Background/Objectives: Epithelial basement membrane dystrophy (EBMD) is a common corneal dystrophy characterized by recurrent corneal erosions and visual impairments due to surface irregularities and opacities. This study aims to evaluate the effectiveness of alcohol-assisted delamination (ALD) of the corneal epithelium in patients with EBMD affecting the visual axis, who experience decreased vision quality due to higher-order aberrations (HOAs) and irregular astigmatism. Methods: Eleven eyes of nine patients (four males and five females) were treated with ALD, with a mean age of 51.3 ± 19.7 years. All patients underwent refraction, best-corrected visual acuity (BCVA) assessment, a comprehensive slit-lamp examination for EBMD pattern identification, anterior segment imaging with and without fluorescein, tear break-up time (BUT) testing, corneal topography, corneal aberrometry (Zernike coefficients ($Z_n^m$) were calculated for a 5.0 mm simulated pupil), and anterior segment optical coherence tomography preoperatively and at 1-day, 14-day, 1-month, 3-month, 6-month, and 12-month intervals. Results: All patients demonstrated improvements in BCVA and visual quality, ocular comfort, and BUT results. The mean root mean square (RMS) value of total corneal aberrations decreased from 1.72 ± 0.90 μm to 0.90 ± 0.62 μm, while the mean RMS value of HOAs reduced from 0.92 ± 0.48 μm to 0.53 ± 0.28 μm. Astigmatism and trefoil were the aberration components that exhibited the most significant reductions. Conclusions: Alcohol-assisted delamination of the corneal epithelium is a safe and effective treatment for central EBMD patients experiencing visual quality deterioration. Astigmatism and trefoil appear to be the primary aberrations contributing to visual disturbances in this patient population.

Purpose: To describe the outcomes of five Salzmann's Nodular Degeneration (SND) cases treated with a combination of alcohol delamination, superficial keratectomy and amniotic membrane patch with fibrin glue. Methods: Five patients affected by SND with significant discomfort and decreased visual acuity were evaluated with refraction, best corrected visual acuity, Break-up time test, corneal topography, Anterior Segment of Optical Coherence Tomography and images of anterior segment with a full slit lamp examination. All the patients underwent alcohol delamination of the corneal epithelium followed by superficial keratectomy to remove the subepithelial nodules. A patch of amniotic membrane was applied to all of them with a ring shape and a banana shape in two patients due to the location of the disease. A bandage contact lens was inserted. The patch was kept in place for 14 days. Another bandage contact lens was inserted for 21 days until the corneal epithelium had completely healed. Results: The surgical procedure was successful in removing the nodules in all patients. Vision was restored in all cases with a significant regularization of the corneal surface and reduction of ocular discomfort. After a 12-month follow-up, none of the patients showed recurrence of the disease. Conclusions: Combining alcohol delamination with superficial keratectomy and amniotic membrane patch with fibrin glue is an effective procedure for the management of SND to regularize the corneal surface and avoid the recurrence of subsequent nodules. This report is the first description of the outcomes of SND cases treated with a combination of the aforementioned techniques.

Background/Objectives: To report the cosmetic, clinical, and visual outcomes of a combined surgical approach for treating a corneal/limbal dermoid using excision and a three-layered amniotic membrane graft with fibrin glue. Methods: An 18-year-old female presented with impaired vision and ocular discomfort caused by a prominent dome-shaped limbal congenital dermoid on the inferotemporal cornea, resulting in a significant aesthetic concern. A full assessment, including refraction, best-corrected visual acuity (BCVA), corneal topography, aberrometry and anterior segment OCT (AS-OCT) was conducted to plan the surgical approach. The dermoid was excised under peribulbar anaesthesia using manual lamellar dissection, followed by the application of 0.02% Mitomycin C and a multilayered amniotic membrane graft with fibrin glue. A bandage contact lens was applied and removed after three weeks, with postoperative treatment including topical antibiotics and steroids. Follow-ups were conducted on day 1, at 1 week, 3 weeks, 2 months, 6 months, 1 year, and 2 years. Results: Histopathological examination confirmed the mesoblastic nature of the lesion. Significant improvements in BCVA and ocular symptoms were observed. Corneal topography showed ocular surface regularization with reduction of high order aberrations and point spread function. AS-OCT showed complete integration of the amniotic membrane, with full epithelial coverage of the defect. The healing process was uneventful and the ocular surface remained stable throughout the entire follow-up, without complications or recurrence. Conclusions: This approach of dermoid excision, multilayered amniotic membrane and fibrin glue restored vision effectively, with notable improvements in ocular surface and cosmetic outcomes, without recurrence over two years.

Purpose: The purpose of this study was to evaluate and compare clinical and visual outcomes, complications, and endothelial cell survival of different endothelial keratoplasty (EK) techniques—Descemet membrane endothelial keratoplasty (DMEK), preloaded DMEK (PL-DMEK), ultra-thin Descemet stripping automated endothelial keratoplasty (UT-DSAEK), and standard DSAEK—using real-world multicenter data. Methods: This retrospective multicenter cohort study included patients undergoing EK across 11 corneal centers in Italy. Clinical and visual outcomes were collected at baseline, 3, 6, and 12 months, and at last follow-up. Donor graft characteristics and their impact on postoperative outcomes were analyzed. Results: A total of 969 eyes were included. All EK techniques resulted in significant improvement in best-corrected visual acuity (BCVA). Although DMEK and PL-DMEK achieved better final BCVA, these groups had better baseline BCVA, and no significant differences in absolute BCVA recovery were observed among techniques, except for greater improvement with UT-DSAEK compared with DSAEK ( P = 0.020). Rebubbling rates were significantly higher in DMEK and PL-DMEK (34.3% and 31.7%) than in UT-DSAEK and DSAEK (16.0% and 16.9%; P < 0.05). Endothelial cell density loss was greater in DSAEK (57.8%) and UT-DSAEK (53.8%) compared with DMEK (46.8%) and PL-DMEK (42.3%) ( P < 0.001). Rejection rates did not differ significantly. Preservation media significantly influenced storage duration, BCVA, and pachymetry in analyses adjusted for baseline (ANCOVA P < 0.001), with Eusol, E-MEM + 6% dextran, and Tissue-C showing the most favorable outcomes. Conclusions: In this large multicenter real-world cohort, all EK techniques provided significant clinical benefit. Differences in visual outcomes, endothelial cell survival, and complication profiles support an individualized approach based on patient, donor, and surgical factors.

Purpose: To report a case of a patient diagnosed with corneal intraepithelial neoplasia (CIN) with ocular discomfort and blurred vision, successfully treated with alcohol delamination (ALD) and topical mitomycin-C. Methods: A 69 year-old man underwent a full slit lamp examination which revealed the presence of a superficial corneal lesion appearing as an opaque intraepithelial plaque extending from the limbus to the visual axis. A manifest refraction with a best corrected visual acuity (BCVA), an anterior segment OCT (AS-OCT) and a corneal topography were performed. In order to remove the lesion an ALD was carried out and the obtained tissue sample was sent for histopathological evaluation confirming the diagnosis of CIN. At the end of the procedure, a bandage contact lens was applied, and the eye was started on a topical treatment with Netilmicin 3% and Dexamethasone 1% 4 times daily for 15 days and mitomycin-C 0.02% drops four times a day, on alternate weeks for 4 weeks. Results: Patient's symptoms improved and BCVA was restored to 20/20 over 1-month period. The ocular surface showed a significant regularization, clinically and both at the AS-OCT and corneal topography. Three years after the procedure patient's BCVA and refraction were stable without any sign of recurrence. Conclusions: ALD is a safe and inexpensive procedure when dealing with CIN allowing both clinical improvements and a definitive histopathological diagnosis.