Background: Corneal allogenic intrastromal ring segments (CAIRSs) offer a novel, biocompatible alternative to synthetic intracorneal ring segments (ICRSs). This review aims to evaluate the clinical outcomes of CAIRS. Methods: Inclusion criteria were studies with a minimum of 20 eyes and six months of follow up. The primary outcome measure was uncorrected distance visual acuity (UDVA). The secondary outcomes were a change in corrected distance visual acuity (CDVA), spherical equivalent (SE), mean keratometry (K-mean), maximum keratometry (K-max), K1, K2, and pachymetry. Results: The primary outcome UDVA improved from 0.83 ± 0.15 to 0.40 ± 0.08 logMAR (p = 0.01), while CDVA improved from 0.52 ± 0.22 to 0.19 ± 0.09 logMAR (p = 0.01). K-max decreased from 57.8 ± 1.09 D to 53.57 ± 2.66 D (p < 0.01), and K-mean reduced from 49.27 ± 0.28 D to 45.30 ± 1.46 D (p < 0.01). An average of 84.92% ± 11.4% of eyes had an improvement in UDVA. No major complications or significant visual acuity deterioration were reported. Conclusions: CAIRSs serve as an alternative to synthetic ICRSs and even corneal transplantation in some cases. They represent a safe, effective, and biocompatible promising advancement in corneal ectasia management to improve visual acuity and corneal topography with minimal complications.

Background/Objectives: To evaluate the efficacy and safety of using the preservative-free topical proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) to control postoperative pain after epithelium-off corneal crosslinking (CXL) for keratoconus. Methods: This is an observational study of patients with mild to severe keratoconus who have undergone epithelium-off CXL. CXL was completed by applying dextran-free riboflavin (0.1%) for 10 min (Vibex Rapid; Avedro, Inc.), followed by continuous UV-A light (Avedro KXL system; Avedro, Inc.) for 30 min at an intensity of 3 mW/cm² and an energy of 5.4 J/cm². All patients were prescribed postoperative proxymetacaine hydrochloride PRN with an allowed frequency of up to eight times per 24 h for the first 3 days to control postoperative pain. Patients were reviewed at 1–2 weeks postoperatively for a comprehensive examination, including assessment of delayed corneal healing, removal of the bandage contact lens, and recording of subjective symptoms. Results: There were 223 eyes of 180 patients with a mean age of 24.9 ± 8.6 years (range: 13–38 years). Male patients were 72%. At their planned first postoperative visit, we found no corneal healing abnormalities, such as persistent epithelial defects, epithelial irregularities, or early postoperative stromal haze, in any patient. All patients subjectively reported that proxymetacaine drops helped them to control postoperative pain, particularly in the first 48 h. Conclusions: None of the patients reported pain after 3 days of using proxymetacaine drops up to eight times a day for the first 3 days. It appears to be a safe and effective solution to control postoperative pain without any complications.

Aims: The aim of this study is to characterise corneal epithelial thickness profiles after Descemet membrane endothelial keratoplasty (DMEK) and compare it with healthy controls, focusing on inferior–superior (I–S) epithelial thickness differences and their relationship with age. Methods: This single-centre observational study included 36 post-DMEK eyes with at least 6 months’ follow-up and 36 healthy control eyes. High-resolution spectral-domain anterior segment OCT maps were analysed for central epithelial thickness (CET, defined as the mean epithelial thickness within the central 2 mm zone [E2.0]) and peripheral sectors to derive inferior (E–I) and superior (E–S) values (between 2 and 7 mm), with the I–S difference computed at a 3 mm radius; group comparisons used t-tests and correlations used Pearson’s r (α = 0.05). Central corneal thickness (CCT) was also compared between groups. Results: Post-DMEK eyes had significantly lower mean CCT than controls (525.7 ± 98.4 μm vs. 544.71 ± 27.8 μm, p = 0.04). Central epithelial thickness did not differ between groups (post-DMEK 53.7 ± 5.5 μm vs. controls 52.7 ± 3.3 μm, p = 0.62), but the I–S epithelial difference was greater after DMEK (5.9 ± 4.3 μm) than controls (3.0 ± 2.2 μm, p < 0.01), indicating a more pronounced inferior thickening pattern. Age showed no significant relationship with epithelial thickness in controls, and only very weak or non-significant correlations with central thickness and I–S difference in post-DMEK eyes, indicating no clinically meaningful age effect postoperatively. Conclusions: DMEK restores central epithelial thickness to values comparable to normal eyes, while accentuating the physiologic inferior–superior epithelial gradient, consistent with localised postoperative epithelial remodelling rather than global epithelial thickening or thinning. Corneal stromal remodelling may result in lower CCT post-DMEK versus controls, and age does not meaningfully influence epithelial distribution after surgery.

Background: Diabetes poses a risk to diabetic keratopathy in up to two-thirds of patients. Insulin-degrading enzyme (IDE) is a protease that can break down insulin and several growth factors and may impair wound healing. Increased IDE levels have been found in fluid from diabetic skin ulcers. This study sought to determine the effect of IDE inhibitor on corneal wound healing in a rat model. Methods: Thirty-four male Wistar rats were divided into two groups: no diabetes and streptozocin-induced diabetes. Six weeks later, a 4-mm central corneal erosion was created under anesthesia in the right eye of all rats. In each group, half the rats were treated with ADT21 drops (IDE inhibitor) and half with NaCl 0.9% (sham) drops, four times daily. Image J analysis was performed to evaluate the area of erosion and healing rate. Results: There was a trend for more rapid healing in rats treated with IDEI than NaCl drops, regardless of the diabetic condition. Comparison of erosion closure over time revealed that the wounds closed significantly more quickly in the non-diabetic rats treated with IDEI than in the non-diabetic rats treated with NaCl (p = 0.045), overall mean closure time 56.00 h, 95% CI [50.54, 61.46]. No such difference was seen in the diabetic group. Conclusions: To our knowledge, this is the first study to test ADT21 drops as a novel treatment for corneal wound repair. Our results suggest a potential benefit of IDE inhibitor for treating corneal injury.

To assess corneal epithelial thickness (ET) changes in affected and fellow eyes of patients with post-traumatic recurrent corneal erosions (RCE) and compare these with healthy age-matched controls. This is a single-centre observational study involving retrospective data collection for patients presenting with traumatic RCE. ET maps were obtained at the follow-up visit once the erosion had healed. Data was recorded for affected (Group 1) and fellow eyes (Group 2) and for healthy age-matched control eyes (Group 3). The primary outcome measure was comparison of "E-Std Dev" values (variation in ET maps between the three groups). Secondary outcome measures were central ET, minimum ET, maximum ET, superior ET, inferior ET and E(min-max) values, and qualitative map assessment, which was performed by analysing the number of zones with thicknesses 60-70 µ and 70-80 µ. Thirty-three patients (66 eyes) and 33 age-matched healthy eyes were included. E-Std Dev values were highest values in Group 1 and lowest in Group 3 (4.65 ± 1.87 µ, 2.92 ± 1.16 µ and 1.94 ± 0.63 µ in Groups 1, 2 and 3 respectively) (p < 0.01). A similar trend was also noted for central ET (p < 0.01), maximum ET (p < 0.01), E(min-max) values (p = 0.03) and qualitative map assessment (p < 0.01). There were no significant inter-group differences for minimum ET (p = 0.05), superior ET {E-S (2-7)} (p = 0.45) and inferior ET {E-I (2-7)} (p = 0.68). Variation and maximum ET were highest in the affected eyes. Even the fellow eyes showed higher values than healthy controls. This may suggest a predisposition of some patients to develop RCE after trauma.