Keratoconus involves progressive corneal thinning and stromal collagen disorganization that may precede conventional morphological detection. Polarimetric interferometry captures corneal birefringence related to collagen anisotropy and could serve as a non-invasive structural biomarker. We conducted a retrospective observational study of 95 keratoconus patients and 21 healthy controls who underwent corneal topography (Pentacam) and polarimetric interferometry (Lumaxis). Isogyre cross-pattern parameters, widest arm width, narrowest arm width, arm-width standard deviation, and centration indices (M1, M2), were quantified with GeoGebra and correlated with keratometric values, thinnest corneal thickness, Amsler-Krumeich staging, and Belin-Ambrosio ABCD classification. Widest arm width correlated strongly with Pentacam-derived AK stage (Spearman’s ρ = 0.798, p < 0.0001) and maximum keratometry (ρ = 0.730, p < 0.001), and moderately with thinnest corneal thickness (ρ = −0.488, p < 0.001). Arm-width asymmetry correlated inversely with thinnest corneal thickness (ρ = −0.381, p < 0.001). Receiver operating characteristic analysis showed promising discriminative performance: arm-width standard deviation (AUC 0.95) and widest arm (AUC 0.87) differentiated keratoconus from controls. Multivariable analyses confirmed independence from corneal curvature and thickness. Lumaxis-derived isogyre parameters correlate significantly with established keratoconus severity indices, supporting polarimetric interferometry as a complementary modality for assessing corneal stromal disorganization. Prospective longitudinal studies with automated image analysis are warranted.

Ophthalmic surgery requires micrometer-level precision due to the eye’s delicate anatomy, yet manual limitations and restricted 3D visualization make absolute accuracy challenging, driving interest in robotic and Artificial Intelligence technologies to enhance safety and precision. This is a narrative review of experimental and published studies on PubMed and Open Evidence to review the current advances, challenges, and translational potential of robotic-assisted needle insertion in corneal surgery. Topics include robotic corneal surgery platforms such as the da Vinci and custom microsurgical robots, telemanipulation, intraoperative optical coherence tomography (iOCT), and reinforcement learning applications. Recent advancements in the field have demonstrated enhanced needle insertion precision, tremor elimination, and improved visualization of needle trajectory in corneal procedures, including corneal lacerations, pterygium repairs and penetrating keratoplasties (PKs). Nonetheless, significant limitations in the state of the art persist, particularly concerning the integration of robotic systems into clinical practice in in vivo settings. Our results indicate that current studies are mostly conducted in an ex vivo setting, which introduces inherent biases and reduces the generalizability of findings to clinical practice. Additionally, the majority of these studies involve small sample sizes, limiting statistical power and the ability to draw robust conclusions. Together, these limitations highlight the need for larger, well-designed in vivo studies to validate and expand upon existing findings. This review bridges experimental innovation and clinical application, highlighting strategies to overcome current barriers in robotic corneal surgery.

Biologic corneal inlays can rarely present with immediate postoperative decentration, which can be subtle and difficult to detect clinically. Real‐time tomography allows precise early diagnosis, while same‐day flap relifting and careful repositioning provide a safe, effective strategy to restore centration and preserve visual quality.