Methicillin-resistant Staphylococcus aureus (MRSA) induced keratitis remains therapeutically intractable due to a dual barrier formed by bacterial biofilms and neutrophil extracellular traps (NETs), which limits drug penetration and sustains a hypoxic, pro-inflammatory microenvironment. Here, we engineer a multifunctional nanoparticle (IHCQ-D) tailored to simultaneously dismantle this dual barrier while concurrently modulating the pathological microenvironment. The IHCQ-D nanoparticles integrate bioactive deoxyribonuclease I (DNase I), catalytic hollow MnO2, oxygen-supported CaO2 and photodynamic indocyanine green (ICG), enabling cofactor-enhanced enzymatic extracellular DNA (eDNA) degradation, oxygen-sustained photodynamic therapy, and reactive oxygen species (ROS) regulation. Released Ca2+ and Mn2+ markedly potentiate DNase I activity, driving efficient hydrolysis of eDNA and structural collapse of both biofilms and NETs. In vitro, IHCQ-D nanoparticles achieved approximately 84.3% disruption of MRSA biofilms and approximately 98.7% clearance of NETs. Under near-infrared irradiation, this oxygen-supported PDT further enhanced antibacterial efficacy. Transcription analysis reveals that IHCQ-D (NIR) triggers global metabolic collapse and attenuates MRSA virulence, including inhibition of oxidative phosphorylation and amino acid biosynthesis. In vivo, the treatment enables complete bacterial eradication and rapid recovery of corneal transparency, with reduced neutrophil infiltration and suppressed pro-inflammatory factor NF-κB (< 23% vs.100% in control). This work will provide a synergistic strategy for dual-barrier disruption and microenvironment modulation, offering a promising therapeutic approach for bacterial keratitis.

To investigate the clinical characteristics and treatment outcomes of fungal keratitis caused by Beauveria bassiana. The clinical data of 11 consecutive patients with fungal keratitis caused by Beauveria bassiana in the Eye Hospital of Shandong First Medical University from January 2019 to May 2024 were retrospectively analyzed. The clinical features, etiological characteristics, treatments and outcomes were analyzed. Most patients were farmers (10/11), with three cases caused by plant trauma and five cases having a history of corneal transplantation. Slit-lamp examination revealed that the keratopathy was characterized by dry ulcerative lesions, predominantly circular with relatively irregular borders. Several cases exhibited typical keratopathy signs of fungal keratitis, such as mycelial mat, pseudopodia and hypopyon. No significant immune ring structure was observed in any patients. Both the corneal scraping and in vivo confocal microscopy (IVCM) revealed branched and septate hyphae structures. Morphological and ITS sequencing identification was performed after isolation and cultivation. B. bassiana exhibited typical morphological characteristics: hyphae were branched, septate, transparent and slender; sympodial development of conidia was on a geniculate or zig-zag pattern; conidiogenous cells were flask-shaped, rachiform and sympodially proliferating, often aggregating into sporodochia or synnemata; conidia were hyaline and globose or ovoid in shape. B. bassiana had a relatively high susceptibility to the majority of antifungal agents in vitro. One patient was treated with medical therapy alone. The five patients with a history of corneal transplantation underwent penetrating keratoplasty (PKP). The two patients with ulcer depth < 1/2 corneal thickness and ulcer diameter ≤ 3 mm underwent corneal ulcer debridement combined with medical treatment. The three patients with ulcer depth exceeding 1/2 corneal thickness underwent PKP. Following treatment, no patient experienced recurrence during the follow-up period. Plant trauma, immunosuppression and involvement in agricultural production have been identified as significant risk factors for B. bassiana keratitis. Although the strains exhibited low minimal inhibitory concentrations (MICs) to most antifungal agents in vitro, early diagnosis and treatment remain crucial.

To characterize the clinical features and therapeutic outcomes of fungal keratitis caused by Plectosphaerella cucumerina. A retrospective analysis was conducted on 13 patients diagnosed with P. cucumerina keratitis from July 2018 to April 2024. Clinical manifestations, microbiological identification, antifungal susceptibility profiles, treatment regimens, and prognostic indicators were evaluated. All the 13 patients were farmers, and 6 of them had a history of trauma or the presence of a foreign body prior to the onset of symptoms. The main clinical manifestations were chronic progressive shallow corneal and middle stromal layer ulceration with dry ulcer surface, and moss formation was visible in 7 patients (7/13). No obvious immune ring structure and satellite lesions were observed in all patients. In vivo confocal microscopy (IVCM) showed that the mycelia showed medium strong reflection, some of them were changed like bamboo joints, most of them were 2–3 μm in diameter, and the arrangement was relatively neat and fasciculate. The Angle between the mycelia was small and most of them were acute angles. Drug sensitivity test showed that Amphotericin B, voriconazole and itraconazole were the main sensitive antifungal drugs. The main treatment was sensitive antifungal drugs combined with local lesion resection and voriconazole matrix injection. 2 cases with deep ulcers were treated with corneal transplantation. P. cucumerina keratitis is relatively rare but distinct clinical entity. Diagnosis can be aided by corneal scraping, microbiological culture and IVCM. Emphasizing a comprehensive treatment approach involving medication, debridement, and surgical intervention is crucial to promote rapid healing of the ulcer.

Biofilm-associated infections remain refractory to antibiotics due to the extracellular polymeric substance (EPS) barrier limiting drug penetration and promoting drug resistance genes transfer. Deoxyribonuclease I (DNase I)-based strategies designed to degrade the EPS scaffold paradoxically fail within the biofilm microenvironment, where oxidative stress rapidly deactivates the enzyme and its cleavage efficiency remains intrinsically low. Here, we developed a self-reinforced nanosystem (D-HIC) by integrating MnO2 (HMnO2) with DNase I and co-loading indocyanine green and ciprofloxacin, simultaneously addressing the intrinsic limitations of enzyme-based therapies. Crucially, HMnO2 catalyzed the excess ROS to protect DNase I from oxidative degradation, and this catalytic process is accompanied by the generation of Mn2+ which was found to significantly accelerate DNase I-mediated EPS cleavage by nearly fourfold to achieve rapid biofilm skeleton disruption. This potentiation created rapid penetration channels, enabling deep delivery of loadings for near-infrared-triggered complete biofilm elimination and remarkable bacterial killing rate (>99%) at reduced antibiotic doses. In a murine bacterial keratitis model, this strategy achieved superior therapeutic outcomes compared to clinical eye drops. By coupling oxidative stress relief with catalytic cofactor generation from a single material platform, this work establishes a versatile strategy that overcomes the fundamental limitations of traditional enzyme-based antibiofilm approaches.

PURPOSE:To compare the corneal densitometry and higher order aberrations (HOAs) following corneal cross-linking (CXL), deep anterior lamellar keratoplasty (DALK), and minimally invasive lamellar keratoplasty (MILK) for keratoconus. METHODS:Twenty-five eyes treated with CXL (CXL group), 17 eyes treated with DALK (DALK group), and 25 eyes treated with MILK (MILK group) were included in this prospective study. Corneal densitometry and HOAs were evaluated preoperatively and at 1, 3, 6, 12, 24, and 36 months postoperatively. RESULTS:In CXL and MILK, corneal densitometry values peaked at 1 month (P < .001), returned to the preoperative level at 6 months (P = .334, 0.224), and declined below baseline at 36 months (P < .001, P = .129); the changes from preoperatively to 36 months postoperatively between groups were not significant (P = .713). In DALK, corneal densitometry values were still higher at 36 months than before surgery (P = .007). The root mean square value of total HOAs from the whole cornea was decreased by 0.192 ± 0.457, 0.823 ± 0.926, and 3.938 ± 1.873 µm at 36 months postoperatively for CXL, MILK, and DALK, respectively (P = .047, <.001, <.001); the differences between groups were all statistically significant. The total HOA or spherical aberration changes from the whole cornea correlated with maximum keratometry changes for CXL (P < .001; R2 = 0.490), MILK (P < .001; R2 = 0.599), and DALK (P < .001; R2 = .558). CONCLUSIONS:MILK and CXL showed a similar improvement in corneal densitometry. HOAs improved most in DALK, followed by MILK and CXL, corresponding to maximum keratometry changes. The coma and spherical aberrations improved in MILK and DALK, but not in CXL. [J Refract Surg. 2025;41(7):e715-e723.].

AIM: To investigate the clinical signs of blepharokeratoconjunctivitis (BKC) and evaluate the efficacy of penetrating keratoplasty (PKP) for the disease. METHODS: Sixteen patients (16 eyes) with BKC complicated by corneal perforation hospitalised at Shandong Eye Hospital were retrospectively analyzed. All patients received PKP. Participants were assessed for symptoms, clinical manifestations, the activity and damage grading of BKC. A paired t-test was used to compare the uncorrected visual acuity (UCVA) before and after surgery for the perforated eye. RESULTS: The mean age of the patients was 16.3y. Blurred vision is the most common discomfort, followed by redness, and then photophobia. The duration of ocular discomfort lasted for 3.2y, on average. Three (18.8%) participants were associated with rosacea, while 11 (68.8%) patients had recurrent chalazion or hordeolum. Demodex in eyelash follicles was positive in 11 (68.8%) cases. All corneal perforations were ≤3.0 mm in diameter. The perforation was located mainly in the inferior cornea (68.8%). The mean area of corneal vascularisation was 3.0 quadrants. All patients manifested bilateral BKC, with the perforated eyes ranked as severely damaged and presenting with severe inflammation. Most contralateral eyes manifested mild damage with no active inflammation. Majority (68.8%) of the perforated eyes were treated with PKP using a minimal graft. The UCVA increased significantly at the final follow-up (mean, 21mo; P<0.001), with the manifestation of BKC alleviated greatly. None of the patients developed immune rejection or other serious complications. CONCLUSION: BKC combined with corneal perforation occurs mainly among young people with a long history of ocular discomfort. PKP, especially using a minimal graft, is an effective and safe option for treating the disease.

Immunity and inflammation are implicated in the progression of keratoconus (KC), but the causal relationships between inflammatory immune phenotypes and the disease remain unclear. We conducted a comprehensive Mendelian randomization (MR) analysis using GWAS data to investigate the causal effects of inflammatory and immune factors on KC. Multiple sensitivity analyses were performed to validate our findings, with significant results confirmed through meta-analyses using independent GWAS datasets. The Steiger test, LD score regression, and multivariate MR were applied to assess independent effects. Analysis of inflammatory proteins revealed that IL-12B (PIVW = 8.26 × 10^-5) and IL-13 (PIVW = 0.012) were associated with an increased risk of KC, whereas IL-17 A (PIVW = 0.049) was inversely associated with KC risk. After FDR adjustment, the results for IL-12B (PFDR = 0.007) remained significant. Twenty-two protective and eleven risk immune cells were identified. Meta-analysis supports CD20 on IgD- CD24- B cells and Central Memory CD8 + T cells %CD8 + T cells as protective factors against KC. Multivariable MR revealed independent heritability for seven inflammatory proteins and three immune cells. These findings highlight the critical role of immune and inflammatory factors in KC pathogenesis, suggesting possible targets for future investigation in KC prevention and treatment.

Purpose To compare the outcomes of big-bubble deep anterior lamellar keratoplasty (BB-DALK) and penetrating keratoplasty (PKP) in the management of medically unresponsive Acanthamoeba keratitis (AK). Methods This retrospective study included 27 eyes of BB-DALK and 24 eyes of PKP from a tertiary ophthalmology care centre. Glucocorticoid eye drops were subsequently added to the treatment plan 2 months postoperatively based on the evaluation using confocal laser scanning microscopy. The clinical presentations, best-corrected visual acuity (BCVA), postoperative refractive outcomes, graft survival, and Acanthamoeba recurrence were analyzed. Results The AK patients included in the study were in stage 2 or stage 3, and the percentage of patients in stage 3 was higher in the PKP group ( P = 0.003). Clinical presentations were mainly corneal ulcers and ring infiltrates, and endothelial plaques, hypopyon, uveitis and glaucoma were more common in the PKP group ( P = 0.007). The BCVA and the graft survival rate showed no statistically significant differences between the two groups at 1 year after surgery. However, 3 years postoperatively, the BCVA of 0.71 ± 0.64 logMAR, the graft survival rate of 89.5%, and the endothelial cell density of 1899 ± 125 cells per square millimeter in the BB-DALK group were significantly better than those of the PKP group ( P = 0.010, 0.046, and 0.032, respectively). 3 eyes (11.1%) in the BB-DALK group and 2 eyes (8.3%) in the PKP group experienced Acanthamoeba recurrence, but the rates showed no statistically significant difference between the two groups ( P = 1.000). In the PKP group, immune rejection and elevated intraocular pressure were observed in 5 and 6 eyes, respectively. Conclusion Corneal transplantation is recommended for AK patients unresponsive to antiamoebic agents. The visual acuity and graft survival can be maintained after BB-DALK surgery. Acanthamoeba recurrence is not related to the surgical approach performed, whereas complete dissection of the infected corneal stroma and delayed prescribing of glucocorticoid eye drops were important to prevent recurrence.

The activation of innate immunity following transplantation has been identified as a crucial factor in allograft inflammation and rejection. However, the role of cyclic guanosine monophosphate-adenosine monophosphate synthase (cGAS)/stimulator of interferon genes (STING) signaling-mediated innate immunity in the pathogenesis of allograft rejection remains unclear. Utilizing a well-established murine model of corneal transplantation, we demonstrated increased expression of cGAS and STING in rejected-corneal allografts compared with syngeneic (Syn) and normal (Nor) corneas, along with significant activation of the cGAS/STING pathway, as evidenced by the enhanced phosphorylation of TANK binding kinase 1and interferon regulatory factor 3. Pharmacological and genetic inhibition of cGAS/STING signaling markedly delayed corneal transplantation rejection, resulting in prolonged survival time and reduced inflammatory infiltration. Furthermore, we observed an increase in the formation of neutrophil extracellular traps (NETs) in rejected allografts, and the inhibition of NET formation through targeting peptidylarginine deiminase 4 and DNase I treatment significantly alleviated immune rejection and reduced cGAS/STING signaling activity. Conversely, subconjunctival injection of NETs accelerated corneal transplantation rejection and enhanced the activation of the cGAS/STING pathway. Collectively, these findings demonstrate that NETs contribute to the exacerbation of allograft rejection via cGAS/STING signaling, highlighting the targeting of the NETs/cGAS/STING signaling pathway as a potential strategy for prolonging allograft survival.

AIM: To describe the surgical procedure of fusiform penetrating keratoplasty (FPK) using multiple trephines of different sizes for treating patients with severe infectious keratitis. METHODS: Fourteen eyes underwent FPK, and 15 eyes received conventional penetrating keratoplasty (PK) were included in the study. The best-corrected visual acuity (BCVA), refractive outcomes, endothelial cell density, and postoperative complications were recorded. RESULTS: The FPK group was followed for an average of 15.3±2.1mo, whereas the PK group was followed for 16.1±1.9mo. The corneal ulcers were elliptical-shaped in all 14 eyes in the FPK group. The mean BCVA (logMAR, 0.26±0.13) showed no statistically significant differences from that in the PK group (logMAR, 0.21±0.12, P>0.05) at 1y after surgery. But the mean curvature, mean astigmatism, and mean spherical equivalent in the FPK group were lower than those in the PK group (P<0.05). Peripheral anterior synechia was observed in one patient in the FPK group, whereas 6 patients in the PK group. Suture loosening and neovascularization were observed in 4 and 5 eyes in the PK group, respectively. No graft immune rejection or elevation of intraocular pressure was observed in the two groups. CONCLUSION: For patients with elliptical-shaped corneas or corneal ulcers, FPK can avoid disrupting of corneal limbus, reduce the risk of postoperative complications, and can result in satisfactory visual quality.

Purpose: Fungal keratitis (FK) is an invasive corneal infection associated with significant risk to vision. Although the cyclic GMP-AMP synthase (cGAS)/stimulator of interferon genes (STING) signaling pathway has been recognized for its role in defending against viral infections, its involvement in FK still remains largely unclear. This study sought to elucidate the contribution of the cGAS/STING signaling pathway to the pathogenesis of FK. Methods: The expression of cGAS/STING signaling components was assessed in a murine model of Candida albicans keratitis through RNA sequencing, western blot analysis, immunofluorescence staining, and real-time PCR. Both genetic (utilizing Sting1gt/gt mice) and pharmacological (using C176) interventions were employed to inhibit STING activity, allowing for the evaluation of resultant pathogenic alterations in FK using slit-lamp examination, clinical scoring, hematoxylin and eosin (H&E) staining, fungal culture, and RNA sequencing. Subconjunctival administration of the NOD-like receptor protein 3 (NLRP3) inflammasome inhibitor MCC950 was performed to evaluate FK manifestations following STING activity blockade. Furthermore, the impact of the STING agonist diABZI on FK progression was investigated. Results: Compared to uninfected corneas, those infected with C. albicans exhibited increased expression of cGAS/STING signaling components, as well as its elevated activity. Inhibiting cGAS/STING signaling exacerbated the advancement of FK, as evidenced by elevated clinical scores, augmented fungal load, and heightened inflammatory response, including NLRP3 inflammasome activation and pyroptosis. Pharmacological inhibition of the NLRP3 inflammasome effectively mitigated the exacerbated FK by suppressing STING activity. Conversely, pre-activation of STING exacerbated FK progression compared to the PBS control, characterized by increased fungal burden and reinforced inflammatory infiltration. Conclusions: This study demonstrates the essential role of the cGAS/STING signaling pathway in FK pathogenesis and highlights the necessity of its proper activation for the host against FK.

This case report describes the performance of corneal plug keratoplasty in a male patient aged 30 years who presented with corneal perforation secondary to metal foreign body.

This study aims to evaluate the clinical outcomes and efficacy of a modified tectonic corneoscleral graft (TCG) in patients suffering from devastating corneoscleral infections. Thirty-eight eyes from 38 patients who underwent the modified TCG were included in this study. The outcomes measured were recurrence rates, best-corrected visual acuity (BCVA), ocular surface stability, postoperative complications, and graft survival. Among the 38 patients, 23 had fungal infections, 9 had bacterial infections and 6 had Pythium insidiosum infections. At the final follow-up, with an average duration of 25.1 ± 8.6 months, the rate of monocular blindness decreased from 100 to 58

Bacterial keratitis (BK) is a serious ocular infection and frequently cause irreversible damage to the corneal tissue and even blindness. Current clinical treatments using antibiotics achieve unsatisfactory outcomes due to the lower bioavailability, high risks of drug resistance and limited therapeutic functions. To address these challenges, we proposed a dual-targeted antibacterial and cascaded immunomodulatory therapy strategy, constructing a multifunctional nanoplatform (HPBH@GLA/AMP) using the 3-aminophenylboric acid (NBA) and hyaluronic acid (HA) co-modified hollow polydopamine (HPDA) to serve as a functional nanocarrier (HPBH) for loading antimicrobial peptide (AMP) and glycyrrhizic acid (GLA). The HPBH@GLA/AMP presented excellent targeting and bactericidal performance to Pseudomonas aeruginosa (P. P. aeruginosa), ), coupled with its capacity to alleviate the bacteria-triggered excessive immune response via an ingenious cascaded immunoregulatory process. Notably, the study of underlying anti-inflammatory mechanism revealed that the functional nanocarrier of HPDA could effectively scavenge the reactive oxygen species (ROS) for controlling early inflammatory responses, while inhibit the expression of late mediator high mobility group box 1 (HMGB1) chemokine through released GLA. Specially, the duel-targeted characteristic enabled this nanoplatform to recognize both the bacteria and inflammatory cells precisely and aggregate the location where bacteria and/or inflammatory cells exist persistently, effectively increased the therapeutic concentration of drugs. Featuring the antibacterial synergistic yet sequential regulation for the inflammatory response, the HPBH@GLA/AMP achieved satisfactory therapeutic effects in a BK mouse model in vivo. This study provides a bright prospect for clinical treatment of refractory bacterial keratitis (BK) and even extended to other immunotherapy in infectious disease.

目的 分析激光角膜屈光术后继发圆锥角膜的发病特征和临床表现,并评估其治疗预后.方法 回顾性病例研究.收集2013 年 1 月至2021 年 12 月于山东第一医科大学附属眼科医院(山东省眼科医院)就诊的激光角膜屈光术后继发圆锥角膜的患者27 例(54 只眼),其中男性患者22 例,女性患者 5 例,4 例单眼发病,23 例双眼发病,患者年龄为 19～48 岁,平均(28.6±5.9)岁.分析其发病特征、临床分期、角膜地形图的参数资料、治疗方法和疗效.结果 27 例继发圆锥角膜患者术前的屈光手术方式为:准分子激光原位角膜磨镶术(LASIK)24 例,准分子激光角膜上皮瓣下磨镶术(LASEK)1 例,经上皮准分子激光屈光性角膜切削术(Trans PRK)1 例,飞秒激光基质透镜切除术(FLEx)1 例.患者接受角膜屈光手术的年龄为 15～34 岁,平均(19.4±3.6)岁.27 例(54 只眼)患者中,潜伏期4 只眼,初发期 16 只眼,完成期 34 只眼.完成期患者均表现出角膜前突变薄,8 只眼(24%)可见Fleischer环、7 只眼(21%)可见 Vogt 线.角膜地形图中角膜后表面形态表现为:初发期患者以桥型递增型(38%)和桥型递减型(25%)为主,完成期患者则以岛型(64%)和不完全岛型(18%)为主.初发期患者主要采用框架眼镜(50.0%)和透气性角膜接触镜(RGP)(31.3%)治疗,而完成期患者多数需行角膜交联术(CXL)(29.5%)或板层角膜移植术(LKP)(50.0%)手术治疗,17 例接受LKP术的患者均为LASIK术后继发圆锥角膜患者.结论 激光角膜屈光术后继发圆锥角膜以LASIK术后多见,初发期患者的角膜地形图后表面形态较少进展为岛型,完成期患者多数需行角膜交联术或角膜移植术手术治疗.

Immune rejection and side effects of long-term administration of immunosuppressants are the two major obstacles to allograft acceptance and tolerance. The immunosuppressive extracellular vesicles (EVs)-based approach has been proven to be effective in treating autoimmune/inflammatory disorders. Herein, the anti-rejection advantage of exosomes (Rapa-Exo) from rapamycin-conditioned myeloid-derived suppressor cells (MDSCs) over exosomes (Exo-Nor) from the untreated MDSCs is shown. The exosomal small RNA sequencing and loss-of-function assays reveal that the anti-rejection effect of Rapa-Exo functionally relies on miR-181d-5p. Through target prediction and double-luciferase reporter assay, Kruppel-like factor (KLF) 6 is identified as a direct target of miR-181d-5p. Finally, KLF6 knockdown markedly resolves inflammation and prolongs the survival of corneal allografts. Taken together, these findings support that Rapa-Exo executes an anti-rejection effect, highlighting the immunosuppressive EVs-based treatment as a promising approach in organ transplantation.

Rapamycin-loaded nano-micelle ophthalmic solution (RAPA-NM) offers a promising application for preventing corneal allograft rejection; however, RAPA-NM has not yet been fully characterized. This study aimed to evaluate the physicochemical properties, biocompatibility, and underlying mechanism of RAPA-NM in inhibiting corneal allograft rejection. An optimized RAPA-NM was successfully prepared using a polyvinyl caprolactam–polyvinyl acetate–polyethylene glycol (PVCL-PVA-PEG) graft copolymer as the excipient at a PVCL-PVA-PEG/RAPA weight ratio of 18:1. This formulation exhibited high encapsulation efficiency (99.25 ± 0.55%), small micelle size (64.42 ± 1.18 nm), uniform size distribution (polydispersity index = 0.076 ± 0.016), and a zeta potential of 1.67 ± 0.93 mV. The storage stability test showed that RAPA-NM could be stored steadily for 12 weeks. RAPA-NM also displayed satisfactory cytocompatibility and high membrane permeability. Moreover, topical administration of RAPA-NM could effectively prevent corneal allograft rejection. Mechanistically, a transcriptomic analysis revealed that several immune- and inflammation-related Kyoto Encyclopedia of Genes and Genomes (KEGG) pathways were significantly enriched in the downregulated genes in the RAPA-NM-treated allografts compared with the rejected allogenic corneal grafts. Taken together, these findings highlight the potential of RAPA-NM in treating corneal allograft rejection and other ocular inflammatory diseases.

To compare the outcomes of femtosecond laser-assisted minimally invasive lamellar keratoplasty (FL-MILK) for mild-to-moderate keratoconus (KC) and advanced KC. Prospective case series study. Sixty-three eyes of 56 patients with progressive KC underwent FL-MILK were divided into group 1 [mean keratometry (Kmean) ≤ 53D] and group 2 (Kmean > 53D). Best spectacle-corrected visual acuity (BSCVA), Kmean, maximum keratometry (Kmax), anterior central corneal elevation (ACE), stiffness parameter A1 (SP-A1) and deformation amplitude (DA) were evaluated preoperatively and up to 24 months postoperatively. Mean BSCVA improved from 0.34 ± 0.13 logMAR preoperatively to 0.25 ± 0.13 logMAR at 24 months postoperatively in group 1 (F = 10.10, P < .0001), and from 0.54 ± 0.31 logMAR to 0.40 ± 0.26 logMAR (F = 9.06, P = .0002) in group 2. Group 2 showed an average Kmax reduction of 10.9 D and an average Kmean reduction of 3.9 D at 24 months postoperatively (both P < .0001), whereas no significant change was observed in group 1. Average ACE decreased from 19.2 ± 10.0 to 5.2 ± 8.4 at 24 months postoperatively in group 1 (F = 28.5, P < .0001), and from 46.2 ± 16.3 to 19.1 ± 9.0 (F = 49.6, P < .0001) in group 2; SP-A1 increased from 53.8 ± 12.7 mmHg/mm to 95.9 ± 20.2 mmHg/mm in group 1 (F = 70.0, P < .0001), and from 38.6 ± 13.4 mmHg/mm to 89.3 ± 18.2 mmHg/mm (F = 96.9, P < .0001) in group 2; DA decreased from 1.30 ± 0.14 mm to 1.17 ± 0.13 mm in group 1 (F = 14.0, P < .0001), and from 1.40 ± 0.16 mm to 1.18 ± 0.10 mm (F = 27.6, P < .0001) in group 2. FL-MILK can stabilize progressive KC in mild-to-moderate cases and advanced cases at 24-month follow-up. Steeper corneas are more likely to undergo flattening after FL-MILK. Date of registration: July 16, 2017. The title of the trail: www.ClinicalTrials.gov Trial registration number: NCT03229239. The name of the trial registry: ClinicalTrials.gov.

PURPOSE:To investigate the eye rubbing habits of Chinese patients with keratoconus.METHODS:This study was carried out from 2018 to June 2022 at Shandong Eye Hospital, Qingdao Eye Hospital, and Henan Eye Hospital. The study compared the number of patients who rubbed their eyes between medical records and second time questionnaires, eye rubbing of patients with myopia and patients with keratoconus, and disease severity between patients with keratoconus. A questionnaire survey of ophthalmologists was conducted to determine their degree of awareness that eye rubbing is a risk factor for keratoconus.RESULTS:The study assessed 799 patients with keratoconus and 798 control patients, and 97 ophthalmologists. The average proportion of patients with keratoconus who rubbed their eyes was 31.0% in the medical records with an increasing trend related to the increase in ophthalmologists' awareness, 66.6% after the second follow-up, and 25.4% among patients with myopia. After multivariate analysis, the following variables showed significant results: eye rubbing frequency more than 10 times/day (odds ratio [OR], 9.168; P < .001); rubbing with knuckles (OR, 9.804; P = .001); and prone sleep position (OR, 12.427; P < .001). The proportion of patients who rubbed their eyes with stage IV keratoconus was 71.9%, 18.9% higher than those with stage I, 4.8% higher than stage II, and 17.8% higher than stage III.CONCLUSIONS:The proportion of Chinese patients with keratoconus who rubbed their eyes was relatively high. The main reasons for the low proportions reported were lack of attention. Clinical attention should be paid to eye rubbing in patients with keratoconus who should be educated to avoid it. [J Refract Surg. 2023;39(10):712-718.].

Objective::To analyze the clinical and etiological characteristics of patients with fungal keratitis secondary to infectious endophthalmitis who required evisceration.Methods::In this retrospective case series study, a total of 44 patients (44 eyes) who were diagnosed with fungal keratitis secondary to infectious endophthalmitis and underwent evisceration from January 2012 to December 2021 were collected in Shandong Eye Hospital. The course of the disease and its predisposing factors, ocular and systemic history, clinical manifestations, microbial culture and drug sensitivity test results were analyzed.Results::The 44 patients included accounted for 2.15% of the total cases of fungal keratitis diagnosed by Shandong Eye Hospital in the same period. The median course of the disease was 18.5 days. At admission, 44 eyes had no light perception, and 20 eyes (45%) were complicated with secondary glaucoma. All 44 eyes showed corneal ulcer, involving the whole corneal layer and limbus, and 27 eyes (61%) complicated with anterior chamber empyema. A total of 39 eyes (89%) of microbial culture had fungal growth, including 20 eyes (51%) of Fusarium, 8 eyes (21%) of Aspergillus, 2 eyes (5%) of Alternaria, others including 4 eyes (10%) of Nonsporulating molds, 2 eyes (5%) of Pythium insidiosum, 1 eye (3%) of Scedosporium apiospemum, 1 eye (3%) of Sarocladium, 1 eye (3%) of Phialemoniopsis pluriloculosa. The geometric mean of the minimum inhibitory concentration values of amphotericin B, posaconazole, voriconazole, itraconazole, 5-fluorocytosine, fluconazole, anifensin, micafungin and caspofungin cultivated in this study were 1.597, 1.338, 1.926, 3.291, 64, 189.699, 1.36, 1.16, 1.23 μg/ml.Conclusions::The patients with infectious endophthalmitis secondary to fungal keratitis often present with total corneal ulceration. In addition to the common pathogenic bacteria of Fusarium, Aspergillus and Alternaria, other bacteria with strong pathogenicity and invasiveness such as Nonsporulating molds, Pythium insidiosum and Scedosporium apiospemum are also common.