BACKGROUND: Corneal dermoid is a congenital benign tumor and ocular malformation, often diagnosed at birth or in early childhood. Its treatment and long-term prognosis remain under-researched, necessitating further investigation.
OBJECTIVE: This study aims to investigate the epidemiological and clinical characteristics of corneal dermoid, evaluate the efficacy of different surgical methods, and identify factors influencing treatment outcomes.
METHODS: A retrospective analysis was conducted on the clinical data of 58 patients treated for corneal dermoid at our hospital from 2017 to 2021. Patients\' demographic information, tumor characteristics, surgical methods, and postoperative outcomes were collected and analyzed. Descriptive statistics, independent sample t-test, chi-square (χ 2) test, and Spearman correlation analysis were used to evaluate the distribution characteristics and intergroup differences of corneal dermoid.
RESULTS: The average age of the patients was 6.3 years, with 55.2% being male and 44.8% female. The right eye was affected in 63.8% of cases, with the temporal limbus being the most common site (75.9%). Pathological examination revealed tumors covered by squamous epithelium, containing hair follicles, sebaceous glands, adipose tissue, and fibrous tissue; some cases also had cartilage and glandular tissue. Surgical methods included corneal dermoid excision (100%), lamellar keratoplasty (37.9%), amniotic membrane grafting (31.0%), and autologous limbal stem cell transplantation (8.6%). None of the 50 followed up patients experienced tumor recurrence. Postoperative vision improved in 58.0% of patients, with more females (61.9%) experiencing visual impairment compared to males (38.1%) (χ²=4.711, p=0.030).
CONCLUSIONS: This study analyzed 58 corneal dermoid patients treated from 2017 to 2021, focusing on epidemiological and clinical characteristics, surgical efficacy, and treatment outcomes. It identified common pathological features and effective surgical methods, with no tumor recurrence in followed up patients. The study highlights the need for further research with larger sample sizes and longer follow-up periods.

UNASSIGNED: Keratoconus (KCN) is characterized by gradual thinning and steepening of the cornea, which can lead to significant vision problems owing to high astigmatism, corneal scarring, or even corneal perforation. The detection of KCN in its early stages is crucial for effective treatment. In this review, we describe current advances in the diagnosis and treatment of KCN.
UNASSIGNED: This narrative review focuses on recent advancements in the diagnosis and treatment of KCN, especially evolving approaches and strategies. To ensure the inclusion of the most recent literature, relevant publications discussing advanced imaging techniques and treatment options for KCN were extensively gathered from the PubMed/MEDLINE and Google Scholar databases. The following index terms and keywords were used for the online search: keratoconus, diagnosis of keratoconus, advances in the diagnosis of keratoconus, topography or tomography, anterior segment optical coherence tomography, treatment of keratoconus, advances in the treatment of keratoconus, collagen crosslinking, intrastromal ring, keratoplasty, and new techniques in keratoconus.
UNASSIGNED: Various screening methods such as corneal topography, tomography, anterior segment optical coherence tomography, and assessment of corneal biomechanics have been developed to identify KCN in its early stages. After diagnosis, KCN management focuses on preventing disease progression. Corneal collagen crosslinking is a minimally invasive treatment that can slow or stop the progression of the condition. Recent research has also explored the use of copper sulfate eye drops (IVMED-80) as a noninvasive treatment to prevent the progression of KCN. Current treatment options for visual improvement include scleral lenses, intracorneal ring segments, corneal allogeneic intrastromal ring segments, and deep anterior lamellar keratoplasty. Recently, novel alternative procedures, such as isolated Bowman layer transplantation, either as a corneal stromal inlay or onlay, have demonstrated encouraging outcomes. Artificial intelligence has gained acceptance for providing best practices for the diagnosis and management of KCN, and the science of its application is contentiously debated; however, it may not have been sufficiently developed.
UNASSIGNED: Early detection and advancements in screening methods using current imaging modalities have improved diagnosis of KCN. Improvement in the accuracy of current screening or diagnostic tests and comparison of their validities are achievable by well-designed, large-scale, prospective studies. The safety and effectiveness of emerging treatments for KCN are currently being investigated. There is an ongoing need for studies to track progress and evaluate clinicians\' knowledge and practices in treating patients with KCN. Artificial intelligence capabilities in management approach considering the currently available imaging modalities and treatment options would best benefit the patient.

OBJECTIVE: To evaluate the clinical efficacy of small-diameter acellular porcine corneal stroma (SAPS) for the treatment of peripheral corneal ulceration (PCU).
METHODS: This retrospective clinical study included 18 patients (18 eyes) with PCU between April 2018 and December 2020. All patients had PCU and underwent lamellar keratoplasty with SAPS. Observation indicators included preoperative and postoperative best-corrected visual acuity (BCVA) and transparency of SAPS. The infection control rate in the surgical eye-lesion area was also calculated.
RESULTS: Eighteen patients underwent lamellar keratoplasty with SAPS to treat PCU. None of the patients experienced rejection after 6mo (18/18) and 12mo (16/16) of follow-up. The BCVA (0.47±0.30) at the 6mo follow-up after operation was significantly improved compared with the baseline (0.99±0.80), and the difference was statistically significant (Z=-3.415, P<0.05). The BCVA at the 12mo follow-up after operation was not statistically significant compared to the 6mo (Z=0, P=1). With time, the SAPS graft gradually became transparent. At the 6mo (18/18) and 12mo (16/16) follow-up, none of the patients had recurrent corneal infection.
CONCLUSIONS: SAPS is clinically effective in the treatment of PCU, improving the patient\'s BCVA and reducing the incidence of rejection after keratoplasty.

OBJECTIVE: We describe the management of a case of severe corneal melting after corneal cross-linking (CXL) treated with a staged approach using a conjunctival flap followed by deep anterior lamellar keratoplasty (DALK).
METHODS: A 12-year-old male developed severe corneal melting with pending perforation after an accelerated epithelium-off CXL protocol. We initially treated the patient with a conjunctival flap to prevent perforation. Three months later, we performed DALK to restore vision.
RESULTS: Conjunctival flap surgery allowed us to avoid corneal perforation and penetrating keratoplasty (PK) à chaud. Once the inflammation had resolved, we recessed the conjunctiva and performed DALK for optical purposes. Twelve months later, the graft was clear and the corrected visual acuity was 20/25 (Snellen). No complications occurred after surgery.
CONCLUSIONS: Although CXL is considered a safe procedure, in rare cases it can lead to serious complications, such as corneal haze, infectious and non-infectious keratitis, stromal melting and perforation. Corneal melting and perforation are usually managed by emergency PK. Herein we suggest a staged approach involving an emergency conjunctival flap followed by DALK at a later time that allowed us to avoid PK à chaud.

UNASSIGNED: To determine which donor characteristics, like previous diseases and surgeries, influence the severity of the DM/endothelial lamella preparation prior to DMEK-surgery.
UNASSIGNED: Retrospective cross-sectional single-center study is presented. Eight hundred and forty-six eyes with DMEK-surgery between 01/2018 and 01/2021 performed at the University Hospital Cologne, Germany, were included. Information regarding the donors\' previous diseases and surgeries were provided by a large database of a cornea bank (Multi Tissue Bank Mecklenburg-Vorpommern) and merged with the Cologne DMEK database, which contains information regarding preparation characteristics of the surgeon-prepared graft directly preoperatively. Three preparation groups (easy, difficult and very difficult) were correlated to the donors\' previous diseases and surgeries. The following characteristics were used for the assignment in one of the three groups: stripping difficulty, rolling and staining behavior, central and peripheral adherences, tissue fragility and DM-splitting.
UNASSIGNED: Significant risk factors for DM-splitting were diabetes mellitus (DMel) type II, heart failure, chronic kidney disease and previous cataract surgery (p=0.022, p=0.012; p=0.047 and p<0.001 respectively). Previous DMel (especially type 2) was significantly associated with the occurrence of central adherences (p=0.009). Several cardiovascular diseases (p-values between <0.001 and p=0.038), DMel type II, chronic kidney disease and previous cataract-surgery were associated with peripheral adherences (p=0.004; p=0.020 and p<0.001 respectively). Furthermore, pseudophakic donor eyes presented a higher degree of fragility of the graft (p<0.001). Age was a significant risk factor for difficult preparation (p<0.001). The staining of the graft was poorer in donors with chronic kidney disease (p=0.037).
UNASSIGNED: Donor diabetes mellitus type 2, heart failure, previous cataract surgery, chronic kidney disease and age are associated with a difficult DMEK graft preparation. For every one-year increment in donor age, the odds of having very difficult preparation were increased by 3%. Also, chronic kidney disease predisposes to a poor tissue staining with trypan blue during preparation.

The present study reports the case of a superficial limbal dermoid surgically treated without suture by using a new technique of lamellar keratoplasty with allogenic lenticule from small incision lenticule extraction. The limbal lesion area was circumscribed by a trephine marker and lamellae were peeled off the anterior corneal stroma and sclera. After excision of the dermoid, the liquid on the bed was dried as much as possible and an appropriate stromal lenticule was attached to the implant bed without fibrin glue or suture. A bandage contact lens was applied to fix the graft. During postoperative follow-ups, the anterior segment optical coherence tomography, corneal refractive power, corneal topography and best-corrected visual acuity were examined to evaluate the surgical results. On the first day after the operation, the patient reported tearing and pain at the site. At one week after the operation, the patient reported no discomfort and conjunctival sutures were removed. At one month after the operation, the thickness of the lesion area was similar to that of the adjacent cornea, and the corneal curvature and refractive power of the lesion area were higher than that of the adjacent cornea. At three months after the operation, the patient was satisfied with the cosmetic outcome and no sign of corneal neovascularization, graft rejection or pseudo-pterygium formation was observed. The astigmatic error remained at 2.50 D. The present case provides insights into a potential treatment option for patients who need lamellar keratoplasty and may provide its benefit in contrast to conventional lamellar keratoplasty.

暂无摘要。

The ability of the femtosecond laser (FSL) to create tissue incisions at desired depth and location with minimal collateral damage to surrounding tissue may offer potential advantages for corneal transplantation surgery. FSL may enable the precise and accurate preparation of both donor and recipient tissue, which can potentially result in enhanced wound integrity, facilitation of wound healing, and improved visual outcomes. Many studies have suggested that FSL may be a viable option in various corneal transplantation procedures, such as, penetrating keratoplasty, anterior lamellar keratoplasty, endothelial keratoplasty, and novel techniques, including Bowman layer transplantation and stromal lenticule addition keratoplasty. In this review, the author presents a brief overview on the application of FSL in various corneal transplantation procedures and discusses the results of studies regarding the safety and efficacy of FSL-assisted corneal transplantation procedures.

UNASSIGNED: Descemet membrane endothelial keratoplasty (DMEK) is increasingly favored in the treatment of endothelial dysfunction due to its benefits, which include swift visual rehabilitation and recovery, a relatively low rejection rate, and superior refractive stability. In this study, we examined alterations in corneal clarity among patients who underwent DMEK and correlated these densitometry findings with other optical parameters of corneal topography.
UNASSIGNED: The study incorporated 35 eyes from 35 patients who had previously undergone DMEK surgery for pseudophakic bullous keratopathy at Ankara Bilkent City Hospital. The results from these patients were compared with those from a healthy control group. The preoperative and postoperative optical parameters of the patients were assessed using Pentacam Scheimpflug topography (Oculus).
UNASSIGNED: We observed significant decreases in corneal densitometry in the 0-2 mm and 2-6 mm zones of the anterior, posterior, central, and total layers at the sixth month postoperatively compared to the preoperative period (P<0.05). The corneal densitometry values at postoperative month 6 were elevated in all layers and zones relative to the healthy group (P<0.05). The root mean square of higher-order aberrations in postoperative period was elevated significantly (P<0.001).
UNASSIGNED: Six months after operation, the optical quality of the cornea following DMEK surgery did not achieve the level of a healthy cornea.

Corneal transplantation (keratoplasty) is necessary when various disorders result in corneal opacities with severe visual loss that cannot be treated conservatively, or the regular structure and curvature of the cornea is distorted, and its function is lost. Among human transplantation, keratoplasty is the most successful surgical procedure. In recent decades, penetrating keratoplasties have been increasingly replaced by lamellar techniques, where only the abnormal layer of the cornea is transplanted. The anterior form is deep anterior lamellar keratoplasty (DALK), recommended mainly for keratoconus. The main forms of posterior lamellar keratoplasty are Descemet\'s stripping automated endothelial keratoplasty (DSAEK) and Descemet\'s membrane endothelial keratoplasty (DMEK). The indications are bullous keratopathy after cataract surgery with endothelial destruction and Fuchs endothelial dystrophy. Lamellar keratoplasty has several advantages over penetrating surgery. Postoperative visual acuity is better, wound healing, patient rehabilitation are faster and the course of any immune rejection is milder and can be better managed. Orv Hetil. 2023; 164(28): 1087-1093.
Szaruhártya-átültetés (keratoplasztika) akkor szükséges, amikor különböző kórállapotok következtében konzervatív kezeléssel nem gyógyítható, súlyos látáscsökkenéssel járó szaruhártyahomályok alakulnak ki, vagy a cornea szabályos szerkezete, görbülete torzul, funkciója elvész. A humán transzplantációk között a keratoplasztika a legsikeresebb műtéti eljárás. Az utóbbi évtizedekben a perforáló keratoplasztikák helyét egyre inkább átveszik a lamelláris transzplantációk, amikor csak a cornea kóros rétegét ültetjük át. Az elülső forma a mély elülső lamelláris keratoplasztika („deep anterior lamellar keratoplasty” – DALK), mely elsősorban keratoconusban ajánlott. A hátsó lamelláris transzplantáció fő formája a Descemet leválasztásos automatizált endothelialis keratoplasztika („Descemet’s stripping automated endothelial keratoplasty” – DSAEK) és a Descemet-membrán endothelialis keratoplasztika („Descemet’s membrane endothelial keratoplasty” – DMEK). Indikációja az endothelium pusztulásával járó szürkehályog-műtét után kialakuló keratopathia bullosa és a Fuchs endothelialis dystrophia. A lamelláris keratoplasztikáknak több előnyük van a perforáló műtétekkel szemben. Jobb a posztoperatív látóélesség, gyorsabb a sebgyógyulás, a betegrehabilitáció, és az esetleges immunológiai kilökődés lefolyása is enyhébb és jobban kezelhető. Orv Hetil. 2023; 164(28): 1087–1093.