Cornea[JOURNAL]
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200 papers
Ab Interno Approach to Sealing Corneal Perforations Using Off-the-Shelf Human Cornea.
Khan SM, Gunasekera C
Cornea · 2026 May · PMID 42149933 · Publisher ↗
PURPOSE: Corneal perforations necessitate prompt surgical intervention to restore globe integrity and mitigate the risk of irreversible vision loss. Larger corneal perforations often require more complex surgical strateg...
PURPOSE: Corneal perforations necessitate prompt surgical intervention to restore globe integrity and mitigate the risk of irreversible vision loss. Larger corneal perforations often require more complex surgical strategies, including tectonic patch grafting or penetrating keratoplasty. However, limited availability of donor tissue presents significant challenges in meeting urgency of these cases. We describe an ab interno technique approach for corneal perforation repair, using off-the-shelf human cornea as an alternative viable surgical treatment. METHODS: The surgery was performed at a tertiary center in the United Kingdom, where Halo (VisionGift, Portland, OR) cornea, made from preserved human corneal tissue, was used for perforation repair. The tissue meets Food and Drug Administration and United Kingdom regulatory standards. RESULTS: An 89-year-old woman presented with a painful, red left eye associated with significant vision loss. She had a complex ocular history, including herpes zoster ophthalmicus keratitis. On examination, the left eye visual acuity was reduced to hand motion with an inferior corneal perforation. Surgical management involved placement of the Halo cornea disc internally over the defect with gas tamponade. At 1 week, the patient's left eye vision had improved to 6/24, with intraocular pressure of 10 mm Hg. Nine months postsurgery, the left eye's visual acuity improved to 6/9, with no graft detachment, inflammation, or vascularization observed. CONCLUSIONS: This case highlights the successful use of a Halo cornea graft for the management of a large peripheral corneal perforation in a patient with complex ocular pathology. This technique would be of particular interest to ophthalmologists who manage corneal perforations.
Successful Cultivation of Oral Mucosal Epithelial Sheet Following Antifungal Therapy in Cases With Limbal Stem Cell Deficiency.
Kitazawa K, Fukuoka H, Komai S … +8 more , Kataoka Y, Adachi K, Kanamura N, Tomida D, Utsunomiya T, Hotta F, Eguchi H, Sotozono C
Cornea · 2026 Apr · PMID 42133945 · Publisher ↗
PURPOSE: The aim of this study was to report four cases of limbal stem cell deficiency in which oral antifungal therapy enabled successful generation of cultured oral mucosal epithelial sheets for ocular surface reconstr...
PURPOSE: The aim of this study was to report four cases of limbal stem cell deficiency in which oral antifungal therapy enabled successful generation of cultured oral mucosal epithelial sheets for ocular surface reconstruction. METHODS: This case series included two patients with Stevens-Johnson syndrome and two with ocular cicatricial pemphigoid, all of whom were scheduled for cultivated oral mucosal epithelial transplantation (COMET). Initial oral mucosal biopsies resulted in fungal contamination during cell culture. Patients subsequently underwent targeted oral management, including dental cleaning, cessation of denture use, and antifungal therapy. RESULTS: All four patients (age range: 45-91 years) exhibited Candida albicans contamination in the primary cultures. After careful oral management, including oral hygiene, denture discontinuation, and oral amphotericin B syrup, the second biopsies were performed with uncontaminated cultures. Autologous COMET sheets were successfully generated and transplanted in all cases, resulting in improved ocular surface stability without postoperative infectious complications. CONCLUSIONS: This case series emphasizes the importance of preoperative dental assessment and oral antifungal treatment in preventing microbial contamination during epithelial sheet preparation for COMET.
Distinguishing Factors for Microbial Keratitis Groups: A Cross-Sectional Survey of US Cornea Specialists.
Vogt EL, Lu MC, Niziol LM … +17 more , Tuli SS, Mian SI, Sugar A, Amescua G, Amin S, Wozniak RAF, Li JY, Deng S, Jeng BH, Rose-Nussbaumer J, Jhanji V, Tu EY, Tuohy MM, Hooton J, Prajna NV, Farsiu S, Woodward MA
Cornea · 2026 Apr · PMID 42133664 · Publisher ↗
PURPOSE: To survey United States (US) cornea specialists on clinical factors that distinguish between microbial keratitis (MK) organism groups. METHODS: This cross-sectional survey of US cornea specialists assessed wheth...
PURPOSE: To survey United States (US) cornea specialists on clinical factors that distinguish between microbial keratitis (MK) organism groups. METHODS: This cross-sectional survey of US cornea specialists assessed whether 61 clinical factors, including history factors, ocular symptoms, and exam findings, distinguished a specific organism group in the typical patient with MK. MK organism groups included gram-positive bacterial keratitis (GPBK), gram-negative bacterial keratitis (GNBK), mold fungal keratitis (MFK), yeast fungal keratitis (YFK), parasitic keratitis (PK), and viral keratitis (VK). The survey was distributed via the Cornea Society's email listserv from March 11, 2024 to May 7, 2024. Descriptive statistical analysis was performed to identify the percentage of specialists identifying a clinical factor as distinguishing a specific MK organism group. RESULTS: A total of 67 specialists completed the survey. There were 20 factors (32.8% of 61) that >75% of specialists identified as distinguishing a specific MK group, including 9 factors for BK (eg copious ocular discharge, loose ocular sutures), 3 factors for FK (eg feathery infiltrate, ocular trauma with organic matter), 5 factors for PK (eg pain out of proportion, perineuritis), and 3 factors for VK (eg reduced/absent corneal sensation, prodromal symptoms). The remaining 41 factors had ≤75% of specialists identify them as distinguishing. CONCLUSIONS: Specialists agreed that 32.5% of clinical factors distinguished different MK organism groups, aligned with prior work demonstrating difficulty with interorganism differentiation. These 20 factors may aid clinicians in their initial MK diagnosis; however, more work is needed to validate their salience in diagnosis.
Indirect Corneal Neurotization With a Sural Nerve Graft in a Pediatric Patient With Congenital Corneal Anesthesia and Recurrent Herpetic Keratitis.
Xolalpa-Peniche AV, Albavera-Giles T, Muleiro-Alvarez M … +7 more , Bages-Rousselon Y, Elnecavé A, Aguilera A, Vera-Duarte GR, Navas A, Graue-Hernandez EO, Ramirez-Miranda A
Cornea · 2026 May · PMID 42133655 · Publisher ↗
PURPOSE: To describe the clinical course, surgical management, and sensory outcomes of indirect corneal neurotization using an autologous sural nerve graft in a pediatric patient with congenital corneal anesthesia compli...
PURPOSE: To describe the clinical course, surgical management, and sensory outcomes of indirect corneal neurotization using an autologous sural nerve graft in a pediatric patient with congenital corneal anesthesia complicated by recurrent herpetic keratitis and neurotrophic keratopathy. METHODS: Case report of a 6-year-old girl with severe unilateral corneal hypoesthesia secondary to recurrent herpes simplex virus keratitis and a history of deep anterior lamellar keratoplasty, who underwent indirect corneal neurotization. Serial postoperative assessments included visual acuity, slit-lamp examination, and Cochet-Bonnet esthesiometry. RESULTS: By mid-term follow-up (8 months), partial peripheral sensory recovery was observed, accompanied by restoration of ocular surface stability and improvement in best-corrected visual acuity to 20/40. At 1 year, asymmetric but clinically meaningful peripheral sensory improvement was documented, whereas central sensitivity remained markedly reduced. The corneal graft remained clear, and no further inflammatory complications occurred. CONCLUSIONS: Indirect corneal neurotization using a sural nerve graft resulted in significant peripheral sensory recovery and enhanced visual function in a pediatric patient with congenital corneal anesthesia and herpes simplex virus-related neurotrophic keratopathy. This case supports indirect corneal neurotization as a promising regenerative strategy capable of restoring corneal sensation and improving ocular surface stability in pediatric patients at risk of amblyopia.
Cytomegalovirus Induced Infectious Crystalline Keratopathy After Penetrating Keratoplasty.
Atighehchian M, Jafari Z, Zarei-Ghanavati S … +2 more , Sheikhghomi S, Zarei-Ghanavati M
Cornea · 2026 Apr · PMID 42133649 · Publisher ↗
PURPOSE: To report a rare case of post-penetrating keratoplasty infectious crystalline keratopathy caused by Cytomegalovirus (CMV). METHODS: The patient's history, clinical presentation, laboratory, and imaging analysis...
PURPOSE: To report a rare case of post-penetrating keratoplasty infectious crystalline keratopathy caused by Cytomegalovirus (CMV). METHODS: The patient's history, clinical presentation, laboratory, and imaging analysis were reviewed. RESULTS: A 55-year-old male patient was referred to our hospital with a medical history of 3 prior penetrating keratoplasty procedures because of post-refractive surgery infectious keratitis and epithelial downgrowth. He has been on both systemic and topical immunosuppressive medications. The patient presented with decreased vision, and on examination, a needle-like branching corneal lesions was identified, consistent with the diagnosis of infectious crystalline keratopathy. After negative results from smear and culture of corneal samples, molecular evaluation using polymerase chain reaction testing revealed the presence of CMV. Consequently, immunosuppressive therapy was adjusted, and systemic and topical antiviral treatments were initiated, resulting in a favorable clinical response. CONCLUSIONS: This case emphasizes the importance of considering CMV infection in progressive and nonresponsive infectious crystalline keratopathy to antimicrobial medications, particularly in immunosuppressed individuals. In addition, polymerase chain reaction is an appropriate laboratory molecular diagnostic test for the accurate diagnosis of CMV keratitis.
Preparation of Donor Descemet Membrane Endothelial Keratoplasty Tissue Under Age 50 Compares Favorably With Older Tissue.
Mittal A, Tran K, Straiko MMW … +2 more , White E, Chamberlain WD
Cornea · 2026 Apr · PMID 42133634 · Publisher ↗
PURPOSE: Corneal tissue shortage is an ongoing concern for corneal surgeons and eye banks across the United States. Descemet membrane endothelial keratoplasty (DMEK) procedure numbers surpassed Descemet stripping automat...
PURPOSE: Corneal tissue shortage is an ongoing concern for corneal surgeons and eye banks across the United States. Descemet membrane endothelial keratoplasty (DMEK) procedure numbers surpassed Descemet stripping automated endothelial keratoplasty in 2023, leading to an increased demand that has been met with limited DMEK tissue availability. In response to the growing demand, our goal is to compare and characterize feasibility of DMEK tissue from donors younger than 50 and donors 50 and older, including DMEK tissue processing times, preprocessing endothelial cell counts, and processing success rate. METHODS: Retrospective review of donor corneas used for DMEK tissue processing from 2018 to 2024 at a single eye bank with a post hoc analysis. RESULTS: A total of 8915 cornea samples were used for transplantation during study period. Preprocessing endothelial cell counts were not significantly different between donor group age 50 or older or donor group younger than 50. Postprocessing endothelial cell counts were higher for donor group under 50. There was no statistically significant difference in processing times between donors 50 or older or younger than 50. Tissue peel difficulty was significantly reduced in donors younger than 50 compared to donors 50 or older. CONCLUSIONS: Preprocessing endothelial cell counts were similar between both age groups with higher postprocessing endothelial cell counts in donors younger than 50. Tissue processing time and tissue processing failure rate were also similar between the 2 age groups while tissue from donors less than 50 was easier to peel. This highlights that younger donors are a viable pool for DMEK tissue, which could help address the ongoing tissue shortage.
Role of Topical Calcineurin Inhibitors During and After Fungal Keratitis: A Narrative Review.
Hsu J
Cornea · 2026 Apr · PMID 42133633 · Publisher ↗
PURPOSE: To describe current data of topical calcineurin inhibitors (CIs) during fungal keratitis in combination with antifungal agents and after therapeutic penetrating keratoplasty (TPKP) for fungal keratitis as steroi...
PURPOSE: To describe current data of topical calcineurin inhibitors (CIs) during fungal keratitis in combination with antifungal agents and after therapeutic penetrating keratoplasty (TPKP) for fungal keratitis as steroid-sparing anti-inflammatory medications. METHODS: This narrative review was performed with a literature search conducted in PubMed. Full-text articles available in English with no date restrictions were used. RESULTS: CIs attenuate T-lymphocyte activation, which is an important mechanism underlying host immune responses in fungal keratitis. Topical CIs are used off-label in a variety of ocular conditions, including in high-risk PKP to decrease risk of corneal graft rejection. In fungal keratitis, in vitro and experimental animal studies have demonstrated both additive and synergistic effects with cyclosporine A and tacrolimus in combination with antifungals. Retrospective data and community consensus further support the perceived clinical benefit of CIs during active fungal keratitis. Topical cyclosporine use in patients who undergo TPKP for fungal keratitis has demonstrated clinical efficacy as a steroid-sparing agent in both minimizing fungal recurrences while optimizing graft clarity rates. CONCLUSIONS: Although not yet widely adopted in clinical practice, topical CIs represent a promising potential solution to the clinical dilemma of balancing inflammation control while avoiding steroids in fungal keratitis. Based on data from both during fungal keratitis and after TPKP for fungal keratitis, there may be a role in early initiation of CIs.
PRESS & ROLL Technique for Descemet Membrane Endothelial Keratoplasty Graft Unfolding in Vitrectomized Eyes.
Park JY, An DH, Song JY … +3 more , Chung SH, Kim HS, Byun YS
Cornea · 2026 Aug · PMID 42127429 · Publisher ↗
PURPOSE: Unfolding a Descemet membrane endothelial keratoplasty (DMEK) graft in vitrectomized eyes is technically demanding because of the characteristic deepening of the anterior chamber seen in these patients. The PRES...
PURPOSE: Unfolding a Descemet membrane endothelial keratoplasty (DMEK) graft in vitrectomized eyes is technically demanding because of the characteristic deepening of the anterior chamber seen in these patients. The PRESS & ROLL technique was developed for use in this challenging scenario to facilitate graft unfolding by combining central corneal indentation with controlled rolling of a small air bubble. METHODS: After insertion of the DMEK graft through the main incision, proper graft orientation is first confirmed. A small air bubble is then injected above the graft. Central corneal indentation is gently applied using a blunt instrument to shallow the space between the graft and the pupillary area. While maintaining central indentation, the surgeon rolls the air bubble circumferentially around the corneal depression, gradually unfolding the graft toward the periphery in all directions. Once the graft is completely unfolded, air is fully injected beneath the graft while simultaneously releasing the indentation pressure. RESULT: In both cases, conventional unfolding maneuvers were unsuccessful because of repeated anterior chamber deepening. The PRESS & ROLL technique enabled complete and controlled graft unfolding without intraoperative complications. At 3 months, both eyes showed successful graft attachment with improved resolution of corneal edema and visual acuity, along with reduced corneal thickness. CONCLUSIONS: The PRESS & ROLL technique offers a practical and effective method for DMEK graft unfolding in vitrectomized or complex eyes with deepening of the anterior chamber. It enhances intraoperative control and predictability in challenging surgical environments.
Long-term Clinical Outcomes of Type 1 Keratoprosthesis: A 10-Year Experience.
Rajagopal RN, Malepati N, Bagga B … +8 more , Senthil S, Gour A, Sangwan V, Tyagi M, Pappuru RR, Dave VP, Basu S, Shanbhag SS
Cornea · 2026 May · PMID 42102311 · Publisher ↗
PURPOSE: To describe the outcome of type I keratoprosthesis (KPro) cases over 10 years of follow-up. METHODS: This retrospective study analyzed data of 125 eyes of 124 patients, which underwent type I KPro between 2009 a...
PURPOSE: To describe the outcome of type I keratoprosthesis (KPro) cases over 10 years of follow-up. METHODS: This retrospective study analyzed data of 125 eyes of 124 patients, which underwent type I KPro between 2009 and 2014 (74: Boston KPro; 51: Auro KPro). Eyes with KPro exchange were included. Eyes that retained a KPro ≥10 years (24 eyes) were compared with the rest of the cohort (101 eyes). RESULTS: The most common indication for surgery was limbal stem cell deficiency [74/125 (59%)]. The KPro retention was 51.2 ± 6% (anatomical) and 30.3 ± 4.7% with respect to visual recovery at 10 years for the cohort of 125 eyes. Among the 24 eyes (19%) that retained the KPro ≥10 years, 17 (71%) received Boston KPro and 7 (29%) received Auro KPro. Glaucoma was seen in 23 eyes (96%), of which 15 eyes (63%) required a glaucoma drainage device. Eighteen eyes (75%) retained the first implanted KPro. The preoperative median best-corrected visual acuity was significantly better in the group that retained the KPro ≥10 years (log MAR 2.8 vs. 3; P = 0.04). Incidence of glaucoma and retroprosthetic membrane was higher in the group that retained the KPro ≥10 years ( P <0.001). CONCLUSIONS: Nineteen percent of eyes operated for KPro over a 5-year period retained a KPro at ≥10 years. A higher incidence of complications was seen with longer follow-up emphasizing the need to schedule frequent follow-up visits, thus enhancing long-term outcomes.
Letter Regarding: "Acanthamoeba Keratitis: Analysis of Risk Factors, Diagnostic Modalities, and Clinical Outcomes at a Tertiary Referral Ophthalmic Unit" Arun K et al. Published in Cornea 7th Sept. 2025.
Dart JKG
Cornea · 2026 Jun · PMID 42085716 · Publisher ↗
Abstract loading — click title to view on PubMed.
Laser Photocoagulation for Ocular Surface Keratinization: A Minimally Invasive Modality of Treatment.
Kate A, Mateen SR, Rana A … +2 more , Basu S, Kapoor AG
Cornea · 2026 Jun · PMID 42085715 · Publisher ↗
PURPOSE: To report 2 cases of lid margin keratinization (LMK) associated with chronic ocular surface inflammation, which were successfully managed using laser photocoagulation. METHODS: A case report. RESULTS: The first...
PURPOSE: To report 2 cases of lid margin keratinization (LMK) associated with chronic ocular surface inflammation, which were successfully managed using laser photocoagulation. METHODS: A case report. RESULTS: The first case was a 20-year-old man with mycoplasma-induced rash and mucositis. He presented with a focal patch of lid margin keratinization extending to a small area of inferior tarsal conjunctiva in the right lower eyelid, which was causing keratopathy. He underwent laser photocoagulation but experienced a recurrence after 2 months, which was successfully managed with a repeat laser session. At 6 months posttreatment, there were no recurrences, the keratopathy had resolved, and the ocular surface remained stable. The second patient was an 18-year-old woman with Stevens-Johnson syndrome sequelae. She had LMK in all 4 lids and underwent mucous membrane grafting. Postoperatively, she developed focal recurrences of keratinization at the edges of the graft in all 4 lids. The recurrent keratin plaques were treated with laser photocoagulation with a 577-nm laser under local anesthesia. At her last follow-up, 6 months after recurrence, there were no signs of keratinization. CONCLUSIONS: Laser photocoagulation is a safe and effective minimally invasive treatment modality for focal LMK in setting of chronic ocular surface disease. These cases demonstrate its potential as an alternative or adjunct to surgical options like mucous membrane grafting, particularly in a setting of recurrent and localized keratinization.
Neurotrophic Keratopathy: Current Concepts, Management, and Emerging Treatments.
Cheung AY, Holland EJ
Cornea · 2026 Jun · PMID 42085714 · Publisher ↗
PURPOSE: To provide an updated brief review on neurotrophic keratopathy (NK) including classification, etiology, features, diagnosis, and management. METHODS: Literature review. RESULTS: NK is defined as the dysfunction...
PURPOSE: To provide an updated brief review on neurotrophic keratopathy (NK) including classification, etiology, features, diagnosis, and management. METHODS: Literature review. RESULTS: NK is defined as the dysfunction of corneal innervation that results in dysregulation of corneal and/or cellular function. It is characterized by loss of corneal sensation and neuronal homeostasis, leading to eventual corneal epithelial breakdown and ultimately keratolysis if untreated. Classification, etiology, features, diagnosis, and management of NK are reviewed. Prevalence is likely higher than previously estimated, and decreased sensation can originate from various causes. The Neurotrophic Keratitis Study Group classification emphasizes verifying corneal sensation early and distinguishes different epithelial and stromal aspects of NK. Optimal treatments regardless of NK stage include preservative-free lubricants (tears, gels, and ointments), punctal occlusion, autologous serum tears/umbilical cord serum drops/platelet-rich plasma drops, and removal of toxic or preservative-containing medications. Specific direct treatments, such as cenegermin and neurotization, address the decreased innervation and can improve sensation. A timely tarsorrhaphy may be necessary in refractory or quickly progressing cases. Keratoplasty is high risk in this setting but may be possible with aggressive medical therapy, adjunct procedures (i.e., amniotic membrane, tarsorrhaphy), perioperative direct treatments increasing sensation, and close follow-up postoperatively. CONCLUSIONS: NK is a chronic and potentially progressive disease that requires vigilance to monitor for future progression even after periods of apparent stability. As in other serious chronic conditions without a cure, earlier intervention in this challenging disease may obviate future decompensation and visually significant sequelae.
Risk Factors for Graft Rejection Following Endothelial Keratoplasty: Focus on Cystoid Macular Edema.
Spena R, Bovone C, Taloni A … +5 more , de Ruvo V, De Rosa L, Yu AC, Busin M, Kilian R
Cornea · 2026 Apr · PMID 41973979 · Publisher ↗
PURPOSE: The aim of this study was to investigate risk factors of immunologic graft rejection following endothelial keratoplasty, with a focus on cystoid macular edema (CMO). METHODS: This is a single-center retrospectiv...
PURPOSE: The aim of this study was to investigate risk factors of immunologic graft rejection following endothelial keratoplasty, with a focus on cystoid macular edema (CMO). METHODS: This is a single-center retrospective case review study including eyes undergoing either Descemet membrane endothelial keratoplasty (DMEK) or Descemet stripping automated keratoplasty (DSAEK). Univariate and multivariate analyses were conducted to evaluate whether several predetermined risk factors could influence the incidence of graft rejection. Receiver operating characteristic curve analysis was performed to determine ideal cutoff points of continuous variables. The following risk factors were assessed: recipient age, sex, indication for surgery, type of keratoplasty, glaucoma, and development of CMO. RESULTS: A total of 3546 eyes were included, with 731 undergoing DMEK and 2815 undergoing DSAEK. The mean follow-up duration was 49.5 ± 37.9 months (median = 36 months). The incidence of graft rejection was 2.9% for DMEK and 4.0% for DSAEK (P = 0.150) and was significantly influenced by the patients' age (odds ratio [OR] = 2.17, 95% confidence interval [CI], 1.46-3.24), the presence of glaucoma (OR = 2.28, 95% CI, 1.50-3.46), and postoperative occurrence of CMO (OR = 11.09, 95% CI, 6.58-18.70) (all P < 0.001). The mean interval between the onset of CMO and the occurrence of rejection was 11.5 ± 14.1 months, with a median of 6 months. CONCLUSIONS: Occurrence of CMO, as well as the presence of glaucoma and a recipient's age <71.5 years, seems to play a significant role in the development of endothelial graft rejection following endothelial keratoplasty. Further studies are indicated to investigate a possible immunologic link between CMO and endothelial graft rejection episodes.
An Open-Source Deep Learning Framework for Automated Corneal Segmentation in Anterior Segment Optical Coherence Tomography With Cross-Device External Validation.
Kandakji L, Liu S, Balal S … +5 more , Moghul I, Allan B, Tuft S, Gore D, Pontikos N
Cornea · 2026 Apr · PMID 41962147 · Publisher ↗
PURPOSE: To develop a deep learning model-Cornea nnU-Net Extractor (CUNEX)-for full-thickness corneal segmentation of anterior segment optical coherence tomography (AS-OCT) images and evaluate its utility in artificial i...
PURPOSE: To develop a deep learning model-Cornea nnU-Net Extractor (CUNEX)-for full-thickness corneal segmentation of anterior segment optical coherence tomography (AS-OCT) images and evaluate its utility in artificial intelligence research. METHODS: CUNEX was developed and evaluated using our Moorfields AS-OCT dataset of 194,599 scans from 37,499 patients, from which 100 normal, 100 keratoconus, and 100 Fuchs endothelial corneal dystrophy eyes were selected for model training. External validation was performed without fine-tuning using AS-OCT images acquired on 4 different OCT devices: Casia SS-1000, Anterion, Visante, and a ultrahigh-resolution custom build. CUNEX was benchmarked against 2 established models, CorneaNet and ScLNet. We then evaluated whether CUNEX-based segmentation influenced downstream deep learning classification of age, sex, and disease staging. RESULTS: On the internal MS-39 validation set, CUNEX achieved Dice similarity coefficient (DSC) and intersection over union (IoU) scores of 94% to 95% and 88% to 91% across healthy, keratoconus, and Fuchs endothelial corneal dystrophy eyes, comparable to ScLNet (within 3%) and superior to CorneaNet (8%-35% lower). On external datasets, CUNEX was the only model to produce anatomically meaningful segmentations across devices (DSC and IoU >70%), whereas ScLNet and CorneaNet showed substantial performance degradation (DSC and IoU <20%). Segmentation minimally affected classification accuracy except for sex prediction, where accuracy dropped from 81% to 68%, suggesting sex-related features may lie outside the cornea. CONCLUSIONS: CUNEX delivers the first open-source AS-OCT corneal segmentation model evaluated across multiple independent OCT platforms. It offers a reproducible foundation for integrating segmentation into clinical and artificial intelligence research workflows. The code and pretrained weights are available at https://github.com/lkandakji/CUNEX.
A Multicenter, Randomized, Double-Masked, Sham-Controlled Phase 3 Study to Evaluate the Efficacy and Safety of Epithelium-on Corneal Crosslinking in Keratoconus Subjects 8 to 45 Years of Age: Baseline Endothelial Studies.
Belin MW, DeMarchi J, Benetz BA … +5 more , Wu Q, Sattar A, Parsons EC, Szczotka-Flynn LB, Lass JH
Cornea · 2026 Apr · PMID 41960981 · Publisher ↗
PURPOSE: Determine the correlation between central endothelial cell density (ECD) and keratoconus tomographic disease severity. METHODS: A subcohort of 254 subjects (477 eyes) at 11 clinical sites enrolled in a phase III...
PURPOSE: Determine the correlation between central endothelial cell density (ECD) and keratoconus tomographic disease severity. METHODS: A subcohort of 254 subjects (477 eyes) at 11 clinical sites enrolled in a phase III study of epithelium-on crosslinking in keratoconus (ages 15-45) underwent specular microscopy of the central endothelium OU at baseline before treatment. ECD was graded by 2 image analysts from a central image analysis reading center with adjudication if ECD differed by ≥5%. The correlation by linear regression between ECD with Pentacam Belin/Ambrósio display final "D," Anterior Radius of Curvature (ARC), Minimal Corneal Thickness (MinCT), and Posterior Elevation a Thinnest Point (PETP) PTI was examined. RESULTS: Approximately 66.9% were male and 33.1% were female. Baseline ECD was 2802 ± 285 cells/mm2 (1868-3650 cells/mm2). In bivariate correlation analysis, ECD negatively correlated with age (r = -0.19, P < 0.01); final "D" (r = -0.25, P < 0.01); and PETP (r = -0.23, P < 0.01). ECD was positively correlated with ARC (r = 0.20, P < 0.01) and MinCT (r = 0.19, P < 0.01). ECD significantly decreased with age (β = -8.89, P < 0.01), with increasing final "D" (β = -8.68, P < 0.01), increasing PETP (β = -1.86, P < 0.01), decreasing ARC (β = 60.95, P < 0.01), and decreasing MinCT (β = 1.33, P < 0.01). Although ECD decreased with increasing disease severity and age, it remained relatively high, with only 1 eye showing an ECD <2000 cell/mm2. CONCLUSIONS: Increasing keratoconus tomographic severity results in a significant decrease in ECD. However, even in the most advanced stages, the ECD remains within physiological range.
Focal Subthreshold Laser Photocoagulation of Eyelid Margin Vascularity in Telangiectatic Meibomian Gland Dysfunction.
Kappos N, Georgalas I, Papaconstantinou D … +1 more , Droutsas K
Cornea · 2026 Apr · PMID 41960977 · Publisher ↗
PURPOSE: To evaluate the safety and efficacy of subthreshold micropulse laser photocoagulation for dry eye disease (DED) associated with telangiectatic meibomian gland dysfunction (MGD). METHODS: In this prospective cont...
PURPOSE: To evaluate the safety and efficacy of subthreshold micropulse laser photocoagulation for dry eye disease (DED) associated with telangiectatic meibomian gland dysfunction (MGD). METHODS: In this prospective contralateral eye study, 60 eyes from 30 patients with DED secondary to MGD were randomized to receive either a single session of focal 532-nm subthreshold laser photocoagulation of eyelid margin telangiectasias (Laser Group, LG) or a sham treatment (Control Group, CG). Evaluations were performed at baseline and 2, 4, 8, and 12 weeks posttreatment and included Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), Schirmer test, tear meniscus height and depth, eyelid margin vascularity, meibomian gland expressivity and secretion quality, ocular surface staining, meiboscore, and assessment of eyelid margin abnormalities. Best-corrected visual acuity (BCVA) and adverse events were recorded. RESULTS: LG showed early and sustained improvements in tear film stability, tear meniscus parameters, and corneal staining from week 2 to week 12 (P < 0.05). No significant changes were observed in CG. Eyelid margin vascularity was significantly reduced until week 8 in LG (P < 0.001), with improvements in meibomian gland expressivity and secretion quality. Meiboscore and chronic eyelid margin structural features remained unchanged in both groups (P > 0.05). No ocular or systemic adverse events occurred, and BCVA remained stable throughout the follow-up period. CONCLUSIONS: Focal subthreshold micropulse laser photocoagulation of eyelid margin telangiectasias appears to be a safe and effective adjunctive treatment for DED associated with MGD.
Scleral Lenses Are Effective in Providing Posthydrops Visual Rehabilitation.
Kreps EO, Koppen C
Cornea · 2026 Jul · PMID 41955515 · Publisher ↗
Abstract loading — click title to view on PubMed.
Ethanol-Preserved Corneoscleral Tissue for Emergency Tectonic Keratoplasty in Corneal Perforations: A Retrospective Clinical Study.
Bonatti P, Palme C, Kremser B … +6 more , Franchi A, Franz N, Stöckl V, Oberauer I, Rehak M, Steger B
Cornea · 2026 Mar · PMID 41955268 · Publisher ↗
PURPOSE: There is a global shortage of donor tissue for corneal transplantation. Long-term stored ethanol-preserved corneoscleral tissue may help address this shortage, particularly in emergency cases of corneal perforat...
PURPOSE: There is a global shortage of donor tissue for corneal transplantation. Long-term stored ethanol-preserved corneoscleral tissue may help address this shortage, particularly in emergency cases of corneal perforation. METHODS: This retrospective study analyzed tectonic keratoplasties for perforated corneal ulcers performed between January 2018 and December 2022. A total of 20 surgeries in 14 patients (6 female, 8 male) using ethanol-conserved corneoscleral tissue were included. Surgical, postoperative, and follow-up data were analyzed until December 2024, including graft storage duration, epithelialization, graft survival, complications, and best-corrected visual acuity. Outcomes were considered favorable if only planned surgery or no further surgery was required, and unfavorable if additional emergency intervention was necessary. RESULTS: The mean patient age was 83.5 (interquartile range 69.2-87.8) years (range 40.2-89.8). The cause of corneal perforation included immune-mediated corneal ulcers n = 8 (40%), neurotrophic corneal ulcers n = 7 (35%), herpetic corneal ulcerations n = 4 (20%), and fungal keratitis n = 1 (5%). The median graft size was 4.0 mm, with a median storage duration of 71.5 days (range 4-346). Graft survival resulted to 23.2 ± 17.4 months. A favorable outcome was achieved in 12 cases (60%). Epithelial closure was observed in all cases within 15 days. Best-corrected visual acuity improved from 1.7 ± 0.8 logMAR to 1.1 ± 0.7 logMAR. CONCLUSIONS: Ethanol-preserved corneoscleral tissue is safe and feasible for emergency tectonic keratoplasty. Its extended storage capacity may aid in the current global shortage of donor corneas.
Regression of Recalcitrant Corneal Neovascularization and Graft Revival With Systemic Bevacizumab: A Case Report.
Muller E, Sharma P, Feinberg L … +5 more , Ahmad S, Scatchard K, Bowley N, Tavakoli M, Roberts H
Cornea · 2026 Mar · PMID 41955263 · Publisher ↗
PURPOSE: Corneal neovascularization is a sight-threatening pathology arising from various conditions and compromises keratoplasty survival. Treating neovascularization is critical for graft outcomes; however, both medica...
PURPOSE: Corneal neovascularization is a sight-threatening pathology arising from various conditions and compromises keratoplasty survival. Treating neovascularization is critical for graft outcomes; however, both medical and surgical interventions often fail in severe cases. We report the first known case of regression of corneal neovascularisation associated with systemic bevacizumab accompanied by unexpected recovery of a previously failed Descemet Membrane Endothelial Keratoplasty (DMEK). METHODS: A 64-year-old woman presented with right eye bullous keratopathy and deep stromal neovascularization after phakic intraocular lens implantation. Corneal neovascularization persisted despite phakic intraocular lens explantation, vessel cautery, and subconjunctival bevacizumab. The patient subsequently underwent combined phacoemulsification and Descemet membrane endothelial keratoplasty (DMEK), which failed secondary to graft rejection despite intensive topical steroid therapy. Further local therapies, including repeat vessel cautery and intrastromal bevacizumab, were unsuccessful. The patient was later diagnosed with ovarian cancer and treated with systemic bevacizumab, carboplatin, and paclitaxel. RESULTS: After systemic therapy for ovarian cancer, the deep stromal vascularization markedly regressed, together with complete resolution of the corneal edema. Central corneal thickness improved from 1111 μm at rejection to 510 μm. Importantly, this represented not only vascular regression but functional recovery of a DMEK that had remained edematous for 10 months and had been considered irreversibly rejected. Visual acuity remained limited (0.8 logMAR) by residual central lipid keratopathy. DISCUSSION: This case demonstrates significant regression of deep established corneal neovascularization in a failed DMEK after systemic bevacizumab previously refractory to local therapy and apparent revival of a previously failed DMEK. To our knowledge, this represents the first reported case of systemic bevacizumab, administered as part of a triple systemic anticancer therapy, associated with regression of advanced corneal neovascularization and recovery of corneal clarify after DMEK failure. Although causality cannot be definitively established, the temporal association suggests a potential adjunctive role for systemic anti-VEGF therapy in selected cases of refractory corneal neovascularization and possibly restore function in transplants thought to have failed irreversibly.
Risk Factors, Treatment Outcomes, and Isolate-dependent Differences of Candida Keratitis.
Hsu J, Miller D, Dubovy S … +2 more , Alfonso E, Amescua G
Cornea · 2026 Mar · PMID 41955231 · Publisher ↗
PURPOSE: To describe risk factors, clinical presentations and treatment outcomes of Candida keratitis and to identify isolate-specific characteristics of Candida albicans compared with Candida parapsilosis. METHODS: Pati...
PURPOSE: To describe risk factors, clinical presentations and treatment outcomes of Candida keratitis and to identify isolate-specific characteristics of Candida albicans compared with Candida parapsilosis. METHODS: Patients with Candida keratitis over a 10-year period were analyzed in a retrospective single-center chart review. Data collected included demographic information, ocular history, clinical characteristics, treatment history, and microbiology data. RESULTS: Seventy-three consecutive cases of Candida keratitis in 69 patients were identified, including 31 cases of Candida albicans and 29 cases of Candida parapsilosis. There were fewer cases presenting from June through September. By year, there were no clear trends in number or type of Candida isolates. Topical steroid use (80.8%), history of corneal transplantation (47.9%), recent ocular surgery (38.4%), contact lens use (37.0%), ocular surface disease (32.9%), and preceding or concurrent bacterial coinfection (27.4%) were the most common identified predisposing risk factors. Approximately 90.4% (n = 66) had two or more predisposing factors. Of the seven remaining cases, bacterial coinfection was the sole factor in three cases. Compared with Candida parapsilosis, Candida albicans demonstrated higher rates of hypopyon formation (45.2% vs. 20.7%, P = 0.044) and more frequently underwent therapeutic penetrating keratoplasty (45.2% vs. 13.8%, P = 0.011). All five isolates with antifungal susceptibilities available were susceptible to all antifungals tested. CONCLUSIONS: Candida is an opportunistic keratomycosis that occurs most commonly in predisposed eyes. Although both Candida albicans and Candida parapsilosis were similarly common in this study, Candida albicans may be associated with more severe disease compared with Candida parapsilosis.
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