Cornea[JOURNAL]
Sun
200 papers
Automated Tissue Segmentation Software for Assessing Global Area of Cell Damage After Descemet Membrane Endothelial Keratoplasty.
Hwang HJ, Bedard P, Cavaleri M … +6 more , Bae AM, Cooney K, Yuan C, Bymark J, LaGassie C, Hou JH
Cornea · 2026 Jun · PMID 42294835 · Publisher ↗
PURPOSE: The purpose of this study was to 1) determine the feasibility of imaging donor corneas during sterile tissue processing for computer vision endothelial cell viability analysis and to 2) compare the accuracy of a...
PURPOSE: The purpose of this study was to 1) determine the feasibility of imaging donor corneas during sterile tissue processing for computer vision endothelial cell viability analysis and to 2) compare the accuracy of automated software versus manual segmentation versus operator estimates in measuring percent area of cell damage (%ACD) on trypan-stained, postprocessed Descemet membrane endothelial keratoplasty (DMEK) corneas. METHODS: Donor corneas were peeled for DMEK and stained with 0.06% trypan blue for 90 seconds and then photographed with a high-resolution microscope camera under sterile conditions in a biosafety cabinet before preloading into an injector or placing in a cornea viewing chamber. The corneas were evaluated for global cell viability based on %ACD using 3 methods: 1) manual Weka segmentation software (ImageJ, National Institute of Health, Bethesda, MD), 2) Kerify (custom-built Aphelion application, ADCIS, S.A., Saint-Contest, France), and 3) technician estimates. The %ACD measured was compared across all 3 modalities using 1-way ANOVA and regression analysis. RESULTS: Standardized whole graft viability imaging was performed for 50 consecutive transplant DMEK grafts. There was no significant difference in group means between Kerify, manual software, and technician estimates in measuring cell damage (5.8% vs. 5.4% vs. 6.1%, P = 0.24). However, at higher ACD levels, Kerify-using manual Weka segmentation software as the reference standard-was more precise than technician estimates at predicting ACD. CONCLUSIONS: Our automated ACD computer vision software Kerify saves time, removes bias, and demonstrates good accuracy compared with manual computer segmentation. Kerify may be a powerful new tool for postprocessing tissue evaluation.
Cornea Classic: Gomes, Tan, Rapuano et al, "Global Consensus on Keratoconus and Ectatic Diseases" (2015).
Sugar A
Cornea · 2026 Mar · PMID 42294832 · Publisher ↗
Abstract loading — click title to view on PubMed.
Inverse Bell Phenomenon and Superior Keratoconus.
Theotoka D, Perzia B, Linaburg TJ … +4 more , Chow J, Thimons J, Kanellopoulos AJ, Donnenfeld ED
Cornea · 2026 Jun · PMID 42285149 · Publisher ↗
PURPOSE: To report 6 eyes of 4 patients with superior keratoconus and its occurrence in conjunction with inverse Bell phenomenon in which the eye rotates downward on eye closure. METHODS: A retrospective review and analy...
PURPOSE: To report 6 eyes of 4 patients with superior keratoconus and its occurrence in conjunction with inverse Bell phenomenon in which the eye rotates downward on eye closure. METHODS: A retrospective review and analysis was performed on all patients with keratoconus who presented to our cornea service between August 2022 and December 2025. Patient demographics, clinical examination findings, and Pentacam anterior segment tomography imaging (Oculus, Arlington, WA) were reviewed. RESULTS: All patients with superior keratoconus had an inverse Bell phenomenon. A 27-year-old man (patient 1), a 15-year-old boy (patient 2), a 60-year-old man (patient 3), and a 29-year-old woman (patient 4) with clinical and topographic findings of keratoconus with a superior cone were identified. Patients 1 and 3 had unilateral superior keratoconus, and patients 2 and 4 had bilateral superior keratoconus. All patients initially denied eye rubbing, atopy, and family history of keratoconus; however, all patients slept on their side or face with their hands pressed against their eyes, and patients 1 and 3 had floppy eyelid syndrome. CONCLUSIONS: Superior keratoconus and inverse Bell phenomenon are both rare ophthalmic findings alone and co-occur in these patients. The inverse Bell phenomenon exposes the superior corneal to mechanical pressure on lid closure and further supports the role of mechanical pressure on the development of keratoconus.
Impact of Cone Position on Prognostic Outcomes of Deep Anterior Lamellar Keratoplasty (DALK) in Advanced Keratoconus.
Chao S, Li S, Jin X … +2 more , Yang F, Zhang H
Cornea · 2026 Jun · PMID 42285138 · Publisher ↗
PURPOSE: To evaluate the impact of cone position on prognostic outcomes of deep anterior lamellar keratoplasty (DALK) in advanced keratoconus. METHODS: This retrospective study analyzed 49 eyes (48 patients) with advance...
PURPOSE: To evaluate the impact of cone position on prognostic outcomes of deep anterior lamellar keratoplasty (DALK) in advanced keratoconus. METHODS: This retrospective study analyzed 49 eyes (48 patients) with advanced keratoconus undergoing DALK between 2015 and 2023. Cases were categorized as central (n = 26) or paracentral (n = 23) based on the position of the cone. Primary outcomes included uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), manifest refraction, keratometric characteristics, corneal thickness, and quality of life assessments. RESULTS: The results showed that the postoperative UCVA and BCVA in the central group were significantly better than those in the paracentral group (UCVA: 0.492 ± 0.192 vs. 0.617 ± 0.241, P = 0.049; BCVA: 0.192 ± 0.102 vs. 0.396 ± 0.199, P < 0.001). Although the paracentral group exhibited a more significant recovery in central corneal thickness (CCT) (CCT: 528.654 ± 30.900 vs. 549.696 ± 36.394, P = 0.034; postop CCT-preop CCT: 127.615 ± 55.697 vs. 155.565 ± 37.490, P = 0.048), no significant difference was found in postoperative keratometric characteristics between the 2 groups (P > 0.05). Quality-of-life assessments revealed that the central group achieved significantly higher postoperative scores in the far vision and driving subscales compared with the paracentral group (both P < 0.05). In contrast, the paracentral group demonstrated significantly better postoperative scores in the color vision and peripheral vision subscales (P = 0.017 and P = 0.038, respectively). Cone position exhibited a positive correlation with UCVA, BCVA, and CCT (P < 0.001). CONCLUSIONS: The corneal cone position significantly affects DALK prognosis, influencing postoperative quality of life. Central group shows better visual acuity, whereas paracentral group demonstrates significant CCT recovery. Tailoring surgical strategies based on cone position may mitigate prognostic disparities and optimize visual rehabilitation.
Bilateral Corneal Sensory and Nerve Structural Alterations in Unilateral Scleritis.
Lin L, Zhou Y, Dai M … +5 more , Xin Q, Li J, Huang Y, Qian S, Chen W
Cornea · 2026 Jun · PMID 42284129 · Publisher ↗
PURPOSE: The objective of this study was to explore the corneal sensitivity and corneal structure of both eyes in patients with unilateral scleritis. METHODS: This was a cross-sectional case series. We enrolled patients...
PURPOSE: The objective of this study was to explore the corneal sensitivity and corneal structure of both eyes in patients with unilateral scleritis. METHODS: This was a cross-sectional case series. We enrolled patients with unilateral scleritis at the Eye Hospital of Wenzhou Medical University between April 2024 and December 2025. Patients with corneal involvement (staining ≥5) were excluded. The corneal sensation of both eyes was examined using a noncontact corneal aesthesiometer and a Cochet-Bonnet aesthesiometer. Then, the corneal structure was examined by in vivo confocal microscopy, and the corneal nerve morphology parameters were calculated using ACCMetrics software. RESULTS: Twenty-four patients (24 affected eyes and their 24 contralateral unaffected eyes) were enrolled, and 24 eyes of 24 age-matched normal volunteers were included as the control group. No significant difference in corneal nerve sensitivity was observed among affected eyes, unaffected eyes, and the control group when measured using the Cochet-Bonnet aesthesiometer, while it was significantly increased compared with unaffected contralateral eyes when measured using the noncontact corneal aesthesiometer (P < 0.001). In addition, we found a significant decrease in corneal nerve parameters in the affected eyes compared with the control group: corneal nerve fiber length, corneal nerve fiber density, corneal nerve branch density, CFracDim (both P < 0.001), corneal total branch density (P = 0.003), and corneal nerve fiber area (P = 0.017); these were lower than those in the unaffected eyes. Moreover, the presence, total area, and perimeter of microneuroma were higher in affected eyes compared with controls (P = 0.003, <0.001, and <0.001, respectively). CONCLUSIONS: Our study demonstrated that hypersensitive state is accompanied by structural nerve degeneration and increased microneuroma formation in the affected eyes in patients with scleritis.
Novel PPOX Mutation With Ocular Involvement in Variegate Porphyria: Case Report and Literature Review.
Ramos-Dávila EM, Sayegh Y, Ebehart CG … +2 more , Thorne JE, Liberman P
Cornea · 2026 Jun · PMID 42284128 · Publisher ↗
PURPOSE: To report the clinical and histopathologic features of cicatrizing conjunctivitis associated with variegate porphyria (VP). METHODS: A comprehensive literature search was performed in PubMed and Google Scholar t...
PURPOSE: To report the clinical and histopathologic features of cicatrizing conjunctivitis associated with variegate porphyria (VP). METHODS: A comprehensive literature search was performed in PubMed and Google Scholar through September 2025 using terms related to porphyria and ocular involvement. All relevant case reports, series, reviews, original articles, and cited references were included. RESULTS: A 52-year-old woman with a history of seizures, dorsal hand skin lesions, and lower-extremity paresthesia presented with cicatrizing conjunctivitis and corneal opacification with neovascularization. A systemic evaluation demonstrated elevated urinary and fecal porphyrins. Molecular analysis revealed a novel heterozygous 3.49-Mb deletion encompassing the entire protoporphyrinogen oxidase gene. Conjunctival histopathology revealed subepithelial bullae with acanthotic epithelium, and direct immunofluorescence was negative for immune complex deposition. CONCLUSIONS: Ocular manifestations in porphyria are rare and have primarily been described in porphyria cutanea tarda and congenital erythropoietic porphyria. A review of the English language literature summarizing reported cases of porphyria-associated cicatrizing conjunctivitis is presented. This report broadens the differential diagnosis of cicatrizing conjunctivitis to include VP.
Vitreoretinal Complications in Two Designs of Type 1 Keratoprosthesis.
Ortiz-Morales G, Franco-Cardenas V, Vera-Duarte GR … +6 more , Rodriguez-Loaiza JL, Graue-Wiechers F, Lozano-Rechy D, Navas A, Ramirez-Miranda A, Graue-Hernandez EO
Cornea · 2026 Jun · PMID 42284105 · Publisher ↗
PURPOSE: To report the incidence and spectrum of vitreoretinal complications (VRCs) in consecutive patients implanted with 2 designs of type 1 keratoprosthesis (KPro). METHODS: Retrospective analysis of electronic medica...
PURPOSE: To report the incidence and spectrum of vitreoretinal complications (VRCs) in consecutive patients implanted with 2 designs of type 1 keratoprosthesis (KPro). METHODS: Retrospective analysis of electronic medical records. Demographic and clinical data were collected from patients who developed VRCs. The main outcome measure was the proportion of VRCs and their management. RESULTS: Eighty-four eyes from 81 patients with KPro were analyzed (Boston = 28; Lucia = 56). VRCs occurred in 32 cases (38.10%). The mean age of patients with VRCs was 55.15 ± 16.67 years (range: 27-90), and the mean follow-up duration was 33.90 ± 16.31 months. The most frequent VRC was retroprosthetic membrane formation requiring pars plana vitrectomy (n = 10, 11.90%), followed by retinal detachment (n = 9, 10.71%), choroidal detachment (n = 8, 9.52%), endophthalmitis (n = 8, 9.52%), vitreous hemorrhage (n = 7, 8.33%), cystoid macular edema (n = 2, 2.38%), asteroid hyalosis (n = 1, 1.19%), epiretinal membrane (n = 1, 1.19%), macular atrophy (n = 1, 1.19%), and sterile vitritis (n = 1, 1.19%). The median best-corrected visual acuity (BCVA) achieved after KPro implantation was 0.6 LogMAR (IQR: 0.18-1.3); in contrast, the median BCVA after any VRC was 2.4 LogMAR (IQR: 0.58-2.7). In all cases (100%), VRCs led to a deterioration in BCVA. Anatomical failure occurred in 7 cases (21.88%) and functional failure in 20 cases (62.50%), after a mean duration of 8.83 months. CONCLUSIONS: VRCs occurred in 38.10% of cases after type 1 KPro implantation and were associated with poorer outcomes, including increased anatomical and functional failure.
Distinct Ocular Surface Microbial Profiles in Corneal Transplant Candidates.
Astolfi A, Potenza M, Ciavarella C … +9 more , Moramarco A, Bonci P, Zaghi A, Foschi C, D'Eliseo LA, D'Eliseo D, Lazzarotto T, Fontana L, Versura P
Cornea · 2026 Jun · PMID 42284092 · Publisher ↗
PURPOSE: To characterize the ocular surface microbiome in patients undergoing corneal transplantation and to evaluate microbial shifts associated with corneal endothelial decompensation and surgical history. METHODS: In...
PURPOSE: To characterize the ocular surface microbiome in patients undergoing corneal transplantation and to evaluate microbial shifts associated with corneal endothelial decompensation and surgical history. METHODS: In this single-center case-control study, conjunctival swabs were collected from 54 adults scheduled for lamellar or penetrating keratoplasty and from 16 healthy controls. Sampling was performed under sterile conditions immediately before surgery. Bacterial DNA was analyzed by 16S rRNA gene sequencing targeting the V3-V4 regions. Alpha and beta diversity indices were calculated using the Shannon index and Bray-Curtis dissimilarity. Taxonomic composition was compared across groups stratified by clinical status and prior ocular surgery. RESULTS: Pretransplant patients showed significantly higher alpha diversity than healthy controls (P = 0.04), and beta diversity analysis confirmed distinct microbial community structures between groups (P = 0.002). The patient group exhibited enrichment of Enterobacteriaceae, Pseudomonas, and Escherichia-Shigella, whereas Bacteroidota and Bacteroidia predominated in healthy subjects. No significant differences in diversity or composition were observed between decompensated and nondecompensated cases. Patients with prior penetrating keratoplasty displayed higher microbial diversity than those with previous phacoemulsification (P = 0.03). CONCLUSIONS: Corneal transplant candidates exhibit distinct ocular surface microbial profiles characterized by increased diversity and enrichment of opportunistic taxa. Although endothelial decompensation did not significantly alter microbial composition, prior surgical history appeared to influence diversity patterns. These exploratory findings provide preliminary evidence that the ocular surface microbiome may play a role in the preoperative assessment and postoperative outcomes of corneal transplantation.
Long-Term Outcomes of 2-Piece Mushroom Keratoplasty: A Comparative Study of Low-Risk and High-Risk Eyes.
Kilian R, Taloni A, de Ruvo V … +9 more , Louise Busin LM, Sollazzo A, De Rosa L, Yu AC, Camburu G, Spena R, Bovone C, Salgari N, Busin M
Cornea · 2026 Jun · PMID 42284083 · Publisher ↗
PURPOSE: The aim of this study was to compare the outcomes of 2-piece mushroom keratoplasty (MK) between eyes at high risk and eyes at low risk of immunologic rejection. METHODS: This is a retrospective interventional ca...
PURPOSE: The aim of this study was to compare the outcomes of 2-piece mushroom keratoplasty (MK) between eyes at high risk and eyes at low risk of immunologic rejection. METHODS: This is a retrospective interventional case series including 475 eyes from 475 patients who underwent 2-piece MK, of whom 146 (30.7%) were classified as high risk of rejection (group 1) and 329 (69.3%) as low risk (group 2). Outcome measures included corrected distance visual acuity, endothelial cell count, endothelial cell loss, graft survival rate, and postoperative complications. RESULTS: There was no significant difference in endothelial cell count between groups at 10 years after transplantation (754.7 ± 316.7 [95% CI: 695.1-956.6] vs. 892.3 ± 298.8 [95% CI: 757.8-969.4] cells/mm2, P = 0.088, respectively). Although corrected distance visual acuity was better in the low-risk group at 1 year (0.37 ± 0.30 [95% CI: 0.32-0.42] vs. 0.25 ± 0.23 [95% CI: 0.23-0.28], P < 0.001) and 5 years (0.20 ± 0.26 [95% CI: 0.15-0.27] vs. 0.14 ± 0.21 [95% CI: 0.10-0.17], P = 0.044), this difference was no longer statistically significant at 10 years (0.25 ± 0.34 [95% CI: 0.13-0.39] vs. 0.18 ± 0.25 [95% CI: 0.12-0.24] logMAR, P = 0.269, respectively). Postoperative complication rates were comparable, except for infections, which occurred more frequently in group 1 (7.5% vs. 1.5%, P < 0.001). Graft survival rates at 10 years were 80.3% for group 1 (n = 24) and 90.7% for group 2 (n = 50) (P = 0.153). CONCLUSIONS: Two-piece MK provides consistent long-term outcomes in both high-risk and low-risk eyes, showing comparable visual, endothelial, and survival results. These findings highlight the potential of MK to reduce the impact of preoperative immunologic risk and expand its role in complex corneal transplantation.
Letter Regarding: Effects of Dexpanthenol on Corneal Neovascularization and Inflammation on Rat Model.
Kiristioglu MO, Baykara M
Cornea · 2026 Jun · PMID 42257438 · Publisher ↗
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A Semi-automated Image Analysis Determination of Regional Differences in Corneal Endothelial Cell Densities in Fuchs Endothelial Corneal Dystrophy.
Miller T, Butt F, Ong Tone S
Cornea · 2026 Jun · PMID 42257437 · Publisher ↗
PURPOSE: Fuchs endothelial corneal dystrophy (FECD) is characterized by progressive corneal endothelial cell loss and guttae formation, leading to edema and vision loss. This study quantifies regional differences in endo...
PURPOSE: Fuchs endothelial corneal dystrophy (FECD) is characterized by progressive corneal endothelial cell loss and guttae formation, leading to edema and vision loss. This study quantifies regional differences in endothelial cell density (ECD) across FECD grades defined by the modified Krachmer grading system. METHODS: Medical records from 2023 to 2024 were retrospectively reviewed to identify patients with FECD who underwent noncontact specular microscopy (Konan Specular CellCheck20Plus). Eyes with analyzable peripheral and available central images were included. ECD (cells/mm2) was determined using semi-automated image analysis from central and 4 peripheral regions 4.0 mm from the apex: superonasal (SN), superotemporal (ST), inferonasal (IN), and inferotemporal (IT). RESULTS: A total of 104 eyes from 66 patients with FECD were analyzed [mean age 66 ± 11 years (range, 41-88); 71% female]. Central ECD was significantly lower than all peripheral regions in grade 4 (central: 757 cells/mm2; ST: 2043; SN: 1613; IT: 1429; IN: 1702; all P < 0.01), although measurements may be underestimated in advanced disease because of guttae-related limitations. By grade 5, the central-inferotemporal difference was no longer significant (central: 558; IT: 763; P = 0.80), and IT ECD remained lower than superior regions (ST: 1440; SN: 1333, both P < 0.05). By grade 6, central and IT ECD were significantly lower than other regions (all P < 0.05). Sex and diabetes were not independent predictors of ECD (P = 0.76 and P = 0.19, respectively). CONCLUSIONS: ECD is differentially affected across corneal regions at different FECD grades. Central and IT ECD are more severely affected than other peripheral regions in advanced FECD, although central estimates may be limited.
Unplanned Return to the Operating Room After Keratoplasty.
Binte Aamir F, Hamza Khan MM, Khan MJ … +9 more , Ali M, Akhlaq A, Eghrari AO, Mohammed ISK, Sulewski ME, Soiberman U, Daoud YJ, Srikumaran D, Woreta FA
Cornea · 2026 Jun · PMID 42257434 · Publisher ↗
PURPOSE: To evaluate the incidence, risk factors, and common indications associated with an unplanned return to the operating room (OR) within 90 days after keratoplasty. METHODS: This retrospective cohort study was cond...
PURPOSE: To evaluate the incidence, risk factors, and common indications associated with an unplanned return to the operating room (OR) within 90 days after keratoplasty. METHODS: This retrospective cohort study was conducted at The Wilmer Eye Institute. Patients who underwent descemet stripping endothelial keratoplasty (DSEK), descemet membrane endothelial keratoplasty (DMEK), deep anterior lamellar keratoplasty (DALK), or penetrating keratoplasty (PK) between 2019 and 2022 were included. The overall rates of unplanned return to the OR were calculated, and temporal trends were analyzed. Mean time between keratoplasty and unplanned return to OR was also calculated. Multivariable logistic regression was used to identify factors associated with unplanned returns. RESULTS: Among 984 keratoplasties, 69 (7%) patients had an unplanned return to the OR within 90 days. The return rate increased from 6% in 2019 to 9% in 2021 and dropped to 5% in 2022. Procedure-specific return rates were highest for DALK (22.5%, n = 9 of 40 total DALK cases), followed by DSEK (11.7%, n = 39 of 333 total DSEK cases), DMEK (4.1%, n = 15 of 363 total DMEK cases), and PK (2.4%, n = 6 of 248 total PK cases). Most unplanned returns (78.3%) occurred within the first 30 days after keratoplasty. Graft detachment is the most common indication for unplanned returns to the OR after EK. Regression analysis revealed no significant associations between age, sex, race, transplant type, American Society of Anesthesiologists physical status classification system, anesthesia type, or prior ocular surgery. CONCLUSIONS: National data on unplanned return to the OR for different types of keratoplasty may serve as useful indicators of corneal surgical quality.
An Eye Bank and Ex Vivo Pilot Study of Shelf-Stable Corneal Plugs for Perforation Repair.
Balk EW, Torres G, Grandgenett L … +3 more , Hicks N, Sawant OB, Sales CS
Cornea · 2026 Jul · PMID 42242238 · Publisher ↗
PURPOSE: Cyanoacrylate tissue adhesive with a plastic disc (CTA-D) is the standard in-office treatment for corneal perforations but often requires reapplication because of reliance on surface adhesion. We developed a cuf...
PURPOSE: Cyanoacrylate tissue adhesive with a plastic disc (CTA-D) is the standard in-office treatment for corneal perforations but often requires reapplication because of reliance on surface adhesion. We developed a cufflink-shaped corneal plug that provides a sutureless intraocular seal by mechanical anchoring. This study evaluated feasibility of eye bank microkeratome production, ex vivo performance compared with CTA-D, and burst pressure testing in whole human globes. METHODS: Cufflink plugs were produced from 1-month glycerin-preserved donor corneas by an eye bank technician using a microkeratome-based cutting system. Dimensional accuracy was assessed after 1 week of storage. Plugs were tested against CTA-D in corneoscleral rims with simulated 1- and 2-mm perforations. The sealed rims were mounted on artificial anterior chambers for burst pressure testing. Whole globes with simulated 2-mm perforations sealed by plugs were tested for burst pressure. RESULTS: Ten plugs were produced with acceptable dimensional accuracy; asymmetry was observed between the leaflets but remained within functional tolerances. In ex vivo corneoscleral rim testing, plugs trended toward higher burst pressures than CTA-D for 1-mm (381 ± 108 vs. 318 ± 142 mm Hg) and 2-mm perforations (346 ± 93 vs. 289 ± 90 mm Hg). In five whole globes, plugs maintained seals above physiological pressures (minimum: 112 mm Hg), and no dislodgement was observed. CONCLUSIONS: Eye bank technicians can reliably produce cufflink-shaped corneal plugs using modified microkeratome systems. Plugs demonstrated strong sealing capacity in both corneoscleral rim and whole globe models. Future animal and human studies are needed to evaluate safety, tissue integration, and long-term stability.
Cosmetic Keratopigmentation Works and Can Be Used as a New Aesthetic Solution to Change the Apparent Color of the Eye.
Alio JL
Cornea · 2026 Jul · PMID 42242237 · Publisher ↗
Keratopigmentation has re-emerged as a corneal surgical technique with therapeutic, functional, and cosmetic applications. Advances in micronized mineral pigments and femtosecond-assisted approaches have expanded its ind...
Keratopigmentation has re-emerged as a corneal surgical technique with therapeutic, functional, and cosmetic applications. Advances in micronized mineral pigments and femtosecond-assisted approaches have expanded its indications from disfigured eyes and selected functional disorders to elective eye color change. Reported short-term outcomes have generally been favorable, with high patient satisfaction in selected cases. However, wider adoption remains limited by the lack of long-term evidence, particularly for cosmetic indications, and by concerns regarding pigment standardization, safety, stability, tolerance, and durability. Cosmetic keratopigmentation also raises ethical and professional considerations and should be undertaken with careful patient selection, appropriate surgical training, and controlled clinical evaluation. Further guideline development and high-quality long-term studies are needed to better define its role in contemporary corneal practice.
Color at What Cost? The Case Against Cosmetic Keratopigmenation in Sighted Eyes.
Jabbour S
Cornea · 2026 Jul · PMID 42242236 · Publisher ↗
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Role of Corneal Screening in Pediatric Patients With Allergic Rhinoconjunctivitis: A Proactive Approach to Preventive Ophthalmology: Initial Report of the CATCH (Capturing Atopic Children) Keratoconus Study Group.
Bilgihan K, Alkan LR, Uysal BS … +7 more , Çetin K, Özmen MC, Atalay HT, Tarlan B, Ertoy Karagöl Hİ, Baran Aksakal FN, Bakırtaş A
Cornea · 2026 Jun · PMID 42241027 · Publisher ↗
PURPOSE: To characterize corneal tomographic and imaging findings in children with allergic rhinoconjunctivitis (AR) and examine their correlation with the severity of ocular allergic signs and symptoms. METHODS: Childre...
PURPOSE: To characterize corneal tomographic and imaging findings in children with allergic rhinoconjunctivitis (AR) and examine their correlation with the severity of ocular allergic signs and symptoms. METHODS: Children diagnosed with AR by pediatric allergists were referred for ophthalmologic evaluation, including corneal tomography (Pentacam, MS-39 AS-OCT) and biomechanical analysis (Corvis ST), in this prospective cross-sectional study. The severity of allergic symptoms was assessed with the rhinoconjunctivitis total symptom score, whereas the intensity of conjunctival papillary reaction was graded clinically. RESULTS: Suspicious or abnormal anterior corneal elevation (Df) was detected in 20.7% of 804 eyes evaluated from 402 pediatric cases with AR; keratoconus was diagnosed in 3 eyes of 2 patients (0.5%). A significant positive correlation was found between Df values and both severity of papillary reaction and rhinoconjunctivitis total symptom score (all P < 0.001). Patients were classified into 2 groups based on Df values. Those with a Df value within the normal range (≤1.6) were classified as group 1, whereas those with abnormal Df values (>1.6) were classified as group 2. Group 2 showed significantly increased epithelial thickness ( P < 0.001) and anterior corneal aberrations compared with group 1, whereas no significant differences were observed in corneal biomechanical indices ( P > 0.05 for all). CONCLUSIONS: Children with AR may exhibit early corneal alterations, particularly in anterior elevation, together with increased epithelial thickness and anterior aberrations. Incorporating corneal imaging into routine evaluation of symptomatic pediatric patients with AR could enable early detection of subtle tomographic and aberrometric abnormalities, underscoring the importance of preventive ophthalmologic screening within pediatric allergy care.
Femtosecond-Laser-Assisted Cataract Surgery Combined With PanOptix Multifocal Lens Implantation in a Patient With a History of Keratopigmentation: A Case Report and Review of Mid-term Outcomes.
Hashemi H, Hadavandkhani A, Khabazkhoob M
Cornea · 2026 Aug · PMID 42241025 · Publisher ↗
PURPOSE: To evaluate femtosecond-laser-assisted cataract surgery combined with the implantation of a PanOptix multifocal intraocular lens (IOL) in a patient with a history of keratopigmentation. METHODS: A 62-year-old fe...
PURPOSE: To evaluate femtosecond-laser-assisted cataract surgery combined with the implantation of a PanOptix multifocal intraocular lens (IOL) in a patient with a history of keratopigmentation. METHODS: A 62-year-old female patient sought a permanent change in her eye color. She had no previous history of ocular or systemic diseases and had not undergone any ocular surgery. After the necessary evaluations, a corneal color change was performed using the femtosecond laser aesthetic annular keratopigmentation method. Six months after the keratopigmentation procedure, the patient underwent femtosecond-laser-assisted cataract surgery on both eyes and received the Acrysof PanOptix multifocal IOL. A 3-month follow-up was conducted to assess her vision and refraction. RESULTS: The outcome of the keratopigmentation was completely satisfactory in cosmetic appearance and visual function. In the following months, the patient expressed a desire to stop using glasses for both distance and near vision. At that time, her uncorrected distance visual acuity measured 20/200 in the right eye and 20/70 in the left eye, whereas her best-corrected visual acuity in both eyes was 20/20. Three weeks and 3 months after cataract surgery, her uncorrected distance visual acuity and best-corrected visual acuity in both eyes were recorded at 20/20, and her near visual acuity was assessed at J2. The patient reported no visual disturbances such as glare or halos and expressed complete satisfaction with the surgical outcomes. No complications were observed during or after the surgical procedure. CONCLUSIONS: The results of the present study suggest that integrating keratopigmentation with multifocal IOL implantation could enhance patient satisfaction.
A Case of Linear IgA Bullous Dermatosis of Childhood With Ocular Involvement: A Diagnostic Challenge.
Haidar H, Amos-Oluwole O, Loomba A … +7 more , Joy R, Sudhakaran S, Zaman R, Jacob D, Wood M, Amin H, Goel S
Cornea · 2026 Aug · PMID 42241023 · Publisher ↗
PURPOSE: Linear IgA bullous dermatosis of childhood is a rare autoimmune blistering disorder that typically presents with cutaneous manifestations but may involve ocular structures. This case highlights diagnostic challe...
PURPOSE: Linear IgA bullous dermatosis of childhood is a rare autoimmune blistering disorder that typically presents with cutaneous manifestations but may involve ocular structures. This case highlights diagnostic challenges and treatment strategies of a 3-year-old girl with corneal involvement, initially misdiagnosed with a viral etiology. METHODS: The patient presented with left-eye redness, photophobia, and eyelid swelling, preceded by a blistering rash. Evaluation included ocular examinations under anesthesia (EUA), autoimmune screening, and skin biopsy with direct immunofluorescence. Pediatric and dermatology teams provided joint care. RESULTS: Initial EUA identified a shield ulcer in the left cornea, managed with topical antibiotics, corticosteroids, and lubricants. Despite this, the ulcer progressed, necessitating partial tarsorrhaphy. Antiviral therapy was initiated when viral keratitis was suspected. As the cutaneous eruption advanced, dermatology review was obtained, and autoimmune testing revealed elevated MPO-ANCA. A repeat EUA demonstrated worsening corneal ulceration with conjunctival inflammation and early contralateral involvement. An amniotic membrane graft was applied. Skin biopsy confirmed linear IgA bullous dermatosis with subepidermal blisters and linear IgA deposits. Systemic corticosteroids led to marked improvement in ocular and cutaneous disease. Follow-up EUA showed early epithelial healing, although Haemophilus influenzae was cultured and treated with topical levofloxacin. A second graft was required, after which EUA confirmed complete resolution of the epithelial defect. The patient was transitioned to dapsone for long-term management. CONCLUSIONS: Autoimmune blistering disease should be considered in children with ocular ulcers, especially when accompanied by cutaneous manifestations. Early biopsy, timely diagnosis, and multidisciplinary management can lead to significant clinical improvement.
Impact of Estrogen Deficiency on Dry Eye Disease in BRCA Mutation Carriers With Premature Menopause.
Sedunov L, Fridman V, Cenkova K … +4 more , Kravchenko V, Cervinkova E, Al-Redouan A, Zikan M
Cornea · 2026 Jun · PMID 42241016 · Publisher ↗
PURPOSE: Dry eye disease is a multifactorial disorder of the ocular surface in which tear film homeostasis is disrupted, and hormonal status is among the contributing factors. BRCA mutation carriers often undergo risk-re...
PURPOSE: Dry eye disease is a multifactorial disorder of the ocular surface in which tear film homeostasis is disrupted, and hormonal status is among the contributing factors. BRCA mutation carriers often undergo risk-reducing bilateral salpingo-oophorectomy (RRBSO) or receive aromatase inhibitors (AIs), both leading to estrogen deprivation. This study examined how estrogen deficiency affects dry eye disease parameters. METHODS: Ninety women aged 40 to 50 years were enrolled: those treated with RRBSO (n = 30), those receiving AIs (n = 30), and healthy controls (n = 30). Tear break-up time (TBUT), Schirmer test score, and Ocular Surface Disease Index were measured. Intergroup differences were assessed using ANOVA with post hoc testing. RESULTS: Both estrogen-deprived groups had significantly shorter TBUT and lower Schirmer scores than controls (all P < 0.01). Ocular Surface Disease Index scores were highest in the RRBSO group, intermediate in the AI group, and lowest in controls (all P < 0.0001). No significant TBUT or Schirmer score differences were observed between the RRBSO and AI groups. CONCLUSIONS: Estrogen deficiency, whether surgical or pharmacological, is linked to impaired tear film stability, reduced tear production, and higher symptom burden in BRCA mutation carriers. RRBSO is associated with the greatest symptom severity, emphasizing the need for proactive ocular surface monitoring and tailored management in this population.
Risk of Cancer Among Individuals With Fuchs Endothelial Corneal Dystrophy in a Large, Population-Based Study.
Meyer JJ, Li K, Christensen B
Cornea · 2026 Jun · PMID 42241014 · Publisher ↗
PURPOSE: To determine whether there is an altered risk of specific cancers among individuals with Fuchs Endothelial Corneal Dystrophy (FECD). METHODS: Retrospective, case-control study using data from the Utah Population...
PURPOSE: To determine whether there is an altered risk of specific cancers among individuals with Fuchs Endothelial Corneal Dystrophy (FECD). METHODS: Retrospective, case-control study using data from the Utah Population Database, Utah Cancer Registry, and associated records. Cases were defined as individuals ≥40 years with a diagnosis of FECD. Controls were matched approximately 3:1 with cases on birth year, sex, whether born in Utah, and duration of follow-up in Utah. Twenty-two types/locations of cancer that were diagnosed between 1996 and 2022 were recorded. Cancer risk models were calculated using mixed-effect logistic regression, with adjustments for obesity, diabetes, tobacco use, race, ethnicity, and sex (except for sex-specific cancers). The main outcome measure was the odds of specific cancer diagnoses among FECD cases compared with matched controls. RESULTS: A total of 4129 FECD cases and 12,371 controls were studied in the final analysis. A total of 885 (21.4%) FECD cases and 2514 (20.3%) controls were diagnosed with any cancer ( P = 0.126). After adjusting for covariates, FECD cases did not have an altered likelihood of having a diagnosis of cancer overall (OR: 1.06; 95% CI, 0.97-1.16; P = 0.174), or according to any of the specific cancer sites/subtypes. There was a slightly higher likelihood of thyroid cancer among FECD cases (OR: 1.55; 95% CI, 1.00-2.38; P = 0.048) and prostate cancer among male FECD cases (OR: 1.20; 95% CI, 1.01-1.43; P = 0.036) that was not statistically significant after accounting for multiple comparisons. CONCLUSIONS: Individuals with FECD did not have a significantly altered risk of any of the studied cancers.
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