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Ye H, Tang R, Fang W, Di Y, Qiao T. Clinical outcomes of posterior scleral reinforcement in Chinese high myopia children. Sci Rep 2024; 14:16479. [PMID: 39013945 PMCID: PMC11252263 DOI: 10.1038/s41598-024-67078-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 07/08/2024] [Indexed: 07/18/2024] Open
Abstract
We aim to observe the posterior scleral reinforcement (PSR) clinical outcomes of children with high myopia and analyze the retinal vessel alteration before and after PSR by using angiography optical coherence tomography (angio-OCT). Fifty-six pediatric participants (112 eyes) clinically diagnosed high myopia were recruited and were treated by PSR in Shanghai Children's Hospital from June 1, 2021 to May 1, 2023. The average age ranged from 5.42 to 14.83 years (mean 8.83 years) and mean follow up duration was 8.7 months (3-24 months). The axial length (AL) was significantly shortened after PSR (p < 0.05). The spherical equivalent (SE) and the best-corrected visual acuity (BCVA) were also improved without severe rejection in the follow-up. Compared with baseline, angio-OCT parafoveal vessel indices including vascular area density (VAD) and vascular skeleton density (VSD) on the superficial capillary plexus layer (SCPL), as well as VAD and vessel perimeter index (VPI) on the deep capillary plexus layer (DCPL), were significantly increased after PSR surgery (p < 0.05). VPI on the SCPL, vascular diameter index (VDI) and VSD on the DCPL were also improved without statistical difference after PSR. The VSD on SCPL, VAD on DCPL of the right eyes and the VPI on SCPL of the left eyes were significantly increased after PSR (p < 0.05). PSR surgery can shorten the AL and can stable BCVA and SE in high myopia children. The angio-OCT parameters indicated that the retinal microcirculation supply was significantly improved after PSR.
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Affiliation(s)
- Haiyun Ye
- Department of Ophthalmology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Ruizhi Tang
- Ghent University Centre for X-Ray Tomography (UGCT), Proeftuinstraat 86/N12, 9000, Ghent, Belgium
| | - Wangyi Fang
- Department of Ophthalmology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Yue Di
- Department of Ophthalmology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai, 200062, China
| | - Tong Qiao
- Department of Ophthalmology, Shanghai Children's Hospital, School of medicine, Shanghai Jiao Tong University, No. 355 Luding Road, Shanghai, 200062, China.
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Villegas L, Germann JA, Marcos S. Effects of Different Scleral Photo-Crosslinking Modalities on Scleral Stiffness and Hydration. Invest Ophthalmol Vis Sci 2024; 65:8. [PMID: 38958968 PMCID: PMC11223619 DOI: 10.1167/iovs.65.8.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/16/2024] [Indexed: 07/04/2024] Open
Abstract
Purpose The purpose of this study was to evaluate the biomechanical and hydration differences in scleral tissue after two modalities of collagen cross-linking. Methods Scleral tissue from 40 adult white rabbit eyes was crosslinked by application of 0.1% Rose Bengal solution followed by 80 J/cm2 green light irradiation (RGX) or by application of 0.1% riboflavin solution followed by 5.4 J/cm2 ultraviolet A irradiation (UVX). Posterior scleral strips were excised from treated and untreated sclera for tensile and hydration-tensile tests. For tensile tests, the strips were subjected to uniaxial extension after excision. For hydration-tensile tests, the strips were dehydrated, rehydrated, and then tested. Young's modulus at 8% strain and swelling rate were estimated. ANOVAs were used to test treated-induced differences in scleral biomechanical and hydration properties. Results Photo-crosslinked sclera tissue was stiffer (Young's modulus at 8% strain: 10.7 ± 4.5 MPa, on average across treatments) than untreated scleral tissue (7.1 ± 4.0 MPa). Scleral stiffness increased 132% after RGX and 90% after UVX compared to untreated sclera. Scleral swelling rate was reduced by 11% after RGX and by 13% after UVX. The stiffness of the treated sclera was also associated with the tissue hydration level. The lower the swelling, the higher the Young's modulus of RGX (-3.8% swelling/MPa) and UVX (-3.5% swelling/MPa) treated sclera. Conclusions Cross-linking with RGX and UVX impacted the stiffness and hydration of rabbit posterior sclera. The Rose Bengal with green light irradiation may be an alternative method to determine the efficacy and suitability of inducing scleral tissue stiffening in the treatment of myopia.
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Affiliation(s)
- Lupe Villegas
- Instituto de Óptica “Daza de Valdés,” Consejo Superior de Investigaciones Científicas, Madrid, Spain
- Universidad Politécnica de Madrid, Madrid, Spain
| | - James A. Germann
- Instituto de Óptica “Daza de Valdés,” Consejo Superior de Investigaciones Científicas, Madrid, Spain
| | - Susana Marcos
- Instituto de Óptica “Daza de Valdés,” Consejo Superior de Investigaciones Científicas, Madrid, Spain
- The Center for Visual Science, The Institute of Optics; Flaum Eye Institute, University of Rochester, Rochester, New York, United States
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Osipyan GA, Khraistin H, Jourieh M. Collagen cross-linking beyond corneal ectasia: A comprehensive review. Indian J Ophthalmol 2024; 72:S191-S202. [PMID: 38271415 DOI: 10.4103/ijo.ijo_1507_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/19/2023] [Indexed: 01/27/2024] Open
Abstract
The history of corneal cross-linking (CXL) dates back to 2003 when some German scientists investigated possible treatments to harden the corneal structure to increase its resistance in ectatic corneal diseases. Nowadays, CXL is considered the most effective therapy in ectatic corneal diseases due to its proven efficacy in hardening the cornea, thus halting the development of the disease. Since 2003, CXL applications have dramatically expanded and have been implemented in several other areas such as infectious keratitis, corneal edema, and before performing keratoplasty for various purposes. Moreover, several irradiation patterns are being studied to correct refractive errors, taking into account the corneal refractive changes that occur after the procedure. Currently, scleral cross-linking is also being investigated as a potential therapy in cases of progressive myopia and glaucoma. In this article, we provide a comprehensive overview of the available applications of cross-linking in nonectatic ocular conditions and highlight the possible future indications of this procedure.
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Affiliation(s)
- Grigory A Osipyan
- Department of Corneal Pathology, Krasnov Research Institute of Eye Diseases, Moscow, Russia
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Yasir ZH, Sharma R, Zakir SM. Scleral collagen cross linkage in progressive myopia. Indian J Ophthalmol 2024; 72:174-180. [PMID: 38153964 PMCID: PMC10941927 DOI: 10.4103/ijo.ijo_1392_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 10/10/2023] [Accepted: 10/26/2023] [Indexed: 12/30/2023] Open
Abstract
High myopia is often associated with local ectasia and scleral thinning. The progression of myopia depends upon scleral biochemical and biomechanical properties. Scleral thinning is associated with decreased collagen fiber diameter, defective collagen fibrillogenesis, and collagen cross-linking. Reversing these abnormalities may make the sclera tougher and might serve as a treatment option for myopic progression. Collagen cross-linking is a natural process in the cornea and sclera, which makes the structure stiff. Exogenous collagen cross-linkage is artificially induced with the help of external mediators by using light and dark methods. In this systematic review, we discussed existing literature available on the internet on current evidence-based applications of scleral collagen cross-linking (SXL) by using different interventions. In addition, we compared them in tabular form in terms of their technique, mechanisms, cytotoxicity, and the stage of transition from preclinical to clinical development. Furthermore, we discussed the in-vivo technique to evaluate the post-SXL scleral biomechanical property and outcome in the human eye.
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Affiliation(s)
- Ziaul H Yasir
- Department of Ophthalmology, T. S. Misra Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Rakesh Sharma
- Department of Ophthalmology, T. S. Misra Medical College and Hospital, Lucknow, Uttar Pradesh, India
| | - Shaik M Zakir
- Department of Ophthalmology, J. N. Medical College, AMU, Aligarh, Uttar Pradesh, India
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Chen C, Wang Z, Xie S, Lu H, Wang Y, Xiong J, Nakao N, Igarashi-Yokoi T, Yoshida T, Uramoto K, Takahashi T, Sugisawa K, Kamoi K, Ohno-Matsui K. Characteristics and Prevalence of Staphyloma Edges at Different Ages in Highly Myopic Eyes. Invest Ophthalmol Vis Sci 2024; 65:32. [PMID: 38236188 PMCID: PMC10807494 DOI: 10.1167/iovs.65.1.32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/03/2024] [Indexed: 01/19/2024] Open
Abstract
Purpose The purpose of this study was to determine the characteristics of staphyloma edges in highly myopic eyes and how they progress. Methods We conducted a cross-sectional analysis using baseline data and a longitudinal study with follow-up data from 256 patients (447 eyes) with high myopia, with a mean (SD) follow-up of 3.79 (0.78) years. Participants were divided into four age groups: children (<13), youth (13-24), mature (25-59), and elderly (>60). Ultrawide-field swept-source optical coherence tomography was used to analyze staphyloma edges, which were divided into four areas: nasal to the optic disc (OD), superior to the macula, inferior to the macula, and temporal to the macula. Results Staphylomas were significantly more prevalent in the mature (42.49%) and the elderly (51.35%) groups than in the children (13%) and youth (9%) groups. Staphyloma edges were predominantly superior to the macula in the mature and elderly groups. In contrast, staphylomas were rare in children and youth, with their edges mainly located nasal to the OD. The edges of staphylomas located superior and temporal to the macula were more likely to be associated with myopic traction maculopathy. During the follow-up period, 11 new staphyloma edges developed primarily in the mature group (64%). Additionally, 12 edges had an increased degree of protrusion over time, with most cases occurring in the mature (75%) group. Conclusions The prevalence and location of staphyloma edges show significant variations depending on age. As time progresses, staphyloma edges manifest at distinct sites and increase their protrusion, potentially playing a role in the emergence of fundus complications.
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Affiliation(s)
- Changyu Chen
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ziye Wang
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shiqi Xie
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
- Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Hongshuang Lu
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yining Wang
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jianping Xiong
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Noriko Nakao
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tae Igarashi-Yokoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeshi Yoshida
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kengo Uramoto
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomonari Takahashi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keigo Sugisawa
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koju Kamoi
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo, Japan
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