Cornea : The Journal of Cornea and External Disease

07/11/2025

ICYMI: Quantifying Corneal Endothelial Cell Damage During Descemet Membrane Endothelial Keratoplasty Graft Loading and Ejection Using a Calcein-AM Imaging Method: Purpose:

(1) To compare total endothelial cell damage from loading and ejection of Descemet membrane endothelial keratoplasty (DMEK) grafts through Straiko and Lions World Vision Institute (LWVI) glass cannulas. (2) To isolate and quantify endothelial cell damage from loading or ejection alone in Straiko tubes.

Methods:

DMEK grafts were peeled, stained with Calcein-AM (CAM), and imaged under fluorescence microscopy to evaluate baseline endothelial damage. Grafts were then loaded and ejected from Straiko and LWVI glass cannulas, and reimaged. Loss of CAM fluorescence signal was evaluated to calculate change in Area of Cell Damage (ACD). ACD changes were compared between Straiko and LWVI cannulas. Custom-made Straiko “half-tubes,” consisting of only the loading or ejection end of a Straiko tube, were used to isolate graft loading from ejection, and CAM-based ACD was again assessed.

Results:

Loading and ejection resulted in a significant increase in ACD for both Straiko (4.88% ± 0.53%) and LWVI (4.22% ± 0.57%) cannulas, but this was not statistically different between cannulas (P = 0.42). For Straiko half-tubes, ejection alone (3.08% ± 0.31%) resulted in a significantly greater increase in ACD compared with loading alone (1.38% ± 0.36%) (P = 0.004).

Conclusions:

Ejection of DMEK grafts through a Straiko tube causes more endothelial cell damage than loading. Loading and ejection of DMEK grafts through Straiko and LWVI tubes were associated with similar endothelial cell damage. Bore size alone cannot explain these results. The overall damage, measured using CAM, was lower than previously reported studies that relied on different methods for quantifying damage.

in Straiko tubes. Methods: DMEK grafts were peeled, stained with Calcein-AM (CAM), and imaged under fluorescence microscopy to evaluate baseline endothelial damage. Grafts were then loaded and ejected from Straiko and LWVI glass cannulas, and reimaged. Loss of CAM fluorescence signal was evaluated t...

07/11/2025

ICYMI: An Indolent Inflammatory Myofibroblastic Tumor of the Conjunctiva: Purpose:

Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm of intermediate biological potential, predominantly affecting children and young adults. While IMT most commonly involves the lungs, abdomen, pelvis, and retroperitoneum, primary occurrences in the orbit or ocular surface are rare.

Methods:

Case report.

Results:

Here we present a case of a 26-year-old woman with a small, indolent conjunctival IMT harboring anaplastic lymphoma kinase rearrangement. Following surgical resection, the patient showed no evidence of recurrence after 9 months of follow-up. Notably, this report firstly provided anterior segment optical coherence tomography scan and ultrasound biomicroscope images of conjunctival IMT.

Conclusions:

IMT should be considered in the differential diagnosis of localized conjunctival lesions unresponsive to steroid therapy. Anterior segment optical coherence tomography and ultrasound biomicroscope serve as valuable tools, aiding in differential diagnosis, surgical planning, and postoperative recurrence monitoring.

ace are rare. Methods: Case report. Results: Here we present a case of a 26-year-old woman with a small, indolent conjunctival IMT harboring anaplastic lymphoma kinase rearrangement. Following surgical resection, the patient showed no evidence of recurrence after 9 months of follow-up. Notably, this...

07/11/2025

ICYMI: Spontaneous Descemet Membrane Detachment After Necrotizing Scleritis: A Case Report: Purpose:

We report a case of spontaneous Descemet membrane detachment (DMD) in a patient with a history of necrotizing scleritis and discuss the management approach and outcome.

Methods:

This was a case report and review of literature.

Results:

A 50-year-old man with a history of rheumatoid arthritis, ankylosing spondylitis, and necrotizing scleritis on systemic methotrexate, rituximab, and prednisone presented with 6 weeks of photophobia, pain, and decreased vision in his left eye. Visual acuity on presentation was 20/80 in the left eye, and intraocular pressure was 18 mm Hg. Slit lamp examination demonstrated scleral injection most significantly in an area of superonasal epithelialized scleral thinning with underlying uveal visibility, indicating prior necrotizing scleritis. Bullous corneal edema extended from the limbus superonasally into the visual axis. The remainder of the anterior and posterior segment evaluations was unremarkable. Anterior segment optical coherence tomography confirmed the presence of DMD underlying the area of corneal edema. The patient was treated with an increased dose of oral prednisone with subsequent taper for systemic autoimmune control given active nonnecrotizing scleritis, followed 2 months later by air bubble injection in the anterior chamber and face-up positioning for 2 days. This led to reattachment of Descemet membrane and complete clearance of corneal edema, with improvement of vision to 20/25 on follow-up.

Conclusions:

This is the first report of spontaneous DMD in a patient with a history of necrotizing scleritis. A possible mechanism may include shearing forces secondary to scleral ectasia, which may result in focal Descemet membrane tears and subsequent detachment.

umatoid arthritis, ankylosing spondylitis, and necrotizing scleritis on systemic methotrexate, rituximab, and prednisone presented with 6 weeks of photophobia, pain, and decreased vision in his left eye. Visual acuity on presentation was 20/80 in the left eye, and intraocular pressure was 18 mm Hg.....

07/11/2025

ICYMI: FRESH OFF THE PRESS: Reply: No abstract available

07/10/2025

ICYMI: Corneal Perforation Associated With Tralokinumab: Purpose:

The purpose of this study was to report the first documented case of peripheral corneal perforation associated with tralokinumab therapy for atopic dermatitis.

Methods:

A detailed clinical examination, imaging, and comprehensive systemic workup were performed to determine the etiology. The case was managed surgically and followed postoperatively at a tertiary hospital within the Spanish National Health System.

Results:

We report the case of a 66-year-old woman receiving tralokinumab for atopic dermatitis who presented with a spontaneous 10 mm peripheral corneal perforation, self-sealed by iris prolapse. Urgent surgical intervention included corneal suturing and amniotic membrane grafting. There was no evidence of trauma, infection, systemic autoimmune disease, or periocular atopic dermatitis. A comprehensive systemic workup ruled out infectious and autoimmune etiologies. Tralokinumab was discontinued in coordination with the dermatology department. The patient experienced a favorable recovery, with complete corneal healing and improvement in best-corrected visual acuity to 0.1 logMAR at 3 months.

Conclusions:

This case represents the first reported instance of corneal perforation potentially related to tralokinumab. Although ocular side effects of IL-13–targeted therapies are typically mild, this report highlights the possibility of severe complications. Given the increasing use of biologic agents in dermatology, awareness of rare but potentially vision-threatening adverse effects is essential. In suspected cases, early ophthalmologic evaluation and multidisciplinary management are crucial for preventing poor outcomes in patients receiving tralokinumab.

ology. The case was managed surgically and followed postoperatively at a tertiary hospital within the Spanish National Health System. Results: We report the case of a 66-year-old woman receiving tralokinumab for atopic dermatitis who presented with a spontaneous 10 mm peripheral corneal perforation,...

07/10/2025

ICYMI: Corneal Epithelial Thickness Mapping in the Diagnosis of Ocular Surface Disorders Involving the Corneal Epithelium: A Comparative Study: Purpose:

The purpose of this study was to analyze the role of corneal epithelial thickness (ET) mapping provided by spectral domain optical coherence tomography in the diagnosis of ocular surface disorders (OSDs) involving the corneal epithelium.

Design:

This was a retrospective comparative study.

Methods:

Institutional settings are as follows. Study population includes 303 eyes with an OSD and 55 normal eyes (controls). Observation procedures include spectral domain optical coherence tomography with epithelial mapping in the central 6 mm. Main outcome measures include ET map classification (normal, doughnut, spoke-wheel, localized/diffuse, and thinning/thickening patterns) and ET data and statistics (minimum, maximum, and SD). A quantitative threshold was determined with receiver operating curves to distinguish pathological from normal corneas. Sensitivity and specificity of classification and quantitative data were calculated using all eyes to assess the ability to distinguish corneas with a given corneal disorder from other conditions.

Results:

Classification of full agreement between 3 readers was obtained in 75.4% to 99.4% of cases. Main OSD features were keratoconus (135 eyes), doughnut pattern (sensitivity/specificity = 56/94%), and max–min ET ≥ 13 μm (84/43%); limbal deficiency (56 eyes), spoke-wheel pattern (66/98%), and max–min ET ≥ 14 μm (91/59%); epithelial basement membrane dystrophy (55 eyes), inferior thickening pattern (55/92%), and central ET > 56 μm (53/81%); dry eye (21 eyes), superior thinning pattern (67/88%), and minimal ET ≤ 44 μm (86/48%); pterygium (10 eyes), nasal thickening pattern (100/86%), and nasal ET > 56 μm (80/71%); and in situ carcinoma (11 eyes), max ET > 60 μm (91/60%), and ET SD >5 μm (100/58%).

Conclusions:

The epithelial map pattern recognition combined with quantitative analysis of ET is relevant for the diagnosis of OSDs and for distinguishing various OSDs from each other. Deep learning analysis of big data could lead to the fully automated diagnosis of these disorders.

ve study. Methods: Institutional settings are as follows. Study population includes 303 eyes with an OSD and 55 normal eyes (controls). Observation procedures include spectral domain optical coherence tomography with epithelial mapping in the central 6 mm. Main outcome measures include ET map classi...

07/10/2025

ICYMI: Randomized Clinical Trial of Topical Insulin Versus Artificial Tears for Healing Rates of Iatrogenic Corneal Epithelial Defects Induced During Vitreoretinal Surgery in Diabetics: Purpose:

The aim of this study was to measure and compare the effect of topical insulin (0.5 units, 4 times per day) versus artificial tears (Vismed, sodium hyaluronate 0.18%, 4 times per day) for the healing of postoperative corneal epithelial defects induced during vitreoretinal surgery in diabetic patients.

Methods:

This is a double-blind randomized controlled hospital-based study involving diabetic patients with postoperative corneal epithelial defects after vitreoretinal surgery. Diabetic patients were randomized into 2 different groups and received either 0.5 units of topical insulin (DTI) or artificial tears (Vismed, sodium hyaluronate 0.18%; DAT). The primary outcome measured was the rate of corneal epithelial wound healing (mm2/h) over a preset interval and time from baseline to minimum size of epithelial defect on fluorescein-stained anterior segment digital camera photography. The secondary outcome measured was the safety of topical insulin 0.5 units and artificial tears (Vismed, sodium hyaluronate 0.18%). Patients were followed up until 3 months postoperation.

Results:

A total of 38 eyes from 38 patients undergoing intraoperative corneal debridement during vitreoretinal surgery with resultant epithelial defects (19 eyes per group) were analyzed. DTI was observed to have a significantly higher healing rate compared with the DAT group at rates over 36 hours (P = 0.010), 48 hours (P = 0.009), and 144 hours (P = 0.009). The rate from baseline to closure was observed to be significantly higher in the DTI group (1.20 ± 0.29) (mm2/h) compared with the DAT group (0.78 ± 0.20) (mm2/h) as well (P < 0.001). No adverse effect of topical insulin and artificial tears was reported.

Conclusions:

Topical insulin (0.5 units, 4 times per day) is more effective compared with artificial tears (Vismed, sodium hyaluronate 0.18%, 4 times per day) for the healing of postoperative corneal epithelial defects induced during vitreoretinal surgery in diabetic patients, without any adverse events.

iabetic patients. Methods: This is a double-blind randomized controlled hospital-based study involving diabetic patients with postoperative corneal epithelial defects after vitreoretinal surgery. Diabetic patients were randomized into 2 different groups and received either 0.5 units of topical insul...

07/10/2025

ICYMI: Global Consensus on Definition, Classification, Diagnosis, and Staging of Limbal Stem Cell Deficiency: Purpose:

Despite extensive knowledge gained over the last 3 decades regarding limbal stem cell deficiency (LSCD), the disease is not clearly defined, and there is lack of agreement on the diagnostic criteria, staging, and classification system among treating physicians and research scientists working on this field. There is therefore an unmet need to obtain global consensus on the definition, classification, diagnosis, and staging of LSCD.

Methods:

A Limbal Stem Cell Working Group was first established by The Cornea Society in 2012. The Working Group was divided into subcommittees. Four face-to-face meetings, frequent email discussions, and teleconferences were conducted since then to obtain agreement on a strategic plan and methodology from all participants after a comprehensive literature search, and final agreement was reached on the definition, classification, diagnosis, and staging of LSCD. A writing group was formed to draft the current manuscript, which has been extensively revised to reflect the consensus of the Working Group.

Results:

A consensus was reached on the definition, classification, diagnosis, and staging of LSCD. The clinical presentation and diagnostic criteria of LSCD were clarified, and a staging system of LSCD based on clinical presentation was established.

Conclusions:

This global consensus provides a comprehensive framework for the definition, classification, diagnosis, and staging of LSCD. The newly established criteria will aid in the correct diagnosis and formulation of an appropriate treatment for different stages of LSCD, which will facilitate a better understanding of the condition and help with clinical management, research, and clinical trials in this area.

working on this field. There is therefore an unmet need to obtain global consensus on the definition, classification, diagnosis, and staging of LSCD. Methods: A Limbal Stem Cell Working Group was first established by The Cornea Society in 2012. The Working Group was divided into subcommittees. Four....

07/09/2025

Quantifying Corneal Endothelial Cell Damage During Descemet Membrane Endothelial Keratoplasty Graft Loading and Ejection Using a Calcein-AM Imaging Method: Purpose:

(1) To compare total endothelial cell damage from loading and ejection of Descemet membrane endothelial keratoplasty (DMEK) grafts through Straiko and Lions World Vision Institute (LWVI) glass cannulas. (2) To isolate and quantify endothelial cell damage from loading or ejection alone in Straiko tubes.

Methods:

DMEK grafts were peeled, stained with Calcein-AM (CAM), and imaged under fluorescence microscopy to evaluate baseline endothelial damage. Grafts were then loaded and ejected from Straiko and LWVI glass cannulas, and reimaged. Loss of CAM fluorescence signal was evaluated to calculate change in Area of Cell Damage (ACD). ACD changes were compared between Straiko and LWVI cannulas. Custom-made Straiko “half-tubes,” consisting of only the loading or ejection end of a Straiko tube, were used to isolate graft loading from ejection, and CAM-based ACD was again assessed.

Results:

Loading and ejection resulted in a significant increase in ACD for both Straiko (4.88% ± 0.53%) and LWVI (4.22% ± 0.57%) cannulas, but this was not statistically different between cannulas (P = 0.42). For Straiko half-tubes, ejection alone (3.08% ± 0.31%) resulted in a significantly greater increase in ACD compared with loading alone (1.38% ± 0.36%) (P = 0.004).

Conclusions:

Ejection of DMEK grafts through a Straiko tube causes more endothelial cell damage than loading. Loading and ejection of DMEK grafts through Straiko and LWVI tubes were associated with similar endothelial cell damage. Bore size alone cannot explain these results. The overall damage, measured using CAM, was lower than previously reported studies that relied on different methods for quantifying damage.

in Straiko tubes. Methods: DMEK grafts were peeled, stained with Calcein-AM (CAM), and imaged under fluorescence microscopy to evaluate baseline endothelial damage. Grafts were then loaded and ejected from Straiko and LWVI glass cannulas, and reimaged. Loss of CAM fluorescence signal was evaluated t...

07/09/2025

An Indolent Inflammatory Myofibroblastic Tumor of the Conjunctiva: Purpose:

Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm of intermediate biological potential, predominantly affecting children and young adults. While IMT most commonly involves the lungs, abdomen, pelvis, and retroperitoneum, primary occurrences in the orbit or ocular surface are rare.

Methods:

Case report.

Results:

Here we present a case of a 26-year-old woman with a small, indolent conjunctival IMT harboring anaplastic lymphoma kinase rearrangement. Following surgical resection, the patient showed no evidence of recurrence after 9 months of follow-up. Notably, this report firstly provided anterior segment optical coherence tomography scan and ultrasound biomicroscope images of conjunctival IMT.

Conclusions:

IMT should be considered in the differential diagnosis of localized conjunctival lesions unresponsive to steroid therapy. Anterior segment optical coherence tomography and ultrasound biomicroscope serve as valuable tools, aiding in differential diagnosis, surgical planning, and postoperative recurrence monitoring.

ace are rare. Methods: Case report. Results: Here we present a case of a 26-year-old woman with a small, indolent conjunctival IMT harboring anaplastic lymphoma kinase rearrangement. Following surgical resection, the patient showed no evidence of recurrence after 9 months of follow-up. Notably, this...

07/09/2025

Spontaneous Descemet Membrane Detachment After Necrotizing Scleritis: A Case Report: Purpose:

We report a case of spontaneous Descemet membrane detachment (DMD) in a patient with a history of necrotizing scleritis and discuss the management approach and outcome.

Methods:

This was a case report and review of literature.

Results:

A 50-year-old man with a history of rheumatoid arthritis, ankylosing spondylitis, and necrotizing scleritis on systemic methotrexate, rituximab, and prednisone presented with 6 weeks of photophobia, pain, and decreased vision in his left eye. Visual acuity on presentation was 20/80 in the left eye, and intraocular pressure was 18 mm Hg. Slit lamp examination demonstrated scleral injection most significantly in an area of superonasal epithelialized scleral thinning with underlying uveal visibility, indicating prior necrotizing scleritis. Bullous corneal edema extended from the limbus superonasally into the visual axis. The remainder of the anterior and posterior segment evaluations was unremarkable. Anterior segment optical coherence tomography confirmed the presence of DMD underlying the area of corneal edema. The patient was treated with an increased dose of oral prednisone with subsequent taper for systemic autoimmune control given active nonnecrotizing scleritis, followed 2 months later by air bubble injection in the anterior chamber and face-up positioning for 2 days. This led to reattachment of Descemet membrane and complete clearance of corneal edema, with improvement of vision to 20/25 on follow-up.

Conclusions:

This is the first report of spontaneous DMD in a patient with a history of necrotizing scleritis. A possible mechanism may include shearing forces secondary to scleral ectasia, which may result in focal Descemet membrane tears and subsequent detachment.

umatoid arthritis, ankylosing spondylitis, and necrotizing scleritis on systemic methotrexate, rituximab, and prednisone presented with 6 weeks of photophobia, pain, and decreased vision in his left eye. Visual acuity on presentation was 20/80 in the left eye, and intraocular pressure was 18 mm Hg.....

07/09/2025

ICYMI: Quality of Life and Symptomatology in Neuropathic Corneal Pain in Comparison With Dry Eye Syndrome: Purpose:

To investigate and compare the quality of life (QoL) and symptomatology between neuropathic corneal pain (NCP) and dry eye disease (DED).

Methods:

We recruited 150 patients, comprising 50 patients with NCP and 100 patients with DED. Patients’ symptoms and QoL were evaluated using the Ocular Pain Assessment Survey and Ocular Surface Disease Index questionnaires. Ocular surface assessments were also performed.

Results:

Patients with NCP demonstrated significantly lower Oxford and National Eye Institute scores for ocular surface and corneal staining, respectively, and a better tear break-up time than patients with DED. However, patients with NCP reported significantly worse scores on most of the Ocular Pain Assessment Survey questions and significantly more severe overall pain (P = 0.019), maximal and average ocular pain and nonocular pain (all P < 0.05). The NCP group reported significantly worse QoL in all aspects of daily living (all P < 0.001). Patients with NCP spent more time thinking about their eye pain and reported significantly higher pain intensities than patients with DED when exposed to chemical and mechanical stimuli (all P ≤ 0.008). Burning sensation and photophobia were significantly more frequent in patients with NCP (P = 0.032 and P = 0.012, respectively). Similarly, the NCP group reported significantly worse total Ocular Surface Disease Index scores, significantly more frequent vision-related function impairment and painful or sore eyes than the DED group (P = 0.029, P = 0.031, and P = 0.014, respectively).

Conclusions:

Compared with DED, NCP is more debilitating, leading to more severe and frequent symptoms, and greater negative impact on all aspects of QoL.

the Ocular Pain Assessment Survey and Ocular Surface Disease Index questionnaires. Ocular surface assessments were also performed. Results: Patients with NCP demonstrated significantly lower Oxford and National Eye Institute scores for ocular surface and corneal staining, respectively, and a better....