To log in, click the teal "Login" button in the upper right-hand corner of this page. If you are logged in but still do not have access, please check your 2026 Annual Meeting registration.
Moderator
Kapil Mishra, MD
Panelists
Naveen K. Rao, MD, ABO; Elmer Y. Tu, MD, ABO
Viewing Papers
Expand a paper title to the right to view the paper abstract and authors. Use the video link to jump to that poster in the session.
Presenting Author
Faruk Semiz, MD
Co-Authors
Ceren Ece Semiz (MD), Fetih Furkan Arslan (MD), Njomza H (MD)
Purpose
To evaluate the long-term outcomes of customized fresh lenticule transplantation as an alternative surgical method for corneal reorganization and stability in patients with herpetic keratitis scarring.
Methods
This retrospective, non-randomized study included 23 eyes (21-46 years) with uni- or multifocal herpetic stromal scarring. Eligibility required age >18, CDVA >0.4 logMAR, no recurrence in 6 months, and informed consent; exclusions were active infection, CDVA <0.4, or CCT <400 µm. Scar thickness was measured by AS-OCT, excised with the SMILE module, and replaced with a SMILE-derived fresh lenticule (mean 66.74 µm, -3.34 ± 1.40 D) via a 130-µm intrastromal pocket, matched to corneal topography. All patients were followed for 3 years. Follow-up evaluations included UDVA, CDVA, slit-lamp biomicroscopy, corneal topography, pachymetry, and AS-OCT.
Results
No cases of recurrent herpetic keratitis or graft rejection were observed, while significant improvements were achieved in UDVA (0.91 ± 0.14 to 0.31 ± 0.06 logMAR, p < 0.001), CDVA (0.58 ± 0.09 to 0.16 ± 0.05 logMAR, p < 0.001), CCT (444.13 ± 16.55 µm to 508.35 ± 7.09 µm, p < 0.001), K1 (39.01 ± 2.36 D to 42.61 ± 1.17 D, p < 0.001), K2 (43.50 ± 2.52 D to 44.09 ± 1.17 D, p < 0.001), and Q-value (?0.47 ± 0.07 to ?0.73 ± 0.08, p < 0.001) at 3 years.
Conclusion
At 3 years, customized fresh stromal lenticule transplantation effective in strengthening the cornea, restoring clarity, and sustaining visual gains in herpetic scarring.
Presenting Author
Samar A. Alswailem, MD
Purpose
Severe microbial keratitis may lead to irreversible vision loss and eye removal, yet few studies have examined such cases. This study aims to characterize the clinical profile, microbial spectrum, and risk factors of microbial keratitis (MK) cases requiring evisceration or enucleation.
Methods
A retrospective review of 69 culture-positive MK cases managed with evisceration or enucleation from 2014 to 2022. Data on demographics, presentation, microbiology, and clinical course were collected.
Results
Most patients were male (63.8%) with a mean age of 64.6 years. Hypertension (44.9%) and diabetes (46.4%) were common comorbidities. Most eyes (81.2%) presented with no light perception. Commonly associated ocular conditions included pseudophakia (36.5%), glaucoma (35.7%), topical steroid use (12.4%), and vitrectomy (7.1%). Endophthalmitis or panophthalmitis occurred in 58% of cases. Streptococci (32.6%) and Staphylococcus (25.6%) were the most frequently isolated organisms. Penicillin resistance was seen in 32.6%, while 37.2% of isolates were sensitive to clindamycin.
Conclusion
MK requiring globe removal is associated with advanced disease, delayed presentation, and systemic comorbidities. Early intervention is critical to avoid irreversible outcomes.
Presenting Author
Jaron Sanchez, DO
Co-Authors
Mohammad Soleimani (MD)
Purpose
This study assesses the feasibility of deep learning (DL) to classify types of microbial keratitis-fungal keratitis (FK), Acanthamoeba keratitis (AK), and nonspecific keratitis (NSK) (any other corneal inflammation)-and subtyping of FK using in vivo confocal microscopy.
Methods
In this study, we employed transfer learning with a ResNet50 architecture to classify culture-confirmed keratitis types in a dataset of 1975 images (1137 FK, 457 AK, and 381 NSK) obtained from the Heidelberg Retinal Tomograph 3 (HRT 3). The dataset was split into training and testing sets. Data augmentation (e.g., rotation, zooming) was applied to the training subset to address class imbalance, and class weighting was used (5x for AK, 30x for NSK). Both models were trained for 150 epochs using the Adam optimizer with 5-fold cross-validation. Model 1 performed multi-class classification (FK, AK, NSK). Model 2 classified FK cases as either filamentous or non-filamentous.
Results
Model 1 achieved a macro average accuracy of 87% and a weighted average accuracy of 89 %. Precision and recall were high for AK (93%, 96%) and FK (90%, 92%), while NSK showed lower performance (78%, 71%). Model 2 demonstrated an accuracy of 85% in subtyping FK, with an F1-score of 0.81 for filamentous and 0.85 for non-filamentous, an ROC AUC of 0.94, and a PR AUC of 0.95.
Conclusion
DL models can accurately classify IK and subtype FK, enhancing diagnostic accuracy and informing targeted treatment strategies.
Presenting Author
Aafreen Bari, MD
Co-Authors
Tushar Agarwal (MD), Namrata Sharma (MD, FRCSEd, FRCOphth)
Purpose
To analyse the risk factors, clinical presentations, outcomes and microbiological profile of corneal graft infections from a tertiary eye centre.
Methods
Ambispective observational study at a tertiary eye centre in India from January 2023 to June 2025. The demographic details of cases with graft infections and their clinical characteristics were studied. The donor details and microbiological profile were also analyzed.
Results
Fifty-eight cases of optical keratoplasty were analyzed, including 44 penetrating, 7 anterior lamellar, and 7 endothelial keratoplasties. The median epithelial defect size was 4?�?4.5?mm�, and median infiltrate size was 2.5?�?2.95?mm� on presentation. Poor clinical response was observed in 34.4% cases undergoing fortified therapy. Additional surgical interventions were required in 53.4% cases. Graft infection was associated with loose sutures in 48.3% and concurrent topical steroid use in 74.1% of cases. Gram-positive cocci were the most frequently isolated pathogens. Small grafts were associated with bacterial infections (p?
Conclusion
Corneal graft infections were commonly linked to loose sutures, topical steroid use, and smaller graft sizes. Gram-positive cocci predominated, and over half of the cases required surgical intervention, underscoring the need for close postoperative surveillance.
Presenting Author
Despoina Karadimou, MD
Co-Authors
A. John Kanellopoulos (MD), Alexandros Kanellopoulos (MD), Filippos Vingopoulos (MD)
Purpose
To evaluate the safety and efficacy of therapeutic custom surface excimer ablations designed to address corneal scars from infections related to contact lens use.
Methods
7 cases of CLR corneal scarring, due to infection, were treated with a surface excimer laser transepithelial ablation in order to remove the scar tissue and normalize the refractive power of the cornea, using a topography-guided customization platform (Alcon/Wavelight, Erlagen, Germany)
Results
At 3 months postoperatively, significantly improved corneal transparency was noted in all cases, CDVA improved from a mean of 20/50 to 20/30. UDVA changed from 20/200 to 20/40. A keratoplasty procedure was avoided in all cases.
Conclusion
Customized excimer laser ablations can offer significant therapeutic improvement in vision in challenging cases of eyes with CLR corneal scars due to previous infection. They may be considered as an alternative to lamellar and or penetrating keratoplasty.
Presenting Author
Yash A Gulani, BA
Co-Authors
Aaishwariya Gulani (MD), Arun Gulani (MD)
Purpose
To evaluate unaided visual outcomes in patients with Herpetic corneal scarring treated with LaZrPlastique, an Excimer laser surface-ablative technique with a refractive approach.
Methods
This retrospective study analyzed 11 eyes (11 patients) with herpetic corneal scars treated at a single center with LaZrPlastique. All patients had preoperative, day-1 postoperative, and most recent follow-up data. Parameters included manifest refraction, uncorrected and best-corrected visual acuity (BCVA), pachymetry, and corneal topography. Outcomes were assessed for unaided visual rehabilitation.
Results
Eleven eyes from 11 patients (2 female, 9 male) were included. The mean preoperative pachymetry was 484.62 µm (SD ± 78.28). Preoperatively, mean uncorrected visual acuity was LogMAR 0.59 (SD ± 0.17) with a mean Se of -0.54 (SD ± 1.90).. On postoperative day 1, mean uncorrected visual acuity improved to LogMAR 0.34 (SD ± 0.20). On average, most recent follow-up was 49.6 months, and the average uncorrected visual acuity was LogMAR 0.10.
Conclusion
LaZrPlastique achieved rapid and durable improvement in unaided visual acuity for herpetic corneal scars. This least-interventional, refractive-based approach represents a safe, and effective, alternative to corneal transplants for visual rehabilitation and long term stability in this challenging population.
Presenting Author
Amber Y Kwon, BA
Co-Authors
Daniel Lee (BSc), Josephine Lu (BSc), Jose Giraldo (MD), Olivia Lee (MD)
Purpose
This study investigates the use of in vivo confocal microscopy (IVCM) features at the time of Acanthamoeba keratitis (AK) diagnosis to serve as predictors of disease severity, complications and clinical outcomes.
Methods
This retrospective study included 13 eyes from 12 patients with confirmed Acanthamoeba cysts on in IVCM. IVCM images of the cornea were manually graded for cyst depth and density in the central cornea and available peripheral quadrants by an investigator masked to clinical outcomes. A retrospective review of medical records was performed by an investigator masked to IVCM images; treatment duration until resolution, best-corrected visual acuity at resolution, and need for keratoplasty or other surgery was collected. Statistical analysis included Spearman correlations for continuous variables and Mann-Whitney U tests for binary outcomes.
Results
In 13 eyes, mean cyst depth was 222 ± 231 µm (range 37-750), mean cyst density 51 ± 55 cells/mm� (range 7-213), and 2.2 ± 1.0 quadrants were affected (range 1-5). Higher cyst density correlated with worse final visual acuity (? = 0.58, p = 0.046). No significant correlations were found for cyst depth or quadrants affected. Eyes requiring keratoplasty had higher median cyst depth (213 vs 72 µm) and density (62 vs 20 cells/mm�); only density showed a trend toward significance (p = 0.087).
Conclusion
Higher initial cyst density on IVCM may predict worse final visual acuity in eyes with AK, while cyst depth and number of affected quadrants were not significantly associated with clinical outcomes. These findings suggest that early IVCM quantification of cyst density could help inform prognosis and guide management.
Presenting Author
Krish V. Shah, BA
Co-Authors
Ahmed Omar (MD, PhD)
Purpose
To determine whether systemic biologic therapy is associated with risk of herpetic keratitis in patients with autoimmune disease compared with conventional immunosuppressants, and to evaluate if findings were consistent across broader herpesviral ocular disease definitions.
Methods
A retrospective cohort study was conducted using a U.S. federated electronic health record network. Adults with autoimmune disease (rheumatoid arthritis, psoriasis, IBD, or ankylosing spondylitis) initiating systemic therapy were included, and patients with prior herpetic keratitis were excluded. Biologics included TNF-?, JAK, and IL-17/23 inhibitors. Conventional agents included methotrexate, azathioprine, and mycophenolate. Cohorts were propensity score-matched for demographics and comorbidities. Outcomes included herpetic keratitis (B00.52), broader herpesviral ocular disease (B00.5), and a combined keratitis definition (B00.52/H16.32). Cox proportional hazards models were performed.
Results
After matching, 259,633 patients per cohort were analyzed. Biologic therapy was associated with a significantly lower risk of herpetic keratitis, with 171 cases (0.07%) compared with 226 cases (0.09%) on conventional therapy (RR 0.76, p = 0.005). Cox modeling suggested a similar but nonsignificant protective trend (p = 0.14). For herpesviral ocular disease, biologics were associated with fewer cases (215 vs 298; 0.08% vs 0.12%), with a consistent reduction that was significant in both matched analysis (RR 0.72, p < 0.001) and Cox modeling (p = 0.03). A combined keratitis definition also demonstrated significantly reduced risk (p = 0.005).
Conclusion
Biologic therapy was associated with reduced risk of herpetic keratitis in patients with autoimmune disease. Broader ocular HSV outcomes confirmed significance, reinforcing a potential protective effect. As HSV keratitis predisposes patients to corneal scarring and keratoplasty, findings may influence therapeutic decision-making and surgical care.
Presenting Author
Ayça Bulut Ustael, MD
Co-Authors
Emine Esra Karaca (MD), Ozlem Evren Kemer (MD), Yonca Asfuro?lu (MD, FEBO), DÖndü Melek Ulusoy (MD)
Purpose
The aim of this study was to report the clinical and microbiological profile of patients with microbial keratitis after standard corneal collagen cross-linking (CXL).
Methods
A retrospective case series of all patients diagnosed with microbial keratitis after CXL who attended Ankara Numune Training and Research Hospital and Ankara Bilkent City Hospital, Turkey, between January 2017 and May 2025 was included. Out of a total of 1206 patients who underwent CXL during this period, those who developed keratitis were identified using hospital coding and pathology databases. Clinical data, including demographics, age at CXL, symptom onset, microbial etiology, treatment, and visual outcomes, were extracted from medical records.
Results
Seven patients (0.58%) developed microbial keratitis after 1206 CXL procedures. The mean age was 25 years, with four males and three females; two had comorbidities, psoriasis and anxiety disorder. Symptoms began 2-14 days after CXL. Pathogens were Microsporidium in two, Staphylococcus aureus in two, herpes simplex virus in two, and Acanthamoeba in one. Both Microsporidium cases failed therapy; one had penetrating keratoplasty with stable vision, the other deep anterior lamellar keratoplasty with improved vision. The remaining five responded to therapy but healed with stromal haze; vision decreased in three and stable in two. Mean best-corrected visual acuity fell from 0.28 to 0.41 logMAR.
Conclusion
Infectious keratitis after epithelium-off CXL is uncommon but may lead to visual morbidity. Most cases in our series healed with stromal haze and some degree of visual reduction. Careful postoperative monitoring and early targeted treatment remain essential to optimize visual outcomes.
Presenting Author
As?m Burak Gündüz, MD
Co-Authors
Yonca Asfuro?lu (MD, FEBO), Emine Esra Karaca (MD), Ozlem Evren Kemer (MD)
Purpose
Infectious corneal ulcers are severe ocular infections causing potential vision loss. Early diagnosis and proper management improve outcomes. Amniotic membrane transplantation (AMT) is used as an adjunct for infection control and corneal healing. We evaluated etiological factors, clinical course, and responses in AMT-treated infectious keratitis.
Methods
Seventy-seven patients diagnosed with infectious corneal ulcer and treated with AMT over the past 5 years at the Cornea Unit of Ankara Bilkent City Hospital were retrospectively analyzed. Demographic and clinical characteristics, risk factors, etiological agents, management strategies, outcomes and complications are evaluated.
Results
Microbiological analysis revealed pathogens in 40 patients: 13 fungal (Aspergillus, Candida, Fusarium), 9 viral (Herpes simplex), 6 Acanthamoeba, and 12 bacterial (Staphylococcus aureus, Pseudomonas, Proteus, Klebsiella, Serratia, Streptococcus). Vegetative trauma history was noted in 5 fungal cases, which had higher intrastromal injection rates (p=0.02). AMT was performed on average 3.02 ± 0.48 days after presentation, with 1.88 ± 1.29 applications, remaining 17.87 ± 14 days. Complete healing occurred in 46 eyes (59.7%), while 31 (40.3%) required patch grafting or keratoplasty. Hypopyon significantly correlated with greater keratoplasty need and prolonged hospitalization (p=0.009, p=0.001).
Conclusion
Clinical course and risk factors were crucial when microbiological diagnosis was limited. AMT controlled infection and preserved corneal structure, reinforcing its therapeutic role in severe infectious keratitis. Hypopyon was a key prognostic marker, associated with poorer outcomes and longer hospitalization.
Presenting Author
Ramy A Elbassiouny, MD, PhD, MRCSEd
Purpose
To assess a novel bacteriophage-loaded in-situ gelling formulation as treatment for Pseudomonas aeruginosa keratitis in a rabbit model, evaluating antimicrobial efficacy, ocular retention, and clinical outcomes versus conventional antibiotic therapy.
Methods
A lytic phage (vB_Pa_ZCPS1) was incorporated into a Pluronic F-127/HPMC K4M gel. Forty New Zealand white rabbits were randomized to four groups: uninfected controls, infected untreated controls, infected rabbits treated with imipenem/cilastatin, and infected rabbits treated with the phage gel. Clinical scores, corneal opacity, ulcer size, microbiology, and histopathology were assessed over 12 days.
Results
Phage-treated eyes showed significant reductions in corneal signs and ulcer size versus untreated infected controls, with intact epithelium and less inflammation on histology. Clinical scores were comparable to the antibiotic group, while corneal architecture was better preserved. No significant intraocular pressure changes occurred.
Conclusion
Bacteriophage in-situ gel achieved sustained ocular retention and effective infection control, providing an antibiotic-sparing alternative for P. aeruginosa keratitis and supporting further translational studies.
