Background: Fungal keratitis remains a serious threat to vision, often progressing despite medical therapy and requiring surgical intervention. Therapeutic deep anterior lamellar keratoplasty (DALK) and therapeutic penetrating keratoplasty (TPK), are frequently required but carry risks of infection recurrence and graft rejection. As timely identification of the etiological agent is essential for improving the outcomes in infectious keratitis, in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT) are instrumental in providing insights that can guide better therapeutic decision-making and improving outcomes in fungal keratitis. Case Description: We report the cases of two previously healthy patients (case one, 56-year-old woman; case two, 38-year-old man), who have presented in our service with unilateral infectious keratitis after ocular trauma with vegetable matter during outdoor activities, with a visual acuity of counting fingers and hand motion, respectively. Slit-lamp examination revealed unilateral extensive corneal infiltrates suggestive for fungal etiology in both cases. In vivo confocal microscopy (HRT-3, Heidelberg Retina Tomograph 3/Rostock Cornea Module, Heidelberg Engineering, Heidelberg, Germany) identified lesions suggestive for Candida Albicans and Acanthamoeba coinfection in case one and filamentous fungal keratitis in case two. Anterior segment optical coherence tomography (MS-39, CSO, Italy) was used to monitor the extent and morphology of the infiltrates. The patients underwent therapeutic DALK and TPK, respectively, with good results at the one-year follow-up. Conclusions: Our cases illustrate the advantages of incorporating IVCM and AS-OCT as complementary imaging techniques into clinical practice. IVCM and AS-OCT in fungal keratitis could lead to an earlier diagnosis, more accurate dynamic treatment response evaluation, and the identification of high-risk features for aggressive fungi for a more tailored medical and surgical management.

To evaluate the diagnostic and surgical relevance of anterior segment optical coherence tomography (AS-OCT) in granular, lattice and macular corneal dystrophies in Romania, and to illustrate key imaging features using cases from our centre. We searched the PubMed/MEDLINE database for articles published between January 2010 and January 2025 using combinations of the following terms "granular corneal dystrophy", "lattice corneal dystrophy", "macular corneal dystrophy" with "anterior segment optical coherence tomography". We excluded studies that contained no anterior segment optical coherence tomography data. We prioritised peer-reviewed original articles and systematic reviews. Given the rare nature of these dystrophies, case reports were included if they contained relevant AS-OCT data. Representative slit-lamp and AS-OCT images from our clinic were included to contextualize findings. Stromal dystrophies are rare in Romania and their overlapping clinical features make diagnosis difficult. Anterior segment optical coherence tomography helps by offering depth-resolved visualization of epithelial, Bowman's layer and stromal changes. It allows more reliable differentiation between entities: granular dystrophy shows sharply defined hyperreflective deposits; lattice dystrophy shows linear, branching stromal amyloid; and macular dystrophy shows diffuse stromal hyperreflectivity with associated thinning. These layer-specific patterns improved phenotypic differentiation and, in surgical candidates, helped estimate lesion depth and residual clear stroma, thereby informing the choice of keratoplasty technique and postoperative monitoring. Anterior segment optical coherence tomography refines diagnosis, enhances early detection and guides surgical decision-making in stromal corneal dystrophies. Its objective imaging markers facilitate monitoring of disease progression and postoperative recurrence. Continued advances in multimodal imaging and automated analysis are expected to further strengthen its role in personalised management.

Background/Objectives: Infectious keratitis remains a major cause of blindness worldwide, and many cases progress to therapeutic keratoplasty despite advances in antimicrobial therapy. This systematic review aims to evaluate the outcomes of therapeutic keratoplasty in microbial keratitis and examine factors influencing anatomical success, graft survival, and visual rehabilitation. Methods: A systematic review was conducted following PRISMA guidelines, including English-language studies, published between 2000 and 2025. Studies with ≥10 eyes and ≥6 months follow-up were included. Data on infection control, graft clarity, anatomical success, visual acuity, and complications were extracted. Results: Fourteen studies encompassing 1527 eyes were analyzed. TPK accounted for 89% of procedures; DALK was used selectively for anterior or mid-stromal infections. Overall infection control ranged from 69 to 100%, with globe preservation in 85–100% of cases. Bacterial keratitis had higher cure rates and graft clarity than fungal or Acanthamoeba keratitis. Larger grafts (>8 mm) and deep stromal involvement were associated with increased graft rejection and postoperative complications. DALK offered higher graft survival and lower immunologic risk when the endothelium was spared. Visual outcomes were generally limited, reflecting preoperative disease severity, timing of surgery, and postoperative immunomodulation constraints. Early surgical intervention improved anatomical outcomes in severe fungal keratitis. Conclusions: Therapeutic keratoplasty is an effective globe-preserving intervention in advanced microbial keratitis, but with limited functional outcomes. Further prospective studies are needed to refine surgical indications, postoperative management, and long-term functional results.

Background/Objectives: Fuchs endothelial corneal dystrophy (FECD) affects not only the corneal endothelium and Descemet membrane, but also the corneal thickness, shape, and optical quality. This study aimed to evaluate the quantitative and qualitative corneal changes after a Descemet membrane endothelial keratoplasty (DMEK) in patients with FECD and to compare the postoperative remodeling between eyes with subclinical corneal edema (F-SCE) and those with clinically evident corneal edema (F-CE). Methods: This retrospective observational study included 48 eyes of 40 patients with FECD who underwent DMEK between April 2023 and October 2025. The following parameters were assessed preoperatively and at 6 months postoperatively: central corneal thickness (CCT), mean pupillary power (MPP), anterior and posterior corneal astigmatism, total corneal higher-order aberrations (HOAs), anterior and posterior optical path difference (OPD), point spread function (PSF), anterior and posterior corneal surface regularity (RMS/A), and Gullstrand anterior/posterior (A/P) and posterior/anterior (P/A) ratios. The corneal data was obtained using a CSO MS-39 (Costruzione Strumenti Oftalmici, Firenze, Italy). Results: In the F-SCE subgroup, significant postoperative improvement was observed in the CCT (Δ = −84.6 ± 48.1 µm, p < 0.001), MPP (Δ = −1.010 ± 2.183, p < 0.001), posterior corneal regularity (posterior RMS/A) (Δ = −0.117 ± 0.229, p = 0.004), and both Gullstrand ratios (A/P: Δ = +0.111 ± 0.089, p < 0.001; P/A: Δ = −0.078 ± 0.064, p < 0.001). No significant change was detected in the anterior corneal regularity, anterior or posterior astigmatic metrics, total corneal higher-order aberrations, or PSF. In the F-CE subgroup, the postoperative response was greater, with significant improvement in the BCVA, CCT, thinnest corneal point, MPP, anterior and posterior corneal astigmatism, cylinder, total corneal HOAs, anterior and posterior corneal HOAs, PSF, anterior and posterior corneal regularity, and both Gullstrand ratios. Compared with the F-SCE eyes, the F-CE eyes showed significantly greater postoperative change in most structural and optical parameters, although most 6-month postoperative values were no longer significantly different between groups. Conclusions: DMEK induced significant corneal remodeling in both subclinical and clinically evident FECD. The eyes with subclinical edema demonstrated meaningful recovery in visual acuity, pachymetry, and posterior corneal regularity, supporting the presence of functional corneal impairment before a clinically visible edema. The eyes with clinically evident edema showed a broader and greater postoperative response, while the final postoperative values largely converged between groups.

Objective: To report the two different surgical approaches in the case of a patient with Fuchs endothelial dystrophy with low endothelial cell count and advanced cataracts.

Salzmann nodular degeneration is a slowly progressive, rare, degenerative disease of the cornea, usually associated with other ocular pathologies such as dry eye disease, previous ocular surgery, involving the peripheral cornea. We present the surgical management of a rare case of a patient diagnosed with Fuchs endothelial dystrophy where the Salzmann nodules present an unusual bilateral central corneal involvement and overlap the area with the most pronounced endothelial dysfunction. The patient underwent anterior superficial keratectomy, cataract surgery and Descemet membrane endothelial keratoplasty (DMEK). In vivo confocal microscopy and anterior segment optical coherence tomography have been used to monitor the morphological and structural evolution.