Background and Objectives: Several studies suggest the complex relationship between Endothelin-1 (ET-1) levels with various types of glaucoma. This systematic review and meta-analysis explore ET-1 levels in plasma and aqueous humor among different types of glaucoma. Materials and Methods: A literature search (PubMed, ScienceDirect, Cochrane Library) was made up to April 2024 (PROSPERO: CRD42023430471). The results were synthesized according to PRISMA Guidelines. Results were presented as standardized mean differences (SMD) with 95% confidence intervals (CI). Results: A total of 2597 subjects (1513 patients with glaucoma vs. 1084 healthy controls) from 23 studies were included in a meta-analysis. Notably, patients with glaucoma reported significantly higher plasma levels of ET-1 compared to controls (SMD: 1.21, 95% CI: 0.59–1.82, p < 0.001). Particularly, plasma ET-1 levels were higher in primary open-angle glaucoma (POAG) (SMD: 0.87, 95% CI: 0.09–1.65, p < 0.05), normal-tension glaucoma (SMD: 0.86, 95% CI: 0.27–1.46, p = 0.05), and angle-closure glaucoma patients (SMD: 1.03, 95% CI: 0.43–1.63, p < 0.001) compared to healthy controls. Moreover, ET-1 aqueous humor levels were significantly higher in patients with glaucoma compared to controls (SMD: 1.60, 95% CI: 1.04–2.15, p < 0.001). In particular, aqueous humor levels were higher in POAG patients (SMD: 2.03 95% CI: 1.00–3.14, p < 0.001), and pseudoexfoliative glaucoma patients (SMD: 2.03, 95% CI: 1.00–3.07, p < 0.001) compared to controls. Conclusions: This meta-analysis indicates that elevated levels of ET-1 plasma and aqueous humor are significantly associated with different types of glaucoma. The pathogenesis of ET-1-related mechanisms may vary across different glaucoma types, indicating that possible therapeutic approaches targeting ET-1 pathways should be tailored to each specific glaucoma type.

Marfan syndrome (MFS) is a genetic disorder that affects the connective tissue in several systems, with ocular, cardiovascular, and skeletal system manifestations. Its ocular manifestations include ectopia lentis (EL), myopia, astigmatism, and corneal abnormalities. This review examines refractive alterations related to MFS such as EL, microspherophakia, lens coloboma, altered corneal biomechanics (flattening, thinning, and astigmatism), and myopia and their impact on visual acuity. The pathogenesis of these manifestations stems from mutations in the FBN1 gene (encoding fibrillin-1). Moreover, the current medical and surgical management strategies for MFS-related refractive errors, including optical correction (eyeglasses, contact lenses, etc.), and surgical interventions like lensectomy, intraocular lens (IOL) implantation (anterior chamber, posterior chamber, scleral-fixated, iris-fixated), and the use of capsular tension rings/segments are further discussed. Considering the likelihood of underdiagnosing and underestimating ocular involvement in MFS, this updated review highlights the critical need to identify and address these refractive issues to enhance the visual outcomes for those affected.

BACKGROUND: Textural Interface Opacities (TIO) following Descemet's Stripping Automated Endothelial Keratoplasty (DSAEK) have become a notable postoperative concern. Several studies have attempted to identify associations between TIO development and intraoperative factors, in-cluding fluid dynamics, irregular stromal surfaces, viscoelastic usage, and recipient immunological responses. Despite these efforts, the precise etiology of TIO remains uncertain. METHODS: Optical Coherence Tomography (OCT) images of DSAEK-processed corneal grafts, prepared using the same microkeratome and technique for transplantation at the Bascom Palmer Eye Institute, underwent blinded analysis using a newly developed grading scale. This analysis focused on DSAEK-processed grafts OCT images to evaluate and categorize the occurrence of TIO and assess the final visual acuity of the patients at the 1-year postoperative evaluation. RESULTS: The study included 221 donor corneas transplanted from 2019 to 2023. Greater TIO based on “M-TIO” grading scale was associated with worse recipient logMAR VA (Mean 0.151 [99% CI: 0.077 to 0.225] for corneas with no TIO increased to 0.680 [99% CI: 0.532 to 0.828] for corneas with the greatest TIO grade). CONCLUSION: This study introduces “M-TIO” grading scale for screening TIO in corneal grafts prior to DSAEK transplantation. Our findings demonstrate a significant association between the presence of TIO identified in OCT images of DSAEK-processed corneal grafts and transplantation outcomes.

Background: Textural Interface Opacities (TIOs) following Descemet’s Stripping Automated Endothelial Keratoplasty (DSAEK) have become a notable postoperative concern. Several studies have attempted to identify associations between TIO development and intraoperative factors, including fluid dynamics, irregular stromal surfaces, viscoelastic usage, and recipient immunological responses. Despite these efforts, the precise etiology of TIO remains uncertain. TIO has not been considered predictable in the preoperative setting. Its detection has relied exclusively on slit-lamp biomicroscopy, a subjective approach lacking standardized diagnostic criteria, which limits diagnostic reliability and is highly susceptible to interobserver variability. Methods: Optical Coherence Tomography (OCT) images of DSAEK-processed corneal grafts, prepared using the same microkeratome and technique for transplantation at the Bascom Palmer Eye Institute, underwent blinded analysis using a newly developed grading scale termed “M-TIO”. This analysis focused on DSAEK-processed grafts OCT images to evaluate and categorize the occurrence of TIO and assess the final visual acuity of the patients at the 1-year postoperative evaluation. Results: Based on the results, the M-TIO grading scale demonstrated strong predictive value, with higher grades on OCT of DSAEK lenticules consistently associated with worse postoperative visual acuity. The study included 221 donor corneas transplanted from 2019 to 2023. Greater TIO based on the “M-TIO” grading scale was associated with worse recipient logMAR VA (Mean 0.151 [99% CI: 0.077 to 0.225] for corneas with no TIO, increased to 0.680 [99% CI: 0.532 to 0.828] for corneas with the greatest TIO grade). These findings highlight the clinical utility of the M-TIO scale as an objective and reliable preoperative tool for assessing graft quality and predicting postoperative visual outcomes. Conclusions: This study introduces the “M-TIO” grading scale, which provides a standardized and objective method for evaluating Textural Interface Opacities in DSAEK grafts prior to transplantation. Our results demonstrate a clear association between the severity of TIO as graded by the M-TIO scale, and postoperative visual outcomes, with higher TIO grades correlating with worse visual acuity, emphasizing its value in improving graft selection, and clinical decision-making in DSAEK.

To report a case of allogeneic anterior lens capsule transplantation (ALCT) for the management of HSV neurotrophic epithelial keratitis. An 81-year-old man was referred to our department due to neurotrophic keratitis in the left eye that he had been suffering from over the past 3 months. He had recurrent episodes of HSV keratitis in the left eye over the past 3 years and despite multiple previous treatments, there was no improvement. At the time of presentation, corrected distance visual acuity (CDVA) was 20/200 in the right eye and no light perception (NLP) in the left eye. Slit-lamp examination revealed a corneal epithelial defect with underlying stromal thinning and concomitant scarring. An allogeneic anterior lens capsule (ALC) was placed over the epithelial defect to act as a biological dressing, anchored with a droplet of fibrin glue. A bandage contact lens (BCL) was placed over to prevent the slippage of the ALC. No intra or postoperative complications were observed. Two weeks later, the ALC was removed revealing complete epithelial healing, while two months later the epithelium remained completely healed with a significant reduction of corneal scarring. Anterior Lens Capsule transplantation (ALCT) seems to be a promising new treatment option for the management of corneal neurotrophic keratitis.

Background: Textural interface opacities (TIOs) following Descemet’s stripping automated endothelial keratoplasty (DSAEK) have become a significant postoperative concern. Studies have explored possible links such as stromal irregularities and viscoelastic usage, but the exact cause of TIOs remains unclear. PURPOSE: To evaluate the relationship between microkeratome dissection parameters and the development of textural interface opacities in DSAEK grafts utilizing the “M-TIO” grading scale for standardized assessment. Methods: Optical coherence tomography (OCT) images of DSAEK-processed corneal grafts, prepared with the same microkeratome and technique for transplantation at Bascom Palmer Eye Institute, underwent blinded analysis using a newly developed grading scale termed “M-TIO”. This analysis aimed to evaluate and categorize the occurrence of TIO, explore its potential correlation with graft characteristics prior to DSAEK preparation, and assess specific stages of the DSAEK dissection process. Data collected included the size of the microkeratome head used, the difference between the head and the actual stromal cut, and the difference between the pre-cut graft thickness and post-cut DSAEK lenticule thickness. Results: The study retrospectively included 422 donor corneas transplanted from 2019 to 2023. Variables associated with TIO in the final multivariable ordinal logistic model included the difference between the pre-cut graft thickness and the post-cut DSAEK lenticule thickness (OR: 1.57 [99% CI: 1.22 to 2.06] per 50 µm) and microkeratome head (OR: 6.95 [99% CI: 1.04 to 36.60] 300 µm, OR: 4.39 [99% CI: 0.76 to 19.00] 350 µm, and OR: 18.86 [99% CI: 2.35 to 175.91] 400 µm vs 450 or 500 µm, respectively). Conclusions: This study identified a statistically significant association between TIOs and the microkeratome DSAEK preparation, proposing several factors that could help prevent its occurrence. Specifically, creating an ultra-thin DSAEK lenticule from an initially thick graft using a smaller microkeratome head with the slow single-pass technique may increase the risk of TIOs. In contrast, utilizing a larger microkeratome head can improve stromal thickness consistency, reduce technical challenges during graft preparation, and lower the risk of TIOs.