Limbal Stem Cell Deficiency Induced by Prolonged Use of Topical 0.03% Tacrolimus Ointment in a Patient with Atopic Keratoconjunctivitis

A 20-year-old female patient with a long-standing history of severe atopic disease was referred to our department because of bilateral gradual blurry vision. She had undergone treatment with daily application of topical tacrolimus ointment 0.03% (Protopic, Fujisawa, Munich, Germany) for a period of 5 years. Slit-lamp examination revealed inferior corneal thinning with conjunctivalization and superficial neovascularization respecting both eyes. A diagnosis of bilateral inferior limbal stem cell deficiency (LSCD) was made. After the tacrolimus ointment discontinuation, symptoms, visual acuity, and objective clinical examination improved during the follow-up period of 6 months. This case suggests that LSCD is possible after prolonged use of topical tacrolimus ointment 0.03%. In this context, it is imperative to monitor patients continuously to evaluate the safety of its chronic use. Copyright © 2025 Contact Lens Association of Ophthalmologists, Inc

Allogeneic anterior lens capsule transplantation (ALCT) for the management of HSV neurotrophic keratitis

Purpose: To report a case of allogeneic anterior lens capsule transplantation (ALCT) for the management of HSV neurotrophic epithelial keratitis. Observations: An 81-year-old man was referred to our department due to neurotrophic keratitis in the left eye that he had been suffering from over the past 3 months. He had recurrent episodes of HSV keratitis in the left eye over the past 3 years and despite multiple previous treatments, there was no improvement. At the time of presentation, corrected distance visual acuity (CDVA) was 20/200 in the right eye and no light perception (NLP) in the left eye. Slit-lamp examination revealed a corneal epithelial defect with underlying stromal thinning and concomitant scarring. An allogeneic anterior lens capsule (ALC) was placed over the epithelial defect to act as a biological dressing, anchored with a droplet of fibrin glue. A bandage contact lens (BCL) was placed over to prevent the slippage of the ALC. No intra or postoperative complications were observed. Two weeks later, the ALC was removed revealing complete epithelial healing, while two months later the epithelium remained completely healed with a significant reduction of corneal scarring. Conclusions and importance: Anterior Lens Capsule transplantation (ALCT) seems to be a promising new treatment option for the management of corneal neurotrophic keratitis

Refractive Alterations in Marfan Syndrome: A Narrative Review

Marfan syndrome (MFS) is a genetic disorder that affects the connective tissue in several systems, with ocular, cardiovascular, and skeletal system manifestations. Its ocular manifestations include ectopia lentis (EL), myopia, astigmatism, and corneal abnormalities. This review examines refractive alterations related to MFS such as EL, microspherophakia, lens coloboma, altered corneal biomechanics (flattening, thinning, and astigmatism), and myopia and their impact on visual acuity. The pathogenesis of these manifestations stems from mutations in the FBN1 gene (encoding fibrillin-1). Moreover, the current medical and surgical management strategies for MFS-related refractive errors, including optical correction (eyeglasses, contact lenses, etc.), and surgical interventions like lensectomy, intraocular lens (IOL) implantation (anterior chamber, posterior chamber, scleral-fixated, iris-fixated), and the use of capsular tension rings/segments are further discussed. Considering the likelihood of underdiagnosing and underestimating ocular involvement in MFS, this updated review highlights the critical need to identify and address these refractive issues to enhance the visual outcomes for those affected