[Clinical feature analysis and preliminary exploration of individualized surgical strategies in cold corneal ulcer].

Objective: To investigate the clinical characteristics of cold corneal ulcer (cicatricial indolent corneal ulcer) and evaluate the efficacy of individualized graded surgical strategies based on multimodal assessment. Methods: A case series study was conducted. Data were collected from 4 patients (4 eyes) with cold corneal ulcer treated at Changsha Aier Eye Hospital from 2023 to 2025, consisting of 1 male and 3 females aged 54 to 80 years. All patients had a long history of corneal scarring with negative infectious workup. Preoperative evaluations included slit-lamp microscopy and multimodal imaging. Individualized surgeries were performed according to lesion characteristics, perforation risk, visual potential and general condition: 2 eyes underwent penetrating keratoplasty (PKP) for visual rehabilitation; 1 eye with concurrent autoimmune disease and impending perforation received conjunctival flap coverage for globe preservation; 1 eye with no useful vision but cosmetic indications underwent lamellar keratoplasty (LKP) combined with interlamellar ink staining. The follow-up period ranged from 6 to 18 months. Results: Ulcers healed completely in all 4 patients, with no corneal perforation or recurrent infection during follow-up. At 1 year postoperatively, the visual acuity of the 2 eyes undergoing PKP improved from counting fingers at 20 cm and 30 cm preoperatively to 0.15 and 0.1, respectively. Globe preservation was achieved and ulcer healing remained stable after conjunctival flap coverage. Corneal anatomical integrity was restored and the ocular appearance was markedly improved after LKP combined with interlamellar ink staining. Conclusions: Cold corneal ulcer is a non-infectious degenerative disorder that responds poorly to conventional conservative treatment and simple amniotic membrane transplantation. Individualized graded surgery based on multimodal assessment can achieve reliable ulcer healing and favorable clinical outcomes.