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Photorefractive keratectomy (PRK) alters corneal biomechanical and tomographic measurements, but postoperative change, an abnormal index classification, and progressive ectasia are distinct. Saif et al. reported biomechanical changes at 6 months; a separate Pentacam cohort showed tomographic changes at 1 month. Clinically and topographically normal eyes assessed approximately 25 years after PRK also had frequent abnormal classifications. These different cohorts and observation periods cannot establish a common postoperative trajectory or show that an abnormal result is benign in an individual eye. Prospective paired Pentacam and Corvis ST measurements in the same eyes, followed by independent validation, are needed to develop postoperative references. Until then, serial clinical and tomographic findings should inform interpretation of isolated index abnormalities.

PurposeTo investigate corneal microstructural alterations in patients with trigeminal neuralgia using in vivo confocal microscopy and to compare these findings with healthy controls.MethodsIn this prospective, cross-sectional study, sixty patients with unilateral trigeminal neuralgia and sixty matched healthy controls underwent central corneal imaging using in vivo confocal microscopy. Images were obtained from all corneal layers. Quantitative analysis of the subbasal nerve plexus assessed corneal nerve fiber density (CNFD), corneal nerve fiber length (CNFL), and corneal nerve branch density (CNBD). Qualitative evaluation of epithelial morphology, dendritic cell density, stromal keratocyte activation, and endothelial features was performed. Associations between corneal findings and disease duration were analyzed.ResultsCompared with controls, trigeminal neuralgia patients demonstrated significant reductions in CNFD, CNFL, and CNBD (all p < 0.001), accompanied by increased nerve tortuosity, fragmentation, and focal nerve dropout. Dendritic cell density and anterior stromal keratocyte activation were increased, particularly in patients with longer disease duration, while posterior stromal layers and endothelial morphology remained preserved. Disease duration was independently associated with greater subbasal nerve loss and inflammatory changes.ConclusionsTrigeminal neuralgia is associated with significant neurodegenerative and inflammatory alterations of the cornea, primarily involving the subbasal nerve plexus. In vivo confocal microscopy provides a sensitive, non-invasive tool for detecting these changes and may aid in assessing disease severity and progression. To our knowledge, this is the first study to demonstrate disease duration-dependent multilayer corneal microstructural alterations in trigeminal neuralgia using in vivo confocal microscopy.

Objectives: To investigate the roles of apoptosis and autophagy in the pathogenesis of primary pterygium and to evaluate potential biomarkers that could lead to nonsurgical therapeutic approaches. Methods: In this prospective, observational, controlled study, patients diagnosed with primary pterygium were included. Excised pterygium tissues (study group) were compared with normal conjunctival tissues obtained from autografts (control group). Immunohistochemical staining was used to assess the expression of autophagy-related proteins (Beclin-1, LC3A/B, ATG5, and p62) and apoptosis-related proteins (Bcl-2 and Caspase-8). Quantitative immunohistochemical evaluation was performed using H-score analysis with Image Tool Software. Results: The study group exhibited significant increases in the expression of Beclin-1 (97.65 ± 2.54 vs. 25.53 ± 0.4), LC3A/B (97.88 ± 5.35 vs. 61.73 ± 5.08), ATG5 (100.73 ± 1.06 vs. 35.35 ± 0.3), p62 (84.18 ± 3.59 vs. 59.54 ± 2.29), and Bcl-2 (107.36 ± 1.60 vs. 53.56 ± 1.38) compared with the control group (p < 0.001 for all). Although Caspase-8 expression was also increased (65 ± 1.53 vs. 49 ± 0.2), the difference was not statistically significant (p = 0.270). These findings suggest altered regulation of autophagy-related pathways accompanied by suppression of apoptotic mechanisms, which may contribute to the persistence, fibrovascular proliferation, and progression of pterygium tissue. Conclusion: The progression of pterygium appears to be associated with dysregulation of autophagy-related pathways and inhibition of apoptotic mechanisms. These findings suggest that modulation of these cellular mechanisms may provide novel pharmacological therapeutic options, potentially reducing the need for surgical intervention.

Purpose: Impaired pupillary dynamics are a well-recognized feature of pseudoexfoliation syndrome (PXF), yet little is known about how cataract surgery influences postoperative iris function in these eyes. This study aimed to determine the longitudinal effects of cataract surgery on static pupil diameters and dilation velocity in eyes with pseudoexfoliation syndrome compared with age-matched controls. Methods: This longitudinal study included 166 eyes of 166 patients undergoing cataract surgery, comprising 91 eyes with pseudoexfoliation syndrome and 75 control eyes without pseudoexfoliation. Pupillary parameters were measured preoperatively and at six months postoperatively using automated pupillometry. Static pupil diameters were assessed under scotopic (0.04 lx), mesopic (4 lx), and photopic (40 lx) illumination conditions. Dynamic pupillary function was evaluated by measuring dilation velocity (DVel, mm/s) following a standardized light stimulus. Postoperative changes (Δ) were calculated as the difference between preoperative and postoperative measurements. Results: Static pupil diameters remained stable in the PXF group across all illumination conditions ( p > 0.05). In contrast, the control group demonstrated a significant reduction in scotopic pupil diameter after surgery ( p = 0.008), while mesopic and photopic diameters remained unchanged. The most notable finding was observed in pupillary kinetics: dilation velocity significantly increased in the PXF group from 0.13 ± 0.04 mm/s to 0.17 ± 0.05 mm/s ( p < 0.001), whereas no significant change was detected in the control group. Between-group comparison showed a significantly greater improvement in dilation velocity in PXF eyes ( p < 0.001). Cataract morphology was not associated with postoperative pupillary changes. Conclusion: These findings suggest that cataract surgery may be associated with measurable changes in dynamic pupillary behavior in PXF eyes, particularly in dilation velocity, while static pupil diameter remains largely unchanged.