Cornea Service Research Articles

Accuracy of keratoconus-specific formulae compared to standard formulae for intraocular lens power calculation in patients with keratoconus.

To compare the accuracy of keratoconus-specific formulae for nontoric and toric intraocular lenses in eyes with keratoconus undergoing cataract surgery. Consecutive retrospective case series. Patients with keratoconus who underwent cataract surgery. A retrospective chart review was conducted on cataract surgeries performed by the Cornea Service in the Department of Ophthalmology and Visual Sciences of the University of British Columbia from 2000 to 2023. The Kane keratoconus, Kane, Barrett Universal 2, Barrett True K, SRK II, SRK/T, Hoffer Q, Holladay I, EVO, Hill RBF and Hoffer QST, and Pearl DGS formulae were calculated. The postoperative mean absolute error (MAE) and mean prediction error (MPE) were calculated for each formula. A total of 133 eyes from 88 patients were eligible for inclusion in the study, 113 from 74 patients received nontoric IOLs, and 20 from 14 patients received toric IOLs. Pearl DGS had the most myopic MPE of -0.51 ± 1.04, which was statistically significant (p < 0.001) compared to all other formulae. There were no statistically significant differences in the MPE and MAE of the Kane keratoconus, Kane, Barrett Universal 2, Barrett True K keratoconus-specific formula, SRK II, SRK/T, Hoffer Q, Holladay I, EVO, Hill RBF and Hoffer QST formulae (p > 0.05). There was no difference in IOL power estimation accuracy with keratoconus-specific formulae compared to conventional formulae for cataract surgery in KC patients. The IOL power estimation in KC remains significantly less accurate compared with non-KC patients.

A Detailed Analysis of Individuals Having Graft Failure After Corneal Transplantation

ABSTRACT Purpose To describe demographic and clinical characteristics of patients with graft failure after keratoplasty, determine the cause of graft failure and outcomes. Methods The charts of patients between 2008–2013 in the Cornea Service at Wills Eye Hospital with a history of a corneal transplant before the end of 2012 were retrospectively reviewed. Included were patients who had graft failure after corneal transplantation and had at least one year of follow-up after transplantation. Penetrating keratoplasty (PK) and Descemet’s stripping endothelial keratoplasty (DSEK) patients were analyzed separately. Results A total of 186 eyes of 170 patients with graft failure after a PK (156) or DSEK (30) procedures were identified. The baseline characteristics included 100 female and 70 male patients with an age between 0 and 90 years (median 63 years). At the time of surgery, 38% had three or more systemic diseases and 68% were using three or more systemic medicines. Mean follow up time for PK was nearly four times of DSEK. Only 2 DSEK eyes (7%) underwent a 3rd DSEK graft, while 47 (30%) PK eyes underwent a 3rd PK and 15 (10%) PK eyes underwent more than three PK procedures. Conclusions Most DSEK failures occurred in 1st year, while graft failure in PKs is scattered over years. Failure in DSEK is mostly due to graft or surgical risk factors but in PK mostly due to factors in the host. DSEK does not appear to be as affected by the patients’ demographic and clinical characteristics as much as PK.

Primary Pterygium Excision Surgery: Analysis of Risk Factors and Clinical Outcomes.

Purpose To evaluate clinical outcomes of primary pterygium excision surgery and analyze risk factors for pterygium recurrence. Setting Eye Treatment Centre, Cornea and External Diseases Service, Whipps Cross Hospital, London, United Kingdom. Methods Retrospective case series of eyes undergoing primary pterygium excision between August 2017 and July 2022. Patients who underwent "pterygium excision" documented in the electronic patient record system were identified. Patients with recurrent pterygium and those lost-to-follow-up were excluded. The duration of follow-up, type of surgery performed (primary conjunctival closure, conjunctival autograft, and amniotic membrane transplantation), recurrences with respect to the type of surgery performed, and postoperative complications were collected and analyzed. Results In total, 83 eyes (from 79 patients) were included. The mean age of our patient cohort was 59.3 ± 5.9 years. The most common ethnic distribution was Black Caribbean (15.7%). Conjunctival autograft was performed in 76 eyes (91.6%), primary conjunctival closure was performed in five eyes (6%) and amniotic membrane transplantation was performed in two eyes (2.4%). The recurrence rate with conjunctival autograft was 1.3% with a median time to recurrence of 2.98 months. Recurrence was significantly more common in patients below the age of 40 years (p=0.03). Recurrence was not significantly associated with gender (p=0.23), ethnicity (p=0.17), or grade of surgeon (p=0.38). Conclusion Our findings demonstrate the effectiveness of conjunctival autograft with fibrin glue fixation for the surgical management of primary pterygium. Recurrence was found to be significantly more common in patients under the age of 40 years old. However, recurrence was not associated with ethnicity,gender, or surgeon grade.

Prevalence of tomographic features associated with subclinical oedema in Fuchs dystrophy across three commercially available corneal tomographers

Aims/Purpose: Specific tomographic alterations suggestive for subclinical oedema have a known impact on FED prognosis. Here, we compare the prevalence of tomographic alterations associated with subclinical oedema in patients affected by Fuchs Endothelial Dystrophy (FED) imaged with corneal tomographers employing three different technologies.Methods: Patients with a clinical diagnosis of FED referred to the cornea service underwent tomography with 3 different devices: the Pentacam Scheimpflung camera (Oculus, Germany), the Casia2 AS‐OCT (Tomey, Japan), and the Precisio 2 blue‐light slit‐scanning tomographer (IVIS, Italy). All patients had confirmed corneal guttae at slit‐lamp examination. Subjects were classified into FED with no oedema, FED with subclinical oedema, and FED with clinical oedema according to a validated classification based on pachymetric and posterior elevation maps appearance on the Scheimpflung camera. The prevalence of these features was compared across the 3 devices, then two experienced ophthalmologists (M.A., M.L.P.) assigned a 0–3 score according to their evidence. A mixed‐effects binomial model estimated Odds Ratios (OR) for the scores of the 3 devices.Results: A total of 30 eyes were included: 7 eyes presented with clinically defined oedema, 18 eyes with no clinical oedema but tomographic features suggestive of subclinical oedema, and 5 eyes with no oedema and no tomographic alterations. The prevalence of Loss of parallel isopachs, Displacement of thinnest point, and Focal posterior depression did not differ between devices. However, identification of Loss of parallel isopachs was most evident on Precisio 2 compared to Pentacam (OR 9.6, p = 0.007), and the Displacement of thinnest point was most evident on Precisio 2 compared to both Pentacam and Casia2 (OR 6.9, p = 0.01 and OR 15.1, p = 0.005). 3 eyes showed alterations only on Precisio 2, one of which was later scheduled for DMEK.Conclusions: Scheimpflung camera, AS‐OCT, and blue‐light slit‐scanning based tomographers were all able to detect tomographic changes in FED. Nevertheless, our results suggest that the blue laser, slit‐scanning tomographer might be able to detect earlier, and delineate better, subclinical changes in FED.

Evaluation Outcomes and Complications of Temporary Suture Tarsorrhaphy (TST) in Cases of Impending Corneal Ulcer Perforation

Introduction: A corneal ulcer, a defect of the corneal epithelium involving the underlying stroma, is a potentially vision-threatening ocular emergency. Even with prompt treatment patients can suffer significant morbidity with complications including corneal scarring or perforation, development of glaucoma, cataracts or anterior and posterior synechiae, and vision loss. Objective: to evaluate outcomes and complications of temporary suture tarsorrhaphy (TST) in cases of impending corneal ulcer perforation. Methods: In this retrospective study was carried out at Department of Ophthalmology, Ad-din Akij Medical College, Khulna and Eye Hospital, Khulna, Bangladesh from January to June 2022. All cases of fungal keratitis that had undergone TST after evaluation were included. Patients with a minimum follow up of 3-month post tarsorrhaphy were included in the study. Information reviewed included patient age and sex, visual acuity (VA) at presentation, size and location of the ulcer, indication for TST, duration of signs and symptoms before TST, time to epithelial healing after TST, complications associated with non-healing corneal ulcer, complications of TST, number of TST needed and the duration of follow up. Results: During the 12 months study period, 300 cases were planned for TST out of which 90 patients (30.0%) fulfilling the inclusion and exclusion criteria were included for the study. There were not any cases of both eye involvement. Mean age of the patients in this study was 50.34+ 14.56 years (range 20—85 years) with a male-to-female ratio of 2.22:1. Only 3 patients (2.52%) had a VA of more than 6/60, 31 patients (34.44%) had VA between 6/60 to counting finger-close to face (CF-CF) and 57(63.33%) had hand movement (HM) to perception of light (PL) at first visit. The patients presented to the cornea service 3 to 45 days (mean 19.34+10.62 days) after the onset of symptoms, with only 7.57% of the patients presenting within 1 week. Out of 90 patients, 64 patients ....

Manual Superficial Keratectomy Is the First Choice Treatment for Salzmann Nodular Degeneration.

This study aimed to describe the optical and topographic changes after manual superficial keratectomy (MSK) for Salzmann nodular degeneration. This was a descriptive, retrospective study. All patients with a clinical diagnosis of Salzmann nodular degeneration were examined at the Cornea Service of the Instituto Clínico Quirúrgico de Oftalmología (ICQO), Bilbao, Spain, and treated with MSK after presenting ocular discomfort and/or decreased visual acuity. The clinical characteristics (including anterior segment optical coherence tomography and Pentacam topography), treatment regimens, surgical procedures, and outcomes were recorded. Descriptive statistics were constructed using mean ± SD, minimum, maximum, and median. The Shapiro-Wilk normality test was used. The Student t test was used to determine significance. Ten eyes of 9 patients were included in this study: 6 patients (66.6%) were female and 3 were male (33.3%). The mean age was 62.2 years, and the follow-up time was between 5 and 21 months. The best-corrected visual acuity before MSK was 0.20 LogMAR (median) and improved to 0.10 after the surgical procedure. The mean spherical equivalent was reduced from -0.23 ± 3.39 D preoperatively to -1.3 ± 3.0 D postoperatively. Astigmatism decreased between 0.5 and 3.75 D. Topographic irregularity normalized total root mean square from 11,596.4 ± 6854.01 to 4817.2 ± 2725.68 μm. MSK is an effective and safe technique for the treatment of Salzmann nodular degeneration when the Bowman layer is preserved. Anterior segment optical coherence tomography and corneal topography are essential tools for the surgical plan and for the detection of corneal aberrations.

Dupilumab induced ocular surface disease: A prospective case series.

To identify the incidence, risk factors, demographics, and clinical profile of dupilumab-induced ocular surface disease (DIOSD) in patients with atopic dermatitis (AD), propose a standardised treatment protocol (STP) and evaluate the response. Prospective case series of AD patients treated in the Dermatology Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK developing ocular symptoms after commencing Dupilumab between September 2018 and February 2020. A standard history and examination protocol were used including subjective symptom severity grading and Ocular Surface Disease Index (OSDI) questionnaire on each visit. Standard treatment was prescribed, and response evaluated. 32 of 113 included patients (28.31%) developed DIOSD, of which 20 (62.5%) were referred to the Cornea Service. Median age was 38.0 years (IQR 26.8; range 19-74). Male to female ratio was 1:1. Average time to onset of ocular symptoms from starting dupilumab was 9.2 weeks (IQR 8.8; range 0.1-40). 90% patients had bilateral conjunctival inflammation and blepharitis at presentation. Significant improvement in the subjective severity scale and the median OSDI score (from 34.0 to 10.2) was noted in response to topical eye treatment. Dupilumab was discontinued in none. DIOSD is not uncommon although, with timely referral and appropriate topical treatment better clinical outcome and patient satisfaction can be achieved without the need to discontinue Dupilumab. Prior allergic conjunctivitis did not affect the incidence or severity of DIOSD. Further prospective studies with longer follow-up and more focus on possible disease mechanism such as goblet cell related changes and immune response are needed.

Visual Outcomes of Cataract Surgery in Patients With Keratoconus Using Toric and Non-toric Lenses

To compare the accuracy and outcomes of different intraocular lens (IOL) power calculation formulas in eyes with keratoconus undergoing cataract surgery with toric and non-toric IOLs. This was a consecutive retrospective case series study including patients from the Cornea Service at the Department of Ophthalmology and Visual Sciences at the University of British Columbia, Vancouver, Canada, from 2000 to 2020. Keratoconus was diagnosed based on corneal topography and clinician opinion. Patients who underwent topography-guided photorefractive keratectomy, intracorneal ring segments implantation, or corneal transplant were excluded. The manifest spherical equivalent, prediction errors, and median absolute errors were calculated. Descriptive statistics were expressed as mean ± standard deviation. There were 160 eyes from 101 patients; 136 eyes received non-toric lenses and 24 eyes received toric lenses. Most patients had mild disease (< 48.00 diopters [D]) when stratified by steep keratometry values. Patients with severe disease (> 53.00 D) were significantly more hyperopic following surgery (P < .05). The Barrett Universal II (0.26 D, inter-quartile range [IQR] = 0.4), Holladay 2 (0.31, IQR = 1.2), and SRK/T (0.42, IQR = 0.86) formulas had the lowest median absolute error. The postoperative prediction error following toric lens insertion was not significantly different than following non-toric lens insertion, and the mean absolute astigmatism was significantly reduced with toric lenses. The Barrett Universal II, Holladay 2, and SRK/T were the most accurate IOL power calculation formulas in patients with keratoconus undergoing cataract surgery. Hyperopic surprise was increased in severe keratoconus. Toric IOLs may be considered in patients with mild keratoconus. [J Refract Surg. 2023;39(5):319-325.].

Commentary: The never-ending story of COVID-19: Accustoming to the new abnormal in glaucoma practice.

Commentary: The never-ending story of COVID-19: Accustoming to the new abnormal in glaucoma practice.

Challenges in management of microbial keratitis during COVID-19 pandemic related lockdown: a comparative analysis with pre pandemic data.

PurposeTo study the challenges of managing microbial keratitis(MK) during the COVID19 pandemic related lockdown and assess the outcomes of treatment at a tertiary cornea service.MethodsRetrospective, non comparative study of electronic medical records of MK presenting to a network of four tertiary care cornea services. The medical history, presenting clinical features, microbiology work up and treatment outcomes were analyzed. The primary outcome measure was final outcome at last follow up. Secondary outcomes measures were non-compliance to treatment due to travel restrictions, therapeutic PKP not done due non availability of corneal tissues. Results- MK was noted in 330 eyes of 330 patients between April and May 2020. Of these 237(71.8%) were males. Median age was 45 years(IQR, 33-56). Low socioeconomic status noted in 102(30.9%). Patients travelling beyond the district from where the hospital was located comprised of 64.9%(n=214). At a median follow up of 32 days(IQR, 9-54), 118(35.8%) patients had resolved, with medical management, 73(22.1%) patients were under active treatment, 139(42.1%) were lost to follow up. Sixty-six patients(20%) were non-compliant to treatment of which 59 could not follow appointment schedule due to travel restrictions. Therapeutic PKP (TPK) was planned in 48/128 (37.5%) patients, but was performed in only 34/48 (70.8%) due to non-availability of donor corneas.ConclusionsAbnormal social circumstances due to the COVID pandemic and the ensuing impediments to travel for access to health care affected compliance to treatment of ocular emergencies such as microbial keratitis.

Editorial introductions.

Editorial introductions.

Scleral Necrosis in Porphyria Cutanea Tarda: A Case Report

Scleral necrosis is a rare but well documented ocular manifestation of Porphyria Cutanea Tarda (PCT). The PCT is caused by a deficiency of Uroporphyrinogen Decarboxylase (Uro-D). The typical clinical manifestations of PCT in the form of cutaneous photosensitivity are due to the accumulation of fluorescent polycarboxylated porphyrins. Here, a case of 30-year-old male patient who was referred to the cornea services department for scleral thinning in right eye has been presented. Slit lamp biomicroscopy revealed focal area (5×5 mm2 ) of punched out scleral thinning (&gt;80%) with uveal show in the interpalpebral area, 2 mm temporal to the limbus in right eye and a partial thickness scleral melt in nasal area. The left eye was phthisical. Patient had multiple blisters and pigmented, slightly depressed scars on the skin, especially in the sun-exposed parts such as face, hands and legs. Digital shortening, atrophy and contractures were seen in hands and legs. Based on the clinical, biochemical and dermatological evaluation, the diagnosis of PCT was made. A rare case of scleral necrosis with uveal show in a patient with PCT which was successfully treated with allogenic scleral patch graft has been reported. On follow-up visits scleral patch graft was well taken up.

Myopic shift after Salzmann nodule excision.

To quantify changes in manifest refractive error and mean keratometric power (Km) at 1 month and ≥12 months after Salzmann nodule excision. Cornea service at Mayo Clinic, Rochester, MN. Retrospective consecutive case series. Changes in manifest refractive error (spherical equivalent), Km, and corrected distance visual acuity (CDVA) were compared for 73 eyes of 58 patients who underwent Salzmann nodule excision. Eyes with ocular comorbidities were excluded. Comparisons between preoperative and postoperative measurements were made by using generalized estimating equation models. Mean patient age was 66 years, and 53 patients (91%) were female. Spherical equivalent manifest refractive error was -0.27 ± 2.66 diopters (D) before nodule excision and became more myopic (-1.10 ± 2.78 D) at 1 month after nodule excision (n = 69, P < .001) with no change at 12 months (n = 14, P = .13). A myopic shift ≥0.5 D occurred in 65% of eyes and ≥1.0 D in 36% of eyes. Km increased from 42.7 ± 2.11 D before nodule excision to 44.2 ± 1.82 D at 1 month after excision (n = 49, P < .001). CDVA improved from 0.18 ± 0.15 logMAR (Snellen equivalent 20/30) before nodule excision to 0.05 ± 0.09 logMAR (20/22, n = 69, P < .001) at 1 month after excision with no change at 12 months (n = 14, P = .73). In addition to known changes in cylinder, Salzmann nodule excision is associated with a myopic shift in most eyes caused by corneal steepening. Patients should be counseled about the likelihood of refractive changes, and cataract surgery should be deferred until refractive stability is achieved.

Editorial introductions.

Editorial introductions.

Topical Corticosteroids for Infectious Keratitis Before Culture-Proven Diagnosis.

PurposeIn clinical practice we sometimes encounter patients with severe corneal ulcers who have been treated with topical corticosteroids. This study reviewed the clinical features and visual outcomes of these patients and investigated the background of the prescription of topical corticosteroids.Patients and MethodsThe medical records of patients who visited the Cornea Service at Fujita Health University Bantane Hospital and were treated for infectious keratitis from April 2016 to March 2020 were retrospectively reviewed. Patients treated with topical corticosteroids before a culture-proven diagnosis were studied in terms of demographics, best-corrected visual acuity at arrival and at last visit, the clinical course after visit, ocular history, and combination therapy by the previous ophthalmologist.ResultsOut of the 200 eyes of 197 patients with infectious keratitis, 14 eyes of 14 patients were treated with topical corticosteroids before a culture-proven diagnosis. All 14 patients were referred, as they had severe keratitis that could not be cured with topical antibiotics and corticosteroids. Based on the culture results, we diagnosed Acanthamoeba keratitis (AK) in six patients, fungal keratitis (FK) in two patients, bacterial keratitis (including a suspected case) in two patients, and unknown cause in four patients. Two patients with AK, FK, and unknown keratitis had unfortunate clinical courses and poor visual outcomes. From the information in the referral letters, at least six of the 14 patients were treated with either acyclovir ocular ointment or valaciclovir tablets, along with topical corticosteroids.ConclusionApplication of topical corticosteroids for keratitis that does not respond to empirical antibiotic therapy is harmful since AK or FK is likely involved in these topical antibiotic-resistant cases. Microbiological evidence, as well as a differential diagnosis of herpetic stromal keratitis, is needed when prescribing topical corticosteroid for the treatment of suspected infectious keratitis.

Characteristics and clinical outcomes of patients diagnosed with keratocone

Objectives: To describe the epidemiological and clinical profile, evolution and outcomes of keratoconus patients diagnosed in the ophthalmologic reference service of the state of Santa Catarina, Brazil. Methods: The medical records of all patients with keratoconus attended at the Cornea service of the Regional Hospital of São José, between January 2016 and December 2018 were retrospectively analyzed. The following data were extracted: sex, age, disease stage, systemic diseases, ophthalmological symptoms, adaptation of contact lenses, previous treatments, best monocular visual [...]

Corneal dystrophies

Purpose: To describe sociodemographic findings, frequency, and clinical characteristics of patients with corneal dystrophy who consulted an ophthalmologic national reference center in Bogotá-Colombia in 10 years. Methods: Observational, descriptive case series study was carried out. The information was obtained from reviewing medical records of patients who consulted the cornea service at an ophthalmologic national reference center in Bogotá-Colombia between 2008 and 2018. The diagnosis of corneal dystrophy was done according to the International Committee for Corneal Dystrophies classification, as well as the currently accepted specific name of the dystrophy. The type of dystrophy, clinical, diagnostic findings, sociodemographic characteristics, and type of treatment were evaluated. Results: A total of 151 eyes of 79 patients were analyzed; 68.3% of subjects were female. The mean age was 57.6 ± 18.9 years, with a range between 2 and 95 years. The median best-corrected visual acuity (BCVA) in all the groups at diagnosis was 0.30 LogMAR (interquartile range 0.5) or 20/40 Snellen. Lattice dystrophy type 1 and its variants had the worse BCVA. Fuchs' dystrophy (FD) was the most frequently identified. Regarding treatment, 80.1% (n = 121) did not require any, and 11.9% (n = 18) had a corneal transplant. Thirteen underwent penetrating keratoplasty. Of those, two had a clinical diagnosis of TGFB1 dystrophy, three of stromal dystrophy, and eight of endothelial dystrophy. DSAEK was performed in 5 eyes four had endothelial dystrophy and one had unclassified dystrophy. Conclusions: Adults and females were the most affected groups. FD was the most frequent and unclassified dystrophies were the second most frequently diagnosed. This highlights the importance of complementary studies such as optical coherence tomography of the anterior segment and genetic markers which are not currently universally available in our healthcare system. Ethical considerations: This study was approved by the Institutional Ethics Committee and was conducted in accordance with the principles of the Declaration of Helsinki.

Successful Treatment of Cryptococcus albidus Keratitis with Voriconazole 1% Drops and Oral Itraconazole

The Cryptococcus genus, include a wide group of yeast, which species are usually found in water and plants. C neoformans and C gatti are considered pathogens for humans and animals, whoever Cryptococcus laurentii, C albidus and C curvatus are considered as potential environmental pathogen for both. We describe one fungal keratitis caused by Cryptococcus albidus, in a male 41 years old, diagnosed previously with diabetes type 2, and ocular surgery for cataract extraction 7 years before, actually he presented a corneal ulcer in right eye diagnosed before as herpetic keratitis unresponsive to Aciclovir, after de first ocular observation in our hospital in Cornea Service, and samples for culture taken, the final diagnosis was Cryptococcus albidus keratitis, the treatment with antimycotic drugs, topic voriconazole 1% and oral itraconazole 100mgs each 12 hs was administered. The corneal ulcer was healed in 3 weeks and the FBCVA was 20/30.

Acanthamoeba Keratitis in Minors With Orthokeratology (OK) Lens Use: A Case Series.

Myopia progression is a significant public health issue. Methods to halt myopia progression in minors continue to gain momentum. Orthokeratology, with market penetrance estimates approximating 1%, is a corneal reshaping therapy and potential myopia progression treatment. Our objective was to explore whether orthokeratology may increase the frequency of Acanthamoeba keratitis compared with other lens modalities. Individuals less than 18 years diagnosed with Acanthamoeba keratitis (AK) at the University of Illinois at Chicago (UIC) Cornea Service between January 1st, 2003, and December 31st, 2016, were retrospectively reviewed. Subjects were grouped by lens modality (soft, rigid gas permeable [RGP], and orthokeratology), and all cases with orthokeratology lens use were reviewed. The primary outcome was a history of orthokeratology lens use in minors diagnosed with AK. Forty-seven contact lens users less than 18 years were diagnosed with AK. The mean age was 15.0 years (range 12-17), 26 (55%) were women, and 4 (8.5%) had bilateral disease. Lens modality included 6 (13%) with orthokeratology, 39 (83%) with soft contact lenses, 0 with nonorthokeratology RGP (0%), and 2 (4%) unknown. The proportion of orthokeratology cases among AK minors (13%) in our case series exceeds the expected proportion of orthokeratology cases expected based on orthokeratology market penetrance (1%). Results from this case series suggest a potential increased risk of AK in orthokeratology users compared with other lens modalities. In the context of the current myopia epidemic and concerns for halting myopia progression in minors, caution should be exercised when selecting appropriate treatment options to minimize the risk of AK.

Causes of congenital corneal opacities and their management in a tertiary care center.

To evaluate causes and management of congenital corneal opacities (CCO) diagnosed in a tertiary care eye center and to compare the data with a previous study at the same institution. Computerized medical records in all patients with congenital corneal opacities diagnosed in the Cornea Service at Wills Eye Hospital (Philadelphia, PA) between January 1, 2007, and December 31, 2015, were retrospectively reviewed. Children aged 12 years and younger at the first visit were included in the study. Patients' demographics, ocular diagnosis, laterality, associated ocular abnormalities, other ocular surgery performed prior or subsequent to the first visit, and their treatment were extracted from the medical records. A total of 77 eyes in 56 patients were examined. The mean age at presentation was 32.8 ± 44.2 months, with the mean follow-up period of 26.7 ± 30.1 months. The most frequent diagnosis was Peters anomaly (53.2%), followed by limbal dermoid (13.0%), aniridia with glaucoma and microphthalmos (6.5%), sclerocornea and congenital glaucoma (5.2%), idiopathic (3.9%), Axenfeld-Rieger anomaly and Hurler syndrome (2.6%), and microcornea (1.3%). Primary keratoplasty was performed in 26 eyes, with the outcome rate in the clear cornea of 76.0% during the follow-up. Peters anomaly is the most common cause of congenital corneal opacities encountered at our institution. Penetrating keratoplasty is the most frequent choice of corneal surgery to treat congenital corneal opacities. Additional interventions during penetrating keratoplasty were moderately positively correlated with graft failure. This study also shows the rates of some etiologies of that changed over the recent decades in our tertiary care Cornea Service. Although Peters anomaly remains the most common presenting reason for congenital corneal opacities, its rate appears to be increasing over the recent decade. Congenital corneal opacities due to birth trauma, which is one of the preventable causes, were observed in a previous study in our clinic; however, no new cases were noted in this study.