Cornea : The Journal of Cornea and External Disease

06/22/2025

ICYMI: Investigating Microplastic Presence in Eye Drops Using Micro-Fourier Transform Infrared Spectroscopy: Purpose:

The ubiquity of microplastics (MPs) in daily life has raised significant health concerns, yet their pathways into the eye remain poorly understood. MPs have a multitude of direct and indirect effects on human health, with a recent murine study indicating that they may cause inflammatory and toxic damage to the ocular surface. Given the prevalence of plastic in eye drop packaging, MPs could potentially contaminate topical ocular medications and thus be absorbed into ocular and systemic tissues. This study aimed to determine the presence of MPs in commercially available eye drops.

Methods:

Commercially available eye drops from 20 brands were analyzed in triplicate (n = 60) for MPs. Particles ≥20 μm were examined using micro-Fourier Transform Infrared Spectroscopy, with identities confirmed by cross-referencing with a polymer and chemical database. Particle area and appearance were also documented.

Results:

Although 498 visible particles were observed, a total of 4 MPs were identified in 2 of the 60 samples, specifically poly(1-dodecne) film (n = 2) and poly(1-octene) film (n = 2). In addition, 12 additional particles, including chemical catalysts and industrial lubricants, were noted across 6 samples.

Conclusions:

The study provides evidence for the presence of MPs ≥20 μm in commercial eye drops. Further investigation into eye drop packaging is essential to discern whether detected particles are manufacturing by-products or expected ingredients. Further studies using micro-Raman spectroscopy are recommended for definitive analysis of MP contamination.

06/22/2025

ICYMI: Infectious Keratitis After Corneal Cross-Linking: A Retrospective Case Series: Purpose:

To evaluate the risk of infectious keratitis after corneal cross-linking (CXL) in eyes with corneal ectasia.

Methods:

In this retrospective case series, we reviewed the medical records of patients with a diagnosis code for keratitis over a 6-month period after all CXLs performed in the Department of Ophthalmology at Oslo University Hospital from 2007 to 2020. To compare our results with existing literature, we reviewed studies evaluating the risk of keratitis after CXL.

Results:

A total of 1809 CXLs were performed in our department during the study period. The annual number of CXLs increased from 3 in 2007 to 219 in 2020. We identified 11 (0.6%) cases registered with a keratitis code within 6 months after CXL, of which the physician considered 5 (0.3%, 95% confidence interval, 0.1%–0.6%) to be procedure-related infectious keratitis. The microbiological agents were Staphylococcus aureus (n = 3), Acanthamoeba (n = 1), or unknown (n = 1). To our knowledge, this is the largest European study to report the risk of infectious keratitis after CXL. The literature review, including papers published up to October 2024, identified 23 relevant studies that reported infectious keratitis in 0% to 2.6% of eyes after CXL treatment.

Conclusions:

We found a low incidence of infectious keratitis after CXL. Our rate was comparable to that reported in the literature, indicating a low risk of this complication in eyes with corneal ectasia treated with CXL.

06/22/2025

ICYMI: Reply: No abstract available

06/22/2025

ICYMI: Acanthamoeba Keratitis Secondary Glaucoma Associated With Mature Cataract and a Fixed Dilated Pupil in a 40-Eye Series: Purpose

This case series describes the incidence, clinical associations, and treatment outcomes of Acanthamoeba keratitis (AK) secondary glaucoma to identify potential prophylactic measures and optimal treatment.

Methods

AK-affected eyes developing secondary glaucoma from 1992 to 2020 were identified from Moorfields databases. The annualized incidence was established from those patients with AK registered between 2000 and 2015.

Results

The 2000–2015 incidence of AK secondary glaucoma was 26 of 417 (6.2%). Forty eyes (39 patients) developed glaucoma or ocular hypertension; 16 of 28 (57%) had been treated for AK for ≥12 months from onset. Thirty-four of 40 eyes (85%) had an associated keratoplasty; 26 of 40 (65%) had a fixed dilated pupil and/or mature cataract. Sixteen of 40 (40%) underwent antiglaucoma drug treatment alone. Twenty-four of 40 (60%) eyes had surgical treatments including cyclodiode laser (2 eyes) leading to phthisis or evisceration, trabeculectomy (2 eyes) failed, glaucoma drainage devices in 20 of 40 (50%) eyes resulted in glaucoma control in 18/20 (90%) but required additional surgery in 9 of 20 (45%) eyes.

Conclusions

Mature cataract or a fixed dilated pupil has not been previously identified as a cause of secondary glaucoma in AK. The implications are that both result in angle closure and that early surgery for maturing cataract, despite its complexity, might prevent the development of angle closure. However, the potential for better medical treatment to reduce the time to cure to less than 12 months is likely the most effective way to reduce AK glaucoma incidence. Successful management of AK glaucoma once developed probably requires use of a glaucoma drainage device.

06/22/2025

ICYMI: Outcomes of Photorefractive Keratectomy in First-Degree Relatives of Patients With Keratoconus: Purpose:

The aim of this study was to evaluate the safety and efficacy of photorefractive keratectomy (PRK) for treating myopic astigmatism in first-degree relatives of patients with keratoconus.

Methods:

This retrospective comparative interventional case series included 146 eyes of 73 consecutive first-degree relatives of patients with keratoconus (group 1). A control group consisted of 150 right eyes from 150 consecutive individuals with no family history of keratoconus (group 2). All eyes had normal clinical and topographic and tomographic examinations preoperatively and underwent PRK for myopic astigmatism. Postoperative visual acuity and refractive error were compared between the groups. Primary outcomes included efficacy, safety, and the occurrence of complications such as corneal ectasia.

Results:

The mean participant age was 27.0 ± 5.3 years in group 1 and 25.8 ± 4.9 years in group 2 (P = 0.09), with follow-up periods of 65.2 ± 38.2 and 63.8 ± 46.8 months, respectively (P = 0.81). The postoperative corrected distance visual acuity was 0.00 ± 0.02 and 0.01 ± 0.03 logarithm of the minimum angle of resolution in groups 1 and 2, respectively (P = 0.26). The mean postoperative spherical equivalent refraction was −0.17 ± 0.37 diopters (D) in group 1 and -0.12 ± 0.33 D in group 2 (P = 0.22), with a mean refractive astigmatism of −0.15 ± 0.28 D and −0.09 ± 0.31 D, respectively (P = 0.11). The safety index was 1.01 ± 0.12 in group 1 and 1.00 ± 0.10 in group 2 (P = 0.29) while the efficacy index was 0.94 ± 0.16 and 0.95 ± 0.16, respectively (P = 0.98). No cases of corneal ectasia were observed in either group.

Conclusions:

PRK is a safe and effective treatment for myopic refractive error in first-degree relatives of patients with keratoconus who have normal preoperative clinical and topographic/tomographic findings.

nsecutive first-degree relatives of patients with keratoconus (group 1). A control group consisted of 150 right eyes from 150 consecutive individuals with no family history of keratoconus (group 2). All eyes had normal clinical and topographic and tomographic examinations preoperatively and underwen...

06/22/2025

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,...

06/22/2025

ICYMI: Etiology of Iridocorneal Endothelial Syndrome: Viral Infection and Immune Suppression: Purpose:

Iridocorneal endothelial (ICE) syndrome is a rare ocular disease affecting the anterior segment, leading to cornea edema and glaucoma. Its unclear etiology limits clinical management to symptomatic interventions. This study uses diverse methodologies to explore potential viral sequences in patients’ samples and to elucidate the transcriptomic profiles of ICE cells.

Methods:

We used a convenience sampling method, including all eligible patients for analysis. We reviewed polymerase chain reaction (PCR) results for herpes viruses across all samples obtained from ICE syndrome patients at our institution. To further delve into potential pathogenic involvement, we used metagenomic sequencing and whole-genome sequencing techniques on samples. We used smart-seq2 RNA sequencing to explore the transcriptomic features of ICE cells compared with normal cells.

Results:

In our PCR tests involving 141 samples, only two positive results were detected in the aqueous humor. Furthermore, the application of metagenomic sequencing on three aqueous humor samples and three corneal endothelium samples, along with whole-genome sequencing on one corneal endothelium sample, yielded no evidence of viral sequences. RNA sequencing revealed upregulated cell growth and neuronal death in ICE cells, alongside downregulated expression in extracellular matrix composition, cell adhesion, and immune response functions.

Conclusions:

Our findings from multiple sequencing assays consistently indicate the absence of compelling evidence supporting viral infection in patients with ICE syndrome. Furthermore, the transcriptional analysis of ICE cells reveals a distinct profile characterized by upregulated cell growth and suppressed immune response. Future studies are necessary to validate these findings and improve the generalizability of the results.

es in patients’ samples and to elucidate the transcriptomic profiles of ICE cells. Methods: We used a convenience sampling method, including all eligible patients for analysis. We reviewed polymerase chain reaction (PCR) results for herpes viruses across all samples obtained from ICE syndrome pati...

06/22/2025

ICYMI: Letter Regarding: Corneal Endothelial Keratoprosthesis EndoArt in Patients With Glaucoma at High Risk of Graft Failure After Keratoplasty: No abstract available

An abstract is unavailable.

06/20/2025

Investigating Microplastic Presence in Eye Drops Using Micro-Fourier Transform Infrared Spectroscopy: Purpose:

The ubiquity of microplastics (MPs) in daily life has raised significant health concerns, yet their pathways into the eye remain poorly understood. MPs have a multitude of direct and indirect effects on human health, with a recent murine study indicating that they may cause inflammatory and toxic damage to the ocular surface. Given the prevalence of plastic in eye drop packaging, MPs could potentially contaminate topical ocular medications and thus be absorbed into ocular and systemic tissues. This study aimed to determine the presence of MPs in commercially available eye drops.

Methods:

Commercially available eye drops from 20 brands were analyzed in triplicate (n = 60) for MPs. Particles ≥20 μm were examined using micro-Fourier Transform Infrared Spectroscopy, with identities confirmed by cross-referencing with a polymer and chemical database. Particle area and appearance were also documented.

Results:

Although 498 visible particles were observed, a total of 4 MPs were identified in 2 of the 60 samples, specifically poly(1-dodecne) film (n = 2) and poly(1-octene) film (n = 2). In addition, 12 additional particles, including chemical catalysts and industrial lubricants, were noted across 6 samples.

Conclusions:

The study provides evidence for the presence of MPs ≥20 μm in commercial eye drops. Further investigation into eye drop packaging is essential to discern whether detected particles are manufacturing by-products or expected ingredients. Further studies using micro-Raman spectroscopy are recommended for definitive analysis of MP contamination.

06/20/2025

Infectious Keratitis After Corneal Cross-Linking: A Retrospective Case Series: Purpose:

To evaluate the risk of infectious keratitis after corneal cross-linking (CXL) in eyes with corneal ectasia.

Methods:

In this retrospective case series, we reviewed the medical records of patients with a diagnosis code for keratitis over a 6-month period after all CXLs performed in the Department of Ophthalmology at Oslo University Hospital from 2007 to 2020. To compare our results with existing literature, we reviewed studies evaluating the risk of keratitis after CXL.

Results:

A total of 1809 CXLs were performed in our department during the study period. The annual number of CXLs increased from 3 in 2007 to 219 in 2020. We identified 11 (0.6%) cases registered with a keratitis code within 6 months after CXL, of which the physician considered 5 (0.3%, 95% confidence interval, 0.1%–0.6%) to be procedure-related infectious keratitis. The microbiological agents were Staphylococcus aureus (n = 3), Acanthamoeba (n = 1), or unknown (n = 1). To our knowledge, this is the largest European study to report the risk of infectious keratitis after CXL. The literature review, including papers published up to October 2024, identified 23 relevant studies that reported infectious keratitis in 0% to 2.6% of eyes after CXL treatment.

Conclusions:

We found a low incidence of infectious keratitis after CXL. Our rate was comparable to that reported in the literature, indicating a low risk of this complication in eyes with corneal ectasia treated with CXL.

06/20/2025

Reply: No abstract available

06/20/2025

Acanthamoeba Keratitis Secondary Glaucoma Associated With Mature Cataract and a Fixed Dilated Pupil in a 40-Eye Series: Purpose

This case series describes the incidence, clinical associations, and treatment outcomes of Acanthamoeba keratitis (AK) secondary glaucoma to identify potential prophylactic measures and optimal treatment.

Methods

AK-affected eyes developing secondary glaucoma from 1992 to 2020 were identified from Moorfields databases. The annualized incidence was established from those patients with AK registered between 2000 and 2015.

Results

The 2000–2015 incidence of AK secondary glaucoma was 26 of 417 (6.2%). Forty eyes (39 patients) developed glaucoma or ocular hypertension; 16 of 28 (57%) had been treated for AK for ≥12 months from onset. Thirty-four of 40 eyes (85%) had an associated keratoplasty; 26 of 40 (65%) had a fixed dilated pupil and/or mature cataract. Sixteen of 40 (40%) underwent antiglaucoma drug treatment alone. Twenty-four of 40 (60%) eyes had surgical treatments including cyclodiode laser (2 eyes) leading to phthisis or evisceration, trabeculectomy (2 eyes) failed, glaucoma drainage devices in 20 of 40 (50%) eyes resulted in glaucoma control in 18/20 (90%) but required additional surgery in 9 of 20 (45%) eyes.

Conclusions

Mature cataract or a fixed dilated pupil has not been previously identified as a cause of secondary glaucoma in AK. The implications are that both result in angle closure and that early surgery for maturing cataract, despite its complexity, might prevent the development of angle closure. However, the potential for better medical treatment to reduce the time to cure to less than 12 months is likely the most effective way to reduce AK glaucoma incidence. Successful management of AK glaucoma once developed probably requires use of a glaucoma drainage device.