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Leclaire MD, Storp JJ, Lahme L, Esser EL, Eter N, Alnawaiseh M. Reduced Retinal Blood Vessel Densities Measured by Optical Coherence Tomography Angiography in Keratoconus Patients Are Negatively Correlated with Keratoconus Severity. Diagnostics (Basel) 2024; 14:707. [PMID: 38611620 PMCID: PMC11011292 DOI: 10.3390/diagnostics14070707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Revised: 03/15/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Keratoconus (KC) is the most common corneal ectasia. Optical coherence tomography angiography (OCT-A) is a relatively new non-invasive imaging technique that allows the visualization and quantification of retinal and choriocapillary blood vessels. The aim of this study is to assess retinal and choriocapillary vessel density (VD) differences between KC patients and healthy controls and to investigate correlations between VD and KC severity. Fifty-two eyes were included in this exploratory study: twenty-six eyes from 26 KC patients and twenty-six eyes from 26 age- and gender-matched healthy controls. All patients underwent Scheimpflug corneal topography with Pentacam, axis lengths measurement and optical coherence tomography angiography (OCT-A). The thinnest spot in corneal pachymetry, maximum K (Kmax) and KC severity indices from the Belin/Ambrósio enhanced ectasia display (BAD) were also assessed. There was a distinct reduction particularly in the retinal VD of the superficial capillary plexus (SCP). Correlation analyses showed strong and moderate negative correlations between the VD in the macular SCP and BAD KC scores and between the SCP VD and Kmax. There was no difference in retinal thickness between the KC and healthy controls. With this study, further evidence for altered VD measurements by OCT-A in KC patients is given. For the first time, we demonstrated negative correlations between BAD KC scores and retinal blood vessel alterations. A major limitation of the study is the relatively small sample size. Since an artefactual reduction of the quantitative OCT-A measurements due to irregular corneal topography in KC must be assumed, it remains to be investigated whether there are also actual changes in the retinal microcirculation in KC.
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Affiliation(s)
- Martin Dominik Leclaire
- Department of Ophthalmology, University Medical Center Münster, 48149 Münster, Germany; (J.J.S.); (E.L.E.); (N.E.)
| | - Jens Julian Storp
- Department of Ophthalmology, University Medical Center Münster, 48149 Münster, Germany; (J.J.S.); (E.L.E.); (N.E.)
| | - Larissa Lahme
- Department of Ophthalmology, University Medical Center Münster, 48149 Münster, Germany; (J.J.S.); (E.L.E.); (N.E.)
| | - Eliane Luisa Esser
- Department of Ophthalmology, University Medical Center Münster, 48149 Münster, Germany; (J.J.S.); (E.L.E.); (N.E.)
| | - Nicole Eter
- Department of Ophthalmology, University Medical Center Münster, 48149 Münster, Germany; (J.J.S.); (E.L.E.); (N.E.)
| | - Maged Alnawaiseh
- Department of Ophthalmology, Klinikum Bielefeld gem. GmbH, 33647 Bielefeld, Germany
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Miao YY, Ma XM, Qu ZX, Eliasy A, Wu BW, Xu H, Wang P, Zheng XB, Wang JJ, Ye YF, Chen SH, Elsheikh A, Bao FJ. Performance of Corvis ST Parameters Including Updated Stress-Strain Index in Differentiating Between Normal, Forme-Fruste, Subclinical, and Clinical Keratoconic Eyes. Am J Ophthalmol 2024; 258:196-207. [PMID: 37879454 DOI: 10.1016/j.ajo.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 10/18/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE This study seeks to evaluate the ability of the updated stress strain index (SSIv2) and other Corvis ST biomechanical parameters in distinguishing between keratoconus at different disease stages and normal eyes. DESIGN Diagnostic accuracy analysis to distinguish disease stages. METHODS 1084 eyes were included and divided into groups of normal (199 eyes), forme fruste keratoconus (FFKC, 194 eyes), subclinical keratoconus (SKC, 113 eyes), mild clinical keratoconus (CKC-Ⅰ, 175 eyes), moderate clinical keratoconus (CKC-Ⅱ, 204 eyes), and severe clinical keratoconus (CKC-Ⅲ, 199 eyes). Each eye was subjected to a Corvis ST examination to determine the central corneal thickness (CCT), biomechanically corrected intraocular pressure (bIOP), SSIv2 (updated stress-strain index), and other 8 Corvis parameters including the stress-strain index (SSIv1), stiffness parameter at first applanation (SP-A1), first applanation time (A1T), Ambrósio relational thickness to the horizontal profile (ARTh), integrated inverse radius (IIR), maximum deformation amplitude (DAM), ratio between deformation amplitude at the apex and at 2 mm nasal and temporal (DARatio2), and Corvis biomechanical index (CBI). The sensitivity and specificity of these parameters in diagnosing keratoconus were analyzed through receiver operating characteristic curves. RESULTS Before and after correction for CCT and bIOP, SSIv2 and ARTh were significantly higher and IIR and CBI were significantly lower in the normal group than in the FFKC group, SKC group and the 3 CKC groups (all P < .05). There were also significant correlations between the values of SSIv2, ARTh, IIR, CBI, and the CKC severity (all P < .05). AUC of SSIv2 was significantly higher than all other Corvis parameters in distinguishing normal eyes from FFKC, followed by IIR, ARTh and CBI. CONCLUSION Corvis ST's updated stress-strain index, SSIv2, demonstrated superior performance in differentiating between normal and keratoconic corneas, and between corneas with different keratoconus stages. Similar, but less pronounced, performance was demonstrated by the IIR, ARTh and CBI.
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Affiliation(s)
- Yuan-Yuan Miao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University (Y.-Y.M., Z.-X.Q., B.-W.W., H.X., P.W., X.-B.Z., J.-J.W., Y.-F.Y., S.-H.C., F.-J.B), Wenzhou, Zhejiang, China
| | - Xiao-Min Ma
- Shanghai Eighth People's Hospital (X.-M.M.), Shanghai, China
| | - Zhan-Xin Qu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University (Y.-Y.M., Z.-X.Q., B.-W.W., H.X., P.W., X.-B.Z., J.-J.W., Y.-F.Y., S.-H.C., F.-J.B), Wenzhou, Zhejiang, China
| | - Ashkan Eliasy
- School of Engineering, University of Liverpool (A.Eli., A.Els.), Liverpool, United Kingdom
| | - Bo-Wen Wu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University (Y.-Y.M., Z.-X.Q., B.-W.W., H.X., P.W., X.-B.Z., J.-J.W., Y.-F.Y., S.-H.C., F.-J.B), Wenzhou, Zhejiang, China
| | - Hui Xu
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University (Y.-Y.M., Z.-X.Q., B.-W.W., H.X., P.W., X.-B.Z., J.-J.W., Y.-F.Y., S.-H.C., F.-J.B), Wenzhou, Zhejiang, China
| | - Pu Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University (Y.-Y.M., Z.-X.Q., B.-W.W., H.X., P.W., X.-B.Z., J.-J.W., Y.-F.Y., S.-H.C., F.-J.B), Wenzhou, Zhejiang, China
| | - Xiao-Bo Zheng
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University (Y.-Y.M., Z.-X.Q., B.-W.W., H.X., P.W., X.-B.Z., J.-J.W., Y.-F.Y., S.-H.C., F.-J.B), Wenzhou, Zhejiang, China; The Institute of Ocular Biomechanics, Wenzhou Medical University (X.-B.Z., J.-J.W., S.-H.C., F.-J.B.), Wenzhou, Zhejiang, China
| | - Jun-Jie Wang
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University (Y.-Y.M., Z.-X.Q., B.-W.W., H.X., P.W., X.-B.Z., J.-J.W., Y.-F.Y., S.-H.C., F.-J.B), Wenzhou, Zhejiang, China; The Institute of Ocular Biomechanics, Wenzhou Medical University (X.-B.Z., J.-J.W., S.-H.C., F.-J.B.), Wenzhou, Zhejiang, China
| | - Yu-Feng Ye
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University (Y.-Y.M., Z.-X.Q., B.-W.W., H.X., P.W., X.-B.Z., J.-J.W., Y.-F.Y., S.-H.C., F.-J.B), Wenzhou, Zhejiang, China
| | - Shi-Hao Chen
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University (Y.-Y.M., Z.-X.Q., B.-W.W., H.X., P.W., X.-B.Z., J.-J.W., Y.-F.Y., S.-H.C., F.-J.B), Wenzhou, Zhejiang, China; The Institute of Ocular Biomechanics, Wenzhou Medical University (X.-B.Z., J.-J.W., S.-H.C., F.-J.B.), Wenzhou, Zhejiang, China.
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool (A.Eli., A.Els.), Liverpool, United Kingdom; National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology (A.Els.), London, United Kingdom; Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University (A.Els.), Beijing, China
| | - Fang-Jun Bao
- National Clinical Research Center for Ocular Diseases, Eye Hospital, WenZhou Medical University (Y.-Y.M., Z.-X.Q., B.-W.W., H.X., P.W., X.-B.Z., J.-J.W., Y.-F.Y., S.-H.C., F.-J.B), Wenzhou, Zhejiang, China; The Institute of Ocular Biomechanics, Wenzhou Medical University (X.-B.Z., J.-J.W., S.-H.C., F.-J.B.), Wenzhou, Zhejiang, China.
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Tran TM, Mittal A, Naik V, Chhadva P, Wade M, Garg S. Prevalence of subclinical keratoconus and impact on adults undergoing routine, uncomplicated age-related cataract extraction. FRONTIERS IN OPHTHALMOLOGY 2023; 3:1269439. [PMID: 38983071 PMCID: PMC11182208 DOI: 10.3389/fopht.2023.1269439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 07/11/2024]
Abstract
Aim To determine the prevalence of subclinical keratoconus (SKCN) among individuals undergoing routine, uncomplicated age-related cataract surgery and its impact on visual and refractive outcomes. Patient and Methods At a major academic ophthalmology department in the United States, we reviewed records of patients aged 50 years and older who underwent surgery from January 2011 to June 2022. We excluded patients who had poor-quality or unreliable tomographic data, previous corneal surgery, keratorefractive procedures, and significant vision-limiting ocular pathology. We defined SKCN if an eye had a Belin-Ambrósio enhanced ectasia index (BAD-D) ≥1.7, which was based on the results of a meta-analysis of large studies. In addition to the BAD-D cutoff, the eye had to deviate significantly on at least one of seven additional parameters: 1) posterior elevation at thinnest point, 2) index of vertical asymmetry, 3) index of surface variation, 4) total front higher order aberrations, 5) front vertical coma, 6) front secondary vertical coma, 7) back vertical coma. An individual had SKCN if at least one eye met the tomography-based classification and did not have manifest KCN in either eye. Visual and refractive outcomes data were acquired from patients of one experienced cataract surgeon with cases done from July 2021 to June 2022. Statistical significance was set at p < 0.05. Results Among 5592 eyes from 3828 individuals, the prevalence of SKCN was 24.7% (95% CI, 23.4 - 26.1, 945 individuals), and the prevalence of KCN was 1.9% (95% CI, 1.6 - 2.4, 87 individuals). The prevalence of SKCN did not increase with age and was more prevalent among females and non-white races. Median post-operative month one distance-corrected visual acuity (DCVA) and proportion of eyes with improvement in DCVA were similar between normal and SKCN eyes. The proportion of eyes reaching ±0.5 and ±1.0 diopter within the refractive target were similar between normal and SKCN eyes. Conclusion SKCN is highly prevalent and should be detected but is unlikely to have a significant deleterious effect on outcomes in routine, uncomplicated cataract surgery.
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Affiliation(s)
- Tu M Tran
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, MN, United States
| | - Aman Mittal
- Dean McGee Eye Institute, University of Oklahoma, Oklahoma, OK, United States
| | - Vihar Naik
- School of Medicine, University of California, Irvine, Irvine, CA, United States
| | - Priyanka Chhadva
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, United States
| | - Matthew Wade
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, United States
| | - Sumit Garg
- Gavin Herbert Eye Institute, University of California, Irvine, Irvine, CA, United States
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