1
|
Chen X, Chen L. Causal Links Between Systemic Disorders and Keratoconus in European Population. Am J Ophthalmol 2024; 265:189-199. [PMID: 38705552 DOI: 10.1016/j.ajo.2024.04.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 04/28/2024] [Accepted: 04/30/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE To establish the presence of a causal linkage between prevalent systemic diseases and keratoconus (KC). DESIGN Mendelian randomization (MR) analysis. METHODS After an exhaustive screening process, genetic variants linked to various systemic diseases were identified as instrumental variables at the genome-wide significance level. Subsequently, MR analyses were conducted to elucidate their potential causal connection with KC (N = 26,742). The encompassed systemic ailments comprise diabetes, hay fever/allergic rhinitis/eczema, obstructive sleep apnea, thyroid dysfunction, aortic aneurysm, major depressive disorder, inflammatory bowel disease (including Crohn's disease and ulcerative colitis), and mitral valve prolapse. Our study adheres to the principles of Strengthening the Reporting of Observational Studies in Epidemiology Using MR guidelines. RESULTS Using inverse variance weighting as the primary MR analysis method, our findings revealed that hay fever/allergic rhinitis/eczema (odds ratio, 10.144; 95% CI, 2.441-42.149; P = .001) and ulcerative colitis (odds ratio, 1.147; 95% CI, 1.054-1.248; P = .002) were associated with an increased risk of KC within the largest population under scrutiny. Conversely, the prolonged hyperglycemic state did not exhibit a potentially protective effect in delaying the pathogenesis of KC, and no correlation was observed between the two (odds ratio, 0.320; 95% CI, 0.029-3.549; P = .353). Also, obstructive sleep apnea, thyroid function, aortic aneurysm, major depressive disorder, Crohn's disease, and mitral valve prolapse did not exhibit a causal association with KC (P > .05 for all comparisons). CONCLUSIONS This study indicates an increased risk of KC related to hay fever/allergic rhinitis/eczema and ulcerative colitis, with diabetes not providing a protective effect. These findings may potentially contribute some insights to inform clinical interventions.
Collapse
Affiliation(s)
- Xiaxue Chen
- From the Department of Ophthalmology (X.C.), The Second Hospital of Jilin University, Changchun, Jilin, China.
| | - Lanlan Chen
- Department of Hepatobiliary and Pancreatic Surgery (L.C.), General Surgery Center, The First Hospital of Jilin University, Changchun, Jilin, China
| |
Collapse
|
2
|
Yin S, Xu L, Yang K, Fan Q, Gu Y, Yin C, Zang Y, Wang Y, Yuan Y, Chang A, Pang C, Ren S. Gene‒Environment Interaction Between CAST Gene and Eye-Rubbing in the Chinese Keratoconus Cohort Study: A Case-Only Study. Invest Ophthalmol Vis Sci 2024; 65:36. [PMID: 39186261 PMCID: PMC11361386 DOI: 10.1167/iovs.65.10.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Accepted: 08/05/2024] [Indexed: 08/27/2024] Open
Abstract
Purpose Keratoconus (KC), characterized by progressive corneal protrusion and thinning, is a complex disease influenced by the combination of genetic and environmental factors. The purpose of this study was to explore potential gene‒environment interaction between the calpastatin (CAST) gene and eye-rubbing in KC. Methods A case-only study including 930 patients (676 patients with eye-rubbing and 254 patients without eye-rubbing) from the Chinese Keratoconus (CKC) cohort study was performed in the present study. Genotyping of single nucleotide polymorphism (SNP) was conducted using the Illumina Infinium Human Asian Screening Array (ASA) Beadchip. The gene‒environment interactions between CAST gene and eye-rubbing were analyzed using PLINK version 1.90. The interactions between CAST genotypes and eye-rubbing were analyzed by logistic regression models. The SNP-SNP-environment interactions were analyzed using generalized multifactor dimensionality reduction (GMDR). Results Three SNPs in CAST gene, namely, rs26515, rs27991, and rs9314177, reached the significance threshold for interactions (defined as P < 2.272 × 10-3). Notably, the minor alleles of these three SNPs exhibited negative interactions with eye-rubbing in KC. The results of logistic regression models revealed that the minor allele homozygotes and heterozygotes of rs26515, rs27991, and rs9314177 also exhibited negative interactions with eye-rubbing. Furthermore, GMDR analysis revealed the significant SNP-SNP-environment interactions among rs26515, rs27991, rs9314177, and eye-rubbing in KC. Conclusions This study identified rs26515, rs27991, and rs9314177 in CAST gene existed gene-environment interactions with eye-rubbing in KC, which is highly important for understanding the underlying biological mechanisms of KC and guiding precision prevention and proper management.
Collapse
Affiliation(s)
- Shanshan Yin
- People's Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
| | - Liyan Xu
- People's Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
- Eye Institute, Henan Academy of Innovations in Medical Science, Zhengzhou, China
| | - Kaili Yang
- People's Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
- Eye Institute, Henan Academy of Innovations in Medical Science, Zhengzhou, China
| | - Qi Fan
- People's Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
| | - Yuwei Gu
- People's Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
| | - Chenchen Yin
- People's Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
| | - Yonghao Zang
- Xinxiang Medical University, Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou, China
| | - Yifan Wang
- People's Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
| | - Yi Yuan
- People's Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
| | - Anqi Chang
- Henan University People’s Hospital, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
| | - Chenjiu Pang
- People's Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
| | - Shengwei Ren
- People's Hospital of Zhengzhou University, Henan Provincial People’s Hospital, Henan Eye Hospital, Zhengzhou, China
- Eye Institute, Henan Academy of Innovations in Medical Science, Zhengzhou, China
| |
Collapse
|
3
|
Muhsin ZJ, Qahwaji R, AlShawabkeh M, AlRyalat SA, Al Bdour M, Al-Taee M. Smart decision support system for keratoconus severity staging using corneal curvature and thinnest pachymetry indices. EYE AND VISION (LONDON, ENGLAND) 2024; 11:28. [PMID: 38978067 PMCID: PMC11229244 DOI: 10.1186/s40662-024-00394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/17/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND This study proposes a decision support system created in collaboration with machine learning experts and ophthalmologists for detecting keratoconus (KC) severity. The system employs an ensemble machine model and minimal corneal measurements. METHODS A clinical dataset is initially obtained from Pentacam corneal tomography imaging devices, which undergoes pre-processing and addresses imbalanced sampling through the application of an oversampling technique for minority classes. Subsequently, a combination of statistical methods, visual analysis, and expert input is employed to identify Pentacam indices most correlated with severity class labels. These selected features are then utilized to develop and validate three distinct machine learning models. The model exhibiting the most effective classification performance is integrated into a real-world web-based application and deployed on a web application server. This deployment facilitates evaluation of the proposed system, incorporating new data and considering relevant human factors related to the user experience. RESULTS The performance of the developed system is experimentally evaluated, and the results revealed an overall accuracy of 98.62%, precision of 98.70%, recall of 98.62%, F1-score of 98.66%, and F2-score of 98.64%. The application's deployment also demonstrated precise and smooth end-to-end functionality. CONCLUSION The developed decision support system establishes a robust basis for subsequent assessment by ophthalmologists before potential deployment as a screening tool for keratoconus severity detection in a clinical setting.
Collapse
Affiliation(s)
- Zahra J Muhsin
- Department of Computer Science, University of Bradford, Bradford, BD7 1DP, UK.
| | - Rami Qahwaji
- Department of Computer Science, University of Bradford, Bradford, BD7 1DP, UK
| | | | | | - Muawyah Al Bdour
- School of Medicine, The University of Jordan, Amman, 11942, Jordan
| | - Majid Al-Taee
- Department of Computer Science, University of Bradford, Bradford, BD7 1DP, UK
| |
Collapse
|
4
|
Alqudah N. Keratoconus: imaging modalities and management. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2024; 13:44-54. [PMID: 38978828 PMCID: PMC11227666 DOI: 10.51329/mehdiophthal1493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/29/2024] [Indexed: 07/10/2024]
Abstract
Background Keratoconus (KCN) is characterized by gradual thinning and steepening of the cornea, which can lead to significant vision problems owing to high astigmatism, corneal scarring, or even corneal perforation. The detection of KCN in its early stages is crucial for effective treatment. In this review, we describe current advances in the diagnosis and treatment of KCN. Methods This narrative review focuses on recent advancements in the diagnosis and treatment of KCN, especially evolving approaches and strategies. To ensure the inclusion of the most recent literature, relevant publications discussing advanced imaging techniques and treatment options for KCN were extensively gathered from the PubMed/MEDLINE and Google Scholar databases. The following index terms and keywords were used for the online search: keratoconus, diagnosis of keratoconus, advances in the diagnosis of keratoconus, topography or tomography, anterior segment optical coherence tomography, treatment of keratoconus, advances in the treatment of keratoconus, collagen crosslinking, intrastromal ring, keratoplasty, and new techniques in keratoconus. Results Various screening methods such as corneal topography, tomography, anterior segment optical coherence tomography, and assessment of corneal biomechanics have been developed to identify KCN in its early stages. After diagnosis, KCN management focuses on preventing disease progression. Corneal collagen crosslinking is a minimally invasive treatment that can slow or stop the progression of the condition. Recent research has also explored the use of copper sulfate eye drops (IVMED-80) as a noninvasive treatment to prevent the progression of KCN. Current treatment options for visual improvement include scleral lenses, intracorneal ring segments, corneal allogeneic intrastromal ring segments, and deep anterior lamellar keratoplasty. Recently, novel alternative procedures, such as isolated Bowman layer transplantation, either as a corneal stromal inlay or onlay, have demonstrated encouraging outcomes. Artificial intelligence has gained acceptance for providing best practices for the diagnosis and management of KCN, and the science of its application is contentiously debated; however, it may not have been sufficiently developed. Conclusions Early detection and advancements in screening methods using current imaging modalities have improved diagnosis of KCN. Improvement in the accuracy of current screening or diagnostic tests and comparison of their validities are achievable by well-designed, large-scale, prospective studies. The safety and effectiveness of emerging treatments for KCN are currently being investigated. There is an ongoing need for studies to track progress and evaluate clinicians' knowledge and practices in treating patients with KCN. Artificial intelligence capabilities in management approach considering the currently available imaging modalities and treatment options would best benefit the patient.
Collapse
Affiliation(s)
- Noor Alqudah
- Division of Ophthalmology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
5
|
Mousa RM, Saif MYS, Said MAE, Mohamed Taher RM. Prevalence of Keratoconus and Characteristics of Refractive Errors in First-Degree Relatives of Patients With Keratoconus Among Egyptians. Cornea 2024:00003226-990000000-00577. [PMID: 38886885 DOI: 10.1097/ico.0000000000003593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 05/05/2024] [Indexed: 06/20/2024]
Abstract
PURPOSE This study investigated the occurrence of keratoconus among first-degree relatives of patients with keratoconus and evaluated their refractive characteristics. METHOD A cross-sectional observational study was conducted on 248 relatives of 52 patients with keratoconus in whom bilateral eye analysis was conducted. Corneal tomography was performed for all participants with a comprehensive analysis of various parameters, including K1, K2, Kmax, elevation, skewing, and thinnest location. In addition, the following data were also analyzed: uncorrected visual acuity, corrected distance visual acuity, refraction measurements alongside a slit-lamp examination, and fundus examination. RESULTS Among 248 participants, 19 (7.7%) had keratoconus, 3.2% had forme fruste, and 15.3% had suspected keratoconus. Among all studied cases, 73.8% had normal corneas. Significant differences (P = 0.001) were found in the distribution of keratoconus prevalence among brothers, mothers, sons, and sisters (13.6%, 4.3%, 5.6%, and 12.1%, respectively). The presence of refractive errors also showed significant differences between the relatives (P = 0.03). CONCLUSIONS Increased keratoconus prevalence among relatives of patients with keratoconus indicates the vulnerability of this population to the development of the disease, necessitating early screening of this group for detection of keratoconus as early as possible.
Collapse
|
6
|
Jurkiewicz T, Marty AS, Febvay C, Burillon C. [Effect of keratoplasty on the quality of life of keratoconus patients]. J Fr Ophtalmol 2024; 47:104185. [PMID: 38608625 DOI: 10.1016/j.jfo.2024.104185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/10/2023] [Accepted: 11/21/2023] [Indexed: 04/14/2024]
Abstract
Corneal deformations caused by keratoconus produce high levels of optical aberration (OA). Despite appropriate optical correction, these alter the quality of vision and diminish the patient's quality of life, especially since the affected population is predominantly young and of working age. When thinning is too severe or corneal transparency too impaired, a corneal transplant may be considered. In this study, we compare the quality of life of patients with keratoconus in the early (stages 1 and 2) or advanced (stages 3 and 4) stages of the Krumeich classification, as well as patients who have had keratoconus treated by keratoplasty. Quality of life was assessed using the NEI-VFQ 25 questionnaire, the most widely used for keratoconus. An aberrometric examination (OQAS®; HD Analyser, Visiometrics, Terrassa, Spain) was also performed to assess patients' quality of vision. Our results show that keratoplasty provides an improvement in quality of life compared with advanced-stage keratoconus in the areas of distance (p=0.0083) and near vision (p=0.029) activities. This improvement also applies to Best-Corrected Visual Acuity (BCVA) (p=0.032) and transparency (OSI) (p=0.049). Our study shows that keratoplasty improves corneal transparency, and it is interesting to note that it improves patients' quality of life over the long term.
Collapse
Affiliation(s)
- T Jurkiewicz
- Centre d'exploration de la rétine Kléber (CERK), 50, cours Franklin-Roosevelt, 69006 Lyon, France; Centre de recherche en neurosciences de Lyon (CRNL), université de Lyon, 69500 Bron, France.
| | - A-S Marty
- Clinique ophtalmologique Thiers, 144, avenue Thiers, 33100 Bordeaux, France
| | - C Febvay
- Cabinet d'ophtalmologie De La Vallée, 8, route de Besançon, 25290 Ornans, France
| | - C Burillon
- Service d'ophtalmologie, Pavillon C, hôpital Edouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France; Faculté de médecine Lyon Sud, Charles-Mérieux, rue du Grand-Revoyet, 69006 Oullins, France
| |
Collapse
|
7
|
Ben-Shaul O, Segal A, Schwartz S, Stein N, Hyams M, Saliba W, Mimouni M. Factors associated with keratoconus in Israel-A cross-sectional population-based study. Acta Ophthalmol 2024. [PMID: 38742987 DOI: 10.1111/aos.16706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 04/11/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE To identify potential factors associated with keratoconus. METHODS This cross-sectional study included data from Israel's largest healthcare provider for the years 2005-2020. Keratoconus patients and age-matched controls were identified. Demographic factors and comorbid conditions, including smoking, diabetes mellitus, asthma, myalgia, mental retardation, Down syndrome, atopic dermatitis and allergy/allergic rhinitis, were compared between the two cohorts. The independent risk factors associated with keratoconus were determined using a multivariable conditional logistic regression model. RESULTS Overall, 145 508 subjects were reviewed of which 13 228 were keratoconus patients. A ten-fold group (n = 132 280) of age-matched control subjects served as controls for comparisons. In multivariable analysis, several factors were found to be significantly associated with keratoconus. Male gender (OR = 1.27, p < 0.001), Arab ethnicity (OR = 1.50, p < 0.001), diabetes (OR = 1.19, p < 0.001), asthma (OR = 1.50, p < 0.001), myalgia (OR = 1.09, p = 0.02), mental retardation (OR = 2.63, p < 0.001), atopic dermatitis (OR = 1.35, p < 0.001) and allergic rhinitis (OR = 1.21, p < 0.001) were significantly associated with keratoconus. Smoking was significantly protective of keratoconus (OR = 0.66, p < 0.001). CONCLUSIONS This population-based study reports male gender, Arab ethnicity, diabetes, asthma, myalgia, mental retardation/Down syndrome, atopic dermatitis and allergic rhinitis as factors associated with keratoconus while smoking demonstrates a protective effect. The results of this study could guide enhanced screening strategies and early interventions, particularly for high-risk groups.
Collapse
Affiliation(s)
- Or Ben-Shaul
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Adi Segal
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Sharon Schwartz
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Nili Stein
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Michael Hyams
- Department of Ophthalmology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Walid Saliba
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Community Medicine and Epidemiology, Lady Davis Carmel Medical Center, Haifa, Israel
| | - Michael Mimouni
- Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| |
Collapse
|
8
|
Al Bdour M, Sabbagh HM, Jammal HM. Multi-modal imaging for the detection of early keratoconus: a narrative review. EYE AND VISION (LONDON, ENGLAND) 2024; 11:18. [PMID: 38730479 PMCID: PMC11088107 DOI: 10.1186/s40662-024-00386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/21/2024] [Indexed: 05/12/2024]
Abstract
Keratoconus is a common progressive corneal disorder that can be associated with significant ocular morbidity. Various corneal imaging techniques have been used for the diagnosis of established cases. However, in the early stages of the disease, which include subclinical keratoconus and forme fruste keratoconus, detection of such cases can be challenging. The importance of detecting such cases is very important because early intervention can halt disease progression, improve visual outcomes and prevent postrefractive surgery ectasia associated with performing corneal refractive procedures in such patients. This narrative review aimed to examine several established and evolving imaging techniques for the detection of early cases of keratoconus. The utilization of combinations of these techniques may further increase their diagnostic ability.
Collapse
Affiliation(s)
- Muawyah Al Bdour
- Department of Ophthalmology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Hashem M Sabbagh
- The National Center for Diabetes Endocrinology and Genetics (NCDEG), Amman, Jordan
| | - Hisham M Jammal
- Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan.
| |
Collapse
|
9
|
Rohira H, Shankar S, Yadav S, Srivastava PP, Minocha S, Vaddavalli PK, Shah SG, Chugh A. RiTe conjugate mediated corneal collagen crosslinking, a novel therapeutic intervention for keratoconus - in vitro and in vivo study. Int J Pharm 2024; 656:124092. [PMID: 38583820 DOI: 10.1016/j.ijpharm.2024.124092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/03/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
Corneal collagen crosslinking (CXL) is an effective method to halt the disease progression of keratoconus, a progressive corneal dystrophy leading to cone shaped cornea. Despite the efficacy of standard protocol, the concerning step of this procedure is epithelial debridement performed to facilitate the entry of riboflavin drug. Riboflavin, a key molecule in CXL protocol, is a sparsely permeable hydrophilic drug in corneal tissues. The present study has employed cell penetrating peptide (CPP), Tat2, to enhance the penetration of riboflavin molecule, and thereby improve currently followed CXL protocol. This study demonstrates approximately two-fold enhanced uptake of CPP riboflavin conjugate, Tat2riboflavin-5'Phosphate (RiTe conjugate), both in vitro and in vivo. Two different CXL protocols (Epi ON and Epi OFF) have been introduced and implemented in rabbit corneas using RiTe conjugate in the present study. The standard and RiTe conjugate mediated CXL procedures exhibited an equivalent extent of crosslinking in both the methods. Reduced keratocyte loss and no endothelial damage in RiTe conjugate mediated CXL further ascertains the safety of the proposed CXL protocols. Therefore, RiTe conjugate mediated CXL protocols present as potential alternatives to the standard keratoconus treatment in providing equally effective, less invasive and patient compliant treatment modality.
Collapse
Affiliation(s)
- Harsha Rohira
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Sujithra Shankar
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Shikha Yadav
- National Institute of Biologicals, NOIDA, Uttar Pradesh 201309, India
| | - Priyanka P Srivastava
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi 110016, India
| | - Shilpi Minocha
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi 110016, India
| | | | - Sushmita G Shah
- Dr C M Shah Memorial Charitable Trust - Netra Mandir, Madona Colony Road, Borivali West, Mumbai, Maharashtra 400092, India.
| | - Archana Chugh
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi 110016, India.
| |
Collapse
|
10
|
Moshirfar M, Pandya S, Zhang S, Stoakes IM, Ayesha A, Hoopes PC. AvaGen Genetic Testing versus Ocular Screening Assessments Including the Keratoconus Severity Score (KSS) and Randleman Ectasia Risk Score System (ERSS) in Refractive Surgery Candidates. Clin Ophthalmol 2024; 18:1245-1255. [PMID: 38737593 PMCID: PMC11088376 DOI: 10.2147/opth.s452128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/15/2024] [Indexed: 05/14/2024] Open
Abstract
Purpose To determine whether the AvaGen (AG) Genetic Eye Test provided additional information for screening for the presence of keratoconus (KC) and assessing KC risk in refractive surgery candidates, as compared to the Keratoconus Severity Score (KSS) and Randleman Ectasia Risk Score System (ERSS). Methods This retrospective study analyzed patients seeking refractive surgery at an eye clinic in the United States between January 2022 and July 2023. The inclusion criteria encompassed those with a family history of KC, positive KC indices, or both. Corneal evaluations and demographic information were recorded and analyzed. KSS and ERSS criteria were utilized to evaluate postoperative KC and ectasia risk, respectively. Patients were categorized on how the AG genetic test compared to KSS and ERSS criteria. Clinicians assessed topographic indices, criteria scoring, and AG testing to deliver a definitive surgical recommendation. Results Among the 19 patients evaluated for ectasia risk, AG testing showed lower KC risk than ocular screening in three patients (15.8%), equal risk in three patients (15.8%), and higher risk in 13 patients (68.4%). The mean AG scores were 45.7 ± 7.0, 49.0 ± 3.46, and 61 ± 13.0 for these respective categories. The most frequently identified KC risk genes were ADAMTS18, COL2A1, and COL4A1. The AG test modified the physician's recommendation for refractive surgery in nine cases (47.4%). Conclusion Despite the promising application of AG testing for assessing KC risk, further research and development are needed to enhance its applicability for screening refractive surgery candidates, in addition to standard ocular screening approaches.
Collapse
Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA
- Utah Lions Eye Bank, Murray, UT, USA
| | - Shreya Pandya
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Stephanie Zhang
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Isabella M Stoakes
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- Pacific Northwest University of Health Sciences, Yakima, WA, USA
| | - Azraa Ayesha
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | | |
Collapse
|
11
|
Shah Z, Purohit D, Danayak P. Keratoconus characteristics and associations: A cross-sectional keratoconus study in western India (CKSWI). Indian J Ophthalmol 2024; 72:704-711. [PMID: 38324266 PMCID: PMC11168558 DOI: 10.4103/ijo.ijo_1069_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/16/2023] [Accepted: 10/22/2023] [Indexed: 02/08/2024] Open
Abstract
PURPOSE To study the clinical and tomographic characteristics and associations of keratoconus (KC) patients visiting a tertiary eye care hospital. METHODS This was a cross-sectional, observational study that included 242 newly diagnosed clinical KC patients. Detailed ocular and systemic history, visual complaints, habit of eye rubbing, best spectacle-corrected visual acuity (BSCVA), retinoscopy reflex, detailed slit-lamp examination and tomographic findings, and presence of any ocular and systemic associations were documented for the included patients. Severity of KC was further graded into stages 0, 1, 2, 3, and 4 according to the ABCD grading system. RESULTS The most common visual complaint was blurred vision (82.64%), followed by itching (48.76%), tearing (43.80%), and photophobia (41.32%). A total of 44.62% of patients had the habit of eye rubbing and 4.54% had a family history of KC. Most common clinical signs were scissor reflex (94.21%), Rizutti's sign (77.27%), corneal protrusion (69.83%), and Fleischer ring (67.35%). A total of 14.05% of patients had stage 0, 42.15% had stage 1, 19.83% had stage 2, 18.60% had stage 3, and 5.37% had stage 4 KC. Of these patients, 70.25% had a BSCVA visual acuity of ≥6/12 or better; 26.45% had a BSCVA of ≥6/60 to <6/12; and 3.30% had a BSCVA of <6/60. Ocular allergies, atopy, and asthma were found in 32.32%, 4.96%, and 2.48% cases, respectively. CONCLUSION This study gives an overview of the clinical findings of KC cases in western India. Our results suggest that use of retinoscopy should be promoted in early KC detection in primary eyecare screening programs.
Collapse
Affiliation(s)
- Zalak Shah
- Department of Cornea and Refractive Surgery, Shree C.H. Nagri Eye Hospital, Ahmedabad, Gujarat, India
| | - Dipali Purohit
- Department of Cornea and Refractive Surgery, Shree C.H. Nagri Eye Hospital, Ahmedabad, Gujarat, India
| | - Parul Danayak
- Department of Cornea and Refractive Surgery, Shree C.H. Nagri Eye Hospital, Ahmedabad, Gujarat, India
| |
Collapse
|
12
|
Lombardo M, Alunni Fegatelli D, Serrao S, Vestri A, Lombardo G. Estimated prevalence of keratoconus in the largest metropolitan area of Italy. Eur J Ophthalmol 2024; 34:649-655. [PMID: 38425220 DOI: 10.1177/11206721241235984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE To estimate the prevalence of keratoconus in a population of subjects undergoing first eye examination in an eye clinic in Italy. METHODS A single-center, cross-sectional, study was conducted involving patients who underwent first eye examination at an eye clinic in Rome between September 2021 and June 2022. The prevalence of keratoconus was determined by Placido-disk corneal topography using the maximum keratometry (Kmax) value and the Cone Magnitude and Location Index (CLMI) for keratoconus screening. Subjective analysis was performed by two experienced corneal specialists, who classified the outcome into two groups: normal and keratoconus. Risk factors, including family history of keratoconus, allergy or atopy, thyroid disease, eye rubbing habit and gender were also examined. RESULTS A total of 512 subjects between 7 and 81 years old were evaluated. The inter-observer agreement to classify subjects in normal or keratoconus group was excellent (k = 1.0); the estimated prevalence in the specific population was 2.1%. Presence of positive family history (9% of keratoconus vs 5% normal), concomitant allergy or atopy (27% vs 9%) and eye rubbing habit (18% vs 4%) were associated with a higher risk of disease. CONCLUSION This study reported a high estimated prevalence of keratoconus in a metropolitan area of Italy, as found in recent studies in the Mediterranean and Middle East countries. Screening for keratoconus is highly recommendable and easily feasible with corneal topography under expert supervision and may be indicated primarily in young population to improve early detection and prompt therapeutic management for halting disease progression.
Collapse
Affiliation(s)
- Marco Lombardo
- Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy
- Vision Engineering Italy srl, Via Livenza 3, 00198, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public health and Infectious diseases, University of Rome "La Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Sebastiano Serrao
- Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy
- Vision Engineering Italy srl, Via Livenza 3, 00198, Rome, Italy
| | - Annarita Vestri
- Department of Public health and Infectious diseases, University of Rome "La Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giuseppe Lombardo
- Vision Engineering Italy srl, Via Livenza 3, 00198, Rome, Italy
- CNR-IPCF, Istituto per i Processi Chimico-Fisici, Viale F. Stagno D'Alcontres 37, 98158, Messina, Italy
| |
Collapse
|
13
|
Sarria Calderón NA, Martínez Córdoba CJ, Pinedo Agudelo JA, Rosas Apraez JA, Revelo Álvarez ML. Keratoconus Frequency and Associated Risk Factors Among Patients Younger Than 18 Years With Significant Refractive Errors. Cornea 2024; 43:585-590. [PMID: 37702565 DOI: 10.1097/ico.0000000000003376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/26/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION Keratoconus is an ectatic corneal disorder that causes low vision secondary to high myopia, irregular astigmatism, and loss of corneal transparency. In children, the disease behaves aggressively, progresses rapidly, is diagnosed at advanced stages, and presents an increased risk for corneal transplantation; however, only few studies in children have been conducted. PURPOSE The aims of this study were to determine the frequency of keratoconus in patients younger than 18 years who underwent the Pentacam study because of high myopia or high astigmatism in the oblique axis, analyze topographic criteria and classify them into severity groups, and identify associated risk factors. METHODS This was a retrospective observational cross-sectional study in which Pentacam examinations were analyzed. Frequency of keratoconus was determined and patients were classified according to visual acuity and severity scales. Medical records were reviewed to identify associated risk factors. RESULTS Four hundred twenty-six patients younger than 18 years were included, 40 (9.4%) had keratoconus according to Pentacam criteria. The mean age at diagnosis was 14.9 years, with male predilection (75%). Atopy was the only statistically significant risk factor, present in 85%. Family history was present in 7.5%. There were no differences in the distribution in groups according to visual acuity or Amsler-Krumeich scale. Most frequent ABCD classification was A2 (35.6%), B4 (47.9%), and C0 (35.6%), posterior curvature radius being a significant severity criterion. CONCLUSIONS The study found that frequency of keratoconus in children is higher than previously reported. Atopy has a clear and possible causal association. Early detection should be sought to reduce the risk of progression. Pentacam is a fundamental tool for early diagnosis using simple criteria.
Collapse
Affiliation(s)
- Natalia Andrea Sarria Calderón
- Ophthalmology Department, Nueva Granada Military University, Bogotá, Colombia
- Ophthalmology Department, Central Military Hospital, Bogotá, Colombia
| | - Claudia Johanna Martínez Córdoba
- Ophthalmology Department, Nueva Granada Military University, Bogotá, Colombia
- Ophthalmology Department, Central Military Hospital, Bogotá, Colombia
| | | | - Jesús Andrés Rosas Apraez
- Ophthalmology Department, Nueva Granada Military University, Bogotá, Colombia
- Ophthalmology Department, Central Military Hospital, Bogotá, Colombia
- Cornea and Anterior Segment Department, Central Military Hospital, Bogotá, Colombia
| | - Mario Leandro Revelo Álvarez
- Ophthalmology Department, Nueva Granada Military University, Bogotá, Colombia
- Ophthalmology Department, Central Military Hospital, Bogotá, Colombia
- Cornea and Anterior Segment Department, Central Military Hospital, Bogotá, Colombia
| |
Collapse
|
14
|
Villa-Collar C, Alvarez-Peregrina C, Martinez-Perez C, Sánchez-Tena MÁ. Citation network analysis on keratoconus. JOURNAL OF OPTOMETRY 2024; 17:100498. [PMID: 38035410 PMCID: PMC10697998 DOI: 10.1016/j.optom.2023.100498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/07/2023] [Accepted: 09/30/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE The high incidence of keratoconus has caused its management, etiology, and pathogenesis to be controversial topics in the ophthalmology field. This study aims to analyze the relationship between the different publications and authors through citation networks, as well as to identify the research areas and determine the most cited article. METHODS The search for publications was carried out through the Web of Science database, using the term "Keratoconus" between 1900 and December 2022. The Citation Network Explorer and CiteSpace software were used for the publication analysis. RESULTS 9,655 publications were found, with 124,379 citations generated on the network. The year with the highest number of publications was 2021. The most cited publication was "Keratoconus" by Rabinowitz, published in 1998. Cluster function gave five groups of research areas about keratoconus: corneal signs and parameters, cross-linking efficiency and effects, clinical factors, keratoplasty, and treatment. CONCLUSIONS The citation network offers an objective and comprehensive analysis of the papers on keratoconus.
Collapse
Affiliation(s)
- Cesar Villa-Collar
- School of Biomedical and Health Science, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Cristina Alvarez-Peregrina
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Clara Martinez-Perez
- ISEC LISBOA - Instituto Superior de Educação e Ciências, 1750-179, Lisboa, Portugal
| | - Miguel Ángel Sánchez-Tena
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain; ISEC LISBOA - Instituto Superior de Educação e Ciências, 1750-179, Lisboa, Portugal.
| |
Collapse
|
15
|
Ng JM, Lin KK, Lee JS, Chen WM, Hou CH, See LC. Incidence and prevalence of keratoconus in Taiwan during 2000-2018 and their association with the use of corneal topography and tomography. Eye (Lond) 2024; 38:745-751. [PMID: 37857718 PMCID: PMC10920627 DOI: 10.1038/s41433-023-02767-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/27/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
PURPOSE The aim of this study was to determine the age- and sex-specific incidence and prevalence of keratoconus (KC) in Taiwan and explore their association with the use of computerized corneal topography and tomography (TG). DESIGN This nationwide retrospective study included the Taiwanese population (N = 27,540,859) from the National Health Insurance Research Database (NHIRD) between 2000 and 2018. METHOD We estimated the incidence of KC by identifying patients with newly diagnosed KC and estimated its prevalence by identifying patients who had the ICD9-CM code 371.6 or ICD-10-CM code H18.609 twice or more in NHIRD during 2000-2018. RESULTS The incidence of KC in Taiwan during 2000-2018 was 7075, with the incidence rate being 1.56 (95% confidence interval [CI]: 1.53-1.60) per 100,000 person-years. The prevalence of KC was 4.29 (95% CI: 4.23-4.35) per 100,000 person-years. The KC incidence rate peaked in patients aged 21-25 (6.40 in males and 3.19 in females). The overall incidence rates in males and females were 2.01 and 1.35, respectively (incidence rate ratio: 1.46), indicating that KC had a significant male predisposition. Moreover, we noted a linear correlation (R2 = 0.7488) between the proportion of the use of TG and the incidence of KC. CONCLUSION Estimates of nationwide population-based incidence and prevalence can contribute to a better understanding of the risk of ethnic groups and geographic locations in KC, and the trend can help physicians improve the general vision health of the population.
Collapse
Affiliation(s)
- Jack Min Ng
- Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ken-Kuo Lin
- Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Jiahn-Shing Lee
- Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
| | - Wei-Min Chen
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chiun-Ho Hou
- Department of Medicine, School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan
- Institute of Public Health, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Lai-Chu See
- Department of Public Health, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Biostatistics Core Laboratory, Molecular Medicine Research Center, Chang Gung University, Taoyuan, Taiwan.
- Division of Rheumatology, Allergy and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, Taiwan.
| |
Collapse
|
16
|
Singh RB, Parmar UPS, Jhanji V. Prevalence and Economic Burden of Keratoconus in the United States. Am J Ophthalmol 2024; 259:71-78. [PMID: 37951332 DOI: 10.1016/j.ajo.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/04/2023] [Accepted: 11/05/2023] [Indexed: 11/13/2023]
Abstract
PURPOSE To assess the prevalence and economic burden of keratoconus in the United States. DESIGN Retrospective cohort study. METHODS Patients enrolled in Medicaid and Children's Health Insurance Program (CHIP) who were diagnosed with keratoconus between 2016 and 2019 were included. The data reported to the Centers for Disease Control and Prevention (CDC) Vision and Eye Health Surveillance System (VEHSS) were analyzed. The crude prevalence rates (national and statewise) were obtained from the database and extrapolated to estimate the keratoconus case count in the United States. The keratoconus prevalence was compared between male and female individuals using the Mann-Whitney test, whereas Brown-Forsythe 1-way analysis of variance was used to compare prevalence between age and racial groups. The Dunnett T3 multiple comparison test was used for intergroup comparison. Finally, the economic burden of keratoconus was assessed by inflation-adjusted direct costs to patients and total cases in the country. RESULTS In the cohort of 69,502,000 patients enrolled for Medicaid and CHIP, the national prevalence of keratoconus was computed to be 0.04% in 2019 and had increased from 0.03% in 2016. The highest prevalence of keratoconus was observed in patients 18 to 39 years of age, followed by patients 40 to 64 years of age; comparable prevalence rates were observed in these age groups in the Black population. The prevalence was moderately higher in female compared to male individuals; however, significantly higher keratoconus prevalence was observed in Black female individuals compared to male individuals. A significantly high prevalence of keratoconus was observed in the Black population, followed by Hispanic population. In 2019, the average inflation-adjusted lifetime cost of keratoconus treatment was USD 28,766.69, with a cumulative economic burden of USD 3.8 billion. CONCLUSIONS In the United States, keratoconus is most prevalent in individuals 18 to 39 years of age. The keratoconus prevalence is higher in the Black population, specifically female individuals, and the diagnosis is often delayed in these patients.
Collapse
Affiliation(s)
- Rohan Bir Singh
- From the Department of Ophthalmology (R.B.S.), Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA; Department of Population, Policy and Practice Research (R.B.S.), Great Ormond Street Institute of Child Health, University College London, London, UK; Discipline of Ophthalmology and Visual Sciences (R.B.S.), Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Uday Pratap Singh Parmar
- Department of Ophthalmology (U.P.S.P.), Government Medical College and Hospital, Chandigarh, India
| | - Vishal Jhanji
- Vision Institute (V.J.), Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
| |
Collapse
|
17
|
Gupta AS, Yu Y, Orlin SE, VanderBeek BL. Real-world socioeconomic determinants of corneal crosslinking in a national cohort. J Cataract Refract Surg 2024; 50:217-223. [PMID: 37847112 PMCID: PMC10878448 DOI: 10.1097/j.jcrs.0000000000001340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/24/2023] [Accepted: 10/08/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE To characterize recent socioeconomic trends in patients with keratoconus/corneal ectasias undergoing corneal crosslinking (CXL). SETTING A deidentified administrative medical claims database comprised commercial and Medicare Advantage health claims from across the United States. DESIGN Population-based retrospective cohort study. METHODS This study identified 552 patients with keratoconus/corneal ectasia who underwent CXL and 2723 matched controls who did not undergo CXL based on Current Procedural Terminology coding from a U.S. national insurance claims database from 2016 to 2020. For each patient, characteristics, including sex, race, age, household net worth, education level, insurance plan type, and geographic region, were extracted. Multivariate logistic regression was conducted to determine the odds of undergoing crosslinking. RESULTS Age 30 years or older (odds ratio [OR], 0.34, P < .001) was associated with decreased likelihood of undergoing CXL. Sex, race, education, and patient income were not associated with odds of undergoing CXL. Patients with health maintenance organization insurance had lower odds of undergoing CXL (OR, 0.64, P = .047). Geographically, patients on the east coast (OR, 0.37, P < .001) and Lower Midwest (OR, 0.31, P < .001) had statistically lower odds of undergoing crosslinking. CONCLUSIONS This is the first study to identify socioeconomic determinants of CXL, and it highlights that geographic location and insurance type may limit accessibility to patients.
Collapse
Affiliation(s)
- Angela S. Gupta
- From the Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania (Gupta, Orlin, VanderBeek); Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Yu); Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (VanderBeek); Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (VanderBeek)
| | - Yinxi Yu
- From the Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania (Gupta, Orlin, VanderBeek); Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Yu); Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (VanderBeek); Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (VanderBeek)
| | - Stephen E. Orlin
- From the Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania (Gupta, Orlin, VanderBeek); Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Yu); Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (VanderBeek); Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (VanderBeek)
| | - Brian L. VanderBeek
- From the Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania, Philadelphia, Pennsylvania (Gupta, Orlin, VanderBeek); Center for Preventive Ophthalmology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Yu); Center for Clinical Epidemiology and Biostatistics, Department of Biostatistics & Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (VanderBeek); Leonard Davis Institute, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (VanderBeek)
| |
Collapse
|
18
|
Cheng J, Yang L, Ye Y, He L, Chen S, Wang J. Mendelian Randomisation Analysis of Causal Association between Lifestyle, Health Factors, and Keratoconus. Bioengineering (Basel) 2024; 11:221. [PMID: 38534495 DOI: 10.3390/bioengineering11030221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Keratoconus (KC), a leading cause of vision impairment, has an unclear aetiology. This study used Mendelian randomization (MR) to explore the causal links between various factors (smoking, asthma, Down syndrome, inflammatory bowel disease, atopic dermatitis, and serum 25-hydroxyvitamin D levels) and KC. A two-sample MR design, grounded in genome-wide association study (GWAS) summary statistics, was adopted using data from FinnGen, UK Biobank, and other GWAS-related articles. The inverse-variance weighted (IVW) method was employed, complemented by the Wald ratio method for factors with only one single-nucleotide polymorphism (SNP). Sensitivity and stability were assessed through Cochrane's Q test, the MR-Egger intercept test, MR-PRESSO outlier test, and the leave-one-out analysis. The IVW results for the ORA (Ocular Response Analyzer) biomechanical parameters indicated significant associations between tobacco smoking (CH: p < 0.001; CRF: p = 0.009) and inflammatory bowel disease (CH: p = 0.032; CRF: p = 0.001) and corneal biomechanics. The Wald ratio method showed tobacco smoking was associated with a lower risk of KC (p = 0.024). Conversely, asthma (p = 0.009), atopic dermatitis (p = 0.012), inflammatory bowel disease (p = 0.017), and serum 25-hydroxyvitamin D levels (p = 0.039) were associated with a higher risk of KC by IVW, and the same applied to Down syndrome (p = 0.004) using the Wald ratio. These results underscore the role of corneal biomechanics as potential mediators in KC risk, warranting further investigation using Corvis ST and Brillouin microscopy. The findings emphasise the importance of timely screening for specific populations in KC prevention and management.
Collapse
Affiliation(s)
- Jiaxuan Cheng
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Lanting Yang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Yishan Ye
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Lvfu He
- Department of Ophthalmology, Sichuan Mental Health Center, Mianyang 621054, China
| | - Shihao Chen
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Junjie Wang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- Department of Ophthalmology, Sichuan Mental Health Center, Mianyang 621054, China
| |
Collapse
|
19
|
Ahadi M, Ramin S, Abbasi A, Tahmouri H, Hosseini SB. Mini review: human clinical studies of stem cell therapy in keratoconus. BMC Ophthalmol 2024; 24:35. [PMID: 38263090 PMCID: PMC10804477 DOI: 10.1186/s12886-024-03297-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024] Open
Abstract
Treatment of keratoconus is one of the most interesting research fields for researchers in the world. Regenerative medicine based on human stem cells in the treatment of keratoconus has recently received attention. Despite extensive laboratory and animal studies in regenerative medicine of cornea, there are limited clinical studies in keratoconus. These studies showed promising results of stem cell therapy. In initial studies, the transplantation of these cells into stroma was associated with increased vision and improved corneal parameters without side effects. In this article, we tried to review different aspects of keratoconus stem cell therapy, including cell extraction and culture, surgical procedure, effectiveness and safety of this method in human clinical studies.
Collapse
Affiliation(s)
- Masoumeh Ahadi
- Department of Optometry, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Shahrokh Ramin
- Department of Optometry, School of Rehabilitation Sciences, Incubation Center for Pharmaceutical Technology (ICPT), Cell Therapy Department, Red Crescent Pharmaceutical and Clinical Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Abbasi
- Department of Optometry, School of Rehabilitation Sciences, Incubation Center for Pharmaceutical Technology (ICPT), Cell Therapy Department, Red Crescent Pharmaceutical and Clinical Complex, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Tahmouri
- Department of Optometry, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Bagher Hosseini
- Department of Ophthalmology, Eye Bank of Islamic Republic of Iran, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| |
Collapse
|
20
|
Sedaghat MR, Shiri H, Tavakkol-Afshari J, Norouzmahani ME, Bahri F, Fooladi S, Momeni-Moghaddam H, Danesh Z, Nikpoor AR, Momeni-Moghaddam MA, Nematollahi MH, Sadeghi J. Impact of a 50bp insertion/deletion polymorphism of the superoxide dismutase-1 on oxidative stress status and risk of keratoconus. Exp Eye Res 2024; 238:109742. [PMID: 38040051 DOI: 10.1016/j.exer.2023.109742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/24/2023] [Accepted: 11/27/2023] [Indexed: 12/03/2023]
Abstract
Keratoconus (KC) is characterized by the predominant primary ectatic disease, affecting the cornea, necessitating corneal transplants in some cases. While some loci associated with KC risk have been identified, the understanding of the disease remains limited. Superoxide dismutase (SOD) enzymes play a crucial role in countering the reactive oxygen species and providing protection against oxidative stress (OS). Accordingly, the objective of this study was to investigate a potential association of a 50 nucleotide base pairs (bp) insertion/deletion (I/D) within the SOD1 promoter, and the located 1684 bp upstream of the SOD1 ATG, with KC in the Iranian population. Additionally, an assessment was conducted on SOD activity and the total antioxidant capacity (TAC), as determined by the ferric reducing-antioxidant power assay, along with malondialdehyde (MDA) levels. In this case-control study, genomic DNA was extracted from the blood cells of KC (n = 402) and healthy (n = 331) individuals. The genotype of this gene was determined using the PCR technique. Furthermore, the amount of SOD enzyme activity and the MDA and TAC levels were measured in the serum of the study groups. The (I/I) genotype was present in 84.23%, the (I/D) genotype in 15.06%, and the (D/D) genotype in 0.69% of both groups. A statistically significant relationship was seen between different genotypes and TAC, MDA, and SOD1 activity indices (P < 0.05). Individuals with the D/D genotype exhibited a decrease in total antioxidant capacity, an increase in the amount of MDA, and a decrease in SOD1 enzyme activity (P < 0.05). Moreover, the logistic regression analysis of KC development indicated that elevated levels of MDA increased the risk of KC incidence in the patient group compared to the healthy group, while a higher activity of SOD1 and greater values of TAC decreased the KC risk. The removal of the 50 bp fragment reduced SOD1 activity and elevated OS levels, thereby impacting the oxidant-antioxidant balance. This could potentially play a significant role in individuals afflicted by KC.
Collapse
Affiliation(s)
| | - Hamidreza Shiri
- Department of Clinical Biochemistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Jalil Tavakkol-Afshari
- Immunogenetic and Cell Culture Department, Immunology Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of allergy and immunology, School of medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Faegheh Bahri
- Applied Cellular and Molecular Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Saba Fooladi
- Yale Cardiovascular Research Center, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, CT, 06511, USA
| | - Hamed Momeni-Moghaddam
- Rehabilitation Sciences Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zeynab Danesh
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Reza Nikpoor
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | | | - Javad Sadeghi
- Eye Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
21
|
Kovalchuk B, Khoramnia R, Son HS, Meis J, Winkler P, Naujokaitis T, Köppe MK, Auffarth GU, Augustin VA. Longitudinal Evaluation of Biomechanical Indices in Fellow Eyes of Patients With Keratoconus Classified as Having Very Asymmetric Ectasia With Normal Topography. J Refract Surg 2024; 40:e48-e56. [PMID: 38190558 DOI: 10.3928/1081597x-20231204-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE To evaluate the biomechanical longitudinal variability and progression of tomographically normal fellow eyes of patients with keratoconus. METHODS Of 513 patients with keratoconus, 30 patients with tomographically normal fellow eyes were included in this study. Tomographic and biomechanical parameters of the Pentacam and Corvis ST (Oculus Optikgeräte GmbH) were analyzed in multiple follow-up examinations, including the ABCD grading, Belin/Ambrósio Enhanced Ectasia total deviation index (BAD-D), Corvis Biomechanical Index (CBI), Corvis Biomechanical Factor (CBiF), and Tomographic and Biomechanical Index (TBI). A mixed regression model was applied. The results were compared to a healthy control group (n = 17) and a keratoconus group (n = 20). RESULTS Within a maximum observation period of 3.3 years, no fellow eye (0%) showed a progression to tomographically evident keratoconus. No significant change in tomographic or biomechanical parameters was detected over the study period. The indices BAD-D, CBI, CbiF, and TBI exhibited a certain variability over time, whereas the tomographic ABC parameters and maximum keratometry barely changed. This was also shown in the control group and for all parameters in the keratoconus group, except the TBI. CONCLUSIONS During the observation period none of the normal fellow eyes progressed to tomographically detectable keratoconus. However, biomechanical parameters CBI, CbiF, and TBI showed pathological values in 43.3% of eyes and certain variability. Subsequent studies with a longer observation period are warranted to confirm the biomechanical trends seen in this study and to rate the ability of single measurements to diagnose early keratoconus. [J Refract Surg. 2024;40(1):e48-e56.].
Collapse
|
22
|
Khan M, Ageed A. Advances in the Treatment of Keratoconus: Epithelial-On (EPI-On) Corneal-Collagen Cross-Linking (CXL) and CXL-Plus Procedures. Cureus 2024; 16:e51565. [PMID: 38173952 PMCID: PMC10762651 DOI: 10.7759/cureus.51565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 01/05/2024] Open
Abstract
Keratoconus (KC) incidence is on the increase. The advent of corneal-collagen cross-linking (CXL) has revolutionized the management of KC. This systematic review looks at the efficacy and complications of two novel treatments within CXL: Epithelial-On (Epi-On) and CXL-plus procedures. Two separate literature searches were carried out up until July 1, 2021. Articles only published in the last two years were included to ensure that only the most recent articles were reviewed. A total of 15 articles were selected for this review. There were varied results regarding the efficacy of Epi-On. No significant difference was found between Epi-On and standard Epithelial-Off (Epi-Off) CXL. However, it was found that Epi-On was inferior to standard CXL in terms of reducing KMAX. There was a higher risk of progression in patients treated with Epi-On CXL, with an increased rate of patients requiring re-treatment due to the advancement of their KC. While some studies report CXL-plus procedures demonstrate long-term efficacy and safety, a considerable number of studies advise caution, reporting a significant deterioration in corrected distance visual acuity (CDVA). Consequently, a question persists regarding the safest and most efficacious approach, given the lack of robust large randomized controlled trials (RCTs) in the current literature.
Collapse
Affiliation(s)
- Maaz Khan
- Medical Education, Royal Surrey County Hospital, Guildford, GBR
| | - Ahmed Ageed
- Internal Medicine, University Hospitals of Leicester NHS Trust, Leicester, GBR
| |
Collapse
|
23
|
Yavangi M, Rabiee S, Sanavi Farimani M, Khansary S, Farhadian M, Ranjbar A, Mahmoudi M, Karimi M, Barati S, Barati Mosleh A, Mohammadpour N. The effects of green tea tablets and metformin on ovulation and menstrual cycle regularity in women with polycystic ovary syndrome. J Med Life 2024; 17:109-115. [PMID: 38737668 PMCID: PMC11080502 DOI: 10.25122/jml-2022-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/28/2023] [Indexed: 05/14/2024] Open
Abstract
Polycystic ovary syndrome is the most common cause of oligo-ovulation and anovulation among women of reproductive age, contributing to infertility. This study aimed to compare the effects of green tea tablets and metformin on ovulation, menstrual cycle regularity, and antioxidant biomarkers in women with polycystic ovary syndrome (PCOS). In this clinical trial study, 94 women with PCOS were randomly assigned to three groups: green tea (n = 33), metformin (n = 29), and control (n = 32). Menstrual status and oxidative stress parameters, including total antioxidant capacity, thiol, and lipid peroxidation, were compared before and 3 months after the intervention among all three groups. Data analysis was conducted using SPSS software version 22 and employing the analysis of variance and paired t-tests. Following the intervention, the mean menstrual cycle duration in the green tea, metformin, and control groups was 32.22 ± 12.78, 48.72 ± 37.06, and 48.53 ± 31.04 days, respectively (P = 0.040). There was no statistically significant difference between the three groups in terms of biochemical, hormonal, and antioxidant indices before and after the intervention (P > 0.05). The intake of green tea tablets was associated with better outcomes in regulating the menstrual cycle in women with PCOS.
Collapse
Affiliation(s)
- Mahnaz Yavangi
- Department of Gynecology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Soghra Rabiee
- Department of Gynecology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Marzieh Sanavi Farimani
- Department of Gynecology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahede Khansary
- Department of Gynecology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Maryam Farhadian
- Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Akram Ranjbar
- Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Minoo Mahmoudi
- Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Masoud Karimi
- Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Somayeh Barati
- Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Amir Barati Mosleh
- Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Noushin Mohammadpour
- Department of Biostatistics, School of Health, Hamadan University of Medical Sciences, Hamadan, Iran
| |
Collapse
|
24
|
Wan Q, Wei R, Ma K, Yin H, Deng YP, Tang J. Deep Learning-Based Automatic Diagnosis of Keratoconus with Corneal Endothelium Image. Ophthalmol Ther 2023; 12:3047-3065. [PMID: 37665500 PMCID: PMC10640564 DOI: 10.1007/s40123-023-00795-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION The primary objective of this study was to develop an end-to-end model that can accurately identify corneal endothelial cells and diagnose keratoconus based on corneal endothelial images acquired from a non-contact specular microscope. METHODS This was a retrospective case-control study performed at the Refractive Surgery Center of West China Hospital. A total of 403 keratoconus eyes (221 patients) and 370 myopic eyes (185 normal controls) were consecutively recruited from January 2021 to September 2022. Specular microscopy was used to image and measure the morphometric parameters of the corneal endothelial cells. A Fully Convolutional Network model with a ResNet50 (FCN_ResNet50) was established to perform the endothelial segmentation. The images were then classified using an ensemble machine learning system consisting of four pre-trained deep learning networks: DenseNet121, ResNet50, Inception_v3, and MobileNet_v2. The performance of the models was evaluated based on different metrics, such as accuracy, intersection over union (IoU), and mean IoU. RESULTS We established a fully end-to-end deep-learning model for the segmentation of endothelial and diagnosis of keratoconus. For endothelial segmentation, the accuracy of the FCN_ResNet50 model achieved near 90% with mean IoU converging to about 80%. The ensemble machine learning system can achieve over 92% accuracy, and > 98% area under curve (AUC) values to diagnose keratoconus with endothelial cell images. In addition, we constructed a diagnostic model based on deep-learning features and developed an associated nomogram which manifested an excellent performance for diagnosis and monitoring the progression of keratoconus. CONCLUSIONS Our research developed an end-to-end model to automatically identify and assess corneal endothelial morphological changes in keratoconus eyes. Moreover, we also constructed a novel nomogram, which can provide valuable information for the diagnosis, monitoring, and management of the disease.
Collapse
Affiliation(s)
- Qi Wan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ran Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ke Ma
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongbo Yin
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Ping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jing Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
25
|
Yu H, Wu J, Li K, Huang Y, Wu T, Wang L, Huang Y. Integrated analysis of murine cornea identifies JAK/STAT signaling pathway upregulated specifically in female Vitamin A Deficient mice. Exp Eye Res 2023; 237:109714. [PMID: 37931772 DOI: 10.1016/j.exer.2023.109714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 10/17/2023] [Accepted: 11/02/2023] [Indexed: 11/08/2023]
Abstract
The Keratoconus (KC) is a corneal ectatic disease with unclear etiology. There are increasing studies that reported its association with a variety of inflammatory mechanisms. Vitamin A(VA) is an important nutrient related to inflammation regulation, and its deficiency may cause abnormalities of the ocular surface. However, the proportion of Vitamin A deficiency(VAD) was found surprisingly high among KC patients in our clinic practice. The aim of this study is to explore the effects of VAD on the transcriptome of corneas with the help of the VAD murine model and transcriptomics techniques. Blood samples of KC patients and non-KC controls (NC) were collected and the serum VA concentrations were measured and analyzed. A total of 52 NC and 39 KC were enrolled and the comparison of serum VA showed that the proportion of VAD in KC patients was 48.7% versus 1.9% in NC group. The further analysis of gender differences showed the proportion of VAD in female KC was 88.9% versus 36.7% in KC male patients. To explore the influence of VAD on cornea, the VAD mice fed with VAD diets were used. The RNA sequencing was employed to compare the corneal transcriptomic characteristics between the VAD female mice, NC female mice, VAD male mice and NC male mice. The transcriptome analysis revealed that the upregulated differential genes were mainly enriched in the immune response related pathways in VAD female mice versus NC female mice, especially the genes of JAK-STAT signaling pathway. The downstream molecules of JAK-STAT pathway were also significant after corneal mechanical scratching in female VAD mice. While, the differential genes between VAD male mice and NC male mice were estrogen signaling pathway instead of JAK-STAT pathway. This study indicates that VAD affects the transcriptomics of murine cornea with gender differences, which specifically affects the inflammatory status of the female murine cornea.
Collapse
Affiliation(s)
- Hanrui Yu
- Medical School of Chinese PLA, Beijing, China
| | - Jie Wu
- Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, Beijing, China; Department of Ophthalmology, Hainan Hospital of Chinese PLA General Hospital, Sanya, Hainan Province, China
| | - Kaixiu Li
- Medical School of Chinese PLA, Beijing, China
| | - Yulei Huang
- Medical School of Chinese PLA, Beijing, China
| | - Tengyun Wu
- Medical School of Chinese PLA, Beijing, China; Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Liqiang Wang
- Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, Beijing, China; The PLA Medical College, Department of Nephrology, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing, China.
| | - Yifei Huang
- Department of Ophthalmology, the Third Medical Center, Chinese PLA General Hospital, Beijing, China.
| |
Collapse
|
26
|
Hadvina R, Estes A, Liu Y. Animal Models for the Study of Keratoconus. Cells 2023; 12:2681. [PMID: 38067109 PMCID: PMC10705680 DOI: 10.3390/cells12232681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/03/2023] [Accepted: 11/15/2023] [Indexed: 12/18/2023] Open
Abstract
Keratoconus (KC) is characterized by localized, central thinning and cone-like protrusion of the cornea. Its precise etiology remains undetermined, although both genetic and environmental factors are known to contribute to disease susceptibility. Due to KC's complex nature, there is currently no ideal animal model to represent both the corneal phenotype and underlying pathophysiology. Attempts to establish a KC model have involved mice, rats, and rabbits, with some additional novel animals suggested. Genetic animal models have only been attempted in mice. Similarly, spontaneously occurring animal models for KC have only been discovered in mice. Models generated using chemical or environmental treatments have been attempted in mice, rats, and rabbits. Among several methods used to induce KC in animals, ultraviolet radiation exposure and treatment with collagenase are some of the most prevalent. There is a clear need for an experimental model animal to elucidate the underlying mechanisms behind the development and progression of keratoconus. An appropriate animal model could also aid in the development of treatments to slow or arrest the disorder.
Collapse
Affiliation(s)
- Rachel Hadvina
- Department of Cellular Biology & Anatomy, Augusta University, 1120 15th Street, Augusta, GA 30912, USA
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| | - Amy Estes
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA 30912, USA
- Department of Ophthalmology, Augusta University, Augusta, GA 30912, USA
| | - Yutao Liu
- Department of Cellular Biology & Anatomy, Augusta University, 1120 15th Street, Augusta, GA 30912, USA
- Center for Biotechnology and Genomic Medicine, Augusta University, 1120 15th Street, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, 1120 15th Street, Augusta, GA 30912, USA
| |
Collapse
|
27
|
Liu L, Fukuyama T, Han T, Zhang Z, Jiang L, Ding Y, Zhou X, Wang J. Observation and assessment of the immediate use of a silicon hydrogel contact lens after transepithelial corneal cross linking: a prospective study. BMC Ophthalmol 2023; 23:471. [PMID: 37985976 PMCID: PMC10662168 DOI: 10.1186/s12886-023-03217-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Transepithelial corneal crosslinking (CXL) is a novel surgical approach for the treatment of keratoconus, which is a bilateral asymmetrical ophthalmological disease accompanied by progressive corneal ectasia. Silicon hydrogel (SiH) contact lenses have been extensively used in clinical ophthalmologic medicine, as a postoperative ophthalmological intervention. However, the ideal lens application duration after transepithelial CXL remains uncertain. Here, we aimed to investigate the effects and comfort of immediate corneal contact lens use after transepithelial CXL for keratoconus. METHODS In this prospective study, 60 patients with keratoconus who underwent transepithelial CXL treatment were enrolled from September 2021 to January 2023 with a male:female ratio of 39:21, and an average age of 25.42 ± 5.47 years. The patients were divided randomly into two groups: group A contained 30 patients wearing silicone hydrogel contact lenses for 7 days postoperatively, and group B contained 30 patients wearing the same contact lenses for 3 days. Ten subjective ophthalmologic symptoms were surveyed by the patients, including pain, photophobia, foreign body sensation, tearing, burning, blurred vision, dry eyes, difficulty opening the eyes, astringency, and stinging. Ophthalmologic signs, including corneal edema and conjunctival congestion, were recorded by a single clinician on postoperative days 1, 3, and 7. RESULTS Each surgical procedure was readily performed without complications, and both groups postoperative day 7 (P = 0.04), where group B scored (0.01 ± 0.41) lesser than group A (0.12 ± 0.29), whilst corneal edema in both groups recorded significantly different on postoperative days 5 and 7 (group A demonstrated the result of 0.17 ± 0.14 and 0.08 ± 0.11 for the respective days, whereas group B indicated 0.10 ± 0.13 and 0.03 ± 0.07 at the corresponding times). CONCLUSIONS Immediate use of silicone hydrogel corneal lenses after transepithelial CXL effectively alleviates postoperative ocular distress, particularly with a three-day use period as the ideal duration.
Collapse
Affiliation(s)
- Liu Liu
- Department of Nursing, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Teruko Fukuyama
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Tian Han
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Zhe Zhang
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Lin Jiang
- Department of Nursing, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Yanlan Ding
- Department of Nursing, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China.
| | - Jifang Wang
- Department of Nursing, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China.
| |
Collapse
|
28
|
Zhu X, Cheng D, Ruan K, Shen M, Ye Y. Causal relationships between type 2 diabetes, glycemic traits and keratoconus. Front Med (Lausanne) 2023; 10:1264061. [PMID: 38020157 PMCID: PMC10658005 DOI: 10.3389/fmed.2023.1264061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose The relationship between diabetes mellitus and keratoconus remains controversial. This study aimed to assess the potential causal relationships among type 2 diabetes, glycemic traits, and the risk of keratoconus. Methods We used a two-sample Mendelian randomization (MR) design based on genome-wide association summary statistics. Fasting glucose, proinsulin levels, adiponectin, hemoglobin A1c (HbA1c) and type 2 diabetes with and without body mass index (BMI) adjustment were used as exposures and keratoconus was used as the outcome. MR analysis was performed using the inverse-variance weighted method, MR-Egger regression method, weighted-mode method, weighted median method and the MR-pleiotropy residual sum and outlier test (PRESSO). Results Results showed that genetically predicted lower fasting glucose were significantly associated with a higher risk of keratoconus [IVW: odds ratio (OR) = 0.382; 95% confidence interval (CI) = 0.261-0.560; p = 8.162 × 10-7]. Genetically predicted lower proinsulin levels were potentially linked to a higher risk of keratoconus (IVW: OR = 0.739; 95% CI = 0.568-0.963; p = 0.025). In addition, genetically predicted type 2 diabetes negatively correlated with keratoconus (IVW: BMI-unadjusted: OR = 0.869; 95% CI = 0.775-0.974, p = 0.016; BMI-adjusted: OR = 0.880, 95% CI = 0.789-0.982, p = 0.022). These associations were further corroborated by the evidence from all sensitivity analyses. Conclusion These findings provide genetic evidence that higher fasting glucose levels are associated with a lower risk of keratoconus. However, further studies are required to confirmed this hypothesis and to understand the mechanisms underlying this putative causative relationship.
Collapse
Affiliation(s)
| | | | | | | | - Yufeng Ye
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| |
Collapse
|
29
|
Sobczak M, Asejczyk M, Wilczyński M. The effect of pupil size on the measurement of corneal birefringence properties: preliminary study. Sci Rep 2023; 13:17439. [PMID: 37838761 PMCID: PMC10576786 DOI: 10.1038/s41598-023-44706-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/11/2023] [Indexed: 10/16/2023] Open
Abstract
We used a partial Mueller matrix polarimeter to measure the corneal anisotropic properties at three pupil sizes (dilated, natural, and constricted). The geometrical parameters of first order isochromes were described by quadrilaterals. These parameters are statistically significantly different between the three pupil sizes. The pupillary size changes do not influence the azimuth angle distribution α. The retardation R and birefringence distributions show asymmetry in the nasal-temporal cross-section. There are differences between pupil sizes for both nasal and temporal parts of the cornea for these distributions. Iridial light scattering and diffraction might be the reason for these differences.
Collapse
Affiliation(s)
- Marcelina Sobczak
- Department of Optics and Photonics, Wrocław University of Science and Technology, Wybrzeże Stanisława Wyspiańskiego 27, 50-370, Wrocław, Poland.
- School of Optometry, Indiana University, 800 Atwater, Bloomington, IN, 47405, United States.
| | - Magdalena Asejczyk
- Department of Optics and Photonics, Wrocław University of Science and Technology, Wybrzeże Stanisława Wyspiańskiego 27, 50-370, Wrocław, Poland
| | - Maciej Wilczyński
- Faculty of Pure and Applied Mathematics, Wrocław University of Science and Technology, Wybrzeże Stanisława Wyspiańskiego 27, 50-370, Wrocław, Poland
| |
Collapse
|
30
|
Eldanasoury A, Abdelazeem E, Ayesh K, Bains H. Transepithelial corneal crosslinking with oxygen enhancement and pulsed light for progressive ectasia: one-year results. Int Ophthalmol 2023; 43:3733-3745. [PMID: 37389763 DOI: 10.1007/s10792-023-02784-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023]
Abstract
PURPOSE To evaluate the efficacy and safety of transepithelial accelerated crosslinking (TE-ACXL) using pulsed light and supplemental oxygen. METHODS Thirty eyes of 30 consecutive patients with progressive keratoconus or post-LASIK ectasia were enrolled in a prospective non-comparative study conducted at the Magrabi Eye Center (Jeddah, Saudi Arabia). All eyes underwent TE-ACXL with supplemental oxygen. Primary outcome measures were the mean change in corrected distance visual acuity (CDVA) (logMAR) and maximum keratometry (max K) from preoperatively to 12 months postoperatively. Secondary outcome measures included change in manifest refractive spherical equivalent (MRSE), refractive cylinder, keratometry, symmetry index (SI), center-surrounding index (CSI) and ectasia index (EI) of the anterior and posterior corneal surfaces, corneal and epithelial thickness at corneal vertex and thinnest location, corneal densitometry, corneal high order aberrations (HOA) and endothelial cell density (ECD). RESULTS Mean age was 29.6 ± 8.2 years. At 1 year, the follow up rate was 93.3%. CDVA improved statistically significantly at 12 months (p = 0.027). Measures of corneal keratometry or pachymetry did not change significantly (p < 0.05). Postoperatively, a demarcation line was documented in 78.6% eyes at 1 month, and in 12 (42.9%) eyes at 12 months. The mean depth of the demarcation line was 341.9 ± 49.4 µm. Corneal densitometry increased significantly at 1- and 3-months (p < 0.05) and returned to normal levels at 6- and 12-months postoperatively. CONCLUSION TE-ACXL with oxygen supplement is effective at halting the progression of corneal ectasia for at least 1 year and can be a refractive neutral procedure.
Collapse
Affiliation(s)
- Alaa Eldanasoury
- Magrabi Hospitals and Centers, Main Jeddah Hospital, Old Makkah Rd. K3, Khozam St., PO Box: 7344, Jeddah, 21462, Saudi Arabia.
| | - Emad Abdelazeem
- Magrabi Hospitals and Centers, Main Jeddah Hospital, Old Makkah Rd. K3, Khozam St., PO Box: 7344, Jeddah, 21462, Saudi Arabia
| | - Karim Ayesh
- Magrabi Hospitals and Centers, Main Jeddah Hospital, Old Makkah Rd. K3, Khozam St., PO Box: 7344, Jeddah, 21462, Saudi Arabia
| | - Harkaran Bains
- Magrabi Hospitals and Centers, Main Jeddah Hospital, Old Makkah Rd. K3, Khozam St., PO Box: 7344, Jeddah, 21462, Saudi Arabia
| |
Collapse
|
31
|
Torres-Netto EA, Abdshahzadeh H, Lu NJ, Kling S, Abrishamchi R, Hillen M, Hafezi NL, Koppen C, Hafezi F. Corneal crosslinking with riboflavin using sunlight. J Cataract Refract Surg 2023; 49:1049-1055. [PMID: 37343287 DOI: 10.1097/j.jcrs.0000000000001241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/14/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE To assess whether sunlight might be used to induce a biomechanical stiffening effect in riboflavin-soaked corneas similar to the effect observed in corneal crosslinking (CXL) using riboflavin and UV-A light. SETTING Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland. DESIGN Experimental study. METHODS 52 porcine eyes were assayed. The concentration of riboflavin in the corneal stroma was estimated using UV-A transmission in a preliminary experiment. Then, the duration of sunlight exposure to achieve a fluence of 7.2/cm 2 was calculated. Finally, de-epithelialized corneas were divided equally into 3 groups and soaked with riboflavin 0.1% (control group and Group 1) or 0.5% (Group 2). Eyes from Groups 1 and 2 were then exposed to sunlight. The elastic modulus was calculated as an indicator of stiffness. RESULTS Riboflavin concentration in Group B was higher by a factor of 2.8 than Group A. According to live illuminance measurements and stromal riboflavin concentration, the sunlight exposure duration varied between 16 minutes and 45 minutes. Groups 1 and 2 had higher elastic modulus than controls ( P < .0001) but did not differ between them ( P = .194). The stiffening effect was 84% and 55%, respectively. CONCLUSIONS Sunlight exposure of ex vivo corneas soaked in both riboflavin 0.1% and 0.5% resulted in increased corneal stiffness. Specifically, riboflavin 0.1% with longer UV-A exposure showed a trend for a greater stiffening effect, which might open new alleys for the use of oral riboflavin and fractioned sunlight exposure as less invasive CXL techniques.
Collapse
Affiliation(s)
- Emilio A Torres-Netto
- From the Ocular Cell Biology Group, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland (Torres-Netto, Abdshahzadeh, Abrishamchi, Hillen, F. Hafezi); ELZA Institute AG, Dietikon, Switzerland (Torres-Netto, Abdshahzadeh, Lu, Abrishamchi, Hillen, N. Hafezi, F. Hafezi); Department of Ophthalmology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil (Torres-Netto); Faculty of Medicine, University of Geneva, Geneva, Switzerland (Torres-Netto, N. Hafezi, Koppen, F. Hafezi); Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium (Lu, Koppen); Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium (Lu); Computer Vision Laboratory, Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology, Zurich, Switzerland (Kling); Department of Ophthalmology, University of Southern California, Los Angeles, California (F. Hafezi); School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China (F. Hafezi)
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Tran TM, Mittal A, Naik V, Chhadva P, Wade M, Garg S. Prevalence of subclinical keratoconus and impact on adults undergoing routine, uncomplicated age-related cataract extraction. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1269439. [PMID: 38983071 PMCID: PMC11182208 DOI: 10.3389/fopht.2023.1269439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 07/11/2024]
Abstract
Aim To determine the prevalence of subclinical keratoconus (SKCN) among individuals undergoing routine, uncomplicated age-related cataract surgery and its impact on visual and refractive outcomes. Patient and Methods At a major academic ophthalmology department in the United States, we reviewed records of patients aged 50 years and older who underwent surgery from January 2011 to June 2022. We excluded patients who had poor-quality or unreliable tomographic data, previous corneal surgery, keratorefractive procedures, and significant vision-limiting ocular pathology. We defined SKCN if an eye had a Belin-Ambrósio enhanced ectasia index (BAD-D) ≥1.7, which was based on the results of a meta-analysis of large studies. In addition to the BAD-D cutoff, the eye had to deviate significantly on at least one of seven additional parameters: 1) posterior elevation at thinnest point, 2) index of vertical asymmetry, 3) index of surface variation, 4) total front higher order aberrations, 5) front vertical coma, 6) front secondary vertical coma, 7) back vertical coma. An individual had SKCN if at least one eye met the tomography-based classification and did not have manifest KCN in either eye. Visual and refractive outcomes data were acquired from patients of one experienced cataract surgeon with cases done from July 2021 to June 2022. Statistical significance was set at p < 0.05. Results Among 5592 eyes from 3828 individuals, the prevalence of SKCN was 24.7% (95% CI, 23.4 - 26.1, 945 individuals), and the prevalence of KCN was 1.9% (95% CI, 1.6 - 2.4, 87 individuals). The prevalence of SKCN did not increase with age and was more prevalent among females and non-white races. Median post-operative month one distance-corrected visual acuity (DCVA) and proportion of eyes with improvement in DCVA were similar between normal and SKCN eyes. The proportion of eyes reaching ±0.5 and ±1.0 diopter within the refractive target were similar between normal and SKCN eyes. Conclusion SKCN is highly prevalent and should be detected but is unlikely to have a significant deleterious effect on outcomes in routine, uncomplicated cataract surgery.
Collapse
Affiliation(s)
- Tu M Tran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, United States
| | - Aman Mittal
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma, OK, United States
| | - Vihar Naik
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Priyanka Chhadva
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, United States
| | - Matthew Wade
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, United States
| | - Sumit Garg
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, United States
| |
Collapse
|
33
|
Sinjab MM. Keratoconus: A historical and prospective review. Oman J Ophthalmol 2023; 16:401-414. [PMID: 38059102 PMCID: PMC10697266 DOI: 10.4103/ojo.ojo_70_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 12/08/2023] Open
Abstract
This article is a historical and prospective review of keratoconus and ectatic corneal diseases. It covers definitions and terminology, the prevalence of keratoconus, predisposing factors, diagnosis, differential diagnosis, management, classifications, and progression criteria. It highlights other aspects of the disease that are usually over-missed, including the psychological, social, and economic impact. This review presents the information chronically in terms of the first author. It concludes by possessing the challenges and difficulties that are still to be overcome and suggests a plan.
Collapse
Affiliation(s)
- Mazen M. Sinjab
- Ophthalmology Department in Dr. Sulaiman Al Habib Hospital, DHCC, Dubai, UAE
- Sinjab Academy, International Keratoconus Society, Muscat, Oman
| |
Collapse
|
34
|
Mehdizadeh Dastjerdi O, Bakhtiarnia M, Yazdchi M, Maghooli K, Farokhi F, Jadidi K. Ocular condition prognosis in Keratoconus patients after corneal ring implantation using artificial neural networks. Heliyon 2023; 9:e19411. [PMID: 37681187 PMCID: PMC10480659 DOI: 10.1016/j.heliyon.2023.e19411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 06/21/2023] [Accepted: 08/22/2023] [Indexed: 09/09/2023] Open
Abstract
The common disorder, Keratoconus (KC), is distinguished by cumulative corneal slimming and steepening. The corneal ring implantation has become a successful surgical procedure to correct the KC patient's vision. The determination of suitable patients for the surgery alternative is among the paramount concerns of ophthalmologists. To reduce the burden on them and enhance the treatment, this research aims to previse the ocular condition of KC patients after the corneal ring implantation. It focuses on predicting post-surgical corneal topographic indices and visual characteristics. This study applied an efficacious artificial neural network approach to foretell the aforementioned ocular features of KC subjects 6 and 12 months after implanting KeraRing and MyoRing based on the accumulated data. The datasets are composed of sufficient numbers of corneal topographic maps and visual characteristics recorded from KC patients before and after implanting the rings. The visual characteristics under study are uncorrected visual acuity (UCVA), sphere (SPH), astigmatism (Ast), astigmatism orientation (Axe), and best corrected visual acuity (BCVA). In addition, the statistical data of multiple KC subjects were registered, including three effective indices of corneal topography (i.e., Ast, K-reading, and pachymetry) pre- and post-ring embedding. The outcomes represent the contribution of practical training of the introduced models to the estimation of ocular features of KC subjects following the implantation. The corneal topographic indices and visual characteristics were estimated with mean errors of 7.29% and 8.60%, respectively. Further, the errors of 6.82% and 7.65% were respectively realized for the visual characteristics and corneal topographic indices while assessing the predictions by the leave-one-out cross-validation (LOOCV) procedure. The results confirm the great potential of neural networks to guide ophthalmologists in choosing appropriate surgical candidates and their specific intracorneal rings by predicting post-implantation ocular features.
Collapse
Affiliation(s)
| | - Marjan Bakhtiarnia
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Mohammadreza Yazdchi
- Department of Biomedical Engineering, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | - Keivan Maghooli
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Fardad Farokhi
- Department of Biomedical Engineering, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Khosrow Jadidi
- Visual Health Research Center, Semnan University of Medical Sciences and Health Services, Semnan, Iran
| |
Collapse
|
35
|
Wu X, Deng Q, Han Z, Ni F, Sun D, Xu Y. Screening and identification of genes related to ferroptosis in keratoconus. Sci Rep 2023; 13:13956. [PMID: 37626095 PMCID: PMC10457308 DOI: 10.1038/s41598-023-41194-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 08/23/2023] [Indexed: 08/27/2023] Open
Abstract
Corneal keratoconus (KC) is a dilated (ectatic) corneal disease characterized by a central thinning of the cornea, which causes protrusion into a conical shape that seriously affects vision. However, due to the complex etiology of keratoconus, its entire mechanism remains unclear and there is no mechanism-directed treatment method. Ferroptosis is a novel programmed cell death mechanism related to lipid peroxidation, stress, and amino acid metabolism, which plays a crucial role in various diseases. This study aimed to explore the relationship between keratoconus and ferroptosis, to provide new insights into the mechanism of keratoconus development, and potential treatment options based on further elucidation of this mechanism. The corresponding mRNA microarray expression matrix data of KC patients were obtained from GEO database (GSE204791). Weighted co-expression network analysis (WGCNA) and support vector machine recursive feature elimination (SVM-RFE) were selected to screen hub genes, which were overlapped with ferroptosis genes (FRGs) from FerrDb. GO and GSEA were performed to analyze differential pathways, ssGSEA was used to determine immune status, and then, feasible drugs were predicted by gene-drug network. Additionally, we predicted the miRNA and IncRNA of hub genes to identify the underlying mechanism of disease so as to predict treatment for the disease. The epithelial transcriptome from keratoconus tissue mRNA microarray data (GSE204791) was extracted for the main analysis, including eight epithelial cells and eight epithelial control cells. The differential genes that were overlapped by WGCAN, SVM-RFE and FRGs were mainly related to oxidative stress, immune regulation, cellular inflammation, and metal ion transport. Through further analysis, aldo-keto reductase family 1 member C3 (AKR1C3) was selected, and negatively correlated with mature CD56 natural killer (NK) cells and macrophages. Then, gene-drug interaction network analysis and miRNA prediction were performed through the website. It was concluded that four immune-related drugs (INDOMETHACIN, DAUNORUBICIN, DOXORUBICIN, DOCETAXEL) and a miRNA (has-miR-184) were screened to predict potential drugs and targets for disease treatment. To our knowledge, this was the first report of KC being associated with ferroptosis and prompted search for differential genes to predict drug targets of gene immunotherapy. Our findings provided insight and a solid basis for the analysis and treatment of KC.
Collapse
Affiliation(s)
- Xiaojun Wu
- School of Pharmacology, Binzhou Medical University, Guanhai Rd 346, Yantai, 264003, China
- Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Yantai, 264003, China
| | - Qing Deng
- School of Pharmacology, Binzhou Medical University, Guanhai Rd 346, Yantai, 264003, China
- Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Yantai, 264003, China
| | - Zhe Han
- School of Pharmacology, Binzhou Medical University, Guanhai Rd 346, Yantai, 264003, China
- Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Yantai, 264003, China
| | - Feixue Ni
- School of Pharmacology, Binzhou Medical University, Guanhai Rd 346, Yantai, 264003, China
- Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Yantai, 264003, China
| | - Daxi Sun
- School of Pharmacology, Binzhou Medical University, Guanhai Rd 346, Yantai, 264003, China
- Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Yantai, 264003, China
| | - Yuxue Xu
- School of Pharmacology, Binzhou Medical University, Guanhai Rd 346, Yantai, 264003, China.
- Shandong Technology Innovation Center of Molecular Targeting and Intelligent Diagnosis and Treatment, Yantai, 264003, China.
| |
Collapse
|
36
|
Nishida T, Kojima T, Ogi S, Kataoka T, Isogai N, Yoshida Y, Nakamura T. Effects of Custom-Designed Soft Contact Lenses on Irregular Astigmatism Correction in Patients with Keratoconus. Clin Ophthalmol 2023; 17:2149-2162. [PMID: 37529756 PMCID: PMC10389083 DOI: 10.2147/opth.s420940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 07/06/2023] [Indexed: 08/03/2023] Open
Abstract
Purpose To evaluate the efficacy of YOUSOFT soft contact lenses in correcting irregular astigmatism and prescription results of patients with keratoconus. Patients and Methods The retrospective observational study included 55 eyes (mean age, 32.2 ± 10.6 years; 36 men and 6 women) of 42 patients with keratoconus who tried YOUSOFT for rigid gas permeable (RGP) lens intolerance. Average keratometry, corneal astigmatism, and maximum keratometry were 49.4 ± 5.2 diopters (D), 3.7 ± 2.1 D, and 57.3 ± 8.2 D, respectively. Patients were divided into YOUSOFT prescription and non-prescription cases, wherein the prescription rates were calculated. YOUSOFT visual acuity was compared with spectacle-corrected distance visual acuity (CDVA) and RGP lens-CDVA. Results YOUSOFT was prescribed to 28 out of 42 patients (prescription rate 67%). In the YOUSOFT prescription cases, YOUSOFT-CDVA (logMAR -0.04; 95% confidence interval [CI]: -0.08 to 0.00) was significantly better than spectacle-CDVA (logMAR 0.23; 95% CI: 0.08 to 0.38; P < 0.0001), whereas YOUSOFT-CDVA (logMAR -0.03; 95% CI: -0.08 to 0.03) did not significantly differ from the RGP lens-CDVA (logMAR -0.02; 95% CI: -0.08 to 0.04; P = 0.856). Conclusion YOUSOFT was effective in correcting irregular corneal astigmatism, suggesting that it is highly effective in patients with RGP lens intolerance.
Collapse
|
37
|
Jaskiewicz K, Maleszka-Kurpiel M, Kabza M, Karolak JA, Gajecka M. Sequence variants contributing to dysregulated inflammatory responses across keratoconic cone surface in adolescent patients with keratoconus. Front Immunol 2023; 14:1197054. [PMID: 37483635 PMCID: PMC10359427 DOI: 10.3389/fimmu.2023.1197054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/09/2023] [Indexed: 07/25/2023] Open
Abstract
Background Keratoconus (KTCN) is the most common corneal ectasia resulting in a conical shape of the cornea. Here, genomic variation in the corneal epithelium (CE) across the keratoconic cone surface in patients with KTCN and its relevance in the functioning of the immune system were assessed. Methods Samples from four unrelated adolescent patients with KTCN and two control individuals were obtained during the CXL and PRK procedures, respectively. Three topographic regions, central, middle, and peripheral, were separated towards the whole-genome sequencing (WGS) study embracing a total of 18 experimental samples. The coding and non-coding sequence variation, including structural variation, was assessed and then evaluated together with the previously reported transcriptomic outcomes for the same CE samples and full-thickness corneas. Results First, pathway enrichment analysis of genes with identified coding variants pointed to "Antigen presentation" and "Interferon alpha/beta signaling" as the most overrepresented pathways, indicating the involvement of inflammatory responses in KTCN. Both coding and non-coding sequence variants were found in genes (or in their close proximity) linked to the previously revealed KTCN-specific cellular components, namely, "Actin cytoskeleton", "Extracellular matrix", "Collagen-containing extracellular matrix", "Focal adhesion", "Hippo signaling pathway", and "Wnt signaling" pathways. No genomic heterogeneity across the corneal surface was found comparing the assessed topographic regions. Thirty-five chromosomal regions enriched in both coding and non-coding KTCN-specific sequence variants were revealed, with a most representative 5q locus previously recognized as involved in KTCN. Conclusion The identified genomic features indicate the involvement of innate and adaptive immune system responses in KTCN pathogenesis.
Collapse
Affiliation(s)
| | - Magdalena Maleszka-Kurpiel
- Optegra Eye Health Care Clinic in Poznan, Poznan, Poland
- Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, Poznan, Poland
| | - Michał Kabza
- Chair and Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Justyna A. Karolak
- Chair and Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marzena Gajecka
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
- Chair and Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, Poznan, Poland
| |
Collapse
|
38
|
Wang YC, Zolnik OB, Yasoda S, Yeh LK, Yuan Y, Kao W, Saika S, Liu CY. Transforming growth factor beta receptor 2 (Tgfbr2) deficiency in keratocytes results in corneal ectasia. Ocul Surf 2023; 29:557-565. [PMID: 37393064 DOI: 10.1016/j.jtos.2023.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023]
Abstract
PURPOSE We hypothesized that Transforming growth factor beta receptor 2 (Tgfbr2) deletion in keratocyte (Tgfbr2kera-cko), the corneal stroma cell, can result in corneal thinning and generate a potential model for Cornea Ectasia (CE). METHODS Corneal thickness of Tgfbr2kera-cko and Tgfbr2Ctrl was examined with Optical Coherence Tomography (OCT) at post-natal (P) days 42 and 70, respectively. Histological H&E staining, transmission electron micrograph (TEM), and immunofluorescence staining (IFS) were harnessed to examine corneal cell morphology, proliferation, differentiation, and collagen fibrils. RESULTS Slit-Lamp revealed that corneas were transparent in both Tgfbr2kera-cko and Tgfbr2Ctrl, however, Tgfbr2kera-cko cornea was 33.5% and 42.9% thinner as compared with those of Tgfbr2Ctrl at P42 and P70, respectively. H&E and semithin section staining with toluidine blue-O confirmed that Tgfbr2kera-cko cornea has a thinner stroma. In contrast, the epithelium in Tgfbr2kera-cko was substantially thicker. The cell proliferation marker Ki67 expression level increased ∼9% in Tgfbr2kera-cko corneal epithelium as compared with that in Tgfbr2Ctrl, however, the Krt14 and Krt12 expression pattern was not obviously changed in Tgfbr2kera-cko corneal epithelium. It was noticed that Col1a1 expression was substantially reduced in Tgfbr2kera-cko as compared with that in Tgfbr2Ctrl. TEM showed that keratocytes were unhealthy and stromal collagen fibril density was significantly reduced in Tgfbr2kera-cko as compared with that in Tgfbr2Ctrl cornea. Moreover, mechanical eye-rubbing on Tgfbr2kera-cko resulted in corneal hydrops and edema. CONCLUSION Tgfbr2 in keratocytes is indispensable for the corneal stroma at postnatal homeostasis. The cornea phenotype manifested in these Tgfbr2kera-cko mice resembles corneal ectasia disease in humans.
Collapse
Affiliation(s)
- Yen-Chiao Wang
- Edith Crawley Vision Research Center, Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; Department of Anesthesiology, School of Medicine, Washington University in St. Louis, MO, USA; School of Optometry, Indiana University, Bloomington, IN, USA.
| | | | - Shingo Yasoda
- Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan
| | - Lung-Kun Yeh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yong Yuan
- Edith Crawley Vision Research Center, Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Winston Kao
- Edith Crawley Vision Research Center, Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Shizuya Saika
- Department of Ophthalmology, Wakayama Medical University, Wakayama, Japan
| | - Chia-Yang Liu
- Edith Crawley Vision Research Center, Department of Ophthalmology, College of Medicine, University of Cincinnati, Cincinnati, OH, USA; School of Optometry, Indiana University, Bloomington, IN, USA
| |
Collapse
|
39
|
Shah R, Amador C, Chun ST, Ghiam S, Saghizadeh M, Kramerov AA, Ljubimov AV. Non-canonical Wnt signaling in the eye. Prog Retin Eye Res 2023; 95:101149. [PMID: 36443219 PMCID: PMC10209355 DOI: 10.1016/j.preteyeres.2022.101149] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 11/12/2022] [Accepted: 11/17/2022] [Indexed: 11/27/2022]
Abstract
Wnt signaling comprises a group of complex signal transduction pathways that play critical roles in cell proliferation, differentiation, and apoptosis during development, as well as in stem cell maintenance and adult tissue homeostasis. Wnt pathways are classified into two major groups, canonical (β-catenin-dependent) or non-canonical (β-catenin-independent). Most previous studies in the eye have focused on canonical Wnt signaling, and the role of non-canonical signaling remains poorly understood. Additionally, the crosstalk between canonical and non-canonical Wnt signaling in the eye has hardly been explored. In this review, we present an overview of available data on ocular non-canonical Wnt signaling, including developmental and functional aspects in different eye compartments. We also discuss important changes of this signaling in various ocular conditions, such as keratoconus, aniridia-related keratopathy, diabetes, age-related macular degeneration, optic nerve damage, pathological angiogenesis, and abnormalities in the trabecular meshwork and conjunctival cells, and limbal stem cell deficiency.
Collapse
Affiliation(s)
- Ruchi Shah
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Regenerative Medicine Institute Eye Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Cynthia Amador
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Regenerative Medicine Institute Eye Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Steven T Chun
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Regenerative Medicine Institute Eye Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; University of California Los Angeles, Los Angeles, CA, USA
| | - Sean Ghiam
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Regenerative Medicine Institute Eye Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Sackler School of Medicine, New York State/American Program of Tel Aviv University, Tel Aviv, Israel
| | - Mehrnoosh Saghizadeh
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Regenerative Medicine Institute Eye Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Andrei A Kramerov
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Regenerative Medicine Institute Eye Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexander V Ljubimov
- Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Regenerative Medicine Institute Eye Program, Cedars-Sinai Medical Center, Los Angeles, CA, USA; David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA; Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| |
Collapse
|
40
|
Deva JP, Ngeow YF, Zin T. The association between VSX1 exon3 gene variants and keratoconus in Malaysian patients. Indian J Ophthalmol 2023; 71:2443-2447. [PMID: 37322657 PMCID: PMC10418017 DOI: 10.4103/ijo.ijo_2894_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/22/2023] [Accepted: 03/24/2023] [Indexed: 06/17/2023] Open
Abstract
Purpose This case-control study aims to examine possible associations of VSX1 exon3 gene variants with the development of keratoconus (KC) in Malaysian patients. Methods A case-control study was done on 42 keratoconus cases, 127 family member controls, and 96 normal controls. Results Three gene variants, p.A182A, p.P237P, and p.R217H showed significant associations with keratoconus (P < 0.05). While p.A182A and p.P227P were more prevalent than in the family and normal controls (OR 3.14-4.05), the reverse was observed with p.R217H (OR 0.086-1.59). With Haploview analysis, p.A182A and p.P237P were shown to be in linkage disequilibrium (LD) (LOD (logarithm of the odds score) score of 2.0, r2 of 0.957, and 95% confidence interval (CI) of 0.96-1.00). Conclusion The study results suggest that the p.A182A and p.P237P variants could have contributed to the development of keratoconus in some Malaysians and that these two variants are likely to be co-inherited. In contrast, the p.R217H variant appeared to confer some protection against the development of keratoconus.
Collapse
Affiliation(s)
- Jenny P Deva
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Sg Long, Malaysia
| | - Yun F Ngeow
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Sg Long, Malaysia
| | - Thaw Zin
- Faculty of Medicine and Health Sciences, Universiti Tunku Abdul Rahman, Sg Long, Malaysia
| |
Collapse
|
41
|
Su J, Yuan J, Xu L, Xing S, Sun M, Yao Y, Ma Y, Chen F, Jiang L, Li K, Yu X, Xue Z, Zhang Y, Fan D, Zhang J, Liu H, Liu X, Zhang G, Wang H, Zhou M, Lyu F, An G, Yu X, Xue Y, Yang J, Qu J. Sequencing of 19,219 exomes identifies a low-frequency variant in FKBP5 promoter predisposing to high myopia in a Han Chinese population. Cell Rep 2023; 42:112510. [PMID: 37171956 DOI: 10.1016/j.celrep.2023.112510] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/13/2022] [Accepted: 04/28/2023] [Indexed: 05/14/2023] Open
Abstract
High myopia (HM) is one of the leading causes of visual impairment and blindness worldwide. Here, we report a whole-exome sequencing (WES) study in 9,613 HM cases and 9,606 controls of Han Chinese ancestry to pinpoint HM-associated risk variants. Single-variant association analysis identified three newly identified -genetic loci associated with HM, including an East Asian ancestry-specific low-frequency variant (rs533280354) in FKBP5. Multi-ancestry meta-analysis with WES data of 2,696 HM cases and 7,186 controls of European ancestry from the UK Biobank discerned a newly identified European ancestry-specific rare variant in FOLH1. Functional experiments revealed a mechanism whereby a single G-to-A transition at rs533280354 disrupted the binding of transcription activator KLF15 to the promoter of FKBP5, resulting in decreased transcription of FKBP5. Furthermore, burden tests showed a significant excess of rare protein-truncating variants among HM cases involved in retinal blood vessel morphogenesis and neurotransmitter transport.
Collapse
Affiliation(s)
- Jianzhong Su
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou 325101, Zhejiang, China; Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325011, China.
| | - Jian Yuan
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Liangde Xu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Shilai Xing
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; Institute of PSI Genomics, Wenzhou 325024, China
| | - Mengru Sun
- Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100190, China
| | - Yinghao Yao
- Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou 325101, Zhejiang, China; Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325011, China
| | - Yunlong Ma
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Fukun Chen
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Longda Jiang
- School of Life Sciences, Westlake University, Hangzhou, Zhejiang 310030, China
| | - Kai Li
- Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325011, China
| | - Xiangyi Yu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Zhengbo Xue
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Yaru Zhang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Dandan Fan
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Ji Zhang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Hui Liu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Xinting Liu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Guosi Zhang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Hong Wang
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Meng Zhou
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Fan Lyu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou 325101, Zhejiang, China
| | - Gang An
- Institute of PSI Genomics, Wenzhou 325024, China
| | - Xiaoguang Yu
- Institute of PSI Genomics, Wenzhou 325024, China
| | - Yuanchao Xue
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; Key Laboratory of RNA Biology, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100190, China.
| | - Jian Yang
- School of Life Sciences, Westlake University, Hangzhou, Zhejiang 310030, China; Westlake Laboratory of Life Sciences and Biomedicine, Hangzhou, Zhejiang 310024, China.
| | - Jia Qu
- School of Ophthalmology & Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China; Oujiang Laboratory, Zhejiang Lab for Regenerative Medicine, Vision and Brain Health, Wenzhou 325101, Zhejiang, China; Wenzhou Institute, University of Chinese Academy of Sciences, Wenzhou 325011, China.
| |
Collapse
|
42
|
Kundu G, Shetty N, Shetty R, Khamar P, D'Souza S, Meda TR, Nuijts RMMA, Narasimhan R, Roy AS. Artificial intelligence-based stratification of demographic, ocular surface high-risk factors in progression of keratoconus. Indian J Ophthalmol 2023; 71:1882-1888. [PMID: 37203049 PMCID: PMC10391495 DOI: 10.4103/ijo.ijo_2651_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
Purpose The purpose of this study was to identify and analyze the clinical and ocular surface risk factors influencing the progression of keratoconus (KC) using an artificial intelligence (AI) model. Methods This was a prospective analysis in which 450 KC patients were included. We used the random forest (RF) classifier model from our previous study (which evaluated longitudinal changes in tomographic parameters to predict "progression" and "no progression") to classify these patients. Clinical and ocular surface risk factors were determined through a questionnaire, which included presence of eye rubbing, duration of indoor activity, usage of lubricants and immunomodulator topical medications, duration of computer use, hormonal disturbances, use of hand sanitizers, immunoglobulin E (IgE), and vitamins D and B12 from blood investigations. An AI model was then built to assess whether these risk factors were linked to the future progression versus no progression of KC. The area under the curve (AUC) and other metrics were evaluated. Results The tomographic AI model classified 322 eyes as progression and 128 eyes as no progression. Also, 76% of the cases that were classified as progression (from tomographic changes) were correctly predicted as progression and 67% of cases that were classified as no progression were predicted as no progression based on clinical risk factors at the first visit. IgE had the highest information gain, followed by presence of systemic allergies, vitamin D, and eye rubbing. The clinical risk factors AI model achieved an AUC of 0.812. Conclusion This study demonstrated the importance of using AI for risk stratification and profiling of patients based on clinical risk factors, which could impact the progression in KC eyes and help manage them better.
Collapse
Affiliation(s)
- Gairik Kundu
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Naren Shetty
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rohit Shetty
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Pooja Khamar
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Sharon D'Souza
- Department of Cornea and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Tulasi R Meda
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, Karnataka, India
| | - Rudy M M A Nuijts
- Department of Ophthalmology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Raghav Narasimhan
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
| | - Abhijit Sinha Roy
- Imaging, Biomechanics and Mathematical Modeling Solutions, Narayana Nethralaya Foundation, Bengaluru, Karnataka, India
| |
Collapse
|
43
|
Balogun MM, Fashola MB. Association between keratoconus and allergic conjunctivitis in children attending a Tertiary Hospital in Nigeria. Rom J Ophthalmol 2023; 67:134-139. [PMID: 37522027 PMCID: PMC10385717 DOI: 10.22336/rjo.2023.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2023] [Indexed: 08/01/2023] Open
Abstract
Objective: To ascertain an association between keratoconus and allergic conjunctivitis and to know if it is necessary to investigate all patients with allergic conjunctivitis for keratoconus. Methods: A hospital-based prospective study in which the eyes of children presenting with ocular allergic diseases were examined. Social demographics and clinical data were captured in a questionnaire. All the patients underwent keratometry using the autorefractor-keratometer and the pachymeter was used to measure the central corneal thickness. Data analysis was done with IBM SPSS version 28 for Windows. Frequency and chi-square were used as descriptive statistics to determine the association between dependent and independent variables. Inferential statistics using one-way ANOVA and t-test. P - Value at <0.05 was considered statistically significant. Results: 121 children with allergic conjunctivitis were reviewed. Males were 72 and females 49. The visual acuity was 6/ 6-6/ 18 in 116, and mild visual impairment - 6/ 18-6/ 60 in 5. The most common complaint was frequent itching in 109 (90.1%). Keratometry was normal in 120 (99.5%), while probable keratoconus was found by keratometry in only one patient (0.5%). Central corneal thickness was within the normal range in 33 (27.3%) children, 43 (35.5%) had thin corneas, while 45 (37.2%) had cornea thickness of more than 560 microns. Discussion: Pediatric keratoconus tends to be more aggressive than adult keratoconus with an increased risk of corneal opacities and subsequent keratoplasty. As a result of these negative impacts, early detection and prompt treatment are mandatory. Conclusion: The prevalence of keratoconus was not found to be high in this study population, but with facts emerging between the association of allergic conjunctivitis, and increased prevalence of keratoconus, it is pertinent to integrate keratoconus screening as part of the management of allergic conjunctivitis using an appropriate tool such as video keratography and slit lamp biomicroscope. Abbreviations: KC = Keratoconus, CLEK = Collaborative Longitudinal Evaluation of Keratoconus, SAC = Seasonal Allergic Conjunctivitis, PAC = Perennial Allergic Conjunctivitis, VKC = Vernal Keratoconjunctivitis, IOP = Intraocular Pressure, CCT = Central Corneal Thickness, TNF-α = Tumor Necrosis Factor-Alpha, IL = Interleukin.
Collapse
Affiliation(s)
- Modupe Medina Balogun
- Department of Surgery, Ophthalmology Unit, Lagos State University, College of Medicine, Lagos State, Nigeria
- Department of Ophthalmology, Lagos State University, Teaching Hospital, Lagos State, Nigeria
| | - Maryam Bola Fashola
- Department of Ophthalmology, Lagos State University, Teaching Hospital, Lagos State, Nigeria
| |
Collapse
|
44
|
Mejia-Salgado G, Cifuentes-González C, Rojas-Carabali W, Zarate-Pinzón L, Peña-Pulgar LF, Polania D, Cruz-Reyes DL, de-la-Torre A. Colombian Ocular Diseases Epidemiology Study (CODES): incidence and sociodemographic characterisation of keratoconus between 2015 and 2020. BMJ Open Ophthalmol 2023; 8:bmjophth-2023-001238. [PMID: 37278430 DOI: 10.1136/bmjophth-2023-001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/08/2023] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE To estimate the incidence and describe the demographic characteristics of keratoconus (KC) in Colombia using national health registry data between January 1st 2015 and December 31th 2020. METHODS AND ANALYSIS We conducted a nationwide, population-based study using the Integrated Social Protection Information System from the Colombian Ministry of Health, the unique official database in the country. We used the International Classification of Diseases code for KC (H186) to identify the number of new cases of KC and estimate the incidence rates both overall and according to age and sex. We made a standard morbidity ratio map to graph Colombia's morbidity risk of KC onset. RESULTS Of 50 372 424 subjects, 21 710 had KC between 2015 and 2020. However, due to the COVID-19 pandemic, all the incidence rates of this study were based on the 18 419 reported until 2019. The incidence rate in the general population was 10.36 (95% CI 10.08 to 10.64) per 100 000 inhabitants. The incidence peak among males was in their early 20s and females in their late 20s. The overall male to female incidence rate ratio was 1.60. Regarding the distribution of the disease, most cases were reported in Bogotá (48.64%), Antioquia (14.04%) and Cundinamarca (10.38%). CONCLUSION We performed the first nationwide, population-based study of KC in Latin America, finding distribution patterns similar to those reported in the literature. This study provides valuable information on the epidemiology of KC in Colombia, which is helpful in the development of policies for the diagnosis, prevention and treatment of the disease.
Collapse
Affiliation(s)
- Germán Mejia-Salgado
- Neuroscience Research Group (NEUROS), NeuroVitae Center. Institute of Translational Medicine (IMT). Escuela de Medicina y Ciencias de la Salud. Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Carlos Cifuentes-González
- Neuroscience Research Group (NEUROS), NeuroVitae Center. Institute of Translational Medicine (IMT). Escuela de Medicina y Ciencias de la Salud. Universidad del Rosario, Bogotá, Colombia
| | - William Rojas-Carabali
- Neuroscience Research Group (NEUROS), NeuroVitae Center. Institute of Translational Medicine (IMT). Escuela de Medicina y Ciencias de la Salud. Universidad del Rosario, Bogotá, Colombia
| | - Laura Zarate-Pinzón
- Neuroscience Research Group (NEUROS), NeuroVitae Center. Institute of Translational Medicine (IMT). Escuela de Medicina y Ciencias de la Salud. Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Luisa Fernanda Peña-Pulgar
- Neuroscience Research Group (NEUROS), NeuroVitae Center. Institute of Translational Medicine (IMT). Escuela de Medicina y Ciencias de la Salud. Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Diego Polania
- Neuroscience Research Group (NEUROS), NeuroVitae Center. Institute of Translational Medicine (IMT). Escuela de Medicina y Ciencias de la Salud. Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| | - Danna Lesley Cruz-Reyes
- Grupo de Investigación Clínica, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | - Alejandra de-la-Torre
- Neuroscience Research Group (NEUROS), NeuroVitae Center. Institute of Translational Medicine (IMT). Escuela de Medicina y Ciencias de la Salud. Universidad del Rosario, Bogotá, Colombia
- Ophthalmology Interest Group, Neuroscience (NEUROS) Research Group, Neurovitae Research Center, Institute of Translational Medicine (IMT), Universidad Del Rosario Escuela de Medicina y Ciencias de la Salud, Bogotá, Colombia
| |
Collapse
|
45
|
Villanueva C, Viviano F, García-Montero M, Lorente-Velázquez A, Martínez-Alberquilla I, Garzón N. Forward-scattered and backward-scattered light in moderate keratoconus. Ophthalmic Physiol Opt 2023. [PMID: 36920155 DOI: 10.1111/opo.13126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/17/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION To evaluate the backscattered light, objective scatter index (OSI) and retinal straylight in patients with moderate keratoconus and healthy control subjects. METHODS A prospective observational study was developed with 33 patients in the moderate-keratoconus group (KC) and 34 in the non-keratoconus group (NKC). Corneal densitometry was obtained using Scheimpflug corneal tomography and measurements were expressed in grayscale units (GSU) over four zones within a 12.00 mm diameter around the corneal apex. A straylight meter was used to determine the amount of intraocular straylight under scotopic conditions, and the straylight parameter (LOG(s)) and test duration were recorded. The Optical Quality Analysis System based on the double-pass technique determined the OSI value. RESULTS Significant differences were observed between the KC and NKC groups for corneal densitometry (except in the 6-10 mm zone), OSI and retinal straylight. A moderate and significant correlation was found between OSI and retinal straylight LOG(s) (r = 0.52, p = 0.002). Weaker and non-significant correlations were found between corneal densitometry and the other parameters analysed (i.e., OSI, retinal straylight LOG(s) and retinal straylight times). CONCLUSIONS Backscattered light, retinal straylight and the OSI show clear differences between healthy eyes and those with moderate KC. The changes present in the stages of KC evaluated in the current study (stages II and III according to the Amsler-Krumeich classification) might alter the scattering of the light entering the eye.
Collapse
Affiliation(s)
- Celia Villanueva
- Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain.,Ophthalmology Department, Hospital Clínico San Carlos, Madrid, Spain
| | - Francesco Viviano
- Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - María García-Montero
- Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Amalia Lorente-Velázquez
- Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Irene Martínez-Alberquilla
- Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Nuria Garzón
- Optometry and Vision Department, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| |
Collapse
|
46
|
Seth I, Bulloch G, Vine M, Outmezguine J, Seth N, Every J, Daniell M. The association between keratoconus and allergic eye diseases: A systematic review and meta-analysis. Clin Exp Ophthalmol 2023. [PMID: 36882200 DOI: 10.1111/ceo.14215] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 02/14/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND To investigate the association between keratoconus (KC) and allergic eye diseases, eye rubbing, and atopy. METHODS PubMed, Web of Science, Scopus, and Cochrane databases were searched for studies investigating eye allergy, atopy, and eye rubbing as risk factors for KC up to April 2021. Two authors independently screened all titles and abstracts against the predefined inclusion and exclusion criteria. The study analysed the prevalence of KC and its risk factors, including eye rubbing, family history of KC, atopy, and allergic eye diseases. The National Institutes of Health Study Quality Assessment Tool was used. Pooled data are presented as odds ratios (OR) and 95% confidence intervals (CI). The analysis was conducted using RevMan version 5.4 software. RESULTS The initial search yielded 573 articles. After screening, 21 studies were identified for qualitative analysis and 15 for quantitative synthesis. A significant association was found between KC and eye rubbing (OR = 5.22, 95% CI [2.80, 9.75], p < 0.00001), family history of KC (OR = 6.67, 95% CI [4.77, 9.33], p < 0.00001), and allergies (OR = 2.21, 95% CI [1.57, 3.13], p < 0.00001). However, no significant association was found between KC and allergic eye disease (OR = 1.82, 95% CI [0.37, 8.97], p = 0.46), atopy (OR = 1.54, 95% CI [0.58, 4.09], p = 0.39), allergic rhinitis (OR = 0.85, 95% CI [0.54, 1.33], p = 0.47), smoking (OR = 0.96, 95% CI [0.76, 1.21], p = 0.73), and asthma (OR = 1.58, 95% CI [0.99, 2.53], p = 0.05). CONCLUSION Significant associations were observed between KC and eye rubbing, family history, and allergy, but not with allergic eye disease, atopy, asthma, and allergic rhinitis.
Collapse
Affiliation(s)
- Ishith Seth
- Bendigo Base Hospital, Bendigo, Victoria, Australia.,Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Ophthalmology, Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| | - Gabriella Bulloch
- Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, Australia.,Department of Ophthalmology, Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| | - Michael Vine
- Bendigo Base Hospital, Bendigo, Victoria, Australia
| | | | - Nimish Seth
- Department of Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - James Every
- Bendigo Base Hospital, Bendigo, Victoria, Australia
| | - Mark Daniell
- Department of Ophthalmology, Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| |
Collapse
|
47
|
Cano-Gómez LE, Casillas-Casillas E, Andrade-Lozano P, Ventura-Juárez J, Barba-Gallardo LF. Animal model of corneal ectasia in rabbits by intrastromal injection of type II collagenase. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:206-212. [PMID: 36871853 DOI: 10.1016/j.oftale.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/17/2023] [Indexed: 03/07/2023]
Abstract
INTRODUCTION Collagenase II has been used to induce experimental keratoconus in animal models. However, its effect when administered by intrastromal injection has not been studied, so the purpose of this study was to study the effects of intrastromal injection of collagenase II on corneal surface and corneal morphology. METHODS Six New Zealand rabbits were used, collagenase II was administered by intrastromal injection (5μL of 2.5mg/mL) in the right eyes and balanced salt solution in the left eyes. Keratometry was performed to evaluate curvature alteration, also at day 7 corneas were obtained and Hematoxylin-Eosin staining was performed to examine morphologic changes. Likewise, changes in type I collagen expression were investigated by Sirius Red staining and semiquantitative PCR. RESULTS K1, K2 and Km presented differences in the means with statistically significant changes. The morphological changes that were demonstrated were degradation and irregular arrangement of the corneal stroma, increase in the cellular density of keratocytes and slight cellular infiltration. Finally, it was demonstrated that there is greater expression of type I collagen fibers in the experimental group as opposed to the controls and the thickness of the fibers also increased due to the action of collagenase II, however, in terms of genetics there were no changes in the expression of type I collagen at molecular level between the control and experimental groups. CONCLUSIONS Collagenase II administered by intrastromal injection is able to induce changes in the corneal surface and stroma, being able to simulate a model of keratoconus.
Collapse
Affiliation(s)
- L E Cano-Gómez
- Maestría en Investigación Biomédica, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - E Casillas-Casillas
- Departamento de Optometría, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - P Andrade-Lozano
- Maestría en Investigación Biomédica, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - J Ventura-Juárez
- Departamento de Morfología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico
| | - L F Barba-Gallardo
- Departamento de Optometría, Centro de Ciencias de la Salud, Universidad Autónoma de Aguascalientes, Aguascalientes, Mexico.
| |
Collapse
|
48
|
Evaluation of Ocular Higher-Order Aberrations in First-Degree Relatives of Patients With Keratoconus. Cornea 2023; 42:308-312. [PMID: 35587897 DOI: 10.1097/ico.0000000000003055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/17/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The aim of this study was to evaluate the corneal higher-order aberrations (HOAs) in first-degree relatives of patients with keratoconus (KCN) and compare with the normal population. METHODS In this prospective comparative study, 210 eyes from 105 family members of 28 patients with KCN and 210 normal eyes of 105 controls were enrolled. In each eye, corneal topography, tomography, and aberrometry were performed and compared between the 2 groups. RESULTS This study included 61 female (58.1%) and 44 male participants (41.9%) and 105 age-matched and sex-matched controls with normal topographic cornea. In 14 of 105 first-degree relatives (13.33%) of patients with KCN, KCN was diagnosed with a male preponderance (71.5% male, 28.5% female). Tomographic indices and irregularity indices in 3 and 5 mm zone in Orbscan were significantly higher in the relative group. In addition, other irregularity indices of TMS-4 topography including surface regularity index, surface asymmetry index, difference sector index, SDP, and irregular astigmatism index were significantly higher in family members of patients with KCN. The most prevalent topographic pattern in the control group was the symmetric bowtie (57.1%) and in the relative group was the asymmetric bowtie (39.5%). In addition, significantly thinnest corneal pachymetry was detected in the relative group. Root mean square of all HOAs including vertical trefoil, vertical coma, horizontal coma, horizontal trefoil, quadrifoil, and fourth-order spherical aberrations were significantly greater in the relative group than controls. CONCLUSIONS Owing to the high prevalence of undiagnosed KCN susceptibility in family members with KCN, keratorefractive surgery should be considered cautiously in these individuals. In addition, comprehensive preoperative examination should be considered to detect subtle topographic and HOAs in these individuals.
Collapse
|
49
|
Al-Atawi SK. Quality of life of a sample of people with keratoconus in KSA. J Taibah Univ Med Sci 2023; 18:1157-1169. [DOI: 10.1016/j.jtumed.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/15/2023] [Accepted: 03/14/2023] [Indexed: 04/03/2023] Open
|
50
|
Krolo I, Kasumović A, Matoc I, Sabol I, Radman I, Ratković M. The ABCD grading system in assessment of corneal cross-linking effect in keratoconus with different cone locations. JOURNAL OF OPTOMETRY 2023; 16:74-80. [PMID: 34657832 PMCID: PMC9811369 DOI: 10.1016/j.optom.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 09/06/2021] [Accepted: 09/08/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE The aim of this study was to analyse the postoperative corneal cross-linking results of corneal parameters and the ABCD grading system, depending on the cone location. METHODS Thirty eyes of 25 patients with keratoconus (KC), who received the corneal cross-linking (CXL) treatment, were included in this study. The exclusion criteria were: patients under 18 years of age, corneal pachymetry less than 400 μm, corneal scarring, history of ocular trauma, history of ocular surgery, and corneal pathology other than KC. Patients were examined at the baseline visit, and followed-up at three, six, and twelve months after the CXL. All patients underwent visual acuity and Scheimpflug tomography at all visits. Progression parameters, keratometries, and ABCD grading were compared between the visits. Patients were classified into two groups: central and paracentral cones group (within the central 5 mm corneal zone) and peripheral cones group (outside the central 5 mm corneal zone), based on X-Y coordinates of maximal keratometry (Kmax). RESULTS Parameter A remained relatively stable throughout the follow-up period in both groups. Parameter B and parameter C showed a significant increase in both groups postoperatively. Parameter D showed stability at the 6-month post-CXL visit in the peripheral KC group, while the central and paracentral KC group showed improvement at the 12-month post-CXL visit. CONCLUSION There was no significant difference in the postoperative response between different cone locations in the ABCD grading system, when classifying according to the Kmax, except an earlier recovery of the parameter D in peripherally located cones.
Collapse
Affiliation(s)
- Iva Krolo
- University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, 10 000 Zagreb, Croatia
| | - Aida Kasumović
- University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, 10 000 Zagreb, Croatia.
| | - Ines Matoc
- University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, 10 000 Zagreb, Croatia
| | - Ivan Sabol
- Division of Molecular Medicine, Rudjer Boskovic Institute, Zagreb, Croatia
| | - Ivana Radman
- University Department of Ophthalmology, University Hospital Center Sestre milosrdnice, Vinogradska cesta 29, 10 000 Zagreb, Croatia
| | - Mirko Ratković
- University Eye Hospital Svjetlost, School of Medicine University of Rijeka, Zagreb, Croatia
| |
Collapse
|