Cornea[JOURNAL]
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200 papers
Magnetic Resonance Imaging and Keratopigmentation: A Systematic Review and Ex Vivo Study of Complications and Adverse Events.
Gaulier A, Nicol L, Lefevre S … +7 more , Jaworski T, Pradier B, Gueudry J, Arnoult C, Gerardin E, Boyer O, Muraine M
Cornea · 2026 Aug · PMID 41649848 · Publisher ↗
PURPOSE: To evaluate the safety of magnetic resonance imaging (MRI) in patients who have previously undergone keratopigmentation, with particular attention to the potential adverse effects associated with different types...
PURPOSE: To evaluate the safety of magnetic resonance imaging (MRI) in patients who have previously undergone keratopigmentation, with particular attention to the potential adverse effects associated with different types of tattoo inks. METHODS: Various colored and black tattoo inks were tested under MRI conditions. In vitro analysis was conducted to assess ink mobility. Ex vivo porcine and rabbit eyes were used to evaluate macroscopic changes, MRI artifact formation, and histological modifications after exposure to the magnetic field. RESULTS: No adverse effects or visible artifacts were observed with iron oxide-free inks during MRI. In contrast, inks containing iron oxide produced artifacts that significantly inhibited eye analysis without affecting posterior structures. Under normal MRI conditions, histological examination revealed subtle pigment migration with iron oxide-based inks; a finding not observed with other ink types. Under supranormal exposure, pigment migration was pronounced, readily visible both macroscopically and histologically. CONCLUSIONS: MRI appears safe in patients with keratopigmentation using iron oxide-free inks, which are the most commonly used. In contrast, iron oxide-containing inks can induce MRI artifacts that inhibit ocular assessment without affecting brain visualization. Under the influence of the magnetic field, their pigments may also migrate, potentially causing ocular pain, central corneal involvement, or weakening of corneal biomechanical integrity. For corneal tattooing, we recommend using carbon-based inks for black pigmentation and one of the iron oxide-free inks for colored keratopigmentation.
A Modified Long Corneal Tunnel Technique for Intracameral Injection in Cultured Human Corneal Endothelial Cell Therapy (Vyznova): A Preliminary Technical Report.
Kobayashi A, Mori N, Yokogawa H … +1 more , Higashide T
Cornea · 2026 Jun · PMID 41649846 · Publisher ↗
PURPOSE: To describe a modified long corneal tunnel technique and report preliminary observations regarding wound sealing during cultured human corneal endothelial cell (cHCEC; Vyznova) injection therapy in a small conse...
PURPOSE: To describe a modified long corneal tunnel technique and report preliminary observations regarding wound sealing during cultured human corneal endothelial cell (cHCEC; Vyznova) injection therapy in a small consecutive case series. METHODS: Ten consecutive eyes with bullous keratopathy underwent cHCEC injection by a single experienced surgeon using a long, tangential corneal tunnel created with a 26-gauge needle. Tunnel dimensions and injection parameters were measured retrospectively from surgical video recordings. Wound integrity was assessed intraoperatively using a dry microsponge to detect macroscopically visible fluid egress. Early postoperative anterior segment OCT (CASIA2) parameters-keratometric cylinder (ΔCyl) and endothelial anterior chamber depth (ΔACD)-were also evaluated. RESULTS: All eyes demonstrated macroscopically leak-free wound closure without sutures. The mean tunnel length was 4.2 ± 0.6 mm, tunnel creation time 14.9 ± 6.3 seconds, and injection time 17.2 ± 7.1 seconds. No intraoperative complications such as hypotony, wound leak, or anterior chamber collapse were observed. Postoperative fluorescein Seidel testing on day 1 confirmed absence of wound leakage in all eyes. Early postoperative OCT measurements showed no clinically meaningful change in keratometric astigmatism (ΔCyl = 0.20 ± 0.53 D), whereas endothelial ACD increased slightly (ΔACD = 0.18 ± 0.17 mm), with no eyes exhibiting anterior chamber shallowing. CONCLUSIONS: This preliminary single-surgeon case series suggests that the long corneal tunnel technique may facilitate macroscopically leak-free wound closure during cHCEC injection. Although encouraging, these findings are limited by subjective leak assessment and small sample size. Larger multicenter studies incorporating objective leak quantification are required to determine reproducibility and comparative performance.
Clinical Predictors of Endothelial Damage in Internationally Transported Donor Corneas.
Imafuku C, Yoshii K, Kishi J … +5 more , Ono Y, Miyawaki Y, Matsuoka Y, Koizumi N, Okumura N
Cornea · 2026 Feb · PMID 41649845 · Publisher ↗
PURPOSE: To identify clinical factors influencing corneal endothelial damage during international transportation by evaluating the condition of donor corneas upon arrival in Japan, representing the real-world scenario fa...
PURPOSE: To identify clinical factors influencing corneal endothelial damage during international transportation by evaluating the condition of donor corneas upon arrival in Japan, representing the real-world scenario faced by importing countries. METHODS: We analyzed 194 donor corneas (from 102 donors; mean age 29.8 years) transported from 3 US eye banks to Japan. All corneas underwent trypan blue staining (0.4%) to quantify endothelial damage, with damaged areas manually traced and analyzed using custom Python-based image analysis. Univariate and multivariate analyses using generalized linear mixed models identified predictors of endothelial damage, with donors stratified into high- and low-damage groups based on median staining rates. RESULTS: Most corneas (62.4%) showed minimal damage (<2% trypan blue-positive area), whereas 4.1% exhibited extensive damage (>10%). Multivariate analysis identified the following 4 independent predictors of increased endothelial damage: eye bank source (eye bank C vs. A: odds ratio [OR] 4.67, 95% confidence interval [CI] 1.08 to 20.07, P = 0.039), younger donor age (≥31 vs. <31 years: OR 0.40, 95% CI 0.17-0.93, P = 0.033), donor race (Black vs. White: OR 3.44, 95% CI 1.28-9.25, P = 0.014), and cause of death (gastrointestinal disorder vs. cardiovascular disease: OR 4.92, 95% CI 1.35-17.95, P = 0.016; malignant tumor vs. cardiovascular disease: OR 14.32, 95% CI 3.01-68.13, P <0.001). Neither time from death to donation nor preservation duration predicted damage, validating current temporal protocols. CONCLUSIONS: This study identifies real-world factors influencing endothelial integrity in internationally transported donor corneas, addressing an underrecognized aspect of global eye banking.
Nine-Year Trends in Antibiotic Resistance of Culture-Proven Pseudomonas aeruginosa Keratitis at a Tertiary Eye Center.
Lakshmipathy M, Anand AR, Saravanan V
Cornea · 2026 Jan · PMID 41649840 · Publisher ↗
PURPOSE: The aim of this study was to evaluate the trends in antibiotic resistance among Pseudomonas aeruginosa isolates from microbial keratitis cases over a 9-year period. METHODS: This retrospective observational stud...
PURPOSE: The aim of this study was to evaluate the trends in antibiotic resistance among Pseudomonas aeruginosa isolates from microbial keratitis cases over a 9-year period. METHODS: This retrospective observational study included 154 patients with culture-proven Pseudomonas aeruginosa keratitis seen between 2014 and 2022. Antibiotic susceptibility data were reviewed for fluoroquinolones, cephalosporins, beta-lactams, aminoglycosides, and other antibiotic groups. Year-wise resistance patterns were analyzed using the chi-square or Fisher exact test. Cross-sensitivity and cross-resistance between ciprofloxacin and other fluoroquinolones were also assessed. RESULTS: Ciprofloxacin and other older-generation fluoroquinolones maintained high sensitivity (>85%) throughout the study. Moxifloxacin showed a higher resistance rate (23%), with a rising trend from 2014 (16%) to 2022 (36%), although there was a rise and dip in between. Cephalosporins showed poor efficacy, except for ceftazidime, which had a notably lower resistance rate (21%). Beta-lactam resistance was high, except for piperacillin-tazobactam. Aminoglycosides (gentamicin, tobramycin, and amikacin) exhibited the lowest resistance rates (<10%). Cross-resistance between ciprofloxacin and other fluoroquinolones was high, especially with ofloxacin and gatifloxacin. CONCLUSIONS: Over 9 years, Pseudomonas aeruginosa isolates retained sensitivity to older fluoroquinolones and aminoglycosides, while there was a trend toward increasing resistance to moxifloxacin. Cephalosporin and beta-lactam resistance remained high, except for ceftazidime and piperacillin-tazobactam. Despite the limitations of the study, these findings support a continued role for ciprofloxacin and aminoglycosides as empiric therapy options.
Correlation of Corneal Sensitivity With Vision-Related Quality of Life, Ocular Surface Symptoms, and Clinical Severity in Parkinson's Disease.
Camacho-Ordonez A, Navarrete-Azuara M, Vera-Duarte GR … +6 more , Guerra-Anzaldo AL, Alcocer-Salas AG, Rodríguez-Violante M, Cervantes-Arriaga A, Ramirez-Miranda A, Graue-Hernandez EO
Cornea · 2026 Jan · PMID 41649380 · Publisher ↗
PURPOSE: To investigate the relationship between corneal sensitivity (CS), vision-related quality of life, ocular surface symptoms, and clinical severity in patients with Parkinson's disease (PwP). METHODS: Prospective o...
PURPOSE: To investigate the relationship between corneal sensitivity (CS), vision-related quality of life, ocular surface symptoms, and clinical severity in patients with Parkinson's disease (PwP). METHODS: Prospective observational cohort study. CS was measured using a noncontact esthesiometer. Vision-related quality of life and ocular surface symptoms were assessed with the NEI VFQ-25 and OSDI questionnaires. Parkinson's disease severity was graded with the Hoehn and Yahr (HY) scale. Associations were analyzed using Pearson correlation and ANOVA. RESULTS: A total of 356 eyes from 178 PwP were included. Mean age was 62.77 ± 11.34 years, and 51.4% were male. Mean CS was 6.47 ± 2.24 mBar, NEI VFQ-25 score was 67.11 ± 9.35, and OSDI score was 25.17 ± 18.19. CS was significantly associated with the NEI VFQ-25 composite score (r = 0.449, P <0.001) but not with the OSDI score (r = 0.122, P = 0.141). NEI VFQ-25 and OSDI scores showed moderate correlation (r = 0.477, P <0.001). CS also correlated with general vision, near vision, distance vision, mental health, and peripheral vision subscales (P <0.05). CS varied across HY stages (P <0.001), with stages 3 to 4 demonstrating significantly reduced sensitivity compared with stages 1 to 2 (all P <0.001). CONCLUSIONS: CS correlates with vision-related quality of life but not directly with ocular surface symptoms in PwP. Its progressive reduction with advancing HY stages suggests potential as a surrogate marker of disease severity. CS measurements may complement quality-of-life assessments and aid in the early detection of ocular surface compromise in this population.
Comparison of Efficacy and Safety of Contact Lens-Assisted Corneal Collagen Crosslinking and Hypoosmolar Corneal Collagen Crosslinking in Pediatric Patients With Keratoconus and Thin Corneas.
Jain P, Annadevula GR, Gupta I … +1 more , Dutta P
Cornea · 2026 Jan · PMID 41649379 · Publisher ↗
PURPOSE: The aim of this study was to compare the efficacy and safety of contact lens-assisted corneal collagen crosslinking (CXL) and hypoosmolar CXL in pediatric patients with progressive keratoconus and thin corneas....
PURPOSE: The aim of this study was to compare the efficacy and safety of contact lens-assisted corneal collagen crosslinking (CXL) and hypoosmolar CXL in pediatric patients with progressive keratoconus and thin corneas. METHODS: Forty eyes of 40 progressive pediatric patients with keratoconus and thin corneas were divided into two groups: the first group underwent contact lens-assisted CXL (CL group), and the second group underwent hypoosmolar riboflavin-assisted CXL (group H). Only patients younger than 18 years with thinnest corneal pachymetry <400 μm were included. The primary outcomes measured were the changes in maximum keratometry (Kmax) on Sirius topography and in endothelial cell count at 6 months postoperatively; the secondary outcome measured was the change in best spectacle-corrected visual acuity at 6 months postoperatively. The demarcation line on anterior segment optical coherence tomography was also recorded at 1 month after CXL. RESULTS: Kmax showed a significant decrease at 6 months after CXL from 65.56 ± 8.19 diopters preoperatively to 63.6 ± 8.27 diopters in the CL group and from 65.61 ± 14.69 diopters preoperatively to 63.14 ± 13.69 diopters in group H. The mean demarcation line depth was 198.89 ± 42.42 μm in the CL group and 215.4 ± 59.01 μm in group H. Both groups showed no significant decrease in endothelial cell count after CXL. CONCLUSIONS: Both methods compared above suggest a halt in the progression of keratoconus for the study duration of 6 months in pediatric patients with thin corneas, thus negating the need for corneal transplantation in these patients. Because there are limited randomized trials on management of pediatric keratoconus with thin corneas, the results of this study will be useful in guiding clinical decisions.
Lipid Keratopathy in Sitosterolemia: A Case Report and Review of The Ophthalmic Manifestations.
Donnelly A, Leary FO, Veitch K … +1 more , McElnea E
Cornea · 2026 Jul · PMID 41649375 · Publisher ↗
PURPOSE: The aim of this study was to describe the case of a 9-year-old girl with inferior arcus in her right cornea and discrete inferior lipid deposition in her left cornea. METHODS: Serum cholesterol and lipid levels...
PURPOSE: The aim of this study was to describe the case of a 9-year-old girl with inferior arcus in her right cornea and discrete inferior lipid deposition in her left cornea. METHODS: Serum cholesterol and lipid levels were measured under general anesthesia for treatment with fine-needle cautery and subconjunctival bevacizumab. RESULTS: Serum cholesterol and low-density lipoprotein were elevated at 12 mmol/L (normal range 3-5 mmol/L) and 10.8 mmol/L (normal range <3 mmol/L), respectively. Genetic testing identified a pathogenic variant in the ATP-binding cassette subfamily G member 5 ( ABCG5 ) gene consistent with sitosterolemia, a rare, autosomal recessive disorder of lipid metabolism. Mutations in the ABC genes result in ineffective transport of plant sterols into the intestinal lumen and their subsequent accumulation in the blood. The girl's cholesterol and lipid profile returned to normal following dietary restriction of plant sterol intake and treatment with ezetimibe 10 mg daily and atorvastatin 10 mg daily. CONCLUSIONS: This is the first reported case of a discrete lipid deposit at the cornea in a patient with sitosterolemia. Untreated, patients with sitosterolemia can develop coronary artery disease early in life. Ophthalmologists should be aware of the potential for underlying disorders of lipid metabolism in young patients with corneal arcus and/or lipid keratopathy.
Impact of Donor Lenticule Depth on the Outcome of Allogeneic Corneal Inlay Treatment for Presbyopia.
Keskin Perk FFN, Cummings AB, Daya SM … +4 more , Hamada S, Stodulka P, Mrochen M, Kilic A
Cornea · 2026 Jan · PMID 41649367 · Publisher ↗
PURPOSE: The aim of this study was to assess the impact of the lenticule's position within the donor cornea on visual, refractive, and topographic outcomes in patients who undergo allogeneic corneal inlay (Allotex Inc.,...
PURPOSE: The aim of this study was to assess the impact of the lenticule's position within the donor cornea on visual, refractive, and topographic outcomes in patients who undergo allogeneic corneal inlay (Allotex Inc., Boston, MA) implantation. METHODS: This retrospective data analysis included 86 patients at 5 study sites that were part of the Allotex EU multicenter clinical trial. During the study, an allogeneic corneal inlay was implanted in the nondominant eye of emmetropic patients with presbyopia. Uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distance visual acuity, distance-corrected near visual acuity, refraction, and keratometric measurements were assessed preoperatively and at 6 months postoperatively. Correlation between the depth of the cornea from which the donor lenticule was obtained and these parameters was investigated. In addition, 3 subgroups, based on the depth of the donor lenticule (anterior, middle, and posterior), were compared. RESULTS: Uncorrected intermediate visual acuity, uncorrected near visual acuity, and distance-corrected near visual acuity increased while uncorrected distance visual acuity, corrected distance visual acuity, and keratometric values decreased 6 months postoperatively ( P < 0.05). No correlation was found between the clinical parameters and lenticule depth. In the subgroup analysis based on lenticule depth, there was no significant difference between the groups in the change in any parameter ( P > 0.05). CONCLUSIONS: Lenticules obtained from different depths can be used as corneal inlays, allowing multiple patients to benefit from one donor cornea.
Efficacy of Cultivated Oral Mucosal Epithelial Transplantation for Limbal Stem Cell Deficiency in Stevens-Johnson Syndrome Versus Other Etiologies.
Ngowyutagon P, Prabhasawat P, Chirapapaisan C … +7 more , Chotikavanich S, Sikarinkul R, Kengpunpanich S, Taetrongchit N, Setthawong S, Ekpo P, Inthasin N
Cornea · 2026 Jan · PMID 41649359 · Publisher ↗
PURPOSE: The aim of this study was to compare the efficacy and outcomes of cultivated oral mucosal epithelial transplantation (COMET) in limbal stem cell deficiency (LSCD) between patients with Stevens-Johnson syndrome (...
PURPOSE: The aim of this study was to compare the efficacy and outcomes of cultivated oral mucosal epithelial transplantation (COMET) in limbal stem cell deficiency (LSCD) between patients with Stevens-Johnson syndrome (SJS) and those with other etiologies (non-SJS), evaluated by clinical manifestations and epithelial phenotypes. METHODS: This prospective, comparative study enrolled patients with LSCD who were scheduled for COMET. Preoperative and postoperative assessments were performed using slit-lamp microscopy, in vivo confocal microscopy (IVCM), and impression cytology with immunofluorescence staining. Successful outcomes were defined as an intact ocular surface without conjunctivalization and the presence of cornea-like epithelium detected by IVCM and/or immunofluorescence staining at the central cornea. Otherwise, the outcomes were interpreted as failure. Visual improvement and risk factors of COMET failure were analyzed. RESULTS: Eighteen eyes of 18 patients (7 with SJS, 11 non-SJS) were included. The median follow-up time was 15.5 months (range: 13-35 months). The overall success rate was 72.2% (13 eyes: 2 with SJS and 11 non-SJS), which was significantly lower in patients with SJS (28.6%) than in non-SJS patients (100%) (P = 0.002). Among successful cases, 60.2% showed visual improvement while the others (30.8%) remained unchanged. The risk of COMET failure was significantly associated with SJS (P = 0.002), lid margin keratinization (P = 0.023), preoperative symblepharon (P = 0.036), postoperative epithelial defects lasting more than 2 weeks (P = 0.022), and the absence of multilayered cornea-like epithelium detected by IVCM at 6 months postoperatively (P = 0.017). CONCLUSIONS: COMET demonstrates good efficacy and favorable outcomes for LSCD, particularly in non-SJS eyes. While the success rate was excellent in non-SJS patients, the outcomes were significantly limited in those with SJS.
Eyelash Extension Wear Potentiates Clinical Signs of Ocular Surface Diseases Among Young Women.
Kyei S, Ofosu DA, Owusu P … +1 more , Asiamah R
Cornea · 2026 Jan · PMID 41637114 · Publisher ↗
PURPOSE: The study investigated the frequency of self-reported symptoms and the association of clinical signs of ocular surface disease with eyelash extension wear among youthful women. METHODS: In this cross-sectional s...
PURPOSE: The study investigated the frequency of self-reported symptoms and the association of clinical signs of ocular surface disease with eyelash extension wear among youthful women. METHODS: In this cross-sectional study, 416 female university students aged 18-29 years were classified into eyelash extension wearers (n = 208) and nonwearers (n = 208). Self-reported symptoms, care practices, and extension type were assessed using a questionnaire. Participants underwent slit-lamp examination for corneal integrity (Modified Oxford Scale), noninvasive tear break-up time (TBUT), and assessment of eyelashes, conjunctiva, and meibomian glands. RESULTS: Eyelash extension wearers reported significantly higher rates of watery eyes (38.5% vs. 21.6%; P < 0.001), natural eyelash loss (17.3% vs. 9.6%; P = 0.022), and discharge (7.7% vs. 1.0%; P = 0.002) compared with nonwearers. Clinically, wearers exhibited more eyelash abnormalities (62.2% vs. 1.9%; χ2 = 172.7, P < 0.001), reduced TBUT <10 seconds (79.8% vs. 15.4%; χ2 = 173.1, P < 0.001), greater conjunctival injection (8.7% vs. 0.5%; χ2 = 16.0, P < 0.001), and meibomian gland abnormality (8.7% vs. 3.4%; χ2 = 5.2, P = 0.023). Logistic regression revealed that extension wear was associated with approximately 22-fold higher likelihood of reduced TBUT [odds ratio (OR) = 21.74; 95% confidence interval (CI) 13.1-36.1], approximately 83-fold higher likelihood of eyelash abnormalities (OR = 83.28; 95% CI 29.8-232.9), and approximately 3-fold higher likelihood of meibomian gland abnormality (OR = 2.72; 95% CI 1.1-6.7). CONCLUSIONS: Eyelash extension wear in young women is strongly associated with increased ocular surface symptoms and clinical signs of ocular surface disease. The findings support the need for improved consumer education, stricter product regulation, and routine ocular health screening to prevent avoidable complications among extension wearers.
Impact of Systemic EGFR Inhibitors on Meibomian Glands: A Meibographic Analysis With Clinical Correlations.
Yuksel N, Guler F, Ucar G … +2 more , Mendi ZN, Onat E
Cornea · 2026 Jan · PMID 41636600 · Publisher ↗
PURPOSE: Epidermal growth factor receptor (EGFR) signaling promotes meibomian gland (MG) epithelial and mesenchymal cell proliferation and is involved in MG morphogenesis. This study aimed to evaluate the impact of syste...
PURPOSE: Epidermal growth factor receptor (EGFR) signaling promotes meibomian gland (MG) epithelial and mesenchymal cell proliferation and is involved in MG morphogenesis. This study aimed to evaluate the impact of systemic EGFR inhibitor (EGFR-I) therapy on MG status using meibography, and its association with ocular surface clinical parameters. METHODS: In this prospective study, 39 patients with no prior history of ocular surface disease who were scheduled to receive systemic EGFR-I therapy for various malignancies were enrolled. All participants underwent Schirmer test, tear film break-up time, ocular surface disease index questionnaire, noninvasive tear break-up time, and noncontact meibography using Sirius topography at baseline, and at 1 and 3 months after treatment initiation. MG loss was quantified and staged based on meibographic analysis. RESULTS: Of the 39 participants, 28 (72%) were female and 11 (28%) were male, with a mean age of 61.8 ± 11 years. Baseline Schirmer test and tear film break-up time values (15.6 ± 4.2 mm and 13.2 ± 3.5 seconds) showed a significant reduction at 1 month (13.8 ± 3.8 mm; 11.1 ± 3.0 seconds), with a further decline observed at 3 months (8.1 ± 3.1 mm; 7.4 ± 2.7 seconds) (P < 0.001). The mean ocular surface disease index score increased from 7.7 ± 6.9 at baseline to 11.6 ± 7.3 at 1 month and 30.3 ± 14.6 at 3 months (P < 0.001). Noninvasive tear break-up time values decreased significantly at 3 months (5.9 ± 2.6 seconds) relative to baseline (11.1 ± 4.5 seconds) (P < 0.001). Meibographic assessments revealed a progressive increase in MG loss percentage and staging from baseline (14.7 ± 6.2%; stage 0.8 ± 0.5) to 1 month (21.3 ± 6.5%; stage 1.3 ± 0.4) and 3 months (31.6 ± 11%; stage 1.9 ± 0.6) (P < 0.001). CONCLUSIONS: Systemic EGFR-I therapy may contribute to progressive MG loss, which may be associated with ocular side effects commonly observed in patients receiving these agents, including dry eye disease, blepharitis, and meibomitis. Early recognition and management of these complications by ophthalmologists may improve patient comfort and support adherence to oncologic treatment.
Association of Elevated Thyroid-Stimulating Hormone With Structural Progression in Keratoconus.
Stival LR, Santhiago MR
Cornea · 2026 Jan · PMID 41636599 · Publisher ↗
PURPOSE: The aim of this study was to evaluate whether serum thyroid-stimulating hormone (TSH), total T3, and free T4 levels are associated with tomographically confirmed structural progression in keratoconus. METHODS: I...
PURPOSE: The aim of this study was to evaluate whether serum thyroid-stimulating hormone (TSH), total T3, and free T4 levels are associated with tomographically confirmed structural progression in keratoconus. METHODS: In a prospective observational cohort, 133 eyes from 74 individuals were classified into progressive keratoconus (n = 53), stable keratoconus (n = 28), and healthy control eyes (n = 52). Progression was defined as a ≥1.0 D increase in maximum keratometry (Kmax) over 12 months. Corneal imaging and serum hormone assays (TSH, T3, T4) were performed at baseline. Group comparisons used ANOVA with Tukey post hoc testing. Pearson correlation assessed associations between hormone levels and structural parameters. RESULTS: The progressive group demonstrated significantly higher TSH levels (1.96 ± 0.83 mU/mL) compared with controls (1.47 ± 0.57 mU/mL; P < 0.05); stable group values were intermediate. No differences were found for T3 or T4. Correlations between TSH and steep keratometry (K2) (r = +0.27; P < 0.05) and between TSH and thinnest pachymetry (r = -0.21; P < 0.05) were statistically significant. No correlation was observed between TSH and minimum epithelial thickness, or with T3/T4 levels. CONCLUSIONS: Elevated TSH is associated with structural progression markers in keratoconus, suggesting a systemic thyroid contribution to disease evolution. While causality is not established, these findings support endocrine screening in early or progressive keratoconus cases and warrant further mechanistic investigation.
Endothelium-In Pull-Through Descemet Membrane Endothelial Keratoplasty for Bullous Keratopathy in Vitrectomized Eyes.
Fujiwara K, Yokogawa H, Shimizu T … +5 more , Igarashi A, Kobayashi A, Higashide T, Yamagami S, Hayashi T
Cornea · 2026 Jun · PMID 41636598 · Publisher ↗
PURPOSE: Descemet membrane endothelial keratoplasty (DMEK) is the preferred treatment for corneal endothelial dysfunction; nonetheless, its feasibility and outcomes in vitrectomized eyes remain uncertain. We evaluated th...
PURPOSE: Descemet membrane endothelial keratoplasty (DMEK) is the preferred treatment for corneal endothelial dysfunction; nonetheless, its feasibility and outcomes in vitrectomized eyes remain uncertain. We evaluated the outcomes and surgical considerations of endothelium-in pull-through DMEK in vitrectomized eyes with bullous keratopathy. METHODS: Eight vitrectomized eyes from eight patients (mean age, 71.9 ± 15.4 years; mean follow-up, 4.9 ± 1.6 months) underwent endothelium-in pull-through DMEK using the EndoGlide between August 2023 and October 2024. Best spectacle-corrected visual acuity, endothelial cell density, central corneal thickness, and complications were recorded. RESULTS: In 5 eyes (62.5%), the graft unfolded smoothly; in 3 eyes (37.5%), excessive unfolding required conversion to an endothelium-out roll using the double-bubble technique. All grafts attached without rebubbling. The best spectacle-corrected visual acuity improved from 1.00 logMAR (interquartile range, 0.65-1.10) preoperatively to 0.30 (0.13-0.55) and 0.40 (0.15-0.52) logMAR at 3 and 6 months, respectively (Wilcoxon, both P < 0.05). The central corneal thickness decreased from 693.5 µm (640-788.8) to 522.5 µm (502.3-564.3) and 549 µm (542-577) at 3 and 6 months, respectively (Wilcoxon, both P < 0.05). The endothelial cell density decreased from 2737 cells/mm 2 (2540-2928) preoperatively to 2412 cells/mm 2 (2284-2610) and 2238 cells/mm 2 (2086-2245) at 3 and 6 months, respectively; at the final follow-up, the median cell density was 2288 cells/mm 2 (2200-2428), representing a 16.4% loss relative to the donor value. CONCLUSIONS: Endothelium-in pull-through DMEK is feasible in vitrectomized eyes, achieving stable attachment with visual and anatomical improvement even when adjunctive maneuvers are required, demonstrating clinical utility in postvitrectomy corneal edema.
Corneal Graft Survival Outcomes After Glaucoma Surgery and Medical Treatment.
Oku H, Mori K, Wakimasu K … +8 more , Yamasaki T, Fukuoka H, Hieda O, Inatomi T, Yokoi N, Ueno M, Sotozono C, Kinoshita S
Cornea · 2026 Jan · PMID 41636596 · Publisher ↗
PURPOSE: To evaluate the association between corneal graft survival and glaucoma surgical procedures and medical treatment in eyes with postkeratoplasty glaucoma. METHODS: This retrospective study involved 1149 eyes that...
PURPOSE: To evaluate the association between corneal graft survival and glaucoma surgical procedures and medical treatment in eyes with postkeratoplasty glaucoma. METHODS: This retrospective study involved 1149 eyes that underwent penetrating keratoplasty or Descemet stripping automated endothelial keratoplasty between 2004 and 2019. They were divided into 5 groups according to the types of glaucoma treatment after keratoplasty: trabeculotomy (TLO), trabeculectomy (TLE), glaucoma drainage device, topical antiglaucoma drugs alone, and no glaucoma treatment. Eyes with trauma, infection, or rejection during the follow-up period, and those that other types of glaucoma surgery, were excluded. Graft survival and risk factors for graft failure after glaucoma treatment were analyzed using Kaplan-Meier survival analysis and the Cox proportional hazards model. RESULTS: The cumulative probability of graft survival at 3 years postoperatively was 87.3% in the TLO group, 58.2% in the TLE group, 68.6% in the glaucoma drainage device group, 89.1% in the topical medication group, and 96.6% in the no-treatment group (P < 0.001, log-rank test). The presence of bleb before keratoplasty [hazard ratio (HR) 3.34; 95% confidence interval (CI) 1.94-5.37; P < 0.001] and failure of intraocular pressure control after glaucoma treatment (HR 4.11; 95% CI 2.15-7.86; P < 0.001) were major risk factors for graft failure, whereas TLO was associated with a significantly lower risk of graft failure compared with TLE (HR 4.57; 95% CI 1.19-17.47; P = 0.03). CONCLUSIONS: Our findings showed that TLO is associated with a lower risk of graft failure compared with TLE. Outflow facility reconstruction procedures, such as TLO, seem to be effective first-line surgical options for postkeratoplasty glaucoma.
Corneal Stromal Thinning and Posterior Irregularity After DMEK: Clinical Observations and Biophysical Hypotheses.
Borgia A, Airaldi M, Vaccaro S … +9 more , Lockington D, Lozza F, Semeraro F, Thathapudi N, Hayes S, Lewis P, Kaye SB, Meek K, Romano V
Cornea · 2026 Jan · PMID 41592350 · Publisher ↗
PURPOSE: The aim of this study was to identify factors associated with significant postoperative stromal thinning in eyes undergoing Descemet membrane endothelial keratoplasty (DMEK). METHODS: This was a retrospective, m...
PURPOSE: The aim of this study was to identify factors associated with significant postoperative stromal thinning in eyes undergoing Descemet membrane endothelial keratoplasty (DMEK). METHODS: This was a retrospective, multicenter interventional study. Eyes that underwent DMEK at Royal Liverpool University Hospital (UK) and ASST Spedali Civili di Brescia (Italy) were included. Eyes were stratified into 2 groups based on the final central corneal thickness (CCT): <500 μm and ≥500 μm. Demographic, clinical, and tomographic parameters were analyzed, including age, preoperative CCT, best corrected visual acuity (BCVA), posterior and total corneal power, and donor endothelial cell density (ECD). Hyperopic shift was defined as an increase of ≥+0.5 D in posterior corneal power or a decrease of ≤-1.0 D in total corneal power. RESULTS: Among 150 eyes (120 patients), those with a final CCT <500 μm were significantly older (mean [SD], 74.5 [9.9] vs. 68.7 [11.5] years; P = 0.001). Hyperopic shift occurred in 43% of eyes with complete tomographic data and correlated with a greater percentage reduction in CCT after DMEK (-25.5% [15.6%] vs. -16.4% [12.4%], P = 0.02). A larger proportional CCT reduction was observed in eyes with a final CCT <500 μm and was associated with the presence of preoperative posterior stromal ripples. No significant differences were observed in final BCVA, donor ECD, or treatment center. CONCLUSIONS: Greater reductions in corneal thickness are associated with postoperative stromal thinning and hyperopic shift after DMEK. Preoperative stromal ripples are associated with greater reductions in corneal thickness after DMEK. Stromal remodeling appears influenced by endothelial recovery and preoperative biomechanical status, supporting emerging hypotheses on keratocyte loss and osmotic imbalance.
Comment on "Characteristics and Outcomes of Descemet Membrane Endothelial Keratoplasty for Treatment of Failed Endothelial Keratoplasty".
Habib E, Us Saba SN
Cornea · 2026 Jun · PMID 41563053 · Publisher ↗
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Impact of Corneal Punctate Epithelial Staining on Patient Satisfaction After Cataract Surgery: An Area of Unmet Need for Clinical Guidance.
Stuard Sambhariya W, Munar K, Medina R … +1 more , Akpek EK
Cornea · 2026 Jan · PMID 41563048 · Publisher ↗
PURPOSE: The goal of this study is to review the existing evidence to quantify the impact of corneal punctate epithelial erosions (PEE) on postoperative refractive error-related patient dissatisfaction after cataract sur...
PURPOSE: The goal of this study is to review the existing evidence to quantify the impact of corneal punctate epithelial erosions (PEE) on postoperative refractive error-related patient dissatisfaction after cataract surgery. METHODS: PubMed and the Cochrane library were systematically searched for studies using the terms "dry eye" or "dry eye disease" or "punctate epithelial erosions" or "corneal staining" combined with "biometry" or "keratometry" or "cataract surgery." ChatGPT was also queried using the same search terms to identify any potentially relevant publications that might have been missed. All retrieved publications and their references were examined, and the results were tabulated. RESULTS: A total of 1446 abstracts were identified through online search, corresponding to 1242 unique publications. Of these, 12 studies were deemed relevant and full articles were retrieved. ChatGPT identified an additional 6 unique publications. None of the 18 studies reviewed in detail, however, quantified the impact of PEE on biometry assessments. The results of 8 studies reporting on 4 other dry eye disease parameters that informed the impact on biometry results were summarized. CONCLUSIONS: Despite the current emphasis on optimizing corneal PEE before biometry, no studies define thresholds or metrics linked to measurable effects on postcataract visual outcomes. This review highlights the need for future studies to inform algorithms used for preoperative cataract decision making.
A Novel Interferometric Device for Measurement of Tear Film Lipid Layer Thickness in Mice.
Kim EC, Jeon HJ, Akter KH … +9 more , Kim JY, Hwang H, Yoon YC, Park SK, Whang WJ, Na KS, Kim HS, Chung E, Hwang HS
Cornea · 2026 May · PMID 41563047 · Publisher ↗
PURPOSE: The aim of this study was to introduce a new method to photograph the tear film lipid layer (LL) in mice and quantitatively measure lipid layer thickness (LLT). METHODS: A total of 39 Bagg albino (BALB/c) mice (...
PURPOSE: The aim of this study was to introduce a new method to photograph the tear film lipid layer (LL) in mice and quantitatively measure lipid layer thickness (LLT). METHODS: A total of 39 Bagg albino (BALB/c) mice (5-week-old) were used in this study. The system was composed of breadboard, light-emitting diode (LED) panel, right-angle mirror, dissection microscope, complementary metal oxide semiconductor camera, and computer. The white light emitted from the LED panel caused thin-film interference in the LL of the tear film, which reflected off the mirror and produced an image on the camera sensor. For the qualitative analysis, the mice were divided into 3 groups according to the LL interference patterns. LLT was quantified by analyzing the colors in the interference patterns. RESULTS: Interference patterns were clearly observed in the lower half of the corneas. Based on quantitative analysis, the average LLT was 62.72 ± 10.65 nm. When the interference pattern was qualitatively classified, 7 eyes were categorized into group 1 (thin), 19 eyes into group 2 (normal), and 3 eyes into group 3 (thick). The average LLT was 54.81 ± 8.23 nm in group 1, 63.68 ± 8.73 nm in group 2, and 75.11 ± 15.48 nm in group 3, with a significant difference among the 3 groups (analysis of variance P = 0.012). CONCLUSIONS: We successfully photographed the interference pattern caused by the tear film LL in mice and quantitatively measured the LLT using an LED panel, mirror, dissection microscope, and camera.
Clinical Characteristics of Ocular Graft-Versus-Host Disease Associated With Tapering of Immunosuppressive Drugs.
Farsi Y, Singh RB, Yuksel E … +4 more , Surico PL, Dohlman TH, Yin J, Dana R
Cornea · 2026 Jan · PMID 41563039 · Publisher ↗
PURPOSE: To evaluate the incidence and clinical characteristics of ocular graft-versus-host disease (oGVHD) associated with tapering of systemic immunosuppression after allogeneic hematopoietic stem cell transplantation...
PURPOSE: To evaluate the incidence and clinical characteristics of ocular graft-versus-host disease (oGVHD) associated with tapering of systemic immunosuppression after allogeneic hematopoietic stem cell transplantation (allo-HSCT). METHODS: This retrospective study included adult allo-HSCT recipients diagnosed with oGVHD during or after immunosuppression tapering at a single tertiary center (1998-2023). Data collected included transplant indications and donor characteristics, GVHD prophylaxis regimens, immunosuppression status at engraftment and at oGVHD onset, and systemic and ocular GVHD manifestations. Cumulative incidence of oGVHD was estimated using Kaplan-Meier survival analyses. RESULTS: Fifty-six patients (mean age, 56 ± 12 years; 59% male) developed oGVHD at a median of 9 months posttransplant (interquartile range, 6.8-13). The predominant prophylaxis regimen at engraftment was tacrolimus with methotrexate (62.5%). At the time of oGVHD diagnosis, 25.0% of patients were fully tapered off systemic immunosuppression, whereas 28.5% remained on tacrolimus monotherapy. Kaplan-Meier analysis showed a rapid rise in oGVHD incidence within the first year, with 75% of cases diagnosed by month 14. Systemic GVHD preceded ocular involvement in 62% of patients, whereas 18% developed isolated oGVHD. Most patients required escalation of ocular surface therapy-including lubrication, punctal occlusion, and topical antiinflammatory or immunomodulatory agents-although no patient required reinstatement or escalation of systemic immunosuppression solely for ocular disease. CONCLUSIONS: oGVHD frequently emerges during the late phase of systemic immunosuppression tapering, with many cases occurring after complete discontinuation or reduction to monotherapy. Given the high incidence within the first posttransplant year and the occurrence of isolated ocular disease, these findings support routine ophthalmic evaluation for all allo-HSCT recipients as systemic immunosuppression is withdrawn. Early detection and timely escalation of topical therapy are essential to prevent ocular surface damage while permitting safe continuation of systemic tapering.
Myeloid-Derived Suppressor Cells Enhance Wound Healing in a Murine Model of Corneal Injury.
Lee S, Heydarian N, Pulimamidi VK … +8 more , Zidan AA, Sandhu S, Xi L, Chen Y, Yin J, Dohlman TH, Chauhan SK, Dana R
Cornea · 2026 Jun · PMID 41557839 · Publisher ↗
PURPOSE: Corneal injury is a leading cause of vision loss and demands rapid, coordinated regeneration. Myeloid-derived suppressor cells (MDSC), innate immunoregulatory cells that aid repair in peripheral tissues, have no...
PURPOSE: Corneal injury is a leading cause of vision loss and demands rapid, coordinated regeneration. Myeloid-derived suppressor cells (MDSC), innate immunoregulatory cells that aid repair in peripheral tissues, have not been evaluated in corneal healing. We tested whether MDSC promote epithelial closure and temper postinjury inflammation. METHODS: For scratch assays, 1.0 × 10 5 human corneal epithelial cells were cocultured with 1.5 × 10 6 MDSC or CD11b + Gr-1 - control cells, and wound areas at 18 and 24 hours were quantified in ImageJ. In vivo, corneal epithelial debridement was induced in BALB/c mice using an Algerbrush-II, followed by subconjunctival injection of MDSC or control cells (5 × 10 4 cells in 50 μL saline). Epithelial healing was assessed by fluorescein staining and slitlamp imaging at 6, 22, and 28 hours, with ImageJ analysis. At 28 hours, corneas were collected for real-time polymerase chain reaction and flow cytometry to assess inflammatory markers. On day 3, corneas were harvested for hematoxylin and eosin staining and histological analysis. RESULTS: MDSC significantly enhanced human corneal epithelial cells migration in vitro versus controls. In vivo, MDSC delivery accelerated epithelial wound closure, reduced CD11b + Ly6G + neutrophil infiltration, and lowered corneal tumor necrosis factor alpha (TNF-α) and interleukin-1 beta (IL-1β) expression compared with saline or CD11b + Gr-1 - control cells. Histology confirmed restoration of epithelial integrity in MDSC-treated eyes. CONCLUSIONS: MDSC expedite corneal epithelial repair and attenuate acute inflammation after injury. These findings identify a previously unrecognized reparative function for MDSC in the cornea and support their development as a cell-based therapy for ocular surface injury.
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