Cornea[JOURNAL]
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200 papers
Surgical Considerations for the Human Implantation of the Gore Synthetic Corneal Device.
Ramirez-Miranda A, Ortiz-Morales G, Domene-Hickman JL … +5 more , Fabregas-Sanchez-Woodworth D, Garcia-Padilla L, Navas A, Akpek EK, Graue-Hernandez EO
Cornea · 2026 May · PMID 41474963 · Publisher ↗
Abstract loading — click title to view on PubMed.
Management and Histological Analysis of a Retroprosthetic Membrane as a Novel Complication After EndoArt Implantation.
Murra S, Wiedemann J, Schlereth S … +2 more , Cursiefen C, Bachmann B
Cornea · 2025 Dec · PMID 41474960 · Publisher ↗
PURPOSE: EndoArt is a novel endothelial keratoprosthesis recently introduced to treat corneal endothelial decompensation. Retroprosthetic membrane (RPM) formation after EndoArt implantation has not been described. This a...
PURPOSE: EndoArt is a novel endothelial keratoprosthesis recently introduced to treat corneal endothelial decompensation. Retroprosthetic membrane (RPM) formation after EndoArt implantation has not been described. This article reports its incidence, risk factors, and management, along with histological analysis. METHODS: A retrospective analysis of patients who underwent EndoArt implantation at Cologne University Hospital (Germany) between June 2023 and March 2025 was conducted. Eyes with RPMs were identified using routine anterior segment optical coherence tomography. Clinical data, treatment approaches, and surgical outcomes were analyzed. Surgical membranectomy was performed in one eye and analyzed by light microscopy with hematoxylin-eosin staining and immunohistochemistry. RESULTS: Sixty-nine eyes underwent EndoArt implantation, and 3 (4.35%) developed RPMs. The main indication was endothelial failure with chronic corneal edema in eyes at high risk of graft failure. Risk factors included multiple previous failed Descemet membrane endothelial keratoplasty (n = 3), aphakia (n = 2), glaucoma (n = 2; one with congenital glaucoma, one with angle-closure glaucoma), glaucoma surgery (n = 1), aniridia (n = 1), iridocorneal endothelial syndrome (n = 1), cyclodialysis (n = 1), artificial iris (n = 1), and pseudophakia (n = 2). The mean time to RPM formation was 7.3 months. One eye had a recurrence 2 months after membranectomy. Histology revealed abundant type III collagen (vimentin+) and macrophages (CD68+), but no significant leukocytes (CD45-) or myofibroblasts (α-SMA-), suggesting chronic remodeling without acute inflammation. CONCLUSIONS: RPM formation after EndoArt implantation is rare and has not been previously described. Surgical removal improves clinical outcomes and preserves implant stability; however, recurrence may occur, highlighting the need for follow-up and additional research. RPM formation may result from chronic blood-aqueous barrier breakdown in eyes with altered anatomy and a history of multiple surgeries.
Residual Bed Thickness in Deep Anterior Lamellar Keratoplasty: A Comparative Study of Peeling-Off and Manual Technique.
Rossi C, Taloni A, Guanta A … +9 more , Rijillo L, Scalia G, Porchia S, Bianca F, Borselli M, Carnovale-Scalzo G, Carnevali A, Lucisano A, Scorcia V
Cornea · 2025 Dec · PMID 41474959 · Publisher ↗
PURPOSE: To compare residual stromal bed thickness (RST) and regularity after manual layer-by-layer deep anterior lamellar keratoplasty (M-DALK) and peeling-off deep anterior lamellar keratoplasty (PO-DALK), after failed...
PURPOSE: To compare residual stromal bed thickness (RST) and regularity after manual layer-by-layer deep anterior lamellar keratoplasty (M-DALK) and peeling-off deep anterior lamellar keratoplasty (PO-DALK), after failed pneumatic dissection. METHODS: This retrospective case series included patients who underwent M-DALK or PO-DALK. Best-corrected visual acuity (BCVA) was assessed preoperatively and 1 month postoperatively. Anterior segment optical coherence tomography used to measure central and peripheral RST and Fourier analysis to assess asymmetry (ASY) were evaluated 1 month after surgery. RESULTS: BCVA varied significantly from baseline to 1 month after surgery in both groups (both P < 0.001). Mean central RST was 55.91 μm [95% confidence interval (CI) 51.87-59.95] in the PO-DALK group versus 56.32 μm (95% CI 51.08-61.56) in the M-DALK group (P = 1.0). Mean peripheral RST was 59.40 μm (95% CI 54.27-64.52) in PO-DALK versus 65.73 μm (95% CI 58.27-73.18) in M-DALK (P = 0.62). In both groups, the difference between mean central and peripheral RST was significant (P = 0.0001 in PO-DALK, P < 0.0001 in M-DALK). However, the mean difference between peripheral and central RST was 5.32 μm (95% CI 3.95-6.69) in PO-DALK versus 11.18 μm (95% CI 7.8-14.56) in M-DALK (P = 0.002) and difference among peripheral RSTs was 4.15 μm (95% CI 3.32-4.97) in PO-DALK versus 13.57 μm (95% CI 8.68-18.46) in M-DALK (P < 0.0004). ASY analysis of the 3-mm and 6-mm zones did not reveal significant differences among the 2 groups (P > 0.05). CONCLUSIONS: PO-DALK provides a significantly more regular and homogeneous residual stromal bed than M-DALK. It is a simple and effective technique, offering a reliable alternative when pneumatic dissection fails.
Symptoms of Small Fiber Neuropathy in Patients With Dry Eye Disease.
Zidan AA, Dean J, Lin Z … +5 more , Kheirkhah A, Dana R, You JY, Oaklander AL, Yin J
Cornea · 2025 Dec · PMID 41474957 · Publisher ↗
PURPOSE: Small fiber neuropathy (SFN) is a neurologic condition affecting small-diameter nerve fibers, including those innervating the ocular surface. In this study, we aim to assess the prevalence and characteristics of...
PURPOSE: Small fiber neuropathy (SFN) is a neurologic condition affecting small-diameter nerve fibers, including those innervating the ocular surface. In this study, we aim to assess the prevalence and characteristics of SFN symptoms in patients with dry eye disease (DED). METHODS: This was a prospective study conducted at 2 academic eye centers. DED symptoms were assessed using the Ocular Surface Disease Index (OSDI) questionnaire, and adult patients with an OSDI score ≥13 and a clinical diagnosis of DED at Mass Eye and Ear and Beth Israel Deaconess Medical Center were included in the study. Ocular pain was assessed using the Ocular Pain Assessment Survey (OPAS). SFN symptoms were measured using validated Small-Fiber Symptom Survey (SSS) questionnaire, with scores ≥32.5 considered abnormal. DED signs including corneal fluorescein staining (CFS), tear breakup time (TBUT), tear production, and corneal sensitivity were assessed. Patients received standard DED treatments, and their responses were reassessed after 6 to 12 months. RESULTS: Among 31 participants with DED (23-87 years, 80.6% female), 38.7% had abnormal SSS scores. SSS scores correlated with DED symptoms (r = 0.43 P = 0.017) and ocular pain (r = 0.62 P = 0.0003); correlated negatively with CFS (r = -0.42 P = 0.018); and did not correlate with TBUT, tear production, or corneal sensitivity. Despite standard treatments and stable clinical signs, most patients with severe SFN symptoms reported worsening dry eye symptoms in follow-up. CONCLUSIONS: This study demonstrates that SFN symptoms were prevalent in DED population and positively correlated with ocular pain and dry eye symptoms and negatively with CFS. Patients with severe SFN symptoms reported less favorable responses to standard dry eye treatments.
Genotype-Phenotype Correlations and Long-Term Surgical Outcomes in TGFBI-Linked Bowman's Layer Corneal Dystrophies.
Mahoun Z, Valleix S, Bourges JL
Cornea · 2025 Dec · PMID 41474953 · Publisher ↗
PURPOSE: Reis-Bücklers corneal dystrophy (RBCD; Mendelian Inheritance in Man 602082) and Thiel-Behnke corneal dystrophy (TBCD; Mendelian Inheritance in Man 608470) are clinically similar corneal dystrophies affecting Bow...
PURPOSE: Reis-Bücklers corneal dystrophy (RBCD; Mendelian Inheritance in Man 602082) and Thiel-Behnke corneal dystrophy (TBCD; Mendelian Inheritance in Man 608470) are clinically similar corneal dystrophies affecting Bowman's layer, caused by the TGFBI variants p.(Arg124Leu) and p.(Arg555Gln), respectively. Yet their distinct clinical courses complicate therapeutic decisions. This study aimed to compare the clinical course and surgical outcomes of genetically confirmed RBCD and TBCD. METHODS: Medical records from 2016 to 2024 were reviewed for age at first surgical intervention, surgical procedure type, and time to clinically significant recurrence (SR). TGFBI genotyping was performed, and phenotypic features were documented using slit-lamp biomicroscopy and anterior segment optical coherence tomography. We retrospectively analyzed clinical data of 2 large French families with 24 patients, 8 being genotyped with either the p.(Arg124Leu) or the p.(Arg555Gln) variants. Main Outcome Measures were the age at first phototherapeutic keratectomy (PTK), recurrence interval after surgery, and visual acuity recovery after PTK. RESULTS: Patients with the p.(Arg124Leu) variant underwent their first surgical procedure at a younger age (mean: 18.43 ± 4.47 years) than those with the p.(Arg555Gln) variant (mean: 28.8 ± 4.16 years; P <0.001). Furthermore, the interval to SR after PTK was shorter in the p.(Arg124Leu) group (48.3 ± 10.4 months) than in the p.(Arg555Gln) group (121.2 ± 20.4 months; P <0.001). CONCLUSIONS: Our findings further support that the p.(Arg124Leu) variant is associated with an earlier onset and a more aggressive clinical course than the p.(Arg555Gln) variant. Genetic testing is key to precise differential diagnosis of these CDs and provides clinical prognostication to guide the therapeutic options.
Incidence and Microbiology of Endophthalmitis in Eyes With a Type 1 Boston Keratoprosthesis: A Systematic Review and Meta-Analysis.
Morcos DM, Dohlman TH, Durand ML
Cornea · 2025 Dec · PMID 41474942 · Publisher ↗
PURPOSE: To evaluate recent literature to determine the incidence and microbiology of endophthalmitis in eyes with the type 1 Boston Keratoprosthesis (BKPro). METHODS: A literature review was performed using PubMed, Emba...
PURPOSE: To evaluate recent literature to determine the incidence and microbiology of endophthalmitis in eyes with the type 1 Boston Keratoprosthesis (BKPro). METHODS: A literature review was performed using PubMed, Embase, and Cochrane databases. Studies were included if published ≥2010, included ≥20 BKPro eyes, and reported the mean follow-up time. Studies with duplicate data sets or limited to 1 type of underlying condition or age group were excluded. A meta-analysis was performed to calculate endophthalmitis incidence (cases per 100 eye-years). RESULTS: Of 501 studies reviewed, 34 met inclusion criteria; these included 2732 BKPro eyes. The mean follow-up (range 1.4-8.9 years) was <5 years in 85% of studies. A total of 161 eyes developed endophthalmitis. Most studies reported the proportion of their cohort that developed endophthalmitis (0%-22%) but not the incidence. The pooled mean incidence of endophthalmitis was 2.09 cases per 100 eye-years (95% CI, 1.63-2.67). In 44 endophthalmitis cases with complete microbiology, 54.5% were bacterial (two thirds because of gram-positive bacteria), 29.5% fungal (primarily Candida), and 16% no growth. Some cases occurred despite topical antibiotics effective against the endophthalmitis pathogen. Risk factors included antecedent keratitis, noncompliance with prophylactic antibiotics, corneal melt around the BKPro, and an exposed glaucoma drainage device. CONCLUSIONS: The incidence of endophthalmitis in BKPro eyes is 2 cases per 100-eye years, based on 34 recent studies with relatively short follow-up times. Future studies should report endophthalmitis incidence rather than proportion. More studies with long follow-up times will be helpful in determining the 5- and 10-year risk of endophthalmitis.
Letter Regarding: "Quantitative Analysis of Endothelial Cell Damage in Corneal Grafts Used for Endothelial Keratoplasty and Correlation to Donor Tissue Characteristics and Postoperative Parameters".
Airaldi M, Parekh M, Ruzza A … +3 more , Ferrari S, Aiello F, Romano V
Cornea · 2026 Jul · PMID 41474940 · Publisher ↗
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HTLV, CMV, and EBV: Implications for Ocular Tissue Transplantation: Report of the Eye Bank Association of America Medical Advisory Board Policy and Position Review Subcommittee.
Farooq AV, Li J, DeMatteo J … +6 more , Buckman N, Mian S, Crosson A, Wagner J, Chamberlain W, Aldave AJ
Cornea · 2026 Feb · PMID 41468512 · Publisher ↗
PURPOSE: Human T-lymphotropic virus (HTLV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) each have the propensity for infection as well as the development of latency in humans. As many ocular tissue report forms p...
PURPOSE: Human T-lymphotropic virus (HTLV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) each have the propensity for infection as well as the development of latency in humans. As many ocular tissue report forms provided by Eye Bank Association of America (EBAA) member eye banks list serological testing results for these viruses, the EBAA Policy and Position Review Subcommittee (PPRS) sought to investigate and clarify the implications of these results. METHODS: Current EBAA policies regarding HTLV, CMV, and EBV were reviewed. Additionally, a search of articles written in or translated into the English language regarding the aforementioned viruses with a focus on ocular infection and ocular tissue transplantation was performed on PubMed. RESULTS: Current EBAA policies indicate that ocular tissues from donors with seropositivity to HTLV, CMV, and/or EBV can be used for transplantation. The risk of transmission of HTLV was felt to be the most consequential, given its low seroprevalence and its association with adult T-cell lymphoma/leukemia. However, as corneal and limbal tissue are not leukocyte-rich, the risk of transmitting HTLV is low. Despite reports of the isolation of all 3 viruses in ocular tissues, a literature review did not reveal any reported cases of viral transmission through ocular tissue transplantation. CONCLUSIONS: Ocular tissues from donors with seropositivity to HTLV, CMV, and/or EBV can be used for transplantation per current EBAA guidelines. Despite the potential for ocular infection by these viruses, there are no reported cases of viral transmission from ocular tissue transplantation, affirming the validity of the current EBAA guidelines.
Two-Year Outcomes of Simultaneous Double Lamellar Keratoplasty: A Novel Alternative to Repeat Penetrating Keratoplasty.
Roberts HW, Sharma P, Myerscough J … +1 more , Ahmad S
Cornea · 2025 Dec · PMID 41384806 · Publisher ↗
PURPOSE: To evaluate the outcomes of Simultaneous Double Lamellar Keratoplasty (SDLK) as a surgical alternative to repeat penetrating keratoplasty (PK) for cases involving both stromal pathology and endothelial graft fai...
PURPOSE: To evaluate the outcomes of Simultaneous Double Lamellar Keratoplasty (SDLK) as a surgical alternative to repeat penetrating keratoplasty (PK) for cases involving both stromal pathology and endothelial graft failure. METHODS: Three patients with failed PK and evidence of both stromal and endothelial pathology underwent SDLK. The procedure combined deep anterior lamellar keratoplasty (DALK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in a single operation. Outcome measures included uncorrected and corrected distance visual acuity (UDVA and CDVA), topographic astigmatism, and postoperative complications, assessed over a 24-month follow-up period. RESULTS: All patients achieved significant improvements in visual acuity and reduced astigmatism. Final CDVA ranged from 0.04 to 0.30 logMAR. One patient had an intraoperative microperforation, which was successfully managed. Postoperative complications included 1 case of partial DSAEK detachment, resolved with rebubbling. No graft rejections were observed. The combination of DALK and DSAEK restored corneal clarity and improved astigmatism while minimizing the risks associated with open-sky surgery. CONCLUSIONS: SDLK offers a viable alternative to repeat PK for managing combined stromal and endothelial failure. This approach preserves structural integrity, provides superior refractive outcomes, and facilitates future lamellar interventions. Further studies are warranted to validate these findings in larger cohorts.
Shared Genetic Architecture Between Psychiatric Disorders and Keratoconus: Insights From a Large-Scale Genome-Wide Cross-Trait Analysis.
Li G, Wang Y, Wang W … +3 more , Liu T, Obeng E, Li S
Cornea · 2025 Dec · PMID 41380697 · Publisher ↗
PURPOSE: The correlation between keratoconus (KC) and psychiatric disorders has been reported, but whether there is a genetic correlation between the 2 remains unclear. METHODS: We identified genetic overlaps between KC...
PURPOSE: The correlation between keratoconus (KC) and psychiatric disorders has been reported, but whether there is a genetic correlation between the 2 remains unclear. METHODS: We identified genetic overlaps between KC and 6 psychiatric disorders by using comprehensive summary data from genome-wide association studies. Cross-trait pleiotropic analysis uncovered shared loci and genes, whereas functional annotations and tissue-specific investigations assessed the impact of these pleiotropic genes. Finally, bidirectional Mendelian randomization was applied to explore causal relationships. RESULTS: Significant genetic correlation and genetic overlap were observed in 3 of the 6 trait pairs. A multiplicity study using the composite null hypothesis discovered significant possible multiplicity single nucleotide variants across 3 trait pairs, revealing 13 pleiotropic genetic loci, of which 3 were confirmed as colocalized loci with a posterior probability (PP.H4) exceeding 0.75. Significantly, numerous pleiotropic loci were identified across various paired traits, including 11p15.5 and 9q34.3. At the gene level, 137 pleiotropic genes were identified, including PDDC1, PIDD, and PNPLA2. Gene-based analyses indicated that these genes were significantly enriched in the brain and fibroblasts. Pathway analysis highlighted critical roles in Wnt/β-catenin signaling pathway. Mendelian randomization analysis further analyzed the correlation between these diseases. CONCLUSIONS: This study offers additional evidence of a multifaceted relationship between psychiatric disorders, specifically attention-deficit/hyperactivity disorder, anorexia nervosa, and posttraumatic stress disorder, and KC. At the same time, it may facilitate novel medications and enhanced clinical treatment techniques.
Diagnostic Yield of Corneal, Contact Lens, and Lens Fluid Cultures in Microbial Keratitis: A 12-Year Single-Center Study.
Airaldi M, Borgia A, Romano D … +5 more , Nardeosingh S, Somerville T, Romano V, Neal T, Kaye SB
Cornea · 2025 Dec · PMID 41380674 · Publisher ↗
PURPOSE: To determine the yield of culturing contact lenses (CL) and contact lens fluid/cases (CLF) to isolate recognized pathogens in suspected microbial keratitis (MK). METHODS: Data from 4298 ocular samples of MK coll...
PURPOSE: To determine the yield of culturing contact lenses (CL) and contact lens fluid/cases (CLF) to isolate recognized pathogens in suspected microbial keratitis (MK). METHODS: Data from 4298 ocular samples of MK collected at the Royal Liverpool University Hospital between January 2012 and December 2023 were reviewed. The isolation rates and proportion of recognized pathogens were compared between corneal impression membranes (CIM) and scrapes (CS), CL, and CLF. Chi-square tests and mixed-effects logistic models were used to assess differences in distribution among all isolates and subgroups of samples. RESULTS: The overall isolation rate was 54.1%, with CL having the highest rate ([348/466], 74.7%), followed by CIM ([1822/2940], 62%), CS ([126/566], 22.3%), and CLF ([23/317], 7.3%). CLF, however, had the highest proportion of recognized pathogens ([22/28], 78.6%), followed by CL ([269/531], 50.7%), CS ([71/142], 50%), and CIM ([728/2218], 32.8%). CIM and CS predominantly detected Gram-positive bacteria, whereas CLF had the highest rates of Acanthamoeba ([13/28], 46.4%) and fungal isolates ([4/28], 14.3%). CL and/or CLF cultures led to altered treatment in 10.5% of cases. CONCLUSIONS: In suspected MK, culturing the CLF and CL can increase the probability of detecting a recognized pathogen that in turn may help guide treatment.
Clinical Outcomes of Rose Bengal Photodynamic Therapy for Severe Infectious Keratitis.
Eskenazi-Betech R, Ortiz-Morales G, Vera-Duarte GR … +9 more , Haro-Morlett L, Hernandez-Solis A, Juarez M, Zamarron D, Lopez J, Fiordelisio T, Navas A, Ramirez-Miranda A, Graue-Hernandez EO
Cornea · 2025 Dec · PMID 41379987 · Publisher ↗
PURPOSE: To report the clinical outcomes, microbiological profile, and efficacy of Rose Bengal photodynamic therapy (RB-PDT) as adjuvant treatment in patients with severe infectious keratitis (IK). METHODS: Prospective,...
PURPOSE: To report the clinical outcomes, microbiological profile, and efficacy of Rose Bengal photodynamic therapy (RB-PDT) as adjuvant treatment in patients with severe infectious keratitis (IK). METHODS: Prospective, noncontrolled, interventional study. Severe IK was defined as meeting ≥2 of the following: central ulcer, infiltrate ≥3 mm, presence of corneal melting or hypopyon, and lack of clinical improvement with conventional medical treatment. Clinical success was defined as avoiding a therapeutic keratoplasty (TPK). RESULTS: A total of 21 eyes from 21 patients underwent RB-PDT. Clinical success was achieved in 61.9%. The mean follow-up was 9 ± 3.33 months (range: 4-15). Cultured samples were positive for 27 total microorganisms, including Fusarium spp (n = 12, 44.44%), S. epidermidis (n = 4, 14.81%), Acanthamoeba (n = 2, 7.40%), Pseudomonas spp (n = 3, 11.11%), and others. Cultured samples were grouped into bacterial (44.44%), fungal (48.14%), and polymicrobial (if cultured for multiple microorganisms, 28.57%) categories for analysis. Corneal melting (57.14%), hypopyon (57.14%), and fung-ball (38.1%) were present at the initial visit. The mean time from onset to clinical success was 89.69 ± 56.59 days. In cases of clinical success, the mean time from RB-PDT to clinical success was 46.69 ± 19.47 days. There was a total of 16 additional interventions, including evisceration (2), optical penetrating keratoplasty (5), conjunctival flap (3), amniotic membrane transplant (1), and topical losartan therapy (5). Clinical variables associated with clinical failure included diabetes and fung-ball at presentation. CONCLUSIONS: RB-PDT shows potential as an adjuvant therapy for managing severe infectious keratitis. TPK was avoided in 61.9% of cases.
Brillouin Optical Spectroscopy for In Vivo and Ex Vivo Assessment of Corneal Biomechanics.
Ravi Kumar S, Hunter K, Shakaib B … +5 more , Garcia P, Archer B, Check C, Mulder C, Ambati BK
Cornea · 2026 May · PMID 41379873 · Publisher ↗
PURPOSE: Corneal ectasias, such as keratoconus, exhibit altered corneal shape, structure, and biomechanics. Patients would greatly benefit from volumetric, 3-dimensional, and regional measurements of corneal stiffness fo...
PURPOSE: Corneal ectasias, such as keratoconus, exhibit altered corneal shape, structure, and biomechanics. Patients would greatly benefit from volumetric, 3-dimensional, and regional measurements of corneal stiffness for early detection and post-treatment monitoring. Current methods use indirect measurements, confounded by intraocular pressure, corneal thickness, describing a global picture of the cornea, and fail to identify crucial early localized changes. We tested the Brillouin Optical Scanner System (BOSS), which uses the Brillouin principle for noncontact focal measurement of compressibility and corneal stiffness, expressed as the 3-dimensional Brillouin Longitudinal Modulus. METHODS: We measured compressibility/corneal stiffness in 3-month and 10-month-old New Zealand white rabbits (n = 2; male = 1; female = 1). Rabbits remained awake, calm, and nonsedated. We separately analyzed ex vivo porcine corneas using BOSS (n = 28) and strip extensiometry (n = 13). The BOSS parameters were optimized for both sets of analyses. RESULTS: The BOSS demonstrated precise measurements in in vivo rabbits and ex vivo porcine corneas with a <2% and <4% variation from the mean. All rabbit corneas (n = 4) showed an increase in Brillouin values, demonstrating an increase in corneal stiffness over 7 months, in vivo. CONCLUSIONS: The BOSS is capable of precise measurements and detecting subtle changes in corneal stiffness in the rabbits. The high precision and accuracy of biomechanical measurements in nonsedated rabbits will enable a reduction in preclinical animal numbers, especially for time course studies. Importantly, the ability of the BOSS to provide spatial biomechanical measurements makes it a valuable tool for early detection of asymmetric corneal ectasias and keratoconus.
To Evaluate the Efficacy of Zero-Shot Prompting Using Large Language Models in the Extraction of Microbial Keratitis Descriptors.
Aruljyothi L, Mungle T, Woodward MA … +4 more , Prajna V, Nuijts RMMA, Berendschot TTJM, Nallasamy N
Cornea · 2025 Dec · PMID 41379872 · Publisher ↗
PURPOSE: To extract microbial keratitis (MK) descriptors from clinician notes in electronic health records using Large Language Models (LLMs) with a zero-shot prompting approach and compare the descriptors with those ide...
PURPOSE: To extract microbial keratitis (MK) descriptors from clinician notes in electronic health records using Large Language Models (LLMs) with a zero-shot prompting approach and compare the descriptors with those identified by expert human annotators. METHODS: Two hundred fifteen patients with culture-proven MK seen between 2019 and 2023 at Aravind Eye Hospital, Salem, India was gathered. Free-text clinical notes from each patient's first encounter corneal examination were obtained. Each of the 3 MK descriptors-centrality, infiltrate depth, and thinning-was annotated by expert consensus and coded as 1 (present), 0 (absent), or 9 (details unavailable). GPT-4o and GPT-4o mini were prompted to extract the 3 MK descriptors. LLM responses were compared with human annotations using agreement measures such as Cohen Kappa scores at 95% confidence interval, in addition to sensitivity and specificity. RESULTS: GPT-4o demonstrated mean sensitivity of 92%, 86%, and 97%, for centrality, depth, and thinning, respectively, and 96%, 93%, and 99% mean specificity. Cohen Kappa scores calculated for centrality, depth, and thinning were 0.88, 0.73, and 0.88, respectively, indicating good agreement. The overall sensitivity, specificity, and Cohen Kappa of GPT-4o mini were lower compared with GPT-4o, but the difference was not statistically significant. CONCLUSIONS: Both GPT-4o and GPT-4o mini showed good agreement with human annotations in extracting MK descriptors. Detection of MK descriptors was influenced by limitations in the quality and consistency of electronic health record documentation. The trade-off between efficiency and performance among LLM architectures remains a consideration for implementation of LLM for large-scale MK data analysis.
Answer to the Letter on Corneal Endothelial Keratoprosthesis EndoArtin Patients with Glaucoma at High Risk of Graft Failure after Keratoplasty.
Bachmann B, Wiedemann J
Cornea · 2026 Feb · PMID 41379863 · Publisher ↗
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Risk Factors and Effect of Sub-Tenon Triamcinolone on Cystoid Macular Edema After Descemet Membrane Endothelial Keratoplasty: Association and Risk Factor Analysis.
Mizuki Y, Takeda M, Yamagami S … +1 more , Hayashi T
Cornea · 2025 Dec · PMID 41379851 · Publisher ↗
PURPOSE: To evaluate whether sub-Tenon triamcinolone acetonide (STTA) reduces cystoid macular edema (CME) after Descemet membrane endothelial keratoplasty (DMEK) and to identify associated risk factors. METHODS: This ret...
PURPOSE: To evaluate whether sub-Tenon triamcinolone acetonide (STTA) reduces cystoid macular edema (CME) after Descemet membrane endothelial keratoplasty (DMEK) and to identify associated risk factors. METHODS: This retrospective, multicenter observational study included 96 eyes of 78 patients who underwent DMEK in Japan and were followed for ≥12 months. Demographic, ocular, and surgical variables were collected. CME was assessed using spectral-domain optical coherence tomography. Kaplan-Meier analysis with log-rank testing compared CME-free survival between eyes with and without STTA. Cox proportional hazards regression identified risk factors. Best-corrected visual acuity at 12 months was compared between CME-positive and CME-negative eyes. RESULTS: CME developed in 13 eyes (13.5%). Kaplan-Meier analysis showed no significant difference in CME-free survival between STTA users (90.9%) and nonusers (84.6%) at 360 days (P = 0.593). Most CME cases occurred within 90 days postoperatively. Multivariable analysis indicated that preoperative anterior chamber depth showed a trend toward association with CME (P = 0.058), and rebubbling was independently associated with increased risk (P = 0.034). Eyes requiring ≥2 rebubbling procedures had a higher CME risk compared with eyes without rebubbling (P = 0.029). Age, STTA use, and nonsteroidal antiinflammatory drug use were not significantly associated with CME. At 12 months, best-corrected visual acuity did not differ between groups (P = 0.419). CONCLUSIONS: STTA was not significantly associated with a lower incidence of CME after DMEK. Shallow anterior chamber depth showed a trend toward association, and rebubbling was significantly associated, suggesting the need for careful postoperative evaluation.
Chronic Ocular Complications in Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis: Clinical Features and Surgical Management in a Brazilian Tertiary Center.
de Alcântara RJA, Wakamatsu TH, Hirai FE … +5 more , Dos Santos MS, Barreiro TP, Demeda VF, Frizon L, Gomes JÁP
Cornea · 2025 Dec · PMID 41379840 · Publisher ↗
PURPOSE: To characterize the chronic ocular complications of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), focusing on culprit medications, long-term visual outcomes, and surgical interventions in...
PURPOSE: To characterize the chronic ocular complications of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), focusing on culprit medications, long-term visual outcomes, and surgical interventions in a tertiary care population. METHODS: This retrospective cross-sectional study was conducted at the Department of Ophthalmology, Federal University of São Paulo. Patients diagnosed with SJS or TEN in the chronic phase and followed for at least 12 months, between January 2012 and December 2024, were included. Clinical data, best-corrected visual acuity, ocular surface findings, implicated medications, and surgical interventions were analyzed. RESULTS: A total of 112 patients were included (102 with SJS and 10 with TEN). Dipyrone (metamizole) was the most commonly implicated drug (38.4%), followed by penicillin (12.5%), phenobarbital (9.8%), phenytoin (8.0%), and sulfonamides (8.0%). The most prevalent chronic ocular findings were dry eye disease (97.3%), meibomian gland dysfunction (98.2%), limbal stem cell deficiency (78.6%), trichiasis (64.3%), symblepharon (60.7%), conjunctival keratinization (55.3%), and corneal keratinization (24.1%). Visual acuity was often severely impaired. Most patients required surgical interventions (88.4%), including mucous membrane grafts, limbal stem cell transplantation, salivary gland transplantation, penetrating keratoplasty, and keratoprosthesis implantation. CONCLUSIONS: Our findings highlight the significant burden of severe ocular surface disease, the predominance of dipyrone as a causative drug in this population, and the need for complex surgical interventions in a significant proportion of cases. These results underscore the importance of early management of ocular complications, long-term follow-up, and access to advanced therapeutic strategies.
Descemet Membrane Versus Amniotic Membrane for Limbal Stem Cell Therapy.
Bedard P, Yuan C, Lee S … +2 more , Roehrich H, Hou JH
Cornea · 2026 May · PMID 41379646 · Full text
PURPOSE: To compare biomarker expression and proliferation rates of limbal epithelial stem cells (LESCs) cultured on Descemet membrane (DM) versus amniotic membrane (AM). To investigate the suitability of DM as a potenti...
PURPOSE: To compare biomarker expression and proliferation rates of limbal epithelial stem cells (LESCs) cultured on Descemet membrane (DM) versus amniotic membrane (AM). To investigate the suitability of DM as a potential long-term scaffold for transplantation of cultivated limbal stem cells on the ocular surface. METHODS: Donor limbal epithelial cells were pooled, reseeded, and expanded on decellularized DM and AM. LESC biomarker expression was assessed by In-Cell Western and immunocytochemical staining. Cell proliferation was evaluated by BrdU incorporation. Airlift organ cultures were performed on DM-limbal tissue constructs and analyzed with 3D immunofluorescence microscopy to determine if DM could support stratified epithelial growth. Suitability of DM as a potential long-term scaffold for cultured LESCs on the cornea was assessed by evaluating transparency and resistance to collagenase digestion versus AM. RESULTS: Cultured cells exhibited higher expression of putative LESC markers (ABCG2, ABCB5), lower expression of transient amplifying cell marker (p63α), and lower cell proliferation rates on DM versus AM, indicating DM maintained LESC stemness better than AM. Under airlifting conditions, cells on DM stratified with differentiation and expression of corneal epithelial cell biomarkers in superficial layers, while maintaining LESC biomarker expression in basal layers. DM was more transparent and resistant to collagenase digestion than AM. CONCLUSIONS: DM promotes LESC stemness better than AM in ex vivo culture and can support stratified corneal epithelium. DM is also a more transparent and potentially durable epithelial scaffold than AM. DM is a promising new alternative to AM for limbal stem cell therapy.
Comparing Microbiologic Tests for Pathogen Detection in Infectious Keratitis Using Latent Class Analysis.
Aaby M, Lalitha P, Prajna NV … +4 more , Gunasekaran R, Seitzman GD, Doan T, Redd TK
Cornea · 2025 Dec · PMID 41379519 · Publisher ↗
PURPOSE: To compare the diagnostic performance of traditional microbiologic tests and next-generation sequencing methods for infectious keratitis pathogen detection. METHODS: Participants included 86 subjects diagnosed w...
PURPOSE: To compare the diagnostic performance of traditional microbiologic tests and next-generation sequencing methods for infectious keratitis pathogen detection. METHODS: Participants included 86 subjects diagnosed with acute infectious keratitis at Aravind Eye Hospital in Madurai, India. Corneal scrapings from all subjects were evaluated using Gram stain, potassium hydroxide (KOH) smear, culture, and metagenomic deep sequencing (MDS). The sensitivity and specificity of each test were estimated using latent class analysis. RESULTS: Among 86 participants, clinical diagnostic tests demonstrated varying sensitivity and specificity for bacterial and fungal keratitis. Gram stain exhibited high sensitivity (89%) and specificity (94%) for bacterial detection, whereas KOH smears showed only moderate sensitivity (75%) and specificity (69%) for fungal detection. Culture testing had lower sensitivity for bacterial (68%) and fungal (56%) identification, but high specificity (92% and 88%, respectively). MDS demonstrated the best balance of sensitivity and specificity across pathogen classes, with 100% sensitivity and 90% specificity for bacterial keratitis and 82% sensitivity with 94% specificity for fungal keratitis. MDS detected critical pathogens missed by culture in 29% of cases, including those whose identification is essential for guiding clinical management and preventing vision-threatening complications. CONCLUSIONS: MDS demonstrated a favorable balance between sensitivity and specificity for both bacterial and fungal keratitis, whereas smears performed well for bacterial but not fungal keratitis and cultures demonstrated high specificity but low sensitivity. Repeated evaluation of diagnostic performance across diverse populations and geographic settings is necessary to validate the reliability and optimize the clinical utility of microbiologic testing for infectious keratitis.
Utility of Stromal Thickness Maps in Surgical Decision Making for Corneal Crosslinking in Patients With Keratoconus.
Henriquez MA, Fernandez S, Vasquez E … +3 more , Chauca J, Rojas R, Izquierdo L
Cornea · 2025 Dec · PMID 41379517 · Publisher ↗
PURPOSE: To assess the effect of surgical decision making on the type of corneal crosslinking (CXL) protocol in eyes with keratoconus (KC) based on stromal thickness maps and thinnest corneal pachymetry (TCP). METHODS: A...
PURPOSE: To assess the effect of surgical decision making on the type of corneal crosslinking (CXL) protocol in eyes with keratoconus (KC) based on stromal thickness maps and thinnest corneal pachymetry (TCP). METHODS: A prospective, nonrandomized cohort study was performed between January 2022 and January 2023. Patients were allocated to Epi-off or transepithelial CXL (TE-CXL) procedures depending on the TCP value using Scheimpflug. TCP ≥450 μm was used to designate patient's eye to the Epi-off CXL procedure and TCP <450 μm to TE-CXL. On the same day, a combined Placido and Anterior Segment OCT evaluation was performed to assess epithelial thickness (ET) and minimum stromal thickness (MinST). The type of surgery was then finally selected: Epi-off CXL was indicated when MinST ≥400 μm, whereas TE-CXL procedure was indicated when MinST <400 μm. We assessed the percentage of cases in which MinST data changed the surgical decision (Utility). RESULTS: The study included 245 eyes, MinST was 407.26 ± 50.92 (range 223-497). Stromal thickness maps assessed before surgery altered the surgeon's decision making in 5.30% (13 out of 245) of cases. The procedure was changed from Epi-off to TE-CXL and from TE-CXL to Epi-Off in 3.67% and 1.63% of the cases, respectively. CONCLUSIONS: Anterior segment optical coherence tomography stromal thickness maps have minimal impact on the surgical decision making for conventional Epi-off and TE-CXL protocols. Considering that MinST data provide objective information on stromal thickness, unlike TCP, and avoid the need for deepithelialization, their implications in sub-400 protocols may be greater.
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