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Flockerzi E, Seitz B. Keratectasia severity staging and progression assessment based on the biomechanical E-staging. EYE AND VISION (LONDON, ENGLAND) 2024; 11:24. [PMID: 38946004 PMCID: PMC11215830 DOI: 10.1186/s40662-024-00392-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 06/07/2024] [Indexed: 07/02/2024]
Abstract
Until recently, corneal topography has been the gold standard in detecting keratectasia and monitoring its progression. The recently introduced ABCD tomographic keratoconus staging system focuses on anterior ("A") and posterior ("B") radius of curvature, thinnest corneal thickness ("C"), best-corrected visual acuity with spectacles ("D") and is supplemented with the introduction of the biomechanical E-staging (BEST, "E"). The need for biomechanical staging arose from the fact of altered biomechanical characteristics of keratectasia in comparison to healthy corneas. Ectatic corneas usually exhibit a biomechanical weakening and greater deformation than healthy corneas when exposed to a biomechanical stressor such as a standardized air puff indentation as provided by the Corvis ST® (CST, Oculus, Wetzlar, Germany). The BEST is based on the linear term of the Corvis Biomechanical Index (CBI) and provides a biomechanical keratoconus severity staging and progression assessment within the CST software. This review traces the development of the BEST as an addition to the tomographic ABCD staging system and highlights its strengths and limitations when applied in daily practice for the detection, monitoring and progression assessment in keratectasia.
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Affiliation(s)
- Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Straße, Building 22, 66421, Homburg, Germany.
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Straße, Building 22, 66421, Homburg, Germany
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2
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Tas MD, Ahmadlı E, Barut Selver O. A rare clinical complication in a rare clinical presentation: hydrops and reverse pellucid marginal degeneration. Clin Exp Optom 2024; 107:581-583. [PMID: 36972552 DOI: 10.1080/08164622.2023.2192340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 03/13/2023] [Indexed: 03/29/2023] Open
Affiliation(s)
| | - Emil Ahmadlı
- Department of Ophthalmology, Ege University, Izmir, Turkey
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3
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Bonato P, Bagno A. Replace or Regenerate? Diverse Approaches to Biomaterials for Treating Corneal Lesions. Biomimetics (Basel) 2024; 9:202. [PMID: 38667213 PMCID: PMC11047895 DOI: 10.3390/biomimetics9040202] [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: 03/04/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The inner structures of the eye are protected by the cornea, which is a transparent membrane exposed to the external environment and subjected to the risk of lesions and diseases, sometimes resulting in impaired vision and blindness. Several eye pathologies can be treated with a keratoplasty, a surgical procedure aimed at replacing the cornea with tissues from human donors. Even though the success rate is high (up to 90% for the first graft in low-risk patients at 5-year follow-up), this approach is limited by the insufficient number of donors and several clinically relevant drawbacks. Alternatively, keratoprosthesis can be applied in an attempt to restore minimal functions of the cornea: For this reason, it is used only for high-risk patients. Recently, many biomaterials of both natural and synthetic origin have been developed as corneal substitutes to restore and replace diseased or injured corneas in low-risk patients. After illustrating the traditional clinical approaches, the present paper aims to review the most innovative solutions that have been recently proposed to regenerate the cornea, avoiding the use of donor tissues. Finally, innovative approaches to biological tissue 3D printing and xenotransplantation will be mentioned.
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Affiliation(s)
| | - Andrea Bagno
- Department of Industrial Engineering, University of Padua, 35131 Padua, Italy
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Mergen B, Sideroudi H, Seitz B, Flockerzi E. Altered Corneal Biomechanics According to the Biomechanical E-Staging in Pellucid Marginal Degeneration. Cornea 2024:00003226-990000000-00478. [PMID: 38334467 DOI: 10.1097/ico.0000000000003479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/03/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE The purpose of this study was to investigate corneal biomechanics in pellucid marginal degeneration (PMD) compared with healthy controls using Corvis ST (Oculus, Germany) by using the new biomechanical E-staging (based on the Corvis Biomechanical Factor, the linearized Corvis Biomechanical Index) together with tomographic parameters. METHODS Corneal biomechanical and topographic data of 75 eyes of 75 patients with PMD and 75 eyes of 75 age-matched and sex-matched healthy controls were investigated. Topographic parameters (K1, K2, Kmax, central corneal thickness (CCT), and Belin/Ambrósio Deviation Index (BAD-D) were evaluated in dependence of and correlated with the biomechanically defined E-stages. Biomechanical parameters were also recorded for the 2 groups. RESULTS Patients with PMD showed higher K2, Kmax, BAD-D, and Corvis Biomechanical Factor values and a lower CCT compared with healthy controls (P < 0.001). The E-stage was positively correlated with K1, K2, Kmax, BAD-D, and intraocular pressure difference and negatively correlated with CCT. Stage-dependent analysis revealed a significant increase in K1, K2, Kmax (P < 0.001), and BAD-D (P = 0.041) in stage E3 compared with E0 and a significant decrease in stage E2 in CCT (P = 0.009) compared with E0. CONCLUSIONS This study showed that patients with PMD may have a reduced corneal stiffness compared with healthy controls which worsens with increasing E-stage. Significant changes in topographic parameters were observed at stage E2 for CCT and at stage E3 for K1, K2, Kmax, and BAD-D when compared with stage E0.
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Affiliation(s)
- Burak Mergen
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
- Department of Ophthalmology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Haris Sideroudi
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
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Wileman JM, Price MO, Price FW. Case of Progressive Keratoconus With Newly Diagnosed Pellucid Marginal Degeneration After Corneal Cross-Linking. Cornea 2024; 43:257-260. [PMID: 37733982 DOI: 10.1097/ico.0000000000003397] [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: 07/06/2023] [Accepted: 08/22/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE The purpose of this study was to document, to our knowledge, the first reported case of keratoconus progression accompanied with newly diagnosed pellucid marginal degeneration after corneal cross-linking (CXL). METHODS A novel case of further keratoconus progression plus development of pellucid marginal degeneration in the same eye after CXL was documented with supporting evidence from Scheimpflug and optical coherence tomography imaging. RESULTS A male patient was diagnosed with progressive keratoconus in the left eye and treated with CXL when aged 25 years. Although strongly cautioned not to rub his eyes, he admitted that he continued eye rubbing in association with atopic disease. At a follow-up examination 3.5 years after CXL, progressive keratoconus was detected and pellucid marginal degeneration was newly diagnosed in the left eye. The eye was retreated with CXL. CONCLUSIONS This case illustrates that progressive keratoconus and pellucid marginal degeneration can occur in the same eye after CXL and demonstrates the deleterious effects that can develop with continued eye rubbing.
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Ambrósio R, Salomão MQ, Barros L, da Fonseca Filho JBR, Guedes J, Neto A, Machado AP, Lopes BT, Sena N, Esporcatte LPG. Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift. EYE AND VISION (LONDON, ENGLAND) 2023; 10:45. [PMID: 37919821 PMCID: PMC10623885 DOI: 10.1186/s40662-023-00363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
Different diagnostic approaches for ectatic corneal diseases (ECD) include screening, diagnosis confirmation, classification of the ECD type, severity staging, prognostic evaluation, and clinical follow-up. The comprehensive assessment must start with a directed clinical history. However, multimodal imaging tools, including Placido-disk topography, Scheimpflug three-dimensional (3D) tomography, corneal biomechanical evaluations, and layered (or segmental) tomography with epithelial thickness by optical coherence tomography (OCT), or digital very high-frequency ultrasound (dVHF-US) serve as fundamental complementary exams for measuring different characteristics of the cornea. Also, ocular wavefront analysis, axial length measurements, corneal specular or confocal microscopy, and genetic or molecular biology tests are relevant for clinical decisions. Artificial intelligence enhances interpretation and enables combining such a plethora of data, boosting accuracy and facilitating clinical decisions. The applications of diagnostic information for individualized treatments became relevant concerning the therapeutic refractive procedures that emerged as alternatives to keratoplasty. The first paradigm shift concerns the surgical management of patients with ECD with different techniques, such as crosslinking and intrastromal corneal ring segments. A second paradigm shift involved the quest for identifying patients at higher risk of progressive iatrogenic ectasia after elective refractive corrections on the cornea. Beyond augmenting the sensitivity to detect very mild (subclinical or fruste) forms of ECD, ectasia risk assessment evolved to characterize the inherent susceptibility for ectasia development and progression. Furthermore, ectasia risk is also related to environmental factors, including eye rubbing and the relational impact of the surgical procedure on the cornea.
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Affiliation(s)
- Renato Ambrósio
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil.
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil.
| | - Marcella Q Salomão
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Benjamin Constant Institute, Rio de Janeiro, Brazil
| | - Lorena Barros
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - João Batista R da Fonseca Filho
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - Jaime Guedes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
| | - Alexandre Neto
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
| | - Aydano P Machado
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Computing Institute, Federal University of Alagoas, Maceió, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Department of Ophthalmology, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Nelson Sena
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - Louise Pellegrino Gomes Esporcatte
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
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Franco AMDM, Makita LS, Perrut VC, Balbi GGM, Barros AM, Medina FMC, Signorelli F. Ocular involvement in primary antiphospholipid syndrome: results of an extensive ophthalmological evaluation performed in the APS-Rio cohort. Lupus 2023; 32:180-188. [PMID: 36444940 DOI: 10.1177/09612033221143294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To study ophthalmological manifestations in a well-characterized primary antiphospholipid syndrome (PAPS) cohort (APS-Rio) and compare them with a healthy control group. METHODS We examined PAPS patients and controls with an extensive ophthalmological evaluation, which included anamnesis, visual acuity, slit-lamp biomicroscopy, binocular indirect ophthalmoscopy, and retinography of the anterior and posterior segments of the eye. PAPS group also underwent angiography exam and optical coherence tomography using spectral domain technology (SD-OCT). RESULTS 98 PAPS patients and 102 controls were included. The most common symptom in PAPS was amaurosis fugax (34.7% vs. 6.9%; p = .001). In the multivariate analyses, Raynaud's phenomenon was associated with amaurosis fugax (OR 3.71, CI:1.33-10.32; p = .012), and livedo correlated with hemianopia (OR 6.96, CI:1.11-43.72, p = .038) and diplopia (OR 3.49, CI:1.02-11.53, p = .047). After ophthalmological evaluation, 84 PAPS patients had ocular involvement (1.0% glaucoma, 94.0% posterior findings, 62.7% anterior findings, and 56.6% both posterior and anterior findings). Vascular tortuosity was more frequent in the PAPS group (63.2% vs. 42.2%; p = .002), as well as peripheral tortuosity (29.6% vs. 7.8%; p < .001). After excluding patients with atherosclerotic risk factors, peripheral vascular tortuosity was still statistically associated with PAPS (35.0 vs. 7.8%, p < .001). Triple positivity was more frequent in PAPS patients with peripheral vascular tortuosity than in those without this ocular finding (34.5% vs. 15.9%, p = .041). CONCLUSION Vasomotor phenomena are importantly related to ocular symptoms in PAPS. Vascular tortuosity was a frequent finding in PAPS patients. Peripheral vascular tortuosity was associated with triple positivity and might be a biomarker of ischemic microvascular retinopathy due to PAPS.
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Affiliation(s)
- Adriana M de M Franco
- Ophthalmology Division, Hospital Universitário Pedro Ernesto (HUPE), 28130Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Lana S Makita
- Ophthalmology Division, Hospital Universitário Pedro Ernesto (HUPE), 28130Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Virginia C Perrut
- Ophthalmology Division, Hospital Universitário Pedro Ernesto (HUPE), 28130Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Gustavo G M Balbi
- Rheumatology Division, Hospital Universitário, 28113Universidade Federal de Juiz de Fora (UFJF), Juiz de Fora, Brazil
| | - Alexandre M Barros
- Ophthalmology Division, Hospital Universitário Pedro Ernesto (HUPE), 28130Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Flavio M C Medina
- Ophthalmology Division, Hospital Universitário Pedro Ernesto (HUPE), 28130Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Flavio Signorelli
- Rheumatology Division, Hospital Universitário Pedro Ernesto (HUPE), 28130Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Sideroudi H, Flockerzi E, Seitz B. Differential Diagnosis of Keratoconus Based on New Technologies. Klin Monbl Augenheilkd 2023; 240:57-72. [PMID: 35940178 DOI: 10.1055/a-1920-6929] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Keratoconus (KC) must be distinguished from other corneal ectatic diseases and thinning disorders for stage-appropriate and suitable management of each condition. The most relevant corneal pathologies that may imitate the tomographic KC pattern are pellucid marginal degeneration (PMD), keratoglobus, posterior keratoconus, and Fuchs-Terrien marginal degeneration (FTMD). In moderate cases of KC, differentiation is typically possible using slit lamp examination and corneal tomography with evaluation of the location of the corneal thinning region. In early cases, however, differential diagnosis may be more challenging since the cornea may look relatively normal. In severe cases, the extended area of corneal thinning also complicates differentiation. Biomicroscopic findings cannot always give all the information needed to distinguish KC from related ectatic corneal conditions. The aim of this work is to discuss contemporary techniques and findings to assist physicians to identify the correct diagnosis. Corneal topography has been used in recent decades as the main tool for imaging in ectatic corneal diseases. Moreover, Scheimpflug cameras (corneal tomographers), which analyze both anterior and posterior corneal surfaces, curvatures, pachymetry, elevation data, higher order aberrations, Fourier analysis of keratometric data, and corneal density have become the most promising tools for diagnosis and follow-up of ectatic diseases. A noninvasive air pulse tonometer in conjunction with an ultrahigh-speed Scheimpflug camera complements tomographic findings by analyzing biomechanical corneal properties. Α confocal microscopy system, which is a novel clinical technique for the study of corneal cellular structure, could contribute effectively in the same direction. Moreover, anterior segment optical coherence tomography (AS-OCT) creates cross-sections, which can be generated into a three-dimensional structure to produce corneal epithelial thickness (ET) measurements. ET mapping is increasingly recognized as a sensitive tool for the diagnosis of ocular surface disorders. Combining information of all these systems could lead to a more effective identification and differential diagnosis of ectatic corneal disorders.
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Affiliation(s)
- Haris Sideroudi
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
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Enhanced Diagnostics for Corneal Ectatic Diseases: The Whats, the Whys, and the Hows. Diagnostics (Basel) 2022; 12:diagnostics12123027. [PMID: 36553038 PMCID: PMC9776904 DOI: 10.3390/diagnostics12123027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
There are different fundamental diagnostic strategies for patients with ectatic corneal diseases (ECDs): screening, confirmation of the diagnosis, classification of the type of ECD, severity staging, prognostic assessment, and clinical follow-up. The conscious application of such strategies enables individualized treatments. The need for improved diagnostics of ECD is related to the advent of therapeutic refractive procedures that are considered prior to keratoplasty. Among such less invasive procedures, we include corneal crosslinking, customized ablations, and intracorneal ring segment implantation. Besides the paradigm shift in managing patients with ECD, enhancing the sensitivity to detect very mild forms of disease, and characterizing the inherent susceptibility for ectasia progression, became relevant for identifying patients at higher risk for progressive iatrogenic ectasia after laser vision correction (LVC). Moreover, the hypothesis that mild keratoconus is a risk factor for delivering a baby with Down's syndrome potentially augments the relevance of the diagnostics of ECD. Multimodal refractive imaging involves different technologies, including Placido-disk corneal topography, Scheimpflug 3-D tomography, segmental or layered tomography with layered epithelial thickness using OCT (optical coherence tomography), and digital very high-frequency ultrasound (VHF-US), and ocular wavefront. Corneal biomechanical assessments and genetic and molecular biology tests have translated to clinical measurements. Artificial intelligence allows for the integration of a plethora of clinical data and has proven its relevance in facilitating clinical decisions, allowing personalized or individualized treatments.
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Choi JH, Jeng BH. Indications for keratoplasty in management of corneal ectasia. Curr Opin Ophthalmol 2022; 33:318-323. [PMID: 35779056 DOI: 10.1097/icu.0000000000000862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review aims to describe recent advancements in treatment of corneal ectasias and its effect on indications for corneal transplantation. RECENT FINDINGS The majority of patients affected by ectatic corneal disease use contact lenses to correct resulting astigmatism. Patients who are intolerant of contact lenses or cannot achieve acceptable vision through conservative measures could consider keratoplasty. However, continuing advancements in both nonsurgical and surgical treatments are either reducing or delaying the need for keratoplasty in patients affected by ectatic corneal disease. SUMMARY Corneal transplantation has been the mainstay of treatment for patients with advanced ectatic corneal disease. In the past decade, numerous improvements have been occurred to make contact lenses not only more effective for visual correction, but also more comfortable. Although corneal cross-linking is the only proven treatment known to prevent progression of disease, several other therapies show early potential for those in which cross-linking is contraindicated. Patients now have access to a wider range of therapies before considering keratoplasty.
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Affiliation(s)
- Jamie H Choi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
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11
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Consejo A, Jiménez-García M, Rozema JJ, Abass A. Influence of eye tilt on corneal densitometry. Ophthalmic Physiol Opt 2022; 42:1032-1037. [PMID: 35708180 PMCID: PMC9543421 DOI: 10.1111/opo.13020] [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: 03/12/2022] [Revised: 05/24/2022] [Accepted: 05/24/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To investigate whether Pentacam densitometry readings are affected by corneal tilt. METHODS In a prospective study, the right eyes of 86 healthy participants aged 42.8 ± 20.0 years (range 18-79 years) were imaged using Scheimpflug tomography. Elevation maps were exported to calculate corneal tilt using custom-made software, and densitometry readings were acquired directly from the corneal densitometry analysis add-on to the standard software Oculus Pentacam HR. Simple mediation analysis was applied to study age as a confounding factor in the correlation between corneal tilt and corneal densitometry. RESULTS Corneal tilt and corneal densitometry are not independent from one another because age is significantly correlated with both corneal tilt (r = 0.50, p < 0.001) and corneal densitometry (r = 0.91, p < 0.001). Only 3.8% of the correlation between tilt and densitometry operates directly, while the remaining 96.2% depends on age. CONCLUSIONS Corneal tilt plays a role in corneal densitometry readings, even though the interaction is strongly influenced by age. Age is a well-known factor in densitometry readings that should be taken into consideration when interpreting Scheimpflug densitometry.
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Affiliation(s)
- Alejandra Consejo
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain
| | - Marta Jiménez-García
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.,Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jos J Rozema
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.,Visual Optics Lab Antwerp (VOLANTIS), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ahmed Abass
- Department of Mechanical, Materials and Aerospace Engineering, School of Engineering, University of Liverpool, Liverpool, UK.,Department of Production Engineering and Mechanical Design, Faculty of Engineering, Port Said University, Port Said, Egypt
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12
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Wang Y, Cao H. Corneal and Scleral Biomechanics in Ophthalmic Diseases: An Updated Review. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2022. [DOI: 10.1016/j.medntd.2022.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Peyman A, Irajpour M, Noorshargh P. Corneal cross-linking in pellucid marginal degeneration: Evaluation after five years. J Curr Ophthalmol 2022; 34:229-233. [PMID: 36147277 PMCID: PMC9487015 DOI: 10.4103/joco.joco_16_22] [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: 01/12/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose: Methods: Results: Conclusion:
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Pellucid marginal degeneration classification development based on investigation of relationship between functional and refractive changes. OPHTHALMOLOGY JOURNAL 2021. [DOI: 10.17816/ov79626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND: One of the problems in the diagnosis and treatment of pellucid marginal degeneration of the cornea is the difficulty of systematizing its manifestations due to the lack of classification. This is due to the low frequency of pellucid marginal degeneration in the structure of primary keratectasia, the main type of which is keratoconus. The developed classifications of keratoconus cannot be fully applied to pellucid marginal degeneration.
AIM: The aim was to develop a classification of pellucid marginal degeneration based on investigation of relationship between functional and refractive changes.
MATERIALS AND METHODS: The study included 42 people (42 eyes) with pellucid marginal degeneration. Keratometry and refractometry were performed, uncorrected and best corrected visual acuity, as well as cylindrical and spherical components of subjective refraction were studied, and retinal visual acuity was determined. The 1st group 12 patients (12 eyes) with fully corrected induced ametropia (best corrected visual acuity 0.8), the 2nd group 17 patients (17 eyes) with partially corrected induced ametropia (0.8 and 0.3), the 3rd group 13 patients (13 eyes) with uncorrected induced ametropia (0.3).
RESULTS: To develop a clinical classification of pellucid marginal degeneration by stages, we selected: the values of corneal astigmatism, best corrected visual acuity and Index of difference between the values of maximum and minimum keratometry (K), all of which had good separation of obtained data, and their demarcate values in groups.
CONCLUSION: The study showed the presence of relationship between functional and refractive changes indices of eyes with pellucid marginal degeneration. The leading parameters of refractive status, objectively determining the value of best corrected visual acuity, are induced corneal astigmatism and K. The developed classification of pellucid marginal degeneration is easy to use and makes it possible to determine the stage of keratectasia even if there is only induced corneal astigmatism or K values.
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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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Kalra N, Asif MI, Bafna RK, Sharma N, Sinha R. Posterior Chamber Phakic Intraocular Lens Implantation for Refractive Correction in Corneal Ectatic Disorders: A Review. J Refract Surg 2021; 37:351-359. [PMID: 34044697 DOI: 10.3928/1081597x-20210115-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To summarize the indications and outcomes of posterior chamber phakic intraocular lens (PIOL) implantation in corneal ectasias including keratoconus, pellucid marginal degeneration (PMD), post-refractive surgery, and post-keratoplasty ectasias. METHODS A review of the literature was conducted using the relevant keywords from various databases up to August 15, 2020. All pertinent studies were reviewed, and the relevant articles were studied in detail for efficacy, stability, predictability, and safety outcomes. In addition, visual quality, corneal biomechanical outcomes, complications, the role of posterior chamber PIOL in combination treatment, and comparison of posterior chamber PIOL with other PIOLs for ectasias were also evaluated. RESULTS A total of 30 relevant studies (13 prospective, 13 retrospective, 4 case reports) on the subject were studied and summarized. All studies showed a favorable refractive outcome. Quality of vision remained unaffected and no significant complications were reported in any of the studies. CONCLUSIONS Posterior chamber PIOLs represent a viable option in the treatment of mild to moderate and stable corneal ectasia in patients with contact lens intolerance who have low irregular astigmatism, a clear central cornea, and good preoperative corrected distance visual acuity. [J Refract Surg. 2021;37(5):351-359.].
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17
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Alternative Indications for Corneal Crosslinking. J Cataract Refract Surg 2021; 47:1360-1366. [PMID: 33929804 DOI: 10.1097/j.jcrs.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/24/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Corneal crosslinking (CXL) is the current mainstay treatment for progressive keratoconus. In the past 15 years, a variety of other indications have been tested. A systematic review was conducted to examine these alternative indications for CXL. In total, of 143 papers on crosslinking as a treatment for infectious keratitis, bullous keratopathy, pellucid marginal degeneration, post- laser in situ keratomileusis (LASIK) ectasia, and as a way to improve vision either on its own or in combination with other interventions were included. Post-LASIK ectasia is a definite indication for crosslinking. Surprisingly, only limited research has been performed on pellucid marginal degeneration, with no randomized trials available to date. Other interesting applications are the combined use of refractive lasers and crosslinking for suspicious or ectatic corneas and crosslinking as a standalone intervention for minor refractive errors. CXL might offer a solution for refractory bacterial keratitis. In bullous keratopathy, it seems to offer only a transient benefit.
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18
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Mimouni M, Sorkin N, Trinh T, Hatch W, Singal N. Central versus paracentral cone location and outcomes of accelerated cross-linking in keratoconus patients. Eye (Lond) 2021; 35:3311-3317. [PMID: 33514906 DOI: 10.1038/s41433-021-01404-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 12/07/2020] [Accepted: 01/13/2021] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To compare outcomes 1 year after accelerated cross-linking (CXL) between keratoconus eyes with central cones to those with paracentral cones. METHODS In this post hoc analysis of data from a prospective multicentre study, consecutive progressive keratoconus eyes treated with accelerated CXL were included. Preoperative and 1 year post CXL manifest refraction, corneal cylinder, maximal keratometry (Kmax), central corneal thickness and coma were assessed. Central and paracentral cones were defined as cones within the central 3 mm and those between 3 and 5 mm, respectively. Eyes with apical scarring and peripheral cones (>5 mm) were excluded. The primary outcome measures were changes in best spectacle-corrected visual acuity (BSCVA) and Kmax. RESULTS Overall, 314 eyes (n = 314) with a mean age of 27.5 ± 7.7 years were included. At baseline, the central cone group was younger (p < 0.001), had lower corneal astigmatism (p = 0.03) and coma (p = 0.02). At 1 year post CXL, after adjusting for baseline characteristics (age, BSCVA, corneal astigmatism, Kmax and coma), the central cone group showed a greater reduction in myopia (mean difference 1.27 ± 0.60D, p = 0.04) and more improvement in BSCVA (mean difference 0.08 ± 0.02 logMAR, p < 0.001) compared to the paracentral group. There was no significant difference in progression rates between the central and paracentral groups (ΔKmax > 2D, 6.7% vs. 6.5%, respectively, p = 0.83). CONCLUSIONS This large-scale study of keratoconus eyes 1 year after accelerated CXL indicates that compared to those with paracentral cones, central cones have on average almost one additional line improvement in BCSVA and 1.27 D more reduction in myopia.
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Affiliation(s)
- Michael Mimouni
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada. .,Kensington Eye Institute, Toronto, ON, Canada.
| | - Nir Sorkin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Kensington Eye Institute, Toronto, ON, Canada.,Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tanya Trinh
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Kensington Eye Institute, Toronto, ON, Canada
| | | | - Wendy Hatch
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Kensington Eye Institute, Toronto, ON, Canada
| | - Neera Singal
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, ON, Canada.,Kensington Eye Institute, Toronto, ON, Canada
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19
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Abstract
Ectatic corneal disease (ECD) comprises a group of disorders characterized by progressive thinning and subsequent bulging of the corneal structure. Different phenotypes have been recognized, including keratoglobus, pellucid marginal degeneration (PMD), and keratoconus (KC). Keratoconus has been widely investigated throughout the years, but the advent of laser refractive surgery boosted an immediate need for more knowledge and research about ectatic diseases. This article discusses nomenclature of ectatic disease, etiology and pathogenesis, along with treatment options, with special focus ok KC and forme fruste keratoconus.
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20
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Mohr N, Shajari M, Krause D, Kassumeh S, Siedlecki J, Priglinger SG, Mayer WJ, Luft N. Pellucid marginal degeneration versus keratoconus: distinction with wide-field SD-OCT corneal sublayer pachymetry. Br J Ophthalmol 2020; 105:1638-1644. [PMID: 33055086 DOI: 10.1136/bjophthalmol-2020-316496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/11/2020] [Accepted: 09/15/2020] [Indexed: 11/03/2022]
Abstract
PURPOSE To evaluate the capability of wide-field spectral-domain optical coherence tomography (SD-OCT) corneal sublayer pachymetry to distinguish between keratoconus and pellucid marginal degeneration (PMD). METHODS This prospective cross-sectional study included 69 eyes (59 with keratoconus and 10 with PMD) of 69 patients. All patients were examined three subsequent times with the RTVue XR system. Pachymetry maps of the total cornea (CT), the epithelium (ET) and the stroma were generated using the onboard software. For analysis of reliability, the coefficients of variation and intraclass correlation coefficients (ICC) were calculated. Receiver operating characteristic analyses were performed to elaborate the most accurate pachymetric parameters for distinguishing between PMD and keratoconus. RESULTS Overall repeatability of (sublayer) pachymetry was comparably good in both keratoconus (ICC ranging between 0.827 and 0.986) and PMD (ICC ranging between 0.753 and 0.998). Measurement reliability in keratoconic eyes was a negative function of Kmax (p<0.05). As compared with keratoconus, PMD exhibited higher CT (526±31 µm vs 503±30 µm; p=0.02) and ET (56±7 µm vs 51±5 µm; p=0.02) in the inferotemporal 2-5 mm sector as well as lower ET in the inferior 7-9 mm sector (52±5 µm vs 57±5 µm; p<0.01). The calculated ratio between CT in the inferotemporal 2-5 mm and in the inferior 7-9 mm sector yielded the highest diagnostic accuracy for distinguishing between PMD and keratoconus with an area under the curve of 0.977 and an optimal cut-off value of 0.90. CONCLUSION Wide-field SD-OCT corneal sublayer pachymetry showed good reliability in PMD and keratoconus and may be useful to differentiate between the two ectatic diseases.
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Affiliation(s)
- Niklas Mohr
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Mehdi Shajari
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.,Department of Ophthalmology, Goethe-University, Frankfurt am Main, Germany
| | - Daniel Krause
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Stefan Kassumeh
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Jakob Siedlecki
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.,SMILE Eyes Clinic, Linz, Austria
| | - Siegfried G Priglinger
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany.,SMILE Eyes Clinic, Linz, Austria
| | - Wolfgang J Mayer
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany
| | - Nikolaus Luft
- Department of Ophthalmology, Ludwig-Maximilians-University, Munich, Germany .,SMILE Eyes Clinic, Linz, Austria
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21
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Bajracharya L, Agrawal N, Dhungel S, Parajuli R, Adhikari S. A Teenager with Vernal Keratoconjunctivitis and Pellucid Marginal Degeneration, Presenting with Exotropia. Int Med Case Rep J 2020; 13:399-408. [PMID: 32982479 PMCID: PMC7498931 DOI: 10.2147/imcrj.s262999] [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: 05/27/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022] Open
Abstract
Background Vernal keratoconjunctivitis (VKC), an allergic disease, has a known association with ectatic disorders of the cornea. Pellucid marginal degeneration (PMD) is a bilateral, asymmetrical, ectatic disorder of the cornea characterized by inferior corneal thinning. We report a case of sensory exotropia due to PMD in association with VKC. Case Details A 19-year old boy with a history of VKC presented with exotropia of the right eye of 3 years’ duration. His unaided vision in his right eye was 1/60 and in his left eye it was 6/36. On examination, both eyes had high against the rule astigmatism, which was more in the right eye. There was exotropia of 15º (40 prism diopter base in) in the right eye with suppression (Worth four dot test). Corneal examination in both eyes showed inferior band thinning, 2 mm above the inferior limbus, extending from 4 to 8 clock hours, with bulging of the cornea just above the thinning. The clinical features were suggestive of PMD, which was supported by his corneal scans – Atlas, Pentacam, and Optovue. Although he was undergoing treatment for VKC, the onset of PMD and decrease in vision went unnoticed. The asymmetric error which was not corrected during the sensitive period of visual development led to sensory exotropia. Conclusion A child with VKC should undergo regular refraction so as not to miss any ectatic changes occurring in the cornea. A delay in diagnosing corneal ectasia may negate the possibility of collagen cross-linking which prevents progression of ectasia. If visual rehabilitation is delayed beyond the age of visual maturation, it can lead to strabismus, suppression, and loss of binocular function.
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Affiliation(s)
- Leena Bajracharya
- Cornea Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Nisha Agrawal
- Pediatric Ophthalmology and Strabismus Department, Taparia Eye Care, Biratnagar, Nepal
| | - Shashwat Dhungel
- Department of Refractive Surgery, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Rojeeta Parajuli
- Pediatric Ophthalmology and Strabismus Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
| | - Srijana Adhikari
- Pediatric Ophthalmology and Strabismus Department, Tilganga Institute of Ophthalmology, Kathmandu, Nepal
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22
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Regueiro U, Pérez-Mato M, Hervella P, Campos F, Sobrino T, Lema I. Toll-like receptors as diagnostic targets in pellucid marginal degeneration. Exp Eye Res 2020; 200:108211. [PMID: 32890481 DOI: 10.1016/j.exer.2020.108211] [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] [Received: 03/27/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 12/30/2022]
Abstract
The main purpose of this study is to evaluate the diagnostic role of Toll-like receptors 2 (TLR2) and 4 (TLR4) expression in corneal and conjunctival epithelial cells of eyes with pellucid marginal degeneration (PMD) compared to keratoconus patients (KC) and control subjects. A prospective case-control study in 29 PMD eyes, 109 KC eyes and 72 healthy eyes was done. All participants were subjected to a clinical, topographic, aberrometric and tomographic exam with extraction of corneal and conjunctival epithelial cells through scraping. The TLR2 and TLR4 expression was measured with flow cytometry. Receiver operating characteristic (ROC) curve analysis was used to determine the most appropriate cutoff point for predicting the risk of PMD and KC. Correlations between TLR2/TLR4 expression and the severity of PMD/KC were evaluated. A TLRs follow-up review was made 19 ± 4 months after to the first review. As result, mean expression of TLR2 and TLR4 in both corneal and conjunctival epithelial cells was significantly higher in eyes with corneal ectasia (PMD and KC) than in control eyes (all p < 0.05). Conjunctival TLR4 expression showed the highest capacity to diagnose the existence of PMD (odd ratio 42.84; 95% confidence interval:6.20-296.20; p < 0.0001) after adjusting by eye rubbing and steeper corneal meridian. Moreover, we found an association between the TLR2/TLR4 overexpression with the severity of the PMD and KC measured by corneal topographic, aberrometric and tomographic quantitative parameters (all p < 0.05). Differences on TLR2/TLR4 expression between study groups were maintained during the follow-up period. In conclusion, the TLR2/TLR4 overexpression in corneal and conjunctival epithelial cells of PMD and KC patients compared to healthy control subjects have demonstrated their role as diagnostic target in both corneal ectatic disorders.
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Affiliation(s)
- Uxía Regueiro
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Facultade de Óptica e Optometría, Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain
| | - María Pérez-Mato
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pablo Hervella
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Isabel Lema
- Clinical Neurosciences Research Laboratory, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain; Facultade de Óptica e Optometría, Universidade de Santiago de Compostela (USC), Santiago de Compostela, Spain; Instituto Galego de Oftalmoloxía (INGO), Hospital Provincial de Conxo, Santiago de Compostela, Spain.
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23
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Ferrari G, Rama P. The keratoconus enigma: A review with emphasis on pathogenesis. Ocul Surf 2020; 18:363-373. [PMID: 32234342 DOI: 10.1016/j.jtos.2020.03.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/11/2020] [Accepted: 03/19/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To review the literature on the etiopathogenesis of keratoconus (KC). METHODS A literature search was conducted using PUBMED and Google Scholar for keratoconus. The authors analyzed epidemiology studies, reviews, and case reports. RESULTS Atopy and ocular surface inflammation are a common features of KC and should lead to a reconsideration of the traditional definition of KC as a "non inflammatory" condition. Co-morbidities suggest that KC may be the ocular manifestation of a systemic disease. Finally, KC shows higher prevalence in certain ethnicities, which calls into question the status of KC as a rare disease, at least in these communities. CONCLUSION We believe that future studies should test whether selected, high prevalence populations exhibit specific genetic background and/or ethno-specific environmental risk factors.
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Affiliation(s)
- Giulio Ferrari
- San Raffaele Hospital, Cornea and Ocular Surface Unit, Eye Repair Lab, Italy.
| | - Paolo Rama
- San Raffaele Hospital, Cornea and Ocular Surface Unit, Eye Repair Lab, Italy
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24
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Boukari M, Kallel H, Kaouel H, Errais K, Ammous I, Zhioua R. [Pellucid marginal degeneration: Role of corneo-scleral contact lens fitting]. J Fr Ophtalmol 2019; 43:e85-e87. [PMID: 31879041 DOI: 10.1016/j.jfo.2019.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/27/2019] [Accepted: 10/09/2019] [Indexed: 10/25/2022]
Affiliation(s)
- M Boukari
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie.
| | - H Kallel
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie
| | - H Kaouel
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie
| | - K Errais
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie
| | - I Ammous
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie
| | - R Zhioua
- Department of Ophthalmology, Faculty of Medicine of Tunis, Tunis El Manar University, Charles Nicolle University Hospital of Tunis, boulevard du 9-Avril-1938, 1006 Tunis Tunisie
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25
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Bézé S, Benoist D'azy C, Lambert C, Chiambaretta F. Efficacy of visual rehabilitation of patients with pellucid marginal degeneration fitted with SPOT® scleral contact lenses. J Fr Ophtalmol 2019; 43:e1-e5. [PMID: 31836294 DOI: 10.1016/j.jfo.2019.11.004] [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: 09/09/2019] [Revised: 10/10/2019] [Accepted: 11/17/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE To assess visual improvement in patients with pellucid marginal degeneration (PMD) after fitting with SPOT® scleral contact lenses (Scleral Protection & Ocular Treatment, Laboratoires d'Appareillage Oculaire, Amphion-Les-Bains, France). METHODS We report a case series of 5 patients with PMD and unsatisfactory refractive correction managed at Clermont-Ferrand university hospital from January to December 2018 fitted with customized SPOT scleral lenses. We assessed the best-corrected visual acuity (BCVA) before and after fitting with SPOT, keratometric data and tolerability of the scleral lenses. RESULTS Nine eyes of 5 patients aged 51.8±8.47 years were fitted. The BCVA was significantly improved from 0.51 logMAR (±0.39) to 0.04 logMAR (±0.07) (P<0.001). Sixty-six percent of the patients recovered optimal BCVA. No serious adverse event was reported. The presence of whitish deposits and an inordinate amount of manipulation required were the main disadvantages of the lenses. Nevertheless, all the patients considered them to be comfortable. CONCLUSION Fitting PMD patients who have failed conventional optical devices with SPOT scleral lenses significantly improves BCVA, without serious adverse events, allowing surgery to be deferred even when it appears to be unavoidable.
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Affiliation(s)
- S Bézé
- Ophthalmology service, centre hospitalier régional universitaire Gabriel-Montpied, place Henri-Dunant, 63000 Clermont-Ferrand, France.
| | - C Benoist D'azy
- Ophthalmology service, centre hospitalier régional universitaire Gabriel-Montpied, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - C Lambert
- Délégation à la recherche clinique et informatique, centre hospitalier régional universitaire Gabriel-Montpied, place Henri-Dunant, 63000 Clermont-Ferrand, France
| | - F Chiambaretta
- Ophthalmology service, centre hospitalier régional universitaire Gabriel-Montpied, place Henri-Dunant, 63000 Clermont-Ferrand, France
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