Cornea最新文献

{"title":"Regression of Recalcitrant Corneal Neovascularization and Graft Revival With Systemic Bevacizumab: A Case Report.","authors":"Evita Muller, Poonam Sharma, Leo Feinberg, Shakeel Ahmad, Katherine Scatchard, Neil Bowley, Mitra Tavakoli, Harry Roberts","doi":"10.1097/ICO.0000000000004158","DOIUrl":"10.1097/ICO.0000000000004158","url":null,"abstract":"<p><strong>Purpose: </strong>Corneal neovascularization is a sight-threatening pathology arising from various conditions and compromises keratoplasty survival. Treating neovascularization is critical for graft outcomes; however, both medical and surgical interventions often fail in severe cases. We report the first known case of regression of corneal neovascularisation associated with systemic bevacizumab accompanied by unexpected recovery of a previously failed Descemet Membrane Endothelial Keratoplasty (DMEK).</p><p><strong>Methods: </strong>A 64-year-old woman presented with right eye bullous keratopathy and deep stromal neovascularization after phakic intraocular lens implantation. Corneal neovascularization persisted despite phakic intraocular lens explantation, vessel cautery, and subconjunctival bevacizumab. The patient subsequently underwent combined phacoemulsification and Descemet membrane endothelial keratoplasty (DMEK), which failed secondary to graft rejection despite intensive topical steroid therapy. Further local therapies, including repeat vessel cautery and intrastromal bevacizumab, were unsuccessful. The patient was later diagnosed with ovarian cancer and treated with systemic bevacizumab, carboplatin, and paclitaxel.</p><p><strong>Results: </strong>After systemic therapy for ovarian cancer, the deep stromal vascularization markedly regressed, together with complete resolution of the corneal edema. Central corneal thickness improved from 1111 μm at rejection to 510 μm. Importantly, this represented not only vascular regression but functional recovery of a DMEK that had remained edematous for 10 months and had been considered irreversibly rejected. Visual acuity remained limited (0.8 logMAR) by residual central lipid keratopathy.</p><p><strong>Discussion: </strong>This case demonstrates significant regression of deep established corneal neovascularization in a failed DMEK after systemic bevacizumab previously refractory to local therapy and apparent revival of a previously failed DMEK. To our knowledge, this represents the first reported case of systemic bevacizumab, administered as part of a triple systemic anticancer therapy, associated with regression of advanced corneal neovascularization and recovery of corneal clarify after DMEK failure. Although causality cannot be definitively established, the temporal association suggests a potential adjunctive role for systemic anti-VEGF therapy in selected cases of refractory corneal neovascularization and possibly restore function in transplants thought to have failed irreversibly.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":"1432-1436"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147644040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association Between Keratoconus and Inflammatory Bowel Disease: A Systematic Review and Meta-Analysis.","authors":"Shayan Lahijanian, Himal Kandel, Richard Kha, Stephanie L Watson","doi":"10.1097/ICO.0000000000004201","DOIUrl":"10.1097/ICO.0000000000004201","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate an association between inflammatory bowel disease and keratoconus.</p><p><strong>Clinical relevance: </strong>Keratoconus can be difficult to diagnose early, and because of its progressive nature, early treatment is beneficial to preserving vision. Understanding potential associations of systemic disease with keratoconus may aid the development of screening protocols and guide early management decisions.</p><p><strong>Methods: </strong>Our search of 5 key databases (PubMed, Ovid Medline, Scopus, Web of Science, and Embase) was conducted on October 16, 2024. The selected papers were categorized as patient studies or genetic association studies for analysis. The primary outcome was odds ratio. Meta-analysis and test of assumptions was conducted on patient studies. Bias assessments were conducted using Q-GENIE and ROBINS-E.</p><p><strong>Results: </strong>Our search yielded 299 publication titles, of which 9 were included in our systematic review and 3 were incorporated into the meta-analysis. The aggregate odds ratio of patient-focused studies was 1.39 (95% confidence interval: 0.82-2.37). In the 4 studies investigating Crohn disease, there was no significant causal association (all P -values >0.05). All 5 genetic association studies demonstrated a genetic association between either inflammatory bowel disease (as a collective) and/or ulcerative colitis and keratoconus.</p><p><strong>Conclusions: </strong>The literature demonstrated a genetic association between ulcerative colitis and keratoconus. This association has not been consistently replicated in patient-focused studies.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":"1467-1472"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626575/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148301128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corneal Densitometry for Early and Long-Term Evaluation of Surgical Outcomes After Phototherapeutic Keratectomy for Granular, Macular, and Lattice Corneal Dystrophy.","authors":"Tim Berger, Berthold Seitz, Elias Flockerzi, Albéric Sneyers, Shady Suffo, Loay Daas","doi":"10.1097/ICO.0000000000004039","DOIUrl":"10.1097/ICO.0000000000004039","url":null,"abstract":"<p><strong>Purpose: </strong>To evaluate early and long-term outcomes of phototherapeutic keratectomy (PTK) in granular (GCD), macular (MCD), and lattice corneal dystrophy (LCD) using corneal densitometry as an objective marker for surgical efficacy.</p><p><strong>Methods: </strong>In this retrospective study, 51 eyes from 31 patients (GCD: n = 27; MCD: n = 13; LCD: n = 11) undergoing PTK were analyzed. Corneal tomography and densitometry were assessed preoperatively and at intervals up to over 5 years. Mixed-model analysis was used for statistical evaluation ( P ≤ 0.05).</p><p><strong>Results: </strong>In GCD, best-corrected visual acuity (BCVA) improved from 0.4 ± 0.3 to 0.2 ± 0.1 logMAR after 6 to 12 months, with sustained reductions in anterior densitometry (0-2 mm and 2-6 mm zones) for up to 1 year. LCD eyes showed a short-term densitometry decrease in the 2 to 6 mm anterior zone at 6 weeks, but no significant BCVA improvement. MCD eyes demonstrated improved BCVA at 6 to 12 months, despite increased densitometry in anterior and central layers at 6 weeks. After 2 years, densitometry of the anterior and central layer as well as the total corneal thickness in all diameters were not statistically different to the preoperative values in all 3 groups.</p><p><strong>Conclusions: </strong>PTK effectively improves BCVA and corneal transparency in GCD, where densitometry provides a useful objective measure. In LCD, densitometry changes are transient and do not clearly reflect functional benefit. In MCD, densitometry has limited value due to diffuse stromal involvement and does not correlate with visual improvement. Overall, corneal densitometry may support preoperative planning and postoperative follow-up in selected dystrophies, with its strongest applicability in GCD.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":"1374-1384"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145494958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Yield of Corneal, Contact Lens, and Lens Fluid Cultures in Microbial Keratitis: A 12-Year Single-Center Study.","authors":"Matteo Airaldi, Alfredo Borgia, Davide Romano, Siddarth Nardeosingh, Tobi Somerville, Vito Romano, Timothy Neal, Stephen B Kaye","doi":"10.1097/ICO.0000000000004045","DOIUrl":"10.1097/ICO.0000000000004045","url":null,"abstract":"<p><strong>Purpose: </strong>To determine the yield of culturing contact lenses (CL) and contact lens fluid/cases (CLF) to isolate recognized pathogens in suspected microbial keratitis (MK).</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>In suspected MK, culturing the CLF and CL can increase the probability of detecting a recognized pathogen that in turn may help guide treatment.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":"1401-1407"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13626590/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145741474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Posterior Segment Pressurization With Intravitreal Balanced Salt Solution to Stabilize Anterior Chamber Gas During Endothelial Keratoplasty.","authors":"Mohammad Soleimani, Kareena Chawla, Kavon Rahmani, Mubarik Mohamed","doi":"10.1097/ICO.0000000000004245","DOIUrl":"10.1097/ICO.0000000000004245","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a novel technique for managing anterior chamber (AC) instability during endothelial keratoplasty in eyes with compromised anterior segment architecture through posterior segment pressurization via intravitreal balanced salt solution (BSS) injection.</p><p><strong>Methods: </strong>In eyes with distorted iris anatomy, large peripheral iridectomies, prior vitrectomy, or iris-lens diaphragm instability undergoing Descemet stripping automated endothelial keratoplasty (DSAEK) or Descemet membrane endothelial keratoplasty, intraocular air or gas may migrate posteriorly, destabilizing the AC and compromising graft apposition. We describe a technique in which approximately 0.2 mL of BSS is injected through the pars plana into the vitreous cavity using a 30-gauge needle, providing transient posterior segment pressurization to stabilize the globe. After injection, the needle is maintained in position with gentle plunger control for approximately 2 minutes to allow stabilization of posterior segment pressure and sustained globe firmness.</p><p><strong>Results: </strong>The technique was successfully applied in 3 complex cases: 1) an 81-year-old man with atonic pupil, postvitrectomy, and glaucoma tube shunt undergoing DSAEK; 2) an 82-year-old female postvitrectomy patient undergoing DSAEK; and 3) 77-year-old man with large peripheral iridectomy undergoing Descemet membrane endothelial keratoplasty. All cases achieved stable AC configuration and secure graft attachment without excessive air/gas fill or posterior gas migration.</p><p><strong>Conclusions: </strong>Posterior intravitreal BSS injection provides an effective method to stabilize the iris-lens diaphragm and maintain AC architecture during endothelial keratoplasty when conventional air/gas injection alone is insufficient.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":"1449-1451"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148367281","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diurnal Variation in Corneal Stromal and Epithelial Thickness in Fuchs Endothelial Corneal Dystrophy: With and Without Intensified Hypertonic Saline Eyedrop Application.","authors":"Michal Cieplucha, J Menzel-Severing, F Steindor, R Bock, M Roth, G Geerling","doi":"10.1097/ICO.0000000000004041","DOIUrl":"10.1097/ICO.0000000000004041","url":null,"abstract":"<p><strong>Purpose: </strong>The purpose of this study was to investigate diurnal fluctuations in corneal stromal and epithelial thickness in patients with Fuchs endothelial corneal dystrophy (FECD), with and without intensified hypertonic 5% saline eye drops, using anterior segment optical coherence tomography.</p><p><strong>Methods: </strong>In this prospective observational study, patients with FECD were examined using anterior segment optical coherence tomography imaging (Anterion, Heidelberg Engineering) to measure corneal epithelial and stromal thickness at admission and on the following morning at 0-, 45-, 60-, and 90-minute postawakening. Eyes were divided into 3 groups: FECD without treatment, treated with hypertonic saline, and post-Descemet membrane endothelial keratoplasty. FECD treated with hypertonic saline eyes received 5 drops of 5% NaCl eye drops at 5-minute intervals after awakening. Corrected distance visual acuity and subjective visual clarity were assessed at admission and at 0, 60, and 90 minutes.A linear mixed-effects model was used to account for the inclusion of both eyes from the same patient, thereby addressing the nonindependence of data.</p><p><strong>Results: </strong>A total of 48 eyes from 25 patients with FECD were analyzed. Overnight corneal swelling was predominantly due to stromal thickening (median increase of 21.0 μm, interquartile ranges 13.0), with a minimal change in the epithelial layer (median increase of 2.0 μm, interquartile ranges 4.75) in the whole cohort. Application of hypertonic saline eyedrops accelerated the physiological deswelling process, leading to almost double the reduction in corneal thickness within 60 minutes after waking compared with untreated eyes (median decrease of 13.0 μm vs. 7.0 μm; estimate -6.24 μm; 95% confidence interval, -9.58 to -2.90; P < 0.001), an effect primarily attributed to stromal thinning. No significant effects of pachymetric fluctuations on corrected distance visual acuity or subjective visual clarity were observed at any time point between the groups.</p><p><strong>Conclusions: </strong>Diurnal fluctuations in corneal thickness in FECD are predominantly stromal. The intensified application protocol of hypertonic saline drops reduces morning corneal edema but does not result in improved vision.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":"1385-1391"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145457862","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subconjunctival Botulinum Toxin-A Injection as a Treatment for Neuropathic Corneal Pain.","authors":"Michael Christensen, Donald R Nixdorf, Wassef Chanbour","doi":"10.1097/ICO.0000000000004262","DOIUrl":"10.1097/ICO.0000000000004262","url":null,"abstract":"<p><strong>Purpose: </strong>To describe a new perilimbal subconjunctival botulinum toxin type A (BTX-A) injection technique and its outcomes in patients with refractory neuropathic corneal pain.</p><p><strong>Methods: </strong>The procedure involves BTX-A injection into the nasal and temporal perilimbal subconjunctival spaces (10 units per site, 20 units total) under topical anesthesia. Pain levels, corneal sensitivity, and adverse events were assessed during follow-up.</p><p><strong>Results: </strong>Two patients with chronic neuropathic corneal pain refractory to both topical and systemic treatments received perilimbal subconjunctival BTX-A injections. In patient 1, the initial lower-dose injections did not result in meaningful improvement; clinical response was observed after dose escalation to 10 units per site. Patient 2 received a single injection session (10 units per site). Both patients experienced clinically significant reductions in pain levels and reductions in corneal sensitivity as measured by Cochet-Bonnet esthesiometry within 2 weeks of the injections with the effective dose. The need for artificial tear drops decreased after each set of injections. Pain relief diminished at approximately 3 months. Subconjunctival hemorrhage and intermittent diplopia were reported, but these events were self-limited within a week, with no long-term complications observed.</p><p><strong>Conclusions: </strong>Perilimbal subconjunctival BTX-A injection may offer a safe, minimally invasive adjunctive treatment for patients with refractory neuropathic corneal pain. The observed analgesic effects are consistent with putative mechanisms and other clinical observations. Larger controlled studies are needed to define optimal dosing, durability, and long-term safety.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":"1452-1455"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the Gut-Eye Axis: Microbial Dysbiosis in Vernal Keratoconjunctivitis.","authors":"Alireza Peyman, Mohsen Pourazizi, Mohammad Kazemi, Fatemeh Ghorbani, Zahra Chitsaz Esfahani, Faeze Ahmadi Beni, Pegah Noorshargh, Sarah Ghorbani","doi":"10.1097/ICO.0000000000004037","DOIUrl":"10.1097/ICO.0000000000004037","url":null,"abstract":"<p><strong>Purpose: </strong>To investigates the gut microbiota in patients with vernal keratoconjunctivitis (VKC) compared with normal subjects.</p><p><strong>Method: </strong>A case-control study was conducted involving 32 patients with VKC and 16 age- and sex-matched healthy controls. Fecal samples were collected and analyzed using quantitative PCR to measure the abundance of 5 bacterial groups: Prevotella , Firmicutes , Faecalibacterium , Bifidobacterium , and Bacteroides . In addition, clinical severity scores for VKC symptoms and signs were recorded and analyzed.</p><p><strong>Results: </strong>Patients with VKC exhibited significant microbial dysbiosis compared with controls, including an upregulation of Prevotella (mean fold change 21.579; P <0.001) and downregulation of Firmicutes , Faecalibacterium , and Bifidobacterium ( P < 0.01 for all). No significant correlations were observed between microbial levels and clinical severity scores.</p><p><strong>Conclusions: </strong>The study identifies significant gut microbial imbalances in patients with VKC, suggesting that dysbiosis may play a role in the disease. Microbiota-targeted interventions, such as probiotics and dietary modifications, may offer novel strategies for managing VKC.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":"1368-1373"},"PeriodicalIF":2.3,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145539140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Supervised Reduction Protocol for Management of Herpetic Stromal Keratitis.","authors":"Shohan Shetty, Mizna Akbar, Philip Zhou, Jackson T Moran, Kevin Chung, Todd P Margolis, Asim V Farooq","doi":"10.1097/ICO.0000000000004349","DOIUrl":"https://doi.org/10.1097/ICO.0000000000004349","url":null,"abstract":"<p><strong>Purpose: </strong>Herpetic stromal keratitis (SK) caused by herpes simplex virus (HSV) or varicella zoster virus (VZV) can cause sight-threatening corneal scarring. Given high recurrence rates of herpetic SK with steroid reduction and limited consensus on treatment duration, we examine outcomes of an approach we term the supervised reduction protocol (SRP).</p><p><strong>Methods: </strong>Among 162 patients with ocular HSV or VZV evaluated between September 2016 and June 2025, 53 had SK managed with SRP. Under the SRP, patients underwent frequent slit-lamp evaluation allowing for early detection and management of stromal inflammation. Topical steroids and systemic antivirals were only reduced under direct physician supervision to ensure quiescence before further reduction.</p><p><strong>Results: </strong>Thirty-three patients had HSV SK and 20 had VZV SK. The median time from diagnosis to quiescence was 72 days [interquartile range (IQR) 35.5-145)] for HSV SK and 51 days (IQR 24.5-77) for VZV SK. The median time from quiescence to recurrence of clinical SK was 63 days (IQR 44-250) for HSV SK and 175 days (IQR 124.3-358) for VZV SK. Most recurrences occurred after steroid discontinuation; none occurred on QID dosing. Recurrence rates were 33% (HSV) and 50% (VZV), and most were asymptomatic at the time of recurrence (73% HSV, 50% VZV). Visual acuity remained stable from initial diagnosis to quiescence.</p><p><strong>Conclusions: </strong>Close follow-up under the SRP allows for detection and treatment of early, often asymptomatic recurrences before they progress to symptomatic or vision-threatening disease. This was a single-site retrospective study of one physician's outcomes; thus, these findings do not establish that SRP is superior to others management approaches. Prospective, multisite comparative effectiveness studies are needed to validate the role of SRP for herpetic SK.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact Lens-Assisted Femtosecond Laser Harvesting of Donor Bowman Layer Grafts: A Pilot In Vitro Study With Preliminary Clinical Application in Advanced Keratoconus.","authors":"Pedro Bertino, Ricardo Machado-Soares, Renata Soares Magalhães, Guilherme Andrade do Nascimento Rocha, Luciene Barbosa de Sousa, Renato Ambrósio","doi":"10.1097/ICO.0000000000004335","DOIUrl":"https://doi.org/10.1097/ICO.0000000000004335","url":null,"abstract":"<p><strong>Purpose: </strong>To describe and evaluate a pilot technique using a sterile bandage contact lens (CL) as a spacer to overcome the minimum-depth limitations of applanation-based femtosecond laser (FSL) platforms when harvesting thin donor Bowman layer (BL) grafts, with preliminary clinical application in BL transplantation for advanced keratoconus (KC).</p><p><strong>Methods: </strong>This experimental and interventional case series included 9 in vitro donor corneas and 4 in vivo eyes with progressive KC. A ∼70-μm plano CL was applied to the bare donor stroma. The FSL dissection depth was programmed by adding the intended graft thickness to the CL thickness (110 μm for a ∼40-μm BL graft). Graft thickness and morphology were evaluated via optical coherence tomography (OCT). For the clinical cases, grafts were implanted into FSL-created stromal pockets; in vivo outcomes were limited to anterior segment OCT assessment of graft integration, graft thickness, and central corneal thickness over 12 months of follow-up.</p><p><strong>Results: </strong>The combined success rate for graft preparation was 92.3% (12/13). In vitro BL grafts yielded a median central thickness of 70 μm. The in vivo BL grafts achieved a median central thickness of 46 μm, with a median deviation of 1.5 μm from the individualized targets. Over the 12-month follow-up, anterior segment OCT showed all grafts to remain well integrated within the stromal pocket, with no displacement or interface complications.</p><p><strong>Conclusions: </strong>In this pilot study, the CL-assisted FSL protocol proved a reproducible method for harvesting BL grafts. By bypassing the minimum depth constraints of widely used applanation-based FSL platforms, this technique may minimize tissue loss and expand surgical access to BL transplantation for managing advanced KC, pending confirmation in larger series.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.3,"publicationDate":"2026-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149243523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}