Cornea : The Journal of Cornea and External Disease

11/06/2025

National Eye Institute Supported Randomized Controlled Trials in Keratoplasty for Endothelial Disorders: Lessons Learned: Abstract:

National Eye Institute (NEI)–funded randomized controlled trials (RCTs) have significantly shaped the modern landscape of keratoplasty for endothelial disorders. Unlike retrospective studies, RCTs have offered the highest level of clinical evidence and have addressed critical questions related to histocompatibility matching, donor and donor tissue characteristics, donor tissue storage, and operative and postoperative factors supporting postoperative endothelial cell health. These RCTs have in turn directly influenced eye banking and keratoplasty practices. The purpose of this review is to 1) summarize the major findings from all of the NEI-sponsored keratoplasty RCTs, including the Collaborative Corneal Transplantation Studies, the Cornea Donor Study and its ancillary study, the Specular Microscopy Ancillary Study, the Cornea Preservation Time Study, as well as the on-going Diabetes Endothelial Keratoplasty Study and the Descemet Endothelial Thickness Comparison Trial; 2) review select keratoplasty RCTs not supported by the NEI; 3) compare findings from these RCTs with those from the major keratoplasty registries; and 4) discuss promising future directions in keratoplasty and eye banking that would lend themselves for RCTs. Collectively, these RCTs have clarified long-standing controversies, validated emerging practices, and will continue to provide the foundation for future innovation in the surgical management of endothelial diseases.

ns related to histocompatibility matching, donor and donor tissue characteristics, donor tissue storage, and operative and postoperative factors supporting postoperative endothelial cell health. These RCTs have in turn directly influenced eye banking and keratoplasty practices. The purpose of this r...

09/01/2025

ICYMI: National Eye Institute Supported Randomized Controlled Trials in Keratoplasty for Endothelial Disorders: Lessons Learned: Abstract:

National Eye Institute (NEI)–funded randomized controlled trials (RCTs) have significantly shaped the modern landscape of keratoplasty for endothelial disorders. Unlike retrospective studies, RCTs have offered the highest level of clinical evidence and have addressed critical questions related to histocompatibility matching, donor and donor tissue characteristics, donor tissue storage, and operative and postoperative factors supporting postoperative endothelial cell health. These RCTs have in turn directly influenced eye banking and keratoplasty practices. The purpose of this review is to 1) summarize the major findings from all of the NEI-sponsored keratoplasty RCTs, including the Collaborative Corneal Transplantation Studies, the Cornea Donor Study and its ancillary study, the Specular Microscopy Ancillary Study, the Cornea Preservation Time Study, as well as the on-going Diabetes Endothelial Keratoplasty Study and the Descemet Endothelial Thickness Comparison Trial; 2) review select keratoplasty RCTs not supported by the NEI; 3) compare findings from these RCTs with those from the major keratoplasty registries; and 4) discuss promising future directions in keratoplasty and eye banking that would lend themselves for RCTs. Collectively, these RCTs have clarified long-standing controversies, validated emerging practices, and will continue to provide the foundation for future innovation in the surgical management of endothelial diseases.

ns related to histocompatibility matching, donor and donor tissue characteristics, donor tissue storage, and operative and postoperative factors supporting postoperative endothelial cell health. These RCTs have in turn directly influenced eye banking and keratoplasty practices. The purpose of this r...

08/30/2025

ICYMI: In Vitro Evaluation of Photoactivated Rose Bengal for Growth Inhibition of Fungi Isolated From Keratitis: Purpose:

The aim of this study was to evaluate the activity of photoactivated 0.1% rose bengal (RB) for in vitro growth inhibition of the most prevalent fungi isolates in infectious keratitis.

Methods:

Eight corneal clinical isolates were included in the experiments: Fusarium solani complex, Purpureocillium lilacinum, Candida albicans, Candida parapsilosis complex, Exophiala oligosperma, Scedosporium apiospermum complex, Aspergillus niger complex, and Curvularia geniculata. Microorganisms, previously identified by phenotypical methods, were grown and incubated at specific conditions and prepared in suspension for concentration adjustments. The following groups were evaluated in triplicate: group I, no treatment; group II, treated with RB and exposed to the dark for 30 minutes; group III, exposed to green-light light-emitting diode 7.2 mW for 30 minutes (photodynamic therapy [PDT]); and group IV, treated with RB and PDT (RB-PDT). The final work concentration was 104 cells per mL. The RB-PDT was combined with Amphotericin B (AmphoB) to target isolates that were not inhibited by RB-PDT alone. Plates were incubated at specific conditions and photographed after growth for pixel analyses.

Results:

The growth was inhibited after RB-PDT for F. solani complex, P. lilacinum, C. albicans, C. parapsilosis complex, and E. oligosperma, and not inhibited for S. apiospermum complex, A. niger complex, and C. geniculata, even though combining RB-PDT with AmphoB.

Conclusions:

RB-PDT presented good activity against five of the tested microorganisms. For the first time, we demonstrated that RB-PDT could inhibit growth of P. lilacinum, C. parapsilosis complex, E. oligosperma, and not inhibit S. apiospermum, A. niger complex, and C. geniculata, even when combined with AmphoB.

ex, Purpureocillium lilacinum, Candida albicans, Candida parapsilosis complex, Exophiala oligosperma, Scedosporium apiospermum complex, Aspergillus niger complex, and Curvularia geniculata. Microorganisms, previously identified by phenotypical methods, were grown and incubated at specific conditions...

08/30/2025

ICYMI: Reply: No abstract available

An abstract is unavailable.

08/23/2025

In Vitro Evaluation of Photoactivated Rose Bengal for Growth Inhibition of Fungi Isolated From Keratitis: Purpose:

The aim of this study was to evaluate the activity of photoactivated 0.1% rose bengal (RB) for in vitro growth inhibition of the most prevalent fungi isolates in infectious keratitis.

Methods:

Eight corneal clinical isolates were included in the experiments: Fusarium solani complex, Purpureocillium lilacinum, Candida albicans, Candida parapsilosis complex, Exophiala oligosperma, Scedosporium apiospermum complex, Aspergillus niger complex, and Curvularia geniculata. Microorganisms, previously identified by phenotypical methods, were grown and incubated at specific conditions and prepared in suspension for concentration adjustments. The following groups were evaluated in triplicate: group I, no treatment; group II, treated with RB and exposed to the dark for 30 minutes; group III, exposed to green-light light-emitting diode 7.2 mW for 30 minutes (photodynamic therapy [PDT]); and group IV, treated with RB and PDT (RB-PDT). The final work concentration was 104 cells per mL. The RB-PDT was combined with Amphotericin B (AmphoB) to target isolates that were not inhibited by RB-PDT alone. Plates were incubated at specific conditions and photographed after growth for pixel analyses.

Results:

The growth was inhibited after RB-PDT for F. solani complex, P. lilacinum, C. albicans, C. parapsilosis complex, and E. oligosperma, and not inhibited for S. apiospermum complex, A. niger complex, and C. geniculata, even though combining RB-PDT with AmphoB.

Conclusions:

RB-PDT presented good activity against five of the tested microorganisms. For the first time, we demonstrated that RB-PDT could inhibit growth of P. lilacinum, C. parapsilosis complex, E. oligosperma, and not inhibit S. apiospermum, A. niger complex, and C. geniculata, even when combined with AmphoB.

ex, Purpureocillium lilacinum, Candida albicans, Candida parapsilosis complex, Exophiala oligosperma, Scedosporium apiospermum complex, Aspergillus niger complex, and Curvularia geniculata. Microorganisms, previously identified by phenotypical methods, were grown and incubated at specific conditions...

08/23/2025

Reply: No abstract available

An abstract is unavailable.

08/21/2025

FRESH OFF THE PRESS: Reply: No abstract available

An abstract is unavailable.

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