To report 2 cases of lid margin keratinization (LMK) associated with chronic ocular surface inflammation, which were successfully managed using laser photocoagulation. A case report. The first case was a 20-year-old man with mycoplasma-induced rash and mucositis. He presented with a focal patch of lid margin keratinization extending to a small area of inferior tarsal conjunctiva in the right lower eyelid, which was causing keratopathy. He underwent laser photocoagulation but experienced a recurrence after 2 months, which was successfully managed with a repeat laser session. At 6 months posttreatment, there were no recurrences, the keratopathy had resolved, and the ocular surface remained stable. The second patient was an 18-year-old woman with Stevens-Johnson syndrome sequelae. She had LMK in all 4 lids and underwent mucous membrane grafting. Postoperatively, she developed focal recurrences of keratinization at the edges of the graft in all 4 lids. The recurrent keratin plaques were treated with laser photocoagulation with a 577-nm laser under local anesthesia. At her last follow-up, 6 months after recurrence, there were no signs of keratinization. Laser photocoagulation is a safe and effective minimally invasive treatment modality for focal LMK in setting of chronic ocular surface disease. These cases demonstrate its potential as an alternative or adjunct to surgical options like mucous membrane grafting, particularly in a setting of recurrent and localized keratinization.

To compare graft survival and alloimmune responses in murine endothelial keratoplasty (EK) versus penetrating keratoplasty (PK) and to elucidate the immunological mechanisms that underlie the differential graft outcomes. Allogeneic EK and PK were performed in BALB/c recipient mice using fully disparate C57BL/6 donors; syngeneic EK recipients served as controls. Graft clarity was monitored over 16 weeks by slitlamp biomicroscopy and scored using standardized opacity grading. Anterior segment optical coherence tomography (AS-OCT) was used to measure central corneal thickness. Graft survival was assessed using Kaplan-Meier analysis. Immunohistochemistry and confocal microscopy were performed to evaluate corneal endothelial cell (CEnC) integrity through ZO-1 staining. T-cell-mediated alloimmunity was assessed using intracellular IFN-γ staining (flow cytometry) and ELISPOT assays targeting both direct and indirect antigen presentation pathways. PK allografts exhibited significantly higher corneal opacity and lower survival (50%) than allogeneic EK grafts (71.4%, P < 0.0001). AS-OCT showed that corneal edema was highest in rejected PK grafts at 4 weeks and in rejected EK grafts at 16 weeks, with EK displaying a more gradual increase in thickness. Flow cytometry revealed significantly greater frequencies of IFN-γ + CD4 + T cells in PK recipients compared with EK recipients ( P < 0.001). ELISPOT assays demonstrated a more robust Th1 response in PK through both the direct and indirect sensitization pathways. Corneal endothelial cell (CEnC) density was significantly reduced in rejected EK and PK grafts compared with their respective accepted counterparts ( P < 0.01), whereas CEnC density was comparable between accepted EK and PK grafts. EK grafts exhibit higher graft survival rates and significantly reduced activation of host T-cell responses compared with PK grafts, which may be attributed to lower frequencies of graft-borne antigen presenting cells, thus resulting in a milder Th1-mediated immune response.

To evaluate Descemet membrane endothelial keratoplasty (DMEK) graft preparation efficiency, success rate, and graft viability after clinically relevant processing of diabetic human donor corneas using DescePrep or submerged cornea using backwards away (SCUBA). Fifteen pairs of diabetic donor corneas with an average diabetic risk score of 4.0 ± 1.3 and mild-moderate cell loss were processed for DMEK by an experienced certified eye bank technician. Corneas within each pair were randomly assigned to DescePrep or SCUBA and trephined with the number 7 trephine for orientation marking. Donor cornea characteristics, preparation duration, number of graft touches, and success rate were recorded. To simulate clinical graft preparation, DMEK grafts were loaded into a Straiko Modified Jones Tube, shipped, and unscrolled on a glass slide before masked cell viability analysis. We found that 93.3% (14/15) of corneas per group were prepared successfully by DescePrep and by SCUBA. DescePrep significantly reduced overall preparation time from 19.2 ± 0.5 to 15.1 ± 1.1 minutes ( P < 0.005) and significantly reduced stripping time from 10.9 ± 0.5 to 6.97 ± 1.1 minutes ( P < 0.005). Grafts processed by DescePrep and SCUBA demonstrated comparable cell loss of 15.8% ± 1.2% and 16.1% ± 1.4%, respectively, after loading, shipping, and unscrolling. DescePrep offers safe and reliable DMEK graft preparation with high success rates in diabetic tissue. DescePrep reduced preparation time by 21.3% and the number of endothelium contacts by 85.7% in comparison to SCUBA.

To report a case of late dehiscence of an EndoArt implant and its successful management 10 months after initial implantation. Case report. A 73-year-old man with a history of multiple failed Descemet membrane endothelial keratoplasty procedures on the right eye underwent EndoArt implantation for bullous keratopathy. The initial surgery was successful with improved visual acuity and a well-attached implant. However, 10 months after implantation, the patient experienced decreased visual acuity because of implant dehiscence in the superior quadrant. A rebubbling procedure using 20% Schwefelhexafluorid (SF6) gas without additional corneal sutures was performed, resulting in successful reattachment of the implant. Although EndoArt dehiscence typically occurs within the first 3 months after implantation, this case demonstrates that late dehiscence can occur even after prolonged implant attachment. Our report highlights the possibility of successful management through rebubbling without additional sutures and emphasizes the importance of extended follow-up for patients with this novel implant.

To provide an updated brief review on neurotrophic keratopathy (NK) including classification, etiology, features, diagnosis, and management. Literature review. NK is defined as the dysfunction of corneal innervation that results in dysregulation of corneal and/or cellular function. It is characterized by loss of corneal sensation and neuronal homeostasis, leading to eventual corneal epithelial breakdown and ultimately keratolysis if untreated. Classification, etiology, features, diagnosis, and management of NK are reviewed. Prevalence is likely higher than previously estimated, and decreased sensation can originate from various causes. The Neurotrophic Keratitis Study Group classification emphasizes verifying corneal sensation early and distinguishes different epithelial and stromal aspects of NK. Optimal treatments regardless of NK stage include preservative-free lubricants (tears, gels, and ointments), punctal occlusion, autologous serum tears/umbilical cord serum drops/platelet-rich plasma drops, and removal of toxic or preservative-containing medications. Specific direct treatments, such as cenegermin and neurotization, address the decreased innervation and can improve sensation. A timely tarsorrhaphy may be necessary in refractory or quickly progressing cases. Keratoplasty is high risk in this setting but may be possible with aggressive medical therapy, adjunct procedures (i.e., amniotic membrane, tarsorrhaphy), perioperative direct treatments increasing sensation, and close follow-up postoperatively. NK is a chronic and potentially progressive disease that requires vigilance to monitor for future progression even after periods of apparent stability. As in other serious chronic conditions without a cure, earlier intervention in this challenging disease may obviate future decompensation and visually significant sequelae.

Unfolding a Descemet membrane endothelial keratoplasty (DMEK) graft in vitrectomized eyes is technically demanding because of the characteristic deepening of the anterior chamber seen in these patients. The PRESS & ROLL technique was developed for use in this challenging scenario to facilitate graft unfolding by combining central corneal indentation with controlled rolling of a small air bubble. After insertion of the DMEK graft through the main incision, proper graft orientation is first confirmed. A small air bubble is then injected above the graft. Central corneal indentation is gently applied using a blunt instrument to shallow the space between the graft and the pupillary area. While maintaining central indentation, the surgeon rolls the air bubble circumferentially around the corneal depression, gradually unfolding the graft toward the periphery in all directions. Once the graft is completely unfolded, air is fully injected beneath the graft while simultaneously releasing the indentation pressure. In both cases, conventional unfolding maneuvers were unsuccessful because of repeated anterior chamber deepening. The PRESS & ROLL technique enabled complete and controlled graft unfolding without intraoperative complications. At 3 months, both eyes showed successful graft attachment with improved resolution of corneal edema and visual acuity, along with reduced corneal thickness. The PRESS & ROLL technique offers a practical and effective method for DMEK graft unfolding in vitrectomized or complex eyes with deepening of the anterior chamber. It enhances intraoperative control and predictability in challenging surgical environments.

To describe the outcome of type I keratoprosthesis (KPro) cases over 10 years of follow-up. This retrospective study analyzed data of 125 eyes of 124 patients, which underwent type I KPro between 2009 and 2014 (74: Boston KPro; 51: Auro KPro). Eyes with KPro exchange were included. Eyes that retained a KPro ≥10 years (24 eyes) were compared with the rest of the cohort (101 eyes). The most common indication for surgery was limbal stem cell deficiency [74/125 (59%)]. The KPro retention was 51.2 ± 6% (anatomical) and 30.3 ± 4.7% with respect to visual recovery at 10 years for the cohort of 125 eyes. Among the 24 eyes (19%) that retained the KPro ≥10 years, 17 (71%) received Boston KPro and 7 (29%) received Auro KPro. Glaucoma was seen in 23 eyes (96%), of which 15 eyes (63%) required a glaucoma drainage device. Eighteen eyes (75%) retained the first implanted KPro. The preoperative median best-corrected visual acuity was significantly better in the group that retained the KPro ≥10 years (log MAR 2.8 vs. 3; P = 0.04). Incidence of glaucoma and retroprosthetic membrane was higher in the group that retained the KPro ≥10 years ( P <0.001). Nineteen percent of eyes operated for KPro over a 5-year period retained a KPro at ≥10 years. A higher incidence of complications was seen with longer follow-up emphasizing the need to schedule frequent follow-up visits, thus enhancing long-term outcomes.