51
|
Aksoy Aydemir G, Ozkoyuncu Kocabas D, Aydemir E, Bayat AH, Cınar SS, Karadağ AS. Alterations in the choroidal thickness and retinal vascular caliber in keratoconus. Int Ophthalmol 2023; 43:95-103. [PMID: 35773524 DOI: 10.1007/s10792-022-02391-6] [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: 02/24/2022] [Accepted: 06/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To compare the choroidal thickness (CT) and retinal vascular caliber in the differentiation of patients who have keratoconus (KC) from those of astigmatic and normal patients. METHODS This was a prospective, cross-sectional study. A total of 72 patients who had KC, 70 who had astigmatism, and 83 healthy control subjects were enrolled in this study. All the patients were examined using the Sirius topography system and spectral domain optical coherence tomography with enhanced depth imaging. Using the digital fundus photographs, the retinal vascular calibers were calculated. The measurements were also analyzed between the KC stages according to the Amsler-Krumeich classification. RESULTS The CT measurements were significantly higher in the KC group, when compared with the other 2 groups, in each location (P < 0.05). No statistically significant difference was observed with regards to the central retinal artery equivalent (CRAE) values (P = 0.959), while significant differences were noted in the central retinal vein equivalent (CRVE) among the groups (P = 0.011). Significant increases were noted in the CT as the stage of KC progressed, except at temporal 3000 µm (P = 0.603). No statistically significant difference was observed with regards to the CRAE among the stages (P = 0.901). However, the CRVE changes increased remarkably as the stages advanced (P < 0.001). CONCLUSION The patients who had KC seemed to have a thicker CT and higher CRVE values than the healthy individuals, and these differences were progressively increased as the stages of KC advanced. Reflecting the vascular effects of inflammation, the high CRVE supported theories based on the inflammatory component of KC.
Collapse
Affiliation(s)
- Gözde Aksoy Aydemir
- Ophthalmology Department, Adıyaman University Training and Research Hospital, 02100, Adıyaman, Turkey.
| | | | - Emre Aydemir
- Ophthalmology Department, Adıyaman University Training and Research Hospital, 02100, Adıyaman, Turkey
| | - Alper Halil Bayat
- Ophthalmology Department, Bahcesehir University Medical Park Goztepe Hospital, Istanbul, Turkey
| | - Serife Sule Cınar
- Ophthalmology Department, Agrı Training and Research Hospital, Agrı, Turkey
| | - Ayse Sevgi Karadağ
- Ophthalmology Department, Adıyaman University Training and Research Hospital, 02100, Adıyaman, Turkey
| |
Collapse
|
52
|
Lasagni Vitar RM, Fonteyne P, Knutsson KA, Bertuzzi F, Galli L, Rama P, Ferrari G. Vitamin D Supplementation Impacts Systemic Biomarkers of Collagen Degradation and Copper Metabolism in Patients With Keratoconus. Transl Vis Sci Technol 2022; 11:16. [PMID: 36580321 PMCID: PMC9804020 DOI: 10.1167/tvst.11.12.16] [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] [Indexed: 12/30/2022] Open
Abstract
Purpose To evaluate the impact of vitamin D (Vit D) supplementation on systemic biomarkers of collagen degradation, inflammation, oxidative stress, and copper metabolism in adolescent patients with keratoconus (KC). Methods This was a prospective observational pilot study. Twenty patients (age range, 16-19 years) presenting KC and Vit D insufficiency (<30 ng/mL) were included. Vit D supplementation was prescribed by their general practitioner as per the standard of care. Patients were followed up for 12 months. At each visit, best spectacle-corrected visual acuity (BSCVA), maximal keratometry (Kmax), and thinnest corneal thickness (TCT) were evaluated. The primary outcome of the study was the proportion of patients with Kmax progression of less than 1 D throughout the 12-month follow-up time. Blood samples were collected at different time points to evaluate Vit D levels and systemic markers of collagen degradation, inflammation, oxidative stress, and copper metabolism by ELISA or RT-PCR. Results Lower Vit D levels in the plasma were correlated with higher levels of systemic biomarkers of collagen degradation. Vit D supplementation increased the cell availability of copper. Moreover, stabilization of KC progression was found in 60% of patients (72% of eyes) after 12 months with Vit D supplementation. BSCVA, Kmax, and TCT rates remained stable during the observation period. Conclusions Our findings support that Vit D administration could affect ocular and systemic biomarkers in KC and illuminate a possible mechanism that can be used to develop new treatment alternatives. Translational Relevance Although KC therapy currently relies exclusively on surgical procedures, Vit D supplementation may offer a non-invasive and inexpensive alternative with minimal associated side effects.
Collapse
Affiliation(s)
- Romina Mayra Lasagni Vitar
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Philippe Fonteyne
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Karl Anders Knutsson
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Bertuzzi
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Rama
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Ferrari
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| |
Collapse
|
53
|
Lombardo G, Bernava GM, Serrao S, Lombardo M. Theranostic-guided corneal cross-linking: Preclinical evidence on a new treatment paradigm for keratoconus. JOURNAL OF BIOPHOTONICS 2022; 15:e202200218. [PMID: 36059083 DOI: 10.1002/jbio.202200218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
Theranostics is an emerging therapeutic paradigm of personalized medicine; the term refers to the simultaneous integration of therapy and diagnostics. In this work, theranostic-guided corneal cross-linking was performed on 10 human sclero-corneal tissues. The samples were soaked with 0.22% riboflavin formulation and underwent 9 minutes UV-A irradiance at 10 mW/cm2 using theranostic device, which provided both a measure of corneal riboflavin concentration and a theranostic score estimating treatment efficacy in real time. A three-element viscoelastic model was developed to fit the deformation response of the cornea to air-puff excitation of dynamic tonometry and to calculate the mean corneal stiffness parameter before and after treatment. Significant correlation was found between the theranostic score and the increase in mean corneal stiffness (R = 0.80; P < .001). Accuracy and precision of the theranostic score in predicting the induced corneal tissue stiffening were both 90%. The riboflavin concentration prior to starting the UV-A photo-therapy phase was the most important variable to allow corneal cross-linking to be effective. Theranostic UV-A light mediated imaging and therapy enables the operator to adopt a precise approach for achieving highly predictable biomechanical strengthening on individual corneas.
Collapse
Affiliation(s)
- Giuseppe Lombardo
- CNR-IPCF, Istituto per i Processi Chimico-Fisici, Viale F, Messina, Italy
- Vision Engineering Italy srl, Rome, Italy
| | | | | | - Marco Lombardo
- Vision Engineering Italy srl, Rome, Italy
- Studio Italiano di Oftalmologia, Rome, Italy
| |
Collapse
|
54
|
Dogan B, Bozdogan YC, Gedik B, Erol MK, Bulut M, Duman F. Optic disc and retinal vessel densities assessment by optical coherence tomography angiography in patients with keratoconus. Photodiagnosis Photodyn Ther 2022; 41:103218. [PMID: 36462703 DOI: 10.1016/j.pdpdt.2022.103218] [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: 08/26/2022] [Revised: 11/13/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND This study aimed to evaluate retinal and optic disc vascular changes in patients with keratoconus (KC) using optical coherence tomography angiography (OCTA). METHODS Thirty-two eyes of 22 patients with KC and 24 eyes of 24 age- and sex-matched healthy controls were included in this study. Corneal topography and OCTA were performed. Quantitative vessel density of the macular superficial capillary plexus (SCP), macular deep capillary plexus (DCP), and radial peripapillary capillaries (RPC); choriocapillaris flow area; and choroidal thickness were compared between the KC and control groups. RESULTS SCP and DCP vessel densities showed a significant reduction in the KC group compared to that in the control group (p < 0.001 and p < 0.001 in the whole image and parafovea, respectively). Choriocapillaris flow area was significantly higher in patients with KC than in the control group (p = 0.003). The foveal avascular zone area did not significantly differ between the two groups (p = 0.949). RPC inside disc vessel density was significantly decreased in the KC group compared to that in the control group (p < 0.001). CONCLUSION This study revealed important macular, choroidal, and optic disc vessel densities changes in patients with KC. Macular whole vessel density and parafoveal vessel density of the SCP and DCP decreased, while choriocapillaris flow area increased in patients with KC.
Collapse
Affiliation(s)
- Berna Dogan
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey.
| | - Yigit Caglar Bozdogan
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Birumut Gedik
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Muhammet Kazim Erol
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Mehmet Bulut
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Fulya Duman
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| |
Collapse
|
55
|
McMonnies CW. Mechanisms of corneal trauma in response to rubbing and other intraocular pressure elevating activities in keratoconus. EXPERT REVIEW OF OPHTHALMOLOGY 2022. [DOI: 10.1080/17469899.2022.2153119] [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: 11/29/2022]
Affiliation(s)
- Charles W McMonnies
- Faculty of Medicine and Health, School of Optometry and Vision Science, University of New South Wales
| |
Collapse
|
56
|
Niazi S, Moshirfar M, Alizadeh F, Doroodgar F, Baradaran-Rafii A, Filutowski O, Niazi F, Ambrósio R. Association of 2 Lysyl Oxidase Gene Single Nucleotide Polymorphisms with Keratoconus: A Nationwide Registration Study. OPHTHALMOLOGY SCIENCE 2022; 3:100247. [PMID: 36748061 PMCID: PMC9898806 DOI: 10.1016/j.xops.2022.100247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/10/2022]
Abstract
Purpose Keratoconus (KC) is the most common primary ectatic corneal disease, characterized by progressive thinning of the cornea, affecting its shape and structure and leading to visual loss. Lysyl oxidase is an important component of the extracellular matrix and contributes to the homeostasis of corneal stromal extracellular matrix via enzymatic reaction. This nationwide registration study aims to examine the association of KC with 2 known single nucleotide polymorphisms, rs2956540 and rs10519694, in a population of Iranian descent. Design Case-control. Participants One hundred seventy-eight subjects with KC and 180 clinically healthy subjects participated in the study. Methods Genomic DNA was extracted from peripheral blood samples, and their genotypes were determined using tetra-primer amplification refractory mutation system-polymerase chain reaction. Main Outcome Measures Allele frequency for rs2956540 and rs10519694. Results Genotype frequency was significantly different between cases and controls for rs2956540 (P value = 0.019). The rs2956540 C allele carriers were significantly more frequent among KC cases than healthy controls (P valuechi-square = 0.015, P valueFisher exact = 0.017). There was a significant difference in genotype frequency between groups for rs10519694 (P value = 0.001). T allele carriers were significantly more frequent among KC patients (P valuechi-square = 0.002, P valueFisher exact = 0.001). Sex stratification revealed no significant differences in genotype frequency between males and females in cases and controls. Fitting the general linear model showed that rs10519694 could be considered a predictor for the development of KC (P value = 0.001); however, this was not observed for rs2956540 (P value = 0.323). Conclusions rs2956540 and rs10519694 are associated with KC in a population of Iranian descent. rs10519694 could potentially be used for KC risk prediction.
Collapse
Affiliation(s)
- Sana Niazi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah
| | - Fatemeh Alizadeh
- Department of Genomic Psychiatry and Behavioral Genomics (DGPBG), Roozbeh Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran,Negah Specialty Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Correspondence: Farideh Doroodgar, MD; Address: Negah Specialty Ophthalmic Hospital and Research Center, No 3., Ketabi St., Shariati Ave., Tehran, Iran; Postal Code: 1544914599
| | - Alireza Baradaran-Rafii
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran,Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Oliver Filutowski
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | - Feizollah Niazi
- Clinical Research Development Center, Shahid Modarres Educational hospital, Shahid Behesht University of Medical Sciences, Tehran, Iran
| | - Renato Ambrósio
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), São Paulo, Brazil,Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil,Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil,Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil,BrAIN: Brazilian Artificial Intelligence Networking in Medicine, Rio de Janeiro & Maceió, Brazil
| |
Collapse
|
57
|
Muacevic A, Adler JR, Alshareef EK, Alkayyal AA, Alharbi JO, Alharbi AH. Awareness About Keratoconus and Its Relation With Eye Rubbing: A Cross-Sectional Study in Medina. Cureus 2022; 14:e32030. [PMID: 36600839 PMCID: PMC9800344 DOI: 10.7759/cureus.32030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Keratoconus is a non-inflammatory, bilateral, asymmetrical progressive disorder characterized by ectasia, thinning, and increased curvature of the cornea, as well as loss of visual acuity. Eye rubbing is considered the most common risk factor for keratoconus. OBJECTIVES This study aims to assess the awareness of the population in Medina about keratoconus and its relation to eye rubbing. METHODS This is a cross-sectional study involving 767 participants via an online pre-designed questionnaire from November 2021 to January 2022, in Medina, Saudi Arabia. Results: Among the study participants, 94.1% have a lack of awareness about keratoconus and its relation to eye rubbing. Participants who have a visual disturbance and positive family history of keratoconus were found to have good awareness levels. Those who heard about keratoconus represent 39.8% of the participants, and relatives with keratoconus were the most common source of their information. An allergic reaction was reported by 34.9% of the participants, and 7.7% have a family history of keratoconus. Only 27.8% believe in the relationship between keratoconus and allergy, and 61.9% have no idea about the treatment. For eye rubbing, 28.9% of participants believe it can lead to keratoconus; also, 80.4% reported rubbing their eyes, and itching was the most common cause of their behavior. CONCLUSION The majority of the participants have a lack of awareness about keratoconus and its relation to eye rubbing. Health education programs for the population should be conducted to enhance public awareness about keratoconus.
Collapse
|
58
|
Hefley BS, Deighan C, Vasini B, Khan A, Hjortdal J, Riaz KM, Liu Y, Karamichos D. Revealing the presence of tear extracellular vesicles in Keratoconus. Exp Eye Res 2022; 224:109242. [PMID: 36084727 PMCID: PMC10159047 DOI: 10.1016/j.exer.2022.109242] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/22/2022] [Accepted: 08/30/2022] [Indexed: 11/19/2022]
Abstract
Extracellular vesicles (EVs) are lipid-bound vesicles that originate from the endosomal system or budded off from the plasma membrane. EVs are involved in cell-cell communication via transporting DNA, RNA, and proteins from one cell to another. Tear EVs (tEVs) have been reported in dry eye, Sjӧgren's Syndrome, and primary open-angle glaucoma. In this study, we sought to investigate the presence of tEVs in relation to keratoconus (KC). Tears were passively collected from the lateral meniscus from 10 healthy (5 males and 5 females) and 9 KC (4 males and 5 females) subjects. Tear samples were processed and analyzed using the ExoView™ R100. Statistical analysis was performed using a Mann-Whitney U non-parametric Student's t-test. All tEVs, in both Healthy and KC subjects, showed a CD9+ dominant tEV cohort independent of sex. A significant decrease in CD63+/CD9+ and CD63+/CD81+/CD9+ was found in the male KC tEVs (p < 0.05), but not in females compared to their healthy counterparts. Neither Healthy nor KC tEVs showed differences in the total number of tEVs, however significant differences were identified between the sexes (p < 0.05), with males having a higher number of tEVs. tEVs diameters ranged from 50 to 200 nm, in both Healthy and KC cohorts, with the majority in the 50-80 nm range suggesting exosome-dominant cohorts. To our knowledge, this is the first time, to date, that tEVs have been isolated and characterized in KCs. While further studies are warranted, the tEVs differences between KC and Healthy subjects suggest a potential role for tEVs in KC pathogenesis.
Collapse
Affiliation(s)
- Brenna S Hefley
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | | | - Brenda Vasini
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA
| | - Asher Khan
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 167, 8200, Aarhus N, Denmark
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Yutao Liu
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA; James & Jean Culver Vision Discovery Institute, Augusta University, Augusta, GA, USA; Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, GA, USA
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, College of Pharmacy, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| |
Collapse
|
59
|
Khashim Alswailmi F, Bokhari K, Aladaileh SH, Ali Alanezi A, Azam M, Ahmad A. Protective and pathogenic role of Collagen subtypes genes (COL3A3 and COL4A3) polymorphisms in the onset of Keratoconus in South-Asian (Pakistani) Cohort. Saudi J Biol Sci 2022; 30:103503. [DOI: 10.1016/j.sjbs.2022.103503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/13/2022] [Accepted: 11/10/2022] [Indexed: 11/18/2022] Open
|
60
|
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.
Collapse
|
61
|
Salman A, Darwish T, Badla AA, Askar M, Al-Rufayie M, Ghabra M, Haddeh Y, Kailani O, Shaaban R, Hajjo S, Hasan H, Ali A. Prevalence of Keratoconus and Keratoconus Suspect among Patients Seeking Refractive Surgery in Syria. Middle East Afr J Ophthalmol 2022; 29:181-185. [PMID: 38162559 PMCID: PMC10754103 DOI: 10.4103/meajo.meajo_50_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: 03/26/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE The purpose of this study was to determine the prevalence of keratoconus (KC) and keratoconus suspect (KCS) among patients seeking refractive surgery in Syria. METHODS This is a retrospective multicenter screening study. The study was conducted in Damascus University, Tishreen University, and Tartous Specialist Eye Center (a private center). Data were collected from refractive surgery candidates referred for preoperative evaluation before laser in situ keratomileusis, photorefractive keratectomy, intrastromal corneal rings, and phakic intraocular lens implantation. Corneal parameters were obtained by Scheimpflug-Placido tomography, Sirius (CSO, Italy). RESULTS A total of 1479 patients were included in this analysis. The prevalence rates of KC and KCS were 18.19% (269/1479) and 13.52% (200/1479), respectively. In addition, patients with KC were found to have higher percentages of eye rubbing and astigmatism than suspect and normal (P < 0.0001). CONCLUSION High prevalence rate of KC was found among patients seeking refractive surgery in Syria. Although this study was carried out on a highly selective population, it may reflect a high prevalence rate in a general population in Syria.
Collapse
Affiliation(s)
| | - Taym Darwish
- Department of Ophthalmology, Tishreen University, Lattakia, Syria
| | - Abdul Aziz Badla
- Department of Ophthalmology, Sulaiman Al-Habib Hospital, Dubai, United Arab Emirates
| | - Mohammad Askar
- Department of Ophthalmology, Damascus University, Damascus, Syria
| | | | - Marwan Ghabra
- Department of Ophthalmology, Whipps Cross University Hospital, Leytonstone, London, UK
| | - Yusra Haddeh
- Department of Ophthalmology, Damascus University, Damascus, Syria
| | - Obeda Kailani
- Department of Ophthalmology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Rafea Shaaban
- Department of Ophthalmology, Tartous University, Tartous, Syria
| | - Samer Hajjo
- Department of Ophthalmology, Damascus University, Damascus, Syria
| | - Hiba Hasan
- Department of Ophthalmology, Tishreen University, Lattakia, Syria
| | - Ali Ali
- Department of Ophthalmology, Tishreen University, Lattakia, Syria
| |
Collapse
|
62
|
EpiSmart® Crosslinking for Keratoconus: A Phase 2 Study. Cornea 2022:00003226-990000000-00116. [PMID: 36173242 DOI: 10.1097/ico.0000000000003136] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to assess changes in visual acuity after epithelium-on ("epi-on") corneal crosslinking after a diagnosis of keratoconus. METHODS Subjects with corneal ectatic diseases were enrolled in a prospective, randomized, controlled, open-label, multicenter trial. Subjects were randomized to 1 of 3 treatment groups and treated with an epi-on crosslinking system including riboflavin/sodium iodide and pulsed UVA exposure (EpiSmart® , CXL Ophthalmics, Encinitas, CA). The UVA treatment groups were 2.4 J/cm2 over 20 minutes, 3.6 J/cm2 over 20 minutes, and 3.6 J/cm2 over 30 minutes. The primary end point was logarithm of the minimum angle of resolution corrected distance visual acuity (CDVA). Secondary end points were logarithm of the minimum angle of resolution uncorrected distance visual acuity (UCVA), maximum corneal curvature (Kmax), and minimum corneal thickness. Data were assessed 6 and 12 months post-operatively, using t-tests for differences from baseline. RESULTS Two thousand two hundred twenty-eight subjects were treated with epi-on crosslinking. One thousand nine hundred twenty-two subjects had a diagnosis of keratoconus; other treated eyes had postsurgical and other ectasias. At 6 and 12 months, the subjects with keratoconus demonstrated significant improvements in CDVA, UCVA, and Kmax; minimum corneal thickness was unchanged. One hundred ninety-five subjects (8.7%) reported at least 1 adverse event (AE). A mild corneal epithelial defect was reported in 31 cases (1.4%) and was the only AE reported in >1% of subjects. There were no serious AEs related to the treatment. CONCLUSIONS EpiSmart® epi-on crosslinking resulted in mean improvements in CDVA, UCVA, and Kmax at both 6 and 12 months and an excellent safety and efficacy profile in subjects with keratoconus, with few significant side effects. Differences between UVA treatment groups were not significant.
Collapse
|
63
|
New Keratoconus Risk Factors: A Cross-Sectional Case—Control Study. J Ophthalmol 2022; 2022:6605771. [PMID: 36211596 PMCID: PMC9534614 DOI: 10.1155/2022/6605771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 07/26/2022] [Accepted: 08/25/2022] [Indexed: 11/20/2022] Open
Abstract
Purpose To evaluate risk factors associated with keratoconus in a monocentric cross-sectional case-control study. Methods This observational study occurred from June 2019 to February 2021 in a university hospital (France). The case group consisted of 195 patients with keratoconus in at least one eye who were followed up by a corneal specialist. The control group consisted of 195 patients without any evidence of keratoconus on slit-lamp examination and corneal topography, who were matched 1 : 1 to controls by age and sex. Data were collected by a self-completed paper questionnaire before the consultation, and a multivariate logistic regression was performed. Results Multivariate analysis revealed significant associations of keratoconus with family history (odds ratio [OR] = 22.2, p < 0.001), rubbing eyes (OR = 10.9, p < 0.001), allergy (any kind) (OR = 3.80, p < 0.001), smoking exposure (OR = 2.08, p=0.017), and dry eyes (OR = 1.77, p=0.045f). The worst eye was associated with the more rubbed eye (p < 0.001) and the more pressed eye during the night according to sleeping position (p < 0.041). Conclusion This study confirmed the association between keratoconus and eye rubbing, family history, and allergy. It highlighted the role of pressure on the eyes during sleep. Other less known risk factors such as dry eyes and smoking exposure should be explored in future studies.
Collapse
|
64
|
Lozano V, Martín C, Blanco N, Alcalde I, Fernandez-Vega Cueto L, Merayo-Lloves J, Quirós LM. Exosomes Released by Corneal Stromal Cells Show Molecular Alterations in Keratoconus Patients and Induce Different Cellular Behavior. Biomedicines 2022; 10:biomedicines10102348. [PMID: 36289615 PMCID: PMC9598276 DOI: 10.3390/biomedicines10102348] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/19/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022] Open
Abstract
Exosomes have been related to various disorders, but their study in relation to ocular pathologies has been limited. In this article, we analyze exosomes produced by corneal stromal cells from healthy individuals and from patients with keratoconus. The proteomic study allowed for the identification of 14 new proteins with altered expression, related to molecules previously associated with the pathology. miRNA analysis detected 16 altered species, including miR-184, responsible for familial severe keratoconus. The prediction of its potential biological targets identified 1121 genes, including some related to this pathology. Exosomes produced by keratoconic cells induced a marked increase in the migration of stromal cells and corneal epithelium, while those produced by healthy cells had no effect on stromal cells. Both types of nanovesicles reduced the proliferation of stromal and corneal cells, but those produced by healthy cells had less effect. Exosomes produced by healthy cells had concentration-dependent effects on the transcription of genes encoding proteoglycans by keratoconus cells, with a relative normalization observed at concentrations of 240 µg/mL. These results show the alteration of stromal exosomes in keratoconus and suggest an influence on the development of the pathology, although the use of healthy exosomes could also have therapeutic potential.
Collapse
Affiliation(s)
- Víctor Lozano
- Department of Functional Biology, University of Oviedo, 33006 Oviedo, Spain; (V.L.); (C.M.); (N.B.)
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Carla Martín
- Department of Functional Biology, University of Oviedo, 33006 Oviedo, Spain; (V.L.); (C.M.); (N.B.)
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Noelia Blanco
- Department of Functional Biology, University of Oviedo, 33006 Oviedo, Spain; (V.L.); (C.M.); (N.B.)
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Ignacio Alcalde
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
| | - Luis Fernandez-Vega Cueto
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain;
- Correspondence: (L.F.-V.C.); (J.M.-L.); (L.M.Q.); Tel.: +34-985240141 (L.F.-V.C.); +34-985240141 (J.M.-L.); +34-985103560 (L.M.Q.)
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Correspondence: (L.F.-V.C.); (J.M.-L.); (L.M.Q.); Tel.: +34-985240141 (L.F.-V.C.); +34-985240141 (J.M.-L.); +34-985103560 (L.M.Q.)
| | - Luis M. Quirós
- Department of Functional Biology, University of Oviedo, 33006 Oviedo, Spain; (V.L.); (C.M.); (N.B.)
- Instituto Universitario Fernández-Vega, Fundación de Investigación Oftalmológica, University of Oviedo, 33012 Oviedo, Spain;
- Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), 33011 Oviedo, Spain
- Correspondence: (L.F.-V.C.); (J.M.-L.); (L.M.Q.); Tel.: +34-985240141 (L.F.-V.C.); +34-985240141 (J.M.-L.); +34-985103560 (L.M.Q.)
| |
Collapse
|
65
|
Goñi N, Martínez-Soroa I, Ibarrondo O, Azkargorta M, Elortza F, Galarreta DJ, Acera A. Tear proteome profile in eyes with keratoconus after intracorneal ring segment implantation or corneal crosslinking. Front Med (Lausanne) 2022; 9:944504. [PMID: 36203781 PMCID: PMC9531826 DOI: 10.3389/fmed.2022.944504] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeKeratoconus (KC) is a corneal ectasia characterized by structural changes, resulting in progressive thinning and biomechanical weakening that can lead to worsening visual acuity due to irregular astigmatism. Corneal collagen Crosslinking (CXL) and Intracorneal Ring Segment (ICRS) are widely used treatments in KC disease, but the alterations they cause in biomechanical mediators are still poorly understood. The aim of this study was to analyze the tear proteome profile before and after treatments to identify biomarkers altered by surgery.Materials and methodsAn observational, prospective, case-control pilot study was conducted, analyzing tear samples from KC patients by nano-liquid chromatography-mass spectrometry (nLC-MS/MS). Data are available via ProteomeXchange with identifier PXD035655. Patients with KC who underwent ICRS surgery (n = 4), CXL (n = 4), and healthy subjects (Ctrl, n = 4) were included in this study. Clinical parameters were measured and tear samples were collected before and 18 months after surgery. Proteins with ≥2 expression change and p-value < 0.05 between groups and times were selected to study their role in post-operative corneal changes.ResultsThese analyses led to the identification of 447 tear proteins, some of which were dysregulated in KC patients. In comparisons between the two surgical groups and Ctrls, the biological processes that were altered in KC patients at baseline were those that were dysregulated as a consequence of the disease and not of the surgical intervention. Among the biological processes seen to be altered were: immune responses, cytoskeleton components, protein synthesis and metabolic reactions. When comparing the two treatment groups (ICRS and CXL), the process related to cytoskeleton components was the most altered, probably due to corneal thinning which was more pronounced in patients undergoing CXL.ConclusionThe changes observed in tears after 18 months post-operatively could be due to the treatments performed and the pathology. Among the deregulated proteins detected, A-kinase anchor protein 13 (AKAP-13) deserves special attention for its involvement in corneal thinning, and for its strong overexpression in the tears of patients with more active KC and faster disease progression. However, it should be kept in mind that this is a pilot study conducted in a small number of patients.
Collapse
Affiliation(s)
- Nahia Goñi
- Department of Ophthalmology, Hospital Universitario Donostia, San Sebastian, Spain
- Department of Ophthalmology, University of the Basque Country UPV/EHU, Leioa, Spain
| | - Itziar Martínez-Soroa
- Department of Ophthalmology, Hospital Universitario Donostia, San Sebastian, Spain
- Department of Ophthalmology, University of the Basque Country UPV/EHU, Leioa, Spain
| | | | - Mikel Azkargorta
- Proteomics Platform, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), CIBERehd, Derio, Spain
| | - Felix Elortza
- Proteomics Platform, CIC bioGUNE, Basque Research and Technology Alliance (BRTA), CIBERehd, Derio, Spain
| | - David J. Galarreta
- Department of Ophthalmology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Arantxa Acera
- Department of Cell Biology and Histology, Experimental Ophthalmo-Biology Group (GOBE:www.ehu.eus/gobe), University of the Basque Country UPV/EHU, Leioa, Spain
- IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
- *Correspondence: Arantxa Acera,
| |
Collapse
|
66
|
Akoto T, Li JJ, Estes AJ, Karamichos D, Liu Y. The Underlying Relationship between Keratoconus and Down Syndrome. Int J Mol Sci 2022; 23:ijms231810796. [PMID: 36142709 PMCID: PMC9503764 DOI: 10.3390/ijms231810796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/16/2022] Open
Abstract
Keratoconus (KC) is one of the most significant corneal disorders worldwide, characterized by the progressive thinning and cone-shaped protrusion of the cornea, which can lead to severe visual impairment. The prevalence of KC varies greatly by ethnic groups and geographic regions and has been observed to be higher in recent years. Although studies reveal a possible link between KC and genetics, hormonal disturbances, environmental factors, and specific comorbidities such as Down Syndrome (DS), the exact cause of KC remains unknown. The incidence of KC ranges from 0% to 71% in DS patients, implying that as the worldwide population of DS patients grows, the number of KC patients may continue to rise significantly. As a result, this review aims to shed more light on the underlying relationship between KC and DS by examining the genetics relating to the cornea, central corneal thickness (CCT), and mechanical forces on the cornea, such as vigorous eye rubbing. Furthermore, this review discusses KC diagnostic and treatment strategies that may help detect KC in DS patients, as well as the available DS mouse models that could be used in modeling KC in DS patients. In summary, this review will provide improved clinical knowledge of KC in DS patients and promote additional KC-related research in these patients to enhance their eyesight and provide suitable treatment targets.
Collapse
Affiliation(s)
- Theresa Akoto
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Jiemin J. Li
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
| | - Amy J. Estes
- Department of Ophthalmology, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
| | - Yutao Liu
- Department of Cellular Biology & Anatomy, Augusta University, Augusta, GA 30912, USA
- James & Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
- Correspondence: ; Tel.: +1-706-721-2015
| |
Collapse
|
67
|
Identification of Important Genes of Keratoconus and Construction of the Diagnostic Model. Genet Res (Camb) 2022; 2022:5878460. [PMID: 36160033 PMCID: PMC9484959 DOI: 10.1155/2022/5878460] [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: 05/10/2022] [Revised: 08/10/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
Objective. The aim of the study is to investigate the potential role of keratoconus (KC) in the diagnosis of keratoconus (KC). Methods. GSE151631 and GSE77938 were downloaded from the comprehensive gene expression database (GEO). By using the random forest model (RF), support vector machine model (SVM), and generalized linear model (GLM), important immune-related genes were identified as biomarkers for KC diagnosis. Results. Through the LASSO, RFE, and RF algorithms and comparing the three sets of DEGs, a total of 8 overlapping DEGs were obtained. We took 8 DEGs as the final optimal combination of DEGs: AREG, BBC3, DUSP2, map3k8, Smad7, CDKN1A, JUN, and LIF. Conclusion. Abnormal cell proliferation, apoptosis, and autophagy defects are related to KC, which may be the etiology and potential target of KC.
Collapse
|
68
|
Ahmad TR, Turner ML, Hoppe C, Kong AW, Barnett JS, Kaur G, Pasricha ND, Indaram M. Parental Keratoconus Literacy: A Socioeconomic Perspective. Clin Ophthalmol 2022; 16:2505-2511. [PMID: 35974902 PMCID: PMC9375995 DOI: 10.2147/opth.s375405] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/26/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To assess the impact of parental socioeconomic status and keratoconus literacy on pediatric eye rubbing and keratoconus severity. Methods In this mixed-methods study, pediatric keratoconus patients (age ≤ 18 years) were retrospectively identified. Sociodemographic and clinical characteristics were extracted from the electronic medical record (EMR). Telephone surveys were subsequently conducted to assess parental keratoconus literacy, receipt of counseling on keratoconus prevention, eye rubbing, and household socioeconomic factors not available in the EMR. Parents reporting poor keratoconus literacy were probed via semi-structured interview to explore barriers to their understanding. Results Forty-eight patients met inclusion criteria, 22 (46%) of whom were reached by telephone. Most patients were insured by Medicaid (73%) and current eye rubbers (82%). Few parents reported good or excellent keratoconus literacy now (32%) or at the time of diagnosis (18%). Parents with a high-school education, limited English proficiency, lower income level, and Medicaid insurance tended to have lower keratoconus literacy, though this was not statistically significant. Parental keratoconus literacy was not correlated with disease severity. High-school education, limited English proficiency, lower income level, and Medicaid insurance were correlated with steeper keratometry readings, which was statistically significant for high-school education. In-depth interviews revealed parents felt unconfident with eye health in general and perceived a personal responsibility for learning more. Conclusion This is the first study exploring keratoconus literacy from a socioeconomic perspective, demonstrating lower literacy among socioeconomically marginalized parents and a tendency toward more severe disease in their children.
Collapse
Affiliation(s)
- Tessnim R Ahmad
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Marcus L Turner
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Charis Hoppe
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Alan W Kong
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Jackson S Barnett
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Gurbani Kaur
- School of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Neel D Pasricha
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA
| | - Maanasa Indaram
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA, USA,Correspondence: Maanasa Indaram, Department of Ophthalmology, University of California San Francisco, 490 Illinois Street, San Francisco, CA, 94158, USA, Email
| |
Collapse
|
69
|
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.
Collapse
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
| |
Collapse
|
70
|
Kobia-Acquah E, Senanu EN, Antwi-Adjei EK, Appiah DP, Kumah DB, Abdul-Kabir M, Donkor R. Prevalence of keratoconus in Ghana: A hospital-based study of tertiary eye care facilities. Eur J Ophthalmol 2022; 32:3185-3194. [PMID: 35818728 DOI: 10.1177/11206721221113197] [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: 11/16/2022]
Abstract
PURPOSE To estimate the prevalence of keratoconus in tertiary eye care facilities in Ghana. METHODS AND ANALYSIS In this hospital-based retrospective cohort study, medical records of patients from tertiary/referral eye care facilities in Ghana were reviewed. Included in the study were records of individuals who visited the eye care facilities and were diagnosed of keratoconus within the period of January 2016 to December 2019 inclusive. Data on patients' demographics, severity of keratoconus, mode of diagnosis, treatment, and visual acuity outcomes were analysed. RESULTS Out of the total of 142,209 records reviewed, 75 patients were diagnosed of keratoconus in at least one eye (127 eyes; 86.8% bilateral cases), representing a prevalence estimate of 53 per 100000 (95% confidence interval (CI): 41 to 65 per 100000). The mean ± SD age of patients at the time of diagnosis was 21.1 ± 9.5 years (66.2% males). The mean ± SD keratometry in keratoconus patients was 52.1 ± 7.0: majority (76.5%) of the cases were moderate to severe keratoconus. The main primary treatment regimen was corneal transplant (58.8%) followed by spectacles (25.0%), crosslinking (8.8%) and rigid contact lens (7.3%). There was a significant association between post-treatment visual acuity outcomes and treatment type (p < 0.001). CONCLUSION Our study represents the first prevalence estimate of keratoconus in Ghana. The prevalence of keratoconus estimated in our study is lower than that reported in countries with tropical climates. This could be due to lower uptake of referrals, underdiagnosis and/or misdiagnosis of the condition in lower-level health facilities.
Collapse
Affiliation(s)
- Emmanuel Kobia-Acquah
- Department of Optometry and Visual Science, 98763Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Esther Nutifafa Senanu
- Department of Optometry and Visual Science, 98763Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Ellen Konadu Antwi-Adjei
- Department of Optometry and Visual Science, 98763Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Dora Pomaa Appiah
- Department of Optometry and Visual Science, 98763Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - David Ben Kumah
- Department of Optometry and Visual Science, 98763Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Mohammed Abdul-Kabir
- Department of Optometry and Visual Science, 98763Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Richard Donkor
- 161800Retina Associates of Cleveland, Cleveland, OH, USA
| |
Collapse
|
71
|
Stachon T, Nastaranpour M, Seitz B, Meese E, Latta L, Taneri S, Ardjomand N, Szentmáry N, Ludwig N. Altered Regulation of mRNA and miRNA Expression in Epithelial and Stromal Tissue of Keratoconus Corneas. Invest Ophthalmol Vis Sci 2022; 63:7. [PMID: 35816043 PMCID: PMC9284461 DOI: 10.1167/iovs.63.8.7] [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] [Indexed: 11/24/2022] Open
Abstract
Purpose Evaluation of mRNA and microRNA (miRNA) expression in epithelium and stroma of patients with keratoconus. Methods The epithelium and stroma of eight corneas of eight patients with keratoconus and eight corneas of eight non-keratoconus healthy controls were studied separately. RNA was extracted, and mRNA and miRNA analyses were performed using microarrays. Differentially expressed mRNAs and miRNAs in epithelial and stromal keratoconus samples compared to healthy controls were identified. Selected genes and miRNAs were further validated using RT-qPCR. Results We discovered 170 epithelial and 1498 stromal deregulated protein-coding mRNAs in KC samples. In addition, in epithelial samples 180 miRNAs and in stromal samples 379 miRNAs were significantly deregulated more than twofold compared to controls. Pathway analysis revealed enrichment of metabolic and axon guidance pathways for epithelial cells and enrichment of metabolic, mitogen-activated protein kinase (MAPK), and focal adhesion pathways for stromal cells. Conclusions This study demonstrates significant differences in the expression and regulation of mRNAs and miRNAs in the epithelium and stroma of Patients with KC. Also, in addition to the well-known target candidates, we were able to identify further genes and miRNAs that may be associated with keratoconus. Signaling pathways influencing metabolic changes and cell contacts are affected in epithelial and stromal cells of patients with keratoconus.
Collapse
Affiliation(s)
- Tanja Stachon
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Homburg (Saar), Germany
| | - Mahsa Nastaranpour
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Homburg (Saar), Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg (Saar), Germany
| | - Eckart Meese
- Department of Human Genetics and Center for Human and Molecular Biology, Saarland University, Homburg (Saar), Germany
| | - Lorenz Latta
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Homburg (Saar), Germany
| | - Suphi Taneri
- Center for Refractive Surgery, Eye Department at St. Francis Hospital, Muenster, Germany
| | | | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Aniridia Research, Homburg (Saar), Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Nicole Ludwig
- Department of Human Genetics and Center for Human and Molecular Biology, Saarland University, Homburg (Saar), Germany
| |
Collapse
|
72
|
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.
Collapse
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
| |
Collapse
|
73
|
Prevalence of Keratoconus in a Population-Based Study in Syria. J Ophthalmol 2022; 2022:6064533. [PMID: 35783343 PMCID: PMC9246644 DOI: 10.1155/2022/6064533] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
Aim To determine the prevalence and associations of keratoconus (KC) in a university student population in Syria. Methods A prospective multicentre cross-sectional cohort study was conducted at two universities in Syria. Student volunteers were recruited from Tishreen University (Latakia governorate) and Damascus University (Damascus governorate). All participants underwent a comprehensive ocular examination. Placido/Scheimpflug-based corneal imaging using the Sirius (CSO, Florence. Italy), and a questionnaire to evaluate the baseline characteristics and medical history, as well as to highlight possible risk factors of KC. Univariate and bivariate analyses were performed. Results The estimated prevalence of KC among all subjects was 1.43% (n = 12). A strong association between eye rubbing and keratoconus was found (OR 9.33, 95% CI 2.94–29.63, P < 0.001). Damascus University participants had a higher prevalence of KC than Tishreen University. However, the difference was not statistically significant. Conclusion The prevalence of keratoconus in this Syrian student population was 1.43%. The results of this study demonstrate a high prevalence of keratoconus in the study population. Early detection of keratoconus through screening may yield benefits in preventing devastating sequelae of KC in populations with a high prevalence.
Collapse
|
74
|
Vitamin D, the Vitamin D Receptor, Calcitriol Analogues and Their Link with Ocular Diseases. Nutrients 2022; 14:nu14112353. [PMID: 35684153 PMCID: PMC9183042 DOI: 10.3390/nu14112353] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/03/2022] [Accepted: 06/03/2022] [Indexed: 11/21/2022] Open
Abstract
The global prevalence of eye diseases continues to grow, bringing with it a reduction in the activity levels and quality of life of patients, and partial or complete blindness if left untreated. As such, there is considerable interest in identifying more effective therapeutic options and preventive agents. One such agent is vitamin D, known to have a range of anti-cancer, anti-angiogenic, anti-inflammatory and anti-oxidative properties, and whose deficiency is linked to the pathogenesis of a range of cardiovascular, cancer, and inflammatory diseases. This review presents the current stage of knowledge concerning the link between vitamin D and its receptor and the occurrence of eye disease, as well as the influence of analogues of calcitriol, an active metabolite of vitamin D. Generally, patients affected by various ocular disorders have vitamin D deficiency. In addition, previous findings suggest that vitamin D modulates the course of eye diseases and may serve as a marker, and that its supplementation could mitigate some disorders. However, as these studies have some limitations, we recommend further randomized trials to clarify the link between vitamin D and its activity with eye disease.
Collapse
|
75
|
Cusumano A, Roshanravan H, Chao-Shern C, Sebastiani J, Levialdi Ghiron JH, DeDionisio L, Moore T. Genetic prescreening of a candidate for laser refractive surgery identifies risk for inadequate tissue response: a case report. J Med Case Rep 2022; 16:207. [PMID: 35578349 PMCID: PMC9109339 DOI: 10.1186/s13256-022-03395-7] [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: 02/26/2021] [Accepted: 03/31/2022] [Indexed: 12/01/2022] Open
Abstract
Background Inadequate response to corneal laser refractive surgery, e.g., ectatic corneal diseases, may not be identified by conventional examinations, hence creating therapeutic uncertainty. Herein we demonstrate the application of genetic prescreening to augment preassessment for corneal laser refractive surgery and highlight the ability to prevent the possibility of enrolling a subject at risk for developing ectatic corneal diseases. Case presentation Preoperative tests were performed alongside deoxyribonucleic acid (DNA) sequencing of 75 genes specific to the structure and health of the eye of a 44-year-old Caucasian male candidate for corneal laser refractive surgery. The patient had no medical, family, or psychosocial history, nor symptoms that could lead to suspect any corneal abnormalities, and conventional preoperative tests confirmed that no corneal abnormalities were present. The sequencing results uncovered rare DNA variants within the ADGRV1, PTK2, ZNF469, and KRT15 genes. These variants were considered potential risk factors for inadequate response in the patient post corneal laser refractive surgery. Subsequent reevaluation with three different last-generation corneal tomographers identified in the left eye a “warning” for a deformity of the posterior profile of the cornea. Conclusions Genetic prescreening identifies potential risk of inadequate response to corneal laser refractive surgery where current technologies in use may lead to a hazardous predictive diagnostic uncertainty.
Collapse
|
76
|
Prevalence of keratoconus in refractive surgery practice population in North Macedonia. Int Ophthalmol 2022; 42:3191-3198. [PMID: 35538254 DOI: 10.1007/s10792-022-02319-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 04/18/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To determine the prevalence of keratoconus (KC) in relation to ethnicity in a group of people who consulted an ophthalmological care institution seeking for refractive surgery in N. Macedonia. METHODS This was a cross-sectional, interventional retrospective study. Chart reviews were performed for all new patients attending between January 2016 and January 2020 at the Sistina Ophthalmology Hospital in Skopje. All patients were screened; KC diagnosis and classification were based on the corneal topography. Ethnicity and gender classifications were according to patients' self-opinions. RESULTS A total of 2812 patients charts reviewed. The mean age was 31.71 years (SD ± 9.73), and 1209 (43%) were male. A total of 2050 (72.9%) declared themselves as Macedonians, 649 (23.1%) Albanians, 76 (2.7%) Turks and 37 (1.3%) in other ethnicities. Differences in age between the ethnic groups were statistically significant (x2 = 90.225, p < 0.001). KC was diagnosed in 343 patients (12.2%), while 9 (0.7%) were KC suspects and 6(0.21%) presented pellucid marginal degeneration. KC was more frequent in males (n = 246, 71.7% of total) and skewed toward younger patients. Increasing patients' age decreased the odds of KC diagnosis by 3.7% (95% CI 1.8%-4.4%) per annum. Males were four times more likely to be diagnosed with KC (AOR = 4.01; 95% CI 3.12-5.16). In comparison with Macedonian patients, Turks were more likely to be diagnosed with KC (AOR = 4.09; 95% CI 2.47-6.78). There was no difference between Macedonians and Albanians (p = 0.08). CONCLUSION The prevalence of KC at a refractive surgery practice in N. Macedonia is much higher compared with general population (6.8/100,000) and similar to the prevalence in Middle East Asia. Nationwide screening programs are needed to diagnose the disease earlier.
Collapse
|
77
|
Seth I, Bulloch G, Vine M, Outmezguine J, Seth N, Every J, Daniell M. The association between keratoconus and allergic eye diseases: A systematic review and meta-analysis. Clin Exp Ophthalmol 2022; 50:280-293. [PMID: 35050519 DOI: 10.1111/ceo.14045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 12/10/2021] [Accepted: 12/31/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND To investigate association between keratoconus and allergic eye diseases, eye rubbing, and atopy. METHODS PubMed, Web of Science, Scopus, and Cochrane were searched for relevant published studies from inception to April 2021 without restrictions or filters. We included case-control, cohort, and cross-sectional studies that investigated eye allergy, atopy, or eye rubbing as possible risk factors for KC. Two authors independently screened all titles and abstracts against predefined inclusion and exclusion criteria. This study analysed keratoconus prevalence and risk factors including eye rubbing, family history of keratoconus, atopy, and allergic eye diseases. The National Institute of Health Study Quality Assessment tool was utilised. Pooled data were presented as odds ratio (OR) and 95% confidence intervals (CI). Analysis was conducted using RevMan version 5.3 software. RESULTS Out of 573 articles, we excluded 161 duplicates than 361 articles by title and abstract screening. The remaining 51 articles underwent full-text screening, and 29 articles were excluded. Twenty-one studies were included in the qualitative synthesis and fifteen for quantitative synthesis. There was no significant association found between KC and allergic eye diseases (OR = 1.03, 95% CI [0.96, 1.11], p = 0.45), eye rubbing (OR = 1.59, 95% CI [0.70, 3.63], p = 0.27), or atopy (OR = 1.08, 95% CI [0.80, 1.44], p = 0.62). CONCLUSION No significant association was observed between KC and allergic eye disease, eye rubbing, or atopy. Further prospective studies are needed to clarify and validate these findings.
Collapse
Affiliation(s)
- Ishith Seth
- Bendigo Base Hospital, Bendigo, Victoria, Australia.,Department of Ophthalmology, Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| | - Gabriella Bulloch
- Department of Ophthalmology, Centre for Eye Research Australia, East Melbourne, Victoria, Australia.,Faculty of Science, Medicine and Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Michael Vine
- Bendigo Base Hospital, Bendigo, Victoria, Australia
| | | | - Nimish Seth
- Department of Surgery, Alfred Health, Melbourne, Victoria, Australia
| | - James Every
- Bendigo Base Hospital, Bendigo, Victoria, Australia
| | - Mark Daniell
- Department of Ophthalmology, Centre for Eye Research Australia, East Melbourne, Victoria, Australia
| |
Collapse
|
78
|
Novel artificial intelligence index based on Scheimpflug corneal tomography to distinguish subclinical keratoconus from healthy corneas. J Cataract Refract Surg 2022; 48:1168-1174. [PMID: 35333829 DOI: 10.1097/j.jcrs.0000000000000946] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to assess the efficiency of an index derived from multiple logistic regression analysis (MLRA) to measure differences in corneal tomography findings between subclinical keratoconus (SKC) in one eye, corneal ectasia, and healthy corneas. SETTING Two private Brazilian ophthalmological centers. DESIGN Multicenter, case-control study. METHODS This study included 187 eyes with very asymmetric ectasia and normal corneal topography and tomography (VAE-NTT) in the VAE-NTT group (G), 2,296 eyes with healthy corneas in the control group (CG), and 410 eyes with ectasia in the ectasia group. An index, termed as Boosted Ectasia Susceptibility Tomography Index (BESTi), was derived using MLRA to identify a cutoff point to distinguish patients in the three groups. The groups were divided into two subgroups with equal number of patients: validation set and external validation (EV) set. RESULTS BESTi had an area under the curve (AUC) of 0.91 with 86.02% sensitivity (Se) and 83.97% specificity (Sp) between CG and VAE-NTT G in the EV set, which were significantly greater than those of the Belin-Ambrósio Deviation Index (BAD-D; AUC: 0.81; Se: 66.67%; Sp: 82.67%; P < .0001) and Pentacam Random Forest Index (PRFI; AUC: 0.87; Se: 78.49%; Sp: 79.88%; P = .021). CONCLUSIONS BESTi facilitated early detection of ectasia in SKC. BESTi demonstrated higher Se and Sp than PRFI and BAD-D for detecting SKC.
Collapse
|
79
|
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.
Collapse
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
| |
Collapse
|
80
|
Lasagni Vitar RM, Bonelli F, Rama P, Ferrari G. Nutritional and Metabolic Imbalance in Keratoconus. Nutrients 2022; 14:nu14040913. [PMID: 35215563 PMCID: PMC8876314 DOI: 10.3390/nu14040913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/18/2022] [Indexed: 12/31/2022] Open
Abstract
Keratoconus (KC) is a progressive corneal degeneration characterized by structural changes consisting of progressive thinning and steepening of the cornea. These alterations result in biomechanical weakening and, clinically, in vision loss. While the etiology of KC has been the object of study for over a century, no single agent has been found. Recent reviews suggest that KC is a multifactorial disease that is associated with a wide variety of genetic and environmental factors. While KC is typically considered a disease of the cornea, associations with systemic conditions have been well described over the years. In particular, nutritional and metabolic imbalance, such as the redox status, hormones, metabolites, and micronutrients (vitamins and metal ions), can deeply influence KC initiation and progression. In this paper, we comprehensively review the different nutritional (vitamins and minerals) and metabolic (hormones and metabolites) factors that are altered in KC, discussing their possible implication in the pathophysiology of the disease.
Collapse
Affiliation(s)
| | | | | | - Giulio Ferrari
- Correspondence: ; Tel.: +39-02-26436186; Fax: +39-02-26436164
| |
Collapse
|
81
|
Yıldız E, Aydemir D, Zibandeh N, Kuşan E, Gümüş K, Saraç Öİ, Karslıoğlu MZ, Çağıl N, Şahin A. Investigation of Mitophagy Biomarkers in Corneal Epithelium of Keratoconus Patients. Curr Eye Res 2022; 47:661-669. [DOI: 10.1080/02713683.2022.2025846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Erdost Yıldız
- Koç University Research Center for Translational Medicine, Koç University, 34450, Istanbul, Turkey
| | - Dilara Aydemir
- Koç University Research Center for Translational Medicine, Koç University, 34450, Istanbul, Turkey
| | - Noushin Zibandeh
- Koç University Research Center for Translational Medicine, Koç University, 34450, Istanbul, Turkey
| | - Eda Kuşan
- Koç University Research Center for Translational Medicine, Koç University, 34450, Istanbul, Turkey
| | - Koray Gümüş
- Department of Ophthalmology, Ankara Memorial Hospital, 06520, Ankara, Turkey
| | - Özge İlhan Saraç
- Department of Ophthalmology, Ankara Yıldırım Beyazıt University, 06010, Ankara, Turkey
| | | | - Nurullah Çağıl
- Department of Ophthalmology, Ankara Yıldırım Beyazıt University, 06010, Ankara, Turkey
| | - Afsun Şahin
- Koç University Research Center for Translational Medicine, Koç University, 34450, Istanbul, Turkey
- Department of Ophthalmology, Koç University Medical School, 34010, Istanbul, Turkey
| |
Collapse
|
82
|
Kandel S, Chaudhary M, Mishra SK, Joshi ND, Subedi M, Puri PR, Gyawali P, Bist J, Kandel H. Evaluation of corneal topography, pachymetry and higher order aberrations for detecting subclinical keratoconus. Ophthalmic Physiol Opt 2022; 42:594-608. [PMID: 35147226 DOI: 10.1111/opo.12956] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE To compare corneal topography, pachymetry and higher order aberrations in keratoconic and normal eyes; to investigate their association in keratoconic eyes; and to determine their diagnostic ability for detecting subclinical keratoconus in a Nepalese population. METHODS Ninety-six eyes of 48 keratoconus patients and 50 normal eyes of 50 control subjects were included in this study. The eyes of keratoconus patients were classified into four different study groups: subclinical, stage 1, stage 2 and advanced stage keratoconus. In each eye, corneal topography, pachymetry and corneal aberrometry indices were measured using a Sirius corneal tomographer. The study parameters of keratoconic eyes were compared with normal eyes, and the possible association of corneal aberrometry with topography and pachymetry indices was investigated. The area under curve (AUC) of receiver operating characteristic (ROC) curves along with optimal cutoff values with best sensitivity and specificity were also determined for each index to detect subclinical keratoconus. RESULTS All the indices except average keratometry measurements (Kavg and mmavg ) and spherical aberration (SA) were found to be significantly different in subclinical keratoconus compared to the control group (p < 0.05). In keratoconic eyes, all corneal aberrations were significantly correlated with the topography and pachymetry indices (range of ρ: -0.25 to 0.96; all p < 0.05) except for trefoil and minimum corneal thickness (Thkmin ). All the indices except Kavg , mmavg and SA showed excellent diagnostic ability (AUC > 0.90) in detecting subclinical keratoconus. The cutoff values proposed for the asymmetry index of the corneal back surface (SIb ), Strehl ratio of point spread function (PSF), coma and Baiocchi-Calossi-Versaci index of corneal back surface (BCVb ) each showed excellent sensitivity (100%) and specificity (≥97%). CONCLUSIONS Corneal higher order aberrations were found to be significantly elevated in subclinical keratoconus compared to healthy controls. SIb , PSF, coma and BCVb were identified as the most powerful Sirius indices for the detection of subclinical keratoconus.
Collapse
Affiliation(s)
- Sandeep Kandel
- Tilganga Institute of Ophthalmology, Gaushala, Kathmandu, Nepal
| | - Meenu Chaudhary
- B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Sanjeeb K Mishra
- B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Niraj D Joshi
- B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Manish Subedi
- B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Prajjol R Puri
- B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Parash Gyawali
- B.P. Koirala Lions Center for Ophthalmic Studies, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
| | - Jeewanand Bist
- Tilganga Institute of Ophthalmology, Gaushala, Kathmandu, Nepal
| | - Himal Kandel
- Specialty of Clinical Ophthalmology and Eye Health, Sydney Medical School, Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
83
|
Mou Y, Qin Q, Huang X, Jin X. Risk factors and severity of keratoconus on the East Coast of China. Int Ophthalmol 2022; 42:2133-2140. [PMID: 35038123 DOI: 10.1007/s10792-022-02212-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 01/01/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE This study aims to investigate the characteristics, potential risk factors and associated severity of keratoconus on the east coast of China. METHODS In this case-control study, patients diagnosed with keratoconus were invited to fill in the online electronic questionnaire designed with the help of the App named WenJuanXing. Several questions like, sex, age of diagnosis and eye care habits were administered to each subject through this e-questionnaire. Corneal topographies at diagnosis taken from Pentacam were also collected. RESULTS Totally 391 Chinese keratoconus outpatients were enrolled in this study, among which 159 patients were newly diagnosed. Only three patients (0.77%) had a positive family history of keratoconus. Atopy could be identified in 66.0% of our patients. A total of 357 patients (91.3%) mentioned the habit of eye rubbing, with 191 patients (48.8%) rubbing their eyes frequently. Patients with younger age at onset (p = 0.005), male sex (p = 0.042), frequent eye rubbing (p = 0.003) and smoke (p = 0.002) were found significantly associated with increased risk of acute hydrops. In newly diagnosed patients, 79.9% had the maximum keratometry (Kmax) more than 52D, with males and patients aged 21-30 being even more serious (p = 0.009; p = 0.005). Besides, in patients aged over 21, frequent eye rubbing was significantly associated with steeper Kmax and more severe astigmatism (all p < 0.05). CONCLUSION Our results suggest that frequent eye rubbing is closely related to the severity of keratoconus in Chinese patients. Chinese keratoconus patients always had much serious disease condition at the time of diagnosis. Thus, increasing the publicity of keratoconus and advocating appropriate eye care habits are needed urgently in China. REGISTRATION The research was retrospectively registered, and the trial registration number is ChiCTR1900021273, and the registration date is 2019/02/09.
Collapse
Affiliation(s)
- Yujie Mou
- Eye Centre, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Qiyu Qin
- Eye Centre, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Xiaodan Huang
- Eye Centre, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Xiuming Jin
- Eye Centre, the Second Affiliated Hospital of Zhejiang University, School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
| |
Collapse
|
84
|
The Role of Estriol and Estrone in Keratoconic Stromal Sex Hormone Receptors. Int J Mol Sci 2022; 23:ijms23020916. [PMID: 35055103 PMCID: PMC8779160 DOI: 10.3390/ijms23020916] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 02/04/2023] Open
Abstract
Keratoconus (KC) is a progressive corneal thinning disease that manifests in puberty and worsens during pregnancy. KC onset and progression are attributed to diverse factors that include: environmental, genetics, and hormonal imbalances; however, the pathobiology remains elusive. This study aims to determine the role of corneal stroma sex hormone receptors in KC and their interplay with estrone (E1) and estriol (E3) using our established 3D in vitro model. Healthy cornea stromal cells (HCFs) and KC cornea stromal cells (HKCs), both male and female, were stimulated with various concentrations of E1 and E3. Significant changes were observed between cell types, as well as between males and females in the sex hormone receptors tested; androgen receptor (AR), progesterone receptor (PR), estrogen receptor alpha (ERα), and estrogen receptor beta (ERβ) using Western blot analysis. E1 and E3 stimulations in HCF females showed AR, PR, and ERβ were significantly upregulated compared to HCF males. In contrast, ERα and ERβ had significantly higher expression in HKC's females than HKC's males. Our data suggest that the human cornea is a sex-dependent, hormone-responsive tissue that is significantly influenced by E1 and E3. Therefore, it is plausible that E1, E3, and sex hormone receptors are involved in the KC pathobiology, warranting further investigation.
Collapse
|
85
|
Association of lens density quantified by IOLMaster 700 with lenticular myopia in nuclear cataract. Graefes Arch Clin Exp Ophthalmol 2022; 260:1565-1572. [PMID: 34993615 DOI: 10.1007/s00417-021-05495-4] [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: 07/19/2021] [Revised: 11/06/2021] [Accepted: 11/10/2021] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To explore the associated ocular parameters with lenticular myopia and assess the correlation between lens density and myopic shift. METHODS This retrospective cross-sectional study enrolled 50 patients with lenticular high myopia as the study group and 85 cases as the validation group. Lens density was obtained through swept-source optical coherence tomography (SS-OCT, IOLMaster 700) and measured by Image J software. Linear regression analysis and correlation analysis were applied to study the association between lenticular myopia and ocular variables. Receiver operating characteristic curves and calibration charts were plotted for nuclear density (ND) in identifying lenticular high myopia. RESULTS Both ND and lens thickness were discovered to be associated with spherical equivalent refraction and lens power (p < 0.05); yet, only ND was significantly correlated with lenticular myopia, as the difference of nuclear density (NDdiff) between the lenticular myopic eye and the fellow eye was significantly correlated with the interocular difference of spherical equivalent refraction (SERdiff, r = - 0.752, p < 0.001) and the interocular difference of lens power (LPdiff, r = 0.834, p < 0.001). The ND is a good metric for diagnosing lenticular high myopia, with the area under curve (AUC) being 0.898 (0.821-0.949) and the cut-off value being 98.88 pixel units. The accuracy of the cut-off value in the validation group was 82.35%. CONCLUSIONS Average ND quantified by IOLMaster 700 is not only associated with lenticular myopia but is a suitable metric for predicting the amount of myopic shift.
Collapse
|
86
|
Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review. Cont Lens Anterior Eye 2022; 45:101559. [PMID: 34991971 DOI: 10.1016/j.clae.2021.101559] [Citation(s) in RCA: 167] [Impact Index Per Article: 83.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023]
Abstract
Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.
Collapse
Affiliation(s)
| | - Gonzalo Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Asaki Suzaki
- Clinical Research and Development Center, Menicon Co., Ltd., Nagoya, Japan
| | - Cesar Villa-Collar
- Department of Pharmacy, Biotechnology, Nutrition, Optics and Optometry, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - James S Wolffsohn
- School of optometry, Health and Life Sciences, Aston University, Birmingham B4 7ET, United Kingdom
| |
Collapse
|
87
|
Gomes JAP, Rodrigues PF, Lamazales LL. Keratoconus epidemiology: A review. SAUDI JOURNAL OF OPHTHALMOLOGY : OFFICIAL JOURNAL OF THE SAUDI OPHTHALMOLOGICAL SOCIETY 2022; 36:3-6. [PMID: 35971497 PMCID: PMC9375461 DOI: 10.4103/sjopt.sjopt_204_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 09/05/2021] [Accepted: 12/20/2021] [Indexed: 11/14/2022]
Abstract
Keratoconus is an ectatic corneal disease that affects both men and women, usually at a young age. Risk factors such as eye rubbing, environmental and genetic factors contribute to its pathogenesis. Keratoconus presents a variable prevalence, being as high as 5% of the population in the Middle East. In this review, an English-language search for keratoconus epidemiology was undertaken using the PubMed database. We present and discuss the findings of the most relevant epidemiological studies on keratoconus and describe its characteristics and risk factors, correlating them with its pathogenesis.
Collapse
Affiliation(s)
- José A P Gomes
- Department of Ophthalmology and Visual Sciences, Paulista Medical School/Federal University of São Paulo (EPM/UNIFESP), Sao Paulo, Brazil
| | - Pablo F Rodrigues
- Department of Ophthalmology and Visual Sciences, Paulista Medical School/Federal University of São Paulo (EPM/UNIFESP), Sao Paulo, Brazil
| | - Luiz L Lamazales
- Department of Ophthalmology and Visual Sciences, Paulista Medical School/Federal University of São Paulo (EPM/UNIFESP), Sao Paulo, Brazil
| |
Collapse
|
88
|
Yang K, Gu Y, Xu L, Fan Q, Zhu M, Wang Q, Yin S, Zhang B, Pang C, Ren S. Distribution of pediatric keratoconus by different age and gender groups. Front Pediatr 2022; 10:937246. [PMID: 35923788 PMCID: PMC9339668 DOI: 10.3389/fped.2022.937246] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the distribution of pediatric keratoconus patients and the disease severity based on different age and gender groups in China. MATERIALS AND METHODS A total of 446 keratoconus eyes in 266 pediatric patients from January 2019 to January 2022 were included in the cross-sectional study. The clinical findings and severity of keratoconus were recorded and Kruskal-Wallis test, chi-squared test, and Cochran-Mantel-Haenszel (CMH) test were used to compare the parameters between different gender and age groups. RESULTS The male/female ratio was 353/93 (3.8:1), and the median age was 16 years (range: 6-17 years). Male patients were statistically younger than female patients (P = 0.041). The male/female ratio decreased with age (P for trend = 0.011). The distribution of the topographic keratoconus classification (TKC) stage was significantly different between gender and age groups (all P < 0.05). Male patients had a higher ratio of advanced keratoconus eyes (TKC ≥ 3) than female patients (P < 0.001), and CMH analysis indicated that being a male was a risk factor for advanced keratoconus after controlling for age (odds ratio: 2.581, P < 0.001). CONCLUSION Male keratoconus patients were younger, with a higher ratio of advanced keratoconus than female patients in the Chinese pediatric patients evaluated. Multicenter studies with larger sample sizes are necessary in the future.
Collapse
Affiliation(s)
- Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Meng Zhu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Qing Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Shanshan Yin
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Bo Zhang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Chenjiu Pang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, China
| |
Collapse
|
89
|
Salouti R, Khosravi A, Fardaei M, Zamani M, Nejabat M, Ghoreyshi M, Yazdanpanah M, Salouti K, Nowroozzadeh MH. Inferior Spear-like Lens Opacity as a Sign of Keratoconus. J Ophthalmic Vis Res 2022; 17:12-18. [PMID: 35194491 PMCID: PMC8850847 DOI: 10.18502/jovr.v17i1.10165] [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: 05/30/2020] [Accepted: 03/11/2021] [Indexed: 11/24/2022] Open
Abstract
Purpose To report 21 cases of typical inferior feather-shape lens opacity associated with keratoconus. Methods In this cross-sectional study, we evaluated the association of keratoconus with inferior feather-shape lens opacity in refractive surgery candidates. Visual acuity, demographic, refractive, and topographic characteristics of 26 eyes of 21 patients with inferior feather-shape lens opacity were evaluated in detail. Pedigree analysis was also performed to assess possible inheritance. Results Overall, 2122 out of 33,368 cases (6.4%) without lens opacity had keratoconus, while 20 out of 21 patients (95.2%) with peculiar lens opacity had definite keratoconus (P < 0.001). Lens opacity was bilateral in 5 cases (24%), and keratoconus was bilateral in all 20 patients with lens opacity. Nine eyes out of thirty-six with a complete data record (25%) had a severe keratoconus and underwent deep lamellar keratoplasty, while 11 (31%) had forme fruste keratoconus. Pedigrees were drawn for eight patients, most families of whom suggested an X-linked recessive inheritance. Conclusion The present study was the first to investigate patients with a peculiar inferior feather-shape lens opacity accompanied by bilateral keratoconus, which was observed in 95% of the patients. This finding should raise awareness as to the possibility of diagnosing keratoconus in the eyes of the patients with these characteristics.
Collapse
Affiliation(s)
- Ramin Salouti
- Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran
| | - Amir Khosravi
- Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Majid Fardaei
- Department of Medical Genetics, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Zamani
- Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran
| | - Mahmoud Nejabat
- Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Ghoreyshi
- Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran.,Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Kia Salouti
- Science Department, The university of British Columbia, Vancouver, Canada
| | - M Hossein Nowroozzadeh
- Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Salouti Cornea Research Center, Salouti Eye Clinic, Shiraz, Iran.,Department of Medical Genetics, Shiraz University of Medical Sciences, Shiraz, Iran.,Health Policy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.,Science Department, The university of British Columbia, Vancouver, Canada
| |
Collapse
|
90
|
Ultraviolet crosslinking of corneal collagen in patients with thin cornea. Literature review. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.6-1.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
For the treatment of progressive keratoconus in the early stages, corneal collagen crosslinking is currently actively used. This technique is based on the stabilization of the pathological process by increasing the biomechanical properties of the own cornea. The thickness of the cornea less than 400 microns significantly limits the possibility of a standard cross-linking procedure performing.The article analyzes the literature data on the use of various methods of corneal crosslinking with a corneal thickness of less than 400 microns, which signifi cantly limits the possibilities of the standard procedure.It is known, that during crosslinking, at the initial stage, de-epithelialization of the cornea is performed, which, in the postoperative period, leads to a pronounced corneal syndrome. This determined the direction of the fi rst modifi cations of the technique associated with the use of partial de-epithelialization or its complete absence. Later, during cross-linking of “thin” corneas, techniques with the use of additional covering materials were actively used in order to replenish the missing corneal tissue of the patient during the UV irradiation procedure. Among them are the use of a soft contact lens without an ultraviolet fi lter, the use of a corneal lenticule obtained after SMILE surgery, the use of a protective fl ap of the donor cornea obtained using a femtosecond laser from the residual stroma of the corneal disc after descemet membrane transplantation or posterior lamellar keratoplasty. The variety of the proposed modifications and the ongoing search for better options indicate the demand for this technology and the need for further research, taking into account the individual characteristics of the patient’s ectasia.
Collapse
|
91
|
[Histological changes in keratoconus and wound healing after corneal cross-linking]. Ophthalmologe 2021; 119:342-349. [PMID: 34874483 DOI: 10.1007/s00347-021-01537-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Keratoconus is classified as a corneal ectasia and is a multifactorial disease. In those affected, mostly adolescent patients visual deterioration occurs due to the development of irregular astigmatism. Treatment by corneal cross-linking (CXL) has been indicated in progressive disease for several years. OBJECTIVE To present the pathophysiology and histological changes in keratoconus as well as wound healing processes after CXL and their potential complications. MATERIAL AND METHODS Histological changes in keratoconus as well as wound healing processes after CXL and their potential complications are presented based on histological examination of corneal specimens with keratoconus with and without a condition after CXL. Relevant literature and own data are analyzed and discussed. RESULTS Besides inflammatory processes, atopic and genetic dispositions play a role in the development of keratoconus. The histological characteristics of keratoconus include changes in the epithelium, Bowman's layer and stroma. Wound healing processes after CXL include healing of the surface epithelium and transient loss of keratocytes and nerve fibers. CONCLUSION Keratoconus shows characteristic histopathological changes, such as epithelial irregularities, stromal thinning and breaks of Bowman's layer, whereas the endothelium and Descemet's membrane remain unchanged (apart from cases of corneal hydrops). After CXL wound healing processes can be followed primarily in vivo by confocal microscopy. Complications after CXL are rare. Persistent loss of keratocytes can be clinically manifested as a visually relevant scar.
Collapse
|
92
|
Meteoukki W, Fodil M, Negaz NA, Rahmoun N, Hetraf SL, Djellouli HO, Messal AD, Abdi M, Aberkane MS, Chiali A, Derdour A, Idder A, -Fodil FZ. Association of IL4 rs2070874, FoxP3 rs3761548 Polymorphisms with Keratoconus in Algeria. J Ophthalmic Vis Res 2021; 16:558-565. [PMID: 34840678 PMCID: PMC8593538 DOI: 10.18502/jovr.v16i4.9745] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 04/15/2021] [Indexed: 01/10/2023] Open
Abstract
Purpose The aim of this case–control study was to determine the impact of environmental factors on the predisposition to develop keratoconus in a sample of Western Algerian population. Subsequently, we were interested in the implication of two single nucleotide polymorphisms (SNPs) IL4 rs2070874 and FOXP3 rs3761548, previously described as contributing to the occurrence of allergy, in the development of keratoconus. Methods The study included 70 unrelated KC cases and 70 controls originating from Western Algeria. DNA genotyping was done using predesigned probe-based allelic discrimination TaqManⓇ assays. Allele and genotype frequencies were compared between the cases and controls by Chi-square test and odds ratios with 95% confidence intervals. Results A significant association between risk factors such as family history, atopy, eye rubbing, and the development of keratoconus was found in our sample. Smoking would provide a protective effect against the pathology. No statistically significant differences were found in the allele and genotype frequencies between cases and controls neither for IL4 rs2070874 nor for FOXP3 rs3761548. Conclusion Our study provides, for the first time, a clear demonstration of the absence of association of the allergy-associated IL4 and FOXP3 polymorphisms with KC in a sample from Western Algerian population.
Collapse
Affiliation(s)
- Wafaa Meteoukki
- Laboratoire de Génétique Moléculaire et Cellulaire (LGMC), Université des Sciences et de la Technologie d'Oran Mohamed BOUDIAF- USTO-MB, BP 1505, El M'naouer, 31000 Oran, Algérie.,Agence Thématique de Recherche en Sciences de la Santé (ATRSS)- Oran, Algérie
| | - Mostefa Fodil
- Agence Thématique de Recherche en Sciences de la Santé (ATRSS)- Oran, Algérie.,Ecole Supérieure des Sciences Biologiques d'Oran (ESSBO)
| | - Nawel Adda Negaz
- Agence Thématique de Recherche en Sciences de la Santé (ATRSS)- Oran, Algérie.,Clinique Chiali, Oran, Algérie
| | - Nesrine Rahmoun
- Laboratoire de Génétique Moléculaire et Cellulaire (LGMC), Université des Sciences et de la Technologie d'Oran Mohamed BOUDIAF- USTO-MB, BP 1505, El M'naouer, 31000 Oran, Algérie
| | - Sarah Lardjam Hetraf
- Laboratoire de Génétique Moléculaire et Cellulaire (LGMC), Université des Sciences et de la Technologie d'Oran Mohamed BOUDIAF- USTO-MB, BP 1505, El M'naouer, 31000 Oran, Algérie
| | - Hadjira Ouhaibi Djellouli
- Laboratoire de Génétique Moléculaire et Cellulaire (LGMC), Université des Sciences et de la Technologie d'Oran Mohamed BOUDIAF- USTO-MB, BP 1505, El M'naouer, 31000 Oran, Algérie
| | - Ahlem Djelti Messal
- Laboratoire de Génétique Moléculaire et Cellulaire (LGMC), Université des Sciences et de la Technologie d'Oran Mohamed BOUDIAF- USTO-MB, BP 1505, El M'naouer, 31000 Oran, Algérie
| | - Meriem Abdi
- Laboratoire de Génétique Moléculaire et Cellulaire (LGMC), Université des Sciences et de la Technologie d'Oran Mohamed BOUDIAF- USTO-MB, BP 1505, El M'naouer, 31000 Oran, Algérie
| | - Meriem Samia Aberkane
- Laboratoire de Génétique Moléculaire et Cellulaire (LGMC), Université des Sciences et de la Technologie d'Oran Mohamed BOUDIAF- USTO-MB, BP 1505, El M'naouer, 31000 Oran, Algérie
| | | | - Amine Derdour
- Laboratoire de Génétique Médicale Appliquée à l'Ophtalmologie, Clinique Hammou Boutlélis Oran, Algérie
| | - Aicha Idder
- Agence Thématique de Recherche en Sciences de la Santé (ATRSS)- Oran, Algérie.,Laboratoire de Génétique Médicale Appliquée à l'Ophtalmologie, Clinique Hammou Boutlélis Oran, Algérie
| | - Faouzia Zemani -Fodil
- Laboratoire de Génétique Moléculaire et Cellulaire (LGMC), Université des Sciences et de la Technologie d'Oran Mohamed BOUDIAF- USTO-MB, BP 1505, El M'naouer, 31000 Oran, Algérie.,Agence Thématique de Recherche en Sciences de la Santé (ATRSS)- Oran, Algérie
| |
Collapse
|
93
|
Femtosecond Laser and Mechanical Dissection for ICRS and MyoRing Implantation: A Meta-Analysis. Cornea 2021; 41:518-537. [PMID: 34839335 DOI: 10.1097/ico.0000000000002937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The aims of this meta-analysis were to evaluate the results of intracorneal ring segments (ICRSs) and MyoRing in the management of corneal ectasia and to compare the clinical outcomes and complication rates between mechanical and femtosecond (FS) laser-assisted surgery. METHODS An online electronic search was performed for pre-post studies published until April 2020. Uncorrected distance visual acuity, corrected distance visual acuity, sphere, cylinder, spherical equivalent, steep, flat, and mean keratometry values were considered as outcomes. Weighted mean difference with 95% confidence interval was used as a pooled estimation of intervention efficacy. RESULTS Of 1484 potentially related studies, 115 studies were finally included in the meta-analysis. Findings of this meta-analysis demonstrated considerable improvement in visual, refractive, and keratometric outcomes in all ICRS models and MyoRing. Intrastromal tunnel creation with both methods yielded similar results. Complication rates were without exception higher when mechanical dissection was used. CONCLUSIONS ICRS and MyoRing are appropriate treatment options for patients with corneal ectasia. Both techniques for tunnel creation are efficacious in achieving good visual, keratometric, and refractive results. Mechanical intrastromal tunnel creation is associated with much higher complication rates when compared with FS laser-assisted technique.
Collapse
|
94
|
Abstract
In this study, corneal findings regarding keratoconus (KC) and early KC among mothers with Down syndrome children (MDS) and a group of age-at-delivery-matched mothers with normal children (MNC) were compared. KC was diagnosed based on the presence of a clinical sign and at least one abnormal tomographic or biomechanical criterion. Early KC was defined as having no clinical sign in the presence of at least one abnormal tomographic or biomechanical criterion. The normal subgroups in each group were compared in terms tomographic and biomechanical parameters. In MDS and MNC, the prevalence rates were 6.5% and 1.6% for KC (P = 0.047), and 30.9% and 14.3% for early KC (P = 0.014), respectively. Comparison between the two normal subgroups showed significant differences in mean index of height asymmetry, irregularity index, anterior asphericity, pentacam random forest index, corneal stiffness parameters at first applanation, deformation amplitude ratios, integrated radius-1 mm, highest concavity deflection amplitude, biomechanical corrected IOP, peak distance, and radius (all P < 0.05). This study showed that MDS are more likely to have KC and also to have thinner, steeper and softer corneas compared to MNC. This results support the need for further work for determining the risk of delivering a child with DS.
Collapse
|
95
|
Sharif W, Elubous KA, Sharif Z, AlRyalat SA, Al Hawamdeh HE, Abu-Rumaileh MA, Khanfar A, Al Bdour MD, Ababneh OH. Association Between Keratoconus and Shoulder Dislocation: A Cross-Sectional Study. Cureus 2021; 13:e19279. [PMID: 34754705 PMCID: PMC8570123 DOI: 10.7759/cureus.19279] [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] [Accepted: 11/05/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Few studies have highlighted the correlation between shoulder dislocation and keratoconus (KC). This study aimed to examine the association between KC and shoulder dislocation using patients with KC and matched controls. Methods This cross-sectional study was conducted at Jordan University Hospital. We included patients diagnosed with KC from Jordan University Hospital's Ophthalmology Department between 2015 and 2018. We also included age- and sex-matched controls recruited randomly from fitness centers and shopping malls. All participants had complete ophthalmic and orthopedic assessments. KC was diagnosed by clinical examination followed by Pentacam (Scheimpflug Images, Oculyzer, WaveLight, Alcon, USA) confirmation. Results A total of 238 patients, with a mean age of 29.53 (±11.20) years, were included in this study. They were 144 (60.5%) men and 94 (39.5%) women. Moreover, 120 (50.4%) had KC while 118 (49.6%) did not have KC. Only 11 (4.6%) patients had previous shoulder dislocation. We did not find a significant difference in the frequency of shoulder dislocation between patients with and without KC (p = 0.512). Conclusion This study provides further evidence on the lack of association between shoulder dislocation and KC, an association that was presumed due to shared collagen characteristics.
Collapse
Affiliation(s)
- Walid Sharif
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Khaled A Elubous
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Zuhair Sharif
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Saif Aldeen AlRyalat
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Hashem E Al Hawamdeh
- Department of Orthopaedics, Jordan University Hospital/The University of Jordan, Amman, JOR
| | | | - Aws Khanfar
- Department of Orthopaedics, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Muawyah D Al Bdour
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| | - Osama H Ababneh
- Department of Ophthalmology, Jordan University Hospital/The University of Jordan, Amman, JOR
| |
Collapse
|
96
|
Ates KM, Estes AJ, Liu Y. Potential underlying genetic associations between keratoconus and diabetes mellitus. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2021; 1:100005. [PMID: 34746916 PMCID: PMC8570550 DOI: 10.1016/j.aopr.2021.100005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 08/18/2021] [Accepted: 08/29/2021] [Indexed: 12/14/2022]
Abstract
Background Keratoconus (KC) is the most common ectatic corneal disease, characterized by significantly localized thinning of the corneal stroma. Genetic, environmental, hormonal, and metabolic factors contribute to the pathogenesis of KC. Additionally, multiple comorbidities, such as diabetes mellitus, may affect the risk of KC. Main Body Patients with diabetes mellitus (DM) have been reported to have lower risk of developing KC by way of increased endogenous collagen crosslinking in response to chronic hyperglycemia. However, this remains a debated topic as other studies have suggested either a positive association or no association between DM and KC. To gain further insight into the underlying genetic components of these two diseases, we reviewed candidate genes associated with KC and central corneal thickness in the literature. We then explored how these genes may be regulated similarly or differentially under hyperglycemic conditions and the role they play in the systemic complications associated with DM. Conclusion Our comprehensive review of potential genetic factors underlying KC and DM provides a direction for future studies to further determine the genetic etiology of KC and how it is influenced by systemic diseases such as diabetes.
Collapse
Affiliation(s)
- Kristin M. Ates
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Amy J. Estes
- Department of Ophthalmology, Medical College of Georgia, Augusta University, Augusta, GA, USA
- James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Yutao Liu
- Department of Cellular Biology and Anatomy, Medical College of Georgia, Augusta University, Augusta, GA, USA
- James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| |
Collapse
|
97
|
Gurnani B, Kaur K, Tripathy K. Is there a genetic link between Keratoconus and Fuch's endothelial corneal dystrophy? Med Hypotheses 2021; 157:110699. [PMID: 34666260 DOI: 10.1016/j.mehy.2021.110699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 09/19/2021] [Accepted: 10/04/2021] [Indexed: 10/20/2022]
Abstract
Keratoconus (KC) is a noninflammatory, bilateral, progressive corneal stromal thinning disorder that leads to corneal ectasia, central anterior corneal stromal scarring, irregular myopic astigmatism, and reduced visual acuity. Fuchs endothelial corneal dystrophy (FECD) is bilateral, sporadic, or autosomal dominant, non-inflammatory, dystrophy involving the corneal endothelium. As the dystrophy evolves, the major complaints include glare, halos, and reduced visual acuity. Very rarely, both the pathologies can co-exist in the same patient. After the initial report of KC with FECD, there have been nearly 70 cases of coexistence reported in the literature till now. The reported number of cases varies from region to region and the majority of cases have no documented family history, hence it is difficult to approximate the incidence and prevalence based on the available literature. Hence, we hypothesize that both pathologies have probably the same genetic link. Available literature supporting the hypothesis has been discussed. We have also discussed various probable mechanisms of coexistence and proposed a management algorithm while assessing and attempting surgery in these patients. We also propose that all these patients must undergo genetic screening and counselling to prevent the spread of these pathologies in future generations.
Collapse
Affiliation(s)
- Bharat Gurnani
- Consultant Cataract, Cornea and Refractive Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry 605007, India
| | - Kirandeep Kaur
- Consultant Cataract, Pediatric Ophthalmology and Squint Services, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Pondicherry 605007, India
| | - Koushik Tripathy
- Consultant Retina and Uvea Services, ASG Eye Hospital, Kolkata, India
| |
Collapse
|
98
|
Cao K, Verspoor K, Chan E, Daniell M, Sahebjada S, Baird PN. Machine learning with a reduced dimensionality representation of comprehensive Pentacam tomography parameters to identify subclinical keratoconus. Comput Biol Med 2021; 138:104884. [PMID: 34607273 DOI: 10.1016/j.compbiomed.2021.104884] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 12/26/2022]
Abstract
PURPOSE To investigate the performance of a machine learning model based on a reduced dimensionality parameter space derived from complete Pentacam parameters to identify subclinical keratoconus (KC). METHODS All 1692 available parameters were obtained from the Pentacam imaging machine on 145 subclinical KC and 122 control eyes. We applied a principal component analysis (PCA) to the complete Pentacam dataset to reduce its parameter dimensionality. Subsequently, we investigated machine learning performance of the random forest algorithm with increasing numbers of components to identify their optimal number for detecting subclinical KC from control eyes. RESULTS The dimensionality of the complete set of 1692 Pentacam parameters was reduced to 267 principal components using PCA. Subsequent selection of 15 of these principal components explained over 85% of the variance of the original Pentacam-derived parameters and input to train a random forest machine learning model to achieve the best accuracy of 98% in detecting subclinical KC eyes. The model established also reached a high sensitivity of 97% in identification of subclinical KC and a specificity of 98% in recognizing control eyes. CONCLUSIONS A random forest-based model trained using a modest number of components derived from a reduced dimensionality representation of complete Pentacam system parameters allowed for high accuracy of subclinical KC identification.
Collapse
Affiliation(s)
- Ke Cao
- Centre for Eye Research Australia, Melbourne, Victoria, Australia; Department of Surgery, Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Verspoor
- School of Computing Technologies, RMIT University, Melbourne, Australia; School of Computing and Information Systems, The University of Melbourne, Melbourne, Australia
| | - Elsie Chan
- Centre for Eye Research Australia, Melbourne, Victoria, Australia; Department of Surgery, Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia; Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Mark Daniell
- Centre for Eye Research Australia, Melbourne, Victoria, Australia; Department of Surgery, Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia; Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
| | - Srujana Sahebjada
- Centre for Eye Research Australia, Melbourne, Victoria, Australia; Department of Surgery, Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Paul N Baird
- Department of Surgery, Ophthalmology, The University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
99
|
Navel V, Malecaze J, Pereira B, Baker JS, Malecaze F, Sapin V, Chiambaretta F, Dutheil F. Oxidative and antioxidative stress markers in keratoconus: a systematic review and meta-analysis. Acta Ophthalmol 2021; 99:e777-e794. [PMID: 33354927 DOI: 10.1111/aos.14714] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis on the levels of oxidative stress markers and antioxidants in keratoconus compared to healthy subject. METHOD The PubMed, Cochrane Library, Embase, Science Direct and Google Scholar databases were searched on 1st June 2020 for studies reporting oxidative and antioxidative stress markers in keratoconus and healthy controls. Main meta-analysis was stratified by type of biomarkers, type of samples (tears, cornea, aqueous humour and blood) and type of corneal samples (stromal cells, epithelium and endothelium). RESULTS We included 36 articles, for a total of 1328 keratoconus patients and 1208 healthy controls. There is an overall increase in oxidative stress markers in keratoconus compared with healthy controls (standard mean deviation (SMD) = 0.94, 95% confidence interval (95% CI) 0.55-1.33), with a significant increase in reactive oxygen and nitrogen species (1.09, 0.41-1.78) and malondialdehyde (1.78, 0.83-2.73). There is an overall decrease in antioxidants in keratoconus compared with healthy controls (-0.63, -0.89 to -0.36), with a significant decrease in total antioxidant capacity/status (-1.65, -2.88 to -0.43), aldehyde/NADPH dehydrogenase (-0.77, -1.38 to -0.17), lactoferrin/transferrin/albumin (-1.92, -2.96 to -0.89) and selenium/zinc (-1.42, -2.23 to -0.61). Oxidative stress markers were higher in tears and in cornea of keratoconus than in aqueous humour, and antioxidants were decreased in tears, aqueous humour and blood without difference between sample type. Oxidative stress markers increased in stromal cells and antioxidants decreased in endothelium. CONCLUSION Oxidative stress markers and antioxidants were dysregulated in keratoconus, involving an imbalance of redox homeostasis in tears, cornea, aqueous humour and blood.
Collapse
Affiliation(s)
- Valentin Navel
- Ophthalmology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
| | - Jean Malecaze
- Ophthalmology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
| | - Bruno Pereira
- Clinical Research and Innovation Direction CHU Clermont–Ferrand University Hospital of Clermont Ferrand Clermont‐Ferrand France
| | - Julien S. Baker
- Department of Sport, Physical Education and Health Centre for Health and Exercise Science Research Hong Kong Baptist University Kowloon Tong Hong Kong
| | - François Malecaze
- Ophthalmology Department Pierre‐Paul Riquet Hospital University Hospital of Toulouse Toulouse France
| | - Vincent Sapin
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
- Medical Biochemistry and Molecular Biology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
| | - Frédéric Chiambaretta
- Ophthalmology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
| | - Frédéric Dutheil
- Preventive and Occupational Medicine CNRS, LaPSCo Physiological and Psychosocial Stress CHU Clermont‐Ferrand Université Clermont Auvergne University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
| |
Collapse
|
100
|
Baudin F, Chemaly A, Arnould L, Barrénéchea E, Lestable L, Bron AM, Creuzot-Garcher C. Quality-of-Life Improvement After Scleral Lens Fitting in Patients With Keratoconus. Eye Contact Lens 2021; 47:520-525. [PMID: 34261868 DOI: 10.1097/icl.0000000000000821] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To assess the quality-of-life improvement after scleral lens fitting in patients with keratoconus. METHODS We conducted a prospective observational study of all consecutive patients with keratoconus starting scleral lens fitting in 2019, from January 2 to December 27, at the Dijon University Hospital, France. Quality of life was assessed before and after wearing scleral lenses for 3 months through the National Eye Institute Visual Function Questionnaire 25 (NEI-VFQ 25) questionnaire. We investigated factors potentially influencing quality of life: final visual acuity, keratoconus stage, and maximum keratometry reading. RESULTS In total, 41 eyes of 24 patients were successfully fitted with scleral lenses, 92.9% were 18 mm in diameter and 7.1% were 17 mm. The visual acuity improved by -0.4±0.3 logarithm of the minimum angle of resolution (P<0.001) after scleral lens fitting. Visual gain increased with keratometry and keratoconus severity (P<0.001; P<0.01). The NEI-VFQ 25 score increased by 19.5±19.1 points on average (P<0.001). No association was found between the factors under study and improvement in quality of life. CONCLUSION Our study confirms the functional improvement in patients with keratoconus fitted with scleral lenses, especially in patients with more advanced disease. Moreover, it suggests a major role of these lenses in improving quality of life, independently of the severity of the disease and the visual gain.
Collapse
Affiliation(s)
- Florian Baudin
- Department of Ophthalmology (F.B., A.C., L.A., E.B., L.L., A.M.B., C.C.-G.), University Hospital, Dijon, France ; Clinical Epidemiology/Clinical Trials Unit (F.B., L.A.), INSERM, CIC1432, Clinical Investigation Center, Dijon University Hospital, Dijon, France ; Taste and Food Science Centre (L.A., A.M.B., C.C.-G.), AgroSup Dijon, CNRS, INRAE, Bourgogne Franche-Comté University, Dijon, France; and EA7460 (F.B.), PEC2, Cerebral and Cardiovascular Epidemiology and Physiopathology, Dijon, France
| | | | | | | | | | | | | |
Collapse
|