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Abstract Purpose This study aimed to investigate the association between variants in the interleukin (IL)-1 gene cluster and susceptibility to keratoconus (KC) in an Iranian population. Methods In the case group, there were 188 KC patients diagnosed by clinical findings and corneal tomography. The control group included all 205 healthy controls with no personal or family history of eye-related, metabolic, or immune system-related disease. Using the standard salting out extraction procedure, genomic DNA was isolated from peripheral blood leukocytes. The genotypes were determined by applying agarose gel electrophoresis for the IL-1RN 86 bp VNTR and polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) for rs16944 and rs1143634. Results The results showed a significant association between the IL-1β rs1143634 (rs1143634 T allele, P = 0.008) and IL-1RN 86 bp VNTR polymorphisms (LL and LS genotype, P = 0.048 and 0.012 respectively) and susceptibility to KC in the Iranian population. The genotype distributions of rs1143634 (P = 0.004) and rs2234663 (P = 0.042) significantly differed between case and control groups, with certain genotypes demonstrating a protective effect against KC. Logistic regression analysis revealed a protective effect of the IL-1RN L allele [odds ratio (OR) = 0.367, 95% confidence interval (CI): 0.240–0.562; P = 0.000] and certain haplotypes (OR = 0.628, 95% CI: 0.447–0.884; P = 0.007) against KC. However, no significant association was found for the IL-1β rs16944 polymorphism. Conclusion This study provides evidence for an association between variants in the IL-1 gene cluster and susceptibility to KC in an Iranian population. Further research on larger and more diverse populations is warranted to validate these findings and explore the underlying mechanisms involved.

AIM: To report the outcomes of three cases of corneal perforation managed with simultaneous tectonic Descemet stripping endothelial keratoplasty (t-DSEK) and tectonic Bowman layer transplant (t-BLT) as an alternative to tectonic penetrating keratoplasty (t-PKP). METHODS: Three eyes of three patients receiving simultaneous t-DSEK and t-BLT for corneal perforation were included. The technique for DSEK was modified depending on individual requirements. The t-BLT technique was standardised using an 8 mm graft and fixated with a running suture. Success was measured by the ability of this procedure to close a corneal perforation. RESULTS: All three cases achieved tectonic eye globe restoration and remained stable during the minimum 3-month observation period. Reinterventions were relatively common: 2 cases required amniotic membrane transplant for persistent epithelial defects. One case required DSEK rebubbling. One case developed angle closure glaucoma requiring surgical peripheral iridectomy. CONCLUSION: Simultaneous t-DSEK and t-BLT may be a useful strategy for the management of corneal perforation as an alternative management to t-PKP for selected cases.

Abstract Background To compare and contrast morpho-volumetric features between Down syndrome (DS) cornea and non-DS keratoconic cornea by three-dimensional (3D) modelling. Methods Forty-three subjects (43 eyes) with DS and 99 patients matching their age and sex (99 eyes) with keratoconus (KC) were included in this single-center cross-sectional study. Main outcome measures were high-order aberrations (HOA), central corneal thickness (CCT), spherical equivalent refraction, and morpho-volumetric parameters established using a 3D corneal model, such as deviation of anterior and posterior corneal apices (Dapexant/Dapexpost) and minimum thickness points (Dmctant/Dmctpost) from corneal vertex, areas of the anterior and posterior surfaces (Aant/Apost), sagittal area passing through the anterior and posterior corneal apices (Aapexant/Aapexpost) and minimum thickness point (Amctpost) and corneal volume of the complete cornea (Vtotal). Results Age, gender, spherical equivalent refraction, CCT and Vtotal were similar between the net on-DS KC and DS groups (P > 0.05), while non-DS KC group had higher HOA than the DS group (P

Abstract Background The aim of this study was to evaluate visual, refractive, quality of vision, visual function and satisfaction of multifocal intraocular lens (MF-IOL) exchange with a monofocal IOL (MNF-IOL) in dissatisfied patients following MF-IOL implantation. Methods This was a retrospective case series. Bilateral IOL exchange (MF-IOL to MNF-IOL) was performed in 13 patients (26 eyes) with neuroadaptation failure. Questionnaires including the Quality of Vision (QoV), Visual Function Index (VF-14 and Rasch-revised VF-8R version), and a satisfaction questionnaire were used. Results The mean time for IOL exchange was 15 months. The corrected distance visual acuity (CDVA) improved from 20/26 to 20/23 (P = 0.028). The uncorrected near visual acuity (UNVA) worsened after exchange from 20/47 to 20/62 (P = 0.024). QoV scores improved significantly across all three subscales after exchange. Visual function for far distance improved with a change in VF-14 score from 74.2 ± 24.8 to 90.9 ± 9.1 (P = 0.03). The VF-8R score showed worsening although not statistically significant. Near vision spectacle independence was totally or partially lost in all cases. Ten patients (77%) reported they would not repeat the lens exchange. Safety and efficacy indices changed from 1.23 to 0.85, respectively, at three months to 1.24 (P = 0.871) and 0.89 (P = 0.568), respectively, at one year. Conclusion IOL exchange (multifocal to monofocal) to solve neuroadaptation failure in this case series resulted in significant improvements in dysphotopsia and improved distance visual function. However, UNVA worsened and patient satisfaction after exchange remained suboptimal with 77% claiming they would not repeat the lens exchange, suggesting the value of near vision spectacle independence for these patients.

Abstract Background The aim of the study was to evaluate the outcomes of dissatisfied patients reporting poor visual quality following implantation of multifocal intraocular lenses (MF-IOLs), managed by IOL exchange with another multifocal optical profile. Methods This is a retrospective series of cases. MF-IOL exchange was done in 15 dissatisfied patients (30 eyes) with the perception of poor visual quality for far distance affected by neuroadaptation failure. Patients underwent a bilateral exchange of a MF-IOL with another MF-IOL of a different optical profile. Visual outcomes and complications were analyzed. Questionnaires including Quality of Vision (QoV), Visual Function Index-14 (VF-14) and its Rasch-revised version (VF-8R) and a satisfaction questionnaire were also used for outcome evaluation. Results The mean elapsed time from implantation to explantation-reimplantation was 11.8 months. The QoV scores improved significantly across all the three subscales. Visual function improved with a change in VF-14 score from 60.41 ± 24.81 to 90.16 ± 10.91 (P

AIM: To compare the visual results of non-topography-guided and topography-guided photorefractive keratectomy (PRK) applying sequential and simultaneous corneal cross-linking (CXL) treatment for keratoconus. METHODS: Interventional and comparative prospective study. Sixty-nine eyes (36 patients) suffering from keratoconus (stages 1 Amsler-Krumeich classification) were divided into four groups: sequential topography-guided photorefractive keratectomy with CXL, simultaneous topography-guided photorefractive keratectomy with CXL, simultaneous non-topography guided photorefractive keratectomy with CXL, and sequential non-topography guided photorefractive keratectomy with CXL. The main outcome measures were pre- and postoperative uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (CDVA), manifest refraction, contrast sensitivity, and keratometry. RESULTS: All analyzed visual, contrast sensitivity, and refractive parameters showed a significant improvement in the four groups (all P

Abstract Background To study and compare the clinical optical image quality following implantation with different premium IOLs by analysing the point spread function (PSF) Strehl ratio using a pyramidal wavefront sensor (PWS)-based aberrometer. Methods This study included 194 eyes implanted with: (a) 19 AcrySof SA60AT (control group); (b) 19 Miniwell; (c) 24 LENTIS Mplus LS-313 MF30; d) 33 LENTIS Mplus LS-313 MF15; (e) 17 AkkoLens Lumina; (f) 31 AT LISA Tri 839MP; (g) 20 Precizon Presbyopic; (h) 20 AcrySof IQ PanOptix; (i) 11 Tecnis Eyhance. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root mean square (RMS), low-order aberration (LOA) and high-order aberration (HOA) RMS measured by PWS aberrometer. Results AT LISA Tri had the highest PSFw2 Strehl ratio at both 3.0- and 4.0-mm pupil size (0.52 ± 0.14 and 0.31 ± 0.10; P

Three-dimensional reconstruction of the corneal surface provides a powerful tool for managing corneal diseases. This study proposes a novel method for reconstructing the corneal surface from elevation point clouds, using modal schemes capable of reproducing corneal shapes using surface polynomial functions. The multivariable polynomial fitting was performed using a non-dominated sorting multivariable genetic algorithm (NS-MVGA). Standard reconstruction methods using least-squares discrete fitting (LSQ) and sequential quadratic programming (SQP) were compared with the evolutionary algorithm-based approach. The study included 270 corneal surfaces of 135 eyes of 102 patients (ages 11–63) sorted in two groups: control (66 eyes of 33 patients) and keratoconus (KC) (69 eyes of 69 patients). Tomographic information (Sirius, Costruzione Strumenti Oftalmici, Italy) was processed using Matlab. The goodness of fit for each method was evaluated using mean squared error (MSE), measured at the same nodes where the elevation data were collected. Polynomial fitting based on NS-MVGA improves MSE values by 86% compared to LSQ-based methods in healthy patients. Moreover, this new method improves aberrated surface reconstruction by an average value of 56% if compared with LSQ-based methods in keratoconus patients. Finally, significant improvements were also found in morpho-geometric parameters, such as asphericity and corneal curvature radii.

Abstract Background The purpose of the study was to determine the advantages and disadvantages of epi-on corneal cross-linking (CXL) techniques compared with standard epi-off CXL. Methods We searched MEDLINE and EMBASE for randomized controlled trials (RCTs) and non-randomized studies of interventions (NRSIs) and we evaluated the selected papers according to the Cochrane risk of bias tool. We considered, as primary outcomes, average Kmax flattening, changes in uncorrected and corrected distance visual acuity (UDVA and CDVA); as secondary outcomes, we considered changes in pachymetry values and endothelial cell density (ECD). We also investigated adverse events related to the treatments and treatment failure. Meta-analysis was conducted with a fixed or random-effects model using weighted mean difference (MD) with 95% confidence interval (CI) as the effect size. Results A total of 15 studies were included and among these 15 trials, 9 were RCTs and 6 were NRSIs, but only 4 studies showed no high risk of bias and were included in this meta-analysis. Our analysis revealed significant postoperative differences in CDVA (MD = 0.07; 95% CI 0.04 to 0.10; P 0.05). Epi-on CXL protocol was found to be significantly less prompt to have risks of delay in epithelial healing (P = 0.035) and persistent stromal haze (P = 0.026). Conclusion Epi-on CXL is as effective as epi-off CXL. Except for a higher significant improvement in CDVA with current epi-on protocols, our meta-analysis demonstrates that epi-on and epi-off CXL have comparable effects on visual, topographic, pachymetric, and endothelial parameters. Epi-on CXL has clinical advantages in terms of comfort and avoidance of complications as it reduces the risk of developing delay in epithelial healing and persistent stromal haze.

Abstract This short report includes 5 eyes of 5 patients (mean age 63.2 ± 12 years) who underwent a tectonic keratoplasty [deep anterior lamellar keratoplasty (DALK) or penetrating keratoplasty (PK)] in order to rehabilitate the eye after the extrusion of the non-perforating keratoprosthesis (Kpro) KeraKlear (KeraMed, USA). The non-perforating Kpro was extruded after a mean period of 21.4 ± 21.8 months due to melting. In two cases, the keratoplasty was performed the same day of the non-perforating Kpro removal due to a severe melting, while in the other three cases it was performed one to 3 months later. Two eyes received a DALK, but in 3 eyes a macroscopic Descemet membrane perforation forced the conversion into a PK. The mean follow-up period after the keratoplasty was 16.8 ± 6.6 months. No cases of rejection were recorded. All the 5 eyes achieved “anatomical success” (transparent graft, with no signs of infection or inflammation). Two eyes showed limited “functional success” because the achievement of the best visual potential was prevented by the development of glaucomatous optic atrophy during the follow-up period. In conclusion, this short report presents an unexpected success of a keratoplasty performed with a tectonic purpose after the extrusion of the non-perforating Kpro because the corneal graft remained transparent, without neovascularization or scarring during the follow-up period. This initial evidence shows some encouraging results regarding graft survival rate and the achievement of a useful visual rehabilitation with keratoplasty after a non-perforating Kpro failure instead of repeating the Kpro implantation.

This work evaluates changes in new morphogeometric indices developed considering the position of anterior and posterior corneal apex and minimum corneal thickness (MCT) point in keratoconus. This prospective comparative study included 440 eyes of 440 patients (age, 7–99 years): control (124 eyes) and keratoconus (KC) groups (316 eyes). Tomographic information (Sirius®, Costruzione Strumenti Oftalmici, Italy) was treated with SolidWorks v2013, creating the following morphogeometric parameters: geometric axis–apex line angle (GA–AP), geometric axis–MCT line angle (GA–MCT, apex line–MCT line angle (AP–MCT), and distances between apex and MCT points on the anterior (anterior AP–MCTd) and posterior corneal surface (posterior AP–MCTd). Statistically significant higher values of GA–AP, GA–MCT, AP–MCT and anterior AP–MCTd were found in the keratoconus group (p ≤ 0.001). Moderate significant correlations of corneal aberrations (r ≥ 0.587, p

Abstract Background To analyze the clinical results of an artificial neural network (ANN) that has been processed in order to improve the predictability of intracorneal ring segments (ICRS) implantation in keratoconus. Methods This retrospective, comparative, nonrandomized, pilot, clinical study included a cohort of 20 keratoconic eyes implanted with intracorneal ring segments KeraRing (Mediphacos, Belo Horizonte, Brazil) using the ANN (ANN group) and 20 keratoconic eyes implanted with KeraRing using the manufacturer’s nomograms (nomogram group). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA) (visual acuity is expressed in decimal value and in LogMAR value in brackets), manifest refraction, corneal topography, tomography, aberrometry, pachymetry and volume analysis (Sirius System. CSO, Firenze, Italy) were performed during the preoperative visit; and the two groups, ANN group and nomogram group, did not differ significantly preoperatively in all of the parameters evaluated. These preoperative values were compared with the results obtained at the third-month visit. Mann-Whitney test and Wilcoxon test were used for the statistical analyses. Results The spherical equivalent and the keratometric values decreased significantly in both groups. The CDVA improved from 0.60 ± 0.23 (0.22 LogMAR) pre-operatively to 0.73 ± 0.21 (0.14 LogMAR) post-operatively in the ANN group (p

(1) Background: This study aimed to evaluate and compare the clinical optical image quality following implantation with different premium IOLs by the analysis of the point spread function (PSF) Strehl ratio using a Pyramidal WaveFront-based sensor (PWS) aberrometer at two different pupil sizes. (2) Methods: This study included 96 eyes of 70 patients implanted with: (1) 19 AcrySof SA60AT (control group); (2) 24 LENTIS Mplus LS-313 MF30; (3) 33 LENTIS Mplus LS-313 MF15; and (4) 20 Precizon Presbyopic. Main outcome measures were PSF Strehl ratio, PSF Strehl ratio excluding second-order aberrations (PSFw2), total root-mean-square (RMS), and low- and high-order aberrations’ RMS measured by PWS aberrometer. Results: SA60AT had the highest significant PSFw2 Strehl ratio at both 3- and 4-mm pupil size (0.41 ± 0.11 and 0.28 ± 0.07) followed by LENTIS Mplus 15 (group C, 0.35 ± 0.1 and 0.21 ± 0.06) and a near tie between LENTIS MPLUS 30 (group B, 0.27 ± 0.08 and 0.18 ± 0.06) and Precizon Presbyopic (group D, 0.27 ± 0.07 and 0.17 ± 0.04). MPlus MF15 was found to be significantly better than MPlus MF30 at both 3.00 mm (p < 0.0001) and 4.00 mm (p = 0.002). (4) Conclusions: The PSFw2 represents a new tool to objectively evaluate the far distance retinal image quality of multifocal IOLs, and the far distance clinical image quality parameters measured by PWS aberrometer differed significantly according to the technology of the implanted lens.

Purpose. To evaluate the efficacy of autologous platelet-rich plasma (E-PRP) eye drops for the treatment of chronic ocular surface syndrome (OSS) following laser in situ keratomileusis (LASIK). Methods. This prospective interventional consecutive clinical study include 156 eyes of 80 patients affected by post-LASIK chronic OSS who were treated with autologous E-PRP 6 times a day as monotherapy for 6 weeks. Results. Dry eye symptoms improved in 85% of the cases. A decrease in at least one quadrant to total disappearance on CFS was observed in 89.6% of the patients who had positive CFS before treatment. Three eyes presented severe punctate keratitis (1.9%) at baseline, all of which healed completely. Conjunctival hyperemia improved in 93.3% of the patients with previous signs of ocular surface inflammation. There was a significant improvement in logMAR CDVA from 0.14 ± 0.19 to 0.06 ± 0.12 (p=0.000), and 74 (71.4%) eyes improved at least 1 line in CDVA. Conclusion. Monotherapy with autologous E-PRP is a well-tolerated, safe, and effective treatment for the management of post-LASIK ocular surface syndrome. Precis. Monotherapy with autologous platelet-rich plasma eye drops has been shown to be an adequate option for the treatment of post-LASIK chronic ocular surface syndrome. This trial is registered with NCT03322917.

Corneal ectatic disorders are characterized by a progressive weakening of the tissue due to biomechanical alterations of the corneal collagen fibers. Carbon nanostructures, mainly carbon nanotubes (CNTs) and graphene, are nanomaterials that offer extraordinary mechanical properties and are used to increase the rigidity of different materials and biomolecules such as collagen fibers. We conducted an experimental investigation where New Zealand rabbits were treated with a composition of CNTs suspended in balanced saline solution which was applied in the corneal tissue. Biocompatibility of the composition was assessed by means of histopathology analysis and mechanical properties by stress-strain measurements. Histopathology samples stained with blue Alcian showed that there were no fibrous scaring and no alterations in the mucopolysaccharides of the stroma. It also showed that there were no signs of active inflammation. These were confirmed when Masson trichrome staining was performed. Biomechanical evaluation assessed by means of tensile test showed that there is a trend to obtain higher levels of rigidity in those corneas implanted with CNTs, although these changes are not statistically significant (p>0.05). Implanting CNTs is biocompatible and safe procedure for the corneal stroma which can lead to an increase in the rigidity of the collagen fibers.

The aim of this study is to describe a new keratoconus detection method based on the analysis of certain parametric morphogeometric operators extracted from a custom patient-specific three-dimensional (3D) model of the human cornea. A corneal geometric reconstruction is firstly performed using zonal functions and retrospective Scheimpflug tomography data from 107 eyes of 107 patients. The posterior corneal surface is later analysed using an optimised computational geometry technique and the morphology of healthy and keratoconic corneas is characterized by means of geometric variables. The performance of these variables as predictors of a new geometric marker is assessed through a receiver operating characteristic (ROC) curve analysis and their correlations are analysed through Pearson or Spearman coefficients. The posterior apex deviation variable shows the best keratoconus diagnosis capability. However, the strongest correlations in both healthy and pathological corneas are provided by the metrics directly related to the thickness as the sagittal plane area at the apex and the sagittal plane area at the minimum thickness point. A comparison of the screening of keratoconus provided by the Sirius topographer and the detection of corneal ectasia using the posterior apex deviation parameter is also performed, demonstrating the accuracy of this characterization as an effective marker of the diagnosis and ectatic disease progression.

Abstract Purpose To analyze the quality of vision of patients implanted bilaterally with the multifocal Precizon Presbyopic intraocular lens (IOL), as well as to evaluate the visual performance provided by the lens. Setting Vissum Miranza Alicante. Design Prospective multicenter study. Methods 56 patients (mean age 65.0 ± 8.7 years old) underwent bilateral implantation with multifocal Precizon Presbyopic IOL. The quality of vision was assessed by a quality of vision questionnaire at 6 months after the implantation procedure, a complete eye examination was also performed including visual and refractive measurements, defocus curve and contrast sensitivity assessment. Visual and refractive variables were compared in preoperative, 3-month postoperative and 6-month postoperative visits by Wilcoxon test. Results The quality of vision analysis showed the absence of severe glare and severe haloes in all evaluated patients. Likewise, non-symptoms of glare, haloes and starbursts were seen in 75%, 68%, and 55% of subjects, respectively. Efficacy and safety index was 1.26 and 1.42, respectively. The 6-month postoperative binocular uncorrected distance visual acuity and near uncorrected visual acuity were 0.00 ± 0.09 and 0.20 ± 0.13 logMAR, respectively. Mean spherical equivalent was 0.29 ± 0.45 D. Conclusions The Precizon Presbyopic NVA IOL (OPHTEC BV) provides a suitable quality of vision with a low rate of disturbance photic phenomena induction, as well as an excellent visual performance at main distances of sight accomplishing the visual demands of the majority of patients.

Abstract Background Keratoconus is an ectatic, progressive corneal disorder characterized by alterations in the morphology of the corneal tissue that leads to limitation of visual function of the patient. Intracorneal ring segments (ICRS) are small synthetic devices that are implanted in the corneal stromal in order to regularize the morphology of the tissue therefore improving the visual function and the quality of life of the patients. Main text The present narrative review summarizes the main scientific articles developed by the authors in relation to the clinical outcomes and long-term results of ICRS in the treatment of keratoconus. It was found that those patients that benefit the most from this surgical intervention are those that have the most severe form of keratoconus. Additionally, patients with good visual function, those with more than 0.9 in the decimal scale are at risk of losing visual acuity after ICRS implantation. In relation to long-term results, scientific investigations published by the authors demonstrate that ICRS is a stable procedure after long period of time in terms of vision, refraction, and topographic variables in those patients with stable keratoconus. However, in patients with keratoconus and signs of progression, ICRS may not have the capability of halting the progression of the disease. Using artificial intelligence to guide ICRS implantation provide better clinical outcomes and improvement in corneal higher-order aberrations in patients with keratoconus in comparison to those treated using the commercial nomogram of implantation. Conclusions ICRS is a safe surgical procedure in the treatment of keratoconus. Patients that benefit most from the surgery are those with a significant visual impairment. ICRS should not be considered in patients with good visual function because of the risk of losing lines of vision. Long-term follow-up demonstrate stability of the clinical outcomes in patients with stable keratoconus although ICRS may not have the ability of halting the progression of the disease. New technologies based artificial intelligence improved the indications and the clinical outcomes of keratoconus patients treated with ICRS.

This review explores contemporary challenges in penetrating keratoplasty (PK), focusing on technical intricacies, technological advancements, and strategies for preventing graft rejection. A systematic literature search from January 2018 to July 2023 was conducted across PubMed, Cochrane, Web of Science, Scopus, and EMBASE. The inclusion criteria comprised studies on PK and its comparison with other corneal pathologies, with emphasis on keratoconus (KC). Two independent reviewers screened studies, extracting relevant data. The review covers PK evolution, highlighting infra-red femtosecond lasers' impact on graft shapes, minimizing astigmatism, and enhancing wound healing. Graft rejection, a primary complication, is examined, detailing risk factors and preventive measures. Preoperative considerations, diagnostic techniques for rejection, and PK in KC are discussed. Postoperative care's significance, including intraocular pressure monitoring and steroid administration, is emphasized. The paper concludes with a comprehensive approach to prevent graft rejection, involving topical and systemic medications. An outlook on evolving monoclonal antibody research is presented. As the field progresses, personalized approaches and ongoing therapeutic exploration are expected to refine strategies, enhancing PK outcomes.

The purpose of this study was to describe a case and clinical course of simultaneous anterior chamber phakic intraocular lens (AC-pIOL) removal, implantation of a posterior chamber phakic intraocular implantable collamer lens (ICL), and Descemet membrane endothelial keratoplasty (DMEK). This was a case report of a 44-year-old male with a unilateral decompensated cornea from a displaced Duet–Kelman lens on his left eye that underwent pIOL extraction and implantation of a posterior chamber phakic intraocular ICL and simultaneous DMEK. After 6 months, the cornea of the left eye had regained clarity, the Descemet membrane was graft stable, and the ICL implanted was centered with good vault. Postoperative anisometropia was avoided. There was no development of cataracts or other complications. The simultaneous pIOL extraction, ICL implantation, and DMEK in our case showed good results with full restoration of anterior segment anatomy and return of transparency of the cornea. The current case shows the feasibility of the simultaneous approach instead of sequential as an alternative for patients with endothelial disease associated with AC pIOLs, restoring vision and anatomy and also avoiding postoperative anisometropia.

Abstract Purpose This study investigates immune cell (ICs) infiltration in advanced keratoconus patients undergoing autologous adipose-derived adult stem cell (ADASC) therapy with recellularized human donor corneal laminas (CL). Methods A prospective clinical trial included fourteen patients divided into three groups: G-1, ADASCs; G-2, decellularized CL (dCL); and G-3, dCL recellularized with ADASCs (ADASCs-rCL). Infiltrated ICs were assessed using in vivo confocal microscopy (IVCM) at 1,3,6, and12 months post-transplant. Results Infiltrated ICs, encompassing granulocytes and agranulocytes, were observed across all groups, categorized by luminosity, structure, and area. Stromal ICs infiltration ranged from 1.19% to 6.62%, with a consistent increase in group-related cell density (F = 10.68, P 300μm2, presumably macrophages, notably in G-3, indicating a potential role in tissue repair and remodeling, explaining reductions in cells remnants

The determination of sulcus-to-sulcus measurements has been challenging due to the limitations of current approaches. Ultrasound methods are highly operator-dependent and require extensive training, while traditional optical devices cannot visualize structures posterior to the iris. However, modern optical anterior segment coherence tomography (AS-OCT) devices are changing this paradigm by identifying some anatomical landmarks posterior to the iris. This study evaluates the reproducibility of optical sulcus measurements in the context of sizing a novel accommodative intraocular lens (IOL). Preoperative OCT scans of patients scheduled for cataract surgery were analyzed regarding the dimensions of the ciliary sulcus using a custom scan method with a clinically available anterior segment optical coherence tomographer. Measurements were compared between two different readers, and various derived parameters were compared. The measurements by both readers were highly correlated (R2 > 0.96), and their agreement was excellent (mean difference 0.02 mm with 95% limits of agreement from −0.11 to 0.15 mm). In contrast, the sulcus diameter measurement did not agree well with automatically calculated values, such as the anterior chamber width or white-to-white. This leads to the conclusion that modern swept-source AS-OCT measurements of the ciliary sulcus dimensions are feasible, reproducible, and may be a clinically useful tool.