Search Results (71)

Combined intrastromal corneal ring segment implantation with corneal collagen cross-linking (CXL) aims to improve optical regularity and reduce the risk of ectatic progression in selected eyes with keratoconus. In this retrospective, single-center, complete-case longitudinal series, 58 eyes from 40 patients treated at OCULENS Ophthalmology Clinic between 2019 and 2022 were analyzed after same-session KeraRing implantation and conventional epithelium-off CXL, with baseline and 6-, 12-, 24-, and 36-month follow-up data. Outcomes included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), thinnest pachymetry, maximum keratometry (Kmax), the Belin/Ambrosio enhanced ectasia total deviation index (BAD-D), the C and D components of the ABCD classification, and Corvis ST-derived dynamic deformation parameters. Longitudinal continuous outcomes were analyzed as eye-level repeated-measures estimates with Holm-adjusted paired comparisons, and stage distributions were analyzed with the Friedman test. At 36 months, UDVA improved from 0.560 ± 0.151 to 0.469 ± 0.136 logMAR and CDVA from 0.350 ± 0.109 to 0.287 ± 0.092 logMAR (both p < 0.001). Kmax decreased from 56.11 ± 3.17 D to 54.87 ± 2.86 D, BAD-D improved from 5.62 ± 1.89 to 4.70 ± 1.75, and thinnest pachymetry measured 440.7 ± 21.9 µm at 36 months, corresponding to 97.0% of baseline thickness. Corvis ST-derived deformation behavior shifted toward lower deformation amplitude and higher stiffness parameter at first applanation (SP-A1), but these device-derived parameters should be interpreted as indirect deformation response metrics rather than as direct tissue stiffness measurements. Two clinically significant complications were recorded (2/58 eyes, 3.4%): one sterile corneal infiltrate requiring ring explantation and one case of corneal melting requiring ring explantation and referral for keratoplasty. The findings support sustained 36-month visual, tomographic, and Corvis ST-derived changes after combined treatment, while interpretation remains limited by the retrospective complete-case design, unavailable denominator for cases excluded because of incomplete follow-up, eye-level analysis with bilateral cases, lack of a control group, and indirect nature of Corvis ST-derived biomechanical assessment. Full article

Tear film instability and dry eye disease (DED) are among the most common postoperative complaints after anterior segment surgery. Cataract surgery, corneal refractive procedures, keratoplasty, glaucoma filtration surgery, and pterygium excision can all disrupt ocular surface homeostasis through mechanisms that include corneal denervation, inflammation, goblet cell loss, and meibomian gland dysfunction. The severity and duration of postoperative dry eye vary substantially according to the surgical procedure performed. This review summarises current evidence on the pathophysiology, clinical manifestations, objective tear film changes, and recovery patterns following major anterior segment interventions. Particular emphasis is placed on standardised, non-invasive assessment methods, including tear breakup time, tear meniscus height, meibography, and validated symptom questionnaires. Procedure-specific recovery trajectories are compared to distinguish transient postoperative tear film instability from persistent chronic dry eye disease. Evidence-based management strategies, including preoperative risk stratification, intraoperative optimisation, and multimodal postoperative therapy, are also reviewed. Understanding these distinct recovery patterns may improve surgical planning, patient counselling, early intervention, visual outcomes, and patient satisfaction. Full article

This retrospective multicenter cohort study investigated the incidence, treatment, and prognostic impact of dysregulated intraocular pressure (DIOP; >24 mmHg requiring therapy) in patients with acanthamoeba keratitis (AK). Eighty-one eyes from 81 patients with confirmed AK were included; co-infections were excluded. DIOP and best corrected visual acuity (BCVA) were assessed at baseline, follow-up, and after penetrating keratoplasty (PKP). Overall, 28% of eyes were managed conservatively, 46% required one PKP, and 26% required two. DIOP occurred in 4% before AK, 11% after AK onset, and 10% after the first PKP. Eyes with DIOP prior to PKP had significantly worse final BCVA compared to those without DIOP (0.5 ± 0.7 vs. 1.8 ± 1.1 logMAR, p < 0.001) and required PKP more frequently (100% vs. 67%, p = 0.01). Time to correct diagnosis was significantly longer in the AK-associated DIOP group (64 ± 50 vs. 50 ± 68 days, p = 0.03). DIOP was also associated with higher rates of prior cortisone use and complications, including fixed dilated pupil, cataract, anterior synechiae, and anterior chamber irritation. Overall, DIOP represents a major complication in AK and is linked to poorer visual outcomes. Earlier therapy may help reduce DIOP and hence improve prognosis. Full article

Bullous keratopathy may lead to severe corneal opacity and impaired visualization of anterior segment structures, complicating surgical qualification for endothelial keratoplasty (EK). We report the case of a 67-year-old male with pseudophakic bullous keratopathy and Fuchs endothelial dystrophy presenting with clinically complete corneal opacity and visual acuity limited to hand motion. Slit-lamp examination and anterior segment optical coherence tomography demonstrated marked epithelial remodeling with a dense plaque-like surface lesion obscuring deeper corneal structures. A staged intraoperative approach was undertaken. Following mechanical epithelial debridement, partial restoration of corneal transparency allowed for an intraoperative reassessment of stromal clarity and subsequent Descemet Stripping Automated Endothelial Keratoplasty (DSAEK). Histopathological examination demonstrated reactive epithelial thickening with associated subepithelial fibrosis consistent with chronic bullous keratopathy. Postoperatively, corneal transparency was restored and best-corrected visual acuity improved to 0.7 Snellen (0.15 logMAR), remaining stable during follow-up without graft-related complications or recurrent epithelial abnormalities. This case highlights the importance of considering epithelial contributions to apparent corneal opacity in advanced bullous keratopathy and suggests that staged intraoperative reassessment may support individualized surgical decision-making in selected patients with inconclusive preoperative evaluation. Full article

Background/Objectives: A disadvantage of Descemet stripping automated endothelial keratoplasty (DSAEK) in eyes with prior glaucoma filtration surgery is the difficulty in maintaining air tamponade during the procedure. Herein, we report the use of bleb compressive sutures in managing air tamponade in the anterior chamber during DSAEK in eyes with blebs following trabeculectomy. Methods: This retrospective case series included 34 eyes of 33 patients that developed bullous keratopathy following trabeculectomy. Bleb compression suturing was performed using a 10-0 nylon suture in eyes with an intraocular pressure (IOP) < 10 mmHg or a fragile ischemic bleb. Postoperative IOP, air ingress into the bleb, rebubbling, bleb leakage, and bleb damage were evaluated. Results: Of the 34 eyes, 13 underwent bleb compression suturing before DSAEK (suture group), whereas 21 eyes did not (non-suture group). The mean preoperative IOP was 7.5 ± 2.5 mmHg and 11.2 ± 4.2 mmHg in the suture and the non-suture groups, respectively. The IOP was measured 2 h postoperatively in 14 eyes, increasing by 18 ± 9.3 and 11.7 ± 3.1 mmHg in the suture and non-suture groups, respectively, compared to the preoperative IOP, with no significant differences. At 2 h postoperatively, two eyes in the suture group and one eye in the non-suture group exhibited an IOP spike (≥30 mmHg). One eye in the non-suture group required rebubbling owing to air ingress into the bleb. The mean IOP was 7.1 ± 3.2 and 9.4 ± 4.6 mmHg in the suture and non-suture groups, respectively, 1–2 weeks postoperatively. Preoperative and postoperative IOPs did not significantly differ in either group, and no suture-related complications were observed. Conclusions: For eyes with blebs, bleb compression suturing in DSAEK provides effective air tamponade during graft adhesion. Full article

Eyelid anomalies represent a relevant cause of corneal injury, including epithelial instability and recurrent erosions up to progressive stromal thinning, corneal melt, and, in severe cases, perforation leading to permanent visual impairment. Correction of eyelid dysfunction is the first step in managing these lesions. However, corneal damage may persist or progress despite adequate eyelid treatment. Therefore, a corneal surgical approach is necessary to preserve ocular surface integrity and visual function. This review synthesizes literature published between 2008 and 2025 on corneal complications secondary to eyelid anomalies and postoperative eyelid procedures. We analyzed the mechanisms of eyelid-induced corneal injury, indications for surgical treatment, and corneal surgical strategies, from surface-stabilizing techniques to tectonic interventions. Entropion and ectropion are the most common eyelid abnormalities associated with mechanical trauma and exposure-related corneal disease. Although definitive eyelid correction is necessary for corneal recovery, persistent epithelial defects, stromal thinning, corneal melt, and perforation frequently require corneal surgical management. Surface-stabilizing procedures, such as amniotic membrane transplantation, are effective in early disease stages, whereas progressive stromal defects necessitate tectonic approaches such as lamellar patch grafting or therapeutic keratoplasty. Interventions aimed at visual rehabilitation should be postponed until sustained ocular surface stability has been achieved. Effective management of eyelid-related corneal damage requires both eyelid surgical correction and corneal management. Close collaboration between corneal and oculoplastic surgeons helps achieving good anatomical outcomes and long-term ocular surface stability. Full article

Descemet stripping automated endothelial keratoplasty (DSAEK) is a well-established surgical technique for the treatment of endothelial dysfunction, in which intracameral gas tamponade plays a critical role in graft adherence. We report the case of a 67-year-old pseudophakic woman with advanced Fuchs endothelial corneal dystrophy and symptomatic pseudophakic bullous keratopathy in the right eye, who presented with progressive visual deterioration and underwent DSAEK using an 8.25 mm donor graft inserted with a Busin glide and tamponaded with a 25% sulfur hexafluoride (SF6) gas–air mixture. On the first postoperative day, slit-lamp examination suggested an appropriate anterior chamber configuration and satisfactory graft attachment. However, detailed multiplanar anterior segment optical coherence tomography (AS-OCT), defined here as assessment using vertical, horizontal, and rotational scan orientations, revealed subtle posterior migration of the gas bubble beneath the iris plane. This clinically occult finding indicated altered anterior segment anatomy associated with a risk of secondary angle-closure mechanisms and raised concern for malignant glaucoma. Prompt surgical re-intervention was undertaken on postoperative day one, involving decompression of the misdirected gas bubble and reinjection of a centrally positioned tamponade. This resulted in restoration of normal anterior chamber configuration and stable graft adherence. Best-corrected visual acuity (BCVA) improved from 0.1 Snellen (1.0 logMAR) preoperatively to 0.7 Snellen (0.15 logMAR) at 2 weeks following surgery. This case highlights the added value of multiplanar AS-OCT in detecting clinically occult posterior gas migration after DSAEK, particularly when the abnormality is scan-orientation-dependent and not apparent on slit-lamp examination, thereby enabling timely intervention in the presence of a potentially sight-threatening postoperative configuration. Full article

Objectives: To evaluate whether preoperative anterior segment optical coherence tomography (AS-OCT) parameters differ according to Big Bubble (BB) formation during deep anterior lamellar keratoplasty (DALK) in patients with TGFBI-related corneal stromal dystrophies (CSD). Methods: This retrospective cohort study included 17 eyes from 12 patients undergoing DALK with an attempted BB technique. Stromal deposit depth was assessed by AS-OCT using both a categorical depth-based classification (anterior, mid-, and posterior stroma) and continuous measurements of stromal involvement (µm). The ratio between stromal involvement and the thinnest corneal point was calculated. Intraoperative data included BB success, BB type, and complications. Inter-eye correlation was accounted for in comparisons of continuous variables using linear mixed-effects models. Results: BB formation was achieved in 11 of 17 eyes (64.7%), with type 1 BB observed in all successful cases. BB success was observed in all eyes with anterior or mid-stromal involvement and in 33.3% of eyes with posterior stromal involvement. Greater stromal deposit depth and a higher stromal-depth-to-thinnest-point ratio were observed in eyes in which BB formation failed (p < 0.01). No intraoperative perforations or conversions to penetrating keratoplasty occurred. Inter-observer agreement for AS-OCT measurements was high. Conclusions: BB failure was more frequent in eyes with greater absolute and relative stromal deposit depth, as assessed by preoperative AS-OCT during DALK in TGFBI-related CSD. These AS-OCT-derived parameters may support surgical planning and improve patient selection for BB DALK in this clinical setting. Full article

Background/Objectives: Infectious keratitis remains a major cause of blindness worldwide, and many cases progress to therapeutic keratoplasty despite advances in antimicrobial therapy. This systematic review aims to evaluate the outcomes of therapeutic keratoplasty in microbial keratitis and examine factors influencing anatomical success, graft survival, and visual rehabilitation. Methods: A systematic review was conducted following PRISMA guidelines, including English-language studies, published between 2000 and 2025. Studies with ≥10 eyes and ≥6 months follow-up were included. Data on infection control, graft clarity, anatomical success, visual acuity, and complications were extracted. Results: Fourteen studies encompassing 1527 eyes were analyzed. TPK accounted for 89% of procedures; DALK was used selectively for anterior or mid-stromal infections. Overall infection control ranged from 69 to 100%, with globe preservation in 85–100% of cases. Bacterial keratitis had higher cure rates and graft clarity than fungal or Acanthamoeba keratitis. Larger grafts (>8 mm) and deep stromal involvement were associated with increased graft rejection and postoperative complications. DALK offered higher graft survival and lower immunologic risk when the endothelium was spared. Visual outcomes were generally limited, reflecting preoperative disease severity, timing of surgery, and postoperative immunomodulation constraints. Early surgical intervention improved anatomical outcomes in severe fungal keratitis. Conclusions: Therapeutic keratoplasty is an effective globe-preserving intervention in advanced microbial keratitis, but with limited functional outcomes. Further prospective studies are needed to refine surgical indications, postoperative management, and long-term functional results. Full article

Background/Objectives: Ocular graft-versus-host disease (oGVHD) is a chronic, immune-mediated complication of allogeneic hematopoietic stem cell transplantation that can progress to corneal ulceration or perforation. These cases are often refractory to standard therapy and present a high risk of graft failure after keratoplasty. We report a case of oGVHD-related corneal perforation successfully managed with a novel amniotic membrane-assisted “envelope” technique during corneal transplantation. Case Report: A 42-year-old man with chronic oGVHD and a full-thickness corneal perforation underwent urgent repair with a lamellar patch graft completely wrapped in cryopreserved amniotic membrane, followed by penetrating keratoplasty (PKP) using an amniotic membrane envelope surrounding the donor lenticule. Results: The amniotic membrane provided a 360° biological barrier that isolated graft antigens from the inflammatory environment while supporting epithelial healing and stromal remodeling. Despite recurrent inflammatory episodes and multiple procedures—including cataract extraction, pars plana vitrectomy, and multilayer amniotic membrane transplantation—the graft remained clear and stable at 12-month follow-up, achieving a best-corrected visual acuity of 20/40. Conclusions: The amniotic membrane envelope technique may represent a valuable adjunct in managing high-risk corneal perforations secondary to oGVHD. By combining immune modulation and regenerative support, this approach can enhance tectonic stability, reduce rejection risk, and promote durable surface recovery, potentially delaying or avoiding keratoprosthesis in refractory cases. Full article

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

Background: To present the management of upside–down Descemet membrane endothelial keratoplasty (DMEK) with intraoperative optical coherence tomography (iOCT). Methods: We report the case of a 74-year-old woman who underwent DMEK for Fuchs’ endothelial corneal dystrophy (FECD) of the right eye. Preoperative corrected distance visual acuity (CDVA) was 20/1500 (counting fingers [CF]), and the central corneal thickness (CCT) was 637 μm. No graft markings were made. Graft positioning was determined using iOCT. An improper graft position was suspected due to the lack of postoperative anatomical and functional improvements. The CDVA noted at that time was 20/1500 (CF), and the CCT was 708 μm. The graft was subsequently repositioned. This procedure was performed 33 days after the primary surgery. Results: The central corneal thickness and CDVA were 495 μm and 20/40 sc, respectively, at the final 18-month postoperative follow-up. Conclusions: Incorrect positioning of the transplanted corneal graft should be considered if no improvement is observed after DMEK. The learning curve significantly affects the occurrence of these complications. Graft repositioning, even 33 days after surgery, is associated with a favorable prognosis. Full article

Pseudophakic bullous keratopathy (PBK) is a vision-threatening corneal complication following cataract surgery, characterised by progressive endothelial cell loss, persistent corneal oedema, and painful epithelial bullae, leading to impaired vision. Corneal transplantation, either penetrating or endothelial keratoplasty, remains the primary treatment but faces challenges such as donor tissue shortages, graft rejection, and limited graft longevity. Recently, Rho-kinase (ROCK) inhibitors have emerged as promising pharmacological alternatives. These agents enhance corneal endothelial cell proliferation, migration, and adhesion, suppress apoptosis, and promote corneal deturgescence and wound healing. Several preclinical and clinical studies have demonstrated the efficacy of ROCK inhibitors in improving corneal clarity, endothelial function, and visual acuity in PBK. Their use has been associated with reductions in corneal oedema, improved endothelial cell density, and delayed or prevented the need for corneal transplantation. A systematic literature search of PubMed, Scopus, and Web of Science databases was conducted, restricted to peer-reviewed English-language articles, ensuring comprehensive coverage. ROCK inhibitors represent a novel pharmacological strategy for PBK prevention and management, potentially reducing dependency on donor grafts. Further research is needed to determine long-term safety, optimal dosing, and efficacy. Full article

To describe a technique for managing acute corneal hydrops in eyes with keratoconus using dome stromal drainage with intracameral air injection under real-time three-dimensional (3D) microscope-integrated optical coherence tomography (OCT) guidance. We describe a retrospective case series of six eyes from six patients with keratoconus who developed acute corneal hydrops. All eyes underwent intracameral air injection with controlled dome puncture for stromal fluid drainage, without the use of sutures. The procedure was performed using a 3D visualization system that enables integrated and simultaneous viewing of the surgical field and intraoperative OCT scan (a 3D digitally assisted visualization system that displayed a split-screen view of the surgical field and OCT cross-sections simultaneously). Postoperative resolution of edema and improvement in clarity were documented. The resolution of corneal edema allowed for subsequent mushroom-shaped penetrating keratoplasty performed with a femtosecond laser in four eyes of four patients. All six eyes showed significant resolution of corneal edema within 2 to 4 weeks. Stromal clefts collapsed rapidly after drainage. In each case, the thick edema was reduced to a confined leucoma. No intraoperative or postoperative complications were observed. All four eyes that underwent a femtosecond laser-assisted mushroom-shaped penetrating keratoplasty showed optimal anatomical and functional success. Air-assisted dome drainage, combined with simultaneous 3D and OCT visualization, is a safe and effective technique for treating acute corneal hydrops. This technology enables real-time decision-making and enhances surgical precision, opening the door to advanced procedures that are otherwise limited by corneal opacity. Full article

Background/Objectives: This retrospective observational study evaluates the efficacy of Descemetorhexis without Keratoplasty (DSO) compared to Descemet Membrane Endothelial Keratoplasty (DMEK) in the management of Fuchs Endothelial Corneal Dystrophy (FECD). The outcomes were compared in terms of the corneal anatomical changes, visual results, and complication rates between the two surgical techniques for FECD. Methods: We conducted a retrospective, descriptive, observational study including 31 eyes from 26 patients who underwent either DSO (n = 16) or DMEK (n = 15) at the Department of Ophthalmology, Hospital Arruzafa. Patients were included if they had complete follow-up data at baseline, 6 months, and 1 year post-intervention. Their clinical information was collected from medical records and complementary tests, including the Snellen visual acuity test, Pentacam corneal tomography, and specular microscopy. Results: The average time to achieve best corrected distance visual acuity (CDVA) was significantly longer for DSO (7.44 ± 2.3 months) than for DMEK (5.73 ± 1.9 months, p = 0.004). Complication rates were higher in the DMEK group (26.7%), and in comparison, there was an absence of complications in the DSO group (p = 0.043). Corneal endothelial cell migration was confirmed in patients who underwent DSO, with a mean cell density of 817.17 ± 91.7 cells/mm² after one year. Conclusions: DSO effectively treated the selected patients with FECD who presented central guttata and corneal edema, achieving visual outcomes equivalent to those of DMEK while reducing complication rates. This technique eliminates the need for donor tissue and immunosuppressive medications, making it a viable alternative for specific cases. Full article