Keratoconus management has significantly changed over the last two decades. The advent of new interventions such as cornea cross-linking, intrastromal corneal ring segments, and combined treatments provide corneal clinicians a variety of treatment options for the visual rehabilitation of keratoconus patients. This review summarizes current evidence for these treatments and highlights their place in keratoconus management while new promising emerging therapies are being investigated.

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We present two cases with focal corneal edema due to Fuchs' endothelial dystrophy that were successfully treated with mini Descemet membrane stripping (m-DMES) (diameter of 3-4 mm; at the area of preexisting focal corneal edema) without endothelial replacement during cataract surgery. Specular microscopy demonstrated Fuchs' endothelial dystrophy and histopathologic evaluation confirmed the diagnosis. Anterior segment optical coherence tomography and confocal microscopy were used for the evaluation of the corneal tissue recovery course after the surgical procedure. In both patients, we observed an initial aggravation of corneal edema in the area of DM removal for two months followed by gradual improvement. At four months postoperatively, corneal edema had completely regressed resulting in corneal clearance and visual acuity improvement in both cases. M-DMES without graft insertion represents a promising alternative surgical technique that could be applied in specific cases of Fuchs' endothelial dystrophy with focal corneal edema.

Purpose: To describe a novel technique of combined Descemet stripping automated endothelial keratoplasty (DSAEK) with implantation of a new scleral fixated, sutureless, posterior chamber intraocular lens (IOL) (Carlevale, Soleko). Methods: A new surgical technique description. Results: We describe a novel surgical approach, namely combining implantation of a new scleral-fixated sutureless posterior chamber IOL with DSAEK for the management of IOL dislocation and corneal endothelial decompensation. The existing, dislocated IOL was removed, and 2 scleral radial incisions were performed 180 degrees apart. Two partial thickness scleral pockets were created along each scleral radial incision, followed by a 23 G sclerotomy. The IOL was placed in the posterior chamber by using 23 G vitreoretinal forceps, and each plug was secured under the 2 pockets. A standard DSAEK procedure was then performed. Four months postoperatively, the corneal graft was attached and clear. The Carlevale IOL was well positioned, and an improvement in the patient's vision was observed. Conclusions: Combining implantation of a new scleral fixated foldable sutureless IOL (Carlevale, Soleko) with DSAEK could represent a viable and effective option for patients with IOL dislocation or aphakia, accompanied by corneal endothelial dysfunction.