Acquired corneal subepithelial hypertrophy (ACSH) is a rare corneal condition whose ultrastructural features have not previously been characterized. We report the first detailed ultrastructural analysis of ACSH in a 57-year-old man with a history of penetrating keratoplasty for corneal trauma followed by Descemet stripping automated endothelial keratoplasty who presented with progressive visual decline due to a superficial corneal opacity. Clinical evaluation included slitlamp biomicroscopy, anterior segment optical coherence tomography, corneal topography, and pachymetry, which localized the lesion to the subepithelial compartment. The lesion was managed with selective surgical peeling, and the excised tissue was examined by light microscopy and transmission electron microscopy. Surgical removal led to restoration of best-corrected visual acuity with no recurrence at 1-year follow-up. Histopathological analysis demonstrated irregular epithelial thickening, complete absence of Bowman layer, and subepithelial fibrosis with myofibroblast proliferation, without evidence of inflammation or neovascularization. Ultrastructural examination revealed epithelial mitochondrial damage with mitophagy, disruption of intercellular junctions, and subepithelial myofibroblasts containing abundant rough endoplasmic reticulum, consistent with active fibrotic remodeling. These findings support ACSH as an acquired corneal fibrotic process driven by wound healing mechanisms, with clinical, epidemiological, and histopathological features distinct from other corneal degenerations and confirmed that surgical peeling of the thickened epithelial and subepithelial tissue can be curative.

We report a case of bilateral vortex keratopathy associated with long-term ribociclib therapy in a 67-year-old woman with metastatic breast cancer. The corneal deposits were identified during routine ophthalmic examination after 4 years of continuous treatment. Slit-lamp biomicroscopy revealed bilateral whorl-like epithelial deposits with a subtle morphological appearance compared with classic amiodarone-associated cornea verticillata. The patient had no history of tamoxifen, amiodarone, or chloroquine use, and there were no clinical features suggestive of Fabry disease. The combined severity of the bilateral cortical cataracts and macular changes associated with dry age-related macular degeneration was considered sufficient to explain the reduced visual acuity, whereas the subtle corneal deposits were not considered visually significant. The patient remained asymptomatic, and systemic therapy was continued without modification. This case suggests that ribociclib-associated vortex keratopathy may be detected after prolonged exposure and remain clinically silent at presentation, highlighting the importance of careful clinical assessment to avoid unnecessary interruption of essential oncologic treatment.

Achromatopsia is a rare inherited cone dysfunction characterized by reduced visual acuity, photophobia, nystagmus, impaired color discrimination, and decreased contrast sensitivity (CS). This case report describes the clinical and patient-reported outcomes of red-tinted contact lens use in a child with achromatopsia. Baseline and postlens assessments included cycloplegic refraction, visual acuity, CS, and vision-related quality of life using a Turkish questionnaire adapted from the 25-Item National Eye Institute Visual Function Questionnaire for low vision and photophobia. After lens fitting, the patient reported reduced glare, improved comfort in bright environments, and better performance in daily visual activities. Questionnaire findings also suggested improvement in distance-related tasks, outdoor functioning, reading/writing comfort, and overall visual comfort. However, CS testing showed deterioration after lens use. These findings suggest that red-tinted contact lenses may provide meaningful symptomatic and functional benefit in pediatric achromatopsia, particularly by alleviating photophobia, even when objective CS does not improve.

We report on a case of HSV-1 necrotizing stromal keratitis arising from femtosecond laser arcuate keratotomy wounds after femtosecond laser-assisted cataract surgery (FLACS) in a patient without known prior ocular herpes. An 80-year-old woman underwent uncomplicated FLACS with paired arcuate keratotomies and was discharged on topical dexamethasone and ofloxacin. Fifteen days later, examination showed dendritic lesions aligned with the keratotomy incisions, stromal infiltrates/necrosis, diffuse endotheliitis, and mild anterior uveitis. Oral valacyclovir and topical antiviral therapy were started with corticosteroids, but rapid progression occurred with hypopyon, worsening stromal necrosis, and hemorrhagic hyphema. Anterior chamber tap PCR confirmed HSV-1. Treatment escalated to fortified antibiotics during workup, intravitreal ganciclovir (with intravitreal antibiotics), anterior chamber washout, hospitalization for intravenous acyclovir, and later surgical management of secondary inflammation (pupillary membrane with iris bombé) with membrane removal and peripheral iridectomies. Inflammation gradually resolved and final best-corrected visual acuity improved to 0.4 logMAR. HSV reactivation may present as severe necrotizing stromal keratitis originating at femtosecond arcuate keratotomy sites even without a known herpetic history; early recognition and aggressive antiviral therapy with careful steroid use are crucial after FLACS.

Scleral lenses (SLs) are increasingly considered a mainstream option for optical correction in patients with corneal irregularity and for protection of the ocular surface in patients with ocular surface disease. However, there can be complications with SL if the fit and disease is not regularly monitored. This case series reviews complications from poorly fitted SLs. Changes in SL design may allow a patient to resume successful lens wear. Regardless, SL fit and underlying disease states should be assessed at regularly scheduled intervals for new concerns in all patients and for recurrence of problems despite modification of fit in those who suffer complications.