Cornea最新文献

{"title":"Two-Piece Mushroom Penetrating Keratoplasty With \"Pull-Through\" Technique to Manage High Vitreous Pressure in Infant Eyes.","authors":"Massimo Busin, Elena Franco, Luigi De Rosa, Linda Marie Louise Busin, Angeli Christy Yu","doi":"10.1097/ICO.0000000000003978","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003978","url":null,"abstract":"<p><strong>Purpose: </strong>To describe the surgical technique for 2-piece mushroom penetrating keratoplasty using the \"pull-through\" technique in infant eyes.</p><p><strong>Methods: </strong>Using a 250-μm microkeratome head, the donor cornea was split into anterior and posterior lamella, which were then punched to 8.0 to 8.5 and 6.0 mm, respectively. After partial trephination of the host cornea (depth = 250 μm, diameter = 7.5-8.0 mm), anterior stromal keratectomy was performed. Another partial-thickness trephination (6.0-mm diameter) was performed on the residual bed, which was then opened full thickness for about 1 o'clock hour at 12, 3, 6 and 9 o'clock positions. The donor anterior lamella was fixated with 4 cardinal sutures over the host residual bed that had been partially opened. Using corneal scissors, the central 6.0-mm trephination of the residual host cornea was completed full thickness and removed under the sutured donor anterior lamella. Descemet stripping automated endothelial keratoplasty microforceps were then inserted under the anterior lamella to grasp and deliver the donor posterior lamella into the anterior chamber through the pull-through technique. Suturing of the anterior lamella was completed with 12 additional interrupted stitches.</p><p><strong>Results: </strong>Surgery was performed in 7 eyes with Peters anomaly between 2 and 12 months. No intraoperative complications were recorded. All grafts were clear at the last follow-up. All patients were able to fix and follow.</p><p><strong>Conclusions: </strong>In infant eyes, fixation of a large anterior lamella over a smaller partially excised recipient cornea allows selective exchange of the centrally diseased host cornea under \"semiclosed system\" conditions, overcoming the threat of expulsion of intraocular structures posed by excessive vitreous pressure and possibly minimizing donor endothelial trauma.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991730","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":"Epstein-Barr Virus Corneal Endotheliitis and Uveitis in a Patient With Extranodal Natural Killer/T-Cell Lymphoma.","authors":"Dong Hee Lee, Hyun Jin Kim, Kyung Eun Han","doi":"10.1097/ICO.0000000000003982","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003982","url":null,"abstract":"<p><strong>Purpose: </strong>To report a case of Epstein-Barr virus (EBV) corneal endotheliitis and uveitis in a patient diagnosed with extranodal natural killer/T-cell lymphoma (ENKTL).</p><p><strong>Methods: </strong>This is a case report performed at a tertiary care center in the Republic of Korea.</p><p><strong>Results: </strong>A 64-year-old man presented with decreased vision in his right eye that had persisted for 4 days. Best-corrected visual acuity was finger counting at 50 cm in the right eye and 0.8 in the left eye. Intraocular pressure was within the normal range in both eyes. Slit-lamp examination revealed scattered keratic precipitations and diffuse corneal edema in the right eye. Because of the severe edema, anterior chamber (AC) details were obscured. In the left eye, +2 inflammatory cells were observed in the AC and +1 cells in the vitreous. A multiplex polymerase chain reaction test using aqueous humor samples from each eye yielded positive results for EBV but negative results for other herpes viruses. One week after initiating treatment with a topical acyclovir ointment, topical steroids, and oral acyclovir, corneal edema and AC inflammation improved. Subsequently, the patient was diagnosed with nasal ENKTL and underwent 3 chemotherapy cycles in the hematology-oncology department. Five months after commencing topical and oral antiviral therapies, best-corrected visual acuities improved to 0.5 in the right eye and 1.0 in the left eye.</p><p><strong>Conclusions: </strong>EBV infection can cause severe corneal edema and uveitis. In patients with ENKTL, EBV should be considered a possible etiology of ocular involvement, and timely ophthalmic management may contribute to better visual outcomes.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991620","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":"Evaluating Natural Progression of Keratoconus in Relation to Age, Gender, and Disease Severity at Presentation.","authors":"Onur Ozalp, Mustafa Kemal Ozaslan, Fatih Apaydin, Metehan Karaatli, Betin Bilkan Karaman, Nilgün Yildirim, Cezmi Dogan, Eray Atalay","doi":"10.1097/ICO.0000000000003979","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003979","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the natural progression of keratoconus (KC) with respect to age, gender, and disease severity at presentation.</p><p><strong>Methods: </strong>This study analyzed 949 eyes from 503 patients with KC followed at Eskişehir Osmangazi University and Istanbul University-Cerrahpaşa between 2009 and 2023. Patients with ≥1 year of follow-up with ≥3 Pentacam (Oculus, Inc) scans spaced ≥3 months apart were eligible. Progression was identified using Belin ABCD Progression Display using 2 baseline visits. Progression rates were analyzed according to age groups (≤18, >18 to ≤24, >24 to ≤30, >30 to <35, and ≥35 years), and KC severity was categorized based on the Topographic Keratoconus Classification (TKC) as subclinical, early-stage (TKC 1-2) and advanced-stage (TKC 3-4). Median time-to-progression (M-TTP) for progressive eyes was calculated with reference to the first presentation.</p><p><strong>Results: </strong>Keratoconus progression rates declined significantly with age (P < 0.001); however, 44.3% of patients aged ≥35 years still showed progression, with the highest rate in those ≤18 years (86.4%). In patients ≥35 years, advanced-stage disease (TKC 3 and 4) markedly increased progression risk (OR: 10.5 [P = 0.03], 20.0 [P = 0.008], respectively). The shortest time-to-progression occurred in patients aged ≤18 years (M-TTP: 8.6 and 5.8 months in TKC 1-2 and 3-4, respectively), whereas in those ≥35 years, advanced-stage disease progressed significantly earlier than early-stage (M-TTP: 18.9 vs. 38.2 months).</p><p><strong>Conclusions: </strong>Although progression typically slows with age, 44% of patients ≥35 years still progressed. The shorter time-to-progression in younger individuals and in older patients with advanced disease at presentation highlight the need for close monitoring in both groups.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144991623","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":"Multicenter Early Experience of Preloaded Descemet Membrane Endothelial Keratoplasty With Endothelium-Inwards Technique With Dextran-Free Preservation Media.","authors":"Alexander Wallace, Mohit Parekh, Matteo Airaldi, Vito Romano, Alfredo Borgia, Enrico Neri, Pietro Viola, Alessandro Ruzza, Stefano Ferrari, Diego Ponzin, Kunal A Gadhvi","doi":"10.1097/ICO.0000000000003965","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003965","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the clinical outcomes of patients treated with preloaded Descemet membrane endothelial keratoplasty (DMEK) with endothelium-inwards fashion stored in dextran-free preservation media.</p><p><strong>Methods: </strong>This study (audit number: 11,392) involved a clinical retrospective analysis of consecutive patients with Fuchs Endothelial Corneal Dystrophy or Bullous Keratopathy at 2 tertiary eye centers. All tissues were stripped using a standard DMEK stripping technique (SCUBA), preloaded with the endothelium facing inwards, stored and shipped in a dextran-free preservation media from the Venice Eye Bank, Italy to Liverpool, United Kingdom and Vicenza, Italy for subsequent surgeries. The main outcome measures included rebubbling rate, best-corrected visual acuity (BCVA), and endothelial cell loss over a 12-month period.</p><p><strong>Results: </strong>Sixty-five eyes of 62 patients were analyzed. At 12 months postoperation, the cumulated mean BCVA improved significantly to 0.25 ± 0.29 logarithm of the minimum angle of resolution from a preoperative BCVA of 0.84 ± 0.55 logarithm of the minimum angle of resolution (P < 0.05), whereas a 33.8% rebubbling rate was recorded with an overall endothelial cell loss of 44.1%.</p><p><strong>Conclusions: </strong>Preloaded endothelium-in DMEK grafts preserved in dextran-free media seem safe and clinically effective, with encouraging outcomes in visual acuity and detachment rates. These results support the feasibility of this approach and highlight the need for prospective controlled trials to confirm its advantages over dextran-based methods.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945708","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":"A Systematic Review and Meta-Analysis Comparing Epithelium-On and Epithelium-Off Corneal Collagen Cross-Linking in Keratoconus Management: Integrating New Evidence.","authors":"Mehrdad Mohammadpour, Shaghayegh Esfandiarifard, Shayan Pourmirbabaei, Paria Bolourinejad","doi":"10.1097/ICO.0000000000003956","DOIUrl":"10.1097/ICO.0000000000003956","url":null,"abstract":"<p><strong>Purpose: </strong>Keratoconus is a progressive corneal ectasia leading to visual impairment. Corneal collagen cross-linking (CXL) is a widely used intervention to halt progression, with 2 main approaches: epithelium-on (Epi-On) and epithelium-off (Epi-Off). This study presents a meta-analysis integrating findings from existing literature and newly analyzed data.</p><p><strong>Methods: </strong>A systematic search was performed to compare Epi-On and Epi-Off CXL outcomes from 2014 to 2024. Meta-analysis techniques were employed to evaluate the changes in visual and imaging outcomes based on the differences between baseline to available 6-month, 1-year, 2-year, and 3-year follow-up. In addition, subgroup analyses were conducted based on study design (randomized controlled trials vs. non-RCT and observational studies) and risk of bias (high vs. low), using standardized risk assessment tools.</p><p><strong>Results: </strong>This meta-analysis included 28 studies, covering 1764 eyes including 875 (49.6%) Epi-Off and 889 (50.4%) Epi-On treated eyes. Maximum keratometry flattening was observed at 6 months (ES = 0.183, P = 0.039), became more pronounced at 1 year (ES = 0.639, P = 0.004), and remained significant at 2 years (ES = 0.377, P <0.001). Central corneal thickness significantly reduced after Epi-Off treatment at 6 months (ES = 0.327, P = 0.012) and 1 year (ES = 0.247, P = 0.040) more than Epi-on group. In addition, spherical equivalent improved significantly at 2 years (ES = -0.395, P = 0.048). In contrast, no significant differences were observed in steepest keratometry, average keratometry, best-corrected distance visual acuity, and uncorrected distance visual acuity between the 2 groups across all follow-up durations. Subgroup analysis supported the robustness of structural outcomes in Epi-Off, particularly in lower risk, observational studies and nonrandomized clinical trials, whereas functional outcomes remained not significant.</p><p><strong>Conclusions: </strong>Epi-Off CXL demonstrates superior topographic and tomographic improvements compared with Epi-On, although visual acuity outcomes remain equivalent. These findings support a personalized approach in selecting CXL technique based on patient profile and treatment goals.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945626","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":"In Vitro Evaluation of Photoactivated Rose Bengal for Growth Inhibition of Fungi Isolated From Keratitis.","authors":"Talita Trevizani Rocchetti, Denise de Freitas, Aileen Miwa Tabuse, Camila Kase, Cynthea Carolina Sanches Zanetti Banqueiro, Jarbas Caiado de Castro Neto, Lucas Orlandi de Oliveira, Maria Cecilia Zorat Yu, Ana Luisa Hofling-Lima","doi":"10.1097/ICO.0000000000003962","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003962","url":null,"abstract":"<p><strong>Purpose: </strong>The aim of this study was to evaluate the activity of photoactivated 0.1% rose bengal (RB) for in vitro growth inhibition of the most prevalent fungi isolates in infectious keratitis.</p><p><strong>Methods: </strong>Eight corneal clinical isolates were included in the experiments: Fusarium solani complex, Purpureocillium lilacinum, Candida albicans, Candida parapsilosis complex, Exophiala oligosperma, Scedosporium apiospermum complex, Aspergillus niger complex, and Curvularia geniculata. Microorganisms, previously identified by phenotypical methods, were grown and incubated at specific conditions and prepared in suspension for concentration adjustments. The following groups were evaluated in triplicate: group I, no treatment; group II, treated with RB and exposed to the dark for 30 minutes; group III, exposed to green-light light-emitting diode 7.2 mW for 30 minutes (photodynamic therapy [PDT]); and group IV, treated with RB and PDT (RB-PDT). The final work concentration was 104 cells per mL. The RB-PDT was combined with Amphotericin B (AmphoB) to target isolates that were not inhibited by RB-PDT alone. Plates were incubated at specific conditions and photographed after growth for pixel analyses.</p><p><strong>Results: </strong>The growth was inhibited after RB-PDT for F. solani complex, P. lilacinum, C. albicans, C. parapsilosis complex, and E. oligosperma, and not inhibited for S. apiospermum complex, A. niger complex, and C. geniculata, even though combining RB-PDT with AmphoB.</p><p><strong>Conclusions: </strong>RB-PDT presented good activity against five of the tested microorganisms. For the first time, we demonstrated that RB-PDT could inhibit growth of P. lilacinum, C. parapsilosis complex, E. oligosperma, and not inhibit S. apiospermum, A. niger complex, and C. geniculata, even when combined with AmphoB.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945748","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":"Global Incidence and Prevalence of Keratoconus: A Systematic Review and Meta-Analysis.","authors":"Aswen Sriranganathan, Clara C Chan, Jobanpreet Dhillon, Tina Felfeli","doi":"10.1097/ICO.0000000000003973","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003973","url":null,"abstract":"<p><strong>Purpose: </strong>To estimate global incidence and prevalence trends of keratoconus (KC).</p><p><strong>Methods: </strong>A systematic review and meta-analysis was conducted using MedLine, Embase, and Scopus databases up to January 2024, including all age groups, sexes, and geographic regions. Pooled incidence and prevalence were estimated using random-effects models, with heterogeneity assessed by χ2 and I2 statistics.</p><p><strong>Results: </strong>This study included 55 studies (53 in meta-analysis). Pooled KC prevalence was 289.1 per 100,000 persons [95% confidence interval (CI) 124.2-671.1] or 0.24% of the population. The pooled incidence was 4.0 per 100,000 person-years (95% CI 2.5-6.3). Males had higher odds of KC compared with females (odds ratio 1.10; 95% CI 1.07-1.13). The 20 to 29 age group had the highest prevalence (525.5 per 100,000 persons; 95% CI 92.6-2822.6) and incidence (20.8 per 100,000 persons-years; 95% CI 12.7-24.1). Prevalence was highest in Africa (2414.2 per 100,000 persons; 95% CI 110.1-1421.5). Prevalence estimates varied significantly across Asian subregions, with lowest prevalence observed in East Asia (12.7 per 100,000 persons; 95% CI 2.81-57.0) and substantially higher rates in West (682.0 per 100,000 persons; 95% CI 141.8-3213.1) and South Asia (1374.5 per 100,000 persons; 95% CI 537.2-3471.5). Prevalence and incidence increased over time, with highest prevalence post-2020 (1155.2 per 100,000 persons; 95% CI 32.4-29682.7) and highest incidence in 2015 to 2019 (15.23 per 100,000 person-years; 95% CI, 8.5-27.3).</p><p><strong>Conclusions: </strong>Over 23.7 million individuals globally are affected by KC, highlighting an increasing global burden of KC and emphasizing the need for further research into temporal and regional patterns to inform public health strategies and optimize patient care.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945778","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":"Indirect Corneal Neurotization: Long-Term Outcomes Using a Sural Nerve Graft in Patients With Facial Palsy and Neurotrophic Keratopathy.","authors":"Tania Albavera-Giles, Guillermo Raul Vera-Duarte, Gustavo Ortiz-Morales, Gerardo Serrano-Robles, Thamar Gomez-Villegas, Alejandro Navas, Enrique Graue-Hernandez, Arturo Ramirez-Miranda","doi":"10.1097/ICO.0000000000003969","DOIUrl":"10.1097/ICO.0000000000003969","url":null,"abstract":"<p><strong>Purpose: </strong>To report long-term clinical outcomes of patients with neurotrophic keratopathy and facial palsy secondary to neurosurgery treated with an indirect technique of corneal neurotization (CN) using a sural nerve graft.</p><p><strong>Methods: </strong>A multicenter, prospective, interventional, noncontrolled study. Subjects underwent indirect CN as part of a staged procedure for reanimation of the affected half of the face using a sural nerve graft coapted to the supratrochlear nerve and nerve fascicles sutured subconjunctivally to the perilimbal region. Data on central corneal sensation, best-corrected visual acuity, tear break-up time, corneal epithelial integrity, corneal stromal opacities, and corneal vascularization were collected.</p><p><strong>Results: </strong>Indirect CN was successfully performed in 14 eyes of 14 patients, with a mean follow-up of 51.61 months. Baseline corneal esthesiometry, defined as the best sensitivity measured in any corneal quadrant, was 0.2 cm (range: 0.00-1.25), improving to 2.83 cm (range: 1.00-5.83) at last follow-up and visual acuity improved from baseline uncorrected distance visual acuity logMAR 0.029 to 0.175 at final follow-up. The time to mean improvement was 6 months. Overall, we observed improvement of the ocular surface health with better tear break-up time, resolution of epithelial defects, a decrease of corneal leukoma and corneal vascularization, and the subjective perception of greater ocular sensitivity in all patients from 3 to 6 months after surgery.</p><p><strong>Conclusions: </strong>CN is a novel procedure that provides a new source of nerve innervation, enhances corneal sensation, and delivers local trophic factors, potentially improving ocular surface health in patients with neurotrophic keratopathy. We successfully implemented this technique in patients with facial paralysis and in those with corneal anesthesia after posterior cranial fossa surgery.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144945767","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":"Impact of Intraoperative Descemet Membrane Perforation on Survival in Deep Anterior Lamellar Keratoplasty for Keratoconus.","authors":"Hiroto Mitamura, Masaki Fukui, Akiko Ogawa, Yukari Yagi-Yaguchi, Daisuke Tomida, Masatoshi Hirayama, Takefumi Yamaguchi, Jun Shimazaki","doi":"10.1097/ICO.0000000000003974","DOIUrl":"10.1097/ICO.0000000000003974","url":null,"abstract":"<p><strong>Purpose: </strong>To investigate the influence of perforation of Descemet membrane (DM) on graft survival outcomes during deep anterior lamellar keratoplasty (DALK) for treating keratoconus.</p><p><strong>Methods: </strong>We retrospectively reviewed 81 eyes of 77 patients with keratoconus who underwent deep anterior lamellar keratoplasty (DALK). Graft survival, best spectacle-corrected visual acuity (BSCVA), corneal endothelial cell density, and postoperative complications were compared between eyes with and without intraoperative Descemet membrane (DM) perforations.</p><p><strong>Results: </strong>The overall rate of clear grafts was 91.4% 5 years after the operation. Intraoperative DM perforations occurred in 44% of the eyes. Graft survival at 5 years did not differ significantly between eyes with (86.1%) and without (95.6%) DM perforation ( P = 0.345). The incidence of double anterior chamber (DAC) was significantly higher in eyes with DM perforation (30.5%) than in eyes without DM perforation (11.1%) ( P = 0.048). Postoperative DAC was significantly associated with graft failure ( P = 0.013), and the 4 groups, with or without DM perforation and with or without DAC ( P = 0.035), differed significantly in graft failure. Visual acuity improved significantly after DALK in comparison with the preoperative BSCVA in eyes with and without DM perforation at all observation periods in both groups ( P < 0.0001). The BSCVA did not significantly differ between the 2 groups, except at 3 months after DALK ( P = 0.045).</p><p><strong>Conclusions: </strong>Intraoperative DM perforation has no negative impact on the long-term prognosis of patients with advanced keratoconus.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871831","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":"Atypical Migratory Serpiginous Corneal Epitheliopathy: Unmasking Herpes Simplex Virus Association.","authors":"Chloe Shields, Swetha Buggareddigari, Saumya Jakati, Sayan Basu, Pragnya Rao Donthineni","doi":"10.1097/ICO.0000000000003966","DOIUrl":"https://doi.org/10.1097/ICO.0000000000003966","url":null,"abstract":"<p><strong>Purpose: </strong>Migratory Serpiginous Corneal Epitheliopathy (MSCE) is a rare condition characterized by migrating corneal epithelial lesions with a serpiginous or amoeboid-shaped appearance. Its etiology remains poorly understood, and the condition often presents a diagnostic and therapeutic challenge. Here, we report a case of a recurrent, unilateral MSCE-like lesion in a 25-year-old woman not responding to standard treatments, including repeated corneal debridement, bandage contact lens placement, and superficial keratectomy with postoperative slow tapering of steroids.</p><p><strong>Methods: </strong>Eventually, microbiological testing of corneal epithelial scrapings obtained during a repeat superficial keratectomy revealed the presence of HSV-1 on both immunofluorescence assay and polymerase chain reaction. Although histopathology did not show classical features of HSV, viral cytopathic effects like perinuclear haloes were noted in some epithelial cells.</p><p><strong>Results: </strong>Based on these findings, our patient was started on topical antiviral therapy (3% acyclovir eye ointment, 5 times daily for 1 month). This led to complete resolution of the lesion, with no recurrence at the last follow-up, 9 months after initiating topical antivirals.</p><p><strong>Conclusions: </strong>To our knowledge, this is the first reported case associating HSV to MSCE, emphasizing the importance of considering viral etiologies and microbiological evaluation, including virology in atypical, recurrent corneal epitheliopathies.</p>","PeriodicalId":10710,"journal":{"name":"Cornea","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144871830","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}