Near-infrared (NIR) and red light photobiomodulation (PBM) has gained increasing interest as a non-invasive therapeutic approach for a variety of medical conditions including ocular diseases. The eye represents a particularly suitable target for light-based therapies owing to its optical accessibility and the high mitochondrial demand of various tissues such as the retina and optic nerve. Ocular aging and several ophthalmic disorders are associated with mitochondrial dysfunction, oxidative stress, and chronic inflammation, providing a biological rationale for the use of PBM as a potential adjunctive approach. This narrative review provides an evidence-weighted, indication-specific synthesis of NIR and red-light PBM in ophthalmology, emphasizing device- and protocol-dependence, differences between multiwavelength PBM and repeated low-level red-light therapy, study-design limitations, safety considerations, and clinical translation gaps. A structured literature search was conducted using major scientific databases to identify relevant experimental studies, clinical trials, and observational reports. The review focuses on proposed mitochondria-centered mechanisms of action, including cytochrome c oxidase-mediated signaling, nitric oxide release, reactive oxygen species-driven hormetic responses, and downstream anti-inflammatory effects. Particular emphasis is reserved to dry age-related macular degeneration, for which literature is more relevant, and to dry eye disease owing to meibomian gland dysfunction and myopia, for which a body of evidence is progressively growing. For other ocular indications, data remain preliminary or exploratory. Overall, available data support biological plausibility and suggest possible functional or anatomical signals in selected ocular diseases, but the clinical evidence remains heterogeneous, with substantial variability in devices, wavelengths, dosimetry, treatment protocols, and study design, and remains insufficient to define PBM as established therapy for most indications. However, the clinical evidence remains heterogeneous, with substantial variability in devices, wavelengths, dosimetry, and treatment protocols. Although available studies generally report favorable short-term tolerability, long-term safety and the role of PBM in routine ophthalmic practice remain insufficiently defined. Well-designed, adequately randomized controlled trials with standardized treatment parameters are required to determine efficacy, optimal protocols, and long-term clinical relevance.

BACKGROUND:Dry age-related macular degeneration (dAMD) is the leading cause of irreversible vision loss in older adults, with no approved treatment to modify progression in early and intermediate stages. Photobiomodulation (PBM), which targets mitochondrial dysfunction and retinal inflammation, has shown promise in early studies. This study aims to evaluate the anatomical and functional efficacy of PBM in eyes with early and intermediate dAMD. METHODS:In this 12-month, multicentre, randomised double-masked controlled trial, 138 eyes from 78 patients with early or intermediate dAMD were included. The primary outcome was change in mean drusen volume (MDV) from baseline to 12 months. Secondary outcomes included change in best-corrected visual acuity (BCVA) and adverse events. Multilevel mixed-effects regression was used to analyse treatment-time interactions. RESULTS:MDV decreased significantly in the PBM group (-0.03±0.05 mm³) while increased in the sham group (+0.02 ± 0.04 mm³; p<0.001) at 12 months. The PBM group also showed a significant improvement in BCVA (+1.31 ± 6.7 letters) compared with a decline in the sham group (-2.62±7.1 letters), yielding a between-group difference of +3.75 letters (95% CI 1.16 to 6.34; p=0.0001). Female sex and higher Age-Related Eye Disease Study (AREDS) category were associated with MDV increase over time (p=0.030 and p=0.003; respectively), while older age was associated with MDV reduction (p=0.049). Four eyes in the sham group developed macular neovascularisation, compared with none in the PBM group (p=0.044), while one eye in the PBM group developed geographic atrophy (p=1.00). No cases of retinal phototoxicity were observed. CONCLUSION:PBM significantly reduced drusen burden and improved visual function in early and intermediate dAMD over 12 months, with an excellent safety profile. These findings support PBM as a promising therapeutic option for patients with non-neovascular age-related macular degeneration, despite further studies with longer follow-up are needed to confirm the role of PBM in potentially slowing the natural course of the disease.

AIM:To compare the results of the Ocular Surface Disease Index (OSDI), 5-item Dry Eye Questionnaire (DEQ-5) and Symptom Assessment Questionnaire iN Dry Eye (SANDE) in patients without glaucoma and with glaucoma at different stages of severity. METHODS:Cross-sectional study including patients who underwent visual field (VF) testing, completed three dry eye disease (DED) questionnaires and had ocular surface examination. Glaucoma severity was staged by averaging the severity grade of both eyes using mean deviation (MD) thresholds as mild (MD≥-6 dB), moderate (-6>MD≥-12 dB) and advanced (MD<-12 dB). Questionnaire results, pairwise correlations and predictors for each questionnaire result were assessed. RESULTS:147 patients with a mean age of 65.8±12.5 years were included. OSDI showed moderate-to-high correlations with DEQ-5 and SANDE in patients without glaucoma (n=43) and with mild-to-moderate (n=32 and n=56) VF damage (always ρ≥0.55; p<0.01 with DEQ-5 and ρ≥0.5; p<0.01 with SANDE); while correlations became low and non-significant in advanced glaucoma (n=16) (ρ:0.38; p=0.60 and ρ:0.41; p=0.464 with DEQ-5 and SANDE, respectively). Conversely, DEQ-5 and SANDE always showed significant correlations (ρ≥0.66; p<0.01). Linear regression showed the OSDI to be the only questionnaire affected by mean MD (p=0.002). Additionally, glaucoma patients were more frequently defined as symptomatic for DED using the OSDI compared with the DEQ-5 (65.4% vs 51.9%; p=0.0082). CONCLUSION:DED questionnaires showed different behaviours in patients with glaucoma. The OSDI failed to maintain its correlation with both the DEQ-5 and SANDE in advanced glaucoma stages and was the only questionnaire influenced by VF damage. Questionnaire choice may influence how DED symptoms are captured in glaucoma patients, particularly in advanced stages.

Background/Aims To evaluate the performance of an artificial intelligence (AI) model for detecting and monitoring microbial keratitis (MK) using anterior segment optical coherence tomography (AS-OCT).Methods This is a prospective observational study. Patients with clinically suspected MK and healthy participants were included. In addition to routine assessment and treatment with topical fluoroquinolone therapy, patients underwent AS-OCT at each clinic visit. These images were tested on our DeepLabV3 network-based AI model, which aims to diagnose and record changes to infiltrate sizes of MK lesions over time.Results The AI model accurately captured MK lesions in 93% of cases (152/163). MK was not detected in scans from healthy eyes, and there were no cases of artefact being falsely detected. The model had a sensitivity of 93% (95% CI 88% to 97%), specificity of 100% (95% CI 88% to 100%), positive predictive value of 100% (95% CI 98% to 100%) and negative predictive value of 73% (95% CI 61% to 83%). Using only the corneal component with masking of the anterior chamber, the AI model showed agreement on change with both observers in 76% (13/18) cases.Conclusions This AI framework reliably identified MK lesions using AS-OCT, with high sensitivity and specificity. The framework was able to identify change in most cases compared with corneal specialists.

INTRODUCTION:Dry eye disease (DED) is a chronic condition that can markedly impair visual function and quality of life. While tear substitutes remain the conventional first-line therapy, expanding knowledge of DED has opened the door to treatments designed to act on distinct pathogenic mechanisms. AREAS COVERED:An extensive literature review using PubMed, Scopus, and Web of Science was conducted to evaluate both established and emerging therapies for DED. This review encompasses conventional tear substitutes and their properties, immune-modulating agents, blood derived products and other biological agents, tear-conservation approaches, device-based interventions, and recently approved as well as investigational treatment options. EXPERT OPINION:The evolving understanding of DED supports a shift toward mechanism-based, personalized management that addresses inflammation, tear film instability, neurosensory dysfunction, and glandular insufficiency. Integrating targeted therapies, device-based interventions, and regenerative approaches with improved diagnostics may enable more predictable, proactive care. Rigorous research is still needed to optimize treatment selection and sequencing.

The purpose of this study was to evaluate the clinical outcomes of insulin eye drops in a real-world cohort of eyes affected by corneal persistent epithelial defects (PEDs) refractory to conventional therapy. This retrospective study included consecutive patients with refractory PEDs treated with topical insulin (1 IU/mL) four times daily. Clinical end points were: time to complete reepithelialization, cumulative probability of closure, longitudinal changes in defect area, postclosure complications, recurrence, and changes in best-corrected visual acuity (BCVA). A total of 45 eyes from 43 patients (mean age 64.6 ± 15.6 years) were included. The most common etiology was chronic ocular surface diseases (62.2

Background: Dry eye disease (DED) is among the most common complications experienced after femtosecond laser-assisted in situ keratomileusis (Femto-LASIK), often affecting visual recovery, as well as patient satisfaction. Low-level light therapy (LLLT) has shown benefits in various ocular surface diseases, but its role in refractive surgery remains underexplored. This study aimed at evaluating the efficacy of perioperative LLLT in preserving tear film parameters and reducing ocular discomfort symptoms after Femto-LASIK. Methods: In this prospective multicentric, randomized, double-masked, sham-controlled clinical study, adult patients undergoing Femto-LASIK were randomized (1:1) to receive periocular LLLT (633 ± 10 nm, 15 min/session) or sham treatment 7 ± 2 days before and after surgery. Ocular surface evaluation was performed at baseline (T0), and 1 week (T1), 1 month (T2), and 3 months (T3) postoperatively. Outcomes were tear meniscus height (TMH), Schirmer test values, and Dry Eye Questionnaire-5 (DEQ-5) scores, noninvasive tear break-up time (NIBUT), and interferometry. Results: Forty eyes of 40 patients (mean age: 34.58 ± 5.67 years) were analyzed. In the LLLT group, tear film parameters and subjective symptoms remained stable throughout follow-up, with no statistically significant changes over time. Conversely, the control group showed a significant decline in TMH (0.27 ± 0.05 mm to 0.20 ± 0.05 mm; p < 0.001), Schirmer test (20.39 ± 10.84 mm/5’ to 15.65 ± 9.02 mm/5’; p = 0.022), and a significant worsening in DEQ-5 scores (3.53 ± 4.10 to 5.94 ± 2.79; p = 0.005). Between-group comparisons demonstrated in the LLLT group significantly higher TMH at T2 ( p = 0.034) and T3 ( p = 0.016), higher Schirmer values at T2 ( p = 0.048) and T3 ( p = 0.018), and lower DEQ-5 scores at T1 ( p = 0.041), T2 ( p = 0.029), and T3 ( p = 0.018). NIBUT and interferometry showed no significant between-group differences at any time point. No treatment-related adverse events were observed. Conclusion: Perioperative LLLT appears to be a safe and well-tolerated adjunctive treatment that may help preserve tear volume and support postoperative comfort after Femto-LASIK. These findings suggest a potential role for LLLT in perioperative refractive surgery care, although further studies are warranted to confirm its clinical benefit.

Purpose:To identify and harmonize preoperative inclusion and exclusion criteria for corneal neurotization (CN) in neurotrophic keratopathy (NK), describe how consistently they are reported, and summarize practical, clinic-ready guidance for selection and follow-up. Methods:Systematic review (PRISMA-2020; PROSPERO CRD420251117787) of human studies on CN for NK (databases searched July 18, 2025). Study-level eligibility criteria, disease stage, esthesiometry, chronicity thresholds, donor-nerve requirements, and stated exclusions were evaluated; risk of bias (ROBINS-I) and certainty (GRADE) were recorded. Results:Thirty-six studies (380 patients) were included; of these, 26 (72.2%) explicitly reported eligibility criteria. Most common inclusion criteria were refractory NK (92.3%), severe/objective corneal anaesthesia or Mackie III severity stage (69.2%), NK with intact donor territory (50.0%), and corneal epithelial instability (46.2%). Exclusion criteria were often not stated (76.9%); when present, they most often listed active infection/non-NK disease (38.5%), systemic unsuitability (34.6%), absent/abnormal donor nerve(s) (15.4%), and severe limbal stem cell deficiency (15.4%). Across studies, CN improved corneal protection and surface stability with sensory recovery over ~6-18 months and in vivo confocal microscopy evidence of nerve regrowth; visual acuity changes were variable. No randomized clinical trials were found; ROBINS-I was commonly moderate to serious, and overall certainty by GRADE was low. Conclusions:This systematic review defined and harmonized preoperative inclusion and exclusion criteria for CN in NK. A minimum preoperative dataset, including disease stage, mapped corneal sensitivity, denervation timeline and etiology, donor-dermatome integrity, feasibility of tension-free coaptation, and ocular surface status, may guide referral timing, donor-feasibility-driven technique selection, and structured follow-up.

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and newer dual-incretin therapies have become central to the treatment of diabetes mellitus and obesity, with benefits extending beyond glycemic control. Their expanding use has prompted growing interest in their potential ocular effects. Experimental data support plausible protective mechanisms, including reduction in oxidative stress and neuroprotective effects on retinal and optic nerve tissues. Clinical evidence, however, remains heterogeneous. In diabetic retinopathy, the main concern appears to be transient early worsening associated with rapid glycemic improvement rather than direct retinal toxicity. A potential semaglutide-associated signal for non-arteritic anterior ischemic optic neuropathy has raised concern, although the absolute risk appears low and causality remains unproven. Emerging studies also suggest possible beneficial associations with glaucoma, ocular surface diseases, and certain retinal vascular outcomes, whereas the evidence regarding age-related macular degeneration and cataract remains conflicting or preliminary. Overall, ocular outcomes associated with incretin-based therapies seem to reflect a complex interplay among drug-specific pharmacology, systemic metabolic changes, and individual patient susceptibility rather than a class effect. Baseline ophthalmic assessment and individualized follow-up may be advisable in selected high-risk patients. Further prospective ophthalmology-focused studies are needed to clarify long-term safety and identify the patients most likely to benefit or develop adverse events.

Background/Objectives: To assess the accuracy of several intraocular lens power calculation formulas in phacotrabeculectomy for open angle glaucoma. Methods: Patients who underwent phacotrabeculectomy for open angle glaucoma were included. Refraction and biometry measurements were repeated at 3, 6 and ≥12 months. Prediction error (PE) and absolute error (AE) were calculated using the SRK/T, Holladay 1, Hoffer Q, Haigis, Kane, Emmetropia Verifying Optical (EVO) and Barrett Universal II formulas at ≥12 months, and their accuracy was compared using linear mixed-effects models accounting for repeated measurements within the same eye and inter-eye correlation. Results: Sixty eyes from 40 patients were included. The linear mixed-effects model showed a significant overall effect of formula on PE (χ2(6) = 119.14, p < 0.001). Most formulas showed a tendency toward a hyperopic refractive shift, whereas Haigis showed a negative PE. Based on estimated marginal mean AE, the formulas were ranked as follows: EVO (0.548 D), Barrett Universal II (0.551 D), Holladay and SRK/T (0.561 D), Haigis (0.572 D), Kane (0.577 D) and Hoffer Q (0.617 D). However, the AE did not significantly differ among the formulas (χ2(6) = 3.75, p = 0.711). The percentage of eyes within ± 1.00D of PE ranged from 81.7% to 90% across the formulas (p > 0.05). Significant axial length shortening, anterior chamber deepening and mean keratometry reduction were detected postoperatively at ≥12 months (p < 0.05). Conclusions: Despite postoperative ocular anatomic changes, all formulas showed acceptable refractive accuracy after phacotrabeculectomy. Although no significant difference in the AE was detected among the formulas, the PE differed significantly, with most formulas showing a tendency toward a hyperopic shift and Haigis showing a myopic shift. This inter-formula difference should be considered when selecting the refractive target, particularly when using formulas that tend toward hyperopic PE.

Purpose:To describe the outcome of a novel combined therapeutic approach encompassing topical insulin eye drops and cross-linked hyaluronic acid canalicular gel in a case of severe recalcitrant neurotrophic keratopathy (NK) complicated by keratolysis. Case presentation:A 52-year-old male presented with a recalcitrant Mackie stage III post-herpetic NK in the right eye, characterized by a large persistent epithelial defect (PED) (area of 49.7 mm2), central stromal melting, corneal anesthesia, and neovascularization. Best-corrected visual acuity (BCVA) was reduced to hand motion. The new therapeutical approach included the withdrawal of previous therapies and the initiation of topical insulin (1 unit/mL, 4 times daily) combined with the insertion in the lower punctum of cross-linked hyaluronic acid canalicular gel (Lacrifill, Nordic Pharma, Inc., Berwyn, PA, US) to enhance ocular surface drug retention. In the subsequent follow-up visits, the PED area progressively decreased to 19.6 mm2 at 2 weeks and 4.4 mm2 at 4 weeks; complete re-epithelialization was achieved at 8 weeks. In parallel, BCVA improved to counting fingers at 1 m. No adverse events were reported. Conclusions:The combined use of topical insulin and cross-linked hyaluronic acid canalicular gel allowed achievement of complete corneal healing in a case of severe recalcitrant NK complicated by keratolysis. The regenerative properties of insulin eye drops were enhanced by the concomitant insertion of the occlusive device. This approach represents a rational, accessible, and well-tolerated therapeutic strategy that warrants further investigation in prospective controlled studies.

Purpose:To quantitatively assess light sensitivity thresholds and ocular surface parameters in patients with thyroid eye disease (TED) compared to sex- and age-matched patients with dry eye disease (DED) and healthy controls, and to further investigate differences between moderate-to-severe active and mild non-active TED. Patients and Methods:This cross-sectional, controlled study included patients with TED, patients with DED, and healthy controls. Light sensitivity was evaluated using the Lumiz 100 device (Essilor International, Paris, France) under three lighting conditions: continuous warm, continuous cold and flashing warm. TED patients were further stratified into moderate-to-severe active and mild non-active subgroups. In addition, ocular surface parameters were assessed using the Keratograph 5M (Oculus, Wetzlar, Germany). Correlations between light sensitivity thresholds and clinical parameters were analyzed. Results:Out of 93 included patients, 39 had TED (14 moderate-to-severe active, 25 mild non-active), 25 had DED, and 29 were healthy controls. TED patients demonstrated significantly lower total light sensitivity thresholds compared to healthy controls (3.17 ± 0.52 vs 3.47 ± 0.42 log10[lux], p = 0.040) but higher thresholds compared to DED patients (2.71 ± 0.52 log10[lux], p = 0.003). Among TED patients, those with moderate-to-severe active disease exhibited significantly lower light sensitivity thresholds than those with mild non-active disease (2.85 ± 0.48 vs 3.35 ± 0.47 log10[lux], p = 0.004). A significant negative correlation was found between total light sensitivity threshold and ocular discomfort symptoms in both subgroups of TED patients (r =-0.623, p = 0.017 for moderate-to-severe active TED and r = -0.405, p = 0.045 for mild non-active TED, respectively). Conversely, no significant correlation was found between light thresholds and tear film or thyroid function parameters. Conclusion:Light sensitivity represents a significant and quantifiable manifestation of TED, particularly in patients with active disease. Quantitative assessment of light sensitivity might be incorporated into clinical evaluation of TED patients to better characterize disease burden and guide management strategies.

To provide an updated and critical overview of the available clinical evidence on the use of faricimab for the treatment of macular edema secondary to retinal vein occlusion (RVO), with particular focus on efficacy, durability of response, and clinical applicability in both trial and real-world settings. A systematic literature review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using PubMed and Scopus databases. Pivotal phase III randomized clinical trials and real-world studies evaluating intravitreal faricimab in patients with branch, central, or hemiretinal vein occlusion were included. Both treatment-naïve and previously treated eyes were considered. Evidence was qualitatively synthesized with attention to visual and anatomical outcomes, treatment durability, and safety. Data from the BALATON and COMINO phase III trials demonstrated that faricimab achieved visual and anatomical outcomes comparable to aflibercept 2.0 mg during fixed monthly dosing, with maintenance of efficacy up to 72 weeks under treat-and-extend regimens. A clinically meaningful proportion of patients achieved extended treatment intervals, suggesting potential reduction in treatment burden. Real-world studies largely confirmed consistent anatomical efficacy across different RVO subtypes and clinical scenarios. However, functional improvement was more heterogeneous, particularly in chronic or therapy-resistant cases, where anatomical and visual outcomes were frequently dissociated, likely reflecting irreversible retinal ischemia or structural damage. Across studies, faricimab showed a generally favorable safety profile. Available evidence supports faricimab as an effective and well-tolerated therapeutic option for RVO-related macular edema, especially when initiated early in the disease course. However, although extended dosing intervals were achieved in a proportion of patients, superiority in durability compared with other anti-VEGF agents has not yet been demonstrated. Further prospective, comparative, and long-term real-world studies are needed to better define patient selection criteria and the optimal positioning of faricimab within current RVO treatment algorithms.

INTRODUCTION:Meibomian Gland Dysfunction (MGD) represents the most common cause of dry eye disease (DED). Traditional treatments mainly rely on heating and liquifying the meibum to favor its expression. However, recent knowledge advances have led to the development of novel therapies specifically designed for patients with MGD. AREAS COVERED:Literature search was conducted on current and novel treatments for MGD. Conventional treatment strategies, non-pharmacological approved device-based therapies, approved dry eye therapies and both recently approved and emerging pharmacological treatments specifically designed to address MGD are discussed. EXPERT OPINION:The better understanding of MGD and DED pathophysiology has allowed to develop drugs able to target the primary mechanisms of the disease. Miebo has been the first FDA approved drug for patients with DED associated with MGD and its ability to reduce the tear film layer evaporation rate and the minimal impact on the quality of vision are important innovations. Great expectations also accompany the phase 3 study of AZR-MD-001, understood to be a keratolytic and lipogenic agent able to improve meibum quantity and quality. The chance to specifically target MGD represents an important step forward and will allow more tailored treatment for each type of ocular surface disease.

Background: This study aims to evaluate the repeatability of the Pentacam HR, comparing two different measurement modes (50-cornea fine and 25-3D scan) in patients affected by keratoconus. Methods: Multicenter retrospective study, conducted at Eye Clinic of the ASST-Spedali Civili-University of Brescia, Italy, and St. Paul’s Eye Unit, Royal Liverpool University Hospital, United Kingdom. A total of 72 eyes from 72 patients with keratoconus underwent six consecutive measurements, three using the 25-3D scan mode and three with the 50-Cornea fine mode. Measurements were made by one single observer, using the Scheimpflug corneal tomographer camera (Pentacam HR, Oculus, Wetzlar, Germany). Repeatability was assessed using the within-subject SD (Sw) statistic from a two-way analysis of variance. Results: Both measurement modes had excellent repeatability. The interclass coefficient correlation (ICC) was excellent (>0.9) in all the parameters evaluated, apart from anterior and posterior astigmatic axes and posterior astigmatism (ICC > 0.8) and index of height asymmetry (IHA) (ICC < 0.6). However, in 18 of 29 parameters, the ICC was higher in case of 25-3D scan. Repeatability limit for Kmax was 1.00D in 25-3D scan mode and 1.02D in case of 50-cornea fine. Conclusions: 25-3D scan may be preferable to 50-Cornea fine, in view of having slightly higher ICC in case of patients with keratoconus. Repeatability limits reported may be helpful in clinical practice for assessing the progression of keratoconus.

Corneal disorders are among the leading causes of visual impairment worldwide, with corneal transplantation historically serving as the cornerstone of surgical treatment. However, the global shortage of donor tissue, risk of immune rejection, and variable long-term graft survival underscore the urgent need for alternative approaches, particularly in the setting of ocular surface diseases such as inflammation or dry eye that can compromise graft survival. Regenerative medicine has emerged as a transformative paradigm, offering strategies to restore corneal architecture and function through cell-based therapies, tissue engineering, and gene modulation. These strategies are promising, addressing structural repair and modulating wound-healing responses. In the corneal epithelium, cultivated limbal epithelial transplantation, simple limbal epithelial transplantation, and cultivated oral mucosal epithelial transplantation have expanded therapeutic options for limbal stem cell deficiency, with clinical trials demonstrating long-term ocular surface stability. Regulatory approval of commercial products, such as Holoclar and Nepic, confirms the potential of standardized regenerative products. Stromal regeneration with stromal and mesenchymal stem cells has shown promise in preclinical and early phase clinical trials, with intrastromal stem cell injection improving corneal transparency and biomechanics and potentially stabilizing progressive disorders such as keratoconus. For endothelial dysfunction, intracameral injection of cultured corneal endothelial cells supplemented with Rho-associated protein kinase (ROCK) inhibitors has yielded sustained corneal clarity and visual restoration at 5–10 years, marking a paradigm shift from transplantation to minimally invasive, donor-independent therapies. Tissue engineering innovations, including matrices, hydrogels, and three-dimensional bioprinting, are advancing toward translation, while gene therapy approaches using viral vectors and Clustered Regularly Interspaced Short Palindromic Repeats -Cas9 are being explored to modulate angiogenesis, fibrosis, and inherited dystrophies. Overall, regenerative medicine is reshaping corneal therapeutics, offering effective alternatives to conventional transplantation with reduced donor dependence and improved safety. Future work must focus on long-term safety, cost-effectiveness, and equitable global access to realize its full clinical potential.

Purpose:To compare the efficacy and safety of topical insulin and amniotic membrane extract eye drops (AMEED) in promoting healing of corneal persistent epithelial defects (PEDs) refractory to conventional therapy. Patients and Methods:This retrospective comparative study included 27 eyes of 24 patients (mean age 61.0 ± 16.6 years) with PEDs treated with either topical insulin (1 IU/mL) or AMEED four times daily. Clinical outcomes included complete epithelial closure, rate of epithelialization, change in best-corrected visual acuity (BCVA), and occurrence of adverse events. Results:Of 27 eyes, 18 received topical insulin and 9 received AMEED. The mean interval from diagnosis to treatment initiation was 93.4 ± 111.7 days in the AMEED group and 72.5 ± 56.1 days in the insulin group. Complete healing occurred in all eyes (100%) in the insulin group versus 44.4% in the AMEED group. The daily reduction in epithelial defect area during the first two weeks was significantly greater with insulin (P = 0.04). At final follow-up, BCVA improved significantly only in the insulin group (P = 0.006). No adverse reactions were observed in either group; one AMEED-treated eye required amniotic membrane transplantation. Conclusion:Topical insulin and AMEED are both safe and effective for refractory PEDs, but insulin showed superior epithelial healing and visual recovery. Given its availability, low cost, and favorable safety profile, topical insulin may represent a practical alternative in the management of persistent epithelial defects.

Background/Objectives: Epithelial basement membrane dystrophy (EBMD) is a common corneal dystrophy characterized by recurrent corneal erosions and visual impairments due to surface irregularities and opacities. This study aims to evaluate the effectiveness of alcohol-assisted delamination (ALD) of the corneal epithelium in patients with EBMD affecting the visual axis, who experience decreased vision quality due to higher-order aberrations (HOAs) and irregular astigmatism. Methods: Eleven eyes of nine patients (four males and five females) were treated with ALD, with a mean age of 51.3 ± 19.7 years. All patients underwent refraction, best-corrected visual acuity (BCVA) assessment, a comprehensive slit-lamp examination for EBMD pattern identification, anterior segment imaging with and without fluorescein, tear break-up time (BUT) testing, corneal topography, corneal aberrometry (Zernike coefficients (Znm) were calculated for a 5.0 mm simulated pupil), and anterior segment optical coherence tomography preoperatively and at 1-day, 14-day, 1-month, 3-month, 6-month, and 12-month intervals. Results: All patients demonstrated improvements in BCVA and visual quality, ocular comfort, and BUT results. The mean root mean square (RMS) value of total corneal aberrations decreased from 1.72 ± 0.90 μm to 0.90 ± 0.62 μm, while the mean RMS value of HOAs reduced from 0.92 ± 0.48 μm to 0.53 ± 0.28 μm. Astigmatism and trefoil were the aberration components that exhibited the most significant reductions. Conclusions: Alcohol-assisted delamination of the corneal epithelium is a safe and effective treatment for central EBMD patients experiencing visual quality deterioration. Astigmatism and trefoil appear to be the primary aberrations contributing to visual disturbances in this patient population.