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Kenia VP, Kenia RV, Bendre P, Pirdankar OH. Corneal stress-strain index in myopic Indian population. Oman J Ophthalmol 2024; 17:47-52. [PMID: 38524314 PMCID: PMC10957058 DOI: 10.4103/ojo.ojo_122_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 11/18/2023] [Indexed: 03/26/2024] Open
Abstract
AIM The purpose is to study the corneal stress-strain index (SSI) in myopic refractive error among Indian subjects. METHODS A retrospective study where young myopic subjects aged between 11 and 35 years who had undergone corneal biomechanics assessment using Corvis ST between January 2017 and December 2021 were enrolled. Subjects with central corneal thickness (CCT) <500 μ, intraocular pressure (IOP) >21 mmHg, history of any systemic and ocular disease or any previous ocular surgery, high astigmatism, corneal disease such as keratoconus were excluded. Subjects with missing data or having poor quality scan were excluded. Corneal biomechanical properties and corneal SSI were assessed using Corvis ST. For statistical purposes, eyes were divided into four different groups and were analyzed using one-way ANOVA. RESULTS Nine hundred and sixty-six myopic eyes with mean ± standard deviation age, IOP, and CCT of 26.89 ± 4.92 years, 16.94 ± 2.00 mmHg, and 540.18 ± 25.23 microns, respectively, were included. There were 311, 388, 172, and 95 eyes that were low, moderate, severe, and extreme myopic. Deformation amplitude ratio at 1 mm and 2 mm were similar across different myopic groups. A significant increase in max inverse radius, ambrosia relational thickness, biomechanically corrected IOP, integrated radius was noted with an increase in myopic refractive error. Corvis biomechanical index, corneal SSI was found to be decreased significantly with an increase in myopic refractive error. We noted a significant positive association between myopic refractive error and SSI (P < 0.001). CONCLUSION Corneal SSI was found to be reduced in extreme myopic eyes.
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Affiliation(s)
- Vaishal P. Kenia
- Department of Cataract and Refractive Surgery, Kenia Eye Hospital, Mumbai, Maharashtra, India
| | - Raj V. Kenia
- Department of Ophthalmology, Kenia Foundation, Mumbai, Maharashtra, India
| | - Pradnya Bendre
- Department of Cataract and Refractive Surgery, Kenia Eye Hospital, Mumbai, Maharashtra, India
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Chang YM, Weng TH, Tai MC, Lin TY, Chen YH, Chien KH. Corneal topographic changes in patients with thyroid eye disease: A retrospective cross-sectional study. Cont Lens Anterior Eye 2023; 46:101843. [PMID: 37037712 DOI: 10.1016/j.clae.2023.101843] [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: 11/02/2022] [Revised: 03/31/2023] [Accepted: 04/06/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE This study aimed to evaluate corneal topographic findings in patients with thyroid eye disease (TED) using a Galilei camera and compare their corneal topographic parameters with those of control patients. METHODS This retrospective cross-sectional study included 52 eyes of 26 patients with TED (study group) and 40 eyes of 20 controls treated at a tertiary medical center in Taiwan between January and December 2021. All participants underwent basic ophthalmological examinations, corneal topography examination using a Galilei dual Scheimpflug camera, thyroid function examination, and orbital computed tomography. The corneal topographic parameters and cross-sectional area of the extraocular muscles were compared between the TED and control groups. RESULTS Several corneal topographic parameters, including the Inferior-Superior Index, Keratoconus Prediction Index, Surface Asymmetry Index, Surface Regularity Index, simulated keratometry astigmatism, and anterior instantaneous astigmatism axis, differed significantly between the groups (P ≤ 0.05). The anterior instantaneous astigmatism axis was more oblique in the TED group than in the control group. A scatter plot revealed a more scattered distribution in the anterior instantaneous astigmatism axis in the TED group than in the control group. However, the corneal topographic parameters did not differ significantly among the different thyroid dysfunction groups. CONCLUSIONS The corneas of patients with TED are suspicious and keratoconus-like, and TED can increase anterior corneal astigmatism in the oblique axis, albeit with large variations in the extent of change. These TED-related corneal changes may aid in the early diagnosis of TED, especially "silent" TED.
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Affiliation(s)
- Yu-Min Chang
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Tzu-Heng Weng
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ming-Cheng Tai
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ting-Yi Lin
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital and School of Medicine, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Kollros L, Torres-Netto EA, Rodriguez-Villalobos C, Hafezi NL, Hillen M, Lu NJ, Hafezi F. Progressive keratoconus in patients older than 48 years. Cont Lens Anterior Eye 2023; 46:101792. [PMID: 36481131 DOI: 10.1016/j.clae.2022.101792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE To report cases of progressive keratoconus (KC) in patients aged ≥48 years and the successful arrest of progression using corneal cross-linking (CXL) with riboflavin and ultraviolet-A light. OBSERVATIONS Five eyes from four patients with progressive KC aged 48, 48, 51 and 54 years are reported in this case series. All eyes were followed regularly after initial diagnosis. Kmax was used as an indicator of progression and KC progressed at a rate of 1.4 diopters in 6 months and 14.6 diopters in 14 months. All patients eventually received CXL, and all were aged ≥50 years at the time of the procedure. One eye required two CXL procedures to successfully stabilize the patient's cornea. CONCLUSION Despite the probability of KC progression strongly declining after the age of 40 years, it never becomes zero. It is therefore advisable to continue regular follow-up corneal tomography examinations in patients with KC, even in their fifth and sixth decades of life.
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Affiliation(s)
| | - Emilio A Torres-Netto
- ELZA Institute, Dietikon, Switzerland; Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil; Faculty of Medicine, University of Geneva, Geneva, Switzerland; University of Zurich, CABMM, Laboratory for Ocular Cell Biology Group, Zurich, Switzerland
| | | | - Nikki L Hafezi
- ELZA Institute, Dietikon, Switzerland; School of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | | | - Nan-Ji Lu
- ELZA Institute, Dietikon, Switzerland; School of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium; School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Farhad Hafezi
- ELZA Institute, Dietikon, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China; USC Roski Eye Institute, University of Southern California, Los Angeles, CA, USA; University of Zurich, CABMM, Laboratory for Ocular Cell Biology Group, Zurich, Switzerland
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Babić Leko M, Pleić N, Lešin M, Gunjača I, Torlak V, Škunca Herman J, Vatavuk Z, Punda A, Polašek O, Hayward C, Zemunik T. Association between Thyroid Function and Ocular Parameters. BIOLOGY 2022; 11:1847. [PMID: 36552356 PMCID: PMC9776046 DOI: 10.3390/biology11121847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/05/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Abstract
During development, thyroid hormones play an important role in eye development, while in adults, some pathological thyroid conditions can affect the normal functioning of the eyes. Thyroid eye disease is the most well-known eye pathology caused by a pathological thyroid condition. Few studies have investigated the association between ocular parameters and thyroid function. Thus, in this study, we aimed to examine whether thyroid activity affects ocular parameters. This cross-sectional study included 4633 healthy adults recruited within the 10,001 Dalmatians project of the Croatian Biobank. The plasma levels of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroglobulin (Tg), thyroglobulin antibodies (TgAb), and thyroid peroxidase antibodies (TPOAb) were measured by an immunoassay. We determined 20 ocular parameters for each participant (10 for each eye, including corneal radius, corneal thickness, anterior chamber depth, anterior chamber angle, lens thickness, posterior chamber length, axial length, intraocular lens power (IOL), spherical power, and cylinder power). Patients with hyperthyroidism had thicker corneas compared to euthyroid individuals. Corneal thickness was also negatively associated with plasma TSH levels. Intra-ocular lens power was higher in patients with clinical hypothyroidism, while spherical power was higher in euthyroid individuals with positive antibodies compared to euthyroid individuals. Intra-ocular lens power negatively correlated with fT4 levels, while spherical power positively correlated with TgAb, TPOAb, and Tg levels and negatively correlated with TSH levels. The anterior chamber angle was positively associated with plasma TSH levels and TPOAb levels and negatively associated with plasma fT4 levels. These findings suggest an interesting interplay between ophthalmic measures and thyroid status, detectable even in the general adult population.
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Affiliation(s)
- Mirjana Babić Leko
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Nikolina Pleić
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Mladen Lešin
- Department of Ophthalmology, University Hospital of Split, 21000 Split, Croatia
| | - Ivana Gunjača
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
| | - Vesela Torlak
- Department of Nuclear Medicine, University Hospital of Split, 21000 Split, Croatia
| | - Jelena Škunca Herman
- Department of Ophthalmology, Clinical Hospital Sisters of Mercy, 10000 Zagreb, Croatia
| | - Zoran Vatavuk
- Department of Ophthalmology, Clinical Hospital Sisters of Mercy, 10000 Zagreb, Croatia
| | - Ante Punda
- Department of Nuclear Medicine, University Hospital of Split, 21000 Split, Croatia
| | - Ozren Polašek
- Department of Public Health, School of Medicine, University of Split, Šoltanska 2, 21000 Split, Croatia
- Algebra University College, 10000 Zagreb, Croatia
| | - Caroline Hayward
- MRC Human Genetics Unit, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh EH4 2XU, UK
| | - Tatijana Zemunik
- Department of Medical Biology, School of Medicine, University of Split, 21000 Split, Croatia
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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.
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Abstract
PURPOSE OF REVIEW The aim of this study was to summarize common eye changes that may occur during pregnancy, and how pregnancy may affect preexisting eye conditions such as glaucoma and diabetic retinopathy. Challenges and complexities surrounding the treatment of these eye conditions during pregnancy are also highlighted. RECENT FINDINGS Refractive changes are common and may persist in the postpartum in patients with keratoconus. Although new medical and surgical glaucoma treatments are available, their safety in pregnancy is unknown. Limited use of topical and systemic glaucoma therapies is recommended, with a preference for selective laser trabeculoplasty as first line treatment in appropriate cases. The impact of pregnancy on diabetic retinopathy remains unclear. Although anti-vascular endothelial growth factor agents are first-line treatment for sight-threatening diabetic retinopathy, their effect on the developing foetus remains unknown and are therefore best avoided in the first and second trimesters. Noninfectious uveitis tends to become less active during pregnancy, allowing the potential tapering of systemic therapy and the use of local topical or injected corticosteroid treatment for active disease as required. SUMMARY Significant changes can occur to the eye during pregnancy, wherein the optimal treatment for many ocular conditions remains uncertain, highlighting the need for further research to develop clear recommendations that best balance the need to preserve the mother's sight, and the health of the developing foetus. The need for preconception planning, and collaborative multidisciplinary care between the obstetrician, physician, ophthalmologist and paediatrician is paramount.
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Affiliation(s)
- Edmund W C Khong
- Department of Surgery, Central Clinical School, Monash University
- Centre for Eye Research Australia, University of Melbourne
| | - Helen H L Chan
- Royal Victorian Eye and Ear Hospital
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria
| | - Stephanie L Watson
- Save Sight Institute, Sydney Medical School, University of Sydney
- Corneal Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne
- Royal Victorian Eye and Ear Hospital
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Dynamics of keratoconus progression after prior successful accelerated cross-linking treatment during and after pregnancy. J Cataract Refract Surg 2021; 48:599-603. [PMID: 34433777 DOI: 10.1097/j.jcrs.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effectiveness of previously applied successful accelerated cross-linking (CXL) treatment in keratoconus stabilization during and after pregnancy. SETTING Ankara Yildirim Beyazit University, Ataturk Training and Research Hospital, Turkey. DESIGN Prospective, clinical study. METHODS Patients who became pregnant with stable keratoconus (after having an accelerated CXL procedure) were included. Uncorrected (UDVA) and corrected distance visual acuity (CDVA), manifest astigmatism (MA), keratometry (K)1, K2, K-max, central corneal thickness (CCT), thinnest corneal thickness (TCT), anterior (AE) and posterior elevation (PE) were recorded at baseline (before CXL), before pregnancy (the last visit after CXL), during pregnancy (3rd trimester) and after pregnancy (the last visit after pregnancy). RESULTS Study included 24 eyes of 19 patients. The mean time between CXL and conception was 12.4±5.1 months. The mean post-partum follow-up period was 27.6±13.3 months. The mean UDVA, CDVA, MA, and PE values did not show any significant differences during and after pregnancy compared to the post CXL values (p>0.05). The mean K-max flattened significantly after the CXL procedure (p=0.011), however it increased during pregnancy (p=0.037:after CXL-pregnancy) and then decreased back to the pre-pregnancy level after pregnancy (p=0.035:pregnancy-after pregnancy). The mean K1, K2, AE, CCT, and TCT remained stable during pregnancy and significantly decreased after pregnancy (p<0.05). CONCLUSION Keratoconus appears to progress during pregnancy in corneas that have previously received successful accelerated CXL treatment. However, this progress is mostly temporary, and generally regression occurs after delivery.
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Atypical Corneal Ectasia Associated With Vitamin C Deficiency. Cornea 2021; 39:1167-1170. [PMID: 32301811 DOI: 10.1097/ico.0000000000002340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To demonstrate a possible correlation between corneal ectasia and vitamin C deficiency. METHODS Case series. RESULTS This case series covers 3 patients with atypical features of corneal ectasia. All 3 had a peculiar general history and visited our tertiary ophthalmology department complaining about decreased visual acuity. Corneal tomography by Scheimpflug imaging (Pentacam) indicated an irregular astigmatism congruent with a corneal ectasia. A blood test diagnosed vitamin C deficiency. CONCLUSIONS To the best of our knowledge, this is the first time a possible correlation between corneal ectasia and vitamin C deficiency is established. Although more research is of course of the essence, it proves useful to determine vitamin C plasma levels in patients presenting with atypical ectasia. To the extent that vitamin C deficiency is indeed diagnosed, it should be substituted orally.
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Corneal Biomechanical Changes in Third Trimester of Pregnancy. ACTA ACUST UNITED AC 2021; 57:medicina57060600. [PMID: 34200925 PMCID: PMC8230443 DOI: 10.3390/medicina57060600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/22/2022]
Abstract
Background and Objectives: There is a clear evidence that pregnancy is associated with high production of sex hormones. During the first, second and third trimester of pregnancy, blood hormones levels increase gradually. Cells with affinity for sex hormones have been identified in different ocular tissues, such as: lid, lacrimal gland, meibomian gland, bulbar and palpebral conjunctivae, cornea, iris, ciliary body, lens, retina (retinal pigment epithelium) and choroid. This is why pregnancy is associated with changes at ocular level, involving anterior and posterior segments. Several clinical trials have been made trying to highlight changes in corneal biomechanics during pregnancy. By conducting this review, we want to evaluate both the changes in parameters that define corneal biomechanics and intraocular pressure values in pregnant. Materials and Methods: Following a systematic search in the literature related mainly to changes in corneal biomechanics during pregnancy, focusing on the paper published in the last decade, we included in a meta-analysis the cumulative results of three prospective comparative studies. Results: Important changes in corneal biomechanics (corneal hysteresis and corneal resistance factor) parameters were observed in women in the third trimester of pregnancy, but these variations were not statistically significant. Also, a decrease in intraocular pressure was mentioned in these women, but only the corneal compensation intraocular pressure showed a decrease with statistical significance. Conclusions: A decrease in corneal compensatory intraocular pressure was observed in pregnant women in the third trimester of pregnancy, but without other statistically significant changes resulting from the analysis of the other three parameters (corneal hysteresis, corneal resistance factor and Goldmann-correlated intraocular pressure).
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Taneja M, Vadavalli PK, Veerwal V, Gour R, Reddy J, Rathi VM. Pregnancy-induced keractesia - A case series with a review of the literature. Indian J Ophthalmol 2021; 68:3077-3081. [PMID: 33245060 PMCID: PMC7856952 DOI: 10.4103/ijo.ijo_1508_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report a case series of patients who developed post-laserassisted in situ keratomileusis (LASIK) ectasia or had a progression of keractesia during pregnancy. We reviewed the medical records of 12 patients (20 eyes) who had reported deterioration of vision during their pregnancy and were diagnosed with keractesia. All 12 patients had experienced symptoms of deterioration of vision between 2 months to 1 year of onset of their pregnancies. A total of 17 eyes of 10 patients had developed post-refractive surgery keractesia. Sixteen of these had undergone LASIK and one had undergone femtosecond lenticule extraction (FLEX). Three eyes of two patients had an exacerbation of keratoconus during pregnancy while one patient had associated hypothyroidism. The results indicate that the hormonal changes that take place in pregnant women can affect the biomechanical stability of the cornea and may trigger the onset of keractesia.
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Affiliation(s)
| | - Pravin K Vadavalli
- Cornea Institute, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Vikas Veerwal
- L V Prasad Eye Institute, GMRV Campus, Vishakhapatnam, Andhra Pradesh, India
| | - Ruchi Gour
- Hajari Hospital, Jogeshwari East, Mumbai, Maharashtra, India
| | - Jagadesh Reddy
- Cornea Institute, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Varsha M Rathi
- Cornea Institute, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
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Hafezi F, Kling S, Gilardoni F, Hafezi N, Hillen M, Abrishamchi R, Gomes JAP, Mazzotta C, Randleman JB, Torres-Netto EA. Individualized Corneal Cross-linking With Riboflavin and UV-A in Ultrathin Corneas: The Sub400 Protocol. Am J Ophthalmol 2021; 224:133-142. [PMID: 33340508 DOI: 10.1016/j.ajo.2020.12.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/03/2020] [Accepted: 12/07/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether corneal cross-linking (CXL) with individualized fluence ("sub400 protocol") is able to stop keratoconus (KC) progression in ultrathin corneas with 12-month follow-up. DESIGN Retrospective, interventional case series. METHODS Thirty-nine eyes with progressive KC and corneal stromal thicknesses from 214 to 398 μm at the time of ultraviolet irradiation were enrolled. After epithelium removal, ultraviolet irradiation was performed at 3 mW/cm2 with irradiation times individually adapted to stromal thickness. Pre- and postoperative examinations included corrected distance visual acuity (CDVA), refraction, Scheimpflug, and anterior segment optical coherence tomography imaging up to 12 months after CXL. Outcome measures were arrest of KC progression at 12 months postoperatively and stromal demarcation line (DL) depth. RESULTS Thirty-five eyes (90%) showed tomographical stability at 12 months after surgery. No eyes showed signs of endothelial decompensation. A significant correlation was found between DL depth and irradiation time (r = +0.448, P = .004) but not between DL depth and change in Kmax (r = -0.215, P = .189). On average, there was a significant change (P < .05) in thinnest stromal thickness (-14.5 ± 21.7 μm), Kmax (-2.06 ± 3.66 D) and densitometry (+2.00 ± 2.07 GSU). No significant changes were found in CDVA (P = .611), sphere (P = .077), or cylinder (P = .915). CONCLUSIONS The "sub400" individualized fluence CXL protocol standardizes the treatment in ultrathin corneas and halted KC progression with a success rate of 90% at 12 months. The sub400 protocol allows for the treatment of corneas as thin as 214 μm of corneal stroma, markedly extending the treatment range. The DL depth did not predict treatment outcome. Hence, the depth is unlikely related to the extent of CXL-induced corneal stiffening but rather to the extent of CXL-induced microstructural changes and wound healing.
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Affiliation(s)
- Farhad Hafezi
- Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland; Department of Ophthalmology, ELZA Institute, Dietikon, Switzerland; Department of Ophthalmology, USC Roski Eye Institute, University of Southern California, Los Angeles, California, USA; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Department of Ophthalmology, University of Wenzhou, Wenzhou, China.
| | - Sabine Kling
- Department of Information Technology and Electrical Engineering, Swiss Federal Institute of Technology Zurich, Zürich, Switzerland
| | - Francesca Gilardoni
- Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland; Department of Ophthalmology, ELZA Institute, Dietikon, Switzerland
| | - Nikki Hafezi
- Department of Ophthalmology, ELZA Institute, Dietikon, Switzerland
| | - Mark Hillen
- Department of Ophthalmology, ELZA Institute, Dietikon, Switzerland
| | - Reyhaneh Abrishamchi
- Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland; Department of Ophthalmology, ELZA Institute, Dietikon, Switzerland
| | - Jose Alvaro P Gomes
- Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland; Department of Ophthalmology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Cosimo Mazzotta
- Department of Medicine, Surgery and Neurosciences, University of Siena, Siena, Italy; Department of Ophthalmology, Siena Crosslinking Center, Siena, Italy
| | - J Bradley Randleman
- Department of Ophthalmology, The Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Emilio A Torres-Netto
- Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich, Switzerland; Department of Ophthalmology, ELZA Institute, Dietikon, Switzerland; Department of Ophthalmology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil; Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Effect of prolactin on normal and keratoconus human corneal stromal fibroblasts in vitro. PLoS One 2021; 16:e0249344. [PMID: 33793669 PMCID: PMC8016287 DOI: 10.1371/journal.pone.0249344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 03/16/2021] [Indexed: 11/28/2022] Open
Abstract
Purpose To examine the effect of prolactin (PRL) on human corneal stromal fibroblasts (CSFs), derived from healthy individuals and from keratoconus (KC) patients, in vitro, specifically assessing physiological and elevated PRL concentrations as apparent during pregnancy. Methods Eye bank corneas of 3 female and 3 male healthy individuals as well as the corneal buttons of 3 female and 3 male KC patients were utilized for this study. The endothelium of the cornea was removed with sterile surgical scalpels, the probes were washed repeatedly with Dulbecco’s PBS and corneoscleral rims were trimmed off. Subsequently the corneal stroma was digested with collagenase type I and the harvested CSFs were cultured. We then examined (1) cell proliferation, (2) cell viability and (3) cytokine release of CSFs upon exposure to prolactin in vitro. Results With respect to viability and proliferation our experiments did not show significant differences between CSFs exposed to different PRL concentrations. Our data show a significantly lower IL-8 concentration in normal CSFs exposed to 10ng/ml PRL compared to 0ng/ml and 1000ng/ml at 5 hours post exposition. Moreover, we can report significantly lower secretion of IL-8, IL-6, HGF, VEGF and FGFb in KC CSFs compared to normal CSFs, independent of PRL exposure, as determined by cytokine ELISA. Conclusion Our data in part points towards corneal cytokine secretion as a possible link between altered stromal PRL concentrations and KC progression. However, in our small dataset a significant influence of PRL concentration on cytokine secretion can only be described for IL-8 in normal CSFs. Further our results contribute to existing reports on the importance of cytokines in KC development, with an emphasis on significantly lower cytokine secretion in KC CSFs compared to normal controls.
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El-Massry A, Doheim MF, Iqbal M, Fawzy O, Said OM, Yousif MO, Badawi AE, Tawfik A, Abousamra A. Association Between Keratoconus and Thyroid Gland Dysfunction: A Cross-Sectional Case-Control Study. J Refract Surg 2021; 36:253-257. [PMID: 32267956 DOI: 10.3928/1081597x-20200226-03] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To examine the clinical association between thyroid gland dysfunction and keratoconus. METHODS This was a cross-sectional case-control study conducted between May 2018 and July 2019. After performing Pentacam (Oculus Optikgeräte GmbH, Wetzlar, Germany) examination, flat, steep, and maximum simulated keratometric readings were recorded for each patient. Serum concentrations of free triiodothyronine, free thyroxine, and thyroid-stimulating hormone were measured. Further examinations by an endocrinologist were indicated for patients with positive laboratory results to confirm thyroid gland dysfunction. RESULTS One hundred eighty-seven patients with bilateral keratoconus and 187 sex- and age-matched healthy controls without keratoconus were analyzed. Mean age was 26.4 ± 8.2 years for the patients with keratoconus and 27.1 ± 9.4 years for the control patients, with no significant difference. The results showed that thyroid gland dysfunction prevalence was 10 of 187 patients with keratoconus (5.3%) and 2 of 187 control patients (1.1%), and the difference was statistically significant (P = .036). For the patients with keratoconus and thyroid gland dysfunction, 8 were women and 2 were men. Additionally, 6 patients (2 men and 4 women) had hyperthyrosis and 4 women had hypothyrosis. For controls, the two patients had hypothyrosis. CONCLUSIONS This study showed that there is a possible association between keratoconus and thyroid gland dysfunction, but more studies are needed to build upon these results. [J Refract Surg. 2020;36(4):253-257.].
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Kenia VP, Kenia RV, Pirdankar OH. Age-related variation in corneal biomechanical parameters in healthy Indians. Indian J Ophthalmol 2020; 68:2921-2929. [PMID: 33229671 PMCID: PMC7856994 DOI: 10.4103/ijo.ijo_2127_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To report age-related variations in corneal biomechanical parameters in healthy Indians. Methods: A retrospective study where healthy Indian individuals aged between 5 and 70 years having undergone corneal biomechanics assessment using Corvis ST between January 2017 and December 2018 and having best corrected visual acuity of 20/20 were enrolled. Subjects with central corneal thickness <500 microns, intra-ocular pressure (IOP) ≥ 22 mmHg, refractive error ≥ 6.00D, history of any systemic and ocular disease, previous ocular surgery, poor scans quality, and subjects with any missing data were also excluded. Corneal biomechanical parameters were noted and compared across different age groups. Results: Total of 3125 eyes had undergone the Corvis ST analysis. After applying exclusion criteria, 718 right eyes of 718 patients were included for the analysis and were further divided into different age groups as per each decade (sample size), such as 5-10 (37), 11-20 (113), 21-30 (396), 31-40 (116), 41-50 (39), 50 and above (17). All the subjects were matched for IOP and central corneal thickness (p > 0.05). A total of 19 out of 26 corneal biomechanical parameters were significantly different across age groups (p < 0.05). Vinciguerra screening parameters, such as deformation amplitude ratio max, biomechanically corrected IOP, and stiffness parameter A1 were significantly different across different age groups (p < 0.05). Conclusion: Corneal biomechanical parameters are affected by age as cornea becomes progressively stiffer. The information reported here would serve as a reference for future corneal biomechanical researches and would help in differentiating the abnormal eyes from normal healthy eyes.
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Affiliation(s)
| | - Raj V Kenia
- Kenia Foundation, Mumbai, Maharashtra, India
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15
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Yang Y, Ye J, Ng TK, Wu N, Sun X, Chen Y, Chen Y. Changes in corneal biomechanics during pregnancy in Chinese healthy female. Eur J Ophthalmol 2020; 31:361-366. [PMID: 31983220 DOI: 10.1177/1120672120902034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the changes of corneal biomechanics and the intraocular pressure during pregnancy in a Chinese healthy female population. METHODS A total of 222 unrelated Chinese females were recruited: 52 non-pregnant, 15 pregnant in the first trimester, 68 pregnant in the second trimester, and 87 pregnant in the third trimester. The intraocular pressure and corneal biomechanical parameters, including corneal-compensated intraocular pressure, Goldmann-correlated intraocular pressure, corneal hysteresis, and corneal resistance factor, were measured by an Ocular Response Analyzer G3. Central corneal thickness was measured by Lenstar (LS900). RESULTS Corneal hysteresis and corneal resistance factor were significantly higher in pregnant women at the second and third trimesters. Corneal-compensated intraocular pressure was lower in women at the third trimester of pregnancy (p = 0.023), but the difference became insignificant after adjustment for corneal hysteresis. Central corneal thickness was marginally higher in pregnant women than non-pregnant women (p = 0.032). There was a negative correlation between corneal-compensated intraocular pressure and corneal hysteresis (r = -0.337, p < 0.001) and a positive correlation between central corneal thickness and corneal hysteresis (r = 0.711, p < 0.0001). After adjustment for corneal-compensated intraocular pressure, corneal hysteresis remained significantly higher in the second and third trimesters of pregnant women than non-pregnant women (p = 0.031, p = 0.005). CONCLUSION This study revealed a significant increase in corneal hysteresis and corneal resistance factor in the second and third trimesters. The increase of corneal hysteresis was independent of corneal-compensated intraocular pressure, indicating pregnant females have unique characteristics in corneal-compensated intraocular pressure and corneal biomechanical properties that may be related to glaucoma and corneal ectatic diseases in pregnancy.
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Affiliation(s)
- Yaping Yang
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jun Ye
- Department of Obstetrics and Gynecology, The Fifth People's Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Na Wu
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Yaping Chen
- Department of Obstetrics and Gynecology, The Fifth People's Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuhong Chen
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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16
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Blackburn BJ, Jenkins MW, Rollins AM, Dupps WJ. A Review of Structural and Biomechanical Changes in the Cornea in Aging, Disease, and Photochemical Crosslinking. Front Bioeng Biotechnol 2019; 7:66. [PMID: 31019909 PMCID: PMC6459081 DOI: 10.3389/fbioe.2019.00066] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/07/2019] [Indexed: 12/27/2022] Open
Abstract
The study of corneal biomechanics is motivated by the tight relationship between biomechanical properties and visual function within the ocular system. For instance, variation in collagen fibril alignment and non-enzymatic crosslinks rank high among structural factors which give rise to the cornea's particular shape and ability to properly focus light. Gradation in these and other factors engender biomechanical changes which can be quantified by a wide variety of techniques. This review summarizes what is known about both the changes in corneal structure and associated changes in corneal biomechanical properties in aging, keratoconic, and photochemically crosslinked corneas. In addition, methods for measuring corneal biomechanics are discussed and the topics are related to both clinical studies and biomechanical modeling simulations.
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Affiliation(s)
- Brecken J. Blackburn
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Ophthalmology, Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - Michael W. Jenkins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
- Department of Pediatrics, Case Western Reserve University, Cleveland, OH, United States
| | - Andrew M. Rollins
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
| | - William J. Dupps
- Cole Eye Institute, Cleveland Clinic, Cleveland, OH, United States
- Department of Biomedical Engineering, Case Western Reserve University, Cleveland, OH, United States
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Torres-Netto EA, Randleman BJ, Hafezi NL, Hafezi F. Late-onset progression of keratoconus after therapy with selective tissue estrogenic activity regulator. J Cataract Refract Surg 2019; 45:101-104. [DOI: 10.1016/j.jcrs.2018.08.036] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 10/27/2022]
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18
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Lee R, El-Massry A, El-Massry Y, Randleman JB. Bilateral, Asymmetric Keratoconus Induced by Thyrotoxicosis With Long-term Stability After Corneal Cross-linking. J Refract Surg 2018; 34:354-356. [PMID: 29738594 DOI: 10.3928/1081597x-20180301-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/16/2018] [Indexed: 11/20/2022]
Abstract
PURPOSE To present a case of bilateral, asymmetric keratoconus presenting unilaterally after partial thyroidectomy with delayed presentation in the second eye after thyrotoxicosis, with disease stabilization following corneal cross-linking (CXL). METHODS Case report and literature review. RESULTS A 17-year-old girl with a history of Graves' disease underwent partial thyroidectomy without thyroid hormone replacement therapy with normal baseline ophthalmic examination of corrected distance visual acuity (CDVA) of 20/20 and no manifest astigmatism in either eye. At age 29 years, keratoconus manifested in the right eye and standard protocol CXL was performed. At age 40 years, the right eye remained stable after CXL, but keratoconus manifested in the left eye and epithelium-off accelerated CXL was performed with subsequent disease stabilization. CONCLUSIONS This case demonstrates the association between thyrotoxicosis and keratoconus and the bilateral nature of keratoconus, and highlights the potentially asymmetric presentation of thyroid-induced keratoconus. CXL had a long-term stabilizing effect over 10 years despite the ongoing effects of thyroid gland dysfunction. [J Refract Surg. 2018;34(5):354-356.].
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