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Moderator
Thomas John, MD, ABO
Panelists
Elmer Y. Tu, MD, ABO; Zachary J. Zavodni, 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
Michael A Bednar, BSc
Co-Authors
Thomas Dohlman (MD), Mark Krauthammer (MD, MBA), Antonio Esquivel Herrera (MD), Euna Lee (BSc), Abby Frenkel (BSc), Eleftherios Paschalis (PhD, MSc)
Purpose
To compare long-term clinical outcomes of Type 1 Boston Keratoprosthesis (B-KPro) devices with polymethylmethacrylate (PMMA) versus titanium (Ti) backplates in a diagnosis-matched cohort, with a focus on device retention, complication rates, and visual acuity.
Methods
A single-center, retrospective review was conducted on 522 eyes that underwent B-KPro implantation at Massachusetts Eye and Ear. 41 eyes with PMMA backplates were randomly selected and diagnosis-matched to 41 eyes with Ti backplates. Clinical data collected included: demographics, ocular history, surgical details, complications, glaucoma status, and visual acuity. Kaplan-Meier survival analysis was used to estimate five-year retention and complication rates. Incidence rates per 100 eye-years were calculated to account for differences in follow-up duration. Visual acuity was reported as Snellen and converted to logMAR scores.
Results
Each group had 41 eyes with mean follow-up of 156.4 ± 76.6 months (518.3 eye-years, PMMA) and 135.5 ± 61.8 months (454.8 eye-years, Ti). Device explantation incidence was 2.12 (PMMA) vs. 1.76 (Ti) per 100 eye-years (p=0.72). RPM was most common (4.37 (PMMA) vs. 4.31 (Ti); p=0.98). Endophthalmitis (1.16 (PMMA) vs. 0.66 (Ti); p=0.25) and sterile vitritis (0.95 (PMMA) vs. 0.44 (Ti); p=0.28) trended lower with titanium. Visual outcomes improved substantially in both groups, with 29.3% (12/41) of Ti and 19.5% (8/41) of PMMA eyes achieving 20/40 or better (p = 0.304). At last follow-up, 43.3% (13/30) of Ti and 50% (15/30) of PMMA eyes maintained 20/200 or better (p = 0.692).
Conclusion
Titanium and PMMA backplates for the B-KPro provide comparable outcomes. The eyes with a Ti backplate demonstrated a trend toward fewer complications and slightly better visual outcomes, though these differences were not statistically significant.
Presenting Author
John W Josephson, MD
Co-Authors
Karanveer Saini (BA)
Purpose
To evaluate improvement in uncorrected visual acuity (UCVA) following Corneal Tissue Addition Keratoplasty (CTAK) in patients with mild, moderate, and severe keratoconus at 1, 3, and 6 months postoperatively.
Methods
A retrospective analysis will be performed on 55 eyes with keratoconus of varying severity who underwent CTAK in an office-based surgery setting. UCVA was measured preoperatively and at 1, 3, and 6 months postoperatively. Eyes were categorized into mild, moderate, and severe keratoconus based on preoperative keratometry and topography. Statistical analysis will be performed to evaluate UCVA improvement in terms of lines gained, comparing preoperative and postoperative values across the different severity groups.
Results
Across all severity levels, UCVA demonstrated significant improvement by 1 month, with minimal downtime after the procedure. Statistical analysis will compare preoperative and postoperative UCVA, quantifying lines of improvement across mild, moderate, and severe groups. The degree of effectiveness is anticipated to vary among severity stages. Statistical analysis is currently underway for the paper.
Conclusion
CTAK has shown to significantly improve UCVA in patients with keratoconus, with the convenience of being offered in an OBS setting as a minimally invasive procedure. The rapid improvement in vision and healing process makes CTAK a practical option for early management of keratoconus to help prevent the need for major surgical intervention later.
Presenting Author
Sujin Kang, MD
Co-Authors
Ellen Koo (MD), Rahul Tonk (MD, MBA), Guillermo Amescua (MD), Sonia Yoo (MD)
Purpose
To evaluate the clinical outcomes and effectiveness of CTAK, a novel technique using customized femtosecond laser-assisted tissue preparation and channel formation, in improving visual acuity, refractive status, and keratometric outcomes in patients with keratoconus.
Methods
A retrospective study reviewed clinical records and Pantacam Scheimpflug tomography results of 20 eyes of 19 patients (31.16±14.83 years, 63.2% male, 42.1% Black, 31.6% White, 26.3% Hispanic) who underwent CTAK for keratoconus treatment. Outcomes assessed included uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), sphere, cylinder, mean refractive spherical equivalent (MRSE), keratometry readings (K1, K2, Km, Kmax), corneal asphericity (Q-value, 8 mm), thinnest corneal thickness, and minimus radius of curvature (Rmin, 8 mm). Data from preoperative to postoperative intervals (2-3 months) were analyzed using paired t-tests or wilcoxon signed rank tests.
Results
Significant improvements post-CTAK were observed in UDVA (?=-0.35 logMAR, p=0.001), CDVA (?=-0.25 logMAR, p=0.008), sphere (?=4.99 D, p=0.012), MRSE (?=4.88 D, p=0.008), K1 (?=-7.89 D, p<0.001), K2 (?=-8.59 D, p<0.001), Km (?=-8.27 D, p<0.001), Kmax (?=-3.79D, p=0.012), Q-value (-1.29 to -0.31, ?=0.99, p=0.001), and Rmin (?=0.31, p=0.004). Cylinder (?=-0.21 D, p=0.758) and thinnest corneal thickness (?=2.70 µm, p=0.380) showed improvement trends without reaching statistical significance.
Conclusion
The CTAK procedure significantly enhances visual acuity, reduces refractive error, and improves corneal curvature and aspherity, offering a promising, biocompatible therapeutic option tailored for the refractive and morphological rehabilitation of keratoconus patients.
Presenting Author
Mais Alkilany, MD, MRCSEd
Co-Authors
Amal Alwreikat (MD, FRCS)
Purpose
To present a rare case of surgical induced necrotizing scleritis (SINS) following wide local excision of conjunctival malignant melanoma and subsequent ocular surface reconstruction.
Methods
A 70-year-old female with diabetes mellitus and hypertension underwent wide local excision of a superficial spreading conjunctival malignant melanoma with free margins using the no-touch technique. Adjunctive procedures included lamellar sclerectomy, double cycle cryotherapy, and mitomycin-C application. The patient later presented with temporal corneal edema, scleral necrosis, fluorescein staining, and anterior chamber inflammation. Laboratory investigations including AC tap, PCR for HSV/VZV/CMV, and systemic autoimmune workup were negative.
Results
The patient experienced corneoscleral perforation despite medical management with antivirals, doxycycline, and vitamin C. She subsequently underwent sclerokeratoplasty combined with tenonoplasty and amniotic membrane grafting. Postoperative course demonstrated restoration of ocular integrity. Final diagnosis was SINS, a rare but severe complication of ocular surgery, most commonly associated with cataract, pterygium, or retinal procedures, and occasionally linked to systemic disease.
Conclusion
SINS is a vision- and globe-threatening surgical complication requiring early recognition, systemic immunosuppression, and surgical intervention to restore ocular integrity. Prompt exclusion of infectious and autoimmune causes is critical. Bringing vascularized tissue to the ischemic scleral bed is essential for surgical success.
Presenting Author
Michael Mimouni, MD
Co-Authors
David Zadok (MD), Eitan Livny (MD), Lior Rosenberg Belmaker (PhD), Amos Eitan (BEng), Yishay Hayardeni (BEng)
Purpose
To describe our initial experience with first-in-human transplantation of the Precise Vision Endothelial Keratoplasty (PVEK) implant for the treatment of corneal edema due to endothelial dysfunction.
Methods
Consecutive patients with corneal edema secondary to endothelial cell loss underwent PVEK implantation using a Descemet Membrane Endothelial Keratoplasty (DMEK)-like surgical technique. The PVEK implant consists of a collagen-based scaffold seeded with allogeneic human corneal endothelial cells. Postoperative assessment included slit-lamp biomicroscopy, corneal thickness measurements, visual acuity, intraocular pressure, and monitoring for adverse events.
Results
Three eyes underwent PVEK implantation with follow-up ranging from 2 weeks to 3 months. In the first patient (3-month follow-up), central graft attachment was maintained following rebubbling, with normalization of central corneal thickness (≈475–485 µm) and improvement in best-corrected visual acuity to 0.5–0.6 (decimal). Two additional patients were recently transplanted, are currently in close follow up. For all three patients no serious adverse events, uncontrolled intraocular pressure, or primary graft failures were observed to date.
Conclusion
First-in-human PVEK implantation appears surgically feasible and capable of achieving sustained central graft attachment and corneal deturgescence at 3 months.To date,no serious adverse events or primary graft failures were observed.Further followup and additional cases are needed to evaluate longterm endothelial function,safety,and reproducibility
Presenting Author
Ruth Lapid-Gortzak, MD, PhD
Co-Authors
Mor Dickman (MD)
Purpose
To report the outcomes of a cohort of patients implanted with the EndoArt (EyeYon Medical). The EndoArt is an acrylic 6.5 mm dome shaped endothelial implant that is used to replace the endothelium in case of cornea endothelial edema or failure. The implant has a barrier function and reduces the stromal edema resulting from endothelial dysfunction.
Methods
Consecutive longitudinal interventional case cohort of eyes implanted with the EndoArt Corneal endothelial artificial implant. Outcome measures: successful adherence, rebubble rates, and suturing, visual acuity, intraocular pressure (IOP), VAS pain score, central corneal thickness(CCT), and change in corneal thickness, central corneal clarity, pre to postop, concurrent eye diseases, and side effects.
Results
In 19 eyes the EndoArt was implanted for corneal endothelial decompensation and edema. All eyes had complex corneal and ocular pathology. In terms of adherence: 18/19 were successfully attached, rebubble rates were 1.68 (SD 1.45), average # of sutures used: 3.16 (SD 2.52), mean DCVA improved from logMAR 1.99, to 1.31 logMAR. IOP was normal in all eyes, Mean Painscore decreased from 7 to 1.6 postop (P<0.001), CCT from 854 (SD 188) preop to 645 (SD 237) at last postop visit, all corneas were centrally clear post. All eyes had ocular comorbidity. Adverse events included 1 CME, 1 epithelial fibrosis, and 2 late failures.
Conclusion
In selected cases of complex corneal and ocular comorbid pathology the EndoArt achieves a reduction in central corneal thickness, decreased pain scores, increased visual acuities. In the Dutch environment the EndoArt is reserved as a treatment option when donor tissue is considered high risk. More study is needed.
Presenting Author
Itay Lavy, MD
Co-Authors
Benjamin Stern (MD), Nadav Shemesh (MD, MHA), David Smadja (MD)
Purpose
To report the outcomes of a novel artificial endothelial replacement membrane implant for treating corneal edema in patients with multiple prior graft rejections, making them less suitable for repeat live donor keratoplasty.
Methods
13 patients with chronic corneal edema and a history of multiple graft rejections underwent implantation of an artificial endothelial replacement membrane (EndoArt, EyeYon Medical, Israel) in eyes after penetrating keratoplasty. The implant was secured to the posterior corneal surface using an air-gas bubble and CU-5 nylon sutures. Outcome measures included corrected distance visual acuity (logMAR), central corneal thickness, and device-related complications.
Results
At 3-24 months postoperatively, the membrane was well-centered and adherent, with improved corneal transparency in 11 patients. Corrected distance visual acuity (logMAR) improved from 2.3 to 1.0, and central corneal thickness decreased from 740 µm to 580 µm. One patient developed infectious keratitis, and another required reimplantation. 2 patients underwent retrocorneal fibrous membrane removal. Most patients needed multiple air-gas bubble or viscoelastic injections and sutures for adhesion. No severe complications occurred, and all patients reported reduced ocular pain.
Conclusion
Synthetic endothelial replacement membrane implantation enhances corneal clarity and vision in patients with failed PK and multiple graft rejections, unsuitable for repeat donor keratoplasty. No major implant-related issues were observed. This novel method shows promise for treating corneal edema in complex, high-risk cases.
Presenting Author
Amir Abd Elkader, MD
Co-Authors
Eitan Livny (MD), Yoav Nahum (MD), Irit Bahar (MD, MHA)
Purpose
To evaluate the impact of systemic chemotherapy on donor corneal endothelial cell density, comparing grafts from chemotherapy-exposed subjects with non-exposed controls, and to identify demographic and clinical factors influencing ECD in this cohort.
Methods
This retrospective study analyzed 960 donor corneas (2013-2023). Endothelial cell density was measured by specular microscopy. Donors with systemic chemotherapy exposure (n=337) were compared with age- and sex-matched controls (n=623). Variables including age, gender, diabetes, hypertension, dyslipidemia, lens status, and prior ocular surgery were assessed. Group comparisons, multivariate linear regression, and subgroup analyses by age strata were performed to identify independent predictors of ECD reduction.
Results
Chemotherapy-exposed donors demonstrated significantly lower mean ECD compared with controls (2225±535 vs 2339±488 cells/mm�, p<0.001). Age and chemotherapy exposure were independent predictors of reduced ECD. Marked differences emerged in donors aged 51-70 (p?0.0002) and ?81 (p<0.0001). Comorbidities such as diabetes and hypertension further amplified endothelial loss. Prior ocular surgery and pseudophakia were associated with additional reductions. The magnitude of decline was most pronounced in older chemotherapy-exposed groups.
Conclusion
Systemic chemotherapy is independently associated with significant donor endothelial cell loss, especially in older age groups. Awareness of this effect may inform eye bank screening and surgical planning, highlighting the need for tailored donor selection in corneal transplantation.
Presenting Author
Lional Raj Daniel Raj Ponniah, MD, PhD
Purpose
To assess the long-term safety and effectiveness of implanting a synthetic endothelial keratoprosthesis in cases with pseudophakic chronic endothelial dysfunction.
Methods
Setting: A prospective open-label clinical safety & efficacy evaluation (INDIA Study). Methods: Endothelial dysfunction following pseudophakic corneal edema which is not associated with systemic diseases like Herpes Simplex or prior corneal surgeries was subjected to a central 6.5 mm synthetic endothelial implantable substitute after a central 7.0mm descemetorhexis & attached with C3F8 gas (85% fill in the AC). Pre & post-operative central pachymetry (in mic.), vision (in ETDRS characters), and pain analog (1-100) were analyzed in addition to re-bubbling rates & toxic reactions due to implants and followed up by end of 3 years.
Results
12 cases were enrolled, 2 subjects died, 9 completed FU by 36M. The longest FU is 48M, min. is 39M. Baseline vision was 10.54+/-2.2 ETDRS characters, which improved to 41.75+/-8.7 by M-1 & retained VA gains by 46.72+/-13.1 characters after M-36. Mean Central pachymetry reduced from 720 mic, to 552 mic. by M-1 & maintained at 491 mic. by M-12, and 521 microns by M-36. The presenting pain was 91.9+/-2.3 & was 7.7+/-2.5 at M-12 and 6.5+/- 2.1 by M-36 (all p<0.0001). No immunologic or other adverse reactions were noticed. None were explanted. 4 cases needed re-bubbling in early periods (D7, D7, D12 & 21,D7, D14&M3). 1 subject developed severe surface scarring after M-18.
Conclusion
Endothelial keratoprosthesis improved vision, reduced edema caused by pseudophakic endothelial dysfunctions & was not associated with toxicities until M-36, & is continuously monitored. It could be an alternative to EK with no risks of rejection or graft failures when tissue availability is challenging or the risk of rejection is greater.
Presenting Author
Ofer Daphna, MD
Purpose
To compare 12-month safety and efficacy outcomes artificial endothelial layer implantation- an impermeable artificial lamella placed on the posterior corneal surface- in adult patients with chronic corneal edema who are at high risk versus those at normal risk for human graft rejection.
Methods
A retrospect study: the implant was implanted in 45 high- risk patients and 71 normal-risk patients. High risk were defined as patients who either failed multiple keratoplasties or had a condition placing them at risk for human graft failure. Safety and efficacy data, including central corneal thickness (CCT), best corrected visual acuity (BCVA) and pain score (measured by visual analogue scale, VAS) are presented for the first 12 months post implantation.
Results
At 12-month an average CCT decrease of 190μm was seen in both groups (p-value<<0.05). CCT improvement was stable and significant throughout follow-up. Pain (VAS) was markedly reduced from 17±19 and 38±37 pre-op (for high-risk and normal-risk, respectively) to 6 at 12 months post implantation (p-value<0.05). BCVA improved in the normal-risk group- from 1.73±0.58 pre-op to 1.22±0.76 at 12-month versus from 1.74±0.59 to 1.45±0.65 in the high-risk group. There were no long-term reported infections or inflammation. The most common post-op intervention was re-bubbling, which occurred at a rate of 45.5% in the normal-risk population, and reached a rate of 61.9% in the high-risk population.
Conclusion
The implant demonstrated safety and efficacy in treating chronic corneal edema in high-risk patients prone to graft rejection, leading to reduced edema and pain while improving vision in most cases. As the implant is synthetic and is not subject to rejection, it may offer a durable long-term solution for high-risk patients.
Presenting Author
Arie L. Marcovich, MD, PhD
Purpose
To report long-term safety and efficacy outcomes of an artificial lamellar implantation on the posterior surface of the cornea of adult patients suffering from chronic corneal edema.
Methods
A hydrophilic water-impermeable layer was implanted and attached to the posterior cornea in patients with chronic corneal edema. Long-term efficacy and safety data from a 24–36 month follow-up of 24 patients is presented. Changes in central corneal thickness (CCT) and best corrected visual acuity (BCVA) are detailed over the follow-up period. The implantations were conducted across multiple centers: Rambam, Soroka and Sourasky Medical Centers in Israel; UMC in the Netherlands; Universitäts-Augenklinik in Germany; LV Prasad Eye Institute in India and Alma Mater Studiorum University of Bologna, Italy.
Results
A significant improvement in CCT was observed after one month and remained stable. At the last follow-up, 88% had at least 15% improvement in CCT. Mean preoperative CCT of 793±104μm improved to 579±84µm and 583±106µm after 24 and 36 months, respectively (n=24/10, respectively, p.value<0.05). In 21 patients with visual potential, in 17 vision improved; notably, 10 patients gained at least 8 ETDRS lines at last visit. Three patients reverted to baseline BCVA due to consistent partial detachment of the device. One implant was replaced by human tissue due to lack of efficacy. No long-term implantation related complications, infections or inflammation were observed. Implants remained transparent.
Conclusion
The artificial implant was found safe and effective, demonstrating improvement in corneal thickness as well as in visual acuity. Outcomes of 24 early cases, from the beginning of the learning curve reveal that when fully attached, EndoArt® the device can alleviate corneal edema and maintain a clear and viable cornea over a long-term period.
Presenting Author
Neal Rangu, MD
Co-Authors
Kamran Riaz (MD), Karanpreet Multani (MD), Ishan Bhanot (BSc, BA)
Purpose
To evaluate visual, refractive, and topographic outcomes of corneal tissue addition keratoplasty (CTAK) in patients with keratoconus and post-surgical ectasia.
Methods
A retrospective review was conducted of eyes undergoing CTAK at a single tertiary center. Collected variables included demographics and pre- and postoperative Pentacam topography, visual acuity, and refraction. Primary outcomes were changes in flat K, steep K, Kmax, uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), and spherical equivalent (SE). Postoperative measurements at 1 day, 1 week, 1 month, and ?3 months were compared with baseline.
Results
Nineteen eyes (mean age 36.3 years) were included. Preoperatively, mean Kmax was 54.8 ± 9.3 D (range 43.0-79.4), flat K 52.6 ± 9.3, steep K 57.3 ± 9.2, and astigmatism 4.7 ± 2.3. At latest follow-up (POM1 or ?POM3), mean flat K decreased by 3.75 D, steep K by 3.94 D, and Kmax by 3.82 D, while astigmatism decreased by 0.20 D. At POM1, mean UCVA improved from 20/215 (logMAR 1.03) to 20/125 (0.80), and mean BCVA from 20/90 (0.65) to 20/60 (0.48). Mean SE improved from -3.3 ± 3.8 D to -0.47 ± 1.0 D.
Conclusion
Our findings demonstrate that CTAK produces notable improvements in corneal shape and functional vision. These results support CTAK as a reliable therapeutic option for patients with keratoconus and post-surgical ectasia.
