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200 papers
Recurrence Rate After Phototherapeutic Keratectomy in Epithelial-Stromal TGFBI Corneal Dystrophies Compared With Epithelial Basement Membrane Dystrophy.
Paoletti T, Daas L, Munteanu C … +1 more , Seitz B
Cornea · 2026 Mar · PMID 41949920 · Publisher ↗
PURPOSE: To compare the recurrence rate and functional outcome of epithelial-stromal TGFBI corneal dystrophies and epithelial basement membrane dystrophy (EBMD) after excimer laser phototherapeutic keratectomy (PTK). MET...
PURPOSE: To compare the recurrence rate and functional outcome of epithelial-stromal TGFBI corneal dystrophies and epithelial basement membrane dystrophy (EBMD) after excimer laser phototherapeutic keratectomy (PTK). METHODS: This single-center retrospective comparative study analyzed the rate of disease recurrence after PTK in a cohort of patients treated at the Department of Ophthalmology of the Saarland University Medical Center in Homburg/Saar between 2009 and 2024. The study included 63 eyes with epithelial-stromal TGFBI corneal dystrophies and 163 eyes with EBMD. Kaplan-Meier survival analysis was performed to assess the recurrence rate. Best-corrected visual acuity (BCVA), changes in refraction, astigmatism, and central corneal thickness before and after PTK were compared. Two-way analysis of variance (ANOVA) was used to examine the effects of time and type of diagnosis on the aforementioned parameters. RESULTS: The recurrence rate after PTK in the TGFBI group was 52% with a mean time to recurrence of 3.0 ± 2.8 years. However, we found no differences among TGFBI dystrophies, which may be attributable, at least in part, to the limited sample size. In the EBMD group, 1.2% of eyes required a second PTK because of significant disease recurrence. CONCLUSIONS: PTK is an effective first-line surgical option for patients with anterior corneal disease, providing both functional and symptomatic improvements. Postoperative disease recurrence was significantly higher in TGFBI dystrophies than in EBMD. PTK can be safely repeated in patients with TGFBI-related corneal dystrophies who are likely to experience 1 or more disease recurrences over the course of their lifetime.
Spatial Phenotyping of Endothelial Injury to Inform Graft Suitability after Shipping.
Bair H, Syed ZA
Cornea · 2026 Jun · PMID 41931702 · Publisher ↗
Abstract loading — click title to view on PubMed.
Epithelial Downgrowth Mimicking Recurrent Retroprosthetic Membrane After Boston Keratoprosthesis Implantation.
Samuel S, August A, Milman T … +2 more , Syed ZA, Hannush SB
Cornea · 2026 Mar · PMID 41931522 · Publisher ↗
PURPOSE: To report a case of epithelial downgrowth mimicking recurrent retroprosthetic membrane (RPM) in a patient with a Boston Keratoprosthesis (KPro). METHODS: Case report and literature review. RESULTS: A 74-year-old...
PURPOSE: To report a case of epithelial downgrowth mimicking recurrent retroprosthetic membrane (RPM) in a patient with a Boston Keratoprosthesis (KPro). METHODS: Case report and literature review. RESULTS: A 74-year-old monocular man with a history of penetrating corneal injury and multiple failed penetrating corneal transplants in the left eye followed by a Boston KPro type 1 implantation presented with decreased visual acuity from baseline 20/70 to 20/200. Examination revealed opaque material posterior to the optical element of the KPro, which was interpreted to be an RPM. The patient was treated with yttrium aluminum garnet laser membranectomy with immediate improvement in vision to baseline. He subsequently developed frequent recurrences of this visually significant membrane, each recurring in less than 7 days, and each responding to yttrium aluminum garnet membranectomy with return to baseline vision. Because of concerns about the frequency of visits required, the patient requested that the KPro be removed and replaced with a corneal allograft. Histopathologic evaluation of the submitted specimen demonstrated stratified, nonkeratinizing squamous epithelium on the posterior surface of the carrier cornea and optical element, consistent with epithelial downgrowth. CONCLUSIONS: Epithelial downgrowth is a rare complication of KPro implantation and should be suspected in patients with frequently and rapidly recurrent RPMs.
Diagnosis of Early Post-LASIK Ectasia With Mean Keratometry-Matched Controls.
Prakash G, Singh RB, Khimani K … +2 more , Palazzolo L, Jhanji V
Cornea · 2026 Mar · PMID 41931507 · Publisher ↗
PURPOSE: To identify topographic and wavefront aberration parameters that distinguish early post-LASIK (PL) ectasia (PLE) from stable PL corneas, keratoconus (KC), and normal eyes when matched for mean central keratometr...
PURPOSE: To identify topographic and wavefront aberration parameters that distinguish early post-LASIK (PL) ectasia (PLE) from stable PL corneas, keratoconus (KC), and normal eyes when matched for mean central keratometry. METHODS: This retrospective comparative study included 200 patients (n = 50 per group): early PLE, stable PL, early KC, and normal eyes, matched for mean central keratometry (∼41.0 D). Corneal topographic indices [index of surface variance (ISV), index of vertical asymmetry (IVA), index of height asymmetry (IHA), index of height decentration, central keratoconus index], keratometric parameters (flat K, steep K, K_max), pachymetry, higher-order aberrations (HOAs), coma, astigmatism, and a novel asymmetry-to-symmetry (A/S) aberration ratio. RESULTS: PLE exhibited higher K_max (46.9 ± 3.1 D) compared with PL (45.2 ± 1.7 D; P <0.01), although lower than early-KC (48.2 ± 4.3 D). Pentacam indices showed elevated ISV (40.98 vs. 23.68), IVA (0.38 vs. 0.16), and IHA (10.22 vs. 6.41) in PLE versus PL (all P < 0.001). PLE eyes had higher anterior HOA RMS (∼3.5 μm) than PL (∼2.5 μm) and normal (∼1.1 μm), approaching early KC (∼5.1 μm). Asymmetric aberrations (coma, astigmatism, trefoil) were disproportionately increased in PLE, whereas symmetric aberrations (spherical aberration, defocus) remained comparable (P ≈ 0.9). The A/S ratio was higher in PLE (0.60 ± 0.44) versus PL (0.30 ± 0.16, P < 0.001). Receiver-operator-characteristics analysis identified IVA (area under the receiver-operator-characteristics curve 0.802), ISV (0.786), coma (0.771), HOA RMS (0.740), and A/S ratio (0.728) as useful discriminators of PLE. An A/S ratio >0.54 yielded 96% specificity for ectasia detection. CONCLUSIONS: Early PLE shows distinctive disproportionate increases in asymmetric aberrations, quantified by the A/S ratio. In combination with ISV, IVA, and coma, this metric may facilitate early diagnosis of PLE, enabling timely intervention to prevent progression.
Artificial Intelligence for Diagnosing Meibomian Gland Dysfunction: A Systematic Review and Meta-Analysis of Diagnostic Test Accuracy Studies.
Liu SH, Shah M, Leslie L … +6 more , Lo JE, Ansah-Asiedu E, Harnke B, Hauswirth SG, Virgili G, Li T
Cornea · 2026 Mar · PMID 41931504 · Publisher ↗
PURPOSE: To identify, appraise, and synthesize the performance of artificial intelligence-based meibography reading as compared with human graders in diagnosing meibomian gland dysfunction. METHODS: We followed Cochrane...
PURPOSE: To identify, appraise, and synthesize the performance of artificial intelligence-based meibography reading as compared with human graders in diagnosing meibomian gland dysfunction. METHODS: We followed Cochrane methodology and reporting guidelines for diagnostic test accuracy reviews. To assess potential risk of bias and applicability, we used a modified Quality Assessment of Diagnostic Accuracy Studies-2 checklist. We applied bivariate logistic models to estimate summary sensitivity and specificity when appropriate and used the GRADE framework to rate the certainty of the evidence. RESULTS: We identified 14 eligible studies involving 5511 predominantly middle-aged participants (average age: 27-55 years) who were primarily female (≥54.5%). A total of 18,926 meibography images were obtained through noncontact infrared (11 studies) or in vivo confocal microscopy (three studies). Two studies reported external validation of deep learning models, 12 reported internally validated models, and one reported both. All but one study had high risk of bias in at least one domain; 12 studies raised high or intermediate concern about applicability. Based on three external evaluations, the summary sensitivity and specificity for diagnosing meibomian gland dysfunction from normal glands were 97.5% (95% confidence interval: 77.5%-99.8%) and 85.5% (95% confidence interval: 47.3%-97.5%). Sources of heterogeneity in internally validated models included study population, case mix, and others. The overall evidence was very low to low certainty because of imprecision, high risk of bias, and concerns about applicability. CONCLUSIONS: Artificial intelligence-based meibography grading appears less accurate than human graders. Future studies should adopt rigorous designs, including a more diverse participant pool (or image set), and external validation.
Driving Forces and Perceived Barriers for the Adoption of Novel Endothelial Cell Therapies: An International Survey of Corneal Surgeons.
Luan Y, Ni Dhubhghaill S, Rose-Nussbaumer J … +3 more , de Kort C, Romano V, Oellerich S
Cornea · 2026 Mar · PMID 41931380 · Publisher ↗
PURPOSE: To evaluate corneal transplant surgeons' current practice pattern and their interest and adoption attitudes toward novel endothelial cell replacement via an online survey. METHODS: The online survey contained 25...
PURPOSE: To evaluate corneal transplant surgeons' current practice pattern and their interest and adoption attitudes toward novel endothelial cell replacement via an online survey. METHODS: The online survey contained 25 questions (13 single-choice, 12 multi-choice) separated in the 4 sections "General Demographics and Practice Patterns," "New Corneal Endothelial Cell Replacement Therapies," "Perceived Barriers," and "Surgeon Perspectives on Graft Design for Tissue-Engineered Endothelial Grafts." A total of 116 responses were evaluated. RESULTS: Most respondents (97.4%, n = 113) would consider the adoption of novel, commercially available cell replacement therapies in the future. Ease of surgical handling (59.5%, n = 69), better clinical outcomes (58.6%, n = 68), and donor tissue shortages (42.2%, n = 49) were seen as the main driving forces for adoption. Although being acknowledged as an easier procedure, most respondents (82.8%, n = 96) expressed that cell injection should be restricted to corneal specialists and not be performed by comprehensive ophthalmologists. Furthermore, 74.1% (n = 86) considered standardized surgical protocols as crucial and 70.7% (n = 82) would prefer wet lab training for the new therapies. The possible high cost (64.7%, n = 75) and regulatory hurdles (60.3%, n = 70) were considered as the main obstacles for implementing the new therapies in clinical practice, whereas patient acceptance was not (5.2%, n = 6). CONCLUSIONS: The survey shows a positive attitude for adopting new endothelial cell replacement therapies among corneal surgeons although current translation to the clinic is still in the early stages. Perceived barriers and expected training requirements for the clinical adoption of the new therapies were identified and should be addressed to ensure a successful clinical translation.
Descemet Membrane Anterior Keratoplasty With BrightMEM Corneal Allograft: An Innovative Technique for Treatment of Nonhealing Diseases of the Ocular Surface.
Hou JH, Tauber J, Shukla R
Cornea · 2026 Aug · PMID 41925731 · Publisher ↗
PURPOSE: To describe an innovative anterior keratoplasty technique using a decellularized Descemet membrane allograft for treating nonhealing diseases of the ocular surface, and to report clinical outcomes. METHODS: We r...
PURPOSE: To describe an innovative anterior keratoplasty technique using a decellularized Descemet membrane allograft for treating nonhealing diseases of the ocular surface, and to report clinical outcomes. METHODS: We reviewed surgeons' survey responses pertaining to the postoperative outcomes of Descemet membrane anterior keratoplasty (DMAK) surgeries using BrightMEM (Brightstar Therapeutics; Lexington, KY) corneal allografts, which were placed during a 3-year period. Data were excluded for cases with less than 60 days of follow-up or no evidence of underlying ocular surface disease. Complete epithelialization rates, mean healing time, and mean change in visual acuity were assessed. RESULTS: Outcomes are reported for 99 cases, performed by 15 surgeons across the United States. Complete epithelialization occurred in 84.8%, with a median healing time of 28.0 days. Healing rates and median healing time were 89.4% and 30.0 days for subtotal limbal stem cell deficiency cases (n = 47); 78.0% and 34.0 days for persistent epithelial defect cases (n = 41); and 79.5% and 30.5 days for neurotrophic keratopathy cases (n = 44). Graft retention was 91.9%. Among patients observed for more than 6 months (n = 35), complete healing was achieved in 97.1%. Nineteen patients (33%) reported pain preoperatively, and all reported improvement or resolution; the mean pain scores decreased from 5.47 preoperatively to 0.84 at follow-up. Visual acuity improved in 52.6% of cases. No infectious complications attributable to the tissue were reported. CONCLUSIONS: DMAK using BrightMEM corneal allograft represents a valuable technique for treating nonhealing ocular surface diseases, providing high rates of durable epithelialization, pain reduction, visual improvement, and graft retention.
Targeted Identification of Acanthamoeba in Clinical Corneal Specimens Using a Monoclonal Antibody: Proof of Concept for a New Diagnostic Tool.
Prado-Costa B, Cristovam PC, Yu MCZ … +11 more , Pinto LF, Weber-Lima MM, Fonseca MF, Finco AB, de Moura JF, Boursin F, Jolivet L, Aubrey N, Leal DAG, de Freitas D, Magalhães Alvarenga L
Cornea · 2026 Mar · PMID 41921041 · Publisher ↗
PURPOSE: To evaluate the diagnostic potential of direct immunofluorescence using a monoclonal antibody and its derived recombinant antibody fragments for specific detection of Acanthamoeba in human clinical corneal sampl...
PURPOSE: To evaluate the diagnostic potential of direct immunofluorescence using a monoclonal antibody and its derived recombinant antibody fragments for specific detection of Acanthamoeba in human clinical corneal samples. METHODS: A previously characterized monoclonal antibody and 2 recombinant fragments derived from it were fluorescently labeled and tested in direct immunofluorescence assays against Acanthamoeba trophozoites and cysts in axenic culture, followed by testing in formalin-fixed, paraffin-embedded corneal sections. Specificity was assessed by examining reactivity against fungi, bacteria, and human corneal tissue. RESULTS: All fluorescently labeled antibodies recognized Acanthamoeba trophozoites and cysts in culture with no observed cross-reactivity against bacterial or fungal cultures or human keratinocytes. In corneal sections, the antibodies clearly detected Acanthamoeba in samples from patients with amoebic keratitis, with labeling correlating to parasite morphology. No specific signal was observed in corneal sections from fungal keratitis, bacterial keratitis, or noninfectious disease controls, although varying levels of background autofluorescence were noted in some non-Acanthamoeba specimens. Findings were consistent across monoclonal and recombinant antibody formats. CONCLUSIONS: Direct immunofluorescence using monoclonal and recombinant antibodies is a promising diagnostic strategy for specific detection of Acanthamoeba in human corneal samples. These proof-of-concept results support further validation in larger cohorts and extension to corneal scraping samples to determine diagnostic performance for early detection of amoebic keratitis.
Central Corneal Thickness 6 Postoperative Months After Pseudophakic-Descemet Membrane Endothelial Keratoplasty, Triple-Descemet Membrane Endothelial Keratoplasty, and Cataract Surgery Alone: A Retrospective Cohort Study and Literature Review.
Delean S, Goetz C, Zevering Y … +1 more , Perone JM
Cornea · 2026 Mar · PMID 41921039 · Publisher ↗
PURPOSE: Descemet membrane endothelial keratoplasty (DMEK) is the gold standard treatment for Fuchs endothelial corneal dystrophy (FECD). It is generally conducted mo/yr or immediately after lens phacoemulsification (pse...
PURPOSE: Descemet membrane endothelial keratoplasty (DMEK) is the gold standard treatment for Fuchs endothelial corneal dystrophy (FECD). It is generally conducted mo/yr or immediately after lens phacoemulsification (pseudophakic-DMEK and triple-DMEK, respectively). A recent meta-analysis reported that mean central corneal thickness (CCT) 6 to 12 months after pseudophakic/triple-DMEK in Western European patients was 522 μm. However, mean CCT in healthy Western Europeans is 552 μm. This retrospective cohort study tested whether post-DMEK CCT in FECD eyes is thinner than normal by comparing consecutive pseudophakic/triple-DMEK eyes to consecutive cataract-surgery control eyes. METHODS: The 3 groups from a French hospital were compared for ultrasonic pachymetry-measured preoperative and 6-month postoperative CCT. To identify predictive factors for 6-month post-DMEK CCT drop, multivariable analysis with age, sex, preoperative CCT, preoperative visual acuity, and DMEK group was performed. RESULTS: The pseudophakic-DMEK, triple-DMEK, and cataract-control groups (n = 61 each) did not differ in age or sex. Preoperative and 6-month CCT in cataract-surgery controls were both 550 μm. CCT dropped after pseudophakic-DMEK (619-526 μm, P < 0.001) and triple-DMEK (614-529 μm, P < 0.001) and was significantly lower at 6 months than in cataract-surgery controls (both P < 0.001). On multivariable analysis, only preoperative CCT predicted post-DMEK CCT drop (parameter estimate = 0.87 ± 0.06, P < 0.001). CONCLUSIONS: Both pseudophakic-DMEK and triple-DMEK associated with thinner 6-month postoperative CCT than cataract-surgery controls. This may reflect residual fibrosis from FECD that compacts the corneal stroma after DMEK-induced deturgescence. This was supported by our finding that greater preoperative CCT, a potential marker of severe FECD/fibrosis, predicted thinner postoperative CCT.
DescePrep Significantly Improves the Efficiency of High-Risk Diabetic Donor Descemet Membrane Endothelial Keratoplasty Processing.
Solley K, Frank K, Straiko MMW … +5 more , Ramulu P, Nesbitt N, Chamberlain D, Tran KD, Parikh KS
Cornea · 2026 Jun · PMID 41921033 · Publisher ↗
PURPOSE: To evaluate Descemet membrane endothelial keratoplasty (DMEK) graft preparation efficiency, success rate, and graft viability after clinically relevant processing of diabetic human donor corneas using DescePrep...
PURPOSE: To evaluate Descemet membrane endothelial keratoplasty (DMEK) graft preparation efficiency, success rate, and graft viability after clinically relevant processing of diabetic human donor corneas using DescePrep or submerged cornea using backwards away (SCUBA). METHODS: Fifteen pairs of diabetic donor corneas with an average diabetic risk score of 4.0 ± 1.3 and mild-moderate cell loss were processed for DMEK by an experienced certified eye bank technician. Corneas within each pair were randomly assigned to DescePrep or SCUBA and trephined with the number 7 trephine for orientation marking. Donor cornea characteristics, preparation duration, number of graft touches, and success rate were recorded. To simulate clinical graft preparation, DMEK grafts were loaded into a Straiko Modified Jones Tube, shipped, and unscrolled on a glass slide before masked cell viability analysis. RESULTS: We found that 93.3% (14/15) of corneas per group were prepared successfully by DescePrep and by SCUBA. DescePrep significantly reduced overall preparation time from 19.2 ± 0.5 to 15.1 ± 1.1 minutes ( P < 0.005) and significantly reduced stripping time from 10.9 ± 0.5 to 6.97 ± 1.1 minutes ( P < 0.005). Grafts processed by DescePrep and SCUBA demonstrated comparable cell loss of 15.8% ± 1.2% and 16.1% ± 1.4%, respectively, after loading, shipping, and unscrolling. CONCLUSIONS: DescePrep offers safe and reliable DMEK graft preparation with high success rates in diabetic tissue. DescePrep reduced preparation time by 21.3% and the number of endothelium contacts by 85.7% in comparison to SCUBA.
Cultured Human Corneal Endothelial Cell Injection (Vyznova) in Eyes with Extremely Low Intraocular Pressure After Glaucoma Surgery: Case Reports.
Ogino R, Shirane M, Ibrahim O … +3 more , Yagi-Yaguchi Y, Tomida D, Yamaguchi T
Cornea · 2026 Mar · PMID 41920020 · Publisher ↗
PURPOSE: Eyes with extremely low intraocular pressure (IOP) less than 4 mm Hg after glaucoma surgery represent a major challenge for endothelial keratoplasty, as inadequate anterior chamber support often leads to graft d...
PURPOSE: Eyes with extremely low intraocular pressure (IOP) less than 4 mm Hg after glaucoma surgery represent a major challenge for endothelial keratoplasty, as inadequate anterior chamber support often leads to graft detachment and early graft failure. Cultivated human corneal endothelial cell (cHCEC) injection has recently emerged as a graft-free therapeutic alternative; however, its efficacy in eyes with extremely low IOP has not been well established. METHODS: This case series describes the clinical outcomes of cHCEC therapy using Vyznova in 2 patients with bullous keratopathy (BK) and preoperative IOP of ≤4 mm Hg after prior filtering glaucoma procedures. RESULTS: In case 1, corneal edema resolved rapidly after cHCEC injection, with improvement in best-corrected visual acuity (BCVA) from 20/2000 to 20/30 at 1 month and 20/25 at 3 months. Central corneal thickness (CCT) decreased from 747 μm preoperatively to 517 μm at 3 months. Endothelial cell density (ECD) reached approximately 2600 cells/mm2 at 1 month and was maintained at 3 months. In case 2, corneal clarity was restored early after surgery, and BCVA improved from 20/400 to 20/20 at 1 month, remaining stable at 3 months. CCT decreased from 859 μm to 535 μm. ECD was approximately 1500 cells/mm2 at 1 month and remained stable at 3 months. IOP remained low throughout follow-up in both cases. CONCLUSIONS: These cases highlight that cHCEC therapy may be a safe and effective treatment for BK in eyes with extremely low IOP after glaucoma surgery, representing a promising alternative when conventional endothelial keratoplasty carries a high risk.
Tacrolimus-Related Kidney Function Change in Ocular Stem Cell Transplantation.
Reinisch CB, Warner DM, Cheung AY … +4 more , Govil A, Jeffery J, Kinosz E, Holland EJ
Cornea · 2026 Mar · PMID 41920016 · Publisher ↗
PURPOSE: This study evaluated the impact of maintaining appropriate trough blood levels of tacrolimus on kidney function in patients undergoing systemic immunosuppression after ocular surface stem cell transplantation. M...
PURPOSE: This study evaluated the impact of maintaining appropriate trough blood levels of tacrolimus on kidney function in patients undergoing systemic immunosuppression after ocular surface stem cell transplantation. METHODS: A retrospective chart review of 56 patients was performed between January 2013 and December 2020. The primary outcome in this study was acute kidney injury. Secondary outcomes included evaluating serum creatinine at 1, 3, 6, and 12 months; glomerular filtration rate at 1, 2, 3, 4, and 5 years; and the incidence of stage 3 or greater chronic kidney disease. RESULTS: The impact of tacrolimus on kidney function was evaluated in 56 patients over a mean follow-up of 3.07 years (range: 0.56-7.23). For the cohort, the mean serum creatinine increased significantly at 1, 3, and 6 months but then returned to baseline by 12 months. Three patients (5.4%) experienced stage 1 acute kidney injury, with two patients progressing to stage 3 chronic kidney disease. Tacrolimus trough levels were closely monitored, with dose adjustments required for 85% of patients within the first year to maintain therapeutic levels. CONCLUSIONS: Systemic immunosuppressive therapy with tacrolimus after ocular surface stem cell transplantation is well tolerated and contributes to high graft survival rates with minimal impact on acute and long-term kidney function.
Ocular Surface Ulceration Associated With an Epidermal Growth Factor Receptor Inhibitor.
Ziari M, Chen JL, Gonzalez C … +3 more , Gibbons DL, Pflugfelder SC, Chen AJ
Cornea · 2026 Jul · PMID 41919994 · Publisher ↗
PURPOSE: To present the case of ocular surface ulceration in a patient receiving erlotinib for lung adenocarcinoma. METHODS: An 80-year-old woman presented with a corneal ulcer of the right eye in the setting of poor con...
PURPOSE: To present the case of ocular surface ulceration in a patient receiving erlotinib for lung adenocarcinoma. METHODS: An 80-year-old woman presented with a corneal ulcer of the right eye in the setting of poor contact lens hygiene and overwear. During the initial treatment of her corneal ulcer, erlotinib therapy was held by her oncologist. After 1.5 months of treatment, the corneal infection resolved with full epithelialization. Erlotinib was then restarted, and she remained out of contact lenses. RESULTS: One week after reinitiation of erlotinib treatment, the patient presented with new onset right eye pain and conjunctival injection. She was found to have a new conjunctival ulcer and new peripheral corneal epithelial defects. Three weeks after the discontinuation of erlotinib, the conjunctival ulceration and all peripheral epithelial defects had resolved. CONCLUSIONS: There are a number of systemic and ocular side effects associated with erlotinib. Ocular adverse effects such as dry eye, epithelial keratopathy, nonhealing corneal epithelial defects, corneal ulceration, conjunctivitis, anterior uveitis, trichomegaly, and periorbital skin rash leading to ectropion and epiphora have been reported in the literature. To our knowledge, this is the first reported case of conjunctival ulceration associated with the use of erlotinib.
Comment on "Efficacy of the Rho-Kinase Inhibitor for Corneal Endothelial Protection in Fuchs Endothelial Corneal Dystrophy after Phacoemulsification by Keeratidamkerngsakul et al.".
Kapur N, Gupta P
Cornea · 2026 May · PMID 41915918 · Publisher ↗
Abstract loading — click title to view on PubMed.
The "Polish Sign": A Novel Intraoperative Visual Indicator During Descemet Membrane Polishing in Cultured Human Corneal Endothelial Cell Injection Therapy.
Kobayashi A, Yamaguchi T, Sugita S … +4 more , Mori N, Yokogawa H, Yagi-Yaguchi Y, Higashide T
Cornea · 2026 May · PMID 41915917 · Publisher ↗
PURPOSE: The aim of this study was to describe a novel intraoperative visual indicator, the "polish sign," which aids safe and effective Descemet membrane (DM) polishing during cultured human corneal endothelial cell (cH...
PURPOSE: The aim of this study was to describe a novel intraoperative visual indicator, the "polish sign," which aids safe and effective Descemet membrane (DM) polishing during cultured human corneal endothelial cell (cHCEC; Vyznova) therapy for bullous keratopathy. METHODS: Thirty-two consecutive eyes with bullous keratopathy underwent cHCEC injection therapy. After a 1.2-mm limbal incision, the central corneal endothelium and associated abnormal extracellular matrix within an approximately 8-mm zone were gently polished using a Kinoshita-type DM polisher, consisting of a blunt needle covered with a silicone sleeve that allows coaxial irrigation. The polish sign-defined as a transient whitish discoloration at the point of instrument contact-was monitored throughout the procedure. Adequacy of polishing was confirmed intraoperatively by trypan blue staining while the absence of DM detachment was verified using anterior segment optical coherence tomography. RESULTS: The polish sign was consistently observed in all 32 eyes (100%). In 1 eye with severe stromal haze following failed Descemet stripping automated endothelial keratoplasty, the sign appeared less prominent but remained detectable under oblique slit illumination. Polishing was completed in all eyes without DM rupture or detachment. Ex vivo porcine experiments (n = 3) reproduced a similar transient whitening, although less distinct than in human cases. CONCLUSIONS: The polish sign provides a simple, real-time indicator that enables safe and consistent DM polishing while minimizing the risk of DM injury. Although its visibility may decrease in eyes with dense stromal opacity, adjusting illumination can enhance recognition, suggesting that the sign may have relevance across various endothelial cell-based therapies.
Recognition of Bulbilli Facilitates the Diagnosis of Cladorrhinum bulbillosum.
Chen AC, Ghaffari R, Glasgow BJ
Cornea · 2026 May · PMID 41915916 · Publisher ↗
PURPOSE: Necrotizing stromal keratitis caused by Cladorrhinum bulbillosum is challenging to diagnose. We report in vivo confocal microscopic and histological studies that can facilitate the diagnosis of this rare fungal...
PURPOSE: Necrotizing stromal keratitis caused by Cladorrhinum bulbillosum is challenging to diagnose. We report in vivo confocal microscopic and histological studies that can facilitate the diagnosis of this rare fungal infection. METHODS: Confocal microscopy imaging and histopathological analysis of the patient's infected cornea were performed in addition to standard clinical and microbiologic methods. The diameters of chlamydoconidium (bulbilli) were measured using a calibrated micrometer. RESULTS: C. bulbillosum was identified based on morphology observed in culture and molecular methods from a patient with a pigmented corneal infiltrate. Confocal microscopy revealed hyphal and cystic structures that have previously been mistaken for acanthamoeba. Histopathological analysis of the fungus in tissue sections showed clusters of oval structures (bulbilli) and characteristic reddish-brown septate hyphae with thin and segmented interseptal nuclei. Bulbilli measured 10 to 40 μm in diameter, whereas hyphae measured approximately 5 μm in cross section. CONCLUSIONS: The presence of pigment in a feathery corneal infiltrate should raise the possibility of a diagnosis of Cladorrhinum sp. and prompt a search for bulbilli by confocal microscopy. In the analysis of smears or biopsies, the finding of chlamydospores greater than 10 μm in diameter associated with nuclei and pigmented hyphae should alert the pathologist that sequencing of the internal transcribed spacer sequence of ribosomal RNA may be needed to confirm the genus and species of the fungus.
Cornea Classics: Identification of Antiangiogenic and Antiinflammatory Proteins in Human Amniotic Membranes.
Cursiefen C
Cornea · 2026 May · PMID 41915915 · Publisher ↗
The use of human amniotic membrane for treatment of ocular surface and corneal diseases gained enormous momentum in the late 1990s. Clinical observations already at that time indicated that amniotic membrane transplantat...
The use of human amniotic membrane for treatment of ocular surface and corneal diseases gained enormous momentum in the late 1990s. Clinical observations already at that time indicated that amniotic membrane transplantation exerts both antiinflammatory and antiangiogenic properties. However, the precise molecular mechanisms of these beneficial effects were largely unknown. Hao and colleagues very elegantly demonstrated that both fresh and cryopreserved human amniotic membrane epithelial and mesenchymal cells contain numerous antiangiogenic and antiinflammatory factors.
Comparative Analysis of the Safety and Efficacy of Corneal cross-Linking in Progressive Keratoconus: Epithelium on With Supplemental Oxygen Versus Epithelium off Protocol.
Sachdev GS, Ramamurthy S, Pandey U … +1 more , Soundarya B
Cornea · 2026 Feb · PMID 41915707 · Publisher ↗
PURPOSE: To compare the safety and efficacy of transepithelial corneal cross-linking (T-CXL) with supplemental oxygen versus epithelium-off accelerated CXL (A-CXL) for progressive keratoconus. METHODS: In a prospective i...
PURPOSE: To compare the safety and efficacy of transepithelial corneal cross-linking (T-CXL) with supplemental oxygen versus epithelium-off accelerated CXL (A-CXL) for progressive keratoconus. METHODS: In a prospective interventional comparative study, eyes with progressive keratoconus underwent 2 treatments: Transepithelial CXL (T-CXL) and Accelerated CXL (A-CXL). T-CXL used ParaCel part 1 (0.25% riboflavin with benzalkonium chloride) every 30 seconds for 4 minutes and then ParaCel part 2 every minute for 6 minutes, followed by UV-A irradiation (365 nm, 30 mW/cm2 for 5 minutes 30 seconds, total fluence of 10 J/cm2) with supplemental oxygen. A-CXL involved debriding the central 9 mm of corneal epithelium, followed by instillation of 0.1% riboflavin every 2 minutes for 10 minutes and subsequent UV-A irradiation (365 nm, 9 mW/cm2 for 10 minutes, total fluence of 5.4 J/cm2). The following parameters were analyzed at preoperative, 1, 3, 6, 12 months, and 3 years postoperative visit: uncorrected distance visual acuity, corrected distance visual acuity (CDVA), mean refractive spherical equivalent (MRSE), corneal tomography, and endothelial cell count. Anterior segment optical coherence tomography evaluation was performed at 1-month postoperative visit to assess the depth of demarcation line. RESULTS: Forty eyes from 40 patients (20 eyes in each group) were included in the study, with a minimum follow-up period of 3 years. At the 1-week postoperative assessment, the T-CXL group demonstrated CDVA comparable with the A-CXL group, with no statistical significance between the 2 groups (P = 0.08). During subsequent follow-up visits, similar CDVA was observed in both groups. At the 3-year postoperative visit, the mean improvement in manifest refraction spherical equivalent (MRSE) was 0.77D in the T-CXL group compared with 0.54D in the A-CXL group (P = 0.32). In addition, keratometry readings indicated a flattening of 1.9D in the T-CXL group and 1.8D in the A-CXL group (P = 0.64). Although the T-CXL group showed a trend toward greater improvement in MRSE (0.77D vs. 0.54D), this difference was not statistically significant due to the small sample size. However, the flattening of the cornea in both groups was similar and statistically insignificant, suggesting that both groups demonstrated comparable efficacy in halting disease progression. Furthermore, the T-CXL group experienced significantly lower levels of corneal haze (P = 0.04) as well as reduced postoperative pain (P = 0.02). CONCLUSIONS: Transepithelial cross-linking (T-CXL) is associated with a lower incidence of corneal haze, faster visual recovery-especially in terms of uncorrected distance visual acuity-and reduced postoperative pain. These benefits make T-CXL with supplemental oxygen a safe and effective alternative to the standard epithelium-off cross-linking procedure.
Comparison of Visual and Topographic Outcomes Between Deep Anterior Lamellar Keratoplasty and Corneal Allogenic Intrastromal Ring Segment Implantation in Advanced Keratoconus: A Preliminary Study.
Kara N, Sarsu Kocaaslan E, Görmez GN … +5 more , Tos B, Aksoy BE, Arslan E, Büyükbayram Ş, Yeşilirmak N
Cornea · 2026 Feb · PMID 41915699 · Publisher ↗
PURPOSE: To compare the visual, refractive, and topographic outcomes of deep anterior lamellar keratoplasty (DALK) and Corneal Allogenic Intrastromal Ring Segment (CAIRS) implantation in eyes with advanced keratoconus. M...
PURPOSE: To compare the visual, refractive, and topographic outcomes of deep anterior lamellar keratoplasty (DALK) and Corneal Allogenic Intrastromal Ring Segment (CAIRS) implantation in eyes with advanced keratoconus. METHODS: This retrospective comparative study included 52 eyes of 52 patients with advanced keratoconus (Kmax > 58.0 D along with poor contact lens tolerance and inadequate spectacle-corrected distance visual acuity) who underwent either DALK (n = 26) or CAIRS implantation (n = 26). Preoperative and postoperative uncorrected and best-corrected visual acuity (UCVA, BCVA), spherical equivalent, keratometric values, and corneal higher-order aberrations were analyzed. All patients completed a minimum follow-up of 6 months after CAIRS implantation or 6 months after suture removal after DALK. RESULTS: Both procedures resulted in significant improvements in UCVA, BCVA, spherical equivalent, and keratometric values (all P < 0.001). Postoperative BCVA was significantly better in the DALK group (P = 0.027), whereas postoperative UCVA, refractive parameters, and keratometric measurements were comparable between groups (all P > 0.05). No significant differences in postoperative aberration parameters were detected between groups. CONCLUSIONS: This study demonstrated that both CAIRS and DALK resulted in significant improvements in visual acuity, refractive outcomes, keratometric values, and aberrometric parameters in advanced keratoconus. CAIRS may have a role as an intermediate option in carefully selected cases before keratoplasty. Larger prospective studies with long-term follow-up are warranted.
Effect of Exposure Keratopathy Protocol Implementation on the Incidence of Exposure Keratopathy Across Different Intensive Care Units.
Gu SZ, Cheong J, Hu J … +3 more , Yu S, O'Connor M, Trief D
Cornea · 2026 Feb · PMID 41915697 · Publisher ↗
PURPOSE: Exposure keratopathy (EK) is a preventable condition commonly affecting critically ill patients. A 2017 to 2018 study at our institution reported high EK incidence across the medical intensive care unit (MICU),...
PURPOSE: Exposure keratopathy (EK) is a preventable condition commonly affecting critically ill patients. A 2017 to 2018 study at our institution reported high EK incidence across the medical intensive care unit (MICU), neurologic ICU (NICU), and pediatric ICU (PICU). This study reassesses EK incidence after the implementation of a prophylaxis protocol implemented within the electronic medical record (EMR). METHODS: This is a prospective cohort study of patients admitted to the MICU, NICU, and PICU. Patients were enrolled within 24 hours of admission to the ICU and underwent daily ocular surface examinations assessing lagophthalmos, conjunctival injection, chemosis, punctate epithelial erosions, ulceration, Bell reflex, and blink reflex. Compliance with the prophylaxis protocol was assessed via review of the EMR for ocular lubricant order and administration history. RESULTS: Sixty patients were recruited (20 each from MICU, NICU, and PICU). Postimplementation, EK incidence decreased significantly overall (11.7% vs. 38.5%, P < 0.001), with notable reductions in the MICU (15.0% vs. 60.0%, P = 0.011) and NICU (5.0% vs. 47.8%, P = 0.002). PICU EK incidence did not significantly change (15.0% vs. 18.5%, P = 1.000). In univariable analysis, intubation (P = 0.0496), lagophthalmos (P = 0.013), injection (P < 0.001), and chemosis (P = 0.004) were associated with EK risk. No variable remained significant in multivariable analysis. Although all patients had EK prophylaxis ordered, only 53.3% received both correctly ordered and administered prophylaxis. CONCLUSIONS: EK incidence decreased significantly in the MICU and NICU because of an EMR-based prophylaxis protocol. Continued provider education is needed to enhance compliance and further reduce EK rates.
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