This clinical consensus statement, developed through the European Reference Network for Rare Eye Diseases (ERN-EYE), provides recommendations for the diagnosis, monitoring and management of paediatric keratoconus. Paediatric keratoconus is a corneal ectasia that typically presents during childhood or adolescence, often advancing rapidly and significantly affecting visual development. Despite its impact, standardised paediatric-specific guidelines are lacking. A multidisciplinary panel of experts from across Europe contributed to this statement through a structured Delphi process. The consensus reviews the current understanding of the physiopathology, diagnostic criteria, risk factors and classification systems of paediatric keratoconus. It outlines strategies for early detection and monitoring, emphasises the role of patient and family education and presents current treatment approaches, with specific recommendations for paediatric care. The aim of this document is to guide ophthalmologists, paediatricians and associated professionals in delivering timely and appropriate care, improving outcomes for children with keratoconus across Europe.

Purpose:To quantify the extent of clinically non-significant Descemet membrane detachment (DMD) at the clear corneal incision (CCI) during phacoemulsification and to compare its extent between longitudinal and torsional ultrasound modulation as a morphological marker of local tissue-instrument interaction. Methods:In this prospective contralateral-eye comparative randomized study, 14 patients (28 eyes) undergoing bilateral cataract surgery were included. One eye received longitudinal and the fellow eye torsional ultrasound (Constellation system, Alcon). DMD was assessed intraoperatively using microscope video recordings under red reflex illumination. Still images were analyzed, and DMD area (mm2) at the internal wound was measured. Correlations with cumulative dissipated energy (CDE) was evaluated. Results:Incision-site DMD was detected in all analyzed cases (100%) using intraoperative red reflex-based visualization. Mean DMD area was 1.33 ± 0.43 mm2 (longitudinal) and 2.37 ± 0.67 mm2 (torsional), with a mean difference of 1.04 mm2 ± 0.74 mm2 (95% CI, 0.60-1.48). The paired analysis demonstrated a highly significant difference (p < 0.001). No correlation was found between DMD extent and CDE. Conclusions:Clinically non-significant incision-site DMD appears to be a frequent intraoperative morphological phenomenon during phacoemulsification when assessed using sensitive visualization techniques. Torsional ultrasound was associated with a significantly greater DMD extent than longitudinal modulation. Rather than indicating greater clinical damage, DMD area may serve as a sensitive quantitative morphological marker of local tissue-instrument interaction at the corneal incision. Its potential value therefore lies primarily in the comparative evaluation and future refinement of phacoemulsification technologies, while the clinical significance of these subtle morphological differences remains to be established.

INTRODUCTION:Cataract surgery is one of the most commonly performed procedures in human medicine. Although the risk of postoperative inflammatory complications is low, their consequences can be devastating. The current global standard for preventing such complications is intracameral administration of antibiotics, while the role of prophylactic topical antibiotics in uncomplicated cases remains controversial. AIM:The aim of this paper is to evaluate the available evidence regarding the effectiveness of topical antibiotic prophylaxis in uncomplicated cataract surgery in the era of routine intracameral antibiotic use. METHODS:The authors conducted a review of the recent literature and major clinical studies (ESCRS, Kaiser Permanente, Cochrane), comparing the incidence of endophthalmitis with the use of intracameral antibiotics alone versus in combination with postoperative topical antibiotics. RESULTS:Intracameral antibiotic administration significantly reduces the risk of endophthalmitis (up to 4.9-fold reduction according to the ESCRS study). There is no evidence that subsequent use of topical antibiotic drops further reduces the risk of infection in uncomplicated cases. Moreover, repeated topical antibiotic use increases the risk of patients developing antibiotic resistance and poses a significant financial and logistical burden. CONCLUSION:In uncomplicated cataract surgery, postoperative topical antibiotics are not indicated when intracameral prophylaxis is applied. Their use should be reserved for high-risk cases only (e.g. following complicated surgery, in immunocompromised patients, or in the presence of chronic blepharitis).

AIMS:To determine the incidence of Fuchs' endothelial corneal dystrophy (FECD) in patients undergoing cataract surgery in the Czech population. MATERIAL AND METHODS:Consecutive group of 2804 eyes of 1499 patients undergoing cataract surgery at the Lexum Karlovy Vary clinic in the period from 4/2022 to 9/2024. The corneal endothelium was examined preoperatively using a slit lamp and an endothelial microscope. The corneas were divided into 6 grades (0-5) according to the Krachmer scale, or 4 clinical stages of the disease. RESULTS:The incidence of FECD in our group of patients undergoing cataract surgery was 29.6% (total 840 eyes). In 578 cases this concerned stage 1 of the disease, which had no effect on the outcome of the operation. In 81 cases it concerned a stage 3-5 disease, in which potential postoperative complications must be taken into account. In 13 cases (0.46%) we primarily performed a combined procedure of cataract surgery and DMEK (Descemet's membrane endothelial keratoplasty). CONCLUSION:FECD in the population of cataract patients is probably often under-diagnosed. In our cohort of patients we registered some signs of the disease in more than a quarter of the patients.

AIMS:The aim of the study was to describe a cohort of patients reoperated on for persistent primary macular hole, and to evaluate the anatomical and functional results of the reoperated patients. MATERIAL AND METHODS:459 eyes of 390 patients were operated on for primary macular hole at Department of Ophthalmology, 3rd Faculty of Medicine, Charles University, Kralovske Vinohrady University Hospital between January 1, 2013, and December 31, 2023. We included 33 eyes of 33 patients in our retrospective case series, in which macular hole persisted after the primary surgery. Preoperative, perioperative and postoperative data of these patients were recorded, as well as initial and resulting best corrected visual acuity (BCVA), surgical technique, whether the first or second reoperation was successful. The minimum follow-up time was 90 days after the revision surgery. The statistical analysis included descriptive statistics to characterize the demographic and clinical parameters. Qualitative and quantitative variables were analyzed using means, medians and standard deviations. RESULTS:Primary surgery for macular holes was successful in 426 eyes of 357 patients (92.8%). The surgery was unsuccessful in the remaining 33 eyes of 33 patients (7.2%), with persistent macular hole. These patients underwent reoperation, which led to closure of the hole in 27 of 33 eyes (reoperation success rate 81.8% and total success rate of primary surgery and reoperation altogether 98.7%). Reoperation was unsuccessful in 6 eyes (18.2% of reoperated eyes and 1.3% of all operated macular holes). In 4 eyes a second reoperation was performed; in 3 eyes the reoperation was successful and led to an improvement of BCVA. The average BCVA of the successfully reoperated eyes was 65.2 ± 11.9 letters (ETDRS ±SD). In the eyes of patients after a successful second reoperation, BCVA was 56.7 ±8.4 letters, while in the eyes of patients who did not undergo further surgery (n = 3), average BCVA was only 39.0 ±11.0 letters. CONCLUSION:Reoperation of macular holes has a very good success rate and usually leads to an improvement of visual acuity. Improvement of visual acuity can also be achieved in patients who only achieved success after a second reoperation.

Descemet membrane detachment (DMD) is an uncommon but clinically significant complication of cataract surgery, particularly phacoemulsification. This review summarizes current evidence on the incidence, risk factors, diagnosis, and management of DMD associated with cataract surgery. A narrative literature review identified 28 relevant publications between 1995 and 2025 across PubMed Medline, Cochrane Library Database, and Scopus, including retrospective and prospective studies, review articles, and case reports. Most cases of DMD result from mechanical trauma at the clear corneal incision site, although spontaneous detachments have also been reported. Recognized risk factors include poor incision architecture, repeated or forceful instrument manipulation, blunt surgical instruments, elevated ultrasound energy, and limited surgical experience. Advances in anterior segment optical coherence tomography (AS-OCT) have significantly improved detection and classification, particularly in cases obscured by corneal edema. Management depends on the extent and morphology of detachment. Small, peripheral, and planar detachments may resolve with conservative treatment, whereas extensive, central, or scrolled detachments usually require surgical intervention, most commonly descemetopexy with intracameral air or gas tamponade. Careful wound construction, meticulous surgical technique and prompt diagnosis are essential to reduce the incidence and visual consequences of this complication.

Objective: The objective was to provide evidence on the effectiveness (intraocular pressure, IOP) and safety of Deep Sclerectomy with the Esnoper Clip implant with and without the use of mitomycin C (MMC) in uncontrolled primary open-angle glaucoma. Methods: This was a multicentric, retrospective, consecutive case series study undertaken as a collaboration between University Hospital Trias i Pujol, Spain, and University Hospital Kralovske Vinohrady, Czech Republic. The IOP reduction was compared between patients who underwent Deep Sclerectomy with the Esnoper Clip implant, where the antifibrotic agent mitomycin C was used perioperatively (MMC group), and patients who underwent Deep Sclerectomy with Esnoper Clip implants where mitomycin C was not used either peri- or postoperatively (non-MMC group). At the end of the study (12 months after surgery), complete success probability (defined as an IOP <21 mmHg without medication) and qualified success probability (defined as an IOP <21 mmHg with or without medication) were assessed. Safety was based on postoperative complications. A descriptive and exploratory analysis was performed. Results: Between January 2017 and June 2019, a total of 72 consecutive patients (40 women and 32 men; age [median (range)] 70 (39-90)) with uncontrolled primary open-angle glaucoma who underwent Deep Sclerectomy with an Esnoper Clip implant were included. Of these, 78 eyes were included: 44 eyes (38 patients) in the MMC group and 34 eyes (34 patients) in the non-MMC group. At the end of the study (38 and 32 eyes, respectively), the complete success probabilities (95% confidence interval) were 62.2% (51.5-75.2%) and 80.5% (69.5-93.2%), p-value: 0.001; qualified success probability (95% confidence interval): 84.7% (76.6-93.7%) and 85.7% (75.8-97%), p-value: 0.188; and complications (total): 36 and 24, p-value: 0.286. Conclusions: In this case series study, the use of mitomycin C in Deep Sclerectomy with the Esnoper Clip implant for patients with uncontrolled primary open-angle glaucoma does not appear to improve IOP one year after surgery. No safety issues related to mitomycin C were observed. Further study is needed to confirm the effectiveness and to assess long-term safety.

For the treatment of bilateral limbal stem cell deficiency (LSCD), cell therapy with transplantation of cultivated oral mucosa epithelial cells (COMET) is a promising alternative. Although not yet established, current protocols on the cultivation of oral mucosal epithelial cell (OMECs) sheets are based mainly on substrates and xenobiotic additives that may lead to variable outcomes and undesirable immune responses by the patient. The aim of this study was to characterize OMECs cultivated in xenobiotic-free media (XF) seeded on fibrin gel, in comparison to conventional complex (COM) medium. Oral mucosal biopsies were retrieved from 31 donors. After cultivation in COM or XF medium, OMECs were compared based on growth kinetics, morphology, cell size and viability. Using immunofluorescence and gene expression analyses, the degree of stemness, proliferation and differentiation was evaluated in OMEC cultures. Our findings showed that although OMECs showed a similar morphology and viability, and comparable growth kinetics, immunofluorescence revealed the preservation of stemness (p63 + p40 positivity in cells <= 11 mu m) and proliferation in both COM and XF. Gene expression analyses showed that keratin (K)13 and K15 expression levels were significantly higher in XF (adj. p < 0.001), but otherwise COM and XF-treated OMECs had comparable transcriptional profiles in a panel of stemness, proliferation and differentiation genes. These results demonstrate the feasibility of culturing OMECs on fibrin gel without xenogeneic additives, while maintaining their undifferentiated state and preserving stemness. In conclusion, both in terms of results and methodology, the procedures presented here are suitable for implementation in clinical practice.

OBJECTIVE:To compare the incidence of postoperative complications after cataract surgery in current types of acrylic intraocular lenses (IOLs) in relation to the material used to manufacture the implant, published in the scientific literature. METHODOLOGY:Search for publications in the Pubmed database, published in 2015-2024 (inclusive), without language restrictions, featuring the keywords Hydrophobic, Hydrophilic, Intraocular lens. Reviewing all abstracts and excluding publications that do not match the specified topic. RESULTS:A total of 220 works were published in the last 10 years that met the specified keywords. Of these, 92 publications were dedicated to the comparison of both types of IOLs. These were 4 meta-analyses, 10 reviews and 47 clinical studies, 21 laboratory and experimental studies and 10 studies of a different nature (editorials, considerations, chapters in textbooks). CONCLUSION:Current types of soft acrylic intraocular lenses achieve excellent refractive results and high subjective patient satisfaction. This applies to lenses made of both hydrophilic and hydrophobic materials. The main disadvantage of hydrophilic implants is the higher risk of opacification of the posterior capsule of the lens, as well as the risk of opacification of the implant itself. Especially in patients who are expected to undergo subsequent surgery (corneal endothelial dystrophy, retinal pathology), as well as in patients with a higher risk of complications after Nd:YAG laser capsulotomy (patients with myopia, chronic uveitis or glaucoma), the use of hydrophobic material should be considered as a priority.

Purpose: The purpose of this study was to assess the effectiveness of legally mandated testing for pathogenic prion proteins in corneal tissue donors in the Czech Republic, considering its impact on safety, financial, and temporal costs. Methods: Between January 2007 and December 2023, standardized brain regions were collected from all corneal tissue donors in the Czech Republic. Tissue samples were tested for the presence of pathogenic prion proteins by the Czech Reference Laboratory for Human Prion Diseases. The testing used a Western blot analysis, using 2 distinct monoclonal anti-PrP antibodies. Results: A total of 8030 donors were tested. Four tested samples were initially weakly positive. Subsequent testing conclusively determined these samples to be negative. The remaining 8026 tests yielded negative results confirming the safety of donor screening. Conclusions: We did not observe any cases of proven transmissible spongiform encephalopathies (TSEs). TSE testing has consistently confirmed that no patients with TSE have been selected into the corneal donor pool, solidifying the effectiveness of the active surveillance program and exclusion criteria. We propose that these mechanisms effectively prevent patients with TSEs from being included in the corneal tissue donor pool. However, the substantial financial costs and a 2-day delay in processing pose challenges, contributing to graft nonutilization and potential negative impacts on patients in acute need. Moreover, the unique requirement for pathogenic prion testing in the Czech Republic also makes importing any corneal grafts from other countries impossible, as those tissues do not fulfill Czech legal requirements.

Background Rhegmatogenous retinal detachment (RRD) is a vision-threatening condition that requires prompt surgical intervention. With advancements in surgical techniques and equipment, pars plana vitrectomy (PPV) has become increasingly popular for the management of RRD. This, in turn, requires beginner vitreoretinal surgeons to be able to manage RRD early in their training. Introduction Comparison of the results and complication rates of a 25-gauge (25 g) PPV with gas tamponade for RRD between experienced and inexperienced surgeons. Methods This is a retrospective comparative consecutive case series study of patients with uncomplicated RRD treated with 25 g PPV with gas tamponade. Patients were divided into two groups: in the experienced surgeon group (ESG), the procedure was performed by an experienced vitreoretinal surgeon, in the inexperienced surgeon group (ISG), it was performed by two inexperienced surgeons. Anatomical and functional results and complication rates were compared between the two groups. Results A total of 216 eyes were included in the study. In the ESG (106 eyes), the single operation success rate was 94.3%, and the final success rate was 100%. In the ISG (110 eyes), the single operation success rate was 93.6%, and the final success rate was 100%. The difference in single surgery success rate between groups was not statistically significant (P = 0.828). The mean postoperative BCVA improvement was 0.348 decimal in the ESG and 0.405 decimal in the ISG (P = 0.234). The difference in complication rates between groups was not significant. Conclusions A 25 g PPV with gas tamponade for the treatment of RRD yields excellent anatomical results and improvement in best-corrected visual acuity (BCVA). With good technique and the use of modern vitrectomy machines and instruments, some inexperienced surgeons can achieve a high single-surgery success rate, suggesting a short learning curve. The complication rate is comparable between experienced and inexperienced surgeons.

A corneal stromal lenticule (CSL) is a part of the corneal stroma that forms as a waste product during the refractive surgery ReLEx SMILE (Small Incision Lenticule Extraction) and is no longer used. With the increasing number of ReLEx SMILE procedures and the number of potentially available CSLs, two main aspects of their usage are currently being investigated. The first aspect includes the biological properties of CSLs and their proper preservation with respect to long-term storage. The second aspect is related to the potential clinical use of CSLs. As a high-quality biomaterial, CSLs have substantial potential to be used for alternative solutions in the treatment of specific eye diseases. In a number of studies it has been shown that RSL transplantation could be a safe and effective method that does not cause any serious complications, for example in terms of immune reaction. The aim of this article is to present an overview of the possibilities for using CSLs for transplantation purposes, and at the same time to discuss our methodology for processing and preserving CSLs with the protocol used at the Eye Tissue Bank of the Královské Vinohrady University Hospital.

AIM:Retinal detachment is an acute sight-threatening condition that requires immediate surgical intervention. The aim of this study is to compare the outcomes of pars plana vitrectomy (PPV) for uncomplicated rhegmatogenous retinal detachment (RRD) between the different types of gases used, the position, and the number of tears. MATERIAL AND METHODS:This is a retrospective non-randomized comparative study of patients with uncomplicated RRD treated at the Department of Ophthalmology from March 2018 to April 2021 using PPV. A total of 494 evaluated eyes were included in the study. The anatomical success of the surgery was monitored with regard to the extent of retinal detachment, the number and position of tears, and the tamponade used. RESULTS:The success rate of retinal reattachment with a single operation was 90.7% (448 eyes), and the final anatomical success rate was 100%. A very weak paired relationship was found between the success of the surgery for tears in the 4-8 hours region and the 9-3 hours region (89.1% vs. 92%). Similarly, no significant differences were observed between procedures using SF6 and C3F8 gases for RRD with a tear in the 4-8 hours region (success rate 93.4% for SF6 vs. 89.1% for C3F8). The average postoperative improvement of best corrected visual acuity was 29.6 ETDRS letters, and a gain of 15 letters was recorded in 55.1% (272 eyes). Overall, the complication rate was very low. CONCLUSION:PPV is a safe and effective method for treating RRD. Extensive experience with this method allows the use of short-acting tamponades in selected patients.

PurposeThe purpose of the study is to evaluate the effectiveness, surgical preoperative and postoperative complications, histopathological findings, and optimize surgical technique after implantation of the new nanofiber glaucoma drainage implant (GDI).MethodImplantation of the GDI, a unique nanofiber drainage device fabricated from polyvinylidene fluoride (PVDF) using the well-established electrospinning technology on the Nanospider™ platform, was first optimized in vitro on cadaver porcine bulbs before the initial in vivo implantations. PVDF was selected due to its favorable properties, including biocompatibility, anti-adhesive behavior, and mechanical stability, which are particularly advantageous in minimizing fibroblast colonization and fibrotic encapsulation. The Nanospider™ technology allows for reproducible, large-scale fabrication of nanofiber materials with controlled fiber morphology, which ensures uniformity and precision of implant dimensions. An in vivo study on 28 normotensive eyes from 14 laboratory New Zealand White rabbits was conducted. There were two groups of animals: the study group (14 eyes) and the control group (14 contralateral eyes). The study group underwent implantation of the new nanofiber GDI; the control group did not undergo any surgical procedure. Intraocular pressure (IOP) was measured preoperatively and at regular times postoperatively (Tono-Pen AVIA®). Preoperative and immediate postoperative complications were monitored. Histological quantification was performed using unbiased sampling and stereological methods to assess leukocyte infiltration, type I and type III collagen fractions, and both absolute and relative levels of inflammation.ResultsBased on the previous results and in vitro surgical experiences, the implant was narrowed to 2.0 mm, a thickness of 100 µm was chosen, and the implant was fixed with two scleral stitches to maintain its position. No serious preoperative complications occurred during in vivo experiments. There was one extrusion of the glaucoma implant noted after surgery, likely due to insufficient conjunctival fixation. This animal was excluded from both the study and the control groups. No serious instances of intraocular hypotension were observed after surgery. All animals tolerated the surgical procedure well, and the postoperative period was without any serious issues. In the study group, the average preoperative IOP was 13.6 mmHg (±4.1, n = 13). The average postoperative IOP on the first day, one, two, and three weeks, and one month after surgery decreased to 8.8 mmHg (±3.3, n = 13), 9.8 mmHg (±2.0, n = 13), 10.3 mmHg (±3.6, n = 13), 10.2 mmHg (±2.6, n = 13), and 9.7 mmHg (±2.0, n = 13), respectively. In the control group of contralateral eyes, the average preoperative IOP was 11.42 mmHg (±4.2, n = 13). The average postoperative IOP was 11.8 mmHg (±5.4, n = 13), 14.2 mmHg (±4.6, n = 13), 14.5 mmHg (±3.4, n = 13), 14.0 mmHg (±3.8, n = 13), and 14.2 mmHg (±2.4, n = 13), respectively, at the same follow-ups. In the study group, the IOP was statistically significantly lower by 29% at the end of the follow-up compared to the preoperative measurements (p = 0.009). Eyes with the implant showed greater leukocyte infiltration and less type I collagen compared to the group without implants. The ratio of type I to type III collagen was lower in the implant group, indicating delayed maturation and weaker connective tissue during early healing.ConclusionFor easier implantation, minor technical adjustments such as implant narrowing and scleral fixation of the GDI were developed and tested using in vitro experiments. In vivo implantation of unique nanofiber GDI appeared safe and technically well-suited for our study. No serious perioperative or postoperative complications were observed. There was one scleral extrusion of the device, which was, in our opinion, caused by insufficient conjunctival fixation. A statistically significant IOP reduction was achieved at the end of the follow-up in the study group with implanted GDIs. Further studies on the effectiveness of the implant with longer monitoring periods, together with other surgical options such as combined cataract surgery and nanofibers GDI, are needed.

AIM: To compare the 12-month outcomes of visual performance and patient satisfaction of a higher-order aspheric monofocal intraocular lens (IOL) and a conventional monofocal IOL. METHODS: Prospective, randomized, comparative, double-blinded study including 22 patients who underwent bilateral cataract surgery with implantation of the Tecnis Eyhance ICB00 IOL in one eye (ICB00 group) and the Tecnis ZCB00 IOL in the fellow eye (ZCB00 group). Uncorrected distance (UDVA), corrected distance (CDVA), uncorrected intermediate (UIVA), distance-corrected intermediate (DCIVA), uncorrected near (UNVA), and distance-corrected near visual acuities (DCNVA) were evaluated during a 12-month follow-up. Contrast sensitivity, defocus curves, and reading text size were also evaluated. Patient satisfaction was assessed with a questionnaire at the 6-month postoperative visit. RESULTS: Mean postoperative logMAR UDVA was 0.01±0.12 and -0.02±0.10 in ICB00 and ZCB00 groups, respectively (P=0.37). Mean logMAR UIVA was 0.32±0.19 and 0.45±0.16 in ICB00 and ZCB00 groups, respectively (P=0.010). Differences between groups in UNVA did not reach statistical significance (P=0.16). The intermediate reading acuity at 66 cm (P=0.02) and 80 cm (P=0.04) was significantly better in the ICB00 group. Postoperative contrast sensitivity results did not differ significantly between groups (P>0.05). Patients reported high overall satisfaction, with 62% of patients using spectacles for reading in everyday life. CONCLUSION: The eyes of patients implanted with the enhanced monofocal IOL evaluated have significantly better visual acuity for intermediate distances with the same contrast sensitivity as a conventional monofocal IOL.

Background : Scleral fixation of intraocular lenses is a surgical technique that involves anchoring an artificial lens to the sclera. Traditional approaches, such as capsular bag placement, may not be feasible in certain situations, making scleral fixation a valuable alternative. The scleral reactions to different types of suture materials are not fully understood. Therefore, the present study describes the microscopic structure of normal scleral tissue and its changes with suture materials. Methods : We compared six groups of rabbit eyes focusing on the sclera: group with polytetrafluoroethylene( PTFE) chain, PTFE fiber, polypropylene( PPE) fiber and control groups. multilevel sampling and stereological methods were used for histological quantification of the leukocyte infiltration fractions and type Ⅰ and type Ⅲ collagen. Results : Quantitative histological evaluation revealed the following:(1) For all materials used, inflammation was present in the surrounding scleral tissue compared with healthy controls. However, leukocyte infiltration in the sclera was not statistically different between the materials.(2) As part of the evaluation of collagen, the greatest changes occurred in the PTFE fiber group at 2 weeks postoperatively. In the PTFE chain group, more significant changes were visible at 4 weeks.(3) The changes in the PPE fiber group compared to healthy scleral tissue were the least significant. Conclusions : From a histological point of view, it is evident that there are differences in the quantitative parameters between the untouched sclera and the sclera with suture material. Furthermore, distinctions were observed among various materials and across different time intervals.

PURPOSE:This review provides an outcome-oriented, comprehensive summary of published works on the topic of repurposing the anterior lens capsule (ALC) in various subfields of ophthalmic surgery. Covering a broad spectrum of studies ranging from pre-clinical experiments on animal models to blinded prospective clinical trials involving patients. MATERIALS AND METHODS:National Institute of Health (NIH) and COCHRANE libraries were comprehensively searched for published works covering the topic of ALC utilization in corneal, retinal, and glaucoma surgical procedures. Studies covering the topic of ALC use unrelated to ophthalmic surgical trials were excluded. A total of 15 studies were included based on the search criteria. Patient follow-up was limited to 18 months. Primary and secondary post-surgical outcomes were evaluated to assess the surgical effectiveness and complication risk of ALC use compared to alternative surgical techniques. RESULTS:ALC is a viable ophthalmic tissue for prospective use in ophthalmic surgery. Despite the limited number of studies conducted on the topic, the results presented have shown promise. Three studies demonstrated superior post-surgical outcomes in ALC-utilizing procedures compared to other ophthalmologic interventions. Remaining studies included in this review have demonstrated potential equivalence of outcomes after ALC-utilizing surgeries to established surgical methods without presenting new limitations and complications. CONCLUSIONS:ALC is an abundant, routinely discarded tissue during cataract surgery. It possesses unique properties of acellularity, optical transparency, and immunologic nativity to the human eye, which enables it to be an excellent donor tissue for ophthalmic surgeries ranging from corneal defect management to prolonging the longevity of anti-glaucoma filtering blebs. The use of ALC autografts in ophthalmic surgery allows for augmentation of standard procedures in phakic patients, delivering satisfactory outcomes and potentially reducing costs. Further research into ALC collection, processing, and long-term storage is needed to enable ALC allograft use in pseudophakic and aphakic patients.

Précis: Deep sclerectomy (DS) with fibrin adhesive can constitute a safe alternative to the classic procedure using sutures, providing nonallergenic, nontoxic, and secure adhesion with no sign of aqueous humor outflow obstruction postoperatively. Objective: To evaluate short and medium-term postoperative results of DS with a fibrin sealant. Patients and Methods: This prospective, noncomparative, interventional case series involves 12 eyes of 12 patients with uncontrolled open angle glaucoma who underwent DS with Esnoper (Clip or V2000) implant between February 2021 and March 2022. A novel method of wound closure (sclera, Tenon fascia, and conjunctiva) employing fibrin glue was used instead of classic sutures. Surgical outcomes assessed include: intraocular pressure and glaucoma therapy reduction, best-corrected visual acuity changes, and number of complications registered peri and postoperatively. All measurements were performed preoperatively, as well as at 1 day, at 1 and 2 weeks, and at 1, 2, 3, 6, 9, and 12 months after surgery. Results: The mean intraocular pressure decreased from 24.0 ± 9.1 mm Hg to 13.8 ± 6.3 mm Hg at 1 year postoperatively (P < 0.001). Kaplan-Meier survival analysis revealed complete and qualified success rates of 83.3% and 91.7%. The mean glaucoma therapy decreased from 3.2 ± 1.1 to 0.8 ± 1.3 drugs 12 months after surgery (P < 0.001). Nd:YAG goniopunture was performed in 2 eyes at 1 and 12 months postoperatively. No significant best-corrected visual acuity changes were registered. Perioperatively, we noted a trabeculo-descemet microperforation in 1 eye, transient hypotony in 5 eyes, and mild hyphema in 2 eyes. Conclusions: Fibrin adhesive provided an effective closure in sutureless DS in the patients included in our study. This modification of classical DS may simplify the surgical technique, ensure secure wound adaptation, optimize healing, and lower the risk of inflammation and fibrosis postoperatively.

Ultrathin electrospun poly(l-lactide-co-dl-lactide) nanofibrous membranes coated with fibronectin were explored as scaffolds for the ex vivo cultivation of limbal epithelial cells (LECs) for the treatment of limbal stem cell deficiency. The developed scaffolds were compared with the “gold-standard” fibrin gel. The resulting membranes composed of nanofibers possessed a very low thickness of 4 μm and allowed very good optical transparency in the wet state. The fibronectin-coated nanofibrous scaffolds demonstrated LEC expansion and successful cultivation similar to that on fibrin gel. Unlike the regular cobblestone epithelial cell morphology on the fibrin gel, the nanofibrous scaffold presented a mostly irregular epithelial morphology with a shift to a mesenchymal phenotype, as confirmed by the upregulation of profibroblastic genes: ACTA2 (p = 0.023), FBLN1 (p < 0.001), and THY1 (p < 0.001). Both culture conditions revealed comparable expression of stem cell markers, including KLF4, ΔNp63α and ABCG2, emphasizing the promise of polylactide-based nanofibrous membranes for further investigations.