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Gupta Y, Devi C, Priyadarshini K, Mandal S, Tandon R, Sharma N. Pediatric Keratoconus. Surv Ophthalmol 2024:S0039-6257(24)00129-2. [PMID: 39396644 DOI: 10.1016/j.survophthal.2024.10.003] [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: 01/07/2024] [Revised: 10/07/2024] [Accepted: 10/07/2024] [Indexed: 10/15/2024]
Abstract
Keratoconus is a common pediatric corneal disease, leading to vision impairment and amblyopia. Compared to its adult counterpart, pediatric keratoconus has an advanced presentation, rapid progression, higher incidence of complications such as corneal hydrops, and potential impact on the child's quality of life. It typically manifests during puberty and can evolve rapidly to more severe stages if left untreated. This rapid progression underscores the importance of early diagnosis through regular screening in pediatric populations and vigilant monitoring of pediatric keratoconus suspects. Concomitant ocular allergies, ocular anomalies, systemic diseases (eg. syndromes), and poor compliance with contact lenses might impede prompt intervention and frequently postpone rehabilitation. Corneal collagen crosslinking is a crucial intervention in the management of pediatric keratoconus because it strengthens the corneal microstructure and halts the disease's progression. When conservative measures fail, keratoplasty remains a viable option with generally favorable outcomes, though with unique challenges in post-operative care, including concerns related to sutures, long-term graft survival and need for repeated examinations under anesthesia. A multidisciplinary approach involving ophthalmologists, optometrists, pediatricians, and other healthcare professionals, focusing on early diagnosis and timely intervention, is essential for the comprehensive management of pediatric keratoconus and to mitigate its impact on children's lives.
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Affiliation(s)
- Yogita Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Chandra Devi
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - K Priyadarshini
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Sohini Mandal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India.
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Pollmann AS, Cohen M, Jabbour S. Corneal Epithelial Hyperplasia Related to Chronic Eye Rubbing Mimicking Keratoconus. Eye Contact Lens 2024:00140068-990000000-00231. [PMID: 39353095 DOI: 10.1097/icl.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 10/04/2024]
Abstract
ABSTRACT We report a case of corneal epithelial hyperplasia associated with chronic eye rubbing mimicking keratoconus. A 32-year-old man was presented with a 3-year history of suboptimal vision and astigmatism in his left eye. His history was significant for chronic left eye rubbing. The anterior corneal curvature map showed inferior steepening in the left eye; however, other features of ectasia were absent. Corneal epithelium thickness mapping with optical coherence tomography was significant for corresponding epithelial thickening. His corneal imaging remained stable at a 6-month follow-up examination. At month 15-and after cessation of eye rubbing behavior-the vision symptoms, refraction, and corneal imaging had normalized. In conclusion, chronic eye rubbing may cause reversible corneal epithelial hypertrophy. Eye rubbing should be considered in the evaluation of patients presenting with unexplained vision symptoms and changes in astigmatism that are not consistent with ectasia on corneal imaging.
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Affiliation(s)
- André S Pollmann
- Department of Ophthalmology (A.S.P., S.J.), Centre Hospitalier de l'Université de Montréal, Montréal, Canada; Department of Ophthalmology (M.C.), University of Sherbrooke, Sherbrooke, Canada; LASIK MD (M.C.), Montréal, Canada; and Department of Ophthalmology (S.J.), McGill University, Montréal, Canada
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Naujokaitis T, Khoramnia R, Friedrich M, Son HS, Auffarth GU, Augustin VA. Inter-zonal epithelial thickness differences for early keratoconus detection using optical coherence tomography. Eye (Lond) 2024; 38:2968-2975. [PMID: 39003429 PMCID: PMC11461491 DOI: 10.1038/s41433-024-03199-7] [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: 11/16/2023] [Revised: 05/09/2024] [Accepted: 06/20/2024] [Indexed: 07/15/2024] Open
Abstract
PURPOSE To develop and test a parameter for early keratoconus screening by quantifying the localized epithelial thickness differences in keratoconic eyes. METHODS The cross-sectional study included 189 eyes of 116 subjects in total: 86 eyes of 54 keratoconus patients with bilateral ectasia and 40 eyes of 20 healthy subjects in the parameter-development dataset and 42 eyes of 21 keratoconus patients with asymmetric ectasia and 21 eyes of 21 healthy subjects in the parameter-validation dataset. Epithelial thickness maps were obtained using anterior segment optical coherence tomography and the inter-zonal epithelial thickness differences were calculated. The developed parameter was tested in keratoconus patients with asymmetric ectasia. RESULTS Compared to healthy controls, the inferior-temporal and global inter-zonal epithelial thickness differences were higher not only in eyes with tomographically significant keratoconus (median [interquartile range] of 4.42 [3.13] µm vs. 0.78 [0.42] µm, p < 0.001, and 3.05 [1.51] µm vs. 1.07 [0.26] µm, p < 0.001, respectively), but also in tomographically normal keratoconus fellow eyes (1.36 [0.85] µm vs. 0.78 [0.42] µm, p = 0.005, and 1.31 [0.32] µm vs. 1.07 [0.26] µm, p = 0.01, respectively). The inferior-temporal inter-zonal epithelial thickness differences had an area under the receiver operating characteristic curve (95% confidence interval) of 0.991 (0.972-1) for detecting tomographically significant keratoconus and 0.749 (0.598-0.901) for differentiating between tomographically normal keratoconus fellow eyes and healthy controls. CONCLUSIONS The inter-zonal epithelial thickness differences are increased in keratoconus fellow eyes which still have a normal Scheimpflug corneal tomography, and therefore may serve as a useful parameter to detect early ectatic changes.
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Affiliation(s)
- Tadas Naujokaitis
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Maximilian Friedrich
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Hyeck-Soo Son
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Victor A Augustin
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.
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Moshirfar M, Rognon GT, Olson N, Kay W, Sperry RA, Ha S, Hoopes PC. Merging Photorefractive Keratectomy and Collagen Crosslinking: An Analysis of Literature and a Guide to Prevalent Protocols. Cornea 2024; 43:1184-1197. [PMID: 38759151 DOI: 10.1097/ico.0000000000003536] [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: 09/15/2023] [Accepted: 02/08/2024] [Indexed: 05/19/2024]
Abstract
PURPOSE The purpose of this review was to summarize the different surgical approaches combining photorefractive keratectomy (PRK) and corneal crosslinking (CXL), present each protocol template in a simple format, and provide an overview of the primary outcomes and adverse events. METHODS A literature review was conducted as outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Eight different databases were searched. Papers were included if PRK was immediately followed by CXL. RESULTS Thirty-seven papers met the inclusion criteria of a total yield of 823. The latest research into simultaneous PRK and CXL has been shown to not only stabilize the cornea and prevent keratoconus progression but also improve the visual acuity of the patient. Improvements in uncorrected distance visual acuity and (spectacle) corrected distance visual acuity were found to be significant when considering all protocols. There were also significant reductions in K1, K2, mean K, Kmax, sphere, cylinder, and spherical equivalent. Random-effects analysis confirmed these trends. Corrected distance visual acuity was found to improve by an average of 0.18 ± 1.49 logMAR (Cohen's D [CD] 0.12; P <0.02). There was also a significant reduction of 2.57 ± 0.45 D (CD 5.74; P <0.001) in Kmax. Cylinder and spherical equivalent were also reduced by 1.36 ± 0.26 D (CD 5.25; P <0.001) and 2.61 ± 0.38 D (CD 6.73; P <0.001), respectively. CONCLUSIONS Combining the 2 procedures appears to be of net benefit, showing stabilization and improvement of ectatic disease, while also providing modest gains in visual acuity. Since customized PRK and CXL approaches appear superior, a combination of these would likely be best for patients.
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Affiliation(s)
- Majid Moshirfar
- Corneal and Refractive Surgery, HDR Vision Research Center, Hoopes Vision, Draper, UT
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT
- Corneal Transplantation and Eye Banking, Utah Lions Eye Bank, Murray, UT
| | - Gregory T Rognon
- Chicago Medical School, Rosalind Franklin University, North Chicago, IL
| | - Nate Olson
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT
| | | | | | - Seungyeon Ha
- Department of Statistics, Texas A&M University, Bryan, TX; and
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Wang Y, Ning R, Li K, Xu H, Li Y, Yang Y, Gustafsson I, Zhou X, Qu X, Huang J. Repeatability of Epithelium Thickness Measured by an AS-OCT in Different Grades of Keratoconus and Compared to AS-OCT/Placido Topography. Am J Ophthalmol 2024; 265:213-223. [PMID: 38621521 DOI: 10.1016/j.ajo.2024.04.001] [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: 12/19/2023] [Revised: 03/29/2024] [Accepted: 04/01/2024] [Indexed: 04/17/2024]
Abstract
PURPOSE To compare agreement of corneal epithelium thickness (ET) between AS-OCT system (RTVue, Optovue) and AS-OCT/Placido topographer (MS-39, CSO) in eyes with different stages of keratoconus (KC), and to assess the repeatability of RTVue AS-OCT. DESIGN Prospective reliability analysis. METHODS KC eyes were classified into forme fruste KC (FFKC), mild, moderate, and severe KC. Agreement was evaluated with Bland-Altman plots and 95% limits of agreement (LoA). The repeatability of RTVue was assessed via within-subject standard deviation (Sw), test-retest variability (TRT), coefficient of variation (CoV), and intraclass correlation coefficient (ICC). RESULTS A total of 119 KC eyes were enrolled, with 21 being FFKC, 26 mild, 39 moderate, and 34 severe. The 95% LoA ranged between -5.9 and 4.8 µm for center epithelium thickness (CET), between -5.7 and 8.2 µm for thinnest epithelium thickness (TET). At 1-mm measuring points, the 95% LoA of superior, inferior, nasal, and temporal were -4.2 to 4.7 µm, -5.2 to 6.0 µm, -7.9 to 10.2 µm, and -11.2 to 6.0 µm. At 3-mm measuring points, the corresponding values were -2.8 to 9.3 µm, -2.0 to 13.0 µm, -4.6 to 9.6 µm, and -6.3 to 9.7 µm, indicating that the 2 instruments were not interchangeable without adjustment. Despite that the repeatability of RTVue measurements in KC patients were acceptable, repeatability decreased gradually with the peripheralization of the measurement points. CONCLUSIONS The 2 OCT-based devices, RTVue and MS-39, do not provide interchangeable measurements of epithelium thickness in KC patients. Repeatability decreases in cases of more severe KC, emphasizing the importance of grading before clinical examination to avoid diagnostic errors.
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Affiliation(s)
- Yiran Wang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China
| | - Rui Ning
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China
| | - Kexin Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China
| | - Huilin Xu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China
| | - Yue Li
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China
| | - Yizhou Yang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China
| | - Ingemar Gustafsson
- Department of Clinical Sciencess, Ophthalmology, Lund University, Skåne University Hospital (I.G.), Lund, Sweden
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China
| | - Xiaomei Qu
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China.
| | - Jinhai Huang
- Eye Institute and Department of Ophthalmology, Eye & ENT Hospital, Fudan University; NHC Key laboratory of Myopia and Related Eye Diseases; Key Laboratory of Myopia and Related Eye Diseases, Chinese Academy of Medical Sciences (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China; Shanghai Research Center of Ophthalmology and Optometry (Y.W., R.N., K.L., H.X., Y.L., Y.Y., X.Z., X.Q., J.H.), Shanghai, China.
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Salah-Mabed I, Saad A, Gatinel D. Investigating the topographic effect of epithelium in myopic eyes with subtle topographic preoperative abnormalities. J Cataract Refract Surg 2024; 50:847-855. [PMID: 38693644 DOI: 10.1097/j.jcrs.0000000000001456] [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: 01/27/2020] [Accepted: 03/30/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE To explore the topographic effect of the epithelium in keratoconus suspected (KCS) and in normal Placido classified corneas. SETTING Rothschild Foundation, Paris, France. DESIGN Prospective interventional case series. METHODS Anterior corneal specular Placido topography using OPD-Scan II was performed in 97 eyes of 67 patients undergoing photorefractive keratectomy for myopia, before and after epithelium removal. The differences in axial keratometry, asphericity, and astigmatism were computed. RESULTS After epithelial peeling, some Placido-normal classified corneas became KCS. Therefore, we have subdivided this group into 2 groups: one of normal classified corneas which stayed normal after epithelium removal (Group NN) and another of corneas that became KCS classified (Group NK). The mean difference in axial mean keratometry in the third central millimeter rings was +0.50 ± 0.24 diopters (D), 0.69 ± 0.31 D, and 0.49 ± 0.35 D and the mean difference in the magnitude of epithelial-induced astigmatism in the first central millimeter ring was 0.37 D × 89 degrees (positive cylinder), 0.54 D 86 degrees, and 0.52 D 86 degrees, respectively, in Group NN, NK, and KK (KCS corneas that stayed KCS). These differences were significant ( P < .0001). Preoperative keratometry was the only predictive factor differentiating Group NN from NK ( P < .001). CONCLUSIONS The epithelial layer tended to reduce the magnitude of the Bowman layer's astigmatism, prolateness, and keratometry, more importantly in Group NK. In the KK group, we found a similar trend as in normal eyes (Group NN). The epithelium would be able to mask Bowman layer's irregularities until a certain degree of severity.
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Affiliation(s)
- Imene Salah-Mabed
- From the Department of Anterior Segment and Refractive Surgery, Fondation Rothschild, Paris, France (Salah-Mabed, Saad, Gatinel); CEROC: Center of Expertise and Research in Optics for Clinicians (Salah-Mabed, Saad, Gatinel)
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Mohr N, Kassumeh S, Luft N, Dirisamer M, Priglinger SG, Mayer WJ. Enhancing ectasia screening using advanced AS-OCT: a case series of challenging refractive candidates. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1405443. [PMID: 38984129 PMCID: PMC11182286 DOI: 10.3389/fopht.2024.1405443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/16/2024] [Indexed: 07/11/2024]
Abstract
Purpose Ectasia screening in candidates for laser refractive surgery is mandatory during preoperative evaluation. Despite the availability of modern imaging techniques, refractive surgeons often face borderline decisions when patients present with suspicious tomographic findings. This case series presents refractive candidates with suspicious tomographic findings and demonstrates how to interpret them using Scheimpflug imaging and additional anterior segment optical coherence tomography (AS-OCT). Setting Department of Ophthalmology, University Hospital, LMU Munich. Case series This case series examines six potential candidates for refractive surgery with a mean age of 29.2 ± 3.9 years, whose corneal assessments using Scheimpflug imaging raised suspicion for ectasia. Each candidate was additionally examined with AS-OCT and reevaluated. The mean manifest subjective spherical equivalent was -3.67 ± 1.8 diopters. The total corneal thickness measured 537 µm ± 30 µm at its thinnest point. None of the candidates had any reported underlying corneal or ophthalmic diseases, and slit lamp examinations revealed no abnormal morphological findings. Conclusions Both Scheimpflug imaging and AS-OCT are appropriate tools for screening refractive candidates for ectasia. While topographic and elevation analyses yielded comparable results regarding corneal structure, the epithelial mapping provided by AS-OCT played a critical role in decision-making for cases with borderline tomographic findings. Establishing a global consensus on the use of epithelial mapping in ectasia screening is necessary.
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Affiliation(s)
- Niklas Mohr
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Stefan Kassumeh
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Nikolaus Luft
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Smile Eyes Clinic, Linz, Austria
| | - Martin Dirisamer
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
- Smile Eyes Clinic, Linz, Austria
| | - Siegfried G. Priglinger
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Wolfgang J. Mayer
- Department of Ophthalmology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
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Yücekul B, Förster A, Dick HB, Taneri S. Detecting Keratoconus in Adolescents with Anterior Segment Optical Coherence Tomography. J Ophthalmol 2024; 2024:6655217. [PMID: 38881564 PMCID: PMC11178420 DOI: 10.1155/2024/6655217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/26/2024] [Accepted: 05/25/2024] [Indexed: 06/18/2024] Open
Abstract
Purpose Assessing the applicability of an algorithm developed for keratoconus detection in adolescents. This algorithm relies on optical coherence tomography (OCT) and incorporates features related to corneal pachymetric and epithelial thickness alterations. Methods We retrospectively reviewed charts of patients under the age of 18 and divided them into four groups according to the Belin-Ambrosio display (Pentacam): normal, manifest, and subclinical keratoconus, as well as very asymmetric eye with normal topography and tomography (VAE-NTT). Corneal and epithelial thickness maps (Cirrus 5000 HD-OCT, Carl Zeiss Meditec, Germany) were evaluated by a human grader. In the first step, if at least one of four parameters (pachymetry minimum (pachy min), pachy minimum-median (min-med), pachy superonasal-inferotemporal (SN-IT), or epithelial (epi SN-IT)) exceeded its cut-off value, the eye was considered as suspect. In the second step, the combined presence of coincident thinning of total cornea and epithelium as well as concentric epithelial thinning lead to the diagnosis of keratoconus. Receiver operating characteristic (ROC) curves were generated to determine area under the curve (AUC), sensitivity, and specificity for the parameters. Results The study involved 19 pediatric patients diagnosed with keratoconus, comprising 29 manifest keratoconic eyes, 3 eyes with subclinical keratoconus, and 5 VAE-NTT eyes. In addition, 22 eyes from 11 normal adolescents were included in the analysis. The AUC values of parameters in step 1 were 0.889 for pachy min, 0.997 for pachy min-med, 0.893 for pachy SN-IT, and 0.998 for epi SN-IT. When both steps were performed, this algorithm captured all manifest and subclinical pediatric keratoconic eyes. When all eyes of the keratoconus patients were combined, step 1 had 97.3% sensitivity and step 2 had 100% specificity. Conclusion Using this OCT-based approach in adolescents yielded a high level of agreement with the current gold standard, tomography. Using them together, potentially also with other examinations may improve the diagnostic accuracy of KC in the pediatric population. Integration of this approach into the software of the device to facilitate automated evaluations is desired.
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Affiliation(s)
- Burcu Yücekul
- Haseki Training and Research Hospital, Department of Ophthalmology, Istanbul, Türkiye
| | - Anika Förster
- Zentrum für Refraktive Chirurgie, Augenzentrum am St. Franziskus Hospital, Münster, Germany
| | | | - Suphi Taneri
- Zentrum für Refraktive Chirurgie, Augenzentrum am St. Franziskus Hospital, Münster, Germany
- Ruhr University Bochum, Eye Clinic, Bochum, Germany
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Goodman D, Zhu AY. Utility of artificial intelligence in the diagnosis and management of keratoconus: a systematic review. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1380701. [PMID: 38984114 PMCID: PMC11182163 DOI: 10.3389/fopht.2024.1380701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/23/2024] [Indexed: 07/11/2024]
Abstract
Introduction The application of artificial intelligence (AI) systems in ophthalmology is rapidly expanding. Early detection and management of keratoconus is important for preventing disease progression and the need for corneal transplant. We review studies regarding the utility of AI in the diagnosis and management of keratoconus and other corneal ectasias. Methods We conducted a systematic search for relevant original, English-language research studies in the PubMed, Web of Science, Embase, and Cochrane databases from inception to October 31, 2023, using a combination of the following keywords: artificial intelligence, deep learning, machine learning, keratoconus, and corneal ectasia. Case reports, literature reviews, conference proceedings, and editorials were excluded. We extracted the following data from each eligible study: type of AI, input used for training, output, ground truth or reference, dataset size, availability of algorithm/model, availability of dataset, and major study findings. Results Ninety-three original research studies were included in this review, with the date of publication ranging from 1994 to 2023. The majority of studies were regarding the use of AI in detecting keratoconus or subclinical keratoconus (n=61). Among studies regarding keratoconus diagnosis, the most common inputs were corneal topography, Scheimpflug-based corneal tomography, and anterior segment-optical coherence tomography. This review also summarized 16 original research studies regarding AI-based assessment of severity and clinical features, 7 studies regarding the prediction of disease progression, and 6 studies regarding the characterization of treatment response. There were only three studies regarding the use of AI in identifying susceptibility genes involved in the etiology and pathogenesis of keratoconus. Discussion Algorithms trained on Scheimpflug-based tomography seem promising tools for the early diagnosis of keratoconus that can be particularly applied in low-resource communities. Future studies could investigate the application of AI models trained on multimodal patient information for staging keratoconus severity and tracking disease progression.
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Leclaire MD, Storp JJ, Lahme L, Esser EL, Eter N, Alnawaiseh M. Reduced Retinal Blood Vessel Densities Measured by Optical Coherence Tomography Angiography in Keratoconus Patients Are Negatively Correlated with Keratoconus Severity. Diagnostics (Basel) 2024; 14:707. [PMID: 38611620 PMCID: PMC11011292 DOI: 10.3390/diagnostics14070707] [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: 02/24/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Keratoconus (KC) is the most common corneal ectasia. Optical coherence tomography angiography (OCT-A) is a relatively new non-invasive imaging technique that allows the visualization and quantification of retinal and choriocapillary blood vessels. The aim of this study is to assess retinal and choriocapillary vessel density (VD) differences between KC patients and healthy controls and to investigate correlations between VD and KC severity. Fifty-two eyes were included in this exploratory study: twenty-six eyes from 26 KC patients and twenty-six eyes from 26 age- and gender-matched healthy controls. All patients underwent Scheimpflug corneal topography with Pentacam, axis lengths measurement and optical coherence tomography angiography (OCT-A). The thinnest spot in corneal pachymetry, maximum K (Kmax) and KC severity indices from the Belin/Ambrósio enhanced ectasia display (BAD) were also assessed. There was a distinct reduction particularly in the retinal VD of the superficial capillary plexus (SCP). Correlation analyses showed strong and moderate negative correlations between the VD in the macular SCP and BAD KC scores and between the SCP VD and Kmax. There was no difference in retinal thickness between the KC and healthy controls. With this study, further evidence for altered VD measurements by OCT-A in KC patients is given. For the first time, we demonstrated negative correlations between BAD KC scores and retinal blood vessel alterations. A major limitation of the study is the relatively small sample size. Since an artefactual reduction of the quantitative OCT-A measurements due to irregular corneal topography in KC must be assumed, it remains to be investigated whether there are also actual changes in the retinal microcirculation in KC.
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Affiliation(s)
- Martin Dominik Leclaire
- Department of Ophthalmology, University Medical Center Münster, 48149 Münster, Germany; (J.J.S.); (E.L.E.); (N.E.)
| | - Jens Julian Storp
- Department of Ophthalmology, University Medical Center Münster, 48149 Münster, Germany; (J.J.S.); (E.L.E.); (N.E.)
| | - Larissa Lahme
- Department of Ophthalmology, University Medical Center Münster, 48149 Münster, Germany; (J.J.S.); (E.L.E.); (N.E.)
| | - Eliane Luisa Esser
- Department of Ophthalmology, University Medical Center Münster, 48149 Münster, Germany; (J.J.S.); (E.L.E.); (N.E.)
| | - Nicole Eter
- Department of Ophthalmology, University Medical Center Münster, 48149 Münster, Germany; (J.J.S.); (E.L.E.); (N.E.)
| | - Maged Alnawaiseh
- Department of Ophthalmology, Klinikum Bielefeld gem. GmbH, 33647 Bielefeld, Germany
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İpek ŞC, Utine CA. Topography-guided excimer laser ablation in refractive surgery. FRONTIERS IN OPHTHALMOLOGY 2024; 4:1367258. [PMID: 38984110 PMCID: PMC11182089 DOI: 10.3389/fopht.2024.1367258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/22/2024] [Indexed: 07/11/2024]
Affiliation(s)
| | - Canan Asli Utine
- Department of Opthalmology, Faculty of Medicine, Dokuz Eylül University, İzmir, Türkiye
- İzmir Biomedicine and Genome Center, İzmir, Türkiye
- Department of Ophthalmology, University of Naples Federico II, Napoli, Italy
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12
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Jeong M, Yoo S. Optical coherence tomographic features of feline acute corneal hydrops: A case report. Vet Ophthalmol 2024; 27:191-196. [PMID: 38413366 DOI: 10.1111/vop.13198] [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: 08/21/2023] [Revised: 01/17/2024] [Accepted: 02/11/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE The objective of the study was to describe the optical coherence tomographic features of a cat with acute corneal hydrops. ANIMAL STUDIED A 4-year-old castrated male domestic shorthaired showing conjunctival redness, ocular discharge, and intermittent squinting of both eyes with asymmetrical disease onset. METHODS Complete ophthalmic examination and optical coherence tomography were performed. RESULTS On slit-lamp biomicroscopic examination, severe intrastromal fluid pockets with profound bullae were observed in the dorsomedial region in both eyes. A diagnosis of feline acute corneal hydrops was made in both eyes. Optical coherence tomography revealed profound stromal lamellar separation representing heterogeneous reflective areas, and fluid pockets and bullae of variable size were concomitant to Descemet's membrane detachment demonstrated by a well-defined homogeneous hyporeflective area. Upon reevaluation 30 days during healing process for both eyes, the thickened epithelia and the thinning pan-stromal areas were identified as homogeneously hyper-reflective epithelia and as heterogeneous hyper-reflectivity, respectively. A thickened posterior corneal surface was shown as heterogeneous with patchy hyper-reflectivity. Additionally, Descemet's membrane detachment in the initial presentation had two distinct forms suspicious of Descemet's membrane rupture in each eye: a break with rolled ends and a break with flat ends. CONCLUSION To the author's knowledge, this study represents the first documentation of in vivo detection of Descemet's membrane detachment and presumed rupture in a cat experiencing acute corneal hydrops. These observations strongly indicate that Descemet's membrane detachment/rupture acts as a most likely risk factor in the onset of acute corneal hydrops in cats.
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Affiliation(s)
- Manbok Jeong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana, USA
| | - Sukjong Yoo
- Yoolim Animal Eye Clinic, Seoul, South Korea
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Hacıağaoğlu S, Akkaya Turhan S, Toker E. A comparison of conventional and accelerated corneal crosslinking: corneal epithelial remodeling and in vivo confocal microscopy analysis. Int Ophthalmol 2024; 44:87. [PMID: 38363414 DOI: 10.1007/s10792-024-03020-0] [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: 04/01/2023] [Accepted: 01/09/2024] [Indexed: 02/17/2024]
Abstract
PURPOSE To evaluate the effect of conventional and accelerated corneal crosslinking (CXL) on visual acuity, corneal topography, corneal epithelial thickness, and subbasal nerve morphology in progressive keratoconus patients. METHODS In this prospective and randomized study, twenty eyes of 20 patients were treated with conventional CXL (3 mW/cm2, 30 min, C-CXL) and 19 eyes of 19 patients were treated with accelerated CXL (9 mW/cm2, 10 min, A-CXL). The spherical equivalent, uncorrected visual acuity, best-corrected visual acuity, keratometric measurements, demarcation line measurement and epithelial thickness mapping analyses, and subbasal nerve morphology with in vivo confocal microscopy (IVCCM) were evaluated at baseline and at postoperative months 1, 3 and 6. RESULTS At postoperative 6 months, a significant improvement was observed in all keratometric values in both treatment groups (p < 0.05). All epithelial thickness indices, except central, temporal, and inferotemporal thickness, were reduced at 1 month postoperatively in both treatment groups. The epithelial map uniformity indices (standard deviation and difference between min-max thickness) were significantly lower than the baseline values at all time points after CXL in both treatment groups (p < 0.001). Compared with the preoperative values, there was a significant decrease in all IVCCM parameters at 1 month postoperatively (p < 0.05). At 6 months postoperatively, corneal nerve fiber density and corneal nerve branch density recovered to preoperative values in the A-CXL group, whereas corneal nerve regeneration was not complete in the C-CXL group. CONCLUSION Both conventional and accelerated CXL treatments appear to be effective in halting the progression of KC. Corneal epithelial irregularity slightly improves after CXL. The regeneration of subbasal nerves is faster after A-CXL treatment.
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Affiliation(s)
- Sezer Hacıağaoğlu
- Department of Ophthalmology, Bahçeşehir University, Sahrayıcedit Mah. Batman Sk. No:66, 34734 Kadıköy, Istanbul, Turkey.
| | - Semra Akkaya Turhan
- Department of Ophthalmology, Marmara University, Marmara Üniversitesi Pendik Eğitim ve Araştırma Hastanesi, Fevzi Çakmak Mah. Muhsin Yazıcıoğlu Cad. No:10 Pendik, Istanbul, Turkey
| | - Ebru Toker
- Department of Ophthalmology and Visual Sciences, West Virginia University, Morgantown, United States
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Dong Y, Hou J, Zhang J, Lei Y, Yang X, Sun F. Epithelial thickness remodeling after small incision lenticule intrastromal keratoplasty in correcting hyperopia measured by RTVue OCT. BMC Ophthalmol 2024; 24:13. [PMID: 38191381 PMCID: PMC10773066 DOI: 10.1186/s12886-023-03272-x] [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: 09/14/2023] [Accepted: 12/20/2023] [Indexed: 01/10/2024] Open
Abstract
PURPOSE To characterize the in vivo corneal epithelial thickness (CET) remodeling profile in a population of eyes after small incision lenticule intrastromal keratoplasty (SMI-LIKE) for hyperopia. METHODS The CET profile was measured by RTVue-100 Fourier-domain OCT system across the central 6-mm diameter of the cornea of 17 eyes from 12 subjects (five males and seven females) who accepted corneal stromal lens implantation surgery for correcting hyperopia. The CET were measured at positions with a radius of 0-1.0 mm, 1.0-2.5 mm (divided into eight quadrants) and 2.5-3.0 mm (divided into eight quadrants) from the corneal center. Corneal maximum simulated keratometry (Km) was measured by Pentacam HR anterior segment analyzer to analyze CET changes. The examination data of subjects were collected in four time periods, which were preoperative, short-term postoperative (one week after surgery), mid-term postoperative (the last review within 3-6 months after surgery), and long-term postoperative (the last review over 1-2.5 years after surgery). The changes of CET were compared and analyzed in the four time periods. RESULTS Mean CET in 0-1.0 mm, 1.0-2.5 mm and 2.5-3.0 mm of the cornea decreased in one week after surgery, respectively, as compared to CET in the preoperative period, which turned from 55.06 ± 0.82 μm、54.42 ± 0.75 μm、53.46 ± 0.60 μm to 51.18 ± 1.05 μm (P = 0.005), 49.38 ± 0.70 μm (P = 0.000), 51.29 ± 0.59 μm (P = 0.025). In the mid-term postoperative period, mean CET in 0-1.0 mm and 1.0-2.5 mm areas kept thinner than mean CET in the preoperative period, CET in 0-1.0 mm is 50.59 ± 0.76 μm (P = 0.000),CET in 1.0-2.5 mm is 50.23 ± 0.57 μm (P = 0.000), while mean CET in 2.5-3.0 mm area recovered to the same thickness as the preoperative level, which is 54.36 ± 0.66 μm (P = 1.000), until the long-term period, CET stabilized in the above doughnut pattern. CONCLUSIONS After stromal lenticule implantation for hyperopia, CET showed a remodeled form of thinning in the 0-2.5 mm area and thickening in the 2.5-3.0 mm area, and remained stable within one year after surgery.
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Affiliation(s)
- Yahui Dong
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Jie Hou
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Jing Zhang
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Yulin Lei
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China.
| | - Xinghua Yang
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
| | - Fangfang Sun
- Jinan Mingshui Eye Hospital, Number 5601, Longquan Road, Zhangqiu District, Jinan, 250200, China
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Abtahi MA, Beheshtnejad AH, Latifi G, Akbari-Kamrani M, Ghafarian S, Masoomi A, Sonbolastan SA, Jahanbani-Ardakani H, Atighechian M, Banan L, Nouri H, Abtahi SH. Corneal Epithelial Thickness Mapping: A Major Review. J Ophthalmol 2024; 2024:6674747. [PMID: 38205099 PMCID: PMC10776199 DOI: 10.1155/2024/6674747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/27/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The corneal epithelium (CE) is the outermost layer of the cornea with constant turnover, relative stability, remarkable plasticity, and compensatory properties to mask alterations in the underlying stroma. The advent of quantitative imaging modalities capable of producing epithelial thickness mapping (ETM) has made it possible to characterize better the different patterns of epithelial remodeling. In this comprehensive synthesis, we reviewed all available data on ETM with different methods, including very high-frequency ultrasound (VHF-US) and spectral-domain optical coherence tomography (SD-OCT) in normal individuals, corneal or systemic diseases, and corneal surgical scenarios. We excluded OCT studies that manually measured the corneal epithelial thickness (CET) (e.g., by digital calipers) or the CE (e.g., by confocal scanning or handheld pachymeters). A comparison of different CET measuring technologies and devices capable of producing thickness maps is provided. Normative data on CET and the possible effects of gender, aging, diurnal changes, refraction, and intraocular pressure are discussed. We also reviewed ETM data in several corneal disorders, including keratoconus, corneal dystrophies, recurrent epithelial erosion, herpes keratitis, keratoplasty, bullous keratopathy, carcinoma in situ, pterygium, and limbal stem cell deficiency. The available data on the potential role of ETM in indicating refractive surgeries, planning the procedure, and assessing postoperative changes are reviewed. Alterations in ETM in systemic and ocular conditions such as eyelid abnormalities and dry eye disease and the effects of contact lenses, topical medications, and cataract surgery on the ETM profile are discussed.
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Affiliation(s)
| | | | - Golshan Latifi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sadegh Ghafarian
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Masoomi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Laleh Banan
- Sunshine Coast University Hospital, Brisbane, Queensland, Australia
| | - Hosein Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed-Hossein Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Ning R, Wang Y, Xu Z, Gustafsson I, Li J, Savini G, Schiano-Lomoriello D, Xiao Y, Chen A, Wang X, Zhou X, Huang J. Assessing progression limits in different grades of keratoconus from a novel perspective: precision of measurements of the corneal epithelium. EYE AND VISION (LONDON, ENGLAND) 2024; 11:1. [PMID: 38163895 PMCID: PMC10759576 DOI: 10.1186/s40662-023-00368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND To assess repeatability and reproducibility of corneal epithelium thickness (ET) measured by a spectral-domain optical coherence tomographer (SD-OCT)/Placido topographer (MS-39, CSO, Florence, Italy) in keratoconus (KC) population at different stages, as well as to determine the progression limits for evaluating KC progression. METHODS A total of 149 eyes were enrolled in this study, with 29 eyes in the forme fruste keratoconus (FFKC) group, 34 eyes in the mild KC group, 40 eyes in the moderate KC group, and 46 eyes in the severe KC group. Employing the within-subject standard deviation (Sw), test-retest variability (TRT), coefficient of variation (CoV), and intraclass correlation coefficient (ICC) to evaluate intraoperator repeatability and interoperator reproducibility. RESULTS The repeatability and reproducibility of MS-39 in patients with KC were acceptable, according to ICC values ranging from 0.732 to 0.954. However, patients with more severe KC and progressive peripheralization of the measurement points had higher TRTs but a thinning trend. The current study tended to set the cut-off values of mild KC, moderate KC, and severe KC to 4.9 µm, 5.2 µm, and 7.4 µm for thinnest epithelium thickness (TET). When differences between follow-ups are higher than those values, progression of the disease is possible. As for center epithelium thickness (CET), cut-off values for mild KC, moderate KC, and severe KC should be 2.8 µm, 4.4 µm, and 5.3 µm. This might be useful in the follow-up and diagnosis of keratoconus. CONCLUSIONS This study demonstrated that the precision of MS-39 was reduced in measuring more severe KC patients and more peripheral corneal points. In determining disease progression, values should be differentiated between disease-related real changes and measurement inaccuracies. Due to the large difference in ET measured by MS-39 between various stages of disease progression, it is necessary to accurately grade KC patients to avoid errors in KC clinical decision-making.
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Affiliation(s)
- Rui Ning
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yiran Wang
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Zhenyu Xu
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Ingemar Gustafsson
- Department of Clinical Sciences, Ophthalmology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jiawei Li
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | | | | | - Yichen Xiao
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Aodong Chen
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Jinhai Huang
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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Khodaparast M, Ambrósio R, Ahmadzadeh H, Khorrami-Nejad M, Mohammadzadeh M, Azizi S, Mohammadi SF, Hashemian H. Evaluation of the effect of artificial tears on corneal epithelial thickness changes after photorefractive keratectomy. Indian J Ophthalmol 2024; 72:66-72. [PMID: 38131572 PMCID: PMC10841771 DOI: 10.4103/ijo.ijo_1354_23] [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: 05/24/2023] [Revised: 07/30/2023] [Accepted: 08/12/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE This study aimed to evaluate the corneal epithelial thickness changes after photorefractive keratectomy (PRK) and the impact of long-term artificial tear usage on epithelial thickness changes in these patients. METHODS This study was performed on 71 patients (142 eyes) without dry eye disease who received PRK for myopic refractive correction. The corneal epithelial thickness profile was obtained before, one, three, and six months after surgery using anterior segment optical coherence tomography. Patients were randomly divided into two groups: group A, who received preservative-free artificial tears post-surgery, and group B, who did not receive artificial tears. RESULTS The epithelial thickness decreased universally in the first month and then increased in the 3- and 6-month follow-ups. Group A had a significantly thicker epithelium in central, paracentral, and midperipheral zones compared with group B in the 3-month follow-up. In the 6-month follow-up, no significant differences were detected between groups. At the last follow-up, the central, paracentral, and midperipheral zone epithelial thicknesses in all patients were significantly higher than preoperative values, but peripheral zone thickness only increased to preoperative values. CONCLUSIONS Patients using artificial tears showed a faster thickening, especially in the central and paracentral zones, but there were no significant differences between the two groups in the final follow-up. Artificial tear usage may increase the rate of the epithelial remodeling process in post-PRK patients without significantly altering the final epithelial thickness profile. Further studies are warranted to evaluate the influence of different factors on epithelial remodeling.
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Affiliation(s)
- Mehdi Khodaparast
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Renato Ambrósio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro and Maceió, Brazil
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Hooman Ahmadzadeh
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Mohammadzadeh
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Samaneh Azizi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farzad Mohammadi
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hesam Hashemian
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Carreira P, Loureiro T, Carreira AR, Gouveia-Moraes F, Cardoso A, Sampaio A, Campos P, Rodrigues-Barros S, Machado I, Campos N. The Effect of Upper Eyelid Blepharoplasty on Corneal Tomography and Epithelial Profile. Clin Ophthalmol 2023; 17:3801-3807. [PMID: 38105910 PMCID: PMC10725641 DOI: 10.2147/opth.s426034] [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: 09/05/2023] [Accepted: 10/16/2023] [Indexed: 12/19/2023] Open
Abstract
Introduction Upper tarsal mechanical forces influence corneal epithelial thickness profile, which could modulate corneal astigmatism. Upper eyelid blepharoplasty reduces upper tarsal strength and may have an impact on ocular surface. The aim of this study is to evaluate the effect of upper eyelid blepharoplasty on corneal epithelial thickness profile, astigmatism and aberrations. Methods Patients with dermatochalasis underwent bilateral upper eyelid blepharoplasty. Anterior segment optical coherence tomography (AS-OCT) (Zeiss Cirrus 5000 HD-OCT) and Pentacam (Oculus, Wetzlar Germany) were performed before surgery and in the 8th postoperative week. Corneal epithelial thickness, keratometry, aberrations and asphericity were considered for statistical purposes. Only right eyes were considered. A p-value lower than 0.05 was considered significant. Results Thirty eyes of 30 patients were included. The degree of astigmatism did not change after surgery (0.95D vs 0.83D, p=0.23). The difference between preoperative and postoperative steepest axis was 3.1° (p=0.04) with a tendency to change toward the vertical meridian. Mean epithelial thickness was higher in the inferior region both pre- and postoperatively and did not change. ET in the superior octant was lower (42 µm vs 45 µm, p<0.01) and the difference between inferior and superior octants (I-S) was higher (7 µm vs 3 µm, p<0.001) before surgery. There were no statistically significant changes in corneal aberrations (p=0.52) and asphericity (p=0.41) after surgery. Conclusion Our results support that upper tarsus pressure influences epithelial thickness profile and, consequently, the corneal steepest keratometry. These results lead us to postulate that upper eyelid blepharoplasty may influence biometric and keratometric measurements.
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Affiliation(s)
- Pedro Carreira
- Centro de Responsabilidade Integrada de Oftalmologia, Hospital Garcia de Orta, Almada, Portugal
| | - Tomás Loureiro
- Centro de Responsabilidade Integrada de Oftalmologia, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Carreira
- Centro de Responsabilidade Integrada de Oftalmologia, Hospital Garcia de Orta, Almada, Portugal
| | - Filipe Gouveia-Moraes
- Centro de Responsabilidade Integrada de Oftalmologia, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Cardoso
- Centro de Responsabilidade Integrada de Oftalmologia, Hospital Garcia de Orta, Almada, Portugal
| | - Audrey Sampaio
- Centro de Responsabilidade Integrada de Oftalmologia, Hospital Garcia de Orta, Almada, Portugal
| | - Paul Campos
- Centro de Responsabilidade Integrada de Oftalmologia, Hospital Garcia de Orta, Almada, Portugal
| | - Sandra Rodrigues-Barros
- Centro de Responsabilidade Integrada de Oftalmologia, Hospital Garcia de Orta, Almada, Portugal
| | - Ines Machado
- Centro de Responsabilidade Integrada de Oftalmologia, Hospital Garcia de Orta, Almada, Portugal
| | - Nuno Campos
- Centro de Responsabilidade Integrada de Oftalmologia, Hospital Garcia de Orta, Almada, Portugal
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Lin AN, Mohammed ISK, Munir WM, Munir SZ, Maripudi S, Wei L, Alexander JL. Repeatability and reliability of semi-automated anterior segment-optical coherence tomography imaging compared to manual analysis in normal and keratoconus eyes. Int Ophthalmol 2023; 43:5063-5069. [PMID: 37874439 DOI: 10.1007/s10792-023-02909-6] [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: 06/23/2022] [Accepted: 09/28/2023] [Indexed: 10/25/2023]
Abstract
PURPOSE To assess the repeatability and reliability of semi-automated EyeMark Python program measurements compared to manual ImageJ image processing of anterior segment-optical coherence tomography (AS-OCT) structures in healthy and keratoconus eyes. METHODS Heidelberg AS-OCT was used to image 25 eyes from 14 healthy subjects and 25 eyes from 15 subjects with keratoconus between the ages of 20 and 80 years, collected prospectively, in this observational case-control study. Visual axis scan containing vertical fixation light beam was selected from the 15-line AS-OCT scan raster. Central corneal thickness (CCT), anterior corneal radius of curvature (ACRC), posterior corneal radius of curvature (PCRC), and truncated anterior vault (TAV) were measured using ImageJ software and the EyeMark Python program. MedCalc and R were used to calculate the intraclass correlation coefficient (ICC) and generate Bland-Altman plots (BAP). RESULTS When comparing the measurements of CCT, ACRC, PCRC, and TAV between manual ImageJ analysis and the EyeMark Python program, ICC values were consistently greater than 0.9, indicating excellent agreement. BAPs comparing the ImageJ and Python measurements of anterior segment structures show no systematic proportional bias and the average differences were near zero and within 95% of the limits of agreement. CONCLUSIONS Semi-automated tools may provide the necessary efficiency for point-of-care quantitative corneal analysis of raw AS-OCT images. The semi-automated EyeMark Python program offers a repeatable and reliable tool compared to manual ImageJ analysis for measuring anterior segment structures from AS-OCT images among individuals with keratoconus.
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Affiliation(s)
- Anna N Lin
- Department of Neurology, University of Maryland, Baltimore, MD, USA
| | | | - Wuqaas M Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland Eye Associates, University of Maryland, Baltimore, MD, USA
| | - Saleha Z Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland Eye Associates, University of Maryland, Baltimore, MD, USA
| | - Snehaa Maripudi
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Libby Wei
- Department of Ophthalmology and Visual Sciences, University of Maryland Eye Associates, University of Maryland, Baltimore, MD, USA
| | - Janet L Alexander
- Department of Ophthalmology and Visual Sciences, University of Maryland Eye Associates, University of Maryland, Baltimore, MD, USA.
- Department of Ophthalmology, University of Maryland School of Medicine, Baltimore, MD, 21201, USA.
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20
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Ambrósio R, Salomão MQ, Barros L, da Fonseca Filho JBR, Guedes J, Neto A, Machado AP, Lopes BT, Sena N, Esporcatte LPG. Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift. EYE AND VISION (LONDON, ENGLAND) 2023; 10:45. [PMID: 37919821 PMCID: PMC10623885 DOI: 10.1186/s40662-023-00363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
Different diagnostic approaches for ectatic corneal diseases (ECD) include screening, diagnosis confirmation, classification of the ECD type, severity staging, prognostic evaluation, and clinical follow-up. The comprehensive assessment must start with a directed clinical history. However, multimodal imaging tools, including Placido-disk topography, Scheimpflug three-dimensional (3D) tomography, corneal biomechanical evaluations, and layered (or segmental) tomography with epithelial thickness by optical coherence tomography (OCT), or digital very high-frequency ultrasound (dVHF-US) serve as fundamental complementary exams for measuring different characteristics of the cornea. Also, ocular wavefront analysis, axial length measurements, corneal specular or confocal microscopy, and genetic or molecular biology tests are relevant for clinical decisions. Artificial intelligence enhances interpretation and enables combining such a plethora of data, boosting accuracy and facilitating clinical decisions. The applications of diagnostic information for individualized treatments became relevant concerning the therapeutic refractive procedures that emerged as alternatives to keratoplasty. The first paradigm shift concerns the surgical management of patients with ECD with different techniques, such as crosslinking and intrastromal corneal ring segments. A second paradigm shift involved the quest for identifying patients at higher risk of progressive iatrogenic ectasia after elective refractive corrections on the cornea. Beyond augmenting the sensitivity to detect very mild (subclinical or fruste) forms of ECD, ectasia risk assessment evolved to characterize the inherent susceptibility for ectasia development and progression. Furthermore, ectasia risk is also related to environmental factors, including eye rubbing and the relational impact of the surgical procedure on the cornea.
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Affiliation(s)
- Renato Ambrósio
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil.
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil.
| | - Marcella Q Salomão
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Benjamin Constant Institute, Rio de Janeiro, Brazil
| | - Lorena Barros
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - João Batista R da Fonseca Filho
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - Jaime Guedes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
| | - Alexandre Neto
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
| | - Aydano P Machado
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Computing Institute, Federal University of Alagoas, Maceió, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Department of Ophthalmology, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Nelson Sena
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - Louise Pellegrino Gomes Esporcatte
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
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21
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Lu NJ, Hafezi F, Koppen C, Alió Del Barrio JL, Aslanides IM, Awwad ST, Ní Dhubhghaill S, Pineda R, Torres-Netto EA, Wang L, Chen SH, Cui LL, Rozema JJ. New keratoconus staging system based on OCT. J Cataract Refract Surg 2023; 49:1098-1105. [PMID: 37531392 DOI: 10.1097/j.jcrs.0000000000001276] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/25/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To establish a numerical spectral-domain optical coherence tomography (SD-OCT)-based keratoconus (KC) staging system and compare it with existing KC staging systems. SETTING Eye Hospital of Wenzhou Medical University, Wenzhou, China. DESIGNS Retrospective case-control study. METHODS Scheimpflug tomography, air-puff tonometry, and SD-OCT were performed on 236 normal and 331 KC eyes. All SD-OCT-derived parameters of the corneal epithelium and stroma were evaluated based on their receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, and specificity to discriminate between normal and KC eyes. The best performing parameters were subsequently used to create an OCT-based staging system, which was compared with existing tomographic and biomechanical staging systems. RESULTS 236 eyes from 236 normal patients and 331 eyes from 331 KC patients of different stages were included. The highest ranked AUC ROC SD-OCT parameters, derived from stroma and epithelium, were stroma overall minimum thickness (ST: AUC 0.836, sensitivity 90%, specificity 67%) and epithelium overall SD (EP: AUC 0.835, sensitivity 75%, specificity 78%). A numerical SD-OCT staging system called STEP including 2 parameters-"ST" and "EP"-with 5 stages was proposed. CONCLUSIONS The new SD-OCT-based KC staging system is the first to take the epithelium with its sublayer stroma information into account, showing a strong agreement to the existing staging systems. This system could be incorporated into daily practice, potentially leading to an overall improvement in KC treatment and follow-up management.
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Affiliation(s)
- Nan-Ji Lu
- From the Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium (Lu, Koppen, Ní Dhubhghaill, Rozema); National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China (Lu, Hafezi, Aslanides, Chen, Cui); State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, China (Lu, Chen, Cui); Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China (Lu, Wang); ELZA Institute, Dietikon, Switzerland (Lu, Hafezi, Torres-Netto); Ocular Cell Biology Group, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Switzerland (Hafezi, Torres-Netto); Faculty of Medicine, University of Geneva, Geneva, Switzerland (Hafezi, Torres-Netto); Department of Ophthalmology, University of Southern California, Los Angeles, California (Hafezi); Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium (Koppen, Rozema); Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain (Alió del Barrio); Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain (Alió del Barrio); Emmetropia Mediterranean Eye Institute, Heraklion, Crete, Greece (Aslanides); The American University of Beirut Medical Center, Beirut, Lebanon (Awwad); The Department of Ophthalmology, Brussels University Hospital, Brussels, Belgium (Ní Dhubhghaill); The faculty of Health Sciences and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium (Ní Dhubhghaill); Department of Ophthalmology, Massachusetts Eye and Ear and Harvard Medical School, Boston, Massachusetts (Pineda)
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22
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Wu PY, Chen HC, Hsueh YJ, Chen KJ, Wang NK, Liu L, Chen YP, Hwang YS, Lai CC, Wu WC. Corneal topography in preterm children aged 2 years to 12 years with or without retinopathy of prematurity. Eye (Lond) 2023; 37:2565-2572. [PMID: 36593346 PMCID: PMC10397294 DOI: 10.1038/s41433-022-02375-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 12/01/2022] [Accepted: 12/16/2022] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To evaluate corneal topography in full-term and preterm children with or without retinopathy of prematurity (ROP). METHODS We enrolled children aged from 2 years to 12 years between January 2019 and May 2021 in the following four groups: full-term (group 1), premature without ROP (group 2), untreated premature with ROP (group 3), and laser-treated and/or intravitreal injection (IVI) of anti-vascular endothelial growth factor (VEGF)-treated premature with ROP (group 4). Corneal topography was measured with the Galilei Placido-dual Scheimpflug analyzer G4 every half year, and was compared among the groups using generalized estimating equation models at approximately 7 years of age. RESULTS We included 77, 178, 45, and 131 participants in groups 1, 2, 3, and 4, respectively. The mean (standard deviation) number of visits per patient was 2.9 (1.4). Compared with full-term eyes, premature eyes demonstrated steeper anterior corneal curvature (p = 0.016 and p = 0.008 for the mean and steep K, respectively), higher anterior and posterior corneal astigmatism (p = 0.036 and p = 0.016, respectively), and thinner thinnest pachymetry (p < 0.001). The laser-treated ROP eyes displayed steeper anterior corneal curvature (p = 0.040 for steep K) and higher anterior corneal astigmatism (p = 0.005) than the IVI-treated eyes. Moreover, they exhibited high cone location and magnitude index (1.96) reaching the cut-off for detecting keratoconus (1.82). CONCLUSIONS The premature status led to greater corneal ectasia, and laser treatment for ROP caused further corneal steepness. Higher anterior corneal astigmatism was associated with laser treatment. The ROP pathology and IVI anti-VEGF treatment exerted a marginal effect on corneal topography.
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Affiliation(s)
- Po-Yi Wu
- Department of Education, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, 112, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yi-Jen Hsueh
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Irving Medical Center, Columbia University, New York, NY, USA
| | - Laura Liu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yen-Po Chen
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Ophthalmology, Tucheng Municipal Hospital, New Taipei, 236, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, 412, Taiwan
| | - Chi-Chun Lai
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan
- Department of Ophthalmology, Chang Gung Memorial Hospital, Keelung Branch, Keelung, 204, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, 333, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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23
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Miażdżyk M, Consejo A, Iskander DR. OCT based corneal densitometry: the confounding effect of epithelial speckle. BIOMEDICAL OPTICS EXPRESS 2023; 14:3871-3880. [PMID: 37799674 PMCID: PMC10549732 DOI: 10.1364/boe.489054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/06/2023] [Accepted: 06/12/2023] [Indexed: 10/07/2023]
Abstract
Corneal densitometry is a clinically validated method for objectively assessing the transparency of stroma. The technique is currently dominated by Scheimpflug technology. Still, optical coherence tomography (OCT), in which examination of the statistical properties of corneal speckle is undertaken, has also been considered to assess corneal densitometry. In-vivo, the stroma is observed via the epithelium. However, the effect of this external layer on stromal densitometry has not been considered as yet. This study aims to quantify the influence of epithelium integrity on corneal OCT densitometry. OCT images from eleven freshly enucleated porcine eyes before and after epithelial debridement were used. OCT densitometry was investigated at different stromal depths using four metrics of speckle statistics. Results indicate that there exist statistically significant differences in speckle statistics for a given stromal depth depending on the presence or absence of the epithelium. The estimation error in speckle statistics can reach over 20% depending on the stromal depth. The anterior stroma densitometry values are the ones most affected by epithelial integrity. In conclusion, if OCT densitometry stromal parameters are to be considered in absolute terms, it is essential to consider the confounding effect of the epithelial layer in the analysis.
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Affiliation(s)
- Maria Miażdżyk
- Department of Biomedical Engineering,
Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland
| | - Alejandra Consejo
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain
- Aragon Institute for Engineering Research (I3A), University of Zaragoza, Zaragoza, Spain
| | - D. Robert Iskander
- Department of Biomedical Engineering,
Wroclaw University of Science and Technology, Wybrzeze Wyspianskiego 27, 50-370 Wroclaw, Poland
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24
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Feng Y, Reinstein DZ, Nitter T, Archer TJ, McAlinden C, Bertelsen G, Stojanovic A. Epithelial Thickness Mapping in Keratoconic Corneas: Repeatability and Agreement Between CSO MS-39, Heidelberg Anterion, and Optovue Avanti OCT Devices. J Refract Surg 2023; 39:474-480. [PMID: 37449505 DOI: 10.3928/1081597x-20230606-01] [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: 07/18/2023]
Abstract
PURPOSE To assess repeatability and agreement of corneal epithelial thickness mapping in eyes with keratoconus using three optical coherence tomography (OCT) devices featuring different technologies: spectral-domain (SD) OCT combined with Placido disk corneal topography (MS-39), swept-source OCT (Anterion), and SD-OCT (Avanti). METHODS Three consecutive measurements were acquired with the three devices in 60 eyes with keratoconus. The mean epithelial thickness was calculated in the central 2-mm zone and in 2- to 5-mm and 5- to 7-mm diameter rings. The repeatability was calculated using pooled within-subject standard deviation (Sw). The agreement was assessed by paired t tests and Bland-Altman plots. RESULTS The repeatability (Sw) of the epithelial thickness for the central 2-mm zone was 0.91, 0.71, and 0.93 μm for the MS-39, Anterion, and Avanti, respectively. All thicknesses with the MS-39 were greater than those of the Anterion and Avanti, with mean differences of 4.11 ± 1.34 μm (P < .001) and 0.52 ± 1.30 μm (P = .003), respectively. The 95% limits of agreement were 1.484 to 6.736 μm for the MS-39 and Anterion, -3.068 to 2.028 μm for the Avanti and MS-39, and 1.258 to 5.922 μm for for the Avanti and Anterion. CONCLUSIONS Epithelial thickness mapping results were most repeatable with the Anterion, followed by the MS-39 and Avanti. The MS-39 gave the thickest values, followed by the Avanti and Anterion. The differences were significant, making the devices not interchangeable for epithelial thickness mapping in eyes with keratoconus. [J Refract Surg. 2023;39(7):474-480.].
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25
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Gui Y, Wang S, He Y, Zhang S, Zhang Y. Progress of corneal morphological examination combined with biomechanical examination in preoperative screening for keratorefractive surgery. Indian J Ophthalmol 2023; 71:2369-2378. [PMID: 37322646 PMCID: PMC10417961 DOI: 10.4103/ijo.ijo_1377_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: 06/09/2022] [Revised: 10/26/2022] [Accepted: 03/28/2023] [Indexed: 06/17/2023] Open
Abstract
Although corneal refractive surgery has been proven to be excellent in terms of safety and effectiveness, the reduction of postoperative corneal ectasia remains one of the most concerned topics for surgeons. Forme fruste keratoconus (FFKC) is the most important factor that leads to postoperative corneal ectasia, and common preoperative screenings of the condition include corneal morphology examination and corneal biomechanical examination. However, there are limitations to the single morphological examination or biomechanical examination, and the advantages of the combination of the two have been gradually emerging. The combined examination is more accurate in the diagnosis of FFKC and can provide a basis for determining suspected keratoconus. It allows one to measure the true intraocular pressure (IOP) before and after surgery and is recommended for older patients and those with allergic conjunctivitis. This article aims to discuss the application, advantages, and disadvantages of single examination and combined examination in the preoperative screening of refractive surgery, so as to provide a certain reference value for choosing suitable patients for surgery, improving surgical safety, and reducing the risk of postoperative ectasia.
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Affiliation(s)
- Yujia Gui
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Shurong Wang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Yuxi He
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Shuangqing Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
| | - Yan Zhang
- Department of Ophthalmology, The Second Hospital of Jilin University, Changchun, China
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26
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Corbin WM, Payne CJ, Momeni-Moghaddam H, Ronquillo YC, Hoopes PC, Moshirfar M. The Combined Utilization of Epithelial Thickness Mapping and Tomography in Keratorefractive Surgery Screening: One Imaging Modality is Not Sufficient. Clin Ophthalmol 2023; 17:1457-1463. [PMID: 37251984 PMCID: PMC10225140 DOI: 10.2147/opth.s404019] [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: 02/03/2023] [Accepted: 03/30/2023] [Indexed: 05/31/2023] Open
Abstract
Increasing popularity and utility of epithelial thickness mapping (ETM) in keratorefractive surgery screening may begin to inappropriately devalue the use of tomography. An increasing body of research suggests that the interpretation of ETM based solely on the corneal resurfacing function may be insufficient to screen and select patients for refractive surgery. ETM and tomography are complementary and, when used together, may provide the safest and most optimal tools for keratorefractive surgery screening.
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Affiliation(s)
- Wyatt M Corbin
- Stritch School of Medicine, Loyola University Chicago, Maywood, IL, USA
| | - Carter J Payne
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Hamed Momeni-Moghaddam
- Rehabilitation Sciences Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | | | - Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, Draper, UT, USA
- Moran Eye Center, University of Utah, Salt Lake City, UT, USA
- Utah Lion’s Eye Bank, Murray, UT, USA
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27
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Borgia A, Romano V, Romano D, Pagano L, Vagge A, Giannaccare G, Ahmed M, Gadhvi K, Menassa N, Ahmad M, Kaye S, Coco G. Managing Post-Keratoplasty Astigmatism: High-Tech vs. Low-Tech Imaging Techniques for Guiding Suture Manipulation. J Clin Med 2023; 12:jcm12103462. [PMID: 37240568 DOI: 10.3390/jcm12103462] [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: 04/29/2023] [Accepted: 05/12/2023] [Indexed: 05/28/2023] Open
Abstract
Astigmatism is a visually significant condition that can develop after keratoplasty. The management of post-keratoplasty astigmatism can be performed both when transplant sutures are in place and when they have been removed. Fundamental for astigmatism management is its identification and characterization in terms of type, amount, and direction. Commonly, post-keratoplasty astigmatism is evaluated through corneal tomography or topo-aberrometry; however, many other techniques can be used in case these instruments are not readily available. Here, we describe several low-tech and high-tech techniques used for post-keratoplasty astigmatism detection in order to quickly understand if it contributes to low vision quality and to determine its characteristics. The management of post-keratoplasty astigmatism through suture manipulation is also described.
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Affiliation(s)
- Alfredo Borgia
- Eye Unit, Humanitas-Gradenigo Hospital, 10153 Turin, Italy
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
| | - Vito Romano
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
- Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, 25125 Brescia, Italy
| | - Davide Romano
- Eye Clinic, Department of Neurological and Vision Sciences, University of Brescia, 25125 Brescia, Italy
- Eye Unit, University Hospitals of Leicester, NHS Trust, Leicester LE1 5WW, UK
| | - Luca Pagano
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
| | - Aldo Vagge
- IRCCS Ospedale Policlinico San Martino, University Eye Clinic of Genoa, 16132 Genova, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health 19 (DiNOGMI), University of Genoa, 16132 Genova, Italy
| | - Giuseppe Giannaccare
- Department of Ophthalmology, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy
| | - Mahmoud Ahmed
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
| | - Kunal Gadhvi
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
| | - Nardine Menassa
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
| | - Mohammad Ahmad
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
| | - Stephen Kaye
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
| | - Giulia Coco
- Department of Corneal Diseases, St. Paul's Eye Unit, Royal Liverpool University Hospital, Liverpool L7 8YE, UK
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
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28
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Reinstein DZ, Archer TJ, Potter JG, Gupta R, Wiltfang R. Refractive and Visual Outcomes of SMILE for Compound Myopic Astigmatism With the VISUMAX 800. J Refract Surg 2023; 39:294-301. [PMID: 37162399 DOI: 10.3928/1081597x-20230301-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
PURPOSE To report the first refractive and visual outcomes of small incision lenticule extraction (SMILE) using the VISUMAX 800 femtosecond laser (Carl Zeiss Meditec AG). METHODS This was a retrospective analysis of consecutive eyes treated by SMILE using the VISUMAX 800 femtosecond laser at London Vision Clinic, EuroEyes Group, London, United Kingdom. Inclusion criteria were patients aged younger than 45 years, a corrected distance visual acuity (CDVA) of 20/20 or better, and the 3-month postoperative timepoint data being available for analysis. Standard outcomes analysis and vector analysis by the Alpins method were performed. RESULTS During the study period, 128 eyes of 66 consecutive patients were treated. Three-month data were available for 118 eyes (92%), and 10 eyes (8%) were lost to follow-up. The mean attempted spherical equivalent refraction (SEQ) was -4.65 ± 1.91 diopters (D) (range: -1.90 to -10.05 D) and the mean cylinder was -0.98 ± 0.78 D (range: 0.00 to -4.00 D). The mean age was 30 ± 5 years (range: 20 to 43 years), with 54% women and 46% men. Postoperative SEQ was within ±0.50 D in 86% and ±1.00 D in 100% of eyes. Uncorrected distance visual acuity was 20/20 or better in 91% of eyes. One line of CDVA was lost in 8% of eyes, and no eyes lost two or more lines. There was a small but statistically significant increase in contrast sensitivity at 3, 6, 12, and 18 cpd. CONCLUSIONS Early outcomes data for SMILE with the second generation VISUMAX 800 femtosecond laser demonstrated an effective and safe option equivalent to published first generation VisuMax outcomes for the treatment myopia and astigmatism. [J Refract Surg. 2023;39(5):294-301.].
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Lu NJ, Koppen C, Hafezi F, Ní Dhubhghaill S, Aslanides IM, Wang QM, Cui LL, Rozema JJ. Combinations of Scheimpflug tomography, ocular coherence tomography and air-puff tonometry improve the detection of keratoconus. Cont Lens Anterior Eye 2023; 46:101840. [PMID: 37055334 DOI: 10.1016/j.clae.2023.101840] [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: 01/18/2023] [Revised: 03/19/2023] [Accepted: 03/29/2023] [Indexed: 04/15/2023]
Abstract
PURPOSE To determine whether combinations of devices with different measuring principles, supported by artificial intelligence (AI), can improve the diagnosis of keratoconus (KC). METHODS Scheimpflug tomography, spectral-domain optical coherence tomography (SD-OCT), and air-puff tonometry were performed in all eyes. The most relevant machine-derived parameters to diagnose KC were determined using feature selection. The normal and forme fruste KC (FFKC) eyes were divided into training and validation datasets. The selected features from a single device or different combinations of devices were used to develop models based on random forest (RF) or neural networks (NN) trained to distinguish FFKC from normal eyes. The accuracy was determined using receiver operating characteristic (ROC) curves, area under the curve (AUC), sensitivity, and specificity. RESULTS 271 normal eyes, 84 FFKC eyes, 85 early KC eyes, and 159 advanced KC eyes were included. A total of 14 models were built. Air-puff tonometry had the highest AUC for detecting FFKC using a single device (AUC = 0.801). Among all two-device combinations, the highest AUC was accomplished using RF applied to selected features from SD-OCT and air-puff tonometry (AUC = 0.902), followed by the three-device combination with RF (AUC = 0.871) with the best accuracy. CONCLUSION Existing parameters can precisely diagnose early and advanced KC, but their diagnostic ability for FFKC could be optimized. Applying an AI algorithm to a combination of air-puff tonometry with Scheimpflug tomography or SD-OCT could improve FFKC diagnostic ability. The improvement in diagnostic ability by combining three devices is modest.
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Affiliation(s)
- Nan-Ji Lu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; ELZA Institute, Dietikon, Switzerland
| | - Carina Koppen
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Farhad Hafezi
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; ELZA Institute, Dietikon, Switzerland; Laboratory of Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA
| | - Sorcha Ní Dhubhghaill
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
| | - Ioannis M Aslanides
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; Emmetropia Mediterranean Eye Institute, Heraklion, Crete, Greece
| | - Qin-Mei Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Le-Le Cui
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China; State Key Laboratory of Ophthalmology, Optometry and Visual Science, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China.
| | - Jos J Rozema
- Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium
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Loureiro T, Rodrigues-Barros S, Carreira AR, Gouveia-Moraes F, Carreira P, Vide Escada A, Campos P, Machado I, Campos N, Ambrosio R, Archer TJ, Reinstein DZ. Corneal Epithelial Thickness Changes After Topical Treatment of Dry Eye Disease in Primary Sjögren Syndrome. Clin Ophthalmol 2023; 17:993-1005. [PMID: 37035513 PMCID: PMC10075387 DOI: 10.2147/opth.s375505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/11/2022] [Indexed: 04/03/2023] Open
Abstract
Purpose To evaluate the changes on epithelial thickness before and after topical treatment in primary Sjögren syndrome-associated dry eye disease (SS-DED). Methods This was a prospective study that included referred women with SS-DED and healthy age-matched controls. Corneal epithelial thickness was evaluated using high-definition anterior segment optical coherence tomography (Cirrus 5000 HD-OCT) in the baseline first consultation, and four weeks after treatment with preservative free 1mg/1mL sodium hyaluronate. Schirmer test 1 (ST1), tear break-up time (TBUT), tear meniscus height (TMH), SICCA Ocular Surface Score (SICCA OSS) and Ocular Surface Disease Index (OSDI) were evaluated. Statistical significance was defined as p-value <0.05. Results The study included 40 eyes, 20 with SS-DED and 20 controls. At baseline, SS-DED patients had lower ST1 (11.1 ± 2.2mm vs 14.1 ± 3.1mm, p<0.01), faster TBUT (9.1 ± 1.8s vs 13.2 ± 1.1s, p<0.01) and lower TMH (211.2 ± 68.4 µm vs 217.2 ± 60.1µm; p<0.01) than the control group, whereas SICCA OSS and OSDI were higher (p<0.01). The superior epithelium was thinner in SS-DED group (41.1 ± 3.2 µm vs 43.1± 2.3 µm, p<0.01). After treatment, ST1, TBUT, TMH, SICCA OSS, and OSDI improved (p<0.01), and superior epithelium thickened (p<0.01) in the SS-DED group. Conclusion Treatment with sodium hyaluronate improved ST1, TBUT, TMH, SICCA-OSS, and OSDI score. Superior epithelium tends to be thinner in SS-DED but becomes thicker with treatment. Our results seem to illustrate the morphological changes in the corneal epithelium in DED, which could be further recognized as a clinical biomarker of SS-DED.
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Affiliation(s)
- Tomas Loureiro
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
- Correspondence: Tomas Loureiro, Ophthalmology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada, 2805-267, Portugal, Tel +351 913 513 175, Email
| | | | | | | | - Pedro Carreira
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Vide Escada
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Paul Campos
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ines Machado
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Nuno Campos
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Renato Ambrosio
- Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Nobl M, Gerhardt M, Kassumeh S, Mohr N, Mayer W, Dirisamer M, Priglinger S, Luft N. [Steering clear of "corneal red disease"-epithelial thickness mapping for differential diagnosis of corneal ectatic disease]. DIE OPHTHALMOLOGIE 2023; 120:430-436. [PMID: 35925332 DOI: 10.1007/s00347-022-01663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 04/29/2023]
Affiliation(s)
- Matthias Nobl
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Maximilian Gerhardt
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Stefan Kassumeh
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Niklas Mohr
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Wolfgang Mayer
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Martin Dirisamer
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
- Auge-Laser-Chirurgie, Linz, Österreich
| | - Siegfried Priglinger
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
- Auge-Laser-Chirurgie, Linz, Österreich
| | - Nikolaus Luft
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland.
- Auge-Laser-Chirurgie, Linz, Österreich.
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Abstract
PURPOSE To enumerate the various diagnostic modalities used for keratoconus and their evolution over the past century. METHODS A comprehensive literature search including articles on diagnosis on keratoconus were searched on PUBMED and summarized in this review. RESULTS Initially diagnosed in later stages of the disease process through clinical signs and retinoscopy, the initial introduction of corneal topography devices like Placido disc, photokeratoscopy, keratometry and computer-assisted videokeratography helped in the earlier detection of keratoconus. The evolution of corneal tomography, initially with slit scanning devices and later with Scheimpflug imaging, has vastly improved the accuracy and detection of clinical and sub-clinical disease. Analyzing the alteration in corneal biomechanics further contributed to the earlier detection of keratoconus even before the tomographic changes became evident. Anterior segment optical coherence tomography has proven to be a helpful adjuvant in diagnosing keratoconus, especially with epithelial thickness mapping. Confocal microscopy has helped us understand the alterations at a cellular level in keratoconic corneas. CONCLUSION Thus, the collective contribution of the various investigative modalities have greatly enhanced earlier and accurate detection of keratoconus, thus reducing the disease morbidity.
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Affiliation(s)
- Akhil Bevara
- Department of Cornea and Anterior segment, Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
| | - Pravin K Vaddavalli
- Department of Cornea and Anterior segment, Cornea Institute, L V Prasad Eye Institute, Hyderabad, India
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Amatu JB, Baudouin C, Trinh L, Labbé A, Buffault J. [Corneal epithelial biomechanics: Resistance to stress and role in healing and remodeling]. J Fr Ophtalmol 2023; 46:287-299. [PMID: 36759249 DOI: 10.1016/j.jfo.2022.09.026] [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: 09/04/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 02/10/2023]
Abstract
The corneal epithelium is one of the first tissue barriers of the eye against the environment. In recent years, many studies provided better knowledge of its healing, its behavior and its essential role in the optical system of the eye. At the crossroads of basic science and clinical medicine, the study of the mechanical stresses applied to the cornea makes it possible to learn the behavior of epithelial cells and better understand ocular surface disease. We describe herein the current knowledge about the adhesion systems of the corneal epithelium and their resistance to mechanical stress. We will also describe the involvement of these mechanisms in corneal healing and their role in epithelial dynamics. Adhesion molecules of the epithelial cells, especially hemidesmosomes, allow the tissue cohesion required to maintain the integrity of the corneal epithelium against the shearing forces of the eyelids as well as external forces. Their regeneration after a corneal injury is mandatory for the restoration of a healthy epithelium. Mechanotransduction plays a significant role in regulating epithelial cell behavior, and the study of the epithelium's response to mechanical forces helps to better understand the evolution of epithelial profiles after refractive surgery. A better understanding of corneal epithelial biomechanics could also help improve future therapies, particularly in the field of tissue engineering.
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Affiliation(s)
- J-B Amatu
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France.
| | - C Baudouin
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Institut de La Vision, Sorbonne Université, Inserm, CNRS, IHU FOReSIGHT, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - L Trinh
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France
| | - A Labbé
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Institut de La Vision, Sorbonne Université, Inserm, CNRS, IHU FOReSIGHT, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
| | - J Buffault
- Department of Ophthalmology III, CHNO des Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012 Paris, France; Institut de La Vision, Sorbonne Université, Inserm, CNRS, IHU FOReSIGHT, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, University of Versailles Saint-Quentin-en-Yvelines, Boulogne-Billancourt, France
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Asymmetric Intrastromal Corneal Ring Segments with Progressive Base Width and Thickness for Keratoconus: Evaluation of Efficacy and Analysis of Epithelial Remodeling. J Clin Med 2023; 12:jcm12041673. [PMID: 36836208 PMCID: PMC9962479 DOI: 10.3390/jcm12041673] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Purpose: The aim of this study is to describe visual outcomes and epithelial remodeling following the implantation of asymmetric intracorneal ring segments (ICRSs) of variable thickness and base width for the management of duck-type keratoconus. Methods: A prospective observational study of patients with duck-type keratoconus was conducted. All patients received one ICRS AJL PRO + implant (AJL Ophthalmic). We analyzed demographic and clinical data, anterior segment optical coherence tomography (AS-OCT) data and Scheimpflug camera images obtained with a Placido disc MS-39 (CSO, Firenze, Italy) one and six months after surgery to determine keratometric and aberrometric outcomes and epithelial remodeling. Results: We studied 33 keratoconic eyes. ICRS implantation significantly improved both corrected distance visual acuity (CDVA) and uncorrected distance visual acuity at six months, as assessed with the logMAR (minimum angle of resolution) system, from 0.32 ± 0.19 to 0.12 ± 0.12 (p < 0.001) and from 0.75 ± 0.38 to 0.37 ± 0.24 (p < 0.001), respectively. Overall, 87% of implanted eyes gained ≥ 1 line of CDVA, and 3% of patients (n = 1) lost one line of CDVA; 55% of eyes attained a manifest refraction spherical equivalent between +1.50 and -1.50 D. Epithelial remodeling was greater at the wider and thicker end (+11.33 µm ± 12.95; p < 0.001 relative to the initial value) than at the narrower and thinner end (+2.24 µm ± 5.67; p = 0.01). Coma aberration was significantly reduced from 1.62 ± 0.81 µm to 0.99 ± 0.59 µm (p < 0.001). Conclusions: AJL-PRO + ICRS implantation for duck-type keratoconus improves refractive, topographic, aberrometric and visual parameters and induces progressive epithelial thickening along the segment.
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Jaskiewicz K, Maleszka-Kurpiel M, Michalski A, Ploski R, Rydzanicz M, Gajecka M. Non-allergic eye rubbing is a major behavioral risk factor for keratoconus. PLoS One 2023; 18:e0284454. [PMID: 37053215 PMCID: PMC10101517 DOI: 10.1371/journal.pone.0284454] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
Since the environmental, behavioral, and socioeconomic factors in the etiology of keratoconus (KTCN) remain poorly understood, we characterized them as features influencing KTCN phenotype, and especially affecting the corneal epithelium (CE). In this case-control study, 118 KTCN patients and 73 controls were clinically examined and the Questionnaire covering the aforementioned aspects was completed and then statistically elaborated. Selected KTCN-specific findings were correlated with the outcomes of the RNA-seq assessment of the CE samples. Male sex, eye rubbing, time of using a computer after work, and dust in the working environment, were the substantial KTCN risk factors identified in multivariate analysis, with ORs of 8.66, 7.36, 2.35, and 5.25, respectively. Analyses for genes whose expression in the CE was correlated with the eye rubbing manner showed the enrichment in apoptosis (TP53, BCL2L1), chaperon-related (TLN1, CTDSP2, SRPRA), unfolded protein response (NFYA, TLN1, CTDSP2, SRPRA), cell adhesion (TGFBI, PTPN1, PDPK1), and cellular stress (TFDP1, SRPRA, CAPZB) pathways. Genes whose expression was extrapolated to the allergy status didn't contribute to IgE-related or other inflammatory pathways. Presented findings support the hypothesis of chronic mechanical corneal trauma in KTCN. Eye-rubbing causes CE damage and triggers cellular stress which through its influence on cell apoptosis, migration, and adhesion affects the KTCN phenotype.
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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
| | - Andrzej Michalski
- Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, Poznan, Poland
| | - Rafal Ploski
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, 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
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Yücekul B, Dick HB, Taneri S. Systematic detection of keratoconus in OCT: corneal and epithelial thickness maps. J Cataract Refract Surg 2022; 48:1360-1365. [PMID: 35714335 DOI: 10.1097/j.jcrs.0000000000000990] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To detect keratoconus (KC) only by analyzing the corneal and epithelial map parameters and patterns in optical coherence tomography (OCT). SETTING Tertiary care refractive surgery center. DESIGN Retrospective data collection. METHODS Corneal and epithelial thickness maps of normal, manifest, and subclinical keratoconic eyes (according to the Belin-Ambrosio display, Pentacam) were evaluated using spectral-domain OCT (Zeiss Cirrus 5000 HD). A new 2-step decision tree was developed based on previous studies with another OCT device. In the first step, if at least 1 of the 4 independent parameters (pachymetry minimum, pachymetry minimum-median, pachymetry superonasal-inferotemporal, and epithelial superonasal-inferotemporal) overruns the cutoff values, the eye was suspicious for KC. In the second step, if the epithelial map showed concentric thinning and the thinnest point of the cornea and epithelium is coincident, the eye was classified as keratoconic. RESULTS 172 manifest keratoconic eyes (108 patients), 21 subclinical keratoconic eyes (20 patients), and 172 normal eyes (90 age-matched participants) were included in this study. Step 1 captured 100% of manifest and subclinical keratoconic eyes. Step 2 ruled out all suspicious but normal cases and, falsely, 2 subclinical keratoconic eyes. Our 2-step decision tree reached 100% specificity, 100% sensitivity in manifest KC, and 90.4% sensitivity in subclinical KC. CONCLUSIONS Pachymetric and epithelial map parameters and patterns in OCT can be used in the diagnosis of KC, including subclinical cases, yielding a high level of agreement with the commonly used diagnostic reference, the Belin-Ambrosio display. Further improvements by refining our algorithm and including an automated evaluation in the software are desirable.
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Affiliation(s)
- Burcu Yücekul
- From the Department of Ophthalmology, Haseki Training and Research Hospital, Istanbul, Turkey (Yücekul); Ruhr University, Bochum, Germany (Dick, Taneri); Zentrum für Refraktive Chirurgie, Augenzentrum am St. Franziskus Hospital, Muenster, Germany (Taneri)
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Santhiago MR, Stival LR, Araujo DC, Kara-Junior N, Toledo MC. Role of Corneal Epithelial Measurements in Differentiating Eyes with Stable Keratoconus from Eyes that Are Progressing. OPHTHALMOLOGY SCIENCE 2022; 3:100256. [PMID: 36579337 PMCID: PMC9791590 DOI: 10.1016/j.xops.2022.100256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
Purpose To evaluate measures of corneal epithelium in eyes that showed documented signs of keratoconus (KC) progression and compare with stable eyes and healthy controls. Also, to determine the correlation of these epithelial parameters with maximum keratometry (K max) and pachymetry. Design Prospective, observational, comparative study. Participants One-hundred and fifty eyes from 150 patients. The study included 50 eyes from patients with documented KC progression, 50 eyes with stable KC, and 50 clinically normal eyes to serve as controls. Methods A spectral-domain (SD)-OCT imaging was obtained in all eyes, and mean values were compared between the groups. The correlation of epithelial parameters with K max and thinnest pachymetry was also investigated. Main Outcome Measures For the purposes of this study, the epithelial measures maximum, minimum, superior, and inferior values as well as the difference between the minimum and maximum (min-max) and epithelial standard deviation were considered, obtained from SD-OCT and compared between groups. Measurements of the thinnest point and min-max in pachymetry were also recorded. Results The only epithelial parameter that presented a statistically significant difference between stable and progressive KC was epithelium min-max. Although stable KC presented epithelium min-max mean values of -18.2 ± 6.6, progressive KC eyes presented mean values of -23.4 ± 10.3 (P < 0.0001). Epithelial maximum (P = 0.16), minimum (P = 0.25), superior (P = 0.28), inferior (P = 0.23), and standard deviation (P = 0.25) values were not significantly different between stable and progressive eyes. Difference min-max pachymetry points in stable (-108.3 ± 33.5) and progressive KC (-115.2 ± 56.0) were not significantly different (P = 0.723). There was no significant correlation between epithelium min-max with corneal thinning (P = 0.39) or K max (P = 0.09) regardless of disease progression. Conclusions Epithelial measures are useful to identify KC eyes that are progressing; the parameters that measure the difference between min-max epithelium points were significantly different between stable and progressive groups, unlike this difference in pachymetry. Finally, this epithelial parameter seems to be independent of corneal thinning and K max. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Marcony R. Santhiago
- Department of Ophthalmology at University of Sao Paulo, Sao Paulo, Brazil,Correspondence: Marcony R. Santhiago, MD, PhD, Instituto Central. 255 Enéas de Carvalho Aguiar AV.–Ophthalmology Department - Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Larissa R. Stival
- Department of Ophthalmology at University of Sao Paulo, Sao Paulo, Brazil,Department of Ophthalmology, Federal University of Goias, Goiania, Brazil
| | - Daniella C. Araujo
- Department of Computer Science, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Newton Kara-Junior
- Department of Ophthalmology at University of Sao Paulo, Sao Paulo, Brazil
| | - Marcia C. Toledo
- Department of Ophthalmology, Federal University of Goias, Goiania, Brazil
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Levy A, Georgeon C, Knoeri J, Tourabaly M, Leveziel L, Bouheraoua N, Borderie VM. Corneal Epithelial Thickness Mapping in the Diagnosis of Ocular Surface Disorders Involving the Corneal Epithelium: A Comparative Study. Cornea 2022; 41:1353-1361. [PMID: 35349542 PMCID: PMC9555759 DOI: 10.1097/ico.0000000000003012] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/25/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to analyze the role of corneal epithelial thickness (ET) mapping provided by spectral domain optical coherence tomography in the diagnosis of ocular surface disorders (OSDs) involving the corneal epithelium. DESIGN This was a retrospective comparative study. METHODS Institutional settings are as follows. Study population includes 303 eyes with an OSD and 55 normal eyes (controls). Observation procedures include spectral domain optical coherence tomography with epithelial mapping in the central 6 mm. Main outcome measures include ET map classification (normal, doughnut, spoke-wheel, localized/diffuse, and thinning/thickening patterns) and ET data and statistics (minimum, maximum, and SD). A quantitative threshold was determined with receiver operating curves to distinguish pathological from normal corneas. Sensitivity and specificity of classification and quantitative data were calculated using all eyes to assess the ability to distinguish corneas with a given corneal disorder from other conditions. RESULTS Classification of full agreement between 3 readers was obtained in 75.4% to 99.4% of cases. Main OSD features were keratoconus (135 eyes), doughnut pattern (sensitivity/specificity = 56/94%), and max-min ET ≥ 13 μm (84/43%); limbal deficiency (56 eyes), spoke-wheel pattern (66/98%), and max-min ET ≥ 14 μm (91/59%); epithelial basement membrane dystrophy (55 eyes), inferior thickening pattern (55/92%), and central ET > 56 μm (53/81%); dry eye (21 eyes), superior thinning pattern (67/88%), and minimal ET ≤ 44 μm (86/48%); pterygium (10 eyes), nasal thickening pattern (100/86%), and nasal ET > 56 μm (80/71%); and in situ carcinoma (11 eyes), max ET > 60 μm (91/60%), and ET SD >5 μm (100/58%). CONCLUSIONS The epithelial map pattern recognition combined with quantitative analysis of ET is relevant for the diagnosis of OSDs and for distinguishing various OSDs from each other. Deep learning analysis of big data could lead to the fully automated diagnosis of these disorders.
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Affiliation(s)
- Arielle Levy
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Cristina Georgeon
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Juliette Knoeri
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Moïse Tourabaly
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Loïc Leveziel
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Nacim Bouheraoua
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
| | - Vincent M. Borderie
- GRC 32, Transplantation et Thérapies Innovantes de la Cornée, Sorbonne Université, Centre Hospitalier National d'Ophtalmologie des Quinze-Vingts, Paris, France.
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Corneal epithelium in keratoconus underexpresses active NRF2 and a subset of oxidative stress-related genes. PLoS One 2022; 17:e0273807. [PMID: 36240204 PMCID: PMC9565379 DOI: 10.1371/journal.pone.0273807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 08/15/2022] [Indexed: 11/07/2022] Open
Abstract
Keratoconus (KC) is a multifactorial progressive ectatic disorder characterized by local thinning of the cornea, leading to decreased visual acuity due to irregular astigmatism and opacities. Despite the evolution of advanced imaging methods, the exact etiology of KC remains unknown. Our aim was to investigate the involvement of corneal epithelium in the pathophysiology of the disease. Corneal epithelial samples were collected from 23 controls and from 2 cohorts of patients with KC: 22 undergoing corneal crosslinking (early KC) and 6 patients before penetrating keratoplasty (advanced KC). The expression of genes involved in the epidermal terminal differentiation program and of the oxidative stress pathway was assessed by real time PCR analysis. Presence of some of the differentially expressed transcripts was confirmed at protein level using immunofluorescence on controls and advanced KC additional corneal samples. We found statistically significant under-expression in early KC samples of some genes known to be involved in the mechanical resistance of the epidermis (KRT16, KRT14, SPRR1A, SPRR2A, SPRR3, TGM1 and TGM5) and in oxidative stress pathways (NRF2, HMOX1 and HMOX2), as compared to controls. In advanced KC samples, expression of SPRR2A and HMOX1 was reduced. Decreased expression of keratin (KRT)16 and KRT14 proteins was observed. Moreover, differential localization was noted for involucrin, another protein involved in the epidermis mechanical properties. Finally, we observed an immunofluorescence staining for the active form of NRF2 in control epithelia that was reduced in KC epithelia. These results suggest a defect in the mechanical resistance and the oxidative stress defense possibly mediated via the NRF2 pathway in the corneal keratoconic epithelium.
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Loureiro T, Rodrigues-Barros S, Carreira AR, Gouveia-Moraes F, Carreira P, Vide Escada A, Campos P, Machado I, Campos N, Archer TJ, Reinstein DZ, Ambrósio R. Corneal Epithelium Asymmetry in Children With Atopy: The Effect of Hand Dominance. Clin Ophthalmol 2022; 16:2453-2461. [PMID: 35968053 PMCID: PMC9365055 DOI: 10.2147/opth.s375504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate the effect of eye rubbing on the epithelial thickness profile in tomographically normal corneas by AS-OCT and to compare right and left eyes in right-handed children. Methods Thirty right-handed boys (mean age 11.2 years) with ocular allergy and history of eye rubbing were evaluated using Scheimpflug (Pentacam HR, Oculus Wetzlar, Germany) and anterior segment optical coherence tomography. Epithelial thickness (ET) and full corneal thickness (CT) parameters were compared between right and left eyes with a non-parametric Mann–Whitney test. A p-value lower than 0.05 was considered for statistical significance. Results No eyes had topometric nor tomographic criteria for keratoconus. The min-max ET was lower in right eyes (−2.8 µm vs −3.5; p = 0.02). The difference between inferior and superior (I-S) octants was lower in right eyes (1.1 µm vs 1.9 µm; p = 0.03) as a result of inferotemporal thinning. The highest ET difference was registered between nasal and temporal octants and was more pronounced in the right eyes (2 µm vs 3.1 µm; p < 0.001). Conclusion AS-OCT analyses reveal different epithelial thickness patterns between the eyes in young atopic patients, likely eye rubbers. Inferior and temporal epithelial thickness seem to be more affected by thinning in the eye on the side of the dominant hand.
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Affiliation(s)
- Tomás Loureiro
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
- Correspondence: Tomás Loureiro, Ophthalmology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada, 2805-267, Portugal, Tel +35 1 913 513 175, Email
| | | | | | | | - Pedro Carreira
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Vide Escada
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Paul Campos
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Inês Machado
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Nuno Campos
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | | | - Renato Ambrósio
- Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Zhou W, Reinstein DZ, Archer TJ, Nitter T, Feng Y, Mule G, Stojanovic A. The Impact of Epithelial Remodeling on Surgical Techniques Used in Topography-guided Surface Ablation in Irregular Corneas. J Refract Surg 2022; 38:529-537. [PMID: 35947001 DOI: 10.3928/1081597x-20220711-02] [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: 11/20/2022]
Abstract
PURPOSE To analyze the optical consequences of epithelial remodeling in irregular corneas and their impact on the choice of different surface ablation techniques. METHODS Anterior corneal and stromal surface topographies and epithelial thickness maps were analyzed in 24 eyes with irregular corneal optics. On two of the eyes, four different surface ablation techniques were simulated: (1) conventional anterior topography-guided photorefractive keratectomy (PRK), (2) transepithelial phototherapeutic keratectomy (PTK), (3) transepithelial anterior topography-guided PRK, and (4) stromal topography-guided PRK. RESULTS Stromal surface topographies showed higher keratometric values, astigmatism, asphericity, and corneal higher order aberrations compared to topographies of anterior corneas covered by epithelium. Transepithelial anterior topography-guided PRK and stromal topography-guided PRK both resulted in regularized stromal surface, transepithelial PTK achieved partial regularization corresponding to the smoothing effect of the epithelial remodeling, and conventional anterior topography-guided PRK delivered after epithelial removal resulted in residual stromal surface irregularities. CONCLUSIONS The difference in optical landscapes between the stromal and anterior surfaces in irregular corneas will represent a source of error when anterior topography-guided treatments are delivered on the deepithelialized stroma, as in conventional PRK. In contrast, anterior topography-guided ablations performed as transepithelial PRK and stromal topography-guided PRK delivered after epithelial removal address the full stromal irregularity, whereas transepithelial PTK alone may be used when topography-guided treatments are not possible. The authors conclude topography-guided PRK of irregular corneas should lead to significantly improved regularization only if it includes the effect of epithelial remodeling. [J Refract Surg. 2022;38(8):529-537.].
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Alghamdi A, Khan MS, Dakhil TA. Understanding Corneal Epithelial Thickness Mapping. Middle East Afr J Ophthalmol 2022; 29:147-155. [PMID: 37408717 PMCID: PMC10319081 DOI: 10.4103/meajo.meajo_207_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/31/2022] [Accepted: 03/06/2023] [Indexed: 07/07/2023] Open
Abstract
Corneal epithelial thickness (CET) and the regional variations in response to changes in corneal architecture and biomechanics have recently drawn the interest of corneal surgeons. Corneal epithelium possesses the tremendous capability of remodeling and changing its thickness. This remodeling of corneal epithelium takes place in response to underlying stromal irregularities which can result from a variety of corneal disorders including corneal ectasia. Measurement of CET can reveal the underlying stromal abnormalities and supplement in early diagnosis of corneal disorders especially corneal ectasia which has been one of the leading challenges in planning corneal refractive surgery. A significant number of patients ends up in ectasia after refractive surgery and the most common cause of this complication is the presence of preoperative subclinical keratoconus. Furthermore, postoperative complications of corneal refractive surgery are partly masked by epithelial remodeling and make the diagnosis and management difficult and extremely challenging. This leads not only to unpredictable visual and refractive outcome but also the need of multiple interventions to treat these complications. Although corneal tomography is considered as gold standard in the detection and diagnosis of corneal ectasia, a small number of subclinical cases may still go undetected. In this review, we have highlighted the underlying mechanism of epithelial remodeling, the devices and imaging modalities used to measure CET, and application of epithelial mapping in the diagnosis and management of various corneal disorders.
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Affiliation(s)
- Abdullah Alghamdi
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Muhammad S. Khan
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Turki A. Dakhil
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Reinstein DZ, Archer TJ, Vida RS. Epithelial thickness mapping for corneal refractive surgery. Curr Opin Ophthalmol 2022; 33:258-268. [PMID: 35779050 DOI: 10.1097/icu.0000000000000867] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW As more devices become available that offer corneal epithelial thickness mapping, this is becoming more widely used for numerous applications in corneal refractive surgery. RECENT FINDINGS The epithelial thickness profile is nonuniform in the normal eye, being thinner superiorly than inferiorly and thinner temporally than nasally. Changes in the epithelial thickness profile are highly predictable, responding to compensate for changes in the stromal curvature gradient, using the eyelid as an outer template. This leads to characteristic changes that can be used for early screening in keratoconus, postoperative monitoring for early signs of corneal ectasia, and for determining whether further steepening can be performed without the risk of apical syndrome following primary hyperopic treatment. Compensatory epithelial thickness changes are also a critical part of diagnosis in irregular astigmatism as these partially mask the stromal surface irregularities. The epithelial thickness map can then be used to plan a trans-epithelial PRK treatment for cases of irregularly irregular astigmatism. Other factors can also affect the epithelial thickness profile, including dry eye, anterior basement membrane dystrophy and eyelid ptosis. SUMMARY Epithelial thickness mapping is becoming a crucial tool for refractive surgery, in particular for keratoconus screening, ectasia monitoring, hyperopic treatment planning, and therapeutic diagnosis and treatment.
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Affiliation(s)
- Dan Z Reinstein
- Reinstein Vision
- London Vision Clinic, London, UK
- Department of Ophthalmology, Columbia University Medical Center, New York, USA
- Sorbonne Université, Paris, France
- School of Biomedical Sciences, University of Ulster, Coleraine, UK
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Achiron A, El-Hadad O, Leadbetter D, Hecht I, Hamiel U, Avadhanam V, Tole D, Darcy K. Progression of Pediatric Keratoconus After Corneal Cross-Linking: A Systematic Review and Pooled Analysis. Cornea 2022; 41:874-878. [PMID: 34294638 DOI: 10.1097/ico.0000000000002808] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 05/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Corneal collagen cross-linking (CXL) is an effective treatment to slow down keratoconus (KC) progression in adults. Several studies have also shown efficacious outcomes in pediatric populations, yet no systematic analysis has been performed and no accepted definition for progression is available in children after CXL. This study aimed to establish the most commonly used criteria for progression and to conduct a systematic review of the literature with pooled analysis to assess children's keratoconus progression after CXL. METHODS A systemic literature review combined with pooled analysis was performed on full-length studies of KC after CXL treatment in a pediatric population and the methods used to report progression were analyzed. RESULTS Thirty-seven studies (2078 eyes) were identified on the rates of KC progression after CXL. The most common method to report progression was increased Kmax, Kmean, or Ksteep by ≥1.0 diopter (78.3% of studies). Using these criteria, the mean pooled progression rate after epithelium-off CXL was 9.9% (95% confidence interval: 6.1% -14.6%, total pooled sample size: 1508 eyes) with high heterogeneity between studies [I 2 = 86.48% (95% confidence interval: 80.98 - 90.39), P < 0.0001]. CONCLUSIONS When considering KC progression after CXL in children, with an increase in Kmax, Kmean, or Ksteep ≥ 1.0 diopter, the progression risk was roughly 10%. We encourage clear quantitative reporting of KC progression in future studies evaluating CXL efficacy in pediatric populations.
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Affiliation(s)
- Asaf Achiron
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omar El-Hadad
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
- Faculty of Medicine, Alexandria University, Egypt
| | - Duncan Leadbetter
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Idan Hecht
- Department of Ophthalmology, Shamir Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; and
| | - Uri Hamiel
- Genetics Institute, Tel Aviv Sourasky Medical Center & Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Venkata Avadhanam
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Derek Tole
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Kieren Darcy
- Bristol Eye Hospital, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
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Toprak I, Kilic D. Current clinical approach to pediatric keratoconus patients. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2085557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Ibrahim Toprak
- Faculty of Medicine, Department of Ophthalmology, Pamukkale University, Denizli, Turkey
| | - Deniz Kilic
- Department of Ophthalmology, Kayseri City Training and Research Hospital, Health Science University, Kayseri, Turkey
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Lu NJ, Elsheikh A, Rozema JJ, Hafezi N, Aslanides IM, Hillen M, Eckert D, Funck C, Koppen C, Cui LL, Hafezi F. Combining Spectral-Domain OCT and Air-Puff Tonometry Analysis to Diagnose Keratoconus. J Refract Surg 2022; 38:374-380. [PMID: 35686708 DOI: 10.3928/1081597x-20220414-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the diagnostic capacity of spectral-domain optical coherence tomography (SD-OCT) combined with air-puff tonometry using artificial intelligence (AI) in differentiating between normal and keratoconic eyes. METHODS Patients who had either undergone uneventful laser vision correction with at least 3 years of stable follow-up or those who had forme fruste keratoconus (FFKC), early keratoconus (EKC), or advanced keratoconus (AKC) were included. SD-OCT and biomechanical information from air-puff tonometry was divided into training and validation sets. AI models based on random forest or neural networks were trained to distinguish eyes with FFKC from normal eyes. Model accuracy was independently tested in eyes with FFKC and normal eyes. Receiver operating characteristic (ROC) curves were generated to determine area under the curve (AUC), sensitivity, and specificity values. RESULTS A total of 223 normal eyes from 223 patients, 69 FFKC eyes from 69 patients, 72 EKC eyes from 72 patients, and 258 AKC eyes from 258 patients were included. The top AUC ROC values (normal eyes compared with AKC and EKC) were Pentacam Random Forest Index (AUC = 0.985 and 0.958), Tomographic and Biomechanical Index (AUC = 0.983 and 0.925), and Belin-Ambrósio Enhanced Ectasia Total Deviation Index (AUC = 0.981 and 0.922). When SD-OCT and air-puff tonometry data were combined, the random forest AI model provided the highest accuracy with 99% AUC for FFKC (75% sensitivity; 94.74% specificity). CONCLUSIONS Currently, AI parameters accurately diagnose AKC and EKC, but have a limited ability to diagnose FFKC. AI-assisted diagnostic technology that uses both SD-OCT and air-puff tonometry may overcome this limitation, leading to improved treatment of patients with keratoconus. [J Refract Surg. 2022;38(6):374-380.].
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Feng Y, Reinstein DZ, Nitter T, Archer TJ, McAlinden C, Chen X, Bertelsen G, Utheim TP, Stojanovic A. Heidelberg Anterion Swept-Source OCT Corneal Epithelial Thickness Mapping: Repeatability and Agreement With Optovue Avanti. J Refract Surg 2022; 38:356-363. [PMID: 35686707 DOI: 10.3928/1081597x-20220414-01] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE To assess the repeatability of corneal epithelial thickness mapping in virgin, post-laser refractive surgery (PLRS), and keratoconic eyes using a novel swept-source optical coherence tomographer (SS-OCT), and to determine the agreement of the measurements with a validated spectral-domain (SD) OCT. METHODS Analysis of 90 virgin, 46 PLRS, and 122 keratoconic eyes was performed. Three consecutive measurements of each eye were acquired with the Anterion SS-OCT and Avanti SD-OCT devices, and averages of the epithelial thickness mapping were calculated in the central 2-mm zone and in the 2- to 5-mm and 5- to 7-mm diameter rings. The repeatability was analyzed using pooled within-subject standard deviation (Sw). The agreement was assessed by Bland-Altman analysis and paired t tests. RESULTS The repeatability ranges of the Anterion and Avanti epithelial thickness mapping measurements were Sw: 0.60 to 1.36 µm and Sw: 0.75 to 1.96 µm, respectively. The 95% limits of agreement of the Anterion and Avanti were 0.826 to 8.297. All values of the thickness measurements with the Anterion were lower than those of the Avanti, with the mean differences being 4.06 ± 1.81, 3.26 ± 2.52, and 3.68 ± 2.51 µm in virgin, PLRS, and keratoconic eyes, respectively (P < .001 for all). CONCLUSIONS The repeatability of the Anterion's epithelial thickness mapping was higher than that of the Avanti. In terms of the agreement between the Anterion and Avanti, the epithelium measured by the Anterion was always thinner than that of the Avanti, making their interchangeable use unsuitable without corrections. [J Refract Surg. 2022;38(6):356-363.].
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Reinstein DZ, Archer TJ, Vida RS, Carp GI, Reinstein JFR, McChesney T, Potter JG. Small Incision Lenticule Extraction (SMILE) for the Correction of High Myopia With Astigmatism. J Refract Surg 2022; 38:262-271. [PMID: 35536712 DOI: 10.3928/1081597x-20220314-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the outcomes of small incision lenticule extraction (SMILE) for high myopia between -9.00 and -14.00 diopters (D). METHODS This was a prospective study of SMILE for high myopia using the VisuMax femtosecond laser (Carl Zeiss Meditec). Inclusion criteria were attempted spherical equivalent refraction (SEQ) between -9.00 and -14.00 D, cylinder up to 7.00 D, corrected distance visual acuity (CDVA) of 20/40 or better, age 21 years or older, and suitable for SMILE. The sub-lenticule thickness was 220 µm or greater, and the total uncut stromal thickness was 300 µm or greater. Patients were to be followed up for 1 year. Standard outcomes analysis was performed using 12-month data where available or 3-month data otherwise. RESULTS Of 187 eyes treated, data were available at 12 months for 181 eyes (96.8%) and 3 months for 4 eyes (2.1%), and 2 eyes (1.1%) were lost to follow-up. Mean attempted SEQ was -10.55 ± 1.00 D (range: -9.00 to -12.99 D). Mean cylinder was -1.19 ± 0.83 D (range: 0.00 to -4.00 D). Preoperative CDVA was 20/20 or better in 73% of eyes. Postoperative uncorrected distance visual acuity was 20/20 or better in 57% and 20/25 or better in 82% of eyes. Mean SEQ relative to target was -0.22 ± 0.48 D (range: -1.63 to +1.38 D), 66% ± 0.50 D and 93% ±1.00 D. Mean SEQ 12-month change was -0.08 ± 0.34 D (range: -1.75 to +0.88 D). There was loss of one line of CDVA in 4% of eyes, and no eyes lost two or more lines. Contrast sensitivity was unchanged. Patient satisfaction was 8 or more out of 10 in 94% and 6 or more in 99% of patients. CONCLUSIONS Outcomes of SMILE for myopia greater than -9.00 D at 3 to 12 months showed excellent efficacy, safety, stability, and predictability, with high patient satisfaction. [J Refract Surg. 2022;38(5):262-271.].
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Lahme L, Storp JJ, Diener R, Eter N, Hansen U, Leclaire MD, Alnawaiseh M. [Corneal epithelial thickness in keratoconus patients compared to healthy controls]. Ophthalmologe 2022; 119:952-957. [PMID: 35362757 DOI: 10.1007/s00347-022-01606-6] [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: 11/25/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND In keratoconus (KC) a progressive deformation and thinning of the cornea occurs. In contrast to Scheimpflug-based examinations, optical coherence tomography (OCT) can precisely measure the corneal layers separately, allowing separate analyses of corneal epithelial and corneal stromal thicknesses. AIM OF THIS WORK The aim of this work was to analyze the corneal epithelial thickness measured by optical coherence tomography (OCT) in patients with KC in comparison to the corneal epithelial thickness in healthy subjects. The diagnostic value of the observed changes was evaluated. MATERIAL AND METHODS In a retrospective analysis 125 eyes of patients with KC and 140 eyes of healthy subjects were included. Corneal measurements were performed by OCT (Optovue, XR-Avanti, Fremont, CA, USA). Corneal stromal thicknesses and corneal epithelial thicknesses in different locations were measured and analyzed. RESULTS There were significant differences in stromal and epithelial thickness measurements. Of the derived epithelial thickness parameters four showed a good discriminatory power between healthy controls and KC patients (area under the curve in the receiver operating characteristic analysis > 0.7). CONCLUSION Patients with KC showed an altered epithelial thickness compared to healthy controls. The derived calculated parameters based on corneal epithelial thickness can distinguish between KC and a healthy cornea.
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Affiliation(s)
- Larissa Lahme
- Universitäts-Augenklinik Münster, Domagkstr. 15, 48149, Münster, Deutschland.
| | - Jens Julian Storp
- Universitäts-Augenklinik Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Raphael Diener
- Universitäts-Augenklinik Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Nicole Eter
- Universitäts-Augenklinik Münster, Domagkstr. 15, 48149, Münster, Deutschland
| | - Uwe Hansen
- Universitäts-Augenklinik Münster, Domagkstr. 15, 48149, Münster, Deutschland
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Avetisov SE, Gridin VN, Bubnova IA, Lebedev AS, Novikov IA. [Prospects for early detection of keratoconus based on systems built for computer-assisted diagnostics of structural changes in the cornea]. Vestn Oftalmol 2022; 138:100-106. [PMID: 35234428 DOI: 10.17116/oftalma2022138011100] [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: 11/17/2022]
Abstract
The article is devoted to the problem of diagnosing subclinical keratoconus (KK). The need to identify early signs of KK is primarily associated with the potential for the development of iatrogenic keratoectasia in cases of underdiagnosis of the disease when determining the conditions for laser keratorefractive surgery involving a decrease in the thickness of the cornea. Today generally accepted algorithms for early computer-assisted diagnosis of KK are mainly based on the analysis of various morphometric parameters of the cornea, reflecting changes in its shape and thickness induced by structural abnormalities. Direct detection of structural changes in the cornea characteristic of early KK requires the use of high-tech imaging methods that are not always applicable in everyday clinical practice. The promising approach proposed in this study is based on the fact that a digital image of a corneal «slice» obtained using serial analyzers such as the Scheimpflug camera widely used in clinical practice provides indirect information about the structure of the epithelial layer, the local thickening of which takes place in the initial stages KK. It is this criterion that underlies the proposed system of computer-assisted diagnosis of KK. The carried out studies have shown the high sensitivity of this algorithm, and its specificity can be increased by involving the known diagnostic indicators of KK.
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Affiliation(s)
- S E Avetisov
- Research Institute of Eye Diseases, Moscow, Russia.,I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - V N Gridin
- Center of Information Technologies in Design Russian Academy of Sciences, Odintsovo, Russia
| | - I A Bubnova
- Research Institute of Eye Diseases, Moscow, Russia.,Center of Information Technologies in Design Russian Academy of Sciences, Odintsovo, Russia
| | - A S Lebedev
- Center of Information Technologies in Design Russian Academy of Sciences, Odintsovo, Russia
| | - I A Novikov
- Research Institute of Eye Diseases, Moscow, Russia.,Center of Information Technologies in Design Russian Academy of Sciences, Odintsovo, Russia
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