To provide an updated brief review on neurotrophic keratopathy (NK) including classification, etiology, features, diagnosis, and management. Literature review. NK is defined as the dysfunction of corneal innervation that results in dysregulation of corneal and/or cellular function. It is characterized by loss of corneal sensation and neuronal homeostasis, leading to eventual corneal epithelial breakdown and ultimately keratolysis if untreated. Classification, etiology, features, diagnosis, and management of NK are reviewed. Prevalence is likely higher than previously estimated, and decreased sensation can originate from various causes. The Neurotrophic Keratitis Study Group classification emphasizes verifying corneal sensation early and distinguishes different epithelial and stromal aspects of NK. Optimal treatments regardless of NK stage include preservative-free lubricants (tears, gels, and ointments), punctal occlusion, autologous serum tears/umbilical cord serum drops/platelet-rich plasma drops, and removal of toxic or preservative-containing medications. Specific direct treatments, such as cenegermin and neurotization, address the decreased innervation and can improve sensation. A timely tarsorrhaphy may be necessary in refractory or quickly progressing cases. Keratoplasty is high risk in this setting but may be possible with aggressive medical therapy, adjunct procedures (i.e., amniotic membrane, tarsorrhaphy), perioperative direct treatments increasing sensation, and close follow-up postoperatively. NK is a chronic and potentially progressive disease that requires vigilance to monitor for future progression even after periods of apparent stability. As in other serious chronic conditions without a cure, earlier intervention in this challenging disease may obviate future decompensation and visually significant sequelae.

To report a case of late dehiscence of an EndoArt implant and its successful management 10 months after initial implantation. Case report. A 73-year-old man with a history of multiple failed Descemet membrane endothelial keratoplasty procedures on the right eye underwent EndoArt implantation for bullous keratopathy. The initial surgery was successful with improved visual acuity and a well-attached implant. However, 10 months after implantation, the patient experienced decreased visual acuity because of implant dehiscence in the superior quadrant. A rebubbling procedure using 20% Schwefelhexafluorid (SF6) gas without additional corneal sutures was performed, resulting in successful reattachment of the implant. Although EndoArt dehiscence typically occurs within the first 3 months after implantation, this case demonstrates that late dehiscence can occur even after prolonged implant attachment. Our report highlights the possibility of successful management through rebubbling without additional sutures and emphasizes the importance of extended follow-up for patients with this novel implant.

To report 2 cases of lid margin keratinization (LMK) associated with chronic ocular surface inflammation, which were successfully managed using laser photocoagulation. A case report. The first case was a 20-year-old man with mycoplasma-induced rash and mucositis. He presented with a focal patch of lid margin keratinization extending to a small area of inferior tarsal conjunctiva in the right lower eyelid, which was causing keratopathy. He underwent laser photocoagulation but experienced a recurrence after 2 months, which was successfully managed with a repeat laser session. At 6 months posttreatment, there were no recurrences, the keratopathy had resolved, and the ocular surface remained stable. The second patient was an 18-year-old woman with Stevens-Johnson syndrome sequelae. She had LMK in all 4 lids and underwent mucous membrane grafting. Postoperatively, she developed focal recurrences of keratinization at the edges of the graft in all 4 lids. The recurrent keratin plaques were treated with laser photocoagulation with a 577-nm laser under local anesthesia. At her last follow-up, 6 months after recurrence, there were no signs of keratinization. Laser photocoagulation is a safe and effective minimally invasive treatment modality for focal LMK in setting of chronic ocular surface disease. These cases demonstrate its potential as an alternative or adjunct to surgical options like mucous membrane grafting, particularly in a setting of recurrent and localized keratinization.

To evaluate Descemet membrane endothelial keratoplasty (DMEK) graft preparation efficiency, success rate, and graft viability after clinically relevant processing of diabetic human donor corneas using DescePrep or submerged cornea using backwards away (SCUBA). Fifteen pairs of diabetic donor corneas with an average diabetic risk score of 4.0 ± 1.3 and mild-moderate cell loss were processed for DMEK by an experienced certified eye bank technician. Corneas within each pair were randomly assigned to DescePrep or SCUBA and trephined with the number 7 trephine for orientation marking. Donor cornea characteristics, preparation duration, number of graft touches, and success rate were recorded. To simulate clinical graft preparation, DMEK grafts were loaded into a Straiko Modified Jones Tube, shipped, and unscrolled on a glass slide before masked cell viability analysis. We found that 93.3% (14/15) of corneas per group were prepared successfully by DescePrep and by SCUBA. DescePrep significantly reduced overall preparation time from 19.2 ± 0.5 to 15.1 ± 1.1 minutes ( P < 0.005) and significantly reduced stripping time from 10.9 ± 0.5 to 6.97 ± 1.1 minutes ( P < 0.005). Grafts processed by DescePrep and SCUBA demonstrated comparable cell loss of 15.8% ± 1.2% and 16.1% ± 1.4%, respectively, after loading, shipping, and unscrolling. DescePrep offers safe and reliable DMEK graft preparation with high success rates in diabetic tissue. DescePrep reduced preparation time by 21.3% and the number of endothelium contacts by 85.7% in comparison to SCUBA.

To describe the clinical course, surgical management, and sensory outcomes of indirect corneal neurotization using an autologous sural nerve graft in a pediatric patient with congenital corneal anesthesia complicated by recurrent herpetic keratitis and neurotrophic keratopathy. Case report of a 6-year-old girl with severe unilateral corneal hypoesthesia secondary to recurrent herpes simplex virus keratitis and a history of deep anterior lamellar keratoplasty, who underwent indirect corneal neurotization. Serial postoperative assessments included visual acuity, slit-lamp examination, and Cochet-Bonnet esthesiometry. By mid-term follow-up (8 months), partial peripheral sensory recovery was observed, accompanied by restoration of ocular surface stability and improvement in best-corrected visual acuity to 20/40. At 1 year, asymmetric but clinically meaningful peripheral sensory improvement was documented, whereas central sensitivity remained markedly reduced. The corneal graft remained clear, and no further inflammatory complications occurred. Indirect corneal neurotization using a sural nerve graft resulted in significant peripheral sensory recovery and enhanced visual function in a pediatric patient with congenital corneal anesthesia and herpes simplex virus-related neurotrophic keratopathy. This case supports indirect corneal neurotization as a promising regenerative strategy capable of restoring corneal sensation and improving ocular surface stability in pediatric patients at risk of amblyopia.

To compare biomarker expression and proliferation rates of limbal epithelial stem cells (LESCs) cultured on Descemet membrane (DM) versus amniotic membrane (AM). To investigate the suitability of DM as a potential long-term scaffold for transplantation of cultivated limbal stem cells on the ocular surface. Donor limbal epithelial cells were pooled, reseeded, and expanded on decellularized DM and AM. LESC biomarker expression was assessed by In-Cell Western and immunocytochemical staining. Cell proliferation was evaluated by BrdU incorporation. Airlift organ cultures were performed on DM-limbal tissue constructs and analyzed with 3D immunofluorescence microscopy to determine if DM could support stratified epithelial growth. Suitability of DM as a potential long-term scaffold for cultured LESCs on the cornea was assessed by evaluating transparency and resistance to collagenase digestion versus AM. Cultured cells exhibited higher expression of putative LESC markers (ABCG2, ABCB5), lower expression of transient amplifying cell marker (p63α), and lower cell proliferation rates on DM versus AM, indicating DM maintained LESC stemness better than AM. Under airlifting conditions, cells on DM stratified with differentiation and expression of corneal epithelial cell biomarkers in superficial layers, while maintaining LESC biomarker expression in basal layers. DM was more transparent and resistant to collagenase digestion than AM. DM promotes LESC stemness better than AM in ex vivo culture and can support stratified corneal epithelium. DM is also a more transparent and potentially durable epithelial scaffold than AM. DM is a promising new alternative to AM for limbal stem cell therapy.

Corneal tissue shortage is an ongoing concern for corneal surgeons and eye banks across the United States. Descemet membrane endothelial keratoplasty (DMEK) procedure numbers surpassed Descemet stripping automated endothelial keratoplasty in 2023, leading to an increased demand that has been met with limited DMEK tissue availability. In response to the growing demand, our goal is to compare and characterize feasibility of DMEK tissue from donors younger than 50 and donors 50 and older, including DMEK tissue processing times, preprocessing endothelial cell counts, and processing success rate. Retrospective review of donor corneas used for DMEK tissue processing from 2018 to 2024 at a single eye bank with a post hoc analysis. A total of 8915 cornea samples were used for transplantation during study period. Preprocessing endothelial cell counts were not significantly different between donor group age 50 or older or donor group younger than 50. Postprocessing endothelial cell counts were higher for donor group under 50. There was no statistically significant difference in processing times between donors 50 or older or younger than 50. Tissue peel difficulty was significantly reduced in donors younger than 50 compared to donors 50 or older. Preprocessing endothelial cell counts were similar between both age groups with higher postprocessing endothelial cell counts in donors younger than 50. Tissue processing time and tissue processing failure rate were also similar between the 2 age groups while tissue from donors less than 50 was easier to peel. This highlights that younger donors are a viable pool for DMEK tissue, which could help address the ongoing tissue shortage.

To describe an innovative anterior keratoplasty technique using a decellularized Descemet membrane allograft for treating nonhealing diseases of the ocular surface, and to report clinical outcomes. We reviewed surgeons' survey responses pertaining to the postoperative outcomes of Descemet membrane anterior keratoplasty (DMAK) surgeries using BrightMEM (Brightstar Therapeutics; Lexington, KY) corneal allografts, which were placed during a 3-year period. Data were excluded for cases with less than 60 days of follow-up or no evidence of underlying ocular surface disease. Complete epithelialization rates, mean healing time, and mean change in visual acuity were assessed. Outcomes are reported for 99 cases, performed by 15 surgeons across the United States. Complete epithelialization occurred in 84.8%, with a median healing time of 28.0 days. Healing rates and median healing time were 89.4% and 30.0 days for subtotal limbal stem cell deficiency cases (n = 47); 78.0% and 34.0 days for persistent epithelial defect cases (n = 41); and 79.5% and 30.5 days for neurotrophic keratopathy cases (n = 44). Graft retention was 91.9%. Among patients observed for more than 6 months (n = 35), complete healing was achieved in 97.1%. Nineteen patients (33%) reported pain preoperatively, and all reported improvement or resolution; the mean pain scores decreased from 5.47 preoperatively to 0.84 at follow-up. Visual acuity improved in 52.6% of cases. No infectious complications attributable to the tissue were reported. DMAK using BrightMEM corneal allograft represents a valuable technique for treating nonhealing ocular surface diseases, providing high rates of durable epithelialization, pain reduction, visual improvement, and graft retention.

To evaluate simultaneous anterior and posterior chamber gas tamponade to improve Descemet membrane endothelial keratoplasty (DMEK) graft attachment in unicameral eyes such as in aniridia or with a history of pars plana vitrectomy (PPV) or glaucoma surgery. This retrospective case series included 10 procedures in 9 complex eyes, many rendered unicameral from prior PPV or glaucoma surgery. Patients underwent DMEK (n = 7) or rebubbling (n = 3) with simultaneous anterior and posterior gas tamponade via 23-G PPV using 20% sulfur hexafluoride (SF6). Main outcomes were graft attachment, central corneal thickness (CCT), best spectacle-corrected visual acuity (BSCVA), and intraocular pressure (IOP) at 3 months. All 10 grafts were attached on day 1; 2 (20%) required subsequent rebubbling. At 3 months, mean CCT significantly decreased from 723.7 ± 166.2 μm to 533.9 ± 84.8 μm (P = 0.019). Mean BSCVA improved from 1.21 ± 0.85 to 0.93 ± 0.89 logMAR (P = 0.207), limited by comorbidities. Mean IOP was stable, changing from 16.9 ± 7.2 mm Hg preoperatively to 19.2 ± 12.5 mm Hg (P = 0.858). Two cases required increased glaucoma therapy; 1 graft failure was successfully managed with a repeat procedure. Simultaneous anterior and posterior chamber gas tamponade seems to be an effective technique for achieving DMEK graft attachment in challenging unicameral eyes after vitrectomy or glaucoma surgery. This approach may help overcome poor graft adhesion because of postoperative gas dislocation common in these conditions but necessitates combined corneal and vitreoretinal surgical expertise.