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Introduction: Complex corneal conditions present surgical challenges and necessitate innovation. Here, we present two cases where we performed intraocular lens trans-scleral fixation using the double-needle Yamane technique, followed by penetrating keratoplasty and vitrectomy using a temporary Landers wide-field keratoprosthesis. Case Presentation: Case 1 involved a 70-year-old man with an aphakic eye of bullous keratopathy and corneal opacity owing to multiple penetrating and endothelial keratoplasty, endophthalmitis, and herpetic keratitis. His visual acuity was counting fingers at 20 cm before surgery. Penetrating keratoplasty with vitrectomy and intraocular lens scleral fixation was performed using the double-needle Yamane technique, and 10 months postoperatively, his best-corrected visual acuity improved to 0.6, presenting a clear cornea. Case 2 involved a 62-year-old man who underwent penetrating keratoplasty twice for corneal perforation and therapeutic penetrating keratoplasty with vitrectomy for traumatic globe rupture, resulting in the loss of the intraocular lens. The patient exhibited graft failure, and his best-corrected visual acuity was 0.03. Utilizing a temporary Landers wide-field keratoprosthesis, we performed penetrating keratoplasty and intraocular lens trans-scleral fixation without complications. His final best-corrected visual acuity improved to 0.15 with a clear cornea. Conclusions: Trans-scleral fixation of intraocular lens with penetrating keratoplasty, using temporary Landers wide-field keratoprosthesis, yielded positive clinical outcomes without serious complications.

Introduction: Corneal graft detachment is a major postoperative complication of Descemet’s stripping automated endothelial keratoplasty (DSAEK). When a corneal graft becomes detached, corneal endothelial function generally fails, and repeat corneal transplantation is required. Herein, we report a rare case in which a transparent cornea was maintained after the removal of a dislocated DSAEK graft. Case Presentation: A 79-year-old woman with a residual lens cortex who had undergone cataract surgery was referred to our hospital. The cortex was removed, and bullous keratopathy progressed. Six months after the initial surgery, DSAEK was performed under topical anesthesia without any complications. Although the corneal graft had attached fairly well, it detached from the host cornea 3 weeks later. Two months after DSAEK, an air tamponade was used to treat the anterior chamber with single interrupted suturing; however, the graft detached again, except for the suture site. Because the detached cornea became cloudy in the anterior chamber, it was surgically removed 8 months after DSAEK. Accordingly, the host cornea transparency improved to a best-corrected visual acuity of 0.8 with a rigid gas permeable lens and a central corneal thickness of 580 μm. The corneal endothelial cell density was 995 cells/mm2. Conclusion: Removal of the corneal graft from the dislocated cloudy graft improved the visual acuity of this patient after DSAEK. The condition of the cornea should be carefully monitored after corneal endothelial transplantation, even after the graft has been dislocated.

Introduction: Inflammatory juvenile conjunctival nevus (IJCN) is a rare condition affecting both children and adolescents. It has misleading clinical and histopathological features; therefore, careful assessment is necessary. We present a case of IJCN with a rare pathological type and misleading histopathological features. Case Presentation: A 13-year-old girl with IJCN in the right eye was treated with antiallergic and steroid eye drops but showed no response and was referred to our hospital for excisional biopsy. Slit-lamp examination revealed a nonpigmented juxtalimbal tumor in the right eye. Histopathologically, nevus cells with mild nuclear atypia proliferated within the conjunctival epithelium. Confluent growth of junctional nests, conjunctival cysts, and prominent inflammatory infiltration were also observed. Considering the young age of the patient and immunohistochemical characteristics (HMB-45, SOX10, p16 and Ki-67), the patient was finally diagnosed with IJCN. IJCN has three pathological subtypes – compound, subepithelial, and junctional – depending on the location of the nevus cells. This case was diagnosed as a rare junctional type, as most of the examined sections only showed lesions within the epithelium; no lesions were clearly identified extending beneath the epithelium. Conclusion: The pathological diagnosis of IJCN is difficult because some features of IJCN suggest malignancy. Detailed microscopic examination, immunohistochemical staining, and the patient’s young age helped render a final diagnosis.

Purpose: This report presents a case of fungal keratitis treated with penetrating keratoplasty using a cryopreserved cornea, highlighting the successful maintenance of corneal transparency post infection resolution. Observations: A 57-year-old man complaining of pain in the right eye was referred to our hospital. Although diagnosed with fungal keratitis, his corneal scraping indicated the presence of Fusarium sp, and he was unresponsive to voriconazole, micafungin, and pimaricin treatments. His right visual acuity was hand motion. Therefore, we performed penetrating keratoplasty using a cryopreserved cornea. A cornea frozen and stored at −80 °C was used, with an 8.5-mm-diameter graft covering the infected area. Fungal keratitis subsided after corneal transplantation, and approximately 2 months later, corneal thickness gradually decreased, leading to improved corneal transparency. Therefore, a secondary optical corneal transplantation was deemed unnecessary. The final best-corrected visual acuity after additional cataract surgery was 20/40. Transparency was subsequently maintained for over a year. Conclusions and importance: Cryopreserved corneas in penetrating keratoplasty may be viable for maintaining corneal transparency. Additionally, waiting several months for secondary optical corneal transplantation after therapeutic keratoplasty may be a good approach.

Toxicity of Paederus species to eyes has scarcely been reported. This report presents a case of chemical blepharokeratoconjunctivitis with delayed re-epithelialization caused by Paederus fuscipes in a patient with dry eye after laser-assisted in situ keratomileusis (LASIK). A 47-year-old woman who had undergone LASIK for myopia 10 years prior experienced visual disturbance and pain in her left eye after being hit by a P. fuscipes insect in her eye 1 day prior to evaluation. At the initial presentation, dermatitis around the patient’s left eye, eyelid oedema, conjunctival chemosis, corneal epithelial defects, and a best corrected visual acuity (BCVA) of 20/200 were noted. No gram-positive/negative bacteria or indication of cellulitis/elevated inflammation was detected. Administration of topical steroids (betamethasone) and antibiotics (topical: cefmenoxime and levofloxacin; intravenous: ceftriaxone) improved the non-infectious chemical blepharokeratoconjunctivitis; however, the large corneal epithelial defect remained for 10 days. Switching from betamethasone to a preservative-free form facilitated re-epithelialization, and the patient’s BCVA improved to 20/16 after 2 months. Ophthalmologists should consider the toxicity of the Paederus species on the ocular surface and eyelid.

Abstract The adverse effects of hard contact lenses (HCL) on the corneal endothelium have been studied in the short term; however, long-term effects remain still unclear. In this study, we analyzed the effect of long-term HCL use on corneal endothelial cell density (ECD) and morphology in healthy Japanese individuals. This cross-sectional observational study included individuals using HCL for refractive errors examined at a single specialty eye hospital. Patient age, duration of HCL usage, ECD, coefficient of variation of the cell area (CV), and rate of appearance of hexagonal cells (6A) obtained via non-contact specular microscopy were assessed. We analyzed 8604 eyes (mean age: 35.6 ± 10.0 years, 837 males, 3465 females). The mean duration of HCL usage was 14.7 ± 9.1 (range, 1–50) years. Multivariate analysis revealed that ECD significantly correlated with age (P

Abstract Bullous keratopathy (BK) is known to present with corneal edema and Descemet's folds, which can cause corneal astigmatism. However, no report quantitatively evaluated BK astigmatism by separating it into regular and irregular astigmatism. This study investigated the regular and irregular astigmatism of the anterior and posterior corneal surface with Fourier harmonic analysis and anterior segment optical coherence tomography. Preoperative data from 43 eyes of 41 BK patients who received corneal endothelial transplantation were compared with the data from 43 eyes of 43 subjects without corneal disease. Anterior and posterior cylinder power, central corneal thickness (CCT) and thinnest corneal thickness were significantly greater in BK. With Fourier harmonic analysis, BK eyes were found to have significantly larger anterior and posterior regular astigmatism, asymmetry component and higher-order irregularity. Asymmetry component and higher-order irregularity that accounted for the posterior irregular astigmatism increased as CCT increased in BK. Higher-order irregularity in the posterior cornea also positively correlated with worsening best corrected visual acuity. Subgroup analysis found significant correlations between CCT and posterior higher-order irregularity for intraocular surgery and laser iridotomy, but not Fuchs endothelial corneal dystrophy. This study has significance in that it revealed the characteristics of the corneal posterior irregular astigmatism of BK.

Purpose: This report aimed to present a case of corneal fibrosis with prolonged atopic blepharitis caused by psychological resistance to steroid treatment. Observations: A 49-year-old woman presented with atopic dermatitis and a history of panic attack and autism spectrum disorder. The upper and lower eyelid margins of her right eye became adherent, and the eyelid remained closed for several years due to refusal of steroid treatment and aggravation of blepharitis. During the initial examination, a lesion with elevated white opacity on the corneal surface was observed. Subsequently, superficial keratectomy was performed. The histopathological findings were indicative of corneal keloid. Conclusions and Importance: Persistent atopic ocular surface inflammation and prolonged eyelid closure resulted in the formation of a corneal keloid.

Abstract The purpose of this study was to evaluate corneal irregular astigmatism of patients with granular and lattice corneal dystrophy (GCD and LCD). 70 GCD, 35 LCD, and 81 control eyes were included. Anterior and posterior corneal topographic data obtained from anterior segment optical coherence tomography were expanded into four components via Fourier harmonic analysis. These components were compared with healthy eyes and the association between each component and best-corrected visual acuity (BCVA) was investigated. Anterior and posterior components increased in both GCD and LCD eyes. Anterior and posterior components of GCD2, anterior of LCD type 1 (LCD1), posterior of LCD type IIIA (LCD 3A), and type IV (LCD4) significantly increased. BCVA was significantly associated with anterior and posterior components in LCD eyes but not in GCD. The anterior components of LCD1, anterior and posterior of LCD3A, and posterior of LCD4 , were positively correlated with BCVA. As conclusions, in GCD eyes, anterior and posterior components differed from those of the control but BCVA was not significantly associated with them. In LCD eyes, the anterior and posterior components increased, and BCVA was significantly associated with the anterior and posterior components.

Graft detachment after Descemet stripping automated endothelial keratoplasty (DSAEK) is usually managed with air-bubbling. However, it is an invasive procedure, which can cause corneal endothelial reduction, and requires hospitalization and supine position maintenance. Only few case reports on graft reattachment in the prone position exist, and this is the first report from Japan. An 87-year-old woman presented with sudden pain in her left eye. Examination of her left eye showed a best-corrected vision of 20/50, shallow anterior chamber, cataractous lens, central corneal thickness (CCT) of 630 μm, and corneal endothelial cell count of 467 cells/mm2. She was diagnosed with left-eye bullous keratopathy due to primary angle closure, and DSAEK was performed after cataract surgery. Post-surgery, she touched her left eye due to agitation. Graft adhesion was good until postoperative day 4; however, a partial detachment was observed on day 12. She was instructed to remain in a prone position for as long as possible; on day 22, the graft was reattached, and the CCT improved to 555 μm. Since then, the graft adhesion has been maintained, and her best-corrected vision has improved to 20/30. To date, 5 cases of graft reattachment in the prone position have been reported, with reattachment observed in all cases within 10 days from the onset of detachment, including this case. Re-bubbling is an effective technique; however, it is invasive and may cause additional corneal endothelial loss. Therefore, it may be beneficial to have the patient initially attempt the prone position for reattachment.

Descemet’s membrane endothelial keratoplasty (DMEK) for patients with corneal endothelial loss rarely results in graft rejection. Herein, we report a rare case of graft rejection following DMEK, in which peripheral anterior synechiae were observed postoperatively. A 66-year-old woman was referred to our hospital after complaints of decreased visual acuity of her right eye after laser iridotomy for primary angle closure 3 years earlier. Her right cornea had bullous keratopathy with mild cataract, and her best-corrected visual acuity (BCVA) was 20/40. After cataract surgery, DMEK was successfully performed, except for development of peripheral anterior synechiae at the temporal cornea. Her BCVA recovered to 20/20. However, when topical instillation was changed to 0.1% fluorometholone from 0.1% betamethasone once a day, corneal edema reappeared with hyperemia, mutton fat keratic precipitates (KPs), and cells in the anterior chamber. The BCVA worsened to 20/32. Graft rejection was diagnosed, and subconjunctival injection of dexamethasone was performed 3 times, once every few days, with 0.1% topical betamethasone instillation. Subsequently, the hyperemia, mutton fat KPs, and cells in the anterior chamber disappeared with a recovered BCVA of 20/20 after 2 weeks. Ten months after graft rejection, there was no recurrence of intraocular inflammation, and only topical betamethasone was administered twice daily. It is important to exercise caution in cases with peripheral anterior synechiae after DMEK. Long-term steroid administration is necessary to prevent graft rejection.

Background. Epikeratophakia is a refractive surgical procedure used to correct aphakic eyes, hyperopia, and keratoconus and is often performed in children. In this report, we present the long-term effects of epikeratophakia on the progression of keratoconus in a patient who underwent surgery. Case Presentation. The patient was a 17-year-old boy with keratoconus who had difficulty wearing hard contact lenses. As a solution, he underwent right eye epikeratophakia with a plano-powered lenticule. We followed up the patient for 30 years. Although the progression of keratoconus ceased in the operated eye, it continued in the nonoperated left eye and resulted in acute hydrops 9 years and 10 months after surgery. Subsequently, 20 years after the operation, anterior-segment optical coherence tomography was performed, which revealed that the progression of keratoconus had been interrupted in the right eye but had continued in the left eye, as evidenced by the parameters of the average and maximum keratometry and thinnest corneal thickness. Conclusions. Herein, we reported the longest follow-up to date of a case of keratoconus, in which one eye was treated with epikeratophakia. The progression of keratoconus was halted in the treated eye but continued in the nonoperated contralateral eye.

Abstract We aimed to investigate the cell density and morphology of the corneal endothelium in ophthalmologically healthy young Japanese, given the lack of normative data in literature. This observational study included eyes without ophthalmologic diseases, besides refractive errors, examined between 1996 and 2015 at Miyata Eye Hospital. Eyes with a history of ophthalmologic diseases or contact lens usage were excluded. Correlation of corneal endothelial cell density (ECD), coefficient of variation (CV), appearance rate of hexagonal cells (6A), and cell area with age were examined. Multivariate linear regression analysis was performed to determine the predictors of corneal parameters. We included 16842 eyes of 8421 individuals (19.6 ± 8.7 years). ECD was 3109.0 ± 303.7 cells/mm2 and significantly reduced with age (p

Objective To assess the long-term efficacy and safety of accelerated transepithelial corneal cross-linking (ATE-CXL) with 30 mW/cm2 × 3 min.Methods and Analysis Thirty-four eyes of 23 patients with progressive keratoconus (KCN) recruited within a single centre were enrolled in this prospective interventional study. Exclusion criteria included: history of Descemet’s membrane rupture, glaucoma, uveitis, severe dry eye, concurrent corneal infections, and systemic disease that could affect corneal healing. ATE-CXL was performed with 3 min of ultraviolet-A continuous irradiation (30 mW/cm2). Follow-up examinations were scheduled on postoperative day 1; 1 and 2 weeks; 1, 3 and 6 months; and 1, 2 and 3 years. Main outcome measures were maximum corneal power (Kmax), average corneal power (AvgK), steepest corneal power (Ks), central corneal thickness, thinnest corneal thickness, uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BCVA) and endothelial cell density.Results Mean Kmax, AvgK, Ks, UCVA, BCVA and endothelial cell density did not significantly change over 3 years. The speed of progression obtained by linear regression analysis on corneal parameters (Kmax, AvgK, Ks) improved after ATE-CXL. All baseline parameters correlated with the postoperative Kmax slope. Two eyes underwent ATE-CXL redo because of continued progression after the primary CXL.Conclusion This is the first report of 3-year results of ATE-CXL with 30 mW/cm2 × 3 min. ATE-CXL (30 mW/cm2 × 3 min) was safe and effective for slowing down KCN progression.Trial registration number This study was registered with ID UMIN000009372 in UMIN-Clinical Trials Registry.

Although a few cases of dermatitis or keratitis caused by exposure to the sap of Euphorbia trigona have been reported, we present a rare case of transient corneal endothelial dysfunction following exposure to the sap, resulting in corneal edema. A woman in her 70s complained of reduced vision, redness, and teariness in her left eye 2 days after exposure to the sap of E. trigona at home. Upon examination, hyperemia, serious corneal edema, and anterior uveitis with hypopyon were observed in her left eye, without corneal epithelial defects or keratic precipitates. The best-corrected visual acuity (BCVA) was 2.0 (logarithm of the minimum angle of resolution), and the measured central corneal thickness (CCT) was 812 µm. The patient was treated with topical instillation of 1.5% levofloxacin and 0.1% dexamethasone to reduce intraocular inflammation and corneal edema. Three weeks later, the BCVA reached 0, the CCT was 519 μm, and the corneal endothelial cell density was 3,233 cells/mm2. Six months after the injury, the patient had good visual acuity, and the cornea was completely transparent. No recurrence of corneal edema or anterior uveitis was observed. Exposure to the sap of E. trigona can lead to severe corneal edema with anterior uveitis, impairing visual acuity. Taking precautions to prevent the exposure of the eye to the sap of this plant is crucial.

Abstract Background Cytomegalovirus (CMV) has been known to cause unilateral corneal endotheliitis with keratic precipitates and localized corneal edema, iridocyclitis, and secondary glaucoma. CMV endotheliitis is diagnosed based on clinical manifestations and viral examination using qualitative polymerase chain reaction (PCR) of the aqueous humor. Case presentation An 80-year-old woman was referred to our department for bullous keratopathy. Pigmented keratic precipitates were found in the right eye without significant anterior chamber inflammation. After 8 months there was inflammation relapse with mutton fat keratic precipitates and PCR on aqueous humor was performed, with negative results for CMV, herpes simplex virus, and varicella zoster virus. Keratic precipitates disappeared with steroid instillation, and Descemet-stripping automated endothelial keratoplasty (DSAEK) was performed for the right eye. CMV-DNA was positive at 6.0 × 102 copies/ GAPDH 105 copies in real time PCR of corneal endothelial specimen removed during DSAEK with negative results for all the other human herpes viruses. After diagnosis of CMV corneal endotheliitis, treatment with systemic and topical ganciclovir was initiated and there was resolution of symptoms. No recurrence of iridocyclitis or corneal endotheliitis was observed at 6 months follow up. Conclusions This case report suggests that PCR should be performed using the endothelium removed during DSAEK for bullous keratopathy of an unknown cause, even if PCR for aqueous humor yields negative results.

We report a case of bilateral iridoschisis with corneal oedema and a quantitative evaluation of the changes in iridotrabecular and iridocorneal contact before and after cataract surgery and after Descemet stripping automated endothelial keratoplasty (DSAEK). A 76-year-old woman with iridoschisis and cataracts, previously managed with laser iridotomy, experienced progressive vision loss. The preoperative iridotrabecular contact (ITC) index measured by anterior segment optical coherence tomography was 23.6% in the right eye and 24.4% in the left eye. Preoperative corneal oedema in the right eye was more severe than that in the left eye. Cataract surgery, followed by DSAEK, was performed in the right eye and subsequently in the left eye. Her visual acuity improved postoperatively, and the corneal oedema of both eyes was treated successfully. Moreover, the ITC index improved in both eyes, to 4.7 and 6.9% after cataract surgery and to 0 and 0% after DSAEK in the right and left eyes, respectively. Staged cataract surgery and DSAEK were effective for endothelial decompensation caused by iridoschisis. Additionally, we confirm that iridotrabecular and iridocorneal contacts improved after both surgical procedures not only after cataract surgery but also after DSAEK. This case report showed the clinical usefulness of the ITC index in the detection of changes after different surgical procedures.

Purpose: Irregular corneal epithelium in limbal stem cell disease can cause visual acuity to deteriorate substantially when it reaches the pupil. In this case series, we assessed the effectiveness of simple corneal epithelial superficial keratectomy in improving visual acuity in patients with irregular corneal epithelium in focal limbal stem cell disease covering the visual axis. Observations: We performed simple corneal epithelial superficial keratectomy in four patients (five eyes) with irregular corneal epithelium covering the visual axis. The main outcome measures were best-corrected visual acuity, slit lamp findings with fluorescein staining, anterior segment optical coherence tomography and histopathology. In all five eyes, slit lamp findings showed uneven fluorescein staining in a spiral pattern, with impaired corneal epithelial smoothness and visual disturbance. We removed the irregular epithelium in all five eyes. Visual acuity in all the eyes was improved immediately after surgery, and good visual acuity and stable epithelium were maintained for the duration of the observation periods. Hematoxylin and eosin staining showed, normal squamous and columnar epithelial cells. Goblet cells were not detected. Conclusionsand Importance: Corneal epithelial superficial keratectomy can lead to a pathological diagnosis by examining the removed epithelial tissues, and result in excellent therapeutic outcomes in focal limbal stem cell disease reaching the pupil.

Abstract To determine the risk factors and unique characteristics of keratoconus (KC) progression after penetrating keratoplasty (PK), anterior segment optical coherence tomography parameters were statistically analyzed in comparison with eyes undergoing PK for other diseases as a control. Ninety-one eyes maintaining clear PK grafts for over 10 years were divided into 2 groups according to the primary indication for PK (KC vs Others groups). Corneal thinning indicators (inferior host thinnest corneal thickness/central corneal thickness [IHT/CCT], inferior graft thinnest corneal thickness/CCT [IGT/CCT]), were smaller whereas anterior chamber depth, and steepest corneal power (Ks), and maximum corneal power (Kmax) were larger in the KC group with statistical significance. Graft size, Kmax and Ks correlated with IHT/CCT and IGT/CCT in the KC group. These correlations were not detected in controls. Graft size and postoperative period were selected by multivariate regression analysis as factors for corneal ectatic changes in the KC group. In conclusion, KC eyes long after PK show inferior graft and host corneal thinning, and corneal protrusion. Corneal power parameters such as Kmax or Ks can be used to monitor KC progression after PK. A small graft might lead to KC progression after PK.

Abstract The aim of this observational study was to examine the characteristics of anterior and posterior corneal topography in keratoconic eyes more than 30 years after penetrating keratoplasty (PK). Patients who maintained clear grafts for more than 30 years after PK were included and divided into the keratoconus (KC) group or other diseases (Others) group, based on the primary indication. Twenty-six eyes of 26 patients were included. The KC group and the Others group included 14 eyes and 12 eyes, respectively. The KC group participants were younger at the time of surgery (P = 0.03). No differences were found in best-spectacle-corrected visual acuity, keratometric power, and central-corneal-thickness. Based on corneal topography using Fourier harmonic analyses, regular astigmatism in the anterior cornea was significantly larger (P = 0.047) and the spherical component in the posterior cornea was significantly lower (P = 0.01) in the KC group. The area under the receiver operating characteristic curve of the spherical component, regular astigmatism, asymmetry component, and higher-order irregularity were 66.07%, 63.10%, 57.14%, and 59.23%, respectively, in the anterior cornea and 80.65%, 52.98%, 63.10%, and 63.99%, respectively, in the posterior cornea. Our results suggested that Fourier harmonic analysis of corneal topography could be useful for patients with KC long after PK.

This study examined the treatment, clinical course, and prognosis of two patients who visited our institution with severe ocular fishhook-related injuries with complications. The first patient was a 57-year-old man injured in the right eye by a fishhook lacerating the right upper eyelid. Although no aqueous humor leakage was observed, intraocular hemorrhage was severe, and the best-corrected visual acuity (BCVA) was “counting fingers” at 15 cm. The eyelid was sutured and vitreous surgery with cataract surgery was performed for traumatic cataract, vitreous hemorrhage, and retinal detachment. The patient experienced recurring iritis and the BCVA recovered to 20/100 eight months postoperatively. The second patient was a 62-year-old man who incurred a penetrating right-eye fishhook injury on a ship with BCVA of “hand motion.” The sclera and iris were ruptured with severe hemorrhage and a shallow anterior chamber without leakage of aqueous humor. A damaged lens and vitreous hemorrhage were observed with intraocular pressure of 38 mmHg. The ruptured sclera was sutured and vitreous surgery with lensectomy was performed. After 16 months, the BCVA improved to 20/40; however, glaucoma control was maintained by topical medication. Therefore, ocular fishhook-related injury could result in irreversible visual impairment. It is important to pay attention and protect the eyes from moving fishhooks during fishing. Plain language summary: There are few reports on fishhook injury of the eye with resulting complications such as retinal detachment. We present the characteristics of the injury, treatment, clinical course, and prognosis of two patients with severe fishhook-related injuries of the eye with complications. Following treatment, most complications, including vitreous hemorrhage, detached lens, and retinal detachment, safely resolved in these cases; however, both patients required further treatment for recurring inflammation of the iris or glaucoma. The visual acuity of both patients improved over several months. Fishhook-related injuries of the eyes might result in irreversible visual impairment. It is important to pay attention and protect the eyes from moving fishhooks during fishing.

Purpose/aimDetecting keratoconus (KC) progression helps determine the surgical indication for corneal cross-linking (CXL). This retrospective observational study aimed to examine changes in keratometric indices and corneal thickness in patients with KC who used rigid gas-permeable (RGP) contact lenses.Materials and methodsThis study involved 31 eyes (31 patients) diagnosed with KC. No patient had used RGP or any other type of contact lenses for at least 1 month. Corneal topographic data were obtained using three-dimensional anterior segment optical coherence tomography before and after >1 month of RGP lens use.ResultsThe average and maximum keratometry values changed after using an RGP lens (-1.05 ± 1.92 D, p < 0.01 and -1.65 ± 4.20 D, p = 0.04, respectively); the spherical component of the anterior corneal surface became significantly smaller (p = 0.02). No change was observed in the central or thinnest corneal thickness values. Keratometric changes were greater in eyes with severe KC than in those with moderate KC (p = 0.014).ConclusionsKeratometry and spherical components of the anterior corneal surface values decreased after RGP lens use; keratometric changes were greater in eyes with severe KC than in those with moderate KC. Corneal progression indices, including corneal thickness, posterior keratometry, and irregular astigmatism values, mostly remained unchanged. It is important to consider these findings when evaluating corneal topography of KC and preparing CXL.

Purpose: The aim of this report was to describe a case of cataract surgery and Descemet stripping automated endothelial keratoplasty (DSAEK) after cytomegalovirus (CMV) corneal endotheliitis and bullous keratopathy (BK) following immunosuppressive treatment for Mooren's ulcer. Observations: A 64-year-old man was referred to our hospital because of peripheral ulcerative keratitis in his left eye. He had a history of trabeculectomy for open angle glaucoma in his left eye. He was diagnosed with Mooren's ulcer and treated with topical betamethasone and tacrolimus with systemic cyclosporine. The corneal ulcer improved, but the peripheral cornea thinned from 6 to 12 and 0–2 o'clock. Five months later, cells were observed in the left anterior chamber, and real-time polymerase chain reaction examination of the aqueous humor showed CMV-DNA-positive results. The patient was diagnosed with CMV corneal endotheliitis, and oral ganciclovir was administered. Fifteen months after the initial presentation, BK appeared with decreased vision to 20 cm/n. d. After confirmation of negative CMV-DNA in the aqueous humor, DSAEK was performed following cataract surgery. The postoperative visual acuity recovered to 0.3. Mooren's ulcer exacerbation and CMV corneal endotheliitis did not recur postoperatively. Conclusions and Importance: This is the first report of a case in which a patient with Mooren's ulcer developed BK due to CMV corneal endotheliitis and required DSAEK. Cataract surgery and DSAEK could be performed without issue by creating the main wound and side ports in a manner that avoids the thinned parts of the cornea.

Abstract Human corneal endothelial cells (HCEnCs) are terminally differentiated cells that have limited regenerative potential. The large numbers of mitochondria in HCEnCs are critical for pump and barrier function required for corneal hydration and transparency. Fuchs Endothelial Corneal Dystrophy (FECD) is a highly prevalent late-onset oxidative stress disorder characterized by progressive loss of HCEnCs. We previously reported increased mitochondrial fragmentation and reduced ATP and mtDNA copy number in FECD. Herein, carbonyl cyanide m-chlorophenyl hydrazone (CCCP)-induced mitochondrial depolarization decreased mitochondrial mass and Mfn2 levels, which were rescued with mitophagy blocker, bafilomycin, in FECD. Moreover, electron transport chain complex (I, V) decrease in FECD indicated deficient mitochondrial bioenergetics. Transmission electron microscopy of FECD tissues displayed an increased number of autophagic vacuoles containing degenerated and swollen mitochondria with cristolysis. An elevation of LC3-II and LAMP1 and downregulation of Mfn2 in mitochondrial fractions suggested that loss of fusion capacity targets fragmented mitochondria to the pre-autophagic pool and upregulates mitophagy. CCCP-induced mitochondrial fragmentation leads to Mfn2 and LC3 co-localization without activation of proteosome, suggesting a novel Mfn2 degradation pathway via mitophagy. These data indicate constitutive activation of mitophagy results in reduction of mitochondrial mass and abrogates cellular bioenergetics during degeneration of post-mitotic cells of ocular tissue.