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Clinical Diagnosis and Management of Corneal Diseases
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Clinical Diagnosis and Management of Corneal Diseases

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Ophthalmology".

Deadline for manuscript submissions: 10 March 2026 | Viewed by 2227

Special Issue Editors

Dr. Eirini-Kanella Panagiotopoulou

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Guest Editor
1. Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Dragana, Alexandroupolis, Greece
2. School of Medicine, Democritus University of Thrace, 68100 Dragana, Alexandroupolis, Greece
Interests: ophthalmology; cataract; corneal diseases; presbyopia; multifocal intraocular lenses
Dr. Georgios Labiris

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Guest Editor
Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Dragana, Alexandroupolis, Greece
Interests: ophthalmology; cataract; corneal diseases; presbyopia; multifocal intraocular lenses; corneal transplantation; refractive surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Panagiota Ntonti

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Guest Editor
1. Department of Ophthalmology, University Hospital of Alexandroupolis, 68100 Dragana, Alexandroupolis, Greece 2. School of Medicine, Democritus University of Thrace, 68100 Dragana, Alexandroupolis, Greece
Interests: ophthalmology; cataract; corneal diseases; presbyopia; multifocal intraocular lenses; glaucoma

Special Issue Information

Dear Colleagues,

Significant progress has been made in the diagnosis and treatment of corneal diseases. Advanced imaging techniques, such as high-resolution anterior segment OCT, corneal topography, tomography, and in vivo confocal microscopy, now enable earlier and more accurate detection of conditions including keratoconus, corneal dystrophies, trauma, infectious keratitis, and drug-induced toxicity. The integration of artificial intelligence and biomechanical analysis has further improved diagnostic precision and risk assessment. In terms of treatment, developments in medical, surgical, and regenerative approaches—from targeted antimicrobial treatments to lamellar keratoplasty and cell-based therapies—have expanded options for managing complex cases. Innovations in corneal cross-linking and tissue engineering also offer new opportunities for restoring corneal health. In this Special Issue, we welcome authors to submit papers on emerging diagnostic tools, clinical innovations, and novel therapies in the management of corneal diseases.

Dr. Eirini-Kanella Panagiotopoulou
Dr. Georgios Labiris
Dr. Panagiota Ntonti
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • corneal imaging
  • corneal disease diagnosis
  • corneal therapeutics
  • regenerative corneal treatments
  • artificial intelligence in corneal diagnostics
  • corneal cross-linking
  • lamellar keratoplasty

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Published Papers (4 papers)

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Research

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11 pages, 516 KB  
Article
Avoiding Post-DMEK IOP Elevation: Insights from a Standardized Surgical Approach
by Stephanie D. Grabitz, Anna L. Engel, Mohammad Al Hariri, Adrian Gericke, Norbert Pfeiffer and Joanna Wasielica-Poslednik
J. Clin. Med. 2026, 15(2), 521; https://doi.org/10.3390/jcm15020521 - 8 Jan 2026
Viewed by 232
Abstract
Background: Descemet membrane endothelial keratoplasty (DMEK) is the most frequently performed keratoplasty procedure in many countries. One of the most common early complications is an elevation of intraocular pressure (IOP). The aim of this study was to characterize early postoperative IOP behavior following [...] Read more.
Background: Descemet membrane endothelial keratoplasty (DMEK) is the most frequently performed keratoplasty procedure in many countries. One of the most common early complications is an elevation of intraocular pressure (IOP). The aim of this study was to characterize early postoperative IOP behavior following DMEK performed with 10% sulfur hexafluoride (SF6) tamponade and to determine the frequency and timing of required IOP-lowering interventions within the first 48 h. Methods: We retrospectively reviewed postoperative outcomes of 116 consecutive DMEK procedures between May and December 2024 at the University Medical Center in Mainz, Germany. No specific exclusion criteria were applied. All surgeries included a surgical iridectomy at the 6 o’clock position, 10% (SF6) tamponade, and maintaining a mid-normal IOP at the end of surgery. Postoperative assessments included IOP measured using Goldmann applanation tonometry, the percentage of gas fill in the anterior chamber evaluated at the slit lamp, and the need for IOP-lowering interventions as determined by the on-call resident at 3, 24, and 48 h after surgery. IOP-lowering interventions consisted of venting in cases of elevated IOP, gas fill > 90%, and/or suspected angle closure or pupillary block, as well as intravenous or oral acetazolamide in cases of moderate IOP elevation with a lower gas fill and a patent iridectomy. If a single intervention was insufficient, a combined approach was used. Results: A total of 116 eyes from 98 patients (62 female, mean age 73.0 ± 9.8 years) were analyzed. DMEK was combined with cataract surgery in 41 eyes, and 4 eyes underwent phakic DMEK. Postoperatively, all iridectomies remained patent, and no cases of pupillary block occurred. Mean IOP and gas fill were within normal limits and declined steadily during the first 48 h. IOP-lowering procedures were performed in 11 eyes (9.5%), including venting (n = 3), acetazolamide administration (n = 7), and a combination of both (n = 1). There was no difference between DMEK and triple-DMEK regarding postoperative gas fill, IOP, or the need for IOP-lowering interventions. Mean postoperative IOP was significantly higher, and IOP-lowering interventions were more frequent in glaucoma vs. non-glaucoma patients. Re-bubbling was performed in 12 eyes (10.3%). Two cases of primary graft failure (1.7%) were recorded. Conclusions: In our patient cohort, a standardized surgical approach incorporating a surgical iridectomy at the 6 o’clock position, 10% SF6 tamponade, and maintaining a mid-normal IOP at the end of surgery effectively prevented pupillary block. We recommend early postoperative assessment of IOP and percent gas fill to promptly identify and manage impending IOP elevation, which is particularly important in patients with glaucoma. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management of Corneal Diseases)
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10 pages, 1060 KB  
Article
Cross-Linked Carboxymethyl Cellulose and Silk Proteins in Corneal Re-Epithelialization: A Case Series
by Francesco Boselli, Fabio Scarinci and Romina Fasciani
J. Clin. Med. 2025, 14(18), 6600; https://doi.org/10.3390/jcm14186600 - 19 Sep 2025
Viewed by 887
Abstract
Background/Objectives: Corneal re-epithelialization is a critical process following surgical procedures such as photorefractive keratectomy (PRK), phototherapeutic keratectomy (PTK), and corneal UV cross-linking (CXL), as well as cases of corneal abrasion. Delayed epithelial healing can lead to increased discomfort, a higher risk of infection, [...] Read more.
Background/Objectives: Corneal re-epithelialization is a critical process following surgical procedures such as photorefractive keratectomy (PRK), phototherapeutic keratectomy (PTK), and corneal UV cross-linking (CXL), as well as cases of corneal abrasion. Delayed epithelial healing can lead to increased discomfort, a higher risk of infection, and suboptimal visual outcomes. This retrospective case series aims to evaluate the efficacy of a novel ophthalmic solution containing cross-linked carboxymethyl cellulose (CX-CMC) and silk proteins in promoting corneal re-epithelialization and improving post-surgical recovery. Patients and methods: A total of 15 patients who underwent PRK, PTK, or CXL or who presented with corneal abrasions were included in the study. Along with standard post-surgical treatment, patients received CX-CMC and silk protein-based eye drops (CORDEV, Ophtagon, Rome, Italy) six times a day. Corneal epithelial thickness was assessed using topography at follow-up visits. Results: Corneal re-epithelialization was observed in all subjects within 24 to 48 h post-procedure. The mean corneal epithelial thickness at 48 h was 73.21 µm, which falls within the typical range of a proliferating corneal epithelium. Conclusions: The CX-CMC and silk protein-based formulation accelerated corneal healing, achieving rapid epithelial recovery. This novel ophthalmic solution offers a promising alternative to conventional post-surgical treatments, potentially improving patient outcomes by reducing healing time, minimising discomfort, and lowering the risk of complications associated with delayed re-epithelialization. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management of Corneal Diseases)
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Review

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14 pages, 693 KB  
Review
Corneal Cross-Linking in Keratoconus: Comparative Analysis of Standard, Accelerated and Transepithelial Protocols
by Ruta Jaruseviciene, Ruta Tamuleviciute and Saulius Galgauskas
J. Clin. Med. 2026, 15(2), 490; https://doi.org/10.3390/jcm15020490 - 8 Jan 2026
Viewed by 229
Abstract
Keratoconus is a progressive, non-inflammatory corneal ectasia characterized by stromal thinning and conical protrusion. Corneal collagen cross-linking (CXL) remains the only proven treatment to halt its progression. This review compares the mechanisms, efficacy, and safety of standard (Dresden), accelerated, and transepithelial (including iontophoretic) [...] Read more.
Keratoconus is a progressive, non-inflammatory corneal ectasia characterized by stromal thinning and conical protrusion. Corneal collagen cross-linking (CXL) remains the only proven treatment to halt its progression. This review compares the mechanisms, efficacy, and safety of standard (Dresden), accelerated, and transepithelial (including iontophoretic) protocols, with particular emphasis on pediatric keratoconus. Studies from PubMed, Scopus, and Web of Science were comprehensively reviewed. Standard CXL remains the gold standard due to its strong biomechanical effect and long-term stability. Accelerated protocols reduce treatment time while maintaining comparable outcomes in selected patients, though the stiffening effect may be shallower. Transepithelial and iontophoretic approaches improve comfort and reduce complications but show reduced efficacy. Future perspectives include oxygen supplementation, customized fluence modulation, and pharmacologic enhancers to improve riboflavin diffusion and oxygen availability. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management of Corneal Diseases)
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Other

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15 pages, 2536 KB  
Case Report
In Vivo Confocal Microscopy and Anterior Segment Optical Coherence Tomography in Optimizing Diagnosis and Therapeutic Management in Fungal Keratitis: Case Reports and Literature Review
by Alina Gabriela Gheorghe, Ana Maria Arghirescu, Maria Cristina Marinescu, Ancuța Georgiana Onofrei, Doina Mihaela Pop, Liliana Mary Voinea and Radu Constantin Ciuluvică
J. Clin. Med. 2025, 14(22), 8066; https://doi.org/10.3390/jcm14228066 - 14 Nov 2025
Viewed by 620
Abstract
Background: Fungal keratitis remains a serious threat to vision, often progressing despite medical therapy and requiring surgical intervention. Therapeutic deep anterior lamellar keratoplasty (DALK) and therapeutic penetrating keratoplasty (TPK), are frequently required but carry risks of infection recurrence and graft rejection. As [...] Read more.
Background: Fungal keratitis remains a serious threat to vision, often progressing despite medical therapy and requiring surgical intervention. Therapeutic deep anterior lamellar keratoplasty (DALK) and therapeutic penetrating keratoplasty (TPK), are frequently required but carry risks of infection recurrence and graft rejection. As timely identification of the etiological agent is essential for improving the outcomes in infectious keratitis, in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) are instrumental in providing insights that can guide better therapeutic decision-making and improving outcomes in fungal keratitis. Case Description: We report the cases of two previously healthy patients (case one, 56-year-old woman; case two, 38-year-old man), who have presented in our service with unilateral infectious keratitis after ocular trauma with vegetable matter during outdoor activities, with a visual acuity of counting fingers and hand motion, respectively. Slit-lamp examination revealed unilateral extensive corneal infiltrates suggestive for fungal etiology in both cases. In vivo confocal microscopy (HRT-3, Heidelberg Retina Tomograph 3/Rostock Cornea Module, Heidelberg Engineering, Heidelberg, Germany) identified lesions suggestive for Candida Albicans and Acanthamoeba coinfection in case one and filamentous fungal keratitis in case two. Anterior segment optical coherence tomography (MS-39, CSO, Italy) was used to monitor the extent and morphology of the infiltrates. The patients underwent therapeutic DALK and TPK, respectively, with good results at the one-year follow-up. Conclusions: Our cases illustrate the advantages of incorporating IVCM and AS-OCT as complementary imaging techniques into clinical practice. IVCM and AS-OCT in fungal keratitis could lead to an earlier diagnosis, more accurate dynamic treatment response evaluation, and the identification of high-risk features for aggressive fungi for a more tailored medical and surgical management. Full article
(This article belongs to the Special Issue Clinical Diagnosis and Management of Corneal Diseases)
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