OBJECTIVE: To report the efficacy of Descemet\'s Membrane (DM) transplantation over the macular hole in patients with recurrent high myopic macular hole (HMMH) associated with retinal detachment (RD).
METHODS: Six eyes of six patients with wide posterior staphyloma including MH and recurrent HMMH associated with RD were included to this retrospective study. All patients underwent pars plana vitrectomy and DM obtained from eye bank was placed over the macular hole during the surgery. Silicone oil endotamponade was used as endotamponade and removed within 6 months following surgery. Pre-operative and post-operative ophthalmologic examination and optical coherence tomography findings were recorded.
RESULTS: The mean follow-up time was 18.53 ± 7.36 months. Macular hole closure was achieved in all patients (100%). Best-corrected visual acuity was improved from 1.51 ± 0.55 logMAR to 1.08 ± 0.50 logMAR (p = 0.043). No complications due to surgery or DM during follow-up. No DM dislocation or hole re-opening occurred after surgery.
CONCLUSIONS: DM transplantation during vitrectomy may be an effective treatment for the recurrent HMMH associated with RD.
CONCLUSIONS: What is known Various surgical techniques have been tried for recurrent high myopic macular hole associated with retinal detachment, but satisfactory anatomical and functional success rates have still not been achieved.
BACKGROUND: The study demonstrates that Descemet\'s membrane transplantation is a safe and effective option for treating recurrent high myopic macular hole associated with retinal detachment. This is a novel technique that may overcome the limitations of existing approaches. The findings suggest that Descemet\'s membrane transplantation could become a promising addition to the surgical options for recurrent high myopic macular hole associated with retinal detachment.

Background: Acute keratoconus (acute KC), which affects approximately 1.6-2.8% of keratoconus (KC) patients, is a pathological condition of the cornea characterized by stromal edema due to entry of aqueous humor through a tear in Descemet\'s membrane. Methods: We present a novel combination of surgical procedures that allows swifter visual recovery in a consecutive, retrospective case series. The new surgical procedure for acute KC consists of a combination of Muraine corneal sutures to smooth the corneal curvature and Excimer laser-assisted penetrating keratoplasty and was performed in six acute KC patients from 2019 to 2022 at the Department of Ophthalmology, University Hospital of Martin-Luther-University Halle-Wittenberg (UMH), Germany. We monitored data on preoperative status, operative details, intraoperative and postoperative complications and visual outcomes were analyzed. Results: The mean age was 41.5 ± 13.5 years (3 OD, 3 OS). Neurodermatitis was present in 3 patients (50%). All patients received significant visual benefits from the procedure. Preoperative BCVA was hand motion (logMAR 3.0) in all patients; postoperatively, BCVA improved significantly logMAR 0.03 ± 0.09 [range: 0.2-0.4; p < 0.001, FUP 20+/-10 months). Visual acuity remained stable throughout the roughly biannual follow-ups. One patient developed endothelial graft rejection after 2 years. During the last examination, all eyes had clear grafts and stable curvatures, K1 and K2 being 42.43 ± 4.17 D and 44.95 ± 4.07 D, respectively, and mean corneal astigmatism was 2.61 ± 1.74 D. The thinnest corneal thickness was 519 ± 31 µm. A graft size of 8.0 × 8.1 mm was the most beneficial. Conclusions: in patients with acute KC and hydrops, a penetrating keratoplasty with Muraine corneal sutures is successful in terms of graft clarity and visual outcome. Combining the procedures allows quicker visual recovery. Patients with a history of neurodermatitis should have preoperative and postoperative dermatologic treatment and close follow-up for possible complications.

OBJECTIVE: This study evaluates the long-term results of surgical treatment of patients with Fuchs\' endothelial corneal dystrophy and cataract.
METHODS: The study included 24 patients (24 eyes) with primary Fuchs\' endothelial corneal dystrophy and cataract, who underwent cataract phacoemulsification with IOL implantation and of Descemet\'s membrane endothelial keratoplasty with a semicircular graft (hemi-DMEK). The effect of treatment was assessed by best corrected visual acuity (BCVA), central corneal thickness (CCT) and endothelial cell density (ECD).
RESULTS: In total, surgical treatment involved 14 donor corneas that were divided in half during the preparation and isolation of the Descemet\'s membrane (DM). By month 12 after the surgery an increase in visual functions and graft transparency were observed in 23 patients (23 eyes) out of 24. Repeated keratoplasty was required in one case due to fibrosis of the posterior layers of recipient\'s corneal stroma. At 12 months postoperatively, the study group showed an increase in BCVA from 0.16±0.1 to 0.75±20, a decrease in CCT from 650.9±4.5 μm to 519.6±43.9, and a decreased in ECD from 2850.5±84.7 cells/mm2 up to 1285.5±277.2 cells/mm2. Thus, the loss of endothelial cells at one year after surgery amounted to 54.9%.
CONCLUSIONS: The developed method for transplantation of a semicircular DM fragment provides a tissue-saving approach to endothelial keratoplasty, and considering the high percentage of transparent engraftment of grafts and complete visual rehabilitation, it can be recommended in the treatment of patients with cataract and Fuchs\' endothelial corneal dystrophy.
UNASSIGNED: Провести анализ отдаленных клинико-функциональных результатов хирургического лечения пациентов с первичной эндотелиальной дистрофией роговицы Фукса и катарактой.
UNASSIGNED: В исследование включены 24 пациента (24 глаза) с первичной эндотелиальной дистрофией роговицы Фукса, сочетанной с катарактой, прооперированных методом одномоментной факоэмульсификации катаракты с имплантацией интраокулярной линзы и трансплантацией полукруглого фрагмента десцеметовой мембраны (ДМ) с эндотелием. Для изучения эффективности представленной методики оценивали показатели максимально корригируемой остроты зрения (МКОЗ), центральной толщины роговицы (ЦТР) и плотности эндотелиальных клеток (ПЭК).
UNASSIGNED: Для хирургического лечения использовали 14 донорских корнеосклеральных дисков, которые в ходе подготовки и выделения ДМ были разделены пополам. К 12-му месяцу наблюдения после операции прозрачное приживление трансплантата и повышение зрительных функций наблюдалось у 23 пациентов (23 глаза) из 24. В 1 случае в связи с фиброзом задних слоев стромы роговицы потребовалась повторная кератопластика. Показатель МКОЗ к 12-му месяцу послеоперационного наблюдения в исследуемой группе увеличился с предоперационных значений, составлявших 0,16±0,1, до 0,75±20. К 12-му месяцу после операции показатель ЦТР уменьшился с исходных 650,9±44,5 до 519,6±43,9 мкм, а ПЭК — с исходных 2850,5±84,7 до 1285,5±277,2 кл/мм2. Таким образом, потеря эндотелиальных клеток за 1-й год наблюдения составила 54,9%.
UNASSIGNED: Учитывая высокий процент прозрачного приживления трансплантатов и полноценную зрительную реабилитацию, разработанный метод трансплантации фрагмента ДМ, обеспечивший тканесберегающий подход к эндотелиальной кератопластике, может быть рекомендован как операция выбора при лечении пациентов с эндотелиальной дистрофией роговицы Фукса и катарактой.

In 2013, based on the results of an experimental pneumodissection of the cornea, English ophthalmologist H. Dua postulated the existence of a previously unknown pre-Descemet\'s layer (PDL) with unique characteristics. However, the need to revise the traditional concepts of the corneal structure raises reasonable doubts among many researchers. This article discusses the question of whether the structural features of the pre-Descemet\'s layer can be a sufficient basis for designating it as a separate anatomical unit.
В 2013 г. на основании результатов экспериментальной пневмодиссекции роговицы английский офтальмолог H. Dua постулировал существование в ней ранее неизвестного предесцеметового слоя (ПДС), обладающего уникальными характеристиками. Однако необходимость пересмотра традиционных представлений о строении роговицы вызывает обоснованные сомнения у многих исследователей. В настоящей статье обсуждается вопрос о том, могут ли структурные особенности ПДС служить достаточным основанием для выделения его в самостоятельную анатомическую единицу.

The article summarizes the outcomes of the discussion concerning the need to designate the pre-Descemet\'s layer (PDL) in the cornea as a separate anatomical structure. Considering the differences in opinions on this highly debated topic, various studies suggested a compromised, purely terminological solution - to limitedly separate the PDL as a deep stromal layer of the cornea.
В статье обобщены результаты дискуссии, касающейся необходимости выделения предесцеметового слоя роговицы (ПДС) в самостоятельную анатомическую структуру. С учетом определенных разногласий в оценке автономности ПДС, на сегодняшний день возможно предлагаемое в различных исследованиях компромиссное и пока только терминологическое решение данного, все еще остающегося дискутабельным, вопроса, заключающегося в выделении ПДС ограниченно — в качестве глубокого слоя стромы роговицы.

The five-layer structure of the cornea has been generally accepted in anatomy for the last 70 years. Since the beginning of 2000, publications about lamellar keratoplasty have appeared, in which during the operation it was necessary to isolate the Descemet\'s membrane (DM). Several options for the formation of a big bubble have been described; in the most frequently used type, the presence of remnants of thin stromal tissue on the isolated DM were found. In 2013 an English group of researchers headed by H. Dua tried to prove that this thin strip of the stroma in DM is the sixth layer of the cornea. However, there is a sufficient number of publications that refute this \"discovery\". In Russian scientific literature there has been no discussion of a «new» layer of the cornea. Only recently one article has been published, which raised the issue of this separate layer in the cornea. Our group of authors has also entered this discourse, believing that it is possible to distinguish terminologically the pre-Descemet\'s layers, but only as part of the corneal stroma, without attributing it with numerous functions and features.
Последние 70 лет в анатомии общепринятым является пятислойное строение роговицы. С начала 2000-х годов появились публикации о послойных кератопластиках, при которых на той или иной стадии операции необходимо было выделить десцеметову мембрану (ДМ). Были описаны несколько вариантов формирования «большого пузыря» (big bubble), причем при первом, наиболее частом его типе доказано наличие остатков тонкой ткани стромы на выделенной ДМ. В 2013 г. английская группа исследователей во главе с H. Dua попыталась доказать, что эта тонкая полоска стромы у ДМ представляет собой шестой слой роговицы. Однако существует достаточное количество зарубежных публикаций, опровергающих это «открытие». В отечественной литературе не было обсуждения «нового» слоя роговицы. Только недавно опубликована российская статья, в которой поднимается вопрос, посвященный отдельному слою роговицы. Наша группа авторов тоже вступила в полемику, считая, что можно терминологически выделять предесцеметовые слои, но лишь как часть стромы роговицы, не приписывая этой строме многочисленные функции и особенности.

Selective exchange of pathologically altered retinal layers is currently considered the most practical approach in corneal transplantation. Deep anterior lamellar keratoplasty (DALK) and Descemet membrane endothelial keratoplasty (DMEK) are often performed as pathogenetically substantiated transplantation methods. The technique and the course of surgery, possible complications, and achieved outcomes, among other things, depend largely on the pre-Descemet\'s layer, which was described more than 10 years ago by several ophthalmologists in varying detail. In view of this, the main issue discussed in literature is the following: is the pre-Descemet\'s layer (Dua\'s layer) a separate (new) layer of the cornea, or is it an integral part of the stroma (the Feizi stroma)? This article continues the discussion on «separate designation of the pre-Descemet\'s layer in the structure of the cornea» and presents the view of the authors on this problem based on own experience, literature data, anatomical subdisciplines, as well as specific aspects of ophthalmological terminology, and with the use of extrapolation and analogies.
В настоящее время селективная замена патологически измененных слоев роговицы считается наиболее целесообразным подходом в кератотрансплантологии. Часто выполняемыми и патогенетически обоснованными методиками трансплантации являются глубокая передняя послойная кератопластика (DALK) и трансплантация десцеметовой мембраны с эндотелием (DMEK). Техника и ход операции, вероятные осложнения, достигаемые результаты во многом зависят в том числе от предесцеметового слоя, описанного более 10 лет назад некоторыми офтальмологами с разной степенью детализации. В связи с этим основной вопрос, обсуждаемый в литературе, формулируется следующим образом: является ли предесцеметовый слой (слой Dua) отдельным (новым) слоем роговицы, или все же это часть стромы (строма Feizi)? В этой публикации, которая является продолжением дискуссии «О выделении предесцеметового слоя в структуре роговицы», мы излагаем свое видение этого вопроса, с учетом собственного опыта, данных литературы, разделов анатомической науки, а также с учетом специфики офтальмологической терминологии и с проведением экстраполяций и аналогий.

Mesenchymal cells (keratocytes, corneal fibroblasts, and myofibroblasts), as well as mesenchymal progenitor bone marrow-derived fibrocytes, are the major cellular contributors to stromal fibrosis after injury to the cornea. Corneal fibroblasts, in addition to being major progenitors to myofibroblasts, also have anti-fibrotic functions in (1) the production of non-basement membrane collagen type IV that binds activated transforming growth factor (TGF) beta-1 and TGF beta-2 to downregulate TGF beta effects on cells in the injured stroma, (2) the production of chemokines that modulate the entry of bone marrow-derived cells into the stroma, (3) the production of hepatocyte growth factor and keratinocyte growth factor to regulate corneal epithelial healing, (4) the cooperation with the epithelium or corneal endothelium in the regeneration of the epithelial basement membrane and Descemet\'s membrane, and other functions. Fibrocytes also serve as major progenitors to myofibroblasts in the corneal stroma. Thus, mesenchymal cells and mesenchymal cell progenitors serve Yin and Yang functions to inhibit and promote tissue fibrosis depending on the overall regulatory milieu within the injured stroma.

Age-related ocular diseases are the leading cause of blindness in developed countries and constitute a sizable socioeconomic burden worldwide. Age-related macular degeneration (AMD) and Fuchs endothelial corneal dystrophy (FECD) are some of the most common age-related diseases of the retina and cornea, respectively. AMD is characterized by a breakdown of the retinal pigment epithelial monolayer, which maintains retinal homeostasis, leading to retinal degeneration, while FECD is characterized by degeneration of the corneal endothelial monolayer, which maintains corneal hydration status, leading to corneal edema. Both AMD and FECD pathogenesis are characterized by disorganized local extracellular matrix (ECM) and toxic protein deposits, with both processes linked to aberrant protease activity. Granzyme B (GrB) is a serine protease traditionally known for immune-mediated initiation of apoptosis; however, it is now recognized that GrB is expressed by a variety of immune and non-immune cells and aberrant extracellular localization of GrB substantially contributes to various age-related pathologies through dysregulated cleavage of ECM, tight junction, and adherens junction proteins. Despite growing recognition of GrB involvement in multiple age-related pathologies, its role in AMD and FECD remains poorly understood. This review summarizes the pathophysiology of, and similarities between AMD and FECD, outlines the current knowledge of the role of GrB in AMD and FECD, as well as hypothesizes putative contributions of GrB to AMD and FECD pathogenesis and highlights the therapeutic potential of pharmacologically inhibiting GrB as an adjunctive treatment for AMD and FECD.

Primary congenital glaucoma (PCG) is a disease of childhood characterized by elevated intraocular pressure (IOP) that causes stretching of the eye\'s outer coats, namely sclera and cornea. This results in the elongation of the eyeball and expansion of the horizontal corneal diameter giving the appearance of a buphthalmos eye. Aggressive disease with high IOP readings causes excessive mechanical stretching that may be poorly tolerated by the corneal Descemet\'s membrane, leading to large breaks in it with subsequent corneal edema due to sudden influx of the aqueous humor into the exposed stroma, resulting in acute corneal hydrops. While acute hydrops is a potential sequel of PCG, it is considered one of its rare presentations. We present two cases who presented to our hospital with acute hydrops secondary to PCG. Both patients were managed surgically where the first patient underwent combined trabeculotomy-trabeculectomy with mitomycin C, while the second patient underwent deep sclerectomy with mitomycin C. The surgical procedures effectively controlled the IOP and aided in clearing corneal edema in both patients. Early diagnosis and timely surgical intervention are of paramount importance to improve visual outcomes, enhance ocular maturation, and prevent potential irreversible vision loss, especially in this young-age group of patients that are prone to amblyopia.