The aim of this study was to review the most recent data about corneal sub-basal nerve plexus (SNP) evaluated with the use of corneal confocal microscopy (CCM). For this purpose, an electronic search was conducted based on PubMed and Google Scholar and Web of Science databases from 2008 up to the end of 2016. Ninety-eight articles in English were cited, as well as abstracts in other languages, concerning the morphology and function of corneal SNP in various diseases. Changes in corneal SNP as a result of local treatment were also introduced. Figures with scans from confocal microscopy from our Department were included. The main conclusion of this review was that both corneal SNP diminishment and high tortuosity as well as low sensitivity are in principle related to the presence or level of pathology. In addition, increased nerve tortuosity may represent a morphological determinant of nerve regeneration. However, the presented literature shows that SNP changes are not characteristic for one unified corneal pathology; rather, they reflect the non-specific pathological process present in many diseases. Future studies should use automatized biometric software and also examine the effects of new treatments on SNP.

Rationale: Conjunctival papilloma is a benign neoplastic lesion of epithelial origin, with a minimal tendency toward malignancy and an exophytic growth type. Etiological factors that contribute to the appearance of papilloma are UV exposure, HPV infection, smoking, and immunodeficiency. A case report of limbal conjunctival papilloma treatment with topical interferon alpha-2b eye drops applied to the conjunctival sac. Patient concerns: A 49-year-old female patient treated in the Clinical Department of Ophthalmology for conjunctival lesion located in the temporal quadrant near the limbus of the right eye. Ocular examination of the patient's eye did not show any abnormalities: visual acuity—20/20, intraocular pressure—16 mmHg. Diagnoses: During physical examination, a broad-based pink lesion of size 4 mm × 6 mm was found in interpalpebral bulbar conjunctiva with prominent feeder vessels and soft consistency. Lesion in the biomicroscopic examination did not show any sign of malignancy. In Swept Source Optical Coherence Tomography (SS-OCT) there was no sign of infiltration into sclera or cornea. In vivo confocal microscopy (IVCM) examination, revealed loss of the normal conjunctival epithelium - hyper-reflective cells, variation of cell size. A clinical diagnosis of limbal conjunctival papilloma was made. Interventions: Interferon alpha-2b 1 million IU/ml eye drops were applied 4 times a day for 5 months. The treatment lasted 5 months without changing the dosing regimen. Three months after the start of the interferon treatment, a complete regression of the lesion was achieved. Treatment was continued for the following 2 months. Controlled IVCM after 6 months showed only few hyper-reflective cells and fibrotic tissue. Outcomes: Treatment of conjunctival papilloma with topical interferon alpha-2b led to the complete regression of the lesion. Although after the therapy the conjunctiva appears normal both in slit lamp and in the OCT examination, there is a noticeable fibrosis of the tissue in confocal microscopy. During the 14-month follow-up period, there were no recurrent lesions. Lessons: In this study, topical interferon alpha-2b has been shown to be an effective and safe therapy for small-to-medium-size conjunctival papilloma without any sign of malignancy.

Background: To evaluate the clinical outcome, efficacy, and safety of femtosecond laser-assisted anterior lamellar keratoplasty. Material and Methods: In this prospective study, 21 males and 10 females aged from 15 to 62 years (mean 38.5) with different pathologies of the anterior corneal layers were enrolled for anterior lamellar keratoplasty using femtosecond laser VisuMax (Carl Zeiss, Germany). All patients were examined for uncorrected (UCVA) and best-corrected (BCVA) distance and near visual acuity, astigmatism, endothelial cell density, corneal thickness, and intraocular pressure. These examinations were performed before transplantation, at hospital discharge, and after 3 and 12 months. The mean follow-up time was 65.36 ± 28.54 months. Results: A statistically significant improvement of both UCVA and BCVA for distance and near vision was registered. BCVA improved from 0.11 preoperatively to 0.168 (p = 0.03), 0.267 (p < 0.01), and 0.472 (p < 0.01) on the hospital discharge day, three months, and 12 months respectively. There were no statistically significant differences in astigmatism, intraocular pressure, endothelial cell density, and corneal pachymetry as compared to preoperative and postoperative values. Six patients (19%) had a graft failure with a rate of 33% at 26 months. Conclusions: Femtosecond laser-assisted anterior lamellar keratoplasty is a safe and effective surgical method, providing satisfactory graft survival rates.

Background: This paper’s objective is to analyze patients with keratoconus who developed sterile infiltrate after corneal collagen cross-linking (CXL), and to evaluate possible risk factors for their occurrence. Methods: 543 medical histories of patients after cross-linking (Epi-off, Epi-on) procedure performed according to the Dresden protocol were analyzed retrospectively. Results: Sterile corneal infiltrates occurred in four men (0.7%) in the age range (16–28) years, the average age being 20.3. The average time from procedure to onset of symptoms was 3.5 days (2–5 days). Inflammatory infiltration resolved in all patients, leaving scars on corneal stroma in two patients. Corneal healing time ranged from 4–12 weeks. In vivo confocal microscopy (IVCM), round inflammatory cells, and Langerhans cells in the epithelium and Bowman’s layer were observed at the site of infiltration. The Optical coherence tomography (OCT) shows hyperreflective lesions of various sizes which decreased over time. The corneal topographic parameters and Best-corrected visual acuity (BCVA) improved after the CXL procedure in all of the described cases. Conclusions: Most likely, damage to the epithelium and the phototoxic effect of the procedure is of significant importance in the formation of sterile corneal infiltrates. Appropriate classification and selection of CXL procedures in combination with protective measures in people at risk may have an overwhelming impact on the incidence of this complication.