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Corneal Diseases and Corneal Transplantation: Current Updates and Perspectives
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Corneal Diseases and Corneal Transplantation: Current Updates and Perspectives

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

Deadline for manuscript submissions: 20 September 2025 | Viewed by 3079

Special Issue Editors

Dr. Itay Lavy

E-Mail Website
Guest Editor
Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
Interests: ophthalmology; myopia; corneal diseases; eye anterior segment; cataract; cornea
Dr. Nir Erdinest

E-Mail Website
Guest Editor
Department of Ophthalmology, Faculty of Medicine, Hadassah-Hebrew University Medical Center, Hebrew University of Jerusalem, Jerusalem 91120, Israel
Interests: cornea; corneal topography; myopia; keratoconus; contact lenses
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As Guest Editors of the forthcoming Special Issue on corneal diseases and corneal transplantation, we warmly invite scholars, clinicians, and researchers to contribute original manuscripts that will enrich our collective understanding of these critical areas of ophthalmology. Corneal diseases can significantly impair vision, causing discomfort and leading to blindness if untreated. Corneal transplantation remains a pivotal intervention, offering hope to those with severe corneal damage.

This Special Issue aims to compile a comprehensive collection of peer reviewed articles exploring various topics related to corneal diseases and transplantation. We invite original articles or reviews focusing on, but not limited to, the following potential topics: prevalence and epidemiology of corneal diseases, advancements in diagnostic technologies and imaging techniques, and corneal transplantation outcomes and techniques.

We are particularly interested in manuscripts addressing the latest research on corneal endothelial, novel approaches to improve graft survival, the impact of donor and recipient factors on transplantation outcomes, and the application of artificial intelligence in corneal disease diagnosis and management. Additionally, insights into patient quality of life post-transplantation and strategies for addressing challenges in global access to corneal transplantation are highly welcome.

We are honored to invite contributors to submit their studies, helping to advance the field and improve patient care.

Dr. Itay Lavy
Dr. Nir Erdinest
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 100 words) can be sent to the Editorial Office for announcement on this website.

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 diseases
  • corneal transplantation
  • imaging techniques
  • pharmacological in-terventions
  • surgical interventions
  • tissue engineering

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Published Papers (5 papers)

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18 pages, 549 KiB  
Article
Clinical Evaluation of Ripasudil for Corneal Edema: A Large-Scale Retrospective Cohort Study
by Nir Erdinest, Michael Tabi, Nadav Shemesh, Jamel Corredores, Claudia Yahalom, Yossi Eshel, Benjamin Stern, David Smadja, Zvi Gur and Itay Lavy
J. Clin. Med. 2025, 14(15), 5572; https://doi.org/10.3390/jcm14155572 - 7 Aug 2025
Viewed by 281
Abstract
Objectives: This study evaluated the therapeutic potential of topical Ripasudil hydrochloride hydrate in managing various forms of corneal edema. Methods: This retrospective study included 96 patients of 72.20 ± 10.52 years, with 53 females (55.2%) who were treated with Ripasudil for corneal edema, [...] Read more.
Objectives: This study evaluated the therapeutic potential of topical Ripasudil hydrochloride hydrate in managing various forms of corneal edema. Methods: This retrospective study included 96 patients of 72.20 ± 10.52 years, with 53 females (55.2%) who were treated with Ripasudil for corneal edema, with a mean treatment duration of 5.2 ± 2.3 months, divided into four groups: post-cataract surgery (n = 32), Fuchs endothelial corneal dystrophy (FECD; n = 29), post-Descemet membrane endothelial keratoplasty (DMEK; n = 25), and post-penetrating keratoplasty (PKP; n = 10). All patients were treated with Ripasudil, typically administered three times daily in the first week and twice daily in the following months. Clinical efficacy outcomes were assessed using changes in best-corrected visual acuity (BCVA), central corneal thickness (CCT), and endothelial cell count (ECC) with specular microscopy, anterior segment optical coherence tomography (OCT), and slit-lamp examination, while intraocular pressure (IOP) was measured using the iCare tonometer. Results: Ripasudil treatment led to a reduction in CCT and improvement in visual acuity across most groups, with minimal changes in ECC. CCT decreased by 30.44 μm (p < 0.001), 25.56 μm (p < 0.001), 8.41 μm (p = 0.05), and 6.80 μm (p > 0.1); visual acuity improved by 0.27 (p = 0.001), 0.18 (p = 0.02), 0.17 (p = 0.025), and 0.07 logMAR units (p > 0.1); and ECC changed by +7.0 (p > 0.1), 15.4 (p > 0.1), −7.6 (p > 0.1), and 2.3 cells/mm2 (p > 0.1) in the post-cataract surgery, FECD, post-DMEK, and post-PKP groups, respectively. Conclusions: No adverse events or progression of edema were recorded during the follow-up period. These findings support the role of Ripasudil as a non-invasive pharmacological approach to managing corneal edema and delaying or possibly avoiding surgical interventions, such as corneal transplantation, in selected cases. Full article
(This article belongs to the Special Issue Corneal Diseases and Corneal Transplantation: Current Updates and Perspectives)
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11 pages, 218 KiB  
Article
Outcomes of Femtosecond Laser-Assisted Arcuate Keratotomy in the Management of Keratoplasty-Related Astigmatism
by Majed S. Alkharashi, Mohammed M. Abusayf, Khalid B. Alburayk and Abdulmajeed S. Alkharashi
J. Clin. Med. 2025, 14(13), 4526; https://doi.org/10.3390/jcm14134526 - 26 Jun 2025
Viewed by 427
Abstract
Background/Objectives: Post-keratoplasty astigmatism can limit visual recovery even after successful corneal transplantation. Femtosecond laser-assisted arcuate keratotomy (FSAK) has emerged as a method to reduce high residual astigmatism and enhance visual outcomes. This study aimed to evaluate the outcome of FSAK in treating [...] Read more.
Background/Objectives: Post-keratoplasty astigmatism can limit visual recovery even after successful corneal transplantation. Femtosecond laser-assisted arcuate keratotomy (FSAK) has emerged as a method to reduce high residual astigmatism and enhance visual outcomes. This study aimed to evaluate the outcome of FSAK in treating astigmatism following keratoplasty. Methods: This retrospective study included 32 eyes from 31 patients who underwent FSAK after keratoplasty. Inclusion required complete suture removal, regular corneal topography, and the absence of additional ocular pathology or prior intraocular surgery. Data collected included uncorrected (UCVA) and best-spectacle-corrected visual acuity (BSCVA), manifest refraction, and tomographic parameters. The primary outcomes were changes in visual, refractive, and tomographic measures across the entire cohort, with further subgroup analysis between penetrating keratoplasty (PKP) and lamellar keratoplasty (LKP) eyes. Secondary outcomes were documentation of complications. Results: UCVA improved significantly from 0.92 ± 0.33 to 0.58 ± 0.39 LogMAR (p < 0.001). BSCVA showed a non-significant trend toward improvement from 0.32 ± 0.21 to 0.26 ± 0.22 LogMAR (p = 0.158). The manifest cylinder reduced significantly from −6.15 ± 2.75 D to −4.49 ± 2.92 D (p = 0.037). Corneal topography revealed significant postoperative steepening in keratometric values. While overall outcomes were comparable between the subgroups, LKP eyes demonstrated a greater myopic shift and a higher rate of overcorrection, whereas PKP eyes tended toward undercorrection. Conclusions: FSAK appears to be an effective approach for reducing post-keratoplasty astigmatism and improving uncorrected visual acuity. Given the biomechanical differences between graft types, individualized treatment planning based on graft characteristics may enhance surgical predictability and optimize outcomes. Full article
(This article belongs to the Special Issue Corneal Diseases and Corneal Transplantation: Current Updates and Perspectives)
20 pages, 942 KiB  
Article
Comparison of Recurrent and Naïve Keratitis in a Cohort of 1303 Patients
by Maciej Kwiatkowski, Emilia Babula, Aleksandra Sikora, Justyna Izdebska, Janusz Skrzypecki, Jacek P. Szaflik and Joanna Przybek-Skrzypecka
J. Clin. Med. 2025, 14(11), 3760; https://doi.org/10.3390/jcm14113760 - 27 May 2025
Viewed by 550
Abstract
Objectives: Microbial keratitis is a precursor to corneal scarring, the fifth-leading cause of blindness and visual impairment worldwide. Despite its significance, there is a paucity of data quantifying the recurrence rates of keratitis and the subsequent corneal damage. This study aims to [...] Read more.
Objectives: Microbial keratitis is a precursor to corneal scarring, the fifth-leading cause of blindness and visual impairment worldwide. Despite its significance, there is a paucity of data quantifying the recurrence rates of keratitis and the subsequent corneal damage. This study aims to address this gap by providing a comprehensive analysis of the frequency and origin of keratitis recurrences and its impact on visual deterioration. Methods: We retrospectively analyzed a cohort of 1303 patients diagnosed with microbial keratitis at the Independent Public University Eye Hospital in Warsaw, Poland, between January 2018 and December 2023. All adult patients with at least one documented episode of infectious keratitis were included in the study. Patients were divided into two cohorts: Group 1: patients with recurrent keratitis (n = 233) and Group 2: patients with the first episode of keratitis (n = 1070). Results: The recurrence rate of keratitis was 17.88% (233 of 1303 patients), regardless of etiology. Visual acuity on admission did not differ significantly between the recurrent and naïve groups. However, among patients with at least three episodes, visual acuity was worse (median logMAR for 1 vs. 2 vs. 3 recurrences were the following: 0.30 (0.08–0.67) vs. 0.60 (0.12–1.30) vs. 0.44 (0.20–0.92), accordingly, p = 0.049). Univariate logistic regression identified contact lens usage as a significant risk factor for recurrence (OR 2.37, 95% CI: 1.84–3.08, p < 0.001), also including its inappropriate use (OR 2.25, 95% CI: 1.42–3.66, p = 0.001). In terms of etiology, bacteria were the most common identified cause of keratitis in both the recurrent and naïve groups, accounting for 38.36% (90 cases) in Group 1 and 47% (503 cases) in Group 2. Viruses were the second most prevalent etiology, representing 31.33% (73 cases) in Group 1 and 19.91% (213 cases) in Group 2. Furthermore, a multivariate logistic regression model indicated that advanced age, delayed treatment, fungal etiology, and post-corneal transplant status were strongly associated with worse visual outcomes. Conclusions: Although each recurrence contributes to cumulative vision loss, the majority of patients with recurrent keratitis present with a useful visual acuity (0.3 to 0.60 logMAR). Our study identified older age, fungal etiology, delayed treatment, and post-keratoplasty keratitis as the most significant risk factors for visual deterioration. These findings underscore the need for targeted interventions in populations at higher risk of adverse visual outcomes. Full article
(This article belongs to the Special Issue Corneal Diseases and Corneal Transplantation: Current Updates and Perspectives)
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14 pages, 5383 KiB  
Article
Classification of Histologically Proven Inflammation in Clinically Inactive Corneal Scars: Implications for Graft Outcomes After Penetrating Keratoplasty
by Max Schliffka, Helena Siegel, Claudia Auw-Haedrich, Christian van Oterendorp, Daniel Boehringer and Thomas Reinhard
J. Clin. Med. 2025, 14(2), 461; https://doi.org/10.3390/jcm14020461 - 13 Jan 2025
Viewed by 930
Abstract
Background/Objectives: Clinically inactive corneal scars have repeatedly been shown to exhibit histological inflammation. This study aimed to evaluate the degree of histological inflammation in clinically inactive corneal scars of different origins and its correlation with graft rejection and failure following penetrating keratoplasty. [...] Read more.
Background/Objectives: Clinically inactive corneal scars have repeatedly been shown to exhibit histological inflammation. This study aimed to evaluate the degree of histological inflammation in clinically inactive corneal scars of different origins and its correlation with graft rejection and failure following penetrating keratoplasty. Methods: The study included 205 primary corneal explants with clinically inactive central scars resulting from herpes simplex virus keratitis (HSV, n = 55), keratoconus (n = 39), mechanical trauma (n = 27), scrophulosa (n = 22) or other/unknown causes (n = 62). Central histological sections were categorized by the degree of inflammation, and an overall inflammation score (IS) was calculated. Results: HSV-associated scars exhibited a trend towards more graft rejection with higher IS (p = 0.074). Keratoconus-associated scars showed no IS-dependent differences in graft rejection or failure. The rejection rate in this group was 13/39. Scars resulting from mechanical trauma, such as perforating injuries, demonstrated a trend towards higher graft rejection (p = 0.15) and failure rates (p = 0.089) with increasing IS. The rejection rate in this group was 11/27. Scrophulosa-associated scars had significantly higher graft rejection rates (p = 0.041) at a lower cut-off of 0.06 compared to the cut-off of 0.36 for the other groups. Scars of other or unknown causes showed no IS-dependent differences in graft rejection or failure. Conclusions: Histological inflammation in HSV scars and scars resulting from mechanical trauma appeared to contribute to graft rejection. Despite low IS, the rejection rate in keratoconus scars and scars following mechanical trauma was unexpectedly high, indicating the presence of other influencing factors. While some correlations did not reach statistical significance due to small sample sizes in the subgroups, the observed trends should be considered clinically relevant. The study may have been “underpowered”, as histopathologically inflamed specimens with clinically inactive corneal scars are relatively rare. Full article
(This article belongs to the Special Issue Corneal Diseases and Corneal Transplantation: Current Updates and Perspectives)
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13 pages, 1336 KiB  
Case Report
Resuturing a Dislocated Scleral-Fixated Intraocular Lens in Brown–McLean Syndrome
by Suguru Nakagawa, Atsushi Okubo and Kiyoshi Ishii
J. Clin. Med. 2025, 14(16), 5769; https://doi.org/10.3390/jcm14165769 - 14 Aug 2025
Abstract
Background/Objectives: Brown–McLean syndrome (BMS) is a rare peripheral corneal edema that may arise years after cataract extraction or intraocular lens (IOLs) fixation. This article presents a case of IOL dislocation following scleral fixation in a patient with BMS, effectively managed by resuturing [...] Read more.
Background/Objectives: Brown–McLean syndrome (BMS) is a rare peripheral corneal edema that may arise years after cataract extraction or intraocular lens (IOLs) fixation. This article presents a case of IOL dislocation following scleral fixation in a patient with BMS, effectively managed by resuturing the existing IOL. Additionally, a literature review was conducted to summarize the clinical features, etiologies, and surgical outcomes of BMS. A PubMed search identified 30 reports encompassing 169 patients (244 eyes). Among these, corneal transplantation was performed in three eyes. Only four eyes underwent intraocular surgery after BMS onset, with no prior reports of IOL resuturing. Methods: A 73-year-old man with a history of left-eye trauma underwent vitrectomy and scleral fixation of a polymethyl methacrylate IOL 18 years prior. The patient presented with reduced vision in his left eye. Examination revealed BMS-related peripheral corneal edema and partial IOL dislocation. The dislocated haptic was resutured using an ab externo approach under a scleral flap. Results: Postoperative IOL fixation remained stable, with best-corrected visual acuity improving from 0.6 to 0.9. Edema persisted without central spread, and endothelial cell density decreased slightly (2496 to 2364 cells/mm2). One year postoperatively, no IOL tilt progression or suture-related complications were observed. Conclusions: Partial resuturing of a scleral-fixated IOL is effective for managing IOL dislocation in BMS when haptics remain stable. This approach minimizes incision size and potential endothelial trauma compared to explantation. However, aqueous dynamics correction may not reverse established BMS. Long-term endothelial monitoring is advised due to its chronic and progressive nature. Full article
(This article belongs to the Special Issue Corneal Diseases and Corneal Transplantation: Current Updates and Perspectives)
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