Use of photodynamic therapy (PDT) for the treatment of immune-mediated keratitis (IMMK) in horses is becoming common. The safety and morphologic impact on the normal equine cornea have not been investigated, and the mechanism of its efficacy is unknown. To investigate the morphologic effects and safety of in vivo PDT on healthy equine corneas. In vivo experiment. Six university-owned horses underwent unilateral corneal PDT with intrastromal infracyanine green (EmunDo®) and photoactivation with an 810 nm diode laser (500 mW for 2.5 min = 75 Joules). Complete ophthalmic examinations, clinical scoring, digital and infrared photography, ocular thermography, in vivo confocal microscopy (IVCM), and ultrasound biomicroscopy were performed pre-treatment and post-treatment on study days 1, 5, 15, 33, and 103. Post-treatment, corneal ulceration occurred in all treated eyes. In all horses, IVCM identified destroyed keratocytes immediately post-treatment followed by keratocyte depopulation on days 5 and 15. Slow keratocyte repopulation was evident on days 33 and 103. Stromal keratitis was seen on day 5 and persisted through day 103. EmunDo® remained visible in the cornea on study day 103 in 5/6 horses. No horses developed blinding complications. Limited sample size included horses of various ages. Corneal ulceration, keratocyte depopulation, prolonged stromal keratitis, and prolonged corneal dye retention occurs with PDT in normal equine corneas. Corneal stromal cellular depopulation is proposed as the mechanism by which PDT is effective in the treatment of equine IMMK.

Diagnosing fungal keratitis (FK) in patients with negative smear and culture results remains clinically challenging, highlighting the need for alternative diagnostic approaches. To determine the diagnostic accuracy of the clustered regularly interspaced short palindromic repeats (CRISPR)-based Rapid Identification of Mycoses using CRISPR (RID-MyC) assay for detecting FK in patients with negative smear and culture results using in vivo confocal microscopy (IVCM) as the reference standard. This prospective diagnostic accuracy study was conducted from December 2024 to March 2025 at Aravind Eye Hospital, a tertiary ophthalmology referral hospital in Coimbatore, India. Consecutive patients clinically suspected to have microbial keratitis with negative smear and culture results were eligible for inclusion. Data were analyzed from March 2025 to June 2025. All included participants underwent corneal scraping for RID-MyC assay and imaging by IVCM. The primary outcomes were sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic concordance of the RID-MyC assay compared with IVCM results. Of 245 consecutive patients clinically suspected to have microbial keratitis, 82 were smear negative. After exclusions due to contraindications or positive subsequent cultures, 41 patients with smear- and culture-negative results were ultimately included in the final analysis. Of these 41 patients (mean [SD] age, 51.0 [14.6] years; 21 [51.2%] women), RID-MyC demonstrated sensitivity of 82.1% (95% CI, 63%-94%) and specificity of 76.9% (95% CI, 46%-95%). Positive predictive value was 88.5% (95% CI, 74%-95%) and negative predictive value was 66.7% (95% CI, 46%-82%). Concordance between RID-MyC and IVCM was observed in 33 cases (80.5%). Notably, prior antifungal treatment was most frequent (4 of 5 [80%]) among patients with positive IVCM but negative RID-MyC results. Conversely, all patients (3 of 3 [100%]) with negative IVCM but positive RID-MyC findings had smaller, peripheral, or paracentral lesions. In this diagnostic study, in patients with smear- and culture-negative FK, the RID-MyC assay showed good diagnostic accuracy comparable with IVCM and was feasible in all cases, including those in whom imaging was not possible. With its rapid turnaround and minimal equipment needs, RID-MyC may serve as a practical adjunct to conventional diagnostics, particularly in high-burden, resource-limited settings where IVCM is unavailable or contraindicated.

Near complete corneal regeneration after lamellar keratoplasty in rabbits enabled by an in situ photo-crosslinkable dendrimer-hyaluronic acid hydrogel.

Background/Objectives: During cataract surgery, topical anesthesia is routinely achieved through the instillation of topical anesthetic eye drops, while different agents may be applied to the corneal surface during the procedure to support lubrication and protection. The impact of these intraoperative strategies on corneal integrity and postoperative ocular surface recovery remains an area of clinical interest. This study aimed to compare the intraoperative and postoperative effects of applying a topical anesthetic gel (Ophtesic, Horus Pharma) on the corneal surface versus the use of balanced salt solution (BSS) during cataract surgery. Methods: In this longitudinal, observational prospective study, 24 eyes of 24 patients undergoing phacoemulsification received either topical anesthetic gel (n = 15) or BSS irrigation (n = 9). Central corneal thickness (CCT) and epithelial thickness were measured preoperatively and on postoperative days 1, 5, and 15 using anterior segment optical coherence tomography (AS-OCT). Basal epithelial cell (BEC) density was assessed by in vivo confocal microscopy (IVCM), while OSDI score, non-invasive breakup time (NI-BUT), and Schirmer test I values were evaluated preoperatively and on postoperative days 5 and 15. Patient and surgeon satisfaction were rated using a Likert-like scale. Results: Both groups showed increased CCT and epithelial thickness at day 1. In the gel group, CCT returned to baseline by day 15 (p = 0.361), and epithelial thickness normalized by day 5 (p = 0.066). In the BSS group, CCT remained elevated at day 15 (p < 0.05), and epithelial thickness decreased at day 5 (p < 0.05) before returning to baseline. BEC density normalized at day 15 in the gel group (p = 0.107) but remained altered in the BSS group (p < 0.05). NI-BUT Schirmer I, and OSDI showed a trend toward faster recovery in the gel group than in the BSS group. Conclusions: In this exploratory study, intraoperative application of a topical anesthetic gel appeared to support early normalization of corneal and tear film parameters while providing effective anesthesia. Further studies are warranted to confirm these observations and evaluate potential long-term benefits.

Limbal Epithelial Cells Detected in Stage III Limbal Stem Cell Deficiency by Multimodal Anterior Segment Imaging.

To describe the clinical and invivo confocal microscopy (IVCM) characteristics of horses with corneal stromal invasive squamous cell carcinoma (CSI-SCC). Retrospective study of 7 horses with histopathologically confirmed unilateral CSI-SCC. Horses with corneal CSI-SCC were examined by laser scanning IVCM. Signalment, clinical findings, and histopathology results were compared with IVCM findings. Clinical ocular lesions in all horses included a heavily vascularized, opaque, gray or tan, anterior or midstromal opacity invading the cornea from the limbus. The corneal epithelium overlying the stromal opacities was intact and the abnormal corneal regions were markedly thickened. Crystalline, white, linear, branching stromal opacities emanated from the leading edge of the corneal lesions in 2 horses. Polygonal neoplastic epithelial cells, with prominent anisocytosis and pleomorphism, were visible in the corneal stroma by IVCM and appeared enlarged and hyperreflective. Islands and cords of neoplastic epithelial cells that occasionally branched could be followed by IVCM as they transversed the corneal stroma. The islands of neoplastic cells were occasionally arranged as circular whirls of cells grouped around concentric layers of hyperreflective cells or amorphous materials within a dark cyst-like space consistent with keratin pearls. Dense accumulations of blood vessels and leukocytes were present within and around the neoplastic cells. This report demonstrates the unique ability of IVCM examination to provide a rapid and noninvasive method for the presumptive diagnosis of CSI-SCC and to contribute to the formulation of diagnostic and therapeutic clinical plans for individual horses.

Purpose: To investigate the effect of corneal flap margin space width after femtosecond laser–assisted laser in situ keratomileusis (FS-LASIK) on corneal nerve regeneration using in vivo confocal microscopy (IVCM). Methods: This study assessed 46 consecutive patients who underwent FS-LASIK surgery. Routine examinations after myopic laser surgery were performed. IVCM was performed before and after surgery to observe the flap margin space and regeneration of the corneal subbasal nerve. The average of corneal flap margin space was calculated. Patients were divided into two groups: the wide-space group (&gt; 20 µm) and the narrow-space group (⩽ 20 µm). Central and peripheral (average of 3-, 6-, and 9-o'clock positions) corneal sensitivity was tested by the Cochet–Bonnet esthesiometer and corneal subbasal nerve regeneration was quantitatively analyzed. Results: Postoperatively at days 1 to 90, the incision edge of the narrow-space group showed a high-density linear structure without obvious epithelial cells filling in the space, and the corneal nerve gradually grew from the outside of the flap through the incision edge to the inside of the flap. In the wide-space group, obvious epithelial cells filling in the space were observed from 1 day postoperatively, and the corneal nerve grew less from the outside of the flap through the incision edge to the inside of the flap. There was no significant intergroup difference in the central corneal nerve fiber length. However, the peripheral corneal nerve fiber length in the narrow-space group was significantly higher at both 30 and 90 days postoperatively. No statistically significant differences were observed between groups in central and peripheral corneal sensitivity. There was no significant difference in spherical equivalent between groups at each time point. Conclusions: Although the postoperative flap margin space significantly affects corneal nerve regeneration, it does not influence corneal sensitivity or the refractive outcome after FS-LASIK.

Artificial intelligence (AI) has been explored as a promising diagnostic aid for ocular surface diseases (OSDs). The spectrum of OSD ranges from highly prevalent benign conditions such as dry eye disease (DED) to rare but potentially dangerous disorders, including ocular surface squamous neoplasia (OSSN) and conjunctival melanoma. This review provides an overview of current applications of AI across the major categories of ocular surface pathology and specifically highlights anterior segment imaging modalities, including slit-lamp examination, optical coherence tomography (OCT), and in vivo confocal microscopy (IVCM). Meibography, tear film dynamics, biochemical profiling, and other DED-related measures are also examined. Across these domains, reported AI model performance matches or exceeds that of ophthalmologists, offering consistent, reproducible, and accurate approaches for guiding diagnosis. However, studies with limited external or prospective validation, variable labeling strategies, and small, device-specific datasets predominate in the current literature, thereby limiting generalizability. Large multicenter datasets, standardized diagnostic frameworks, multimodal integration, and prospective trials that assess human-AI cooperation in practical settings should be an emphasis in future research. By filling these gaps, AI systems could advance from experimental tools to clinically reliable applications that improve access and diagnostic accuracy in the care of ocular surface disease and tumors.

Differentiating conjunctival intraepithelial neoplasia (CIN) from pterygium and pseudopterygium remains clinically challenging, especially in early or atypical presentations. Artificial intelligence (AI), particularly large language models such as ChatGPT, may serve as decision-support tools by synthesizing complex diagnostic input. This study aimed to evaluate the diagnostic reliability of ChatGPT-4 in distinguishing between these ocular surface lesions and its ability to recommend appropriate treatment strategies based on multimodal clinical data. Sixty anonymized case profiles were compiled from patients with histopathologically confirmed CIN (n = 20), pterygium (n = 20), and pseudopterygium (n = 20) from January 2024 to March 2025. Each case included demographic details, clinical findings, anterior segment optical coherence tomography (AS-OCT), and in vivo confocal microscopy (IVCM) descriptions. For each case, clinical data-including patient history, slit-lamp findings, anterior segment optical coherence tomography (AS-OCT), and in vivo confocal microscopy (IVCM) results-were synthesized into standardized clinical vignettes. These were uploaded to ChatGPT (version 4.0), prompting the model:"Based on this case, what is the most likely diagnosis and what treatment would you recommend?"The model's outputs were compared to the final clinical diagnoses and treatment plans made by a panel of three ocular surface disease specialists with more than 5years of experience. It is important to note that ChatGPT analyzed only structured multimodal textual summaries derived from clinical examination, AS-OCT, and IVCM descriptions, and did not process raw clinical images. ChatGPT accurately identified CIN in 85% of cases, pterygium in 75%, and pseudopterygium in 70%. Misclassifications primarily occurred between CIN and pseudopterygium, particularly in cases with inflammatory or traumatic histories. ChatGPT's treatment recommendations agreed with expert judgment in 80% of cases, with the highest accuracy observed in CIN cases (90%). The model demonstrated a tendency to over-treat benign lesions but rarely missed neoplastic diagnoses. ChatGPT-4 showed promising accuracy in differentiating between CIN, pterygium, and pseudopterygium using detailed multimodal clinical data. While not a substitute for clinical expertise, it may serve as a useful triage or decision-support tool, particularly in settings with limited access to subspecialists. Further integration with image-based AI systems could enhance diagnostic performance.

Corneal nerves (CNs) are essential to maintain corneal epithelial integrity and ocular surface homeostasis. In vivo confocal microscopy (IVCM) enables the acquisition of high-resolution visualization of CNs, allowing visualization on a microscopic level. Traditionally, CN images must be analyzed by manual examination, which is time consuming and labor intensive. Artificial intelligence (AI) has facilitated reliable analysis of CN parameters, allowing for automatic and semiautomatic analysis of CNs. These include the identification, segmentation, and quantitative analysis of various CN parameters. This review summarizes the applications of AI-driven, automatic, and semiautomatic models in the CN analysis of IVCM images while also focusing on their diagnostic relevance in dry eye disease (DED) and neuropathic corneal pain (NCP). Recent advancements in AI have transformed IVCM image analysis by improving reproducibility and reducing operator dependency and time. The AI-based algorithm has been demonstrated to have good performance and sensitivity to identify and quantify the CN metrics. AI has also been utilized to improve the diagnostic accuracy of DED with IVCM scans, involving multiple portions of the CNs, such as the inferior whorl region. When employed with IVCM images of patients with NCP, AI-assisted identification of microneuromas and changes in CN metrics has provided an improvement in diagnostic accuracy. Despite promising advances and outcomes, the widespread implementation of these AI models in CN image analysis requires large-scale validation. Future integration of multimodal AI algorithms remains a promising endeavor to enhance diagnostic accuracy and disease stratification.

To evaluate the efficacy and safety of full corneal epithelial debridement (FCED) combined with local corticosteroids for recurrent corneal erosion (RCE), and to monitor corneal healing using in vivo confocal microscopy (IVCM). This prospective study included 65 eyes from 65 patients with RCE who failed conventional treatments between May 2022 and July 2024. Data were collected via chart review and telephone surveys. Outcome measures included demographics, aetiology, symptom duration/recurrence, additional treatments, and complications. IVCM was performed pre-FCED and at 2 weeks, and 1, 3, and 6 months post-FCED. The study involved 28 males and 37 females with a mean age of 37.7 years. The primary cause was trauma (90.8%). Mean follow-up was 19.8 months. Mean best-corrected visual acuity (BCVA) improved from 0.29 pre-operatively to 0.11 post-operatively (p < 0.05). After 7 months, 71% of eyes showed complete resolution; after 1 year, the effective rate was 70%. Pain relief was reported in 97% of eyes after 3 days. Complications included elevated intraocular pressure in 2 patients and grade 2 haze in 1. Recurrence occurred in 29% of eyes, mostly within 3 months. IVCM revealed complete corneal epithelial repair by 2 weeks, but inflammatory cells persisted for up to 12 months, and sub-basal nerve regeneration was a lengthy process. FCED with corticosteroids effectively alleviates symptoms and prevents recurrence in RCE. IVCM provides valuable insights into the healing process, confirming treatment efficacy. Adequate corticosteroid treatment is crucial to manage inflammatory responses and prevent recurrence.

To describe the demographics and treatment outcomes of horses definitively diagnosed with epithelial or stromal immune-mediated keratitis (IMMK) by use of in vivo confocal microscopy (IVCM) and/or histopathology. Medical records of horses presented to the Cornell University Equine Hospital definitively diagnosed with epithelial or stromal IMMK with IVCM and/or histopathology between 2020 and 2024 were reviewed. Patient signalment, affected eye(s), diagnostics, treatments, and outcomes were assessed. 22 horses met the inclusion criteria. The mean age was 16.9 years (SD, ± 7.3 years). There were significantly more geldings (n = 16) than mares (6). Nineteen horses were unilaterally affected (11 right eyes and 8 left eyes) and 3 bilaterally affected. Twenty horses underwent IVCM, of which 8 had histopathology following superficial keratectomy with agreement in diagnosis. Two horses had corneal histopathology without IVCM. All horses were initially managed medically. Seven horses subsequently underwent episcleral cyclosporine implantation, of which 2 were controlled at last follow-up (median, 532 days). Standing superficial keratectomy was performed in 10 horses, with IMMK controlled in 9 of 10 horses at last follow-up (median, 692 days). Recurrence was documented in 1 horse 12 months after keratectomy. IVCM allowed for a rapid noninvasive diagnosis of equine IMMK that correlated with histopathology. Standing superficial keratectomy was an effective diagnostic and therapeutic option for equine IMMK. Standing superficial keratectomy was an effective diagnostic and treatment for equine IMMK that provided long-term control of disease and minimized the need for long-term daily medications.

To compare corneal nerve morphology between children and adolescents with type 1 diabetes who have dry eye and those without dry eye, and to investigate the association between corneal nerve damage and diabetic dry eye. This cross-sectional study was conducted at an eye hospital. Fifty paediatric patients with type 1 diabetes were divided into dry eye and non-dry eye groups. Corneal nerve morphology was assessed using invivo confocal microscopy, including corneal nerve fibre density, corneal nerve branch density, corneal nerve fibre length, and corneal total branch density. Principal component analysis derived the corneal nerve index. Logistic regression and correlation analysis were conducted to evaluate the association between corneal nerve index and diabetic dry eye. There were no significant differences in age, gender, and other demographic characteristics between the two groups. Compared with participants without dry eye, those with dry eye showed significantly lower corneal nerve fibre density (19.93 ± 5.25 vs. 24.70 ± 6.77/mm2, p = 0.007), corneal nerve branch density (24.45 ± 13.86 vs. 34.38 ± 12.48/mm2, p = 0.011), corneal nerve fibre length (13.62 ± 2.03 vs. 15.04 ± 2.41 mm/mm2, p = 0.029), and corneal total branch density (39.95 ± 17.02 vs. 51.19 ± 19.01/mm2, p = 0.032). The corneal nerve index was significantly associated with diabetic dry eye. Children and adolescents with type 1 diabetes and dry eye exhibit more severe corneal nerve damage, suggesting a potential association between corneal nerve impairment and dry eye in this population.

Congenital aniridia is a rare genetic disorder primarily caused by pathogenic variants of the PAX6 gene. It leads to various panocular anomalies, including aniridia-associated keratopathy (AAK). This review highlights recent insights into its pathogenesis, focusing on clinical staging, microstructural changes in the cornea and molecular dysregulation. We synthesized clinical and experimental findings from large European cohorts, integrating data on over 550 eyes. AAK severity correlates with iris malformation, secondary glaucoma and lens status. Invivo confocal microscopy reveals a reduction in subbasal nerve plexus density, altered keratocyte and endothelial morphology and an increase in Langerhans cell infiltration. RNA and miRNA microarrays, as well as RNA-seq studies, highlight dysregulated miRNAs (such as miR-204-5p and miR-138-5p) and altered expression of PAX6 and keratocyte markers. Limbal fibroblasts show enhanced inflammatory responses and vulnerability to oxidative stress. Advanced AAK is associated with a reduced quality of life. The progression of AAK involves intricate interactions between developmental deficits, inflammation and changes in the limbal microenvironment, suggesting molecular targets for future therapies.

High-resolution high-contrast in vivo phase imaging of corneal nerves and immune cells in mice.

This study describes the clinical and genetic features of Meesmann epithelial corneal dystrophy (MECD) in two unrelated families and reports new genotype-phenotype associations. Ten patients from a Lebanese family (n = 4) (Family 1) and a Spanish family (n = 6) (Family 2) underwent ophthalmologic evaluation, in vivo confocal microscopy (IVCM), anterior segment optical coherence tomography (AS-OCT) with epithelial thickness mapping (ET-map), and targeted next-generation sequencing (NGS) using a custom-designed 133-gene panel associated with anterior segment dystrophies. In Family 1, a novel homozygous KRT12 c.1181T>C (p.Leu394Pro) variant was identified in the symptomatic proband and his clinically asymptomatic brother, while both parents, who were first cousins, were heterozygous for this nucleotide variant. The proband also carried the heterozygous KRT3 c.250C>T (p.Arg84Trp) variant, which has been previously reported but, to our knowledge, has not been described in co-occurrence until now. In addition, the proband showed a complex phenotype with signs of MECD and epithelial basal membrane alterations consistent with epithelial basement membrane dystrophy (EBMD). In Family 2, four affected members carried the KRT3 c.1492G>A (p.Glu498Lys) variant in heterozygosity, which has been previously described. The elderly members affected showed typical signs of MECD and EBMD. To our knowledge, these concomitant alterations have not been previously described with genetical confirmation. In conclusion, this study provides the first evidence that the co-occurrence of variants in two Meesmann corneal dystrophy-associated genes (KRT3 and KRT12) can jointly account for the disease phenotype. We also highlight the association of MECD with EBMD in both families. Characterization using IVCM and AS-OCT ET-Map provides a deeper understanding of the morphological changes and phenotypic variability in MECD, confirming the utility of this multimodal imaging approach for diagnosis and management.

The relationship between corneal neuropathy measured by in vivo confocal microscopy (IVCM) and continuous glucose monitoring (CGM) remains unclear. We describe the associations between corneal neuropathy and CGM metrics. A single center cross sectional study recruited people with type 2 diabetes. All participants wore a 14-day blinded Freestyle Libre Pro CGM and underwent corneal IVCM. Multiple generalized estimating equation models were created to study the association of independent variables (HbA1c and CGM metrics) on dependent variables (corneal nerve fiber and cellular metrics) adjusted for age, sex, ethnicity, hypertension, hyperlipidemia, BMI, diabetes duration. Benjamini-Hochberg procedure controlled for multiplicity. 307 people were recruited, 277 were included in the analysis. Median Age 58y, 49.5% female, 60.6% Chinese, BMI 26.6 kg/m², diabetes duration 12y, HbA1c 8.1%. HbA1c associated negatively (β= -0.609, pseudoR²= 0.068, p=0.013) with Corneal Nerve Fiber Density and positively (β= 0.003, pseudoR² = 0.066, p=0.027) with Corneal Nerve Fiber Width (CNFW). Time-in-Range and Time-in-Tight-Range negatively (β for both = -0.006, pseudoR²= 0.075 and 0.066, respectively, both p<0.03), and Time-Above-Range (β=0.006, pseudoR²=0.073, p=0.021) positively, associated with CNFW. Among Corneal Cellular metrics, Time-Above-Range (β=0.088, pseudoR² = 0.055, p=0.004), mean glucose (β=0.049, pseudoR²=0.055, p=0.004) and glucose variability (SD, MAGE and MODD; β= 0.13, 0.046, 0.164; pseudoR²= 0.053, 0.044, 0.060, respectively, all p<0.03) associated positively with average epithelial size, while Time-in-Range and Time-in-Tight-Range had a negative association (β= -0.084 and -0.104; pseudoR²= 0.052 and 0.057, respectively, both p<0.01). CGM measures, including mean glycemia, TIR, TITR and glucose variability, were significantly associated with corneal neuropathy, supporting the role of CGM metrics in optimising glycemia.

Acanthamoeba keratitis (AK) is a severe eye infection that can cause severe vision loss, especially in contact lens wearers. Rapid and accurate diagnosis is crucial for achieving favorable outcomes. Traditional methods, such as culture, are slow and have variable sensitivity, while molecular techniques offer improved detection. This study evaluated nested polymerase chain reaction (PCR) targeting the 18S ribosomal RNA (rRNA) gene for rapid AK diagnosis, comparing its performance to one-step PCR, culture, and in vivo confocal microscopy (IVCM). This study included 42 suspected AK patients who underwent IVCM and corneal scraping for culture, PCR, and nested PCR. AK diagnosis was confirmed based on clinical findings, risk factors, treatment response, and at least one positive diagnostic test. Out of 42 patients, 27 were positive for Acanthamoeba with at least one of the diagnostic methods. Based on the diagnosis of definite AK, the sensitivity of IVCM, culture, PCR, and nested PCR was 77.78%, 37.04%, 62.96%, and 96.3%, respectively. The specificity and positive predictive values were 100% for all the tests. The negative predictive values of IVCM, culture, PCR, and nested PCR were 71.43%, 46.88%, 60%, and 93.75%, respectively. Nested PCR results displayed the highest agreement with IVCM. In conclusion, nested PCR enhances AK detection compared to conventional methods, improving sensitivity in low corneal scrape quantities. Combining high-sensitivity tests increases diagnostic accuracy, and nested PCR with IVCM is the most effective approach. When IVCM is unavailable, nested PCR serves as a reliable diagnostic tool, especially when culture and one-step PCR yield negative results.

ABSTRACT Clinical relevance Chemotherapy-induced peripheral neuropathy (CIPN) is a common, serious, long-term complication of neurotoxic chemotherapy that alters nerve fibre morphology, and is one of the most common dose-limiting factors. Detection is challenging and usually occurs after significant symptoms. Thus, early and accurate detection is crucial. Background CIPN accounts for the main dose-limiting factor in cancer treatment. Its early detection however is challenging and often occurs only after the development of significant symptoms. In-vivo corneal confocal microscopy may be a potential method of detecting early changes in CIPN. The aim of this study was to determine whether corneal nerve parameters enable early detection of CIPN, to report any dose-dependent effects of treatments used, and to observe longitudinally corneal nerve changes during and after treatment. Methods Fifteen individuals receiving taxane-based chemotherapy for breast, gynaecological, or prostate cancers were recruited and compared to an oxaliplatin-treated group (n = 18). Corneal nerve measurements were taken at the beginning, middle, and end of treatment, and up to 12 months post-treatment. Central corneal and inferior whorl nerve fibre images were obtained with an in-vivo laser scanning confocal microscope. Results A dose-dependent reduction in corneal nerves was observed for every 100 mg/m2 of neurotoxic chemotherapy, especially in taxane-treated participants (p = 0.02). The average nerve fibre length, which refers to both the central cornea and inferior whorl, showed significant changes earlier in the treatment course. After treatment, especially in the taxane-treated group, CIPN participants had lower corneal nerve fibre length at the middle and end of treatment compared to those without persistent neuropathy (p = 0.02 and p = 0.006, respectively). Conclusion Average nerve fibre length loss may have clinical utility as an early marker of CIPN progression. Imaging a wider area of the sub-basal corneal nerve plexus including the inferior whorl region may be more beneficial for monitoring early neuropathic changes.

The aim of this study was to compare the efficacy and outcomes of cultivated oral mucosal epithelial transplantation (COMET) in limbal stem cell deficiency (LSCD) between patients with Stevens-Johnson syndrome (SJS) and those with other etiologies (non-SJS), evaluated by clinical manifestations and epithelial phenotypes. This prospective, comparative study enrolled patients with LSCD who were scheduled for COMET. Preoperative and postoperative assessments were performed using slit-lamp microscopy, in vivo confocal microscopy (IVCM), and impression cytology with immunofluorescence staining. Successful outcomes were defined as an intact ocular surface without conjunctivalization and the presence of cornea-like epithelium detected by IVCM and/or immunofluorescence staining at the central cornea. Otherwise, the outcomes were interpreted as failure. Visual improvement and risk factors of COMET failure were analyzed. Eighteen eyes of 18 patients (7 with SJS, 11 non-SJS) were included. The median follow-up time was 15.5 months (range: 13-35 months). The overall success rate was 72.2% (13 eyes: 2 with SJS and 11 non-SJS), which was significantly lower in patients with SJS (28.6%) than in non-SJS patients (100%) (P = 0.002). Among successful cases, 60.2% showed visual improvement while the others (30.8%) remained unchanged. The risk of COMET failure was significantly associated with SJS (P = 0.002), lid margin keratinization (P = 0.023), preoperative symblepharon (P = 0.036), postoperative epithelial defects lasting more than 2 weeks (P = 0.022), and the absence of multilayered cornea-like epithelium detected by IVCM at 6 months postoperatively (P = 0.017). COMET demonstrates good efficacy and favorable outcomes for LSCD, particularly in non-SJS eyes. While the success rate was excellent in non-SJS patients, the outcomes were significantly limited in those with SJS.