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Wang R, Li Y, Gao S, Zhang Y, He Z, Ji J, Yang X, Ye L, Zhao L, Liu A, Zhai G. An active transport dual adaptive nanocarrier designed to overcome the corneal microenvironment for neovascularization therapy. Biomater Sci 2024; 12:361-374. [PMID: 37982147 DOI: 10.1039/d3bm01349a] [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: 11/21/2023]
Abstract
The eyes have a complicated microenvironment with many clearance mechanisms, making it challenging for effective drug delivery to the targeted areas of the eyes. Substrate transport mediated by active transporters is an important way to change drug metabolism in the ocular microenvironment. We designed multifunctional, dual-adaptive nanomicelles (GSCQ@NTB) which could overcome multiple physiological barriers by acting on both the efflux transporter and influx transporter to achieve deep delivery of the P-gp substrate in the cornea. Specifically, an effective "triple" antiangiogenic agent, nintedanib (NTB), was loaded into the biocompatible micelles. The expression of the efflux transporter was reversed by grafting quercetin. The peptide (glycylsarcosine, GS) was modified to target the influx transporter "Peptide Transporter-1" (PepT-1). Quercetin (QRT) and nintedanib (NTB) were transported to the cornea cooperatively, achieving long retention on the ocular surface and high compatibility. In a New Zealand rabbit model, within 8 hours after local administration, GSCQ@NTB was enriched in corneal stromal neovascularization and effectively inhibited the progress of neovascularization. Its effectiveness is slightly better than that in the first-line clinical application of steroids. In this study, we introduce the preparation of a dual adaptive nano-micelle system, which may provide an effective non-invasive treatment for corneal neovascularization.
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Affiliation(s)
- Rui Wang
- Department of Pharmacy, Qilu Hospital of Shandong University, 107 Wenhua Xilu, Jinan 250012, P.R. China.
- Department of Pharmaceutics, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
- Department of Pharmacy, Qilu Hospital of Shandong University (Qingdao), No. 758 Hefei Road, Qingdao, 266035, P.R. China
| | - Yingying Li
- Department of Pharmaceutics, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
| | - Shan Gao
- Department of Pharmaceutics, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
| | - Yu Zhang
- Department of Pharmaceutics, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
| | - Zhijing He
- Department of Pharmaceutics, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
| | - Jianbo Ji
- Department of Pharmaceutics, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
| | - Xiaoye Yang
- Department of Pharmaceutics, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
| | - Lei Ye
- Department of Pharmaceutics, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
| | - Lixia Zhao
- Department of Pharmacy, Qilu Hospital of Shandong University, 107 Wenhua Xilu, Jinan 250012, P.R. China.
| | - Anchang Liu
- Department of Pharmacy, Qilu Hospital of Shandong University, 107 Wenhua Xilu, Jinan 250012, P.R. China.
- Department of Pharmaceutics, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
- Department of Pharmacy, Qilu Hospital of Shandong University (Qingdao), No. 758 Hefei Road, Qingdao, 266035, P.R. China
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Shandong University, 44 Wenhua Xilu, Jinan 250012, P.R. China
| | - Guangxi Zhai
- Department of Pharmacy, Qilu Hospital of Shandong University, 107 Wenhua Xilu, Jinan 250012, P.R. China.
- Department of Pharmaceutics, Key Laboratory of Chemical Biology (Ministry of Education), NMPA Key Laboratory for Technology Research and Evaluation of Drug Products, School of Pharmaceutical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, 250012, P.R. China.
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Khan S, Neuhaus K, Thaware O, Ni S, Ju MJ, Redd T, Huang D, Jian Y. Corneal imaging with blue-light optical coherence microscopy. BIOMEDICAL OPTICS EXPRESS 2022; 13:5004-5014. [PMID: 36187260 PMCID: PMC9484440 DOI: 10.1364/boe.465707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 06/16/2023]
Abstract
Corneal imaging is important for the diagnostic and therapeutic evaluation of many eye diseases. Optical coherence tomography (OCT) is extensively used in ocular imaging due to its non-invasive and high-resolution volumetric imaging characteristics. Optical coherence microscopy (OCM) is a technical variation of OCT that can image the cornea with cellular resolution. Here, we demonstrate a blue-light OCM as a low-cost and easily reproducible system to visualize corneal cellular structures such as epithelial cells, endothelial cells, keratocytes, and collagen bundles within stromal lamellae. Our blue-light OCM system achieved an axial resolution of 12 µm in tissue over a 1.2 mm imaging depth, and a lateral resolution of 1.6 µm over a field of view of 750 µm × 750 µm.
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Affiliation(s)
- Shanjida Khan
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Kai Neuhaus
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - Omkar Thaware
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Shuibin Ni
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Myeong Jin Ju
- Department of Ophthalmology and Visual
Sciences, University of British Columbia,
Vancouver, BC, Canada
- School of Biomedical Engineering,
University of British Columbia, Vancouver,
BC, Canada
| | - Travis Redd
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
| | - David Huang
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
| | - Yifan Jian
- Casey Eye Institute, Oregon Health & Science University, Portland, OR 97239, USA
- Department of Biomedical Engineering, Oregon Health & Science University, Portland, OR 97239, USA
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Chen Z, Yin X, Lin L, Shi G, Mo J. Centerline extraction by neighborhood-statistics thinning for quantitative analysis of corneal nerve fibers. Phys Med Biol 2022; 67. [DOI: 10.1088/1361-6560/ac7b63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 06/22/2022] [Indexed: 11/11/2022]
Abstract
Abstract
Objective. Corneal nerve fiber (CNF) has been found to exhibit morphological changes associated with various diseases, which can therefore be utilized to aid in the early diagnosis of those diseases. CNF is usually visualized under corneal confocal microscopy (CCM) in clinic. To obtain the diagnostic biomarkers from CNF image produced from CCM, image processing and quantitative analysis are needed. Usually, CNF is segmented first and then CNF’s centerline is extracted, allowing for measuring geometrical and topological biomarkers of CNF, such as density, tortuosity, and length. Consequently, the accuracy of the segmentation and centerline extraction can make a big impact on the biomarker measurement. Thus, this study is aimed to improve the accuracy and universality of centerline extraction. Approach. We developed a new thinning algorithm based on neighborhood statistics, called neighborhood-statistics thinning (NST), to extract the centerline of CNF. Compared with traditional thinning and skeletonization techniques, NST exhibits a better capability to preserve the fine structure of CNF which can effectively benefit the biomarkers measurement above. Moreover, NST incorporates a fitting process, which can make centerline extraction be less influenced by image segmentation. Main results. This new method is evaluated on three datasets which are segmented with five different deep learning networks. The results show that NST is superior to thinning and skeletonization on all the CNF-segmented datasets with a precision rate above 0.82. Last, NST is attempted to be applied for the diagnosis of keratitis with the quantitative biomarkers measured from the extracted centerlines. Longer length and higher density but lower tortuosity were found on the CNF of keratitis patients as compared to healthy patients. Significance. This demonstrates that NST has a good potential to aid in the diagnostics of eye diseases in clinic.
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Corneal toxicity associated with belantamab mafodotin is not restricted to the epithelium: neuropathy studied with confocal microscopy. Am J Ophthalmol 2022; 242:116-124. [PMID: 35752319 DOI: 10.1016/j.ajo.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to investigate epithelial and neuronal changes in patients with refractory/relapsed multiple myeloma (RRMM) before/during belantamab mafodotin (belamaf) treatment using confocal microscopy. DESIGN Retrospective case series. METHODS RRMM patients underwent best corrected visual acuity (BCVA) testing and slit-lamp examination/photography, followed by corneal confocal microscopy (CCM) to evaluate the epithelium and subbasal nerve plexus (SNP) to measure corneal nerve fiber density (CNFD), -branch density (CNBD), and -fiber length (CNFL) before and during belamaf treatment. RESULTS In 14 eyes of 7 patients (4 female, 68±10 years) with complete follow-up (4±2 months), the median BCVA dropped from 20/25 (20/25-20/20) to 20/40 (20/200-20/32) in the worse eye at the end of follow-up. Microcystic epithelial changes and ocular surface disease were demonstrated biomicroscopically. CCM showed "grape-like" hyperreflective spots in the central basal epithelium that changed to polymorphous-structured cysts in the superficial epithelium, with no pathology detected at the(peri-)limbal structures. The baseline, normal SNP morphology with a mean CNFD, CNBD, and CNFL of 20.25±7.06/mm2, 19.49±12.34/mm2, and 11.8±3.74mm/mm2 respectively, showed severe fiber fragmentation during follow-up, and an observed complete loss of the SNP at the end of follow-up in all eyes. CONCLUSIONS This study is the first to illustrate neurotoxic effects of belamaf on the human cornea.
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Corneal Densitometry and In Vivo Confocal Microscopy in Patients with Monoclonal Gammopathy—Analysis of 130 Eyes of 65 Subjects. J Clin Med 2022; 11:jcm11071848. [PMID: 35407456 PMCID: PMC9000138 DOI: 10.3390/jcm11071848] [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: 03/01/2022] [Revised: 03/19/2022] [Accepted: 03/23/2022] [Indexed: 12/03/2022] Open
Abstract
Background: Corneal imaging may support an early diagnosis of monoclonal gammopathy. The goal of our study was to analyze corneal stromal properties using Pentacam and in vivo confocal cornea microscopy (IVCM) in subjects with monoclonal gammopathy. Patients and methods: In our cross-sectional study, patients with monoclonal gammopathy (130 eyes of 65 patients (40.0% males; age 67.65 ± 9.74 years)) and randomly selected individuals of the same age group, without hematological disease (100 eyes of 50 control subjects (40.0% males; age 60.67 ± 15.06 years)) were included. Using Pentacam (Pentacam HR; Oculus GmbH, Wetzlar, Germany), corneal stromal light scattering values were obtained (1) centrally 0–2 mm zone; (2) 2–6 mm zone; (3) 6–10 mm zone; (4) 10–12 mm zone. Using IVCM with Heidelberg Retina Tomograph with Rostock Cornea Module (Heidelberg Engineering, Heidelberg, Germany), the density of hyperreflective keratocytes and the number of hyperreflective spikes per image were manually analyzed, in the stroma. Results: In the first, second and third annular zone, light scattering was significantly higher in subjects with monoclonal gammopathy, than in controls (p ≤ 0.04). The number of hyperreflective keratocytes and hyperreflective spikes per image was significantly higher in stroma of subjects with monoclonal gammopathy (p ≤ 0.012). Conclusions: Our study confirms that increased corneal light scattering in the central 10 mm annular zone and increased keratocyte hyperreflectivity may give rise to suspicion of monoclonal gammopathy. As corneal light scattering is not increased at the limbal 10–12 mm annular zone in monoclonal gammopathy subjects, our spatial analysis provides evidence against the limbal origin of corneal paraprotein deposition. Using IVCM, stromal hyperreflective spikes may represent specific signs of monoclonal gammopathy.
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Hoffman JJ, Massae P, Weiss HA, Makupa W, Burton MJ, Hu VH. In vivo confocal microscopy and trachomatous conjunctival scarring: Predictors for clinical progression. Clin Exp Ophthalmol 2020; 48:1152-1159. [PMID: 32798249 DOI: 10.1111/ceo.13843] [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: 02/27/2020] [Revised: 07/23/2020] [Accepted: 07/31/2020] [Indexed: 01/14/2023]
Abstract
IMPORTANCE In vivo confocal microscopy (IVCM) provides high-resolution images of the ocular surface and has been validated in trachomatous conjunctival scarring. BACKGROUND This study used IVCM to identify parameters associated with clinical scarring progression. DESIGN Prospective cohort study. PARTICIPANTS A total of 800 participants in Northern Tanzania with trachomatous scarring. METHODS Participants underwent clinical examination, photography and IVCM at baseline and 24-months. Clinical progression of scarring was defined by comparing baseline and 24-month photographs. Masked grading of IVCM images was used to identify scarring at both time points. Multivariable logistic regression was used to assess factors associated with clinical progression. MAIN OUTCOME MEASURES Risk factors associated with clinical scarring progression. RESULTS Clinical and IVCM assessment of 800 participants were performed at baseline, with 617 (77.1%) seen at 24-months. Of these, 438 of 617 (71.0%) had gradable IVCM images at both time points and 342 of 438 (78.1%) of these could be graded as showing definite clinical progression or no progression on image comparison. Clinical progression was found to occur in 79 of 342 (23.1%). After adjusting for age and sex, clinical scarring progression was strongly associated with a high IVCM connective tissue organization score at both baseline (odds ratio [OR] = 1.84 for each increase in scarring category; P = .002) and 24-months (OR = 1.60; P = .02). Dendritiform cells present at 24-months were strongly associated with clinical scarring progression after adjustment (OR = 2.62; P = .03). CONCLUSIONS AND RELEVANCE Quantitative IVCM parameters, including connective tissue organization score and the presence of dendritiform cells, are associated with disease progression and may be useful markers in trachoma and other conjunctival fibrotic diseases.
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Affiliation(s)
- Jeremy J Hoffman
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK.,Department of Ophthalmology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Patrick Massae
- Department of Ophthalmology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Helen A Weiss
- MRC Tropical Epidemiology Group, London School of Hygiene & Tropical Medicine, London, UK
| | - William Makupa
- Department of Ophthalmology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Matthew J Burton
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Victor H Hu
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, UK
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Elsawy A, Abdel-Mottaleb M, Sayed IO, Wen D, Roongpoovapatr V, Eleiwa T, Sayed AM, Raheem M, Gameiro G, Shousha MA. Automatic Segmentation of Corneal Microlayers on Optical Coherence Tomography Images. Transl Vis Sci Technol 2019; 8:39. [PMID: 31211004 PMCID: PMC6561132 DOI: 10.1167/tvst.8.3.39] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/25/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To propose automatic segmentation algorithm (AUS) for corneal microlayers on optical coherence tomography (OCT) images. Methods Eighty-two corneal OCT scans were obtained from 45 patients with normal and abnormal corneas. Three testing data sets totaling 75 OCT images were randomly selected. Initially, corneal epithelium and endothelium microlayers are estimated using a corneal mask and locally refined to obtain final segmentation. Flat-epithelium and flat-endothelium images are obtained and vertically projected to locate inner corneal microlayers. Inner microlayers are estimated by translating epithelium and endothelium microlayers to detected locations then refined to obtain final segmentation. Images were segmented by trained manual operators (TMOs) and by the algorithm to assess repeatability (i.e., intraoperator error), reproducibility (i.e., interoperator and segmentation errors), and running time. A random masked subjective test was conducted by corneal specialists to subjectively grade the segmentation algorithm. Results Compared with the TMOs, the AUS had significantly less mean intraoperator error (0.53 ± 1.80 vs. 2.32 ± 2.39 pixels; P < 0.0001), it had significantly different mean segmentation error (3.44 ± 3.46 vs. 2.93 ± 3.02 pixels; P < 0.0001), and it had significantly less running time per image (0.19 ± 0.07 vs. 193.95 ± 194.53 seconds; P < 0.0001). The AUS had insignificant subjective grading for microlayer-segmentation grading (4.94 ± 0.32 vs. 4.96 ± 0.24; P = 0.5081), but it had significant subjective grading for regional-segmentation grading (4.96 ± 0.26 vs. 4.79 ± 0.60; P = 0.025). Conclusions The AUS can reproduce the manual segmentation of corneal microlayers with comparable accuracy in almost real-time and with significantly better repeatability. Translational Relevance The AUS can be useful in clinical settings and can aid the diagnosis of corneal diseases by measuring thickness of segmented corneal microlayers.
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Affiliation(s)
- Amr Elsawy
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.,Electrical and Computer Engineering, University of Miami, Coral Gables, FL, USA
| | | | - Ibrahim-Osama Sayed
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Dan Wen
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Taher Eleiwa
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.,Ophthalmology Department, Benha Faculty of Medicine, Egypt
| | - Ahmed M Sayed
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.,Biomedical Engineering Department, Faculty of Engineering, Helwan University, Egypt
| | - Mariam Raheem
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Gustavo Gameiro
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.,Electrical and Computer Engineering, University of Miami, Coral Gables, FL, USA.,Biomedical Engineering, University of Miami, Coral Gables, FL, USA
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Abstract
PURPOSE This study analyzes images of Kayser-Fleischer (K-F) rings in patients with Wilson disease (WD) using in vivo confocal microscopy (IVCM) and explores whether IVCM can be a useful clinical tool in facilitating the diagnosis and characterization of K-F rings. METHODS One hundred four eyes of 52 patients with WD and K-F rings (K-F group) and 52 normal eyes of 52 age- and gender-matched control subjects (control group) were enrolled in the study. Both K-F and control groups consisted of 29 male patients and 23 female patients. IVCM imaging was performed, and images of the peripheral Descemet membrane were analyzed. RESULTS All patients in K-F group showed abnormal patterns in the peripheral Descemet membrane from IVCM images. These abnormalities can be generally divided into 3 types: patchy, stripy, and spotty patterns. Each patient may have a combination of these patterns, with patchy pattern being most prevalent (100%), whereas stripy and spotty patterns are present in 30% to 40% of the K-F rings. Notably, these patterns are not correlated with other systematic symptoms of WD. CONCLUSIONS IVCM images can be used as an objective clinical diagnostic tool to facilitate the identification of K-F rings and the diagnosis of WD.
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Efficacy of eyedrops containing cross-linked hyaluronic acid and coenzyme Q10 in treating patients with mild to moderate dry eye. Eur J Ophthalmol 2018; 28:25-31. [PMID: 28777385 DOI: 10.5301/ejo.5001011] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Dry eye disease (DED) is a common condition causing substantial burden. A randomized, controlled, single-masked study was performed in 40 patients with mild to moderate DED to evaluate the efficacy and safety of a collyrium based on crosslinked hyaluronic acid (XLHA) with coenzyme Q10 (CoQ10). METHODS Enrolled subjects were divided into 2 groups: group A, treated with XLHA + CoQ10; and group B, treated with hyaluronic acid (HA). Eyedrops were administered 4 times daily for 3 months. The Ocular Surface Disease Index (OSDI) questionnaire, tear break-up time (TBUT), corneal and conjunctival staining, and meibomian gland assessment (MGD) were evaluated; furthermore, corneal aesthesiometry, in vivo corneal confocal microscopy, visual acuity, intraocular pressure (IOP), and fundus examination were performed. RESULTS At the end of treatment, OSDI score significantly decreased in groups A and B (p<0.01 and p<0.05, respectively); the decrease was significantly higher in group A. Corneal staining decreased in both groups, with lower scores in group A. The MGD was significantly ameliorated in group A patients. No differences were found for corneal aesthesiometry or TBUT. Epithelial cell reflectivity was significantly reduced only in group A. For keratocytes and stromal matrix parameters, there was a significant improvement in group A. No changes were found for visual acuity, IOP, or fundus examination. CONCLUSIONS The XLHA + CoQ10 treatment showed greater effectiveness in DED compared to HA alone, probably due to the longer permanency on ocular surface and the antioxidant activity of CoQ10. Therefore, XLHA + CoQ10 eyedrops could represent a new possibility in dry eye treatment.
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Yamagiwa Y, Haranosono Y, Nemoto S, Atsumi I, Kurata M, Kito G, Hatakeyama H, Koizumi H, Sakaki H. Characteristics of corneal phospholipidosis induced by topical ocular application of chloroquine and amiodarone in rabbits. J Toxicol Pathol 2017; 30:135-143. [PMID: 28458451 PMCID: PMC5406592 DOI: 10.1293/tox.2016-0003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 11/01/2016] [Indexed: 11/22/2022] Open
Abstract
Several cationic-amphiphilic drugs such as chloroquine and amiodarone are known to induce phospholipidosis in the cornea by systemic administration. However, the characteristics of ophthalmological and pathological changes when phospholipidosis-inducing drugs are topically applied have not been well studied. This study was conducted to investigate the characteristics of corneal changes caused by topical application of chloroquine and amiodarone to Japanese white rabbits. The changes were evaluated by ophthalmological, histopathological, and ultrastructural examinations. An in vivo confocal microscopy was also applied to the chloroquine-treated corneas. In both chloroquine- and amiodarone-treated corneas, diffuse cloudiness was observed by slit-lamp biomicroscopy, and its transparency increased with duration of dosing. Confocal microscopy showed punctate dots in the corneal epithelium. Histopathologically, cytoplasmic vacuolation was found in the corneal epithelium and keratocytes in both chloroquine- and amiodarone-treated eyes. Furthermore, foamy cytoplasm of the corneal endothelium was observed in the chloroquine-treated eyes. Ultrastructural examination showed multi-lamellar inclusion bodies or membrane-like debris in the lysosome-like vacuoles in the cytoplasm of corneal cells, which is a characteristic of the lesions of phospholipidosis. These changes disappeared after a withdrawal period. Continuous dosing of chloroquine resulted in corneal erosion and focal corneal opacity as shown by gross observation and slit-lamp biomicroscopy. Confocal microscopy could detect the corneal changes prior to the appearance of these ophthalmological changes. The present study showed that phospholipidosis caused by ocular administration of chloroquine and amiodarone first induces reversible diffuse corneal cloudiness. Confocal microscopy is a useful method for monitoring induction of corneal phospholipidosis.
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Affiliation(s)
- Yoshinori Yamagiwa
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Yu Haranosono
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Shingo Nemoto
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Ikuyo Atsumi
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Masaaki Kurata
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Gakushi Kito
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
| | - Hirofumi Hatakeyama
- Clinical Pathology Department, Ina Research Inc., 2148-288 Nishi-minowa, Ina, Nagano 399-4501, Japan
| | - Haruko Koizumi
- Clinical Pathology Department, Ina Research Inc., 2148-288 Nishi-minowa, Ina, Nagano 399-4501, Japan
| | - Hideyuki Sakaki
- Pharmacokinetics and Toxicology Research Laboratories, Senju Pharmaceutical Co., Ltd., 1-5-4 Murotani, Nishi-ku, Kobe, Hyogo 651-2241, Japan
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Abstract
PURPOSE To analyze the factors affecting central corneal endothelial cell density (ECD) in an eye bank corneal donor database. METHODS The Lion's Eye Institute corneal donor database consisting of 18,665 donors (34,234 corneas) aged 20 years or older was analyzed. In particular, differences in the ECD based on age, sex, race, prior ocular surgery, a history of systemic diseases, and smoking were investigated. Furthermore, risk factors for donor cell count inadequacy (defined here as ECD less than 2000/mm) were identified. RESULTS ECD decreased with age. Regarding race, the average ECD of African American donors was higher than those of white or Hispanic donors. A history of diabetes mellitus (DM) and ocular surgery were associated with a lower ECD. Donor medical history of hypertension, glaucoma, depression, dementia, Parkinson disease, hyper- or hypothyroidism, or smoking did not seem to affect the ECD. The risk factors for donor cell count inadequacy, based on binary logistic regression analyses were advanced age [65-74 years yielded an odds ratio of 17.8; confidence interval (CI), 10.6-29.8; P < 0.001; and 75-99 years yielded an odds ratio of 24.6 (CI, 14.5-41.61; P < 0.001) when compared with 20-34 years], cataract surgery (odds ratio, 4.3; CI, 4.0-4.8; P < 0.001), and DM (odds ratio, 1.2; CI, 1.1-1.3; P = 0.001). CONCLUSIONS Age, race, ocular surgery (cataract and refractive), and DM seem to significantly affect donor corneal ECD. Of these variables, age, a history of cataract surgery, and DM were found to be the greatest risk factors for inadequate donor cell density (less than 2000/mm).
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Werkmeister RM, Sapeta S, Schmidl D, Garhöfer G, Schmidinger G, Aranha dos Santos V, Aschinger GC, Baumgartner I, Pircher N, Schwarzhans F, Pantalon A, Dua H, Schmetterer L. Ultrahigh-resolution OCT imaging of the human cornea. BIOMEDICAL OPTICS EXPRESS 2017; 8:1221-1239. [PMID: 28271013 PMCID: PMC5330598 DOI: 10.1364/boe.8.001221] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 12/19/2016] [Accepted: 12/26/2016] [Indexed: 05/03/2023]
Abstract
We present imaging of corneal pathologies using optical coherence tomography (OCT) with high resolution. To this end, an ultrahigh-resolution spectral domain OCT (UHR-OCT) system based on a broad bandwidth Ti:sapphire laser is employed. With a central wavelength of 800 nm, the imaging device allows to acquire OCT data at the central, paracentral and peripheral cornea as well as the limbal region with 1.2 µm x 20 µm (axial x lateral) resolution at a rate of 140 000 A-scans/s. Structures of the anterior segment of the eye, not accessible with commercial OCT systems, are visualized. These include corneal nerves, limbal palisades of Vogt as well as several corneal pathologies. Cases such as keratoconus and Fuchs's endothelial dystrophy as well as infectious changes caused by diseases like Acanthamoeba keratitis and scarring after herpetic keratitis are presented. We also demonstrate the applicability of our system to visualize epithelial erosion and intracorneal foreign body after corneal trauma as well as chemical burns. Finally, results after Descemet's membrane endothelial keratoplasty (DMEK) are imaged. These clinical cases show the potential of UHR-OCT to help in clinical decision-making and follow-up. Our results and experience indicate that UHR-OCT of the cornea is a promising technique for the use in clinical practice, but can also help to gain novel insight in the physiology and pathophysiology of the human cornea.
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Affiliation(s)
- René M. Werkmeister
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Sabina Sapeta
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Singapore Eye Research Institute The Academia, 20 College Road, Discovery Tower Level 6, 169856, Singapore
| | - Doreen Schmidl
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Gerhard Garhöfer
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Gerald Schmidinger
- Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Valentin Aranha dos Santos
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Gerold C. Aschinger
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Isabella Baumgartner
- Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Niklas Pircher
- Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - Florian Schwarzhans
- Department of Ophthalmology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Spitalgasse 23, A-1090 Vienna, Austria
| | - Anca Pantalon
- Department of Ophthalmology, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Sf. Spiridon University Hospital, 16 Universitatii Str, Iasi, 700115, Romania
| | - Harminder Dua
- Academic Section of Ophthalmology, Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust QMC campus, Derby Road, Nottingham, NG7 2UH, UK
| | - Leopold Schmetterer
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Christian Doppler Laboratory for Ocular and Dermal Effects of Thiomers, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Singapore Eye Research Institute The Academia, 20 College Road, Discovery Tower Level 6, 169856, Singapore
- Department of Clinical Pharmacology, Medical University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria
- Lee Kong Chian School of Medicine, Nanyang Technological University Novena Campus, 11 Mandalay Road, 308232, Singapore
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Tanaka S, Kohanim S. The Role of Confocal Microscopy in Diagnosing Ocular Surface Tumors. Int Ophthalmol Clin 2017; 57:75-85. [PMID: 27898615 DOI: 10.1097/iio.0000000000000146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Anterior Segment Imaging in Ocular Surface Squamous Neoplasia. J Ophthalmol 2016; 2016:5435092. [PMID: 27800176 PMCID: PMC5069377 DOI: 10.1155/2016/5435092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022] Open
Abstract
Recent advances in anterior segment imaging have transformed the way ocular surface squamous neoplasia (OSSN) is diagnosed and monitored. Ultrasound biomicroscopy (UBM) has been reported to be useful primarily in the assessment of intraocular invasion and metastasis. In vivo confocal microscopy (IVCM) shows enlarged and irregular nuclei with hyperreflective cells in OSSN lesions and this has been found to correlate with histopathology findings. Anterior segment optical coherence tomography (AS-OCT) demonstrates thickened hyperreflective epithelium with an abrupt transition between abnormal and normal epithelium in OSSN lesions and this has also been shown to mimic histopathology findings. Although there are limitations to each of these imaging modalities, they can be useful adjunctive tools in the diagnosis of OSSN and could greatly assist the clinician in the management of OSSN patients. Nevertheless, anterior segment imaging has not replaced histopathology's role as the gold standard in confirming diagnosis.
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Azizi S, Uçak T, Yaşar I, Karakurt Y, Erdogan E, Salman I. Evaluation of the Corneal Layers in Meibomian-Gland-Dysfunction-Related Dry Eye by In Vivo Slit-Scanning Confocal Microscopy. Semin Ophthalmol 2016; 32:377-383. [DOI: 10.3109/08820538.2015.1115084] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sedat Azizi
- Department of Ophthalmology, Mengucek Gazi Education and Research Hospital, Eye Clinic, Erzincan, Turkey
| | - Turgay Uçak
- Department of Ophthalmology, Mengucek Gazi Education and Research Hospital, Eye Clinic, Erzincan, Turkey
| | - Ibrahim Yaşar
- Department of Ophthalmology, Mengucek Gazi Education and Research Hospital, Eye Clinic, Erzincan, Turkey
| | - Yucel Karakurt
- Department of Ophthalmology, Mengucek Gazi Education and Research Hospital, Eye Clinic, Erzincan, Turkey
| | - Erkan Erdogan
- Health Science University Konya Training And Research Hospital, Department of Ophthalmology, Konya, Turkey
| | - Ilknur Salman
- Department of Ophthalmology, Erzurum Atatürk University, Eye Clinic, Erzurum, Turkey
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Overestimation of Corneal Endothelial Cell Density in Smaller Frame Sizes in In Vivo Confocal Microscopy. Cornea 2016; 35:363-9. [DOI: 10.1097/ico.0000000000000698] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sharif MS, Qahwaji R, Shahamatnia E, Alzubaidi R, Ipson S, Brahma A. An efficient intelligent analysis system for confocal corneal endothelium images. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2015; 122:421-436. [PMID: 26386613 DOI: 10.1016/j.cmpb.2015.09.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 08/03/2015] [Accepted: 09/01/2015] [Indexed: 06/05/2023]
Abstract
A confocal microscope provides a sequence of images of the corneal layers and structures at different depths from which medical clinicians can extract clinical information on the state of health of the patient's cornea. A hybrid model based on snake and particle swarm optimisation (S-PSO) is proposed in this paper to analyse the confocal endothelium images. The proposed system is able to pre-process images (including quality enhancement and noise reduction), detect cells, measure cell densities and identify abnormalities in the analysed data sets. Three normal corneal data sets acquired using a confocal microscope, and three abnormal confocal endothelium images associated with diseases have been investigated in the proposed system. Promising results are presented and the performance of this system is compared with manual and two morphological based approaches. The average differences between the manual and the automatic cell densities calculated using S-PSO and two other morphological based approaches is 5%, 7% and 13% respectively. The developed system will be deployable as a clinical tool to underpin the expertise of ophthalmologists in analysing confocal corneal images.
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Affiliation(s)
- M S Sharif
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - R Qahwaji
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - E Shahamatnia
- Universidade Nova de Lisboa/FCT-UNINOVA, Caparica 2829-516, Portugal
| | - R Alzubaidi
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - S Ipson
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - A Brahma
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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Alzubaidi R, Sharif MS, Qahwaji R, Ipson S, Brahma A. In vivo confocal microscopic corneal images in health and disease with an emphasis on extracting features and visual signatures for corneal diseases: a review study. Br J Ophthalmol 2015; 100:41-55. [PMID: 26553917 DOI: 10.1136/bjophthalmol-2015-306934] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 10/15/2015] [Indexed: 11/04/2022]
Abstract
There is an evolution in the demands of modern ophthalmology from descriptive findings to assessment of cellular-level changes by using in vivo confocal microscopy. Confocal microscopy, by producing greyscale images, enables a microstructural insight into the in vivo cornea in both health and disease, including epithelial changes, stromal degenerative or dystrophic diseases, endothelial pathologies and corneal deposits and infections. Ophthalmologists use acquired confocal corneal images to identify health and disease states and then to diagnose which type of disease is affecting the cornea. This paper presents the main features of the healthy confocal corneal layers and reviews the most common corneal diseases. It identifies the visual signatures of each disease in the affected layer and extracts the main features of this disease in terms of intensity, certain regular shapes with both their size and diffusion, and some specific region of interest. These features will lead towards the development of a complete automatic corneal diagnostic system that predicts abnormalities in the confocal corneal data sets.
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Affiliation(s)
- Rania Alzubaidi
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - Mhd Saeed Sharif
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - Rami Qahwaji
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - Stanley Ipson
- School of Electrical Engineering and Computer Science, University of Bradford, Bradford, UK
| | - Arun Brahma
- Manchester Royal Eye Hospital, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Aging and corneal layers: an in vivo corneal confocal microscopy study. Graefes Arch Clin Exp Ophthalmol 2014; 253:267-75. [DOI: 10.1007/s00417-014-2812-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 09/02/2014] [Accepted: 09/22/2014] [Indexed: 12/19/2022] Open
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Malandrini A, Martone G, Canovetti A, Menabuoni L, Balestrazzi A, Fantozzi C, Lenzetti C, Fantozzi M. Morphologic study of the cornea by in vivo confocal microscopy and optical coherence tomography after bifocal refractive corneal inlay implantation. J Cataract Refract Surg 2014; 40:545-57. [PMID: 24680518 DOI: 10.1016/j.jcrs.2013.08.057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 08/24/2013] [Accepted: 08/27/2013] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the biocompatibility of the Flexivue Microlens intracorneal inlay based on healing of corneal wounds and analysis of corneal structural features using in vivo confocal microscopy (IVCM) and anterior segment optical coherence tomography (AS-OCT). SETTING Ophthalmology Department, Misericordia e Dolce Hospital, Prato, Italy. DESIGN Case series. METHODS The intracorneal inlay was inserted in a stromal pocket created in the nondominant eye of emmetropic presbyopic patients using a femtosecond laser. In vivo confocal microscopy and AS-OCT examinations were performed preoperatively and 1, 6, and 12 months postoperatively. RESULTS The mean follow-up was 7.6 months. In the early postoperative period, IVCM showed intense cellular activity in the stroma around the inlay, edema, inflammation, and degenerative material deposition but normal regularity after 12 months. Anterior segment OCT showed a regular planar shape of the corneal pocket in all eyes. The mean of the side-cut angles was 30.7 degrees. The mean difference between the measured and planned pocket depth was 9.77 μm. At 1 month, hyperreflective areas beneath the inlay and microfolds were observed in 21 of the 52 eyes. After 12 months, the anterior segment profile was regular and interface pocket reflectivity decreased over time. Six patients had inlay removal postoperatively (3 before 6 months; 3 before 12 months); after removal, IVCM and AS-OCT showed clear corneas without signs of irregularity. CONCLUSION In vivo confocal microscopy and AS-OCT analysis showed that the inlay elicited a low-level wound-healing response in its immediate vicinity with no alteration in the corneal structures. FINANCIAL DISCLOSURE Dr. M. Fantozzi is a member of the Presbia medical advisory board. No other author has a financial or proprietary interest in any material or method mentioned.
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Affiliation(s)
- Alex Malandrini
- From the Department of Ophthalmology (Malandrini, Canovetti, Menabuoni, C. Fantozzi, M. Fantozzi, Lenzetti), Misericordia e Dolce Hospital, Prato, and the Department of Ophthalmology (Martone, Balestrazzi), University of Siena, Siena, Italy.
| | - Gianluca Martone
- From the Department of Ophthalmology (Malandrini, Canovetti, Menabuoni, C. Fantozzi, M. Fantozzi, Lenzetti), Misericordia e Dolce Hospital, Prato, and the Department of Ophthalmology (Martone, Balestrazzi), University of Siena, Siena, Italy
| | - Annalisa Canovetti
- From the Department of Ophthalmology (Malandrini, Canovetti, Menabuoni, C. Fantozzi, M. Fantozzi, Lenzetti), Misericordia e Dolce Hospital, Prato, and the Department of Ophthalmology (Martone, Balestrazzi), University of Siena, Siena, Italy
| | - Luca Menabuoni
- From the Department of Ophthalmology (Malandrini, Canovetti, Menabuoni, C. Fantozzi, M. Fantozzi, Lenzetti), Misericordia e Dolce Hospital, Prato, and the Department of Ophthalmology (Martone, Balestrazzi), University of Siena, Siena, Italy
| | - Angelo Balestrazzi
- From the Department of Ophthalmology (Malandrini, Canovetti, Menabuoni, C. Fantozzi, M. Fantozzi, Lenzetti), Misericordia e Dolce Hospital, Prato, and the Department of Ophthalmology (Martone, Balestrazzi), University of Siena, Siena, Italy
| | - Chiara Fantozzi
- From the Department of Ophthalmology (Malandrini, Canovetti, Menabuoni, C. Fantozzi, M. Fantozzi, Lenzetti), Misericordia e Dolce Hospital, Prato, and the Department of Ophthalmology (Martone, Balestrazzi), University of Siena, Siena, Italy
| | - Chiara Lenzetti
- From the Department of Ophthalmology (Malandrini, Canovetti, Menabuoni, C. Fantozzi, M. Fantozzi, Lenzetti), Misericordia e Dolce Hospital, Prato, and the Department of Ophthalmology (Martone, Balestrazzi), University of Siena, Siena, Italy
| | - Marco Fantozzi
- From the Department of Ophthalmology (Malandrini, Canovetti, Menabuoni, C. Fantozzi, M. Fantozzi, Lenzetti), Misericordia e Dolce Hospital, Prato, and the Department of Ophthalmology (Martone, Balestrazzi), University of Siena, Siena, Italy
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Abstract
Purpose We report a case of Terrien’s marginal degeneration (TMD) with a unilaterally typical narrow band of peripheral corneal stroma thinning, accompanied by the presence of an unusual network of opacities diffusing throughout the anterior stroma layers. Case Report A 43-year-old woman presented with superior nasal peripheral corneal thinning and an unusual network of polygonal stromal opacities in the anterior corneal stroma of the right eye. Latticed corneal changes were unusually extensive and distributed diffusely in the stroma. No abnormalities were found in the corneal epithelium and in the basal epithelial cells. No noticeable changes were found in the left eye. Because of a progressively worse ocular irritation of the right eye, a diagnosis of TMD was made for this patient. Conclusions This case of TMD accompanied by keratopathy was unusual. The branching stromal lattice pattern of the corneal opacities was difficult to distinguish from lattice corneal dystrophy. In this case, the polygonal stromal opacities were located in the anterior corneal stroma and therefore were distinguished from a similar manifestation in posterior crocodile shagreen.
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Corneal confocal microscopy for vision disturbance after an epithelial abrasion. Optom Vis Sci 2013; 91:e18-20. [PMID: 24212189 DOI: 10.1097/opx.0000000000000109] [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] Open
Abstract
PURPOSE To demonstrate the use of in vivo corneal confocal microscopy to reveal the reason for persistent disturbance of vision after a corneal abrasion. CASE REPORT A 49-year-old man presented with a decrease in visual acuity and monocular diplopia after a traumatic corneal abrasion. Anterior segment optical coherence tomography was not beneficial. In vivo corneal confocal microscopy showed abnormal folding in the basal epithelial layer of the cornea. Based on these findings, a therapeutic abrasion of the affected epithelium was performed. Visual acuity returned to 1.0 after therapeutic abrasion, and overall findings on the eye were within physiological limits. Control corneal confocal microscopic examination confirmed reparation of the structure of epithelial cell layers. CONCLUSIONS The in vivo corneal confocal microscopy can reveal corneal pathologic abnormality even in cases where other methods are not beneficial. Alongside other modern methods, it may become an important tool to help locate pathologic abnormality accurately and choose the proper therapeutic strategy.
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Fernández Jiménez-Ortiz H, Toledano Fernández N, Fernández Escamez CS, Perucho Martinez S, Crespo Carballés MJ. [The effects of ocular hypotensive drugs on the cornea: an in vivo analysis with confocal microscopy]. ACTA ACUST UNITED AC 2013; 88:423-32. [PMID: 24157320 DOI: 10.1016/j.oftal.2013.04.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 01/27/2013] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To evaluate the effects of anti-glaucoma treatments containing benzalconium chloride (BAC) on the human cornea. METHODS A prospective single masked cohort study was conducted on the 50 eyes of 50 patients. The inclusion criteria were: recently diagnosed glaucoma or ocular hypertension with previous treatment, or ophthalmologist-prescribed anti-glaucoma therapy, and oral consent to participate in the study. The patients were not randomised, as the ophthalmologist decided the best therapy according to clinical criteria. The patients were divided in 2 cohorts: one exposed to BAC (23 patients), and not exposed (27 patients). The mean follow-up period was 22 weeks (range 18-30). The change in cell density before and after therapy was measured in: basal layer epithelium, basal layer of limbal epithelium and endothelium. The change in stromal reflectivity and the number of nerve branches in sub-basal nerve plexus was also measured. BAC exposure was blinded to the main researcher. RESULTS A greater increase in basal layer epithelium cell density was observed in BAC exposed cohort (P<.05). No significant differences were detected in the endothelium, limbal cell density, stromal reflectivity, or sub-basal nerve plexus. Age, sex, IOP, active ingredient or BAC concentration did not affect the direction or magnitude of the ocular surface alterations found. CONCLUSION Chronic anti-glaucoma therapy induces changes in the corneal epithelium. Preservative free drops showed less disruption of the ocular surface by confocal microscopy analysis. Further studies should be conducted to evaluate the clinical impact of these histological findings.
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In vivo laser scanning confocal microscopy of the cornea in patients with silicone oil tamponade after vitreoretinal surgery. Cornea 2012; 31:876-82. [PMID: 22511025 DOI: 10.1097/ico.0b013e3182408cef] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the morphological changes in the cornea by in vivo laser scanning confocal microscopy (LSCM) in a large case series with silicone oil endotamponade after vitreoretinal surgery and to explore the value of LSCM in the early detection of silicone keratopathy (SK). METHODS Ninety-nine patients (99 eyes) with silicone oil endotamponade after vitreoretinal surgery were included in the current study. Slit-lamp examination and measurement of intraocular pressure (IOP) were performed first. Then the central corneas of the subjects' eyes were examined by in vivo LSCM. The analysis of images of each corneal layer was performed and the endothelial cellular density (ECD), endothelial cellular area (ECA), coefficient of variation of cell size (CoV), and percentage of hexagonal cells (PHC) were measured. Moreover, the total size of stromal deposits was measured, and the correlation between the size of deposits and the parameters of endothelial cells was analyzed. RESULTS Clinically recognizable abnormalities involving the cornea were identified in only 12 eyes (12.1%) under slit-lamp biomicroscopy, whereas in vivo LSCM revealed morphological abnormalities in 40 eyes (40.4%). The manifestations of endothelial lesions varied from decreased cellular density, increased polymegathism and pleomorphism to hyperreflective silicone oil membrane or droplets adhering to the endothelium. Moreover, hyperreflective deposits with various shapes could be identified in both posterior and anterior stroma, along with the infiltration of Langerhans cells beneath the epithelium. The average ECD and PHC of eyes with corneal abnormalities were significantly lower than those of normal corneas, whereas the average ECA and CoV were significantly larger (all Ps < 0.001). The patients with corneal abnormalities were significantly older than those others (P = 0.003). The rate of pseudophakic and aphakic eyes having corneal abnormalities was significantly higher than that of phakic eyes (P = 0.045). Interestingly, the total size of stromal deposits had a significant negative correlation with ECD and PHC but a significant positive correlation with ECA and CoV (all Ps < 0.001). Further correlation analysis performed in groups divided according to the lens status showed similar results and even stronger correlations in aphakic and pseudophakic eyes, whereas no statistically significant correlations were found in phakic eyes. CONCLUSIONS In vivo LSCM was a useful tool in the early detection of corneal abnormalities caused by silicone oil injection, including varying corneal endothelium lesions and stromal abnormalities. Pseudophakic or aphakic eyes, as well as those of older patients, should receive more attention because they are more inclined to develop silicone keratopathy.
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Hu VH, Weiss HA, Massae P, Courtright P, Makupa W, Mabey DCW, Bailey RL, Burton MJ. In vivo confocal microscopy in scarring trachoma. Ophthalmology 2011; 118:2138-46. [PMID: 21920608 PMCID: PMC3267045 DOI: 10.1016/j.ophtha.2011.04.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 03/02/2011] [Accepted: 04/11/2011] [Indexed: 11/05/2022] Open
Abstract
Objective To characterize the tissue and cellular changes found in trachomatous scarring (TS) and inflammation using in vivo confocal microscopy (IVCM). Design Two complimentary case-control studies. Participants The first study included 363 cases with TS (without trichiasis), of whom 328 had IVCM assessment, and 363 control subjects, of whom 319 had IVCM assessment. The second study included 34 cases with trachomatous trichiasis (TT), of whom 28 had IVCM assessment, and 33 control subjects, of whom 26 had IVCM assessment. Methods All participants were examined with ×2.5 loupes. The IVCM examination of the upper tarsal conjunctiva was carried out with a Heidelberg Retina Tomograph 3 with the Rostock Cornea Module (Heidelberg Engineering GmbH, Dossenheim, Germany). Main Outcome Measures The IVCM images were graded in a masked manner using a previously published grading system evaluating the inflammatory infiltrate density; the presence or absence of dendritiform cells (DCs), tissue edema, and papillae; and the level of subepithelial connective tissue organization. Results Subjects with clinical scarring had a characteristic appearance on IVCM of well-defined bands and sheets of scar tissue visible. Similar changes were also seen in some clinically normal subjects consistent with subclinical scarring. Scarred subjects had more DCs and an elevated inflammatory infiltrate, even after adjusting for other factors, including the level of clinical inflammation. Cellular activity was usually seen only in or just below the epithelium, rarely being seen deeper than 30 μm from the surface. The presence of tissue edema was strongly associated with the level of clinical inflammation. Conclusions In vivo confocal microscopy can be quantitatively used to study inflammatory and scarring changes in the conjunctiva. Dendritic cells seem to be closely associated with the scarring process in trachoma and are likely to be an important target in antifibrotic therapies or the development of a chlamydial vaccine. The increased number of inflammatory cells seen in scarred subjects is consistent with the immunopathologic nature of the disease. The localization of cellular activity close to the conjunctival surface supports the view that the epithelium plays a central role in the pathogenesis of trachoma. Financial Disclosure(s) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Victor H Hu
- International Centre for Eye Health, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, UK.
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Comparison Between Laser Scanning In Vivo Confocal Microscopy and Noncontact Specular Microscopy in Assessing Corneal Endothelial Cell Density and Central Corneal Thickness. Cornea 2011; 30:754-9. [PMID: 21150426 DOI: 10.1097/ico.0b013e3182000c5d] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Abstract
PURPOSE To analyse in vivo structural and cellular features of ocular surface squamous neoplasia using clinical confocal microscopy. METHODS Ten consecutive cases of untreated ocular surface squamous neoplasia were in vivo investigated using clinical confocal microscopy (ConfoScan4, Nidek Co. Ltd, Gamagori, Japan) with a × 40 surface non-contact objective lens. Confocal microscopy images were compared with cytologic samples obtained by scraping technique. RESULTS Confocal microscopy examination revealed large areas of superficial cells debris and/or keratin debris accompanied by syncytial-like groupings, loss of the normal structure of the conjunctival epithelium and or of the corneal basal epithelium layer, papillomatous organization, large fibrovascular structures, and fine vessels perpendicular to the tumour surface. Sub-epithelial (pre-Bowman) space involvement was documented in four cases (50%). Irregular healthy tissue infiltration at the lateral edge of the lesion was documented in two cases (20%) whereas abrupt demarcation between neoplastic cells and normal epithelium was documented in eight cases (80%). In vivo cyto-morphologic study using clinical confocal microscopy showed cellular anisocytosis, pleocytosis, and anisonucleosis, enlarged nuclei with high nuclear to cytoplasmic ratio, high reflective cytoplasm and indistinct cytoplasmic borders in all cases (100%) . CONCLUSION CCM appears to be a promising and non-invasive method for in vivo structural and cellular analysis of OSSN.
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Ferrari G, Tedesco S, Delfini E, Macaluso C. Laser scanning in vivo confocal microscopy in a case of Terrien marginal degeneration. Cornea 2011; 29:471-5. [PMID: 20168219 DOI: 10.1097/ico.0b013e3181b46aa3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe corneal microstructural modifications in an early case of Terrien marginal degeneration by means of laser scanning in vivo corneal confocal microscopy. METHODS A 20-year-old man affected by Terrien marginal degeneration in his right eye was examined with the Heidelberg Retina Tomograph 2 with a Rostock Cornea Module. The patient presented a corneal lesion with marked superior thinning and no clinical signs of inflammation. The left eye showed no clinical signs of degeneration. RESULTS The right eye showed irregular Bowman's membrane, amorphous-appearing substance co-localizing with lipid exudation, and needle-like hyperreflective material in the affected peripheral corneal region. Abnormally scarce and branched sub-basal plexus nerves as well as numerous activated keratocytes, sometimes organized in hyperreflective nests, were observed in the central cornea of the same eye. Although the left eye was clinically unaffected, activated keratocytes were detected in its anterior central stroma. CONCLUSIONS In vivo confocal microscopy supports the hypothesis of a mild inflammatory state with an atypical sub-basal nerve pattern in a patient affected by Terrien marginal degeneration. This new technique shows promise in studying this still elusive pathology.
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Ducat E, Evrard B, Peulen O, Piel G. Cellular uptake of liposomes monitored by confocal microscopy and flow cytometry. J Drug Deliv Sci Technol 2011. [DOI: 10.1016/s1773-2247(11)50076-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Jin SE, Bae JW, Hong S. Multiscale observation of biological interactions of nanocarriers: from nano to macro. Microsc Res Tech 2010; 73:813-23. [PMID: 20232368 DOI: 10.1002/jemt.20847] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Microscopic observations have played a key role in recent advancements in nanotechnology-based biomedical sciences. In particular, multiscale observation is necessary to fully understand the nano-bio interfaces where a large amount of unprecedented phenomena have been reported. This review describes how to address the physicochemical and biological interactions of nanocarriers within the biological environments using microscopic tools. The imaging techniques are categorized based on the size scale of detection. For observation of the nanoscale biological interactions of nanocarriers, we discuss atomic force microscopy (AFM), scanning electron microscopy (SEM), and transmission electron microscopy (TEM). For the micro to macro-scale (in vitro and in vivo) observation, we focus on confocal laser scanning microscopy (CLSM) as well as in vivo imaging systems such as magnetic resonance imaging (MRI), superconducting quantum interference devices, and IVIS. Additionally, recently developed combined techniques such as AFM-CLSM, correlative light and electron microscopy (CLEM), and SEM spectroscopy are also discussed. In this review, we describe how each technique helps elucidate certain physicochemical and biological activities of nanocarriers such as dendrimers, polymers, liposomes, and polymeric/inorganic nanoparticles, thus providing a toolbox for bioengineers, pharmaceutical scientists, biologists, and research clinicians.
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Affiliation(s)
- Su-Eon Jin
- Department of Biopharmaceutical Sciences, College of Pharmacy, University of Illinois at Chicago, Chicago, Illinois 60612, USA
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Hu VH, Massae P, Weiss HA, Cree IA, Courtright P, Mabey DCW, Bailey RL, Burton MJ. In vivo confocal microscopy of trachoma in relation to normal tarsal conjunctiva. Ophthalmology 2010; 118:747-54. [PMID: 21055819 PMCID: PMC3267042 DOI: 10.1016/j.ophtha.2010.08.029] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2010] [Revised: 08/16/2010] [Accepted: 08/17/2010] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To describe the in vivo confocal microscopy (IVCM) appearances of the tarsal conjunctiva in trachoma compared with the appearance of healthy conjunctiva and to develop grading systems for IVCM examination of the tarsal conjunctiva for use in future studies on trachoma and other conjunctival diseases. DESIGN Prospective observational study. PARTICIPANTS In vivo confocal microscopy examination was performed on 302 clinically normal adults, 16 clinically normal children, 750 adults with trachomatous conjunctival scarring, and 25 children with active trachoma. METHODS Clinical evaluation was performed with ×2.5 loupes, and IVCM examination of the upper tarsal conjunctiva was carried out with a Heidelberg Retina Tomograph 3 with the Rostock Cornea Module (Heidelberg Engineering GmbH, Dossenheim, Germany). MAIN OUTCOME MEASURES In vivo confocal microscopy images were analyzed for cellular and tissue changes associated with trachomatous inflammation and scarring compared with healthy subjects. RESULTS Trachomatous subjects with follicular and papillary inflammation had an increased inflammatory cellular infiltrate, including dendritiform cells, discrete follicular and papillary structures, and cystic lacunae suggestive of tissue edema. Trachomatous conjunctival scarring was seen with IVCM as organization of the subepithelial connective tissue into bands/sheets. Grading systems for inflammatory changes and scarring were developed, with the system for scarring showing good interobserver agreement with an intraclass coefficient of 0.88. CONCLUSIONS In vivo confocal microscopy provides a powerful tool for examining the ocular surface. Numerous cellular and tissue changes were observed in subjects with trachoma, the first time IVCM has been applied to this disease. These changes both complement and add to previous histologic analyses. In vivo confocal microscopy promises to provide new insights into the pathogenesis of trachoma and other conjunctival diseases.
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Affiliation(s)
- Victor H Hu
- International Centre for Eye Health, Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London, United Kingdom.
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Gaujoux T, Touzeau O, Laroche L, Borderie VM. Morphometry of Corneal Epithelial Cells on Normal Eyes and After Anterior Lamellar Keratoplasty. Cornea 2010; 29:1118-24. [DOI: 10.1097/ico.0b013e3181d5d93b] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yeniad B, Corum I, Ozgun C. The effects of blunt trauma and cataract surgery on corneal endothelial cell density. Middle East Afr J Ophthalmol 2010; 17:354-8. [PMID: 21180438 PMCID: PMC2991455 DOI: 10.4103/0974-9233.71604] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
PURPOSE This study was designed to investigate the effects of trauma and cataract surgery on corneal endothelial cell density (ECD) in patients with a traumatic cataract due to blunt trauma without globe laceration. MATERIALS AND METHODS In this prospective study, 31 subjects with traumatic cataract (traumatic cataract group) and 30 subjects with a senile cataract (control group) were enrolled. The subjects with traumatic cataract were subdivided into two groups: uncomplicated surgery subgroup (n = 19) in which subjects underwent standard phacoemulsification with intraocular lens implantation and complicated surgery subgroup (n = 12) in which subjects underwent cataract surgery other than standard phacoemulsification. The ECD of the traumatic cataract group and the control group was compared preoperatively and at 3 months or later postoperatively. A P value less than 0.05 was considered statistically significant. RESULTS The ECD in the eyes with traumatic cataract was 13.1% lower than that for healthy eyes preoperatively (P = 0.043). Postsurgical ECD decreased by 16.7% in complicated surgery subgroup and 11.9% in uncomplicated surgery subgroup (P = 0.049) after 3 months postoperatively. The ECD decreased by 10.8% in the control group (P = 0.489). CONCLUSIONS Patients with cataracts due to blunt trauma had a decreased endothelial cell count, which was significantly aggravated by cataract surgery. The loss of corneal endothelium cells due to surgery depends on the surgical approach.
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Affiliation(s)
- Baris Yeniad
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Isik Corum
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Cahit Ozgun
- Department of Ophthalmology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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The Relationship Between Corneal Biomechanical Properties and Confocal Microscopy Findings in Normal and Keratoconic Eyes. Cornea 2010; 29:641-9. [DOI: 10.1097/ico.0b013e3181c11dc6] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Hassani RTJ, Brasnu E, Amar N, Gheck L, Labbé A, Sterkers M, Baudouin C. Apport de la microscopie confocale in vivo dans les formes invasives de néoplasie malpighienne de la surface oculaire: à propos d’un cas. J Fr Ophtalmol 2010; 33:163-8. [DOI: 10.1016/j.jfo.2010.01.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Accepted: 01/04/2010] [Indexed: 10/19/2022]
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Ledbetter EC, Scarlett JM. In vivoconfocal microscopy of the normal equine cornea and limbus. Vet Ophthalmol 2009; 12 Suppl 1:57-64. [DOI: 10.1111/j.1463-5224.2009.00730.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Chen JJ, Rao K, Pflugfelder SC. Corneal epithelial opacity in dysfunctional tear syndrome. Am J Ophthalmol 2009; 148:376-82. [PMID: 19541283 DOI: 10.1016/j.ajo.2009.04.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Revised: 04/22/2009] [Accepted: 04/22/2009] [Indexed: 11/18/2022]
Abstract
PURPOSE To compare the appearance of the superficial corneal epithelium in patients with dysfunctional tear syndrome (DTS) and that of an asymptomatic control group using laser scanning confocal microscopy and to determine the correlations between confocal microscopic findings and clinical severity parameters. DESIGN Prospective case-control study. METHODS Thirty-one patients with newly diagnosed DTS and 21 asymptomatic control subjects were evaluated for this study. Subjects with DTS were classified into 4 levels of clinical severity (DTS 1 through 4) based on the Delphi dry eye panel report criteria. The Heidelberg Retina Tomograph 2 Rostock Cornea Module (Heidelberg Engineering GmbH, Heidelberg, Germany) laser scanning confocal microscope was used to image the superficial corneal epithelium. Areas of single or multiple opaque superficial epithelial cells were measured as a percentage of the 400 x 400-microm(2) field area in 4 randomly selected confocal images from each eye. Spearman correlations between the confocal findings and severity of symptoms, visual acuity, and ocular surface signs were calculated. RESULTS The mean area of opaque superficial corneal epithelial cells was significantly greater in DTS patients than in normal subjects (P < .0001). Significant differences were observed between the DTS severity groups and the control group (P < .001), except for the DTS 1 group. The area of opaque cells significantly increased with level of clinical severity. The confocal findings showed significant correlation with clinical severity parameters, including blurred vision symptoms (r = 0.86; P = .0001), best-corrected visual acuity (Spearman r = 0.4; P = .03), conjunctival lissamine green staining scores (Spearman r = 0.4; P = .026), corneal fluorescein staining scores (Spearman r = 0.5; P = .002), and videokeratoscopic surface regularity index (Spearman r = 0.5; P = .02). CONCLUSIONS Morphologic changes in the superficial corneal epithelium of DTS patients detected by laser scanning confocal microscopy correlates with blurred vision symptoms and objective severity parameters. Objective confocal image analysis of the superficial corneal epithelium may prove useful for classifying DTS severity and for monitoring the efficacy of therapies.
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Affiliation(s)
- Joseph J Chen
- Ocular Surface Center, Cullen Eye Institute, Department of Ophthalmology, Baylor College of Medicine, Houston, Texas 77030, USA
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Morishige N, Takahashi N, Chikamoto N, Nishida T. Quantitative evaluation of corneal epithelial oedema by confocal microscopy. Clin Exp Ophthalmol 2009; 37:249-53. [PMID: 19472533 DOI: 10.1111/j.1442-9071.2009.02020.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Naoyuki Morishige
- Department of Ophthalmology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi, Japan.
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Kim NM, Shin MK, Kim SJ, Lee JS. Confocal Microscopic Findings of Transplanted Cornea 10 Years After Penetrating Keratoplasty. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.5.779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Na Mi Kim
- Department of Ophthalmology, School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Min Kyu Shin
- Department of Ophthalmology, School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Su Jin Kim
- Department of Ophthalmology, School of Medicine, Pusan National University Hospital, Busan, Korea
| | - Jong Soo Lee
- Department of Ophthalmology, School of Medicine, Pusan National University Hospital, Busan, Korea
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Ciancaglini M, Carpineto P, Agnifili L, Nubile M, Fasanella V, Lanzini M, Calienno R, Mastropasqua L. An in vivo confocal microscopy and impression cytology analysis of preserved and unpreserved levobunolol-induced conjunctival changes. Eur J Ophthalmol 2008; 18:400-7. [PMID: 18465723 DOI: 10.1177/112067210801800314] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To provide an in vivo confocal microscopy (IVCM) and impression cytology analysis of preserved-and unpreserved levobunolol-induced changes of conjunctival epithelium. METHODS 27 eyes of 27 patients were consecutively randomized to receive preserved or unpreserved levobunolol; all patients had a recent diagnosis of primary open angle glaucoma (POAG) or ocular hypertension and were not previously treated with topical medications. IVCM and impression cytology were performed before and after six months of therapy. Goblet cells density and a conjunctival epithelium regularity index were considered in the IVCM analysis, whereas impression cytology specimens were graded and scored in accordance with Nelson's method. RESULTS After six months of therapy, IVCM and impression cytology parameters showed significant differences with respect to baseline in both groups (p<0.001); significant differences were also found between the two groups (p<0.001). The IVCM analysis showed a goblet cells density reduction (61% and 17% from baseline, respectively in group 1 and 2) (p<0.001) and an higher index of epithelial regularity (p<0.001) in both groups; the impression cytology analysis showed an higher score in both groups (p<0.001). CONCLUSIONS All the IVCM and impression cytology parameters correlated well with the conjunctival modifications induced by the topical therapy, suggesting the less toxicity of unpreserved drugs.
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Affiliation(s)
- M Ciancaglini
- Department of Medicine and Ageing Science, Ophthalmic Clinic, University of Chieti-Pescara - Italy.
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Coupling of HRT II and AS-OCT to evaluate corneal endothelial cell loss and in vivo visualization of the Ahmed glaucoma valve implant. Eye (Lond) 2008; 23:1836-44. [DOI: 10.1038/eye.2008.321] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Zhao LQ, Wei RL, Ma XY, Zhu H. Effect of intraoperative mitomycin-C on healthy corneal endothelium after laser-assisted subepithelial keratectomy. J Cataract Refract Surg 2008; 34:1715-9. [DOI: 10.1016/j.jcrs.2008.06.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2007] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
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Malandrini A, Martone G, Traversi C, Caporossi A. In vivo confocal microscopy in a patient with recurrent conjunctival intraepithelial neoplasia. Acta Ophthalmol 2008; 86:690-1. [PMID: 18076726 DOI: 10.1111/j.1600-0420.2007.01075.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Alex Malandrini
- Ophthalmology and Neurosurgery Department, University of Siena, Siena, Italy
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Shi W, Li S, Liu M, Jin H, Xie L. Antifungal chemotherapy for fungal keratitis guided by in vivo confocal microscopy. Graefes Arch Clin Exp Ophthalmol 2007; 246:581-6. [DOI: 10.1007/s00417-007-0719-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 10/19/2007] [Accepted: 10/27/2007] [Indexed: 11/30/2022] Open
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Abstract
PURPOSE OF REVIEW Confocal microscopy's role within ophthalmology has been evolving since the introduction of this technology in 1955. The purpose of this review is to describe the confocal microscope and illustrate its recent ophthalmic applications. RECENT FINDINGS Numerous investigators have used confocal microscopy to research ophthalmic disease and to find new diagnostic applications. This review will describe the development and uses of this technology. The cornea was the first ophthalmic tissue to be imaged due to its transparency, although, tissues, such as conjunctiva, are now being studied. This article will review normal confocal corneal appearance and discuss a wide range of recent applications that include corneal infections, dystrophies and disease. Furthermore, this article will discuss recent developments in refractive surgery, ocular surgery and various miscellaneous discoveries. SUMMARY Confocal microscopy is developing into a powerful research and diagnostic tool in ophthalmology. The future uses of this novel technology will evolve and is increasingly becoming a vital tool in the ophthalmologist's armamentarium.
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Bibliography. Current world literature. Curr Opin Ophthalmol 2007; 18:342-50. [PMID: 17568213 DOI: 10.1097/icu.0b013e3282887e1e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Patel DV, McGhee CNJ. Contemporary in vivo confocal microscopy of the living human cornea using white light and laser scanning techniques: a major review. Clin Exp Ophthalmol 2007; 35:71-88. [PMID: 17300580 DOI: 10.1111/j.1442-9071.2007.01423.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
In vivo confocal imaging of the cornea has evolved exponentially over the last few decades and it has increasingly emerged from the laboratory to be used in the clinical setting in relation to inherited corneal diseases, corneal infections, contact lens wear and the effects of corneal surgery. This evolution has led to significant enhancement of our knowledge of the living cornea in both its physiological and pathological states. A number of in vivo confocal microscope devices using white, and more recently coherent, light sources have been developed to provide non-invasive assessment of the corneal microstructure at a lateral resolution of 1-2 microm. The fundamental principles of in vivo confocal microscopy and the key differences between these devices are highlighted in this review. By providing a systematic review of the extensive literature on the human cornea, this perspective paper aims to provide an overview of how in vivo confocal microscopy has contributed to our greater understanding of the human cornea in health, in disease, and following surgery, with a particular emphasis on quantitative data. The utility and limitations of available data are highlighted as are possibilities for the future development of this innovative technology.
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Affiliation(s)
- Dipika V Patel
- Department of Ophthalmology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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