Marfan syndrome (MFS) is a genetic disorder that affects the connective tissue in several systems, with ocular, cardiovascular, and skeletal system manifestations. Its ocular manifestations include ectopia lentis (EL), myopia, astigmatism, and corneal abnormalities. This review examines refractive alterations related to MFS such as EL, microspherophakia, lens coloboma, altered corneal biomechanics (flattening, thinning, and astigmatism), and myopia and their impact on visual acuity. The pathogenesis of these manifestations stems from mutations in the FBN1 gene (encoding fibrillin-1). Moreover, the current medical and surgical management strategies for MFS-related refractive errors, including optical correction (eyeglasses, contact lenses, etc.), and surgical interventions like lensectomy, intraocular lens (IOL) implantation (anterior chamber, posterior chamber, scleral-fixated, iris-fixated), and the use of capsular tension rings/segments are further discussed. Considering the likelihood of underdiagnosing and underestimating ocular involvement in MFS, this updated review highlights the critical need to identify and address these refractive issues to enhance the visual outcomes for those affected.

Purpose: To report initial surgical experience and learning curve with a new finger-controlled, ultrasoundless lens extractor device and provide insights for future surgical endeavors. Setting: Bascom Palmer Eye Institute, Miami, Florida. Design: Single-center, noncomparative, retrospective, consecutive case series. Methods: 61 eyes of 51 individuals with cataract. All surgeries were performed with the miCOR 700 lens extractor by a single experienced physician. Nuclear density was graded preoperatively. Corrected distance visual acuity (CDVA), intraocular pressure (IOP), and pachymetry were evaluated preoperatively and postoperatively. Surgical videos were reviewed to collect data on time for each surgical step and complications. Regression analyses assessed the learning curve, performance improvement, and effects of nuclear density on surgical time and postoperative pachymetric variation. Results: Patients had a mean age of 72.2 ± 7.6 years. Increased surgical experience significantly reduced procedure time (P < .001), nuclear removal time (P = .018), and cortex removal time (P = .002). Higher nuclear density resulted in a longer procedure (P < .001) and nuclear removal time (P < .001). One posterior capsular rent occurred, not attributed to the lens extractor. No thermal damage to the corneal wound was observed. Postoperative CDVA improved significantly (P < .001 for eyes without ocular comorbidities, P = .016 for eyes with ocular comorbidities). All cases of corneal edema and IOP spikes resolved within a month. Conclusions: The miCOR 700 lens extractor offers an innovative, cost-effective approach to cataract surgery. Further research is needed to compare it with conventional phacoemulsification techniques.

A 20-year-old female patient with a long-standing history of severe atopic disease was referred to our department because of bilateral gradual blurry vision. She had undergone treatment with daily application of topical tacrolimus ointment 0.03% (Protopic, Fujisawa, Munich, Germany) for a period of 5 years. Slit-lamp examination revealed inferior corneal thinning with conjunctivalization and superficial neovascularization respecting both eyes. A diagnosis of bilateral inferior limbal stem cell deficiency (LSCD) was made. After the tacrolimus ointment discontinuation, symptoms, visual acuity, and objective clinical examination improved during the follow-up period of 6 months. This case suggests that LSCD is possible after prolonged use of topical tacrolimus ointment 0.03%. In this context, it is imperative to monitor patients continuously to evaluate the safety of its chronic use.

Background: Textural Interface Opacities (TIOs) following Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) have become a notable postoperative concern. Several studies have attempted to identify associations between TIO development and intraoperative factors, including fluid dynamics, irregular stromal surfaces, viscoelastic usage, and recipient immunological responses. Despite these efforts, the precise etiology of TIO remains uncertain. TIO has not been considered predictable in the preoperative setting. Its detection has relied exclusively on slit-lamp biomicroscopy, a subjective approach lacking standardized diagnostic criteria, which limits diagnostic reliability and is highly susceptible to interobserver variability. Methods: Optical Coherence Tomography (OCT) images of DSAEK-processed corneal grafts, prepared using the same microkeratome and technique for transplantation at the Bascom Palmer Eye Institute, underwent blinded analysis using a newly developed grading scale termed “M-TIO”. This analysis focused on DSAEK-processed grafts OCT images to evaluate and categorize the occurrence of TIO and assess the final visual acuity of the patients at the 1-year postoperative evaluation. Results: Based on the results, the M-TIO grading scale demonstrated strong predictive value, with higher grades on OCT of DSAEK lenticules consistently associated with worse postoperative visual acuity. The study included 221 donor corneas transplanted from 2019 to 2023. Greater TIO based on the “M-TIO” grading scale was associated with worse recipient logMAR VA (Mean 0.151 [99% CI: 0.077 to 0.225] for corneas with no TIO, increased to 0.680 [99% CI: 0.532 to 0.828] for corneas with the greatest TIO grade). These findings highlight the clinical utility of the M-TIO scale as an objective and reliable preoperative tool for assessing graft quality and predicting postoperative visual outcomes. Conclusions: This study introduces the “M-TIO” grading scale, which provides a standardized and objective method for evaluating Textural Interface Opacities in DSAEK grafts prior to transplantation. Our results demonstrate a clear association between the severity of TIO as graded by the M-TIO scale, and postoperative visual outcomes, with higher TIO grades correlating with worse visual acuity, emphasizing its value in improving graft selection, and clinical decision-making in DSAEK.

To report a case of allogeneic anterior lens capsule transplantation (ALCT) for the management of HSV neurotrophic epithelial keratitis. An 81-year-old man was referred to our department due to neurotrophic keratitis in the left eye that he had been suffering from over the past 3 months. He had recurrent episodes of HSV keratitis in the left eye over the past 3 years and despite multiple previous treatments, there was no improvement. At the time of presentation, corrected distance visual acuity (CDVA) was 20/200 in the right eye and no light perception (NLP) in the left eye. Slit-lamp examination revealed a corneal epithelial defect with underlying stromal thinning and concomitant scarring. An allogeneic anterior lens capsule (ALC) was placed over the epithelial defect to act as a biological dressing, anchored with a droplet of fibrin glue. A bandage contact lens (BCL) was placed over to prevent the slippage of the ALC. No intra or postoperative complications were observed. Two weeks later, the ALC was removed revealing complete epithelial healing, while two months later the epithelium remained completely healed with a significant reduction of corneal scarring. Anterior Lens Capsule transplantation (ALCT) seems to be a promising new treatment option for the management of corneal neurotrophic keratitis.

BACKGROUND: Textural Interface Opacities (TIO) following Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) have become a notable postoperative concern. Several studies have attempted to identify associations between TIO development and intraoperative factors, in-cluding fluid dynamics, irregular stromal surfaces, viscoelastic usage, and recipient immunological responses. Despite these efforts, the precise etiology of TIO remains uncertain. METHODS: Optical Coherence Tomography (OCT) images of DSAEK-processed corneal grafts, prepared using the same microkeratome and technique for transplantation at the Bascom Palmer Eye Institute, underwent blinded analysis using a newly developed grading scale. This analysis focused on DSAEK-processed grafts OCT images to evaluate and categorize the occurrence of TIO and assess the final visual acuity of the patients at the 1-year postoperative evaluation. RESULTS: The study included 221 donor corneas transplanted from 2019 to 2023. Greater TIO based on “M-TIO” grading scale was associated with worse recipient logMAR VA (Mean 0.151 [99% CI: 0.077 to 0.225] for corneas with no TIO increased to 0.680 [99% CI: 0.532 to 0.828] for corneas with the greatest TIO grade). CONCLUSION: This study introduces “M-TIO” grading scale for screening TIO in corneal grafts prior to DSAEK transplantation. Our findings demonstrate a significant association between the presence of TIO identified in OCT images of DSAEK-processed corneal grafts and transplantation outcomes.