Background: Mirvetuximab soravtansine (MIRV) improves outcomes in FRα-positive, platinum-resistant ovarian cancer; however ocular adverse events (OAEs), particularly corneal epithelial toxicity, are frequent and warrant structured ophthalmologic monitoring. Methods: In this retrospective observational study, 31 consecutive patients receiving MIRV for FRα-positive gynecologic malignancies underwent standardized ophthalmic assessments at baseline and prior to each treatment cycle (every 21 days). The protocol included best corrected visual acuity (BCVA), slit-lamp biomicroscopy, anterior-segment optical coherence tomography (AS-OCT), corneal topography, and tear film analysis. OAEs were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0, based on symptom severity and functional impairment. Results: OAEs occurred in all patients (31/31, 100%), predominantly grade 1–2. Corneal epithelial toxicity was documented in 28/31 patients (90.3%), while no grade ≥ 3 events were observed. Symptoms typically developed 7–14 days after the second infusion. AS-OCT and corneal topography consistently revealed epithelial microcysts and surface irregularities, which were usually detected during scheduled pre-cycle ophthalmologic evaluations. Tear-film instability (break-up time ≤ 5 s) developed in 19/31 patients (61.3%), generally within 10 days after the second infusion, and improved in all but 2 patients (6.5%) following prophylactic lubrication. Transient refractive changes occurred in 28/31 patients (90.3%) and were associated with a temporary BCVA reduction (mean nadir ~20/32 Snellen), followed by recovery during follow-up. Conclusions: MIRV-related ocular alterations are frequent but reversible and clinically manageable. Multimodal imaging combined with functional and refractive assessment provides sensitive markers of corneal epithelial toxicity and supports integrated ophthalmologic monitoring to preserve visual function and maintain oncologic treatment continuity.

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.