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Posterior embryotoxon, an anteriorly displaced Schwalbe’s line, is the most common feature of Axenfeld Rieger syndrome. We report a case of Axenfeld anomaly with unusual corneal manifestation, that is, a fairly symmetric, hyperproliferated posterior embryotoxon mimicking double cornea as well as a double pupil.

We describe a case with complex Descemet membrane detachment (DMD) which persisted despite initial two failed surgical attempts to appose the ocular tissues. However, over time, tissue alignment was obtained spontaneously. A 60-year-old woman, operated trabeculectomy, had a total DMD intraoperatively during a complicated cataract surgery. Initial attempt to DM repositioning with intracameral air injection failed. Anterior Segment Optical Coherence Tomography (ASOCT) showed detachment of both DM and pre-Descemet’s layer (PDL). After consultation with a corneal surgeon, patient was again attempted for Intra-operative Optical Coherence Tomography (iOCT)-guided settlement of DMD with intracameral air which again failed. So, the patient was registered for lamellar corneal transplant, but at 3 months follow-up, DM had spontaneously attached, confirmed on ASOCT. This case shows for the first time that even complex DMDs involving PDL, can spontaneously appose despite failed surgical interventions.

The purpose of this report is to highlight the early clinical signs and management of ocular surface neoplasia following penetrating keratoplasty in xeroderma pigmentosa. A 14-year-old girl reported increased conjunctival hyperemia, tearing, photophobia in the right eye at 6 months after penetrating keratoplasty that worsened rapidly over the subsequent 2 weeks. Slit lamp examination showed increased vascularity, epithelial haze and raised whitish lesions at the graft–host junction. Alcohol keratoepithelectomy was performed for confirming the diagnosis. Histology of the sample revealed severe dysplasia. The lesion resolved after surface plaque brachytherapy. The graft clarity was restored and maintained until the last follow-up of 15 months following brachytherapy. Exacerbated symptoms and clinical signs of increased vascularisation and epithelial lesions should arouse the suspicion of ocular surface neoplasia in grafted eyes. Early diagnosis and management can salvage the graft clarity.

Purpose. To compare the total corneal astigmatism (TCA) measured by IOLMaster 700 and Pentacam and to investigate the consistency of corneal keratometry (CK) measured by IOLMaster and Pentacam. Methods. Cataract patients were retrospectively enrolled in March and April, 2021. Retrospective analysis was performed on those patients with binocular and monocular CK measured by IOLMaster and Pentacam. Results. A total of 102 patients (204 eyes) were included, 64 of whom were female (62.75%). The flat (K1) and steep (K2) CK of anterior corneal surface (ACS) and flat (TK1) and steep (TK2) of total cornea measured with IOLMaster 700 were 44.16 ± 1.60 D , 45.09 ± 1.68 D , 44.12 ± 1.62 D , and 45.14 ± 1.69 D , respectively. Those measured with Pentacam were 44.31 ± 1.57 D , 45.22 ± 1.65 D , 44.15 ± 1.67 D , and 45.19 ± 1.82 D , respectively. The astigmatism of ACS and TCA were − 0.94 ± 0.63 D and − 1.02 ± 0.69 D ( p < 0.01 ) in the IOLMaster group and − 0.90 ± 0.59 D and − 1.05 ± 0.81 D in the Pentacam group, respectively ( p < 0.01 ). TCA measurement results of IOLMaster and Pentacam were consistent ( Pearson = 0.710 , p < 0.01 ), and there was no significant difference ( p = 0.591 ). Conclusions. Total corneal astigmatism measured by IOLMaster was consistent with that measured by Pentacam. The difference between the astigmatism of anterior corneal surface and total cornea was detected in the measurement of IOLMaster and Pentacam, respectively.

Postoperative astigmatism is one of the common complications affecting visual outcomes after a penetrating keratoplasty. It can result from various factors related to host, donor and surgical technique, resulting in suboptimal visual outcome. While some of the measures taken during preoperative planning and during actual surgery can reduce the magnitude of postoperative astigmatism, postoperative correction of astigmatism is often required in cases with high degrees of astigmatism. When spectacles and contact lenses fail to provide optimal visual outcomes, various surgical techniques that include astigmatic keratotomy, compression sutures, toric intraocular lens placement, and laser refractive procedures can be considered. When none of these techniques are able to achieve a desired result with in the acceptable optical range, a repeat keratoplasty is considered a last option. We discuss the various causes and management of complication of postoperative astigmatism occurring after a full thickness corneal transplantation surgery.

Corneal oedema results from an underlying pathology, which can be diverse in origin, and may be mechanical, dystrophic, or inflammatory, and affect any layer of the cornea. Diagnostic tools such as Scheimpflug imaging and anterior segment optical coherence tomography have standardised quantification of corneal oedema and have become important aids in clinical practice. Timely diagnosis and treatment are key to preventing irreversible damage to the corneal ultrastructure, such as anterior corneal fibrosis or endothelial cell damage. The oedema usually resolves quickly when the underlying cause has been addressed. Symptomatic treatment using hyperosmolar agents has failed to show any benefits in oedema resolution or improvement in visual acuity compared to placebo. In contrast, rho-associated protein kinase (ROCK) inhibitors offer a promising option for medical treatment in cases of endothelial dysfunction, but their safety and efficacy must be further validated in large scale clinical trials. Until then, endothelial or penetrating keratoplasties remain the mainstay treatment where structural changes to the cornea have occurred.Hornhautödeme entwickeln sich als Folge einer mechanischen, dystrophischen oder inflammatorischen Erkrankung der Hornhaut, die alle Schichten der Hornhaut betreffen kann. Diagnostische Instrumente, wie die Scheimpflug-Tomografie und die optische Kohärenztomografie des Vorderabschnitts, erlauben eine standardisierte Quantifizierung des Hornhautödems und sind so zu wichtigen Hilfsmitteln in der klinischen Praxis geworden. Die frühzeitige Diagnose und Behandlung kornealer Ödeme ist wichtig, um dauerhafte Schäden wie Endothelzellverlust oder Fibrosierung im Bereich der anterioren Hornhaut zu vermeiden. Meist bildet sich das Hornhautödem schnell zurück, wenn die ursächliche Erkrankung behandelt wird. Die symptomatische Behandlung des Hornhautödems mit hyperosmolaren Augentropfen zeigte im Vergleich zu Placebo keinen Mehrwert in Bezug auf die Abnahme des Ödems oder eine Verbesserung der Sehfunktion. Im Gegensatz dazu scheinen Rho-kinase-(ROCK-)Inhibitoren eine vielversprechende nicht chirurgische Therapieoption bei endothelialer Dysfunktion zu sein, deren Sicherheit und Wirksamkeit in klinischen Studien überprüft werden muss. Bis dahin bleiben die endotheliale oder penetrierende Keratoplastik die Therapie der Wahl bei strukturellen Veränderungen der Hornhaut.

Purpose: To evaluate the clinical outcomes of nanothin Descemet stripping automated endothelial keratoplasty (DSAEK) in Korean patients with corneal endothelial dysfunction.Methods: We retrospectively reviewed medical records of the patients who underwent nanothin DSAEK (graft thickness ≤50 μm) due to corneal endothelial dysfunction and followed up more than 1 year. We evaluated best-corrected visual acuity (BCVA), central corneal thickness, and corneal endothelial cell density at preoperative and 1, 3, 6, and 12 months postoperatively.Results: Sixteen eyes of 16 patients with the mean follow-up period of 13.00 ± 0.96 months were included. The mean graft thickness after deswelling was 45.25 ± 4.59 µm (range, 38.0–50.0 µm). The mean logarithm of the minimum angle of resolution BCVA improved from 1.37 ± 0.53 preoperatively to 0.68 ± 0.46, 0.55 ± 0.35, 0.40 ± 0.25, and 0.39 ± 0.25 at 1, 3, 6, and 12 months postoperatively (p = 0.005, p < 0.001, p < 0.001, and p < 0.001), respectively. The mean central corneal thickness improved from 752.00 ± 129.11 to 555.75 ± 54.66 µm at 12 months postoperatively (p = 0.006). The mean graft endothelial cell density decreased from 2,859.62 ± 228.34 to 1,542.25 ± 627.34 cells/mm2 at 12 months postoperatively (p = 0.012). The postoperative complications included increased intraocular pressure (n = 3, 18.75%) and graft dislocation (n = 1, 6.25%), all of which were successfully managed by anterior chamber paracentesis or rebubbling. No other serious complications were encountered.Conclusions: Nanothin DSAEK produced significant and stable visual improvements without severe postoperative complications in Korean patients with corneal endothelial dysfunction.

Purpose To determine the role and optimal timing of glaucoma surgery in relation to Boston keratoprosthesis type 1 (KPro) implantation. Design Retrospective, comparative, non-randomized clinical study. Methods Single-center study of a total of 100 eyes (100 patients) implanted with a KPro between 2008-2017 and diagnosed with glaucoma before or after KPro. Patients were separated into 2 groups: those with preexisting glaucoma and those who developed glaucoma de novo after KPro. Groups were then divided based on whether patients were medically or surgically managed. Glaucoma surgery included glaucoma drainage device (GDD) implantation, trabeculectomy, and cyclophotocoagulation (CPC). Primary outcomes included best-corrected visual acuity (BCVA), glaucoma progression, and complications. Differences in outcomes were compared using parametric and non-parametric tests, as well as log-rank test to compare time-to-outcome events. Results Among 72 eyes with preexisting glaucoma, 27 (38%) had glaucoma surgery before KPro (18 GDD), while 45 (62%) were medically managed only. Among the latter, 19 (42%) needed glaucoma surgery post-KPro (16 GDD). Among 28 eyes with de novo glaucoma, 12 (43%) had glaucoma surgery post-KPro (9 GDD). For eyes with preexisting glaucoma, glaucoma progression was greater with glaucoma surgery performed post-KPro (100%) compared to pre-KPro (74%, P=0.016) and to medical management (54%, P=0.002). No increase in complications were observed with glaucoma surgery compared to medications only (P>0.05), while fewer eyes maintained BCVA of 20/200 or better over time with medical management (P=0.013). Eyes with de novo glaucoma had similar progression, BCVA and complications between medical and surgical care (P>0.05). Conclusions Glaucoma surgery should be performed prior or with KPro in eyes with preexisting glaucoma. Complication rates are not increased when glaucoma surgery is performed in KPro eyes with preexisting or de novo glaucoma. To ensure optimal glaucoma control, glaucoma surgery should be performed as early as possible in KPro eyes with good visual potential.

The corneal epithelium serves to protect the underlying cornea from the external environment and is essential for corneal transparency and optimal visual function. Regeneration of this epithelium is dependent on a population of stem cells residing in the basal layer of the limbus, the junction between the cornea and the sclera. The limbus provides the limbal epithelial stem cells (LESCs) with an optimal microenvironment, the limbal niche, which strictly regulates their proliferation and differentiation. Disturbances to the LESCs and/or their niche can lead to the pathologic condition known as limbal stem cell deficiency (LSCD) whereby the corneal epithelium is not generated effectively. This has deleterious effects on the corneal and visual function, due to impaired healing and secondary corneal opacification. In this concise review, we summarize the characteristics of LESCs and their niche, and present the current and future perspectives in the management of LSCD with an emphasis on restoring the function of the limbal niche.

Cell therapies are emerging as a unique class of clinical therapeutics in medicine. In 2015, Holoclar (ex vivo expanded autologous human corneal epithelial cells containing stem cells) gained the regulatory approval for treating limbal stem cell deficiency after chemical eye burn. This has set a precedent in ophthalmology and in medicine, reinforcing the therapeutic promise of cell therapy. However, to generalize and commercialize cell therapies on a global scale, stringent translational and regulatory requirements need to be fulfilled at both local and international levels. Over the past decade, the Singapore group has taken significant steps in developing human corneal endothelial cell (HCEnC) therapy for treating corneal endothelial diseases, which are currently the leading indication for corneal transplantation in many countries. Successful development of HCEnC therapy may serve as a novel solution to the current global shortage of donor corneas. Based on the experience in Singapore, this review aims to provide a global perspective on the translational and regulatory challenges for bench-to-bedside translation of cell therapy. Specifically, we discussed about the characterization of the critical quality attributes (CQA), the challenges that can affect the CQA, and the variations in the regulatory framework embedded within different regions, including Singapore, Europe, and the United States. Impact statement Functional corneal endothelium is critical to normal vision. Corneal endothelial disease-secondary to trauma, surgery, or pathology-represents an important cause of visual impairment and blindness in both developed and developing countries. Currently, corneal transplantation serves as the current gold standard for treating visually significant corneal endothelial diseases, although limited by the shortage of donor corneas. Over the past decade, human corneal endothelial cell therapy has emerged as a promising treatment option for treating corneal endothelial diseases. To allow widespread application of this therapy, significant regulatory challenges will need to be systematically overcome.