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De Clerck EEB, Bravetti GE, Kropp M, Massa H, Pajic B, Thumann G, Guber I. Bowman Layer Transplantation for Treating Keratoconus-Preliminary Findings. J Clin Med 2023; 12:jcm12062402. [PMID: 36983402 PMCID: PMC10055818 DOI: 10.3390/jcm12062402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/10/2023] [Accepted: 03/19/2023] [Indexed: 03/30/2023] Open
Abstract
(1) Background: Mid-stromal isolated Bowman layer transplantation aims to reduce and stabilize corneal ectasia in patients with advanced, progressive keratoconus. The purpose of this review is to evaluate the effectiveness and safety of this new surgical technique. (2) Methods: Following the PRISMA statement and checklist, we searched Medline, the Cochrane Controlled Trials Register, and Embase and used a broad systematic search strategy according to the Cochrane Collaboration. (3) Results: Eight studies with a total number of 120 eyes of 106 patients met our inclusion criteria. One month after Bowman layer transplantation, patients with keratoconus showed a significant decrease in the measured simulated keratometry (-4.74 D [95% CI -6.79 to -2.69]) and the maximum keratometry (-7.41 D [95% CI -9.64 to -5.19]), which remained significant one year postoperatively (-2.91 D [95% CI -5.29 to -0.53] and -5.80 D [-8.49 to -3.12]). Intra- and postoperative complications were observed in 3% and 9% of the patients, respectively. An estimated success rate of 75% to 85% was achieved by experienced surgeons at 5 to 8 years postoperatively. (4) Conclusions: Bowman layer transplantation may be an effective and safe treatment option in patients with advanced, progressive keratoconus. Additional multicenter prospective interventional studies are needed to confirm these preliminary findings.
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Affiliation(s)
- Eline Elodie Barbara De Clerck
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Giorgio Enrico Bravetti
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Martina Kropp
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Horace Massa
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
| | - Bojan Pajic
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
- Eye Clinic ORASIS, Swiss Eye Research Foundation, 5734 Reinach, Switzerland
- Faculty of Sciences, Department of Physics, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia
- Faculty of Medicine of the Military Medical Academy, University of Defense, 11000 Belgrade, Serbia
| | - Gabriele Thumann
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
- Experimental Ophthalmology, University of Geneva, 1205 Geneva, Switzerland
| | - Ivo Guber
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland
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Navel V, Barriere JV, Joubert R, Coutu A, Watson SL, Lambert C, Dutheil F, Chiambaretta F. Irregular Astigmatism Management Using SPOT Scleral Lenses in the Treatment of Corneal Ectasia and Penetrating Keratoplasty. Eye Contact Lens 2021; 47:401-407. [PMID: 33941725 DOI: 10.1097/icl.0000000000000792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the outcome of SPOT scleral lenses in the management of irregular astigmatism in patients with corneal ectasia and penetrating keratoplasty. Second, we analyzed patients' characteristics and tolerance, comfort, and geometries of fitted lenses. METHOD Over a 5-year period, we included patients experiencing irregular astigmatism fitted with SPOT scleral contact lenses, from the University Hospital of Clermont-Ferrand, France. Data collected included corneal diseases, refractive error, best-corrected visual acuity (VA) with SPOT lenses, geometry of the lens, number of adjustment consultations, and the duration of follow-up. Comfort, quality of vision, less handling, and satisfaction were evaluated using visual analog scales after a 6-month follow-up period. RESULTS Sixty-five patients were included, analyzing 107 eyes. Eighty percent of patients still daily wore lenses after a follow-up of 22.3±13.8 months. Visual acuity improved by 0.47±0.51 logarithm of the minimum angle of resolution (average increase of 5 lines) (P<0.001) after wearing scleral lenses. Comfort, quality of vision, less handling, and satisfaction of contact lenses were excellent (>75/100). Contact lenses were daily worn 10.0±4.1 hr/day. Most patients wore size M (17 mm) lenses (53.3% of patients), with an average sagittal height of 5.2±1.2 mm. Internal toricity was used in 30% of cases. Best geometry was found after 2.69±0.87 consultations. CONCLUSION SPOT scleral contact lenses are an effective and well tolerated method to improve the VA of patients with irregular astigmatism.
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Affiliation(s)
- Valentin Navel
- University Hospital of Clermont-Ferrand (V.N., J.-V.B., R.J., A.C., F.C.), CHU Clermont-Ferrand, Ophthalmology, Clermont-Ferrand, France ; Université Clermont Auvergne (V.N., F.C.), CNRS UMR 6293, INSERM U1103, Genetic Reproduction and Development Laboratory (GReD), Translational Approach to Epithelial Injury and Repair Team, Clermont-Ferrand, France ; The University of Sydney (S.L.W.), Save Sight Institute, Discipline of Ophthalmology, Faculty of Medicine and Health, Sydney, Australia; Sydney Eye Hospital (S.L.W.), Sydney, Australia; University Hospital of Clermont Ferrand (C.L.), CHU Clermont-Ferrand, Clinical Research and Innovation Direction, Clermont-Ferrand, France; and Université Clermont Auvergne (F.D.), CNRS, LaPSCo, Physiological and Psychosocial Stress, CHU Clermont-Ferrand, University Hospital of Clermont-Ferrand, Preventive and Occupational Medicine, Witty Fit, Clermont-Ferrand, France
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Elkitkat RS, Badran TA, Ebeid WM. Revisiting the Robustness of Pentacam HR Indices Against Soft Contact Lens Wear. Clin Ophthalmol 2021; 15:1573-1581. [PMID: 33883874 PMCID: PMC8055255 DOI: 10.2147/opth.s308560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/23/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate various selected Pentacam HR indices in a cohort of soft contact lens (SCL) wearers before and after SCL discontinuation. Methods Ninety right eyes of 90 SCL wearers (group 1) were compared to healthy controls (group 2). For group 1 eyes, Pentacam HR images were captured within one hour of SCL removal and after one month of discontinuation. The evaluated indices included curvature, elevation, and pachymetric parameters. Results Elevation indices and two pachymetric indices (central corneal thickness and thinnest corneal thickness) did not show significant differences, either between the two groups or in group 1 after SCL discontinuation. Some pachymetric indices (average and maximum corneal pachymetry progression indices, and maximum Ambrosio's relational thickness index) showed statistically significant (P-value <0.001), yet clinically irrelevant differences. Contrarily, changes in curvature indices were both statistically significant (P-value <0.001) and clinically relevant. Conclusion From a clinical point of view, many elevation and pachymetric indices are robust against SCL wear, and can be relied upon for corneal ectasia screening of SCL wearers, even without abstaining from wearing SCLs.
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Affiliation(s)
- Rania Serag Elkitkat
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Watany Eye Hospitals, Cairo, Egypt.,Watany Research and Development Center, Cairo, Egypt
| | - Tamer Abdelfattah Badran
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt.,Specialized Eye Center, Cairo, Egypt
| | - Weam Mohamed Ebeid
- Ophthalmology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Randomised controlled trial of corneal vs. scleral rigid gas permeable contact lenses for keratoconus and other ectatic corneal disorders. Cont Lens Anterior Eye 2020; 43:543-552. [DOI: 10.1016/j.clae.2019.12.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 12/07/2019] [Accepted: 12/07/2019] [Indexed: 11/23/2022]
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Kumar M, Shetty R, Lalgudi VG, Vincent SJ. Scleral lens wear following penetrating keratoplasty: changes in corneal curvature and optics. Ophthalmic Physiol Opt 2020; 40:502-509. [PMID: 32436631 DOI: 10.1111/opo.12693] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE Visual rehabilitation following penetrating keratoplasty is the primary indication for approximately 15% of all scleral lens fittings. Since corneal biomechanics are altered following penetrating keratoplasty, the aim of this study was to quantify changes in anterior corneal optics following short-term scleral lens wear in eyes with corneal grafts. METHODS Scheimpflug images were obtained before and after a period of scleral lens wear (mean 6.3 ± 1.4 h), from eyes that had previously undergone penetrating keratoplasty (10 eyes of nine participants, mean age 31 ± 9 years). Corneal power and thickness data were examined over the central 6 mm, including regional analyses of the central (0-3 mm) and the mid-peripheral cornea (3-6 mm annulus) using customised software to deterime corneal power vectors M (best fit sphere), J0 (90/180 astigmatism) and J45 (45/135 astigmatism). Anterior corneal aberrations were extracted using corneal elevation data. RESULTS Corneal power vector J45 increased following lens wear (by 0.22 ± 0.05 D, p = 0.003) across the central 6 mm, while M displayed regional variations following lens wear indicating larger changes further from the corneal centre (p = 0.004). The change in corneal power vector M was also correlated with the magnitude of central corneal swelling (r = 0.65, p = 0.04). The anterior corneal aberration terms of oblique astigmatism, hoirzontal coma, and spherical aberration also varied following lens wear (all p ≤ 0.01). The mean change in the corneal spherocylinder derived from the elevation data following lens wear was +0.14/-0.54 × 44 for a 6 mm corneal diameter. CONCLUSIONS Clinically significant alterations in anterior corneal topography and higher order aberrations were observed following short-term scleral lens wear in eyes that had undergone penetrating keratoplasty. Spherocylindrical changes were approximately double the magnitude and more oblique in orientation compared to previous reports of healthy eyes. Changes in corneal power vector M may be related to epithelial corneal oedema.
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Affiliation(s)
- Mukesh Kumar
- Narayana Nethralaya, Bangalore, Karnataka, India
| | - Rohit Shetty
- Narayana Nethralaya, Bangalore, Karnataka, India
| | | | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry & Vision Science, Queensland University of Technology, Brisbane, Australia
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Sharif R, Bak-Nielsen S, Hjortdal J, Karamichos D. Pathogenesis of Keratoconus: The intriguing therapeutic potential of Prolactin-inducible protein. Prog Retin Eye Res 2018; 67:150-167. [PMID: 29758268 PMCID: PMC6235698 DOI: 10.1016/j.preteyeres.2018.05.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 04/25/2018] [Accepted: 05/08/2018] [Indexed: 12/15/2022]
Abstract
Keratoconus (KC) is the most common ectatic corneal disease, with clinical findings that include discomfort, visual disturbance and possible blindness if left untreated. KC affects approximately 1:400 to 1:2000 people worldwide, including both males and females. The aetiology and onset of KC remains a puzzle and as a result, the ability to treat or reverse the disease is hampered. Sex hormones are known to play a role in the maintenance of the structure and integrity of the human cornea. Hormone levels have been reported to alter corneal thickness, curvature, and sensitivity during different times of menstrual cycle. Surprisingly, the role of sex hormones in corneal diseases and KC has been largely neglected. Prolactin-induced protein, known to be regulated by sex hormones, is a new KC biomarker that has been recently proposed. Studies herein discuss the role of sex hormones as a control mechanism for KC onset and progression and evidence supporting the view that prolactin-induced protein is an important hormonally regulated biomarker in KC is discussed.
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Affiliation(s)
- Rabab Sharif
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, Oklahoma City, OK 73104, United States
| | - Sashia Bak-Nielsen
- Department of Ophthalmology, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus DK-8200, Denmark
| | - Dimitrios Karamichos
- Department of Cell Biology, University of Oklahoma Health Sciences Center, 975 NE 10th Street, Oklahoma City, OK 73104, United States; Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Science Center, 608 Stanton L. Young Blvd, Oklahoma City, OK 73104, United States.
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A Case of Late Spontaneous Post–Radial Keratotomy Corneal Perforation Managed With Specialty Lenses. Eye Contact Lens 2018; 44 Suppl 1:S341-S344. [DOI: 10.1097/icl.0000000000000353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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