MGD is characterized by reduced lipid secretion by the meibomian glands, causing tear-film instab...PURPOSE: Meibomian gland dysfunction (MGD) can occur after allogeneic hematopoietic stem cell transplantation (allo-HSCT). MGD is characterized by reduced lipid secretion by the meibomian glands, causing tear-film instability. Because chemotherapy and radiation can induce oxidative stress, we hypothesize that these exposures will increase the hazard of MGD after allo-HSCT. METHODS: This retrospective cohort study analyzed 139 allo-HSCT recipients at the University of Maryland Medical Center who completed post-transplant eye examinations from 2013 to 2025. Descriptive analysis summarized demographic characteristics in our sample. Unadjusted and adjusted Cox proportional hazard models were used to evaluate the independent effects of conditioning regimens on MGD. RESULTS: Unadjusted Cox proportional hazards models showed that fludarabine was associated with a higher MGD hazard compared with nonfludarabine based regimens (HR = 3.671, 95% CI, 1.338-10.070; P = 0.012). After adjusting for age at transplant, sex, race, transplant type, cancer type, and presence of pretransplant ocular conditions, fludarabine-based conditioning remained associated with a higher hazard of MGD (HR = 5.242, 95% CI, 1.725-15.928; P = 0.003). CONCLUSIONS: These findings suggest that fludarabine-based conditioning increases the hazard of developing MGD post-transplant. Alternatives to fludarabine in conditioning regimens are warranted to reduce the likelihood of MGD. Allo-HSCT patients who receive fludarabine may also benefit from education, monitoring, and interventions aimed at mitigating MGD severity.
PURPOSE: To compare waste generated from corneal, conjunctival, and cataract surgeries globally to assess environmental sustainability within ophthalmology. METHODS: This prospective, multicenter observational study was...PURPOSE: To compare waste generated from corneal, conjunctival, and cataract surgeries globally to assess environmental sustainability within ophthalmology. METHODS: This prospective, multicenter observational study was conducted in 9 countries: Australia, Canada, Egypt, India, Italy, Mexico, Peru, Singapore, and the United States, in both hospital and surgical centers. Surgical waste data were collected from corneal (deep anterior lamellar keratoplasty [DALK], Descemet membrane endothelial keratoplasty [DMEK], Descemet stripping automated endothelial keratoplasty [DSAEK], penetrating keratoplasty [PK]), conjunctival (pterygium), and cataract surgeries. Centers followed standardized waste segregation protocols. Surgical, anesthesia, and corneal waste were weighed postoperatively. Data were analyzed using Kruskal-Wallis test with significance set at P < 0.05. RESULTS: A total of 428 surgeries were evaluated: 278 corneal/conjunctival and 150 cataract. Significant intercountry differences in waste generation were found. India generated the least overall waste for DMEK (0.61 kg), DSAEK (0.49 kg), PK (0.62 kg), and cataract (0.48 kg) surgeries. The United States had the highest corneal waste for DMEK (0.28 kg) and DSAEK (0.24 kg); Peru had the highest for PK (0.35 kg). Peru also reported the highest waste for cataract (4.1 kg) surgeries. Countries producing less waste also used fewer disposable instruments and more reusable surgical items. No intraoperative complications or endophthalmitis were reported. CONCLUSIONS: Substantial variability in ophthalmic surgical waste exists globally, with lower waste generation not associated with more frequent adverse outcomes. These findings suggest opportunities to reduce single-use practices and advance more sustainable ophthalmic surgery, although further study is needed to assess safety implications.
PURPOSE: Fusarium keratitis is a leading cause of fungal corneal ulceration worldwide and is associated with substantial visual morbidity. Despite the availability of randomized controlled trial (RCT) data, optimal antif...PURPOSE: Fusarium keratitis is a leading cause of fungal corneal ulceration worldwide and is associated with substantial visual morbidity. Despite the availability of randomized controlled trial (RCT) data, optimal antifungal therapy remains debated. This study aims to define an evidence-based therapeutic hierarchy for F. keratitis using RCT evidence. METHODS: A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 guidelines. MEDLINE, EMBASE, and CINAHL were searched from inception to December 2025 for RCTs evaluating antifungal therapies in fungal keratitis with extractable Fusarium -specific data. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the Cochrane Risk of Bias 2.0 tool. Random-effects meta-analysis (DerSimonian-Laird) was used to pool outcomes. The primary outcome was best spectacle-corrected visual acuity (BSCVA, LogMAR). Secondary outcomes included corneal perforation and requirement for therapeutic penetrating keratoplasty. Certainty of evidence was assessed using the GRADE framework. RESULTS: Eleven RCTs comprising over 1800 participants were included. Meta-analysis demonstrated that topical natamycin 5% was associated with significantly improved visual acuity compared with topical voriconazole 1% (pooled mean difference -0.18 LogMAR, 95% confidence interval -0.30 to -0.05; I2 = 38%), corresponding to an improvement of approximately 2 Snellen lines. Natamycin was also associated with a substantial reduction in corneal perforation and requirement for therapeutic keratoplasty (pooled odds ratio 0.42, 95% confidence interval 0.22-0.80). The direction of effect was consistent across included trials, with low-to-moderate heterogeneity ( I2 = 38%). Adjunctive systemic or intrastromal voriconazole did not demonstrate consistent benefit and was associated with increased adverse events. Evidence for alternative antifungal agents remains limited. CONCLUSIONS: Meta-analytic findings define a clear evidence-based therapeutic hierarchy in F. keratitis and establish topical natamycin 5% as the standard of care. Routine use of voriconazole is not supported in unselected patients. Further adequately powered, species-specific randomized trials are required to optimize treatment strategies in this vision-threatening condition.
PURPOSE: To quantify full-thickness healing of clear-corneal incisions after cataract surgery in patients with and without diabetes, thereby providing evidence-based foundation for perioperative care. METHODS: In this re...PURPOSE: To quantify full-thickness healing of clear-corneal incisions after cataract surgery in patients with and without diabetes, thereby providing evidence-based foundation for perioperative care. METHODS: In this retrospective cohort, 141 eyes (51 diabetic, 90 nondiabetic) that underwent phacoemulsification were followed. Corneal epithelial healing was assessed via fluorescein staining at 1 week. Anterior segment optical coherence tomography was used to measure the volume of the hemi-cornea containing the surgical incision and its rate of change (RCVHCSI) postoperatively at 1 week and 1 month. Structure defects-internal gape, endothelial misalignment, and Descemet membrane detachment-were recorded. RESULTS: At 1 week, compared with the nondiabetic group, diabetic eyes showed slower epithelial healing (80.39% vs. 92.22%, P = 0.038) and greater corneal edema (RCVHCSI 5.62% vs. 3.68%, P = 0.017). They also exhibited more internal gape (39.22% vs. 16.67%, P = 0.003), endothelial misalignment (15.69% vs. 2.22%, P = 0.008), and Descemet membrane detachment (27.45% vs. 12.22%, P = 0.023). In diabetic eyes, higher preoperative intraocular pressure (IOP) increased the odds of gape (odds ratio [OR] = 1.26, P = 0.010), whereas older age increased the risks of misalignment (OR = 1.14, P = 0.038) and detachment (OR = 1.26, P = 0.002). Age correlated positively with 1-week RCVHCSI, and male patients showed higher 1-month RCVHCSI. CONCLUSIONS: Diabetes delays corneal incision healing and amplifies incision-related edema and structural defects, elderly male diabetic patients with higher preoperative intraocular pressure are more prone to delayed corneal incision.
PURPOSE: To evaluate whether variability in ambient light levels affects Scheimpflug corneal optical densitometry measurements in clear and opaque corneas. METHODS: Eyes with clear corneas (N = 60) or infectious corneal...PURPOSE: To evaluate whether variability in ambient light levels affects Scheimpflug corneal optical densitometry measurements in clear and opaque corneas. METHODS: Eyes with clear corneas (N = 60) or infectious corneal opacity (N = 49) underwent Scheimpflug densitometry (Pentacam, Oculus) under 3 ambient lighting conditions: dark room (1.8 ± 0.9 lux), mild ambient light (7.9 ± 0.9 lux), and bright light (>1000 lux). Densitometry measurements in grayscale units (GSUs) were obtained for the anterior, middle, posterior, and entire cornea and concentric corneal zones. The Wilcoxon signed-rank test and generalized estimating equation models were used to compare measurements across lighting settings. RESULTS: Under bright light, densitometry measurements could not be obtained in 90% of clear corneas and 92% of opaque corneas because of machine error, while measurements that were obtained were significantly elevated (P < 0.001). Comparing dark room versus mild ambient light settings, clear corneas showed significantly higher readings under mild ambient light for anterior (1.0 GSUs, P = 0.004), middle (1.5 GSUs, P < 0.001), and posterior (1.5 GSUs, P < 0.001) layers, all concentric corneal zones, and the entire cornea (all P < 0.05). Among opaque corneas, all regions except the anterior and far peripheral cornea (P > 0.05) showed significant differences (1.3-2.4 GSUs, all P < 0.05). Overall, 88.3% of clear corneas and 73.5% of opaque corneas demonstrated higher readings under mild ambient light compared with dark room conditions. CONCLUSIONS: Scheimpflug densitometry should not be performed under regular room lighting because of frequent errors and measurement overestimation. Dark room conditions are recommended for optimal measurement, particularly when quantifying subtle changes in opacity.
PURPOSE: To evaluate the diagnostic performance and limitations of a general-purpose multimodal large language model (GPT-5.4) in detecting early keratoconus (KC) using corneal tomography images. METHODS: This retrospect...PURPOSE: To evaluate the diagnostic performance and limitations of a general-purpose multimodal large language model (GPT-5.4) in detecting early keratoconus (KC) using corneal tomography images. METHODS: This retrospective study included 66 eyes: 15 with subclinical KC, 18 with forme fruste keratoconus (ffKC), and 33 normal controls. Control eyes were obtained from refractive surgery candidates with normal corneas. For each eye, a standardized four-map Pentacam tomography image was analyzed using GPT-5.4 (OpenAI) with a predefined prompt. Only images were provided, without clinical or demographic data. Diagnostic performance for detecting early KC was assessed using sensitivity, specificity, predictive values, accuracy, and receiver operating characteristic (ROC) analysis. RESULTS: GPT-5.4 demonstrated low sensitivity (30.3%) and high specificity (100%) for detecting early KC, with an overall accuracy of 65.2% and an area under the ROC curve of 0.65. The model showed a strong tendency to classify eyes as normal, resulting in a high rate of false-negative classifications. Multiclass analysis revealed a stage-dependent performance pattern, with excellent classification of normal corneas (100%), moderate detection of subclinical KC (53.3%), and poor detection of ffKC (11.1%), with most ffKC cases misclassified as normal. CONCLUSIONS: GPT-5.4 demonstrates high specificity but limited sensitivity for detecting early KC using image-only input and is not a reliable diagnostic or screening tool in its current form.
PURPOSE: To compare the accuracy and safety of 4 large language models on cornea and external disease multiple-choice questions (MCQs). METHODS: DeepSeek-V3.2, GPT-5.2 (via ChatGPT), Gemini 3 Pro, and Claude Opus 4.5 wer...PURPOSE: To compare the accuracy and safety of 4 large language models on cornea and external disease multiple-choice questions (MCQs). METHODS: DeepSeek-V3.2, GPT-5.2 (via ChatGPT), Gemini 3 Pro, and Claude Opus 4.5 were tested on American Academy of Ophthalmology (AAO) Ophthalmic News and Education (ONE) Network Cornea/External MCQs (114 text-only) and AAO Basic and Clinical Science Course Cornea/External study questions (38 text-only). Each item was queried once per model using a standardized prompt for the primary analysis. In secondary analyses, each item was requeried 5 times per model in independent sessions. Accuracy was compared using Cochran Q and pairwise exact McNemar tests with Holm adjustment. Potentially harmful wrong answers (HarmfulWrong) were independently coded using a prespecified rubric. RESULTS: In the AAO ONE dataset, accuracy was 65.8% for DeepSeek-V3.2, 93.0% for GPT-5.2, 93.9% for Gemini 3 Pro, and 92.1% for Claude Opus 4.5 (Cochran Q P < 0.001). DeepSeek-V3.2 was significantly less accurate than all other models; the other 3 did not differ significantly. In the Basic and Clinical Science Course dataset, accuracy was 57.9%, 76.3%, 94.7%, and 84.2%, respectively (Cochran Q P < 0.001); DeepSeek-V3.2 was significantly less accurate than Gemini 3 Pro and Claude Opus 4.5. Five-run retesting showed similar ranking but imperfect stability, particularly for DeepSeek-V3.2. HarmfulWrong responses were infrequent, and 2 cornea specialists achieved 98.0% and 97.4% overall accuracy without HarmfulWrong responses. CONCLUSIONS: GPT-5.2, Gemini 3 Pro, and Claude Opus 4.5 achieved similarly high accuracy on text-only cornea/external disease MCQs, whereas DeepSeek-V3.2 underperformed. Potentially harmful errors were uncommon but support continued clinician oversight.
PURPOSE: To describe clinical outcomes of decellularized Descemet membrane anterior keratoplasty (DMAK) as a basement membrane scaffold for ocular surface reconstruction in limbal stem cell deficiency (LSCD). METHODS: In...PURPOSE: To describe clinical outcomes of decellularized Descemet membrane anterior keratoplasty (DMAK) as a basement membrane scaffold for ocular surface reconstruction in limbal stem cell deficiency (LSCD). METHODS: Interventional case series. RESULTS: Case 1: A 66-year-old man with ocular cicatricial pemphigoid-like keratoconjunctivitis presented with bilateral total LSCD (Stage III) and visually significant cataracts. Best-corrected visual acuity was 0.01 (decimal) in both eyes. Sequential DMAK combined with phacoemulsification and intraocular lens implantation was performed without adjunctive epithelial stem cell transplantation. Supplemental amniotic membrane transplantation was required in the left eye at 3 weeks postoperatively. Complete epithelialization was achieved within approximately 8 weeks in both eyes. The ocular surface remained stable during follow-up, with no significant complications. CASE: A 70-year-old man with postsurgical partial LSCD (Stage II) in the left eye following tube-shunt glaucoma surgery underwent autologous limbal transplantation using the blind right eye as the limbal tissue donor, combined with simultaneous DMAK. Complete epithelialization was achieved, and a stable ocular surface was maintained throughout follow-up. CONCLUSIONS: DMAK may serve as a biologically compatible and optically transparent basement membrane scaffold that facilitates epithelial regeneration and ocular surface stabilization in advanced and postsurgical LSCD.
PURPOSE: Myxomatous corneal degeneration is a rare, often misdiagnosed lesion miming other corneal pathologies. We report 2 cases of secondary corneal myxomatous degeneration, along with systematic review of literature h...PURPOSE: Myxomatous corneal degeneration is a rare, often misdiagnosed lesion miming other corneal pathologies. We report 2 cases of secondary corneal myxomatous degeneration, along with systematic review of literature highlighting all reported cases of corneal myxomas. METHODS: Two cases were reported. A comprehensive search for corneal myxomatous degeneration in PubMed, Embase, Web of Science, and Scopus was conducted until December 2025. RESULTS: A 65-year-old man with history of bullous keratopathy presented with long-standing unilateral progressive corneal opacity and hand-motion vision. Anterior segment optical coherence tomography revealed a 600-μm thick subepithelial lesion. A 37-year-old male patient with suspected prior foreign body trauma also presented with a unilateral progressive conjunctival-corneal lesion and no light perception vision. Examination and anterior segment optical coherence tomography revealed a conjunctivalized fibrovascular growth with associated corneal surface irregularity. Both patients underwent superficial keratectomy with adjunctive mitomycin C, and no subsequent recurrence. Histopathological analysis demonstrated findings consistent with secondary myxomatous degeneration. The systematic review identified 20 studies of 35 patients. Most lesions were secondary to developmental anomalies, trauma, surgery, or corneal disease, whereas ∼23% were primary. Presentations commonly included decreased vision, high intraocular pressure, or progressive opacification, with lesions typically appearing as whitish or gelatinous elevations and managed through excision or keratoplasty. CONCLUSIONS: The current cases add to the spectrum of secondary corneal myxomatous degeneration, ranging from chronic degenerative to posttraumatic reactive process. Recognition of this entity is important as lesions can be successfully managed with superficial keratectomy and adjunctive mitomycin C rather than more invasive penetrating keratoplasty.
PURPOSE: To evaluate the feasibility and assess outcomes of using optimal cutting temperature (OCT) compound as a transport medium without immediate freezing, for the delayed processing of conjunctival biopsies in patien...PURPOSE: To evaluate the feasibility and assess outcomes of using optimal cutting temperature (OCT) compound as a transport medium without immediate freezing, for the delayed processing of conjunctival biopsies in patients with suspected ocular mucous membrane pemphigoid. METHODS: This retrospective study was conducted over 2 years and included suspected ocular mucous membrane pemphigoid patients who underwent conjunctival biopsy. The samples were transported in OCT compound in cold chain without immediate freezing and processed in a laboratory situated nearly 300 km away. The time from biopsy to processing, biopsy results including basement membrane (BM) presence, and direct immunofluorescence (DIF) outcomes were analyzed. RESULTS: A total of 71 patients (139 eyes) were included in the study with a slight female preponderance. The samples were processed after a median of 4 days (interquartile range: 3-5) after the date of collection. An intact BM was present in 137/139 samples (99%). Of the 71 patients, 43 (61%) showed presence of immunoreactants in the BM on DIF. C3 and IgA were the most frequently identified markers. CONCLUSIONS: OCT compound can be used as a transport medium for conjunctival biopsy samples processed for DIF. Delayed processing does not affect tissue viability or the diagnostic outcomes. Hence, it is a useful method for low resource settings where a specialized laboratory for DIF testing is not available.
PURPOSE: To assess the efficacy of theranostic-guided corneal UV therapy in progressive keratoconus and the association between theranostic imaging biomarkers and 1-year outcomes. METHODS: Seventy-three consecutive patie...PURPOSE: To assess the efficacy of theranostic-guided corneal UV therapy in progressive keratoconus and the association between theranostic imaging biomarkers and 1-year outcomes. METHODS: Seventy-three consecutive patients (73 eyes; mean age 22 ± 6 years) with progressive keratoconus underwent epithelial removal followed by theranostic-guided corneal UV therapy using 0.22% riboflavin ophthalmic solution. Eyes received either 10- or 15-minute preset riboflavin application protocol, followed by UV irradiation at 10 mW/cm2 for 9 minutes. The device generated 2 intraoperative imaging biomarkers: the riboflavin score, estimating stromal riboflavin concentration, and the theranostic score, quantifying UV-A mediated photoactivation. These scores enabled real-time monitoring to guide effective completion of treatment. A multivariate linear regression model evaluated the relationship between theranostic imaging biomarkers, baseline patient characteristics, and 1-year Kmax change. RESULTS: Theranostic-guided treatment was effective and showed 94% concordance with the 1-year Kmax flattening. Eight eyes (11%) required an additional 15% UV energy (1.3 extra minute at 10 mW/cm2) to surpass the theranostic score threshold of 0.60. Mean Kmax decreased by -1.6 ± 1.6 D (P < 0.001), whereas uncorrected distance visual acuity and corrected distance visual acuity improved significantly (P < 0.001). The regression model explained a limited proportion of outcome variance (R2 = 0.239; P = 0.01) and indicated that the riboflavin score had a greater association with Kmax flattening compared with the other variables included in the model. CONCLUSIONS: Real-time monitoring of stromal riboflavin permeation and photoactivation enables precise, individualized treatment, enhancing the ability to halt keratoconus progression by tailoring therapeutic effect to each cornea's molecular response.
PURPOSE: To evaluate patient satisfaction and experiences in an asynchronous remote clinic telemedicine pathway for keratoconus monitoring, treating satisfaction as a primary quality indicator and exploring factors assoc...PURPOSE: To evaluate patient satisfaction and experiences in an asynchronous remote clinic telemedicine pathway for keratoconus monitoring, treating satisfaction as a primary quality indicator and exploring factors associated with patient perceptions. METHODS: A cross-sectional survey was conducted at The Royal Liverpool University Hospital between October 2023 and August 2025. Patients with keratoconus who attended asynchronous remote clinic telemedicine follow-up monitoring appointments completed an anonymous online questionnaire. Quantitative outcomes (visit history, waiting time before the appointment, comparison with face-to-face care, overall quality, and willingness to recommend) were analyzed descriptively, and free-text comments underwent thematic analysis. Ordinal logistic regression assessed associations with age, sex, ethnicity, and travel distance. RESULTS: A total of 385 patients completed the survey. Most were first-time attendees (304, 79.0%), and the most commonly reported waiting time before the visit was 30 to 60 minutes (194/385, 50.4%). Compared with face-to-face care, 201 (52.2%) rated the experience as equivalent, 124 (32.2%) as better, and 44 (11.4%) as worse. Overall, 310 patients (80.5%) rated clinic quality as high or very high, and 242 (62.9%) would recommend it to others. Greater travel distance was associated with lower satisfaction and willingness to recommend (odds ratios per 10 minutes 0.93, 95% confidence intervals 0.87-0.99). CONCLUSIONS: Patient satisfaction with the asynchronous remote clinic telemedicine follow-up monitoring visits was high, supporting its feasibility for routine care. Longer travel distances reduced satisfaction, highlighting the need for decentralized, patient-centered service models to optimize accessibility and experience. Future refinement should prioritize patient-centered elements to secure both efficiency and quality of care.
PURPOSE: Neurotrophic keratopathy (NK), caused by deficient corneal innervation, leads to progressive corneal ulceration. Corneal neurotization (CN) uses nerve transfers to direct new nerve fibers to the insensate cornea...PURPOSE: Neurotrophic keratopathy (NK), caused by deficient corneal innervation, leads to progressive corneal ulceration. Corneal neurotization (CN) uses nerve transfers to direct new nerve fibers to the insensate cornea to treat NK. However, selecting a donor nerve with functional nociception remains challenging, especially in pediatric patients with congenital NK. This study evaluates the "pinch test" as a reliable method to assess nociceptive function in potential donor nerves for CN. METHODS: A retrospective chart review identified patients who underwent CN at a single center between 2021 and 2023. Patient demographics, NK etiology, donor nerve selection, and postoperative sensory outcomes were analyzed. The "pinch test" was performed on the greater auricular nerve, supraorbital nerve, supratrochlear nerve, and infraorbital nerve to assess nociception based on patient response. Corneal sensation was evaluated preoperatively and postoperatively using a Cochet-Bonnet Esthesiometer (CBE) or cotton wisps. RESULTS: Fifteen patients (26 eyes) underwent CN with donor nerves assessed via the pinch test. All 15 exhibited a positive nociceptive response in at least 1 tested dermatome. Mean age at neurotization was 11.9 ± 17.1 years. Among 8 patients with 12-month follow-up data, 5 patients demonstrated improved corneal sensation, with CBE measurements ranging from 10 to 45 mm in affected quadrants, 1 patient showed reflexive responses, and 2 had no sensory evidence of improvement but exhibited signs of improvement in ocular surface integrity. CONCLUSIONS: The "pinch test" can assist the surgeon before sensory nerve transfer to identify dermatomes with sensory nerves as potential donors.