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Stanescu N, Arnon R, Yahalomi T, Nemet A, Cohen I, Pikkel J. The association between elevated blood estradiol level and corneal ectasia in women. Eur J Ophthalmol 2024:11206721241266002. [PMID: 39056134 DOI: 10.1177/11206721241266002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
PURPOSE This study aims to investigate the association between blood estradiol level and two different etiologies of corneal ectasia in premenopausal women. METHODS This is an observational case-control study with three groups of women. Group 1 included women with keratoconus. Group 2 included women with post refractive surgery ectasia (PRSE). Group 3 was the control group. Venous blood for the measurement of estradiol was collected in order to assess the relationship between estradiol levels and ectasia. Participant's age, regular cycle (yes/no) and oral contraceptive pills (OCP) use (yes/no) was also documented. We compared the differences in estradiol levels between the 3 groups. Logistic regression was used to detect variables' effect on participants' chance to ectasia. RESULTS Ninety-six women were enrolled: 36 (37%), 29 (30%), and 31 (32%) in the keratoconus, PRSE, and control group, respectively. The mean age of the participants was 29.8 ± 3.2, 31.9 ± 2.6, and 30.7 ± 3.5 years, respectively (p = 0.04, between groups 1 and 2). Estradiol levels [pg/mL] were 38.0 ± 2.4, 43.4 ± 2.4, and 28.6 ± 3.9, respectively (p < 0.001, between any pair of groups). Two multivariate logistic regression models adjusted to age, regular cycle, and OCP use, indicated that higher blood estradiol levels were associated with an increased risk of ectasia (OR = 2.71 and 2.44, respectively; p < 0.001). CONCLUSION Corneal ectasia may be associated with elevated blood estradiol levels. Estradiol measurements could be useful in women with keratoconus or in women who undergo refractive surgery.
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Affiliation(s)
- Nir Stanescu
- Department of Ophthalmology, Assuta Samson Hospital, Ashdod, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Roee Arnon
- Department of Ophthalmology, Assuta Samson Hospital, Ashdod, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Tal Yahalomi
- Department of Ophthalmology, Assuta Samson Hospital, Ashdod, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Achia Nemet
- Department of Ophthalmology, Assuta Samson Hospital, Ashdod, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
| | - Itzhak Cohen
- Faculty of Engineering, Shenkar College of Engineering and Design, Ramat-Gan, Israel
| | - Joseph Pikkel
- Department of Ophthalmology, Assuta Samson Hospital, Ashdod, Israel
- Faculty of Medicine, Ben-Gurion University of the Negev, Be'er Sheva, Israel
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Erkan Pota Ç, Çetinkaya Yaprak A. Evaluation of anterior segment parameters between pregnancy trimesters and postpartum with pentacam scheimflug ımaging: a prospective study. Int Ophthalmol 2024; 44:268. [PMID: 38913127 PMCID: PMC11196334 DOI: 10.1007/s10792-024-03173-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 06/15/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE To evaluate the effect of pregnancy on the anterior chamber, corneal parameter, and intraocular pressure measurements; and compare the results between trimesters, postpartum and non-pregnant healthy age-matched women. METHODS This prospective study included 41 pregnant women and 53 non-pregnant women. Four measurements were taken from the pregnant women, in each trimester and postpartum third month, and once from the control group. Of the individuals included in the study, anterior chamber depth (ACD), anterior chamber volume (ACV), K1 (flat keratometry), K2 (steep keratometry), Kmean (mean value of K1 and K2), anterior chamber angle (ACA), central corneal thickness (CCT), thinnest corneal thickness (TCT), astigmatism value (AST), corneal volume (CV), biometry, axial length (AL), spherical equivalent (SFEQ), intraocular lens power (ILP), VA (visual acuity) datas were recorded. RESULTS We observed a statistically significant decrease in K2, CCT, ACD, AL and CV in the postpartum period (p = 0.025, p < 0.001, p = 0.029, p = 0.005, p = 0.004 respectively) and a statistically significant increase in ACV, CCT, and TCT as the gestational week progressed in the pregnant group (p = 0.007, p < 0.001, p = 0.025, respectively). A statistically significant decrease in IOP towards to the third trimester, and an increase in the postpartum period was observed (p < 0.001). We did not observe statistically significant changes in K1, Kmean, AST, ACA, VA, ILP, and SFEQ values. CONCLUSION It is important to investigate the physiological changes that may occur during pregnancy, distinguish them from pathological changes, and avoid unnecessary treatment. We consider that it's also important to guide the timing of anterior segment surgeries such as cataract and refractive surgery and to prescribe glasses/contact lenses.
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Affiliation(s)
- Çisil Erkan Pota
- Department of Ophthalmology, Antalya Manavgat State Hospital, Manavgat, Antalya, Turkey
| | - Aslı Çetinkaya Yaprak
- Department of Ophthalmology, Akdeniz University Faculty of Medicine, 07070, PınarbaşıMah., Konyaaltı, Antalya, Turkey.
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Meng F, Ren S. Identification of hub genes and molecular pathways in keratoconus by integrating bioinformatics and literature mining at the RNA level. Int Ophthalmol 2024; 44:244. [PMID: 38904678 DOI: 10.1007/s10792-024-03071-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/16/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Keratoconus (KC) is a condition characterized by progressive corneal steepening and thinning. However, its pathophysiological mechanism remains vague. We mainly performed literature mining to extract bioinformatic and related data on KC at the RNA level. The objective of this study was to explore the potential pathological mechanisms of KC by identifying hub genes and key molecular pathways at the RNA level. METHODS We performed an exhaustive search of the PubMed database and identified studies that pertained to gene transcripts derived from diverse corneal layers in patients with KC. The identified differentially expressed genes were intersected, and overlapping genes were extracted for further analyses. Significantly enriched genes were screened using "Gene Ontology" (GO) and "Kyoto Encyclopedia of Genes and Genomes" (KEGG) analysis with the "Database for Annotation, Visualization, and Integrated Discovery" (DAVID) database. A protein-protein interaction (PPI) network was constructed for the significantly enriched genes using the STRING database. The PPI network was visualized using the Cytoscape software, and hub genes were screened via betweenness centrality values. Pathways that play a critical role in the pathophysiology of KC were discovered using the GO and KEGG analyses of the hub genes. RESULTS 68 overlapping genes were obtained. Fifty genes were significantly enriched in 67 biological processes, and 16 genes were identified in 7 KEGG pathways. Moreover, 14 nodes and 32 edges were identified via the PPI network constructed using the STRING database. Multiple analyses identified 4 hub genes, 12 enriched biological processes, and 6 KEGG pathways. GO enrichment analysis showed that the hub genes are mainly involved in the positive regulation of apoptotic process, and KEGG analysis showed that the hub genes are primarily associated with the interleukin-17 (IL-17) and tumor necrosis factor (TNF) pathways. Overall, the matrix metalloproteinase 9, IL-6, estrogen receptor 1, and prostaglandin-endoperoxide synthase 2 were the potential important genes associated with KC. CONCLUSION Four genes, matrix metalloproteinase 9, IL-6, estrogen receptor 1, and prostaglandin endoperoxide synthase 2, as well as IL-17 and TNF pathways, are critical in the development of KC. Inflammation and apoptosis may contribute to the pathogenesis of KC.
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Affiliation(s)
- Feiying Meng
- Henan Eye Hospital, Henan Provincial People's Hospital/People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
- Eye Institute, Henan Academy of Innovations in Medical Science, Zhengzhou, China
| | - Shengwei Ren
- Henan Eye Hospital, Henan Provincial People's Hospital/People's Hospital of Zhengzhou University, Zhengzhou, 450003, China.
- Eye Institute, Henan Academy of Innovations in Medical Science, Zhengzhou, China.
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Van L, Bennett S, Nicholas SE, Hjortdal J, McKay TB, Karamichos D. Prospective Observational Study Evaluating Systemic Hormones and Corneal Crosslinking Effects in Keratoconus. OPHTHALMOLOGY SCIENCE 2024; 4:100364. [PMID: 37868794 PMCID: PMC10585634 DOI: 10.1016/j.xops.2023.100364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 07/03/2023] [Accepted: 07/05/2023] [Indexed: 10/24/2023]
Abstract
Purpose To evaluate associations between hormone levels and corneal parameters in patients with keratoconus (KC), before and after photooxidative corneal collagen crosslinking (CXL). Design Prospective, observational cohort study. Participants Twenty-eight patients with KC who were scheduled for CXL at Aarhus University Hospital in Denmark. Methods Androgen (dehydroepiandrosterone sulfate [DHEA-S]) and estrogen (estrone and estriol) plasma levels were measured and clinical assessments were performed before CXL and 2 to 3 months post-CXL, comparing the CXL eye with the control eye from the same participant. Main Outcome Measures Associations between hormone levels and maximum corneal curvature (Kmax) and minimum central corneal thickness (CCtmin) before and after CXL. Results Corneal collagen crosslinking was associated with a 2% reduction in Kmax values in the CXL eye, post-CXL, from baseline (median, 56.8 diopters [D]; 95% confidence interval [CI], 50.4-60.3) to the second visit (55.7 D; 95% CI, 50.4-58.8; P < 0.001). Systemic DHEA-S levels were 5 to 6 orders of magnitude higher than estriol or estrone concentrations in plasma. Importantly, estriol levels, rather than DHEA-S or estrone levels, were more closely correlated with Kmax before CXL (Spearman's r = 0.55, P = 0.01). Post-CXL Kmax and CCtmin were not associated with DHEA-S, estrone, or estriol plasma levels at the same timepoint. Conclusions This study provides supporting evidence based on a KC clinical population that systemic estrogen levels may influence corneal parameters (curvature and thickness) pre-CXL. Further studies evaluating the interplay between the therapeutic benefits of CXL and systemic hormone distributions are needed to determine if perturbation of the local corneal microenvironment influences endocrine function. Financial Disclosures The authors have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Lyly Van
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Sashia Bennett
- Department of Ophthalmology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Sarah E. Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, 8200 Aarhus N, Denmark
| | - Tina B. McKay
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas
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Sharma P, Ma JX, Karamichos D. Effects of hypoxia in the diabetic corneal stroma microenvironment. Exp Eye Res 2024; 240:109790. [PMID: 38224848 DOI: 10.1016/j.exer.2024.109790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 12/15/2023] [Accepted: 01/12/2024] [Indexed: 01/17/2024]
Abstract
Corneal dysfunctions associated with Diabetes Mellitus (DM), termed diabetic keratopathy (DK), can cause impaired vision and/or blindness. Hypoxia affects both Type 1 (T1DM) and Type 2 (T2DM) surprisingly, the role of hypoxia in DK is unexplored. The aim of this study was to examine the impact of hypoxia in vitro on primary human corneal stromal cells derived from Healthy (HCFs), and diabetic (T1DMs and T2DMs) subjects, by exposing them to normoxic (21% O2) or hypoxic (2% O2) conditions through 2D and 3D in vitro models. Our data revealed that hypoxia affected T2DMs by slowing their wound healing capacity, leading to significant alterations in oxidative stress-related markers, mitochondrial health, cellular homeostasis, and endoplasmic reticulum health (ER) along with fibrotic development. In T1DMs, hypoxia significantly modulated markers related to membrane permeabilization, oxidative stress via apoptotic marker (BAX), and protein degradation. Hypoxic environment induced oxidative stress (NOQ1 mediated reduction of superoxide in T1DMs and Nrf2 mediated oxidative stress in T2DMs), modulation in mitochondrial health (Heat shock protein 27 (HSP27), and dysregulation of cellular homeostasis (HSP90) in both T1DMs and T2DMs. This data underscores the significant impact of hypoxia on the diabetic cornea. Further studies are warranted to delineate the complex interactions.
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Affiliation(s)
- Purnima Sharma
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Jian-Xing Ma
- Department of Biochemistry, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
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Youngblood H, Schoenlein PV, Pasquale LR, Stamer WD, Liu Y. Estrogen dysregulation, intraocular pressure, and glaucoma risk. Exp Eye Res 2023; 237:109725. [PMID: 37956940 PMCID: PMC10842791 DOI: 10.1016/j.exer.2023.109725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/20/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
Characterized by optic nerve atrophy due to retinal ganglion cell (RGC) death, glaucoma is the leading cause of irreversible blindness worldwide. Of the major risk factors for glaucoma (age, ocular hypertension, and genetics), only elevated intraocular pressure (IOP) is modifiable, which is largely regulated by aqueous humor outflow through the trabecular meshwork. Glucocorticoids such as dexamethasone have long been known to elevate IOP and lead to glaucoma. However, several recent studies have reported that steroid hormone estrogen levels inversely correlate with glaucoma risk, and that variants in estrogen signaling genes have been associated with glaucoma. As a result, estrogen dysregulation may contribute to glaucoma pathogenesis, and estrogen signaling may protect against glaucoma. The mechanism for estrogen-related protection against glaucoma is not completely understood but likely involves both regulation of IOP homeostasis and neuroprotection of RGCs. Based upon its known activities, estrogen signaling may promote IOP homeostasis by affecting extracellular matrix turnover, focal adhesion assembly, actin stress fiber formation, mechanosensation, and nitric oxide production. In addition, estrogen receptors in the RGCs may mediate neuroprotective functions. As a result, the estrogen signaling pathway may offer a therapeutic target for both IOP control and neuroprotection. This review examines the evidence for a relationship between estrogen and IOP and explores the possible mechanisms by which estrogen maintains IOP homeostasis.
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Affiliation(s)
- Hannah Youngblood
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA
| | - Patricia V Schoenlein
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA; Department of Radiology and Georgia Cancer Center, Augusta University, Augusta, GA, USA; Department of Surgery, Augusta University, Augusta, GA, USA
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - W Daniel Stamer
- Department of Ophthalmology and Biomedical Engineering, Duke University, Durham, NC, USA
| | - Yutao Liu
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, USA; James and Jean Culver Vision Discovery Institute, Medical College of Georgia, Augusta University, Augusta, GA, USA; Center for Biotechnology and Genomic Medicine, Augusta University, Augusta, GA, USA.
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Escandon P, Nicholas SE, Vasini B, Cunningham RL, Murphy DA, Riaz KM, Karamichos D. Selective Modulation of the Keratoconic Stromal Microenvironment by FSH and LH. THE AMERICAN JOURNAL OF PATHOLOGY 2023; 193:1762-1775. [PMID: 36822267 PMCID: PMC10726429 DOI: 10.1016/j.ajpath.2023.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/19/2023] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
Keratoconus (KC) affects the corneal structure, with thinning and bulging outward into a conelike shape. Irregular astigmatism and decreased visual acuity appear during puberty and progress into the mid-30s, with unpredictable disease severity. The cause of KC is recognized as multifactorial, but remains poorly understood. Hormone imbalances are a significant modulator of the onset of KC. This study sought to investigate the role of gonadotropins, follicle-stimulating hormone (FSH), and luteinizing hormone (LH) in KC, using a three-dimensional, self-assembled matrix in vitro model. Healthy corneal fibroblasts and human KC cells in the corneal stroma were isolated, cultured, and stimulated with stable vitamin C to promote extracellular matrix assembly. Cultures were further stimulated with 2.5 or 10 mIU/mL FSH and 5 or 35 mIU/mL LH. Samples were evaluated for cell proliferation and morphology via BrdU assay and imaging; protein expression was assessed via Western blot analysis. Proliferation was significantly greater in human KC cells compared to healthy corneal fibroblasts with LH stimulation, but no changes were found with FSH stimulation. Additionally, in sex hormone receptors, fibrotic markers, proteoglycans, and members of the gonadotropin signaling pathway were significantly changed, largely driven by exogenous LH. The impact of exogenous FSH/LH in the KC stromal microenvironment was demonstrated. These results highlight the need to further examine the role of FSH/LH in KC and in human corneal homeostasis.
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Affiliation(s)
- Paulina Escandon
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
| | - Sarah E Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
| | - Brenda Vasini
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas
| | - David A Murphy
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, Texas; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, Texas; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, Texas.
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Muñoz-Villegas PDC, Sánchez-Ríos A, Olvera-Montaño O. The Effect of Sodium Hyaluronate Eye Drops 2, 4 or 6 Times a Day on Signs and Symptoms of Dry Eye Disease. Clin Ophthalmol 2023; 17:2945-2955. [PMID: 37822327 PMCID: PMC10563771 DOI: 10.2147/opth.s433709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/29/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose A randomized clinical trial was run to evaluate the effectiveness of a preservative-free 0.4% sodium hyaluronate eye drop (LOF) in different dosage schemes to alleviate signs and symptoms of dry eye disease (DED). Methods A total of 116 subjects with mild-to-moderate DED were included, and 111 completed the study (from which 67.6% were female and 65.3% were users of oral contraceptives). Patients were randomly assigned to instill a drop of LOF either 2 (BID), 4 (QID) or 6 (6TD) times a day (at least 3 hours apart) for 30 days. The clinical parameters and symptom endpoints were Ocular Surface Disease Index (OSDI), tear break-up time (TBUT), ocular surface staining, and conjunctival hyperemia. Other parameters evaluated were chemosis, best corrected visual acuity, and the incidence of adverse events (AE). Results There was a significant reduction in OSDI scores by day 30 in all groups. The recovery of the OSDI score back to normal values was observed in 51.4% of patients treated (50%, 48.6%, and 55.6% in BID, QID, and 6TD, respectively, p = 0.822). Similar improvement was observed for TBUT, 50.5% of patients increased this variable to >10 seconds (39.5%, 51.4%, and 61.1%, p = 0.175), and for ocular surface staining, ≥72% showed Grade 0. There were no significant differences among posology groups regarding ocular surface staining, conjunctival hyperemia, or any safety parameters. No overall improvement in OSDI and TBUT to normal values was noted for 31 patients (21 were female and 71.4% users of contraceptive drugs). Conclusion The ophthalmic use of preservative free LOF, 2, 4 or 6 times a day, may alleviate clinical parameters and symptoms in 50% of patients with mild-to-moderate DED after a one-month treatment. This improvement seemed to be less ubiquitous in patients within reproductive age and using oral contraceptives. Trial Registration This trial is registered at clinicaltrials.gov (NCT0704531).
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Affiliation(s)
- Patricia del Carmen Muñoz-Villegas
- Regional Medical Affairs Department, Laboratorios Sophia, S.A. de C.V, Zapopan, Jalisco, Mexico
- Centro de Investigación en Matemáticas A.C. (CIMAT), Unidad Aguascalientes, Aguascalientes, Mexico
| | - Alejandra Sánchez-Ríos
- Regional Medical Affairs Department, Laboratorios Sophia, S.A. de C.V, Zapopan, Jalisco, Mexico
| | - Oscar Olvera-Montaño
- Regional Medical Affairs Department, Laboratorios Sophia, S.A. de C.V, Zapopan, Jalisco, Mexico
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Han S, Mueller C, Wuebbolt C, Kilcullen S, Nayyar V, Calle Gonzalez B, Mahdavi Fard A, Floss JC, Morales MJ, Patel SP. Selective effects of estradiol on human corneal endothelial cells. Sci Rep 2023; 13:15279. [PMID: 37714879 PMCID: PMC10504266 DOI: 10.1038/s41598-023-42290-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023] Open
Abstract
In Fuchs endothelial corneal dystrophy (FECD), mitochondrial and oxidative stresses in corneal endothelial cells (HCEnCs) contribute to cell demise and disease progression. FECD is more common in women than men, but the basis for this observation is poorly understood. To understand the sex disparity in FECD prevalence, we studied the effects of the sex hormone 17-β estradiol (E2) on growth, oxidative stress, and metabolism in primary cultures of HCEnCs grown under physiologic ([O2]2.5) and hyperoxic ([O2]A) conditions. We hypothesized that E2 would counter the damage of oxidative stress generated at [O2]A. HCEnCs were treated with or without E2 (10 nM) for 7-10 days under both conditions. Treatment with E2 did not significantly alter HCEnC density, viability, ROS levels, oxidative DNA damage, oxygen consumption rates, or extracellular acidification rates in either condition. E2 disrupted mitochondrial morphology in HCEnCs solely from female donors in the [O2]A condition. ATP levels were significantly higher at [O2]2.5 than at [O2]A in HCEnCs from female donors only, but were not affected by E2. Our findings demonstrate the resilience of HCEnCs against hyperoxic stress. The effects of hyperoxia and E2 on HCEnCs from female donors suggest cell sex-specific mechanisms of toxicity and hormonal influences.
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Affiliation(s)
- Seoyoung Han
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Christian Mueller
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Caitlin Wuebbolt
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Sean Kilcullen
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Varinda Nayyar
- Research Service, Veterans Administration Western New York Healthcare System, Buffalo, NY, USA
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Brayan Calle Gonzalez
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ali Mahdavi Fard
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jamie C Floss
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Michael J Morales
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Sangita P Patel
- Research Service, Veterans Administration Western New York Healthcare System, Buffalo, NY, USA.
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
- Ophthalmology Service, Veterans Administration Western New York Healthcare System, Buffalo, NY, USA.
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10
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Choi AJ, Hefley BS, Nicholas SE, Cunningham RL, Karamichos D. Novel Correlation between TGF-β1/-β3 and Hormone Receptors in the Human Corneal Stroma. Int J Mol Sci 2023; 24:13635. [PMID: 37686439 PMCID: PMC10487450 DOI: 10.3390/ijms241713635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
This study investigated the interplay between transforming growth factor beta (TGF-β1/T1 and TGF-β3/T3), and sex hormone receptors using our 3D in vitro cornea stroma model. Primary human corneal fibroblasts (HCFs) from healthy donors were plated in transwells at 106 cells/well and cultured for four weeks. HCFs were supplemented with stable vitamin C (VitC) and stimulated with T1 or T3. 3D construct proteins were analyzed for the androgen receptor (AR), progesterone receptor (PR), estrogen receptor alpha (ERα) and beta (ERβ), luteinizing hormone receptor (LHR), follicle-stimulating hormone receptor (FSHR), gonadotropin-releasing hormone receptor (GnRHR), KiSS1-derived peptide receptor (KiSS1R/GPR54), and follicle-stimulating hormone subunit beta (FSH-B). In female constructs, T1 significantly upregulated AR, PR, ERα, FSHR, GnRHR, and KiSS1R. In male constructs, T1 significantly downregulated FSHR and FSH-B and significantly upregulated ERα, ERβ, and GnRHR. T3 caused significant upregulation in expressions PR, ERα, ERβ, LHR, FSHR, and GNRHR in female constructs, and significant downregulation of AR, ERα, and FSHR in male constructs. Semi-quantitative Western blot findings present the interplay between sex hormone receptors and TGF-β isoforms in the corneal stroma, which is influenced by sex as a biological variable (SABV). Additional studies are warranted to fully delineate their interactions and signaling mechanisms.
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Affiliation(s)
- Alexander J. Choi
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Brenna S. Hefley
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Sarah E. Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Rebecca L. Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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11
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Kelly DS, Sabharwal S, Ramsey DJ, Morkin MI. The effects of female sex hormones on the human cornea across a woman's life cycle. BMC Ophthalmol 2023; 23:358. [PMID: 37587412 PMCID: PMC10428535 DOI: 10.1186/s12886-023-03085-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 07/14/2023] [Indexed: 08/18/2023] Open
Abstract
The cornea is a hormone-responsive tissue that responds to changing levels of female sex hormones. This review focuses on the structural and functional changes in the human cornea associated with the hormonal milestones of menarche, pregnancy, and menopause, as well as consequences stemming from the use of exogenous sex hormones for fertility control and replacement. Articles were identified by searching PubMed without language or region restrictions. The primary outcomes evaluated were changes in central corneal thickness (CCT), intraocular pressure (IOP), and quality of the ocular tear film. The potential impact of hormone-associated changes on the diagnosis and surgical management of common eye diseases, as well as the potential use of sex hormones as therapeutic agents is also considered. Understanding the physiological effects of female sex hormones on the cornea is important because that knowledge can shape the management decisions physicians and women face about ocular health across their life stages.
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Affiliation(s)
- Donel S Kelly
- United States Naval Hospital Okinawa, Ginowan, Japan
| | | | - David J Ramsey
- Department of Ophthalmology, Lahey Hospital & Medical Center, Burlington, MA, 01805, USA
- Department of Ophthalmology, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA
| | - Melina I Morkin
- Department of Ophthalmology, Tufts University School of Medicine, 800 Washington St, Boston, MA, 02111, USA.
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12
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Han S, Mueller C, Wuebbolt C, Kilcullen S, Nayyar V, Gonzalez BC, Fard AM, Floss JC, Morales MJ, Patel SP. Selective effects of estradiol on human corneal endothelial cells. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.27.538629. [PMID: 37162976 PMCID: PMC10168450 DOI: 10.1101/2023.04.27.538629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Fuchs endothelial corneal dystrophy (FECD) results from genetic and environmental factors triggering mitochondrial and oxidative stress in corneal endothelial cells (CEnCs) leading to CEnC death and corneal opacification. FECD is more common in women than men, but the basis for this observation is unknown. Because FECD is commonly diagnosed around the time of the menopausal transition in women when estrogen levels decrease precipitously, we studied the effects of the potent estrogen,17-β estradiol (E2) on growth, oxidative stress, and metabolism in primary cultures of human CEnCs (HCEnCs) under conditions of physiologic 2.5% O 2 ([O 2 ] 2.5 ) and under hyperoxic stress ([O 2 ] A : room air + 5% CO 2 ). We hypothesized that E2 would counter the stresses of the hyperoxic environment in HCEnCs. HCEnCs were treated ± 10 nM E2 for 7-10 days at [O 2 ] 2.5 and [O 2 ] A followed by measurements of cell density, viability, reactive oxygen species (ROS), mitochondrial morphology, oxidative DNA damage, ATP levels, mitochondrial respiration (O 2 consumption rate [OCR]), and glycolysis (extracellular acidification rate [ECAR]). There were no significant changes in HCEnC density, viability, ROS levels, oxidative DNA damage, OCR, and ECAR in response to E2 under either O 2 condition. We found that E2 disrupted mitochondrial morphology in HCEnCs from female donors but not male donors at the [O 2 ] A condition. ATP levels were significantly higher at [O 2 ] 2.5 compared to [O 2 ] A in HCEnCs from female donors only, but were not affected by E2. Our findings demonstrate the overall resilience of primary HCEnCs against hyperoxic stress. The selective detrimental effects of hyperoxia and estradiol on HCEnCs from female but not male donors suggests mechanisms of toxicity based upon cell-sex in addition to hormonal environment.
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Affiliation(s)
- Seoyoung Han
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Christian Mueller
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Caitlin Wuebbolt
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Sean Kilcullen
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Varinda Nayyar
- Research Service, Veterans Administration of Western New York Healthcare System, Buffalo, New York, USA
- Ross Eye Institute, Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Brayan Calle Gonzalez
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Ali Mahdavi Fard
- Ross Eye Institute, Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Jamie C. Floss
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Michael J. Morales
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Sangita P. Patel
- Research Service, Veterans Administration of Western New York Healthcare System, Buffalo, New York, USA
- Ross Eye Institute, Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
- Ophthalmology Service, Veterans Administration of Western New York Healthcare System, Buffalo, New York, USA
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13
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Douglass A, Dattilo M, Feola AJ. Evidence for Menopause as a Sex-Specific Risk Factor for Glaucoma. Cell Mol Neurobiol 2023; 43:79-97. [PMID: 34981287 PMCID: PMC9250947 DOI: 10.1007/s10571-021-01179-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/03/2021] [Indexed: 01/07/2023]
Abstract
Glaucoma is a leading cause of irreversible blindness worldwide and is characterized by progressive loss of visual function and retinal ganglion cells (RGC). Current epidemiological, clinical, and basic science evidence suggest that estrogen plays a role in the aging of the optic nerve. Menopause, a major biological life event affecting all women, coincides with a decrease in circulating sex hormones, such as estrogen. While 59% of the glaucomatous population are females, sex is not considered a risk factor for developing glaucoma. In this review, we explore whether menopause is a sex-specific risk factor for glaucoma. First, we investigate how menopause is defined as a sex-specific risk factor for other pathologies, including cardiovascular disease, osteoarthritis, and bone health. Next, we discuss clinical evidence that highlights the potential role of menopause in glaucoma. We also highlight preclinical studies that demonstrate larger vision and RGC loss following surgical menopause and how estrogen is protective in models of RGC injury. Lastly, we explore how surgical menopause and estrogen signaling are related to risk factors associated with developing glaucoma (e.g., intraocular pressure, aqueous outflow resistance, and ocular biomechanics). We hypothesize that menopause potentially sets the stage to develop glaucoma and therefore is a sex-specific risk factor for this disease.
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Affiliation(s)
- Amber Douglass
- grid.484294.7Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA USA
| | - Michael Dattilo
- grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, B2503, Clinic B Building, 1365B Clifton Road NE, Atlanta, GA 30322 USA ,grid.414026.50000 0004 0419 4084Department of Ophthalmology, Atlanta Veterans Affairs Medical Center, Atlanta, GA USA ,grid.213917.f0000 0001 2097 4943Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA USA
| | - Andrew J. Feola
- grid.484294.7Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Healthcare System, Decatur, GA USA ,grid.189967.80000 0001 0941 6502Department of Ophthalmology, Emory Eye Center, Emory University School of Medicine, B2503, Clinic B Building, 1365B Clifton Road NE, Atlanta, GA 30322 USA ,grid.213917.f0000 0001 2097 4943Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA USA
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14
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Ocular findings in central precocious puberty. J AAPOS 2022; 26:316.e1-316.e5. [PMID: 36270587 DOI: 10.1016/j.jaapos.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/30/2022] [Accepted: 09/07/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate ocular findings in central precocious puberty (PP). METHODS This prospective study included 38 children with PP and 34 healthy control children. All participants were evaluated in terms of refractive error, axial length (AL), and anterior segment parameters, including keratometry (K), corneal volume (CV), anterior chamber depth (ACD), anterior chamber volume (ACV), and iridocorneal angle (ICA). Central macular thickness (CMT), retinal nerve fiber layer (RNFL) thickness and central subfoveal choroidal thickness (ChT) were also analyzed. The correlation of these parameters with Tanner stage was also investigated in the PP group. RESULTS Compared with the control group, spherical refraction was less hyperopic (P = 0.017) and AL was significantly higher (P = 0.001) in the PP group. Spherical value and AL were significantly associated with the Tanner stage. None of the anterior segment parameters obtained by Pentacam was different in the PP group compared with controls. In PP cases, CMT and RNFL thicknesses in all sectors did not differ from controls. Subfoveal ChT was significantly higher in the PP group, regardless of Tanner stage (P < 0.001). CONCLUSIONS In our cohort of children with central PP, AL and ChT were higher than in children without PP.
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15
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Phan MAT, Gibson E, Golebiowski B, Stapleton F, Jenner AM, Bucknall MP. Analysis of sex steroids in human tears using LC-MS and GC-MS: Considerations and developments to improve method sensitivity and accuracy. Exp Eye Res 2022; 225:109283. [PMID: 36273577 DOI: 10.1016/j.exer.2022.109283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/29/2022]
Abstract
Sex steroids play a role in regulation of tear film function and may exert their action locally at the ocular surface. However, measurement of sex steroids in tears is difficult due to small-volume tear samples and very low concentrations of the hormones. This short communication highlights what has been achieved to date in the analysis of tear sex steroids using ultra-performance LC-MS (UPLC-MS) as previously published, and reports further and more recent investigations toward optimising mass spectrometry method sensitivity and accuracy. The published UPLC-MS method successfully measured progesterone, androsterone glucuronide and 5α-androstane-3α,17β-diol in pooled basal tears of postmenopausal women, and fourteen sex steroid standards in methanol. Limitations included sub-optimal limits of detection (LOD) and lower limits of quantification (LLOQ) for some analytes (particularly oestrogens), exclusion of sample matrix effects and no use of internal standards. This update reports on further experiments carried out to improve sensitivity and accuracy. Sample matrix effects, internal standard spiking, and derivatisation with dansyl chloride and oximes were investigated. Dansylation significantly improved the LOD and LLOQ of oestrogens and their metabolites, by a factor of 10 for oestradiol and a factor of 5 for oestrone, but sensitivity of this updated method is not sufficient however for analysis of these oestrogens in human tears. Using gas chromatography-mass spectrometry (GC-MS) as an alternative technique to LC-MS, improved sensitivity for derivatised oestradiol is reported. This work demonstrates the need to develop higher sensitivity methods and points researchers towards specific MS ionisation techniques for future analysis of sex steroids in tears, in order to progress current understanding of the role of sex steroids in tear function and dry eye.
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Affiliation(s)
- Minh Anh Thu Phan
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, NSW, 2052, Australia
| | - Emma Gibson
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, NSW, 2052, Australia; Optometry, Faculty of Health and Applied Sciences, University of the West of England, Bristol, BS16 1QY, UK
| | - Blanka Golebiowski
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, NSW, 2052, Australia.
| | - Fiona Stapleton
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, NSW, 2052, Australia
| | - Andrew M Jenner
- Bioanalytical Mass Spectrometry Facility, Mark Wainwright Analytical Centre, UNSW, Sydney, NSW, 2052, Australia
| | - Martin P Bucknall
- School of Optometry and Vision Science, Faculty of Medicine and Health, UNSW, Sydney, NSW, 2052, Australia; Bioanalytical Mass Spectrometry Facility, Mark Wainwright Analytical Centre, UNSW, Sydney, NSW, 2052, Australia
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16
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Hashemi H, Asgari S. Corneal characteristics in Down syndrome patients with normal and keratoconic cornea. Front Med (Lausanne) 2022; 9:985928. [PMID: 36186827 PMCID: PMC9524572 DOI: 10.3389/fmed.2022.985928] [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: 07/04/2022] [Accepted: 09/01/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To determine the reference range of corneal indices in Down syndrome patients with normal corneas (DS-N) and to compare it with the corneal indices in Down syndrome patients with keratoconic corneas (DS-KC). Methods A study was conducted using the data of 154 eyes of 154 DS-N and 25 eyes of 25 DS-KC patients. Eighteen indices related to thickness, anterior chamber, keratometry, elevation, and aberrations routinely used for KC diagnosis were extracted from the Pentacam. Results The mean age of the participants in DS-N and DS-KC groups was 16.73 ± 4.70 and 16.56 ± 4.22 years (P = 0.852). In the DS-N group, 95% CI were 511.65–520.31 for minimum corneal thickness, 2.97–3.07 for anterior chamber depth (ACD), 46.83–47.37 for maximum keratometry (Kmax), 46.13–46.62 for zonal Kmax at 3 mm, 0.35–0.58 for inferior-superior asymmetry (I-S value), 1.56–1.88 for Belin/Ambrósio display-total deviation, 8.65–10.79 for best-fit-sphere posterior elevation at the thinnest point, and 0.18–0.22 for corneal vertical coma. The age-related change in I-S value and corneal spherical aberration (SA) was significant (both P < 0.05). There were significant inter-gender differences in 11 indices; the female DS patients had shallower, steeper, more elevated, and more aberrated corneas (all P < 0.05). There were significant differences in all indices except for ACD (P = 0.372) and corneal SA (P = 0.169) between DS-N and DS-KC groups. Conclusion In DS patients aged 10–30 years, the reference ranges of corneal indices are different from the range reported for non-DS subjects and are close to values reported for mild KC non-DS cases. The normal values are different between DS male and female; hence, sex-specific ranges should be considered for diagnosis of corneal abnormality in DS patients.
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17
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The effects of systemic aromatase inhibitors on meibomian glands and corneal structure. Eye (Lond) 2022; 36:1185-1193. [PMID: 34117393 PMCID: PMC9151770 DOI: 10.1038/s41433-021-01612-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 05/14/2021] [Accepted: 05/18/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES To evaluate the ocular surface, meibomian glands and corneal structural changes using in vivo confocal microscopy (IVCM) in patients receiving aromatase inhibitor (AI) therapy due to the breast cancer. METHODS This prospective observational study included 13 patients undergoing AI therapy. The patients were evaluated before the treatment, at 3- and 6-month timepoints of AI therapy. To examine the ocular surface and tear film, corneal sensitivity (CS) measurement with Cochet-Bonnet Aesthesiometer, tear film break-up time (TBUT), lissamine green (LG) staining, Schirmer I test with anaesthesia (ST) and the ocular-surface disease index (OSDI) questionnaire were performed consecutively. Corneal cell densities and sub-basal nerve plexus were evaluated with IVCM (ConfoScan 4, Nidek, Japan). Finally, quantitative MG drop-out assessment was made using infrared meibography. Shapiro Wilk, Friedman's and Post-hoc Dunn tests were used for the statistical analysis. RESULTS TBUT, ST scores, basal epithelium, anterior and posterior keratocytes and endothelial cell densities, long and total sub-basal nerve densities were found to be decreased (p < 0.001, p = 0.023, p < 0.001, p = 0.01, p = 0.002, p = 0.004, p < 0.001, p < 0.001), and meiboscore, CS, OSDI scores and sub-basal nerve tortuosity values were increased (p < 0.001, p = 0.015, p = 0.001, p = 0.004) during the treatment. Endothelial pleomorphism rates were lower at the 3- and 6-month timepoints compared to before the treatment (p = 0.04). CONCLUSION This study showed that aromatase inhibitor therapy causes deteriorations in many of the ocular-surface parameters and corneal structural changes in relation with the duration of treatment. These patients should be observed during the therapy in terms of the ocular-surface side effects.
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18
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Sex Hormones and Their Effects on Ocular Disorders and Pathophysiology: Current Aspects and Our Experience. Int J Mol Sci 2022; 23:ijms23063269. [PMID: 35328690 PMCID: PMC8949880 DOI: 10.3390/ijms23063269] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 12/27/2022] Open
Abstract
Sex hormones are molecules produced by the gonads and to a small extent by the adrenal gland, which not only determine the primary and secondary sexual characteristics of an individual, differentiating man from woman, but also participate in the functioning of the various systems of the body. The evidence that many eye diseases differ in terms of prevalence between men and women has allowed us, in recent years, to carry out several studies that have investigated the association between sex hormones and the pathophysiology of eye tissues. Specific receptors for sex hormones have been found on the lacrimal and meibomian glands, conjunctiva, cornea, lens, retina, and choroid. This work summarizes the current knowledge on the role that sex hormones play in the pathogenesis of the most common ocular disorders and indicates our clinical experience in these situations. The aim is to stimulate an interdisciplinary approach between endocrinology, neurology, molecular biology, and ophthalmology to improve the management of these diseases and to lay the foundations for new therapeutic strategies.
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19
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Abusamak M. Corneal Epithelial Mapping Characteristics in Normal Eyes Using Anterior Segment Spectral Domain Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:6. [PMID: 35258560 PMCID: PMC8914566 DOI: 10.1167/tvst.11.3.6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The detailed mapping characteristics of the corneal epithelial thickness (CET) in normal eyes from a Middle Eastern population were investigated in relation to age, sex, intraocular pressure, and keratometric power (K). Methods A retrospective cross-sectional and analytical study was conducted using spectral domain optical coherence tomography (OCT). We calculated the CET in 124 subjects in 17 zones within a 6 mm circle. Exclusion criteria included subjects with dry eyes, keratoconus, previous eye surgery, glaucoma, and irregular corneas. Results A total of 124 individuals was composed of 64 males and 60 females. The mean age of this population was 45.52, ranging from 18 to 79 years. The central CET was thicker in the central 2 mm than the other zones of the cornea except the nasal, inferior-nasal, inferior and inferior-temporal zones, respectively. Males have thicker CET than females in all zones except in the peripheral nasal zone. We found a positive and significant correlation between age and CET in the central, superior-peripheral, inferior-paracentral, and inferior-temporal paracentral zones. Additionally, a medium-positive correlation was detected between increasing age and the variability of epithelial spectral domain in different zones. No link between CET and intraocular pressure was found. Conclusions This study analyzed 17 CET zones within the central 6 mm, where the central epithelium is resistant to aging. The CET was thinner superiorly than inferiorly. This may help in decision-making in refractive procedures and in the prediction of corneal diseases. Translational Relevance OCT novel algorithms are noninvasive methods for measuring CET and have been demonstrated to be useful in refractive surgery planning and follow-up, as well as a robust tool for diagnosing potential corneal ectasia.
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Affiliation(s)
- Mohammad Abusamak
- Department of Surgery, School of Medicine, Al-Balqa Applied University, Al-Salt, Jordan.,Amman Eye Clinic, Amman, Jordan
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20
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The Role of Estriol and Estrone in Keratoconic Stromal Sex Hormone Receptors. Int J Mol Sci 2022; 23:ijms23020916. [PMID: 35055103 PMCID: PMC8779160 DOI: 10.3390/ijms23020916] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 01/06/2022] [Accepted: 01/08/2022] [Indexed: 02/04/2023] Open
Abstract
Keratoconus (KC) is a progressive corneal thinning disease that manifests in puberty and worsens during pregnancy. KC onset and progression are attributed to diverse factors that include: environmental, genetics, and hormonal imbalances; however, the pathobiology remains elusive. This study aims to determine the role of corneal stroma sex hormone receptors in KC and their interplay with estrone (E1) and estriol (E3) using our established 3D in vitro model. Healthy cornea stromal cells (HCFs) and KC cornea stromal cells (HKCs), both male and female, were stimulated with various concentrations of E1 and E3. Significant changes were observed between cell types, as well as between males and females in the sex hormone receptors tested; androgen receptor (AR), progesterone receptor (PR), estrogen receptor alpha (ERα), and estrogen receptor beta (ERβ) using Western blot analysis. E1 and E3 stimulations in HCF females showed AR, PR, and ERβ were significantly upregulated compared to HCF males. In contrast, ERα and ERβ had significantly higher expression in HKC's females than HKC's males. Our data suggest that the human cornea is a sex-dependent, hormone-responsive tissue that is significantly influenced by E1 and E3. Therefore, it is plausible that E1, E3, and sex hormone receptors are involved in the KC pathobiology, warranting further investigation.
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21
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McKay TB, Priyadarsini S, Karamichos D. Sex Hormones, Growth Hormone, and the Cornea. Cells 2022; 11:cells11020224. [PMID: 35053340 PMCID: PMC8773647 DOI: 10.3390/cells11020224] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/03/2022] [Accepted: 01/07/2022] [Indexed: 12/31/2022] Open
Abstract
The growth and maintenance of nearly every tissue in the body is influenced by systemic hormones during embryonic development through puberty and into adulthood. Of the ~130 different hormones expressed in the human body, steroid hormones and peptide hormones are highly abundant in circulation and are known to regulate anabolic processes and wound healing in a tissue-dependent manner. Of interest, differential levels of sex hormones have been associated with ocular pathologies, including dry eye disease and keratoconus. In this review, we discuss key studies that have revealed a role for androgens and estrogens in the cornea with focus on ocular surface homeostasis, wound healing, and stromal thickness. We also review studies of human growth hormone and insulin growth factor-1 in influencing ocular growth and epithelial regeneration. While it is unclear if endogenous hormones contribute to differential corneal wound healing in common animal models, the abundance of evidence suggests that systemic hormone levels, as a function of age, should be considered as an experimental variable in studies of corneal health and disease.
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Affiliation(s)
- Tina B. McKay
- Department of Cell Biology, University of Oklahoma Health Sciences, Oklahoma City, OK 73104, USA;
| | | | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
- Correspondence: ; Tel.: +1-817-735-2101
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22
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Karamichos D, Escandon P, Vasini B, Nicholas SE, Van L, Dang DH, Cunningham RL, Riaz KM. Anterior pituitary, sex hormones, and keratoconus: Beyond traditional targets. Prog Retin Eye Res 2021; 88:101016. [PMID: 34740824 PMCID: PMC9058044 DOI: 10.1016/j.preteyeres.2021.101016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022]
Abstract
"The Diseases of the Horny-coat of The Eye", known today as keratoconus, is a progressive, multifactorial, non-inflammatory ectatic corneal disorder that is characterized by steepening (bulging) and thinning of the cornea, irregular astigmatism, myopia, and scarring that can cause devastating vision loss. The significant socioeconomic impact of the disease is immeasurable, as patients with keratoconus can have difficulties securing certain jobs or even joining the military. Despite the introduction of corneal crosslinking and improvements in scleral contact lens designs, corneal transplants remain the main surgical intervention for treating keratoconus refractory to medical therapy and visual rehabilitation. To-date, the etiology and pathogenesis of keratoconus remains unclear. Research studies have increased exponentially over the years, highlighting the clinical significance and international interest in this disease. Hormonal imbalances have been linked to keratoconus, both clinically and experimentally, with both sexes affected. However, it is unclear how (molecular/cellular signaling) or when (age/disease stage(s)) those hormones affect the keratoconic cornea. Previous studies have categorized the human cornea as an extragonadal tissue, showing modulation of the gonadotropins, specifically luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Studies herein provide new data (both in vitro and in vivo) to further delineate the role of hormones/gonadotropins in the keratoconus pathobiology, and propose the existence of a new axis named the Hypothalamic-Pituitary-Adrenal-Corneal (HPAC) axis.
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Affiliation(s)
- Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Paulina Escandon
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Brenda Vasini
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Sarah E Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Lyly Van
- University of Oklahoma Health Sciences Center, 940 Stanton L Young, Oklahoma City, OK, USA; Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Deanna H Dang
- College of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L Young, Oklahoma City, OK, USA
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Abstract
PURPOSE OF REVIEW The aim of this study was to summarize common eye changes that may occur during pregnancy, and how pregnancy may affect preexisting eye conditions such as glaucoma and diabetic retinopathy. Challenges and complexities surrounding the treatment of these eye conditions during pregnancy are also highlighted. RECENT FINDINGS Refractive changes are common and may persist in the postpartum in patients with keratoconus. Although new medical and surgical glaucoma treatments are available, their safety in pregnancy is unknown. Limited use of topical and systemic glaucoma therapies is recommended, with a preference for selective laser trabeculoplasty as first line treatment in appropriate cases. The impact of pregnancy on diabetic retinopathy remains unclear. Although anti-vascular endothelial growth factor agents are first-line treatment for sight-threatening diabetic retinopathy, their effect on the developing foetus remains unknown and are therefore best avoided in the first and second trimesters. Noninfectious uveitis tends to become less active during pregnancy, allowing the potential tapering of systemic therapy and the use of local topical or injected corticosteroid treatment for active disease as required. SUMMARY Significant changes can occur to the eye during pregnancy, wherein the optimal treatment for many ocular conditions remains uncertain, highlighting the need for further research to develop clear recommendations that best balance the need to preserve the mother's sight, and the health of the developing foetus. The need for preconception planning, and collaborative multidisciplinary care between the obstetrician, physician, ophthalmologist and paediatrician is paramount.
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Affiliation(s)
- Edmund W C Khong
- Department of Surgery, Central Clinical School, Monash University
- Centre for Eye Research Australia, University of Melbourne
| | - Helen H L Chan
- Royal Victorian Eye and Ear Hospital
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria
| | - Stephanie L Watson
- Save Sight Institute, Sydney Medical School, University of Sydney
- Corneal Unit, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Lyndell L Lim
- Centre for Eye Research Australia, University of Melbourne
- Royal Victorian Eye and Ear Hospital
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Dynamics of keratoconus progression after prior successful accelerated cross-linking treatment during and after pregnancy. J Cataract Refract Surg 2021; 48:599-603. [PMID: 34433777 DOI: 10.1097/j.jcrs.0000000000000801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effectiveness of previously applied successful accelerated cross-linking (CXL) treatment in keratoconus stabilization during and after pregnancy. SETTING Ankara Yildirim Beyazit University, Ataturk Training and Research Hospital, Turkey. DESIGN Prospective, clinical study. METHODS Patients who became pregnant with stable keratoconus (after having an accelerated CXL procedure) were included. Uncorrected (UDVA) and corrected distance visual acuity (CDVA), manifest astigmatism (MA), keratometry (K)1, K2, K-max, central corneal thickness (CCT), thinnest corneal thickness (TCT), anterior (AE) and posterior elevation (PE) were recorded at baseline (before CXL), before pregnancy (the last visit after CXL), during pregnancy (3rd trimester) and after pregnancy (the last visit after pregnancy). RESULTS Study included 24 eyes of 19 patients. The mean time between CXL and conception was 12.4±5.1 months. The mean post-partum follow-up period was 27.6±13.3 months. The mean UDVA, CDVA, MA, and PE values did not show any significant differences during and after pregnancy compared to the post CXL values (p>0.05). The mean K-max flattened significantly after the CXL procedure (p=0.011), however it increased during pregnancy (p=0.037:after CXL-pregnancy) and then decreased back to the pre-pregnancy level after pregnancy (p=0.035:pregnancy-after pregnancy). The mean K1, K2, AE, CCT, and TCT remained stable during pregnancy and significantly decreased after pregnancy (p<0.05). CONCLUSION Keratoconus appears to progress during pregnancy in corneas that have previously received successful accelerated CXL treatment. However, this progress is mostly temporary, and generally regression occurs after delivery.
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Abstract
Pregnancy influences ocular changes which may exacerbate existing or develop new pathology. This review summarises the existing evidence on the association between pregnancy and progressive keratoconus or iatrogenic keratectasia. Ten online databases were searched systematically. Eligible studies were published in English and reported objective ophthalmic outcomes for women with evidence of (i) a new diagnosis of keratoconus, (ii) keratoconus progression or (iii) iatrogenic keratectasia following refractive surgery; during or within one year of pregnancy. Strength of evidence was assessed using the Oxford Centre for Evidence-Based Medicine levels of evidence. Seventeen articles have reported 33 peripartum women with new-onset or progressive ectasia, evident by signs of corneal hydrops or protrusion (n = 8); steepening on topography imaging (n = 20); a mean decline in best corrected visual acuity by +0.20 logMAR (95% CI -0.01 to +0.40, n = 23); a mean increase in maximum keratometry by 2.18 D (95% CI 1.44 to 2.91, n = 42); a mean decline in spherical equivalent refraction by -1.33 D (95% CI -1.73 to -0.93, n = 41); and a mean increase in astigmatism by -1.61 D (95% CI -2.46 to -0.75, n = 19). Pregnancy is associated with progressive ectasia in some women including those with previously stable keratoconus, or a history of laser-assisted in situ keratomileusis surgery or no history of corneal ectasia. This review highlights the heterogeneity in limited existing evidence, the need for a standardised definition of ectasia progression and further prospective studies for clinical guidelines. Closely monitoring women at risk may assist in early intervention with collagen cross-linking and prevent peripartum vision loss.
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Affiliation(s)
- Devanshi Jani
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - James McKelvie
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Stuti L Misra
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Anton N, Doroftei B, Ilie OD, Ciuntu RE, Bogdănici CM, Nechita-Dumitriu I. A Narrative Review of the Complex Relationship between Pregnancy and Eye Changes. Diagnostics (Basel) 2021; 11:1329. [PMID: 34441264 PMCID: PMC8394444 DOI: 10.3390/diagnostics11081329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/14/2021] [Accepted: 07/21/2021] [Indexed: 12/14/2022] Open
Abstract
Pregnancy is a condition often characterized by changes that occur in different parts of the body. Generally, the eyes suffer several changes during pregnancy that are usually transient but may become permanent at times. This may occur due to the release of placental hormones and those of maternal endocrine glands and fetal adrenal glands. Due to hormonal influences, physiological ocular changes during pregnancy have been shown in Caucasian women, so corneal sensitivity, refractive status, intraocular pressure, and visual acuity may change during pregnancy. Within this review, all studies that referred to physiological aspects and to changes of ocular pathology of pregnancy, the effect of the pregnancy on pre-existing (diabetic retinopathy, neuro-ophthalmic disorders) eye disorders, postpartum ocular changes, the intraocular pressure and the effect of hypotensive ophthalmic medicine during pregnancy, the connection between pregnancy and the neuro-ophthalmic pathology, as well as the role of anesthesia were analyzed.
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Affiliation(s)
- Nicoleta Anton
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
| | - Bogdan Doroftei
- Department of Mother and Child Medicine, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania
- Origyn Fertility Center, Palace Street, No. 3C, 700032 Iasi, Romania
| | - Ovidiu-Dumitru Ilie
- Department of Biology, Faculty of Biology, “Alexandru Ioan Cuza” University, Carol I Avenue, No. 20A, 700505 Iasi, Romania;
| | - Roxana-Elena Ciuntu
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
| | - Camelia Margareta Bogdănici
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
| | - Ionela Nechita-Dumitriu
- Department of Ophthalmology, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street, No. 16, 700115 Iasi, Romania; (N.A.); (R.-E.C.); (C.M.B.); (I.N.-D.)
- Ophthalmology Clinic, “Saint Spiridon” Emergency Clinic Hospital, Independence Avenue, No. 1, 700111 Iasi, Romania
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Corneal Biomechanical Changes in Third Trimester of Pregnancy. ACTA ACUST UNITED AC 2021; 57:medicina57060600. [PMID: 34200925 PMCID: PMC8230443 DOI: 10.3390/medicina57060600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 12/22/2022]
Abstract
Background and Objectives: There is a clear evidence that pregnancy is associated with high production of sex hormones. During the first, second and third trimester of pregnancy, blood hormones levels increase gradually. Cells with affinity for sex hormones have been identified in different ocular tissues, such as: lid, lacrimal gland, meibomian gland, bulbar and palpebral conjunctivae, cornea, iris, ciliary body, lens, retina (retinal pigment epithelium) and choroid. This is why pregnancy is associated with changes at ocular level, involving anterior and posterior segments. Several clinical trials have been made trying to highlight changes in corneal biomechanics during pregnancy. By conducting this review, we want to evaluate both the changes in parameters that define corneal biomechanics and intraocular pressure values in pregnant. Materials and Methods: Following a systematic search in the literature related mainly to changes in corneal biomechanics during pregnancy, focusing on the paper published in the last decade, we included in a meta-analysis the cumulative results of three prospective comparative studies. Results: Important changes in corneal biomechanics (corneal hysteresis and corneal resistance factor) parameters were observed in women in the third trimester of pregnancy, but these variations were not statistically significant. Also, a decrease in intraocular pressure was mentioned in these women, but only the corneal compensation intraocular pressure showed a decrease with statistical significance. Conclusions: A decrease in corneal compensatory intraocular pressure was observed in pregnant women in the third trimester of pregnancy, but without other statistically significant changes resulting from the analysis of the other three parameters (corneal hysteresis, corneal resistance factor and Goldmann-correlated intraocular pressure).
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Songur MS, İntepe YS, Bayhan SA, Bayhan HA, Çiftçi B. Evaluation of the corneal endothelium by specular microscopy in patients with chronic obstructive pulmonary disease. CLINICAL RESPIRATORY JOURNAL 2021; 15:1056-1062. [PMID: 34101348 DOI: 10.1111/crj.13408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/25/2021] [Accepted: 06/03/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the corneal endothelium in patients with chronic obstructive pulmonary disease (COPD) using a specular microscope. METHODS The right eyes of 64 patients with a COPD diagnosis and 65 healthy individuals were evaluated. Cell density (CD) (cell/mm2 ), corneal thickness (CT) (μ), hexagonal cell ratio (%), and coefficient of variation (cell area standard deviation/mean cell area, μm2 ) were analyzed by specular microscopy (SM). RESULTS The CT was significantly reduced in the COPD group compared with the control group (P = 0.021). Moreover, a significant difference was found between the COPD group and the control group in terms of corneal endothelial CD (P = 0.011), hexagonal cell ratio (P = 0.008), and coefficient of variation (P = 0.012). CONCLUSION The corneal endothelial structure was significantly deteriorated in patients with COPD compared with the control group. SM is a valuable method that could be used in treatment and follow-up of corneal endothelium in patients with COPD.
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Affiliation(s)
- Murat Serkan Songur
- Faculty of Medicine, Department of Ophthalmology, Yozgat Bozok University, Yozgat, Turkey
| | - Yavuz Selim İntepe
- Faculty of Medicine, Department of Chest Disease, Yozgat Bozok University, Yozgat, Turkey
| | - Seray Aslan Bayhan
- Faculty of Medicine, Department of Ophthalmology, Yozgat Bozok University, Yozgat, Turkey
| | - Hasan Ali Bayhan
- Faculty of Medicine, Department of Ophthalmology, Yozgat Bozok University, Yozgat, Turkey
| | - Bülent Çiftçi
- Faculty of Medicine, Department of Chest Disease, Yozgat Bozok University, Yozgat, Turkey
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Taneja M, Vadavalli PK, Veerwal V, Gour R, Reddy J, Rathi VM. Pregnancy-induced keractesia - A case series with a review of the literature. Indian J Ophthalmol 2021; 68:3077-3081. [PMID: 33245060 PMCID: PMC7856952 DOI: 10.4103/ijo.ijo_1508_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
We report a case series of patients who developed post-laserassisted in situ keratomileusis (LASIK) ectasia or had a progression of keractesia during pregnancy. We reviewed the medical records of 12 patients (20 eyes) who had reported deterioration of vision during their pregnancy and were diagnosed with keractesia. All 12 patients had experienced symptoms of deterioration of vision between 2 months to 1 year of onset of their pregnancies. A total of 17 eyes of 10 patients had developed post-refractive surgery keractesia. Sixteen of these had undergone LASIK and one had undergone femtosecond lenticule extraction (FLEX). Three eyes of two patients had an exacerbation of keratoconus during pregnancy while one patient had associated hypothyroidism. The results indicate that the hormonal changes that take place in pregnant women can affect the biomechanical stability of the cornea and may trigger the onset of keractesia.
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Affiliation(s)
| | - Pravin K Vadavalli
- Cornea Institute, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Vikas Veerwal
- L V Prasad Eye Institute, GMRV Campus, Vishakhapatnam, Andhra Pradesh, India
| | - Ruchi Gour
- Hajari Hospital, Jogeshwari East, Mumbai, Maharashtra, India
| | - Jagadesh Reddy
- Cornea Institute, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
| | - Varsha M Rathi
- Cornea Institute, L V Prasad Eye Institute, KAR Campus, Hyderabad, Telangana, India
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Leonard BC, Kermanian CS, Michalak SR, Kass PH, Hollingsworth SR, Good KL, Maggs DJ, Thomasy SM. A Retrospective Study of Corneal Endothelial Dystrophy in Dogs (1991-2014). Cornea 2021; 40:578-583. [PMID: 32947393 PMCID: PMC7960559 DOI: 10.1097/ico.0000000000002488] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To retrospectively evaluate the clinical data, diagnostic tests, treatments, and outcomes for dogs with corneal endothelial dystrophy (CED) and determine risk factors for CED when compared with a canine reference population. METHODS Medical records of 99 dogs (1991-2014) diagnosed with CED at the University of California Davis Veterinary Medical Teaching Hospital were reviewed and compared with 458,680 dogs comprising the general hospital population during the study period. Retrieved data included signalment, examination findings, diagnoses, treatments, and outcomes associated with CED. The exact Pearson χ2 test or exact Kruskal-Wallis test was used to compare parameters between the groups. Progression of corneal edema was assessed using 3 independent Kaplan-Meier curves, identifying clinically significant changes in corneal opacity. RESULTS Boston terriers, German wirehaired pointers, and Dachshunds were overrepresented in the CED-affected group, whereas Labradors were underrepresented. Dogs older than 11 years were overrepresented in the CED-affected group, whereas intact dogs were underrepresented. Surgical intervention was performed (n = 11) based on the severity of disease and secondary complications from CED. Median time to progression of corneal edema was 1) 368 days when an at-risk eye initially without edema developed edema at a subsequent visit, 2) 701 days when there was progression from mild to marked corneal edema, and 3) 340 days when there was progression from focal to diffuse corneal edema. CONCLUSIONS Many CED-affected dogs progress over months to years without surgical intervention, making dogs with CED a useful model for studying genetic predispositions and development of novel therapeutics for Fuchs endothelial corneal dystrophy.
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Affiliation(s)
- Brian C. Leonard
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Celine S. Kermanian
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Sarah R. Michalak
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Philip H. Kass
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Steven R. Hollingsworth
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Kathryn L. Good
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - David J. Maggs
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
| | - Sara M. Thomasy
- Departments of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, Davis, CA
- Department of Ophthalmology & Vision Science, School of Medicine, University of California, Davis, Davis, CA
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Zhang T, Jiang Q, Xu F, Zhang R, Liu D, Guo D, Wu J, Wen Y, Wang X, Jiang W, Bi H. Alternation of Resting-State Functional Connectivity Between Visual Cortex and Hypothalamus in Guinea Pigs With Experimental Glucocorticoid Enhanced Myopia After the Treatment of Electroacupuncture. Front Neuroinform 2021; 14:579769. [PMID: 33519409 PMCID: PMC7838498 DOI: 10.3389/fninf.2020.579769] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
Excessive glucocorticoids (GC) may lead to the aggravation of several basic diseases including myopia, due to plasma hormone imbalances associated with the hypothalamic–pituitary–adrenal axis (HPAA). Electroacupuncture (EA) is an effective therapeutic method to treat many diseases, although it remains unclear whether EA at acupoints on the foot or back would be effective in treating eye diseases. It was recently found that visual cortex activity for responses to visual stimuli with spatial frequency and resting-state functional connectivity (FC) between the supramarginal gyrus and rostrolateral prefrontal cortex was significantly reduced in patients with high myopia. The present study aims to investigate the role of the alternation of resting-state FC among the bilateral visual cortex and hypothalamus in exerting anti-myopia effects of EA in GC-enhanced lens-induced myopic (LIM) guinea pigs such that the mechanisms of EA to treat GC-enhanced myopia at Shenshu (BL23) acupoints can be probed. To confirm the effects of EA, ocular parameters including axial length and GC-associated physiological parameters such as animal appearance, behavior, bodyweight, and levels of four HPAA-associated plasma hormones [free triiodothyronine (FT3), free thyroxine (FT4), estradiol (E2), and testosterone (T)] were also collected. Increased resting-state FC between the left and right visual cortex was detected in GC-enhanced lens-induced myopic guinea pigs with EA at BL23 acupoints (LIM+GC+EA) guinea pigs compared to GC-enhanced lens-induced myopic guinea pigs with EA at sham acupoints (LIM+GC+Sham) guinea pigs, as well as suppressed myopia and recovery of symptoms initially caused by overdose of GC. Recovered symptoms included improved animal appearance, behavior, bodyweight, and HPAA-associated plasma hormone levels were observed after 4 weeks of EA treatment. In contrast, the LIM+GC+Sham group showed decreased FC with elongation of axial length for myopization as compared to the control group and LIM group and exhibited a deterioration in physiological parameters including reduced body weight and balance disruption in the four measured HPAA-associated plasma hormones. Our findings suggest that EA could effectively treat GC-enhanced myopia by increasing resting-state FC between the left and right visual cortices, which may be pivotal to further understanding the application and mechanisms of EA in treating GC-enhanced myopia.
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Affiliation(s)
- Tao Zhang
- The First College of Clinical Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Qian Jiang
- Department of Ophthalmology and Optometry, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Furu Xu
- Department of Ophthalmology and Optometry, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ruixue Zhang
- Department of Ophthalmology and Optometry, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dezheng Liu
- Department of Ophthalmology and Optometry, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Dadong Guo
- Shandong Province Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Disease, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Jianfeng Wu
- Department of Ophthalmology and Optometry, Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Ying Wen
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Xingrong Wang
- Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Wenjun Jiang
- Shandong Province Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Disease, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Hongsheng Bi
- Shandong Province Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Therapy of Ocular Disease, Eye Institute of Shandong University of Traditional Chinese Medicine, Jinan, China
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Ong Tone S, Kocaba V, Böhm M, Wylegala A, White TL, Jurkunas UV. Fuchs endothelial corneal dystrophy: The vicious cycle of Fuchs pathogenesis. Prog Retin Eye Res 2021; 80:100863. [PMID: 32438095 PMCID: PMC7648733 DOI: 10.1016/j.preteyeres.2020.100863] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
Abstract
Fuchs endothelial corneal dystrophy (FECD) is the most common primary corneal endothelial dystrophy and the leading indication for corneal transplantation worldwide. FECD is characterized by the progressive decline of corneal endothelial cells (CECs) and the formation of extracellular matrix (ECM) excrescences in Descemet's membrane (DM), called guttae, that lead to corneal edema and loss of vision. FECD typically manifests in the fifth decades of life and has a greater incidence in women. FECD is a complex and heterogeneous genetic disease where interaction between genetic and environmental factors results in cellular apoptosis and aberrant ECM deposition. In this review, we will discuss a complex interplay of genetic, epigenetic, and exogenous factors in inciting oxidative stress, auto(mito)phagy, unfolded protein response, and mitochondrial dysfunction during CEC degeneration. Specifically, we explore the factors that influence cellular fate to undergo apoptosis, senescence, and endothelial-to-mesenchymal transition. These findings will highlight the importance of abnormal CEC-DM interactions in triggering the vicious cycle of FECD pathogenesis. We will also review clinical characteristics, diagnostic tools, and current medical and surgical management options for FECD patients. These new paradigms in FECD pathogenesis present an opportunity to develop novel therapeutics for the treatment of FECD.
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Affiliation(s)
- Stephan Ong Tone
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Viridiana Kocaba
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Myriam Böhm
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Adam Wylegala
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Tomas L White
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Ula V Jurkunas
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States.
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Kamil S, Mohan RR. Corneal stromal wound healing: Major regulators and therapeutic targets. Ocul Surf 2020; 19:290-306. [PMID: 33127599 DOI: 10.1016/j.jtos.2020.10.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/16/2020] [Accepted: 10/25/2020] [Indexed: 12/12/2022]
Abstract
Corneal stromal wound healing is a complex event that occurs to restore the transparency of an injured cornea. It involves immediate apoptosis of keratocytes followed by their activation, proliferation, migration, and trans-differentiation to myofibroblasts. Myofibroblasts contract to close the wound and secrete extracellular matrix and proteinases to remodel it. Released proteinases may degenerate the basement membrane allowing an influx of cytokines from overlying epithelium. Immune cells infiltrate the wound to clear cellular debris and prevent infections. Gradually basement membrane regenerates, myofibroblasts and immune cells disappear, abnormal matrix is resorbed, and transparency of the cornea is restored. Often this cascade deregulates and corneal opacity results. Factors that prevent corneal opacity after an injury have always intrigued the researchers. They hold clinical relevance as they can guide the outcomes of corneal surgeries. Studies in the past have shed light on the role of various factors in stromal healing. TGFβ (transforming growth factor-beta) signaling is the central player guiding stromal responses. Other major regulators include myofibroblasts, basement membrane, collagen fibrils, small leucine-rich proteoglycans, biophysical cues, proteins derived from extracellular matrix, and membrane channels. The knowledge about their roles helped to develop novel therapies to prevent corneal opacity. This article reviews the role of major regulators that determine the outcome of stromal healing. It also discusses emerging therapies that modulate the role of these regulators to prevent stromal opacity.
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Affiliation(s)
- Sabeeh Kamil
- Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA; One-Health Vision Research Program, Department of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA
| | - Rajiv R Mohan
- Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, USA; One-Health Vision Research Program, Department of Veterinary Medicine & Surgery and Biomedical Sciences, College of Veterinary Medicine, University of Missouri, Columbia, MO, USA; Mason Eye Institute, School of Medicine, University of Missouri, Columbia, MO, USA.
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Borrelli M, Frings A, Geerling G, Finis D. Gender-Specific Differences in Signs and Symptoms of Dry Eye Disease. Curr Eye Res 2020; 46:294-301. [PMID: 32735461 DOI: 10.1080/02713683.2020.1801758] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Dry eye disease (DED) is a multifactorial disease of the ocular surface characterized by loss of homeostasis of the tear film. Epidemiological studies suggest it occurs more frequently in women than men. The aim of this retrospective analysis was to determine whether patients with DED show gender-specific differences in symptoms and signs. MATERIAL AND METHODS A retrospective analysis of 107 patients was conducted at the Department of Ophthalmology of the University of Düsseldorf - Germany. After completing the OSDI questionnaire, the patients underwent objective refraction and were asked about the following symptoms: burning, itching, foreign body sensation, epiphora, sticky eyes, pain, red eyes and swollen eyelids. Furthermore, they underwent an evaluation of the following signs: lipid layer thickness, non-invasive break-up-time (NI-BUT), conjunctival hyperemia, lid parallel conjunctival folds, meibography, Schirmer test and tear meniscus height, ocular surface staining, expressibility of meibomian glands. RESULTS Of the 107 patients (56.2 ± 17.3 years) 75 were women and 32 men. Women reported significantly more often eyelid swelling (p = .03) and showed a tendency to complain more about red eyes (p = .051), while men tended to complain more often about epiphora (p = .053). In an age-matched sample taken from the cohort, significant differences were found for OSDI-scores (p = .025) showing women reporting more symptoms compared to men, while men showed more conjunctival hyperaemia (p = .004) than women. Women showed a significant thicker lipid layer (p = .0009) in the full cohort, but not in the age-matched sample (p = .43). CONCLUSION Although the majority of the investigated parameters did not show gender-specific differences, women reported higher OSDI scores. These findings could be explained by an increased frequency of neuropathic symptoms or ocular surface sensitivity in women or higher resilience of men to consult an ophthalmologist. Sex may have an effect on the clinical characteristics of DED, but further studies are needed to confirm these findings.
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Affiliation(s)
- Maria Borrelli
- Department of Ophthalmology, University Hospital Duesseldorf , Düsseldorf, Germany
| | - Andreas Frings
- Department of Ophthalmology, University Hospital Duesseldorf , Düsseldorf, Germany
| | - Gerd Geerling
- Department of Ophthalmology, University Hospital Duesseldorf , Düsseldorf, Germany
| | - David Finis
- Department of Ophthalmology, University Hospital Duesseldorf , Düsseldorf, Germany
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Subepithelial Corneal Deposits Associated with Exemestane. Case Rep Ophthalmol Med 2020; 2020:5703164. [PMID: 32685225 PMCID: PMC7336228 DOI: 10.1155/2020/5703164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 05/27/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
This is a case report of corneal deposits noted in a 69-year-old female patient taking the aromatase inhibitor, exemestane, after undergoing a mastectomy and chemotherapy for breast cancer. The patient presented to our eye clinic for a new-onset floater in one eye, and bilateral subepithelial opacities were found incidentally on exam. The patient completed a 5-year course of the medication shortly after her initial visit with us and was noted to have a slight improvement in the density of the opacities on a follow-up visit 3 months later. We believe these corneal changes were most likely secondary to exemestane. The effect of aromatase inhibitors on the eye deserves further exploration as an increasing number of patients are prescribed these medications.
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Leshno A, Prokai-Tatrai K, Rotenstreich Y, Magid A, Bubis E, Schwartz S, Skaat A, Zloto O, Avni-Zauberman N, Barak A. Topical Estrogen Therapy for Hyperopia Correction in Vivo. Invest Ophthalmol Vis Sci 2020; 61:55. [PMID: 32579682 PMCID: PMC7415902 DOI: 10.1167/iovs.61.6.55] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Purpose In vitro studies found that 17β-estradiol (estrogen) modulates corneal biomechanical properties and reduces tissue stiffness. Therefore we hypothesized that topical estrogen might affect the refractive properties of the cornea, inducing a myopic shift. Methods Twelve female New Zealand white rabbits 16 weeks old were used. The rabbits were randomly divided to either the treatment group receiving 1.5% (w/v) estrogen eye drops or a control group receiving vehicle only (n = 6 each group). Both groups were given drops (50 µL) to the right eye every 12 hours for 35 days. Ocular examination, pachymetry, intraocular pressure (IOP), keratometry, and refraction were evaluated at baseline and on a weekly basis. Results No significant differences were observed between the two groups at baseline in all outcome measures. Both groups displayed corneal flattening and a hyperopic shift. However, the change rate was slower in the treatment group. Repeated measurements analysis revealed a statistically significant difference in keratometry readings between groups (P = 0.034) with steeper keratometry by up to 0.6 diopters in the treatment group. The difference between the two groups diminished and became statistically insignificant after treatment cessation. No significant changes were observed in IOP and pachymetry throughout the study period. No side effects were observed in either group. Conclusions Estrogen eye drops induced a myopic shift in keratometry readings. These results suggest that corneal refractive power might be manipulated pharmacologically. Further studies on the physiology behind this change are warranted to facilitate a pathway for development of novel pharmacologic treatments to correct refractive errors.
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The effects of adjuvant hormonotherapy on tear functions in patients with breast cancer. Int Ophthalmol 2020; 40:2077-2083. [PMID: 32333340 DOI: 10.1007/s10792-020-01384-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 04/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Aromatase inhibitors (anastrozole, letrozole) and selective estrogen receptor modulators (tamoxifen) are widely used as adjuvant hormonal therapy in women with hormone receptor-positive breast cancer. We aimed to evaluate the effects of oral adjuvant hormonotherapy on tear functions in patients with breast cancer. METHODS In this case-control study, we enrolled eligible patients with breast cancer who were receiving regular medical selective estrogen receptor modulator (tamoxifen, n:50), aromatase inhibitors (anastrozole, letrozole, n:50) and gender-matched healthy controls (n:50). Tear functions were measured and compared by the Schirmer test, fluorescein breakup time, corneal staining evaluated by Oxford grading scale and Ocular Surface Disease Index scores. RESULTS Mean age was 49.95 (± 9.2), 51.52 (± 7.2) and 51.91 (± 10.3) in tamoxifen, aromatase inhibitors groups and controls (p = 0.426). Mean duration of BC diagnosis (p = 0.536) and drug use (p = 0.417) was not significant between two groups. Ocular Surface Disease Index scores were lower (p < 0.001), and fluorescein breakup time measurements were higher (p < 0.001) in controls. Schirmer test scores were higher in controls than aromatase inhibitors group (p < 0.001). According to the scores of all measurements, the differences between aromatase inhibitors and tamoxifen groups were statistically significant (p < 0.001). CONCLUSIONS Our results demonstrated a high difference in all parameters in patients receiving aromatase inhibitors compared to tamoxifen group and controls. Aromatase inhibitors, which reduce estrogen levels in the blood, might affect the tear functions more than tamoxifen, which affects as antiestrogenic on estrogen receptors.
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Kanellopoulos AJ, Vingopoulos F. Does Pregnancy Affect Refractive and Corneal Stability or Corneal Epithelial Remodeling After Myopic LASIK? J Refract Surg 2020; 36:118-122. [DOI: 10.3928/1081597x-20200115-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 01/15/2020] [Indexed: 11/20/2022]
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Yang Y, Ye J, Ng TK, Wu N, Sun X, Chen Y, Chen Y. Changes in corneal biomechanics during pregnancy in Chinese healthy female. Eur J Ophthalmol 2020; 31:361-366. [PMID: 31983220 DOI: 10.1177/1120672120902034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate the changes of corneal biomechanics and the intraocular pressure during pregnancy in a Chinese healthy female population. METHODS A total of 222 unrelated Chinese females were recruited: 52 non-pregnant, 15 pregnant in the first trimester, 68 pregnant in the second trimester, and 87 pregnant in the third trimester. The intraocular pressure and corneal biomechanical parameters, including corneal-compensated intraocular pressure, Goldmann-correlated intraocular pressure, corneal hysteresis, and corneal resistance factor, were measured by an Ocular Response Analyzer G3. Central corneal thickness was measured by Lenstar (LS900). RESULTS Corneal hysteresis and corneal resistance factor were significantly higher in pregnant women at the second and third trimesters. Corneal-compensated intraocular pressure was lower in women at the third trimester of pregnancy (p = 0.023), but the difference became insignificant after adjustment for corneal hysteresis. Central corneal thickness was marginally higher in pregnant women than non-pregnant women (p = 0.032). There was a negative correlation between corneal-compensated intraocular pressure and corneal hysteresis (r = -0.337, p < 0.001) and a positive correlation between central corneal thickness and corneal hysteresis (r = 0.711, p < 0.0001). After adjustment for corneal-compensated intraocular pressure, corneal hysteresis remained significantly higher in the second and third trimesters of pregnant women than non-pregnant women (p = 0.031, p = 0.005). CONCLUSION This study revealed a significant increase in corneal hysteresis and corneal resistance factor in the second and third trimesters. The increase of corneal hysteresis was independent of corneal-compensated intraocular pressure, indicating pregnant females have unique characteristics in corneal-compensated intraocular pressure and corneal biomechanical properties that may be related to glaucoma and corneal ectatic diseases in pregnancy.
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Affiliation(s)
- Yaping Yang
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Jun Ye
- Department of Obstetrics and Gynecology, The Fifth People's Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Tsz Kin Ng
- Joint Shantou International Eye Center of Shantou University and The Chinese University of Hong Kong, Shantou, China.,Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong
| | - Na Wu
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China.,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science and Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Yaping Chen
- Department of Obstetrics and Gynecology, The Fifth People's Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yuhong Chen
- Department of Ophthalmology and Visual Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China.,Key Laboratory of Myopia, Ministry of Health, Shanghai, China.,Key Laboratory of Visual Impairment and Restoration, Shanghai, China
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Kang DH, Song SW, Kim BY, Hwang KY, Kim KY. Clinical Aspects of Phlyctenular Keratoconjunctivitis Using a Tear Film Interferometer. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2020. [DOI: 10.3341/jkos.2020.61.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Dong Hyun Kang
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Sang Wroul Song
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Byung Yeop Kim
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Kyu Yeon Hwang
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
| | - Kook Young Kim
- Myung-Gok Eye Research Institute, Department of Ophthalmology, Kim's Eye Hospital, Konyang University College of Medicine, Seoul, Korea
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Tong J, Phu J, Kalloniatis M, Zangerl B. Modeling Changes in Corneal Parameters With Age: Implications for Corneal Disease Detection. Am J Ophthalmol 2020; 209:117-131. [PMID: 31469999 DOI: 10.1016/j.ajo.2019.08.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To apply computational methods to model normal age-related changes in corneal parameters and to establish their association with demographic factors, thereby providing a framework for improved detection of subclinical corneal ectasia (SCE). DESIGN Cross-sectional study. METHODS One hundred seventeen healthy participants were enrolled from Centre for Eye Health (Sydney, Australia). Corneal thickness (CT), front surface sagittal curvature (FSSC), and back surface sagittal curvature (BSSC) measurements were extracted from 57 corneal locations from 1 eye per participant using the Pentacam HR. Cluster analyses were performed to identify locations demonstrating similar variations with age. Age-related changes were modeled using polynomial regression with sliding window methods, and model accuracy was verified with Bland-Altman comparisons. Pearson correlations were applied to examine the impacts of demographic factors. RESULTS Concentric cluster patterns were observed for CT and FSSC but not for BSSC. Sliding window analyses were best fit with quartic and cubic regression models for CT and FSSC/BSSC, respectively. CT and FSSC sliding window models had narrower 95% limits of agreement compared with decade-based models (0.015 mm vs 0.017 mm and 0.14 mm vs 0.27 mm, respectively), but were wider for BSSC than decade-based models (0.73 mm vs 0.54 mm). Significant correlations were observed between CT and astigmatism (P = .02-.049) and FSSC and BSSC and gender (P = <.001-.049). CONCLUSIONS The developed models robustly described aging variations in CT and FSSC; however, other mechanisms appear to contribute to variations in BSSC. These findings and the identified correlations provide a framework that can be applied to future model development and establishment of normal databases to facilitate SCE detection.
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Affiliation(s)
- Janelle Tong
- Centre for Eye Health and the School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Jack Phu
- Centre for Eye Health and the School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Kalloniatis
- Centre for Eye Health and the School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia
| | - Barbara Zangerl
- Centre for Eye Health and the School of Optometry and Vision Science, University of New South Wales, Sydney, New South Wales, Australia.
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Hypothyroidism is Not Associated with Keratoconus Disease: Analysis of 626 Subjects. J Ophthalmol 2019; 2019:3268595. [PMID: 31815013 PMCID: PMC6877948 DOI: 10.1155/2019/3268595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 09/04/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022] Open
Abstract
Purpose To analyze the association between hypothyroidism and keratoconus, we examined blood thyroid hormone levels and corneal tomographic parameters in healthy subjects and patients with keratoconus. Methods We included 626 subjects (304 left eyes, 49%; 431 males, 69%; age 38.4 ± 14.3 y). Patients with keratoconus were from our Homburg Keratoconus Center (HKC) (n = 463); patients with hypothyroidism were from the Department of Internal Medicine of Saarland Medical University, Homburg/Saar, Germany (n = 75); and healthy subjects were from the Department of Ophthalmology of Saarland University Medical Center (n = 88). We included only one randomly selected eye of each subject and the first examination data. Exclusion criteria Previous thyroid medication, previous ocular surgery, and patients with suspected keratoconus (topographic keratoconus classification, [TKC]: 0 < 1). Patient eyes were classified (TKC) with dedicated, instrument-based, keratoconus detection software provided with the Pentacam. TKC = 0 was considered “normal,” and TKCs ≥ 1 were considered keratoconus. Subjects were also classified as euthyroid or hypothyroid, based on blood thyroid hormone status (i.e., TSH, FT3, and FT4). A multiple logistic linear regression model was constructed to determine the effects of age (covariate), gender, and hypothyroidism (effect sizes) on “TKC-positive” disease. Results The significance levels for a constant parameter, sex, thyroid condition, and age were p < 0.0001, p < 0.0001, p < 0.0001, and p=0.003, respectively. The odds ratios for age, sex, and hypothyroidism were 0.98, 3.05, and 3.34, respectively. Male sex and a euthyroid condition had significantly positive, clinically relevant effects, and age had a significantly negative, but clinically irrelevant effect on the estimated TKC index. Conclusions Keratoconus appeared to occur more often in patients classified as euthyroid than in patients with hypothyroidism. Thus, hypothyroidism alone could not support the development of keratoconus. Based on these results, it should not be mandatory to screen patients with hypothyroidism for keratoconus or patients with keratoconus for hypothyroidism.
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Karamichos D, Barrientez B, Nicholas S, Ma S, Van L, Bak-Nielsen S, Hjortdal J. Gonadotropins in Keratoconus: The Unexpected Suspects. Cells 2019; 8:cells8121494. [PMID: 31766771 PMCID: PMC6953013 DOI: 10.3390/cells8121494] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/15/2019] [Accepted: 11/21/2019] [Indexed: 11/23/2022] Open
Abstract
Keratoconus (KC) is the most common ectatic corneal disease with a significant visual acuity burden. The actual burden is intangible given that KC can disrupt daily activities (reading, driving, and various career paths). Despite decades of research and clinical studies, the etiology, onset, and pathobiology of KC remain a mystery. The purpose of this study was to investigate the role of gonadotropins in KC. We recruited 86 KC patients (63 males, 23 female), and 45 healthy controls (22 male, 23 female). Plasma samples were collected and analyzed using an enzyme-linked immunosorbent assay. Corneal stromal cells from KC and healthy controls, and human epithelial corneal cells, were also investigated for gonadotropin-related markers. Our results show significant alterations of LH/FSH in KCs, compared to healthy controls. Our data also reveals, for the first time, the existence of gonadotropins and their receptors in KC. Our study is the first to demonstrate the role of LH/FSH in KCs, and expand the list of organs known to express gonadotropins, or their receptors, to include the human cornea. Our findings suggest that the human cornea is capable of responding to gonadotropins, and propose an intriguing mechanism for the onset and/or progression of KC.
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Affiliation(s)
- Dimitrios Karamichos
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, 73104 OK, USA
- Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, 73104 OK, USA; (B.B.); (S.N.); (S.M.); (L.V.)
- Correspondence: ; Tel.: +1-405-271-4019
| | - Brayden Barrientez
- Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, 73104 OK, USA; (B.B.); (S.N.); (S.M.); (L.V.)
| | - Sarah Nicholas
- Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, 73104 OK, USA; (B.B.); (S.N.); (S.M.); (L.V.)
| | - Symon Ma
- Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, 73104 OK, USA; (B.B.); (S.N.); (S.M.); (L.V.)
| | - Lyly Van
- Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, 73104 OK, USA; (B.B.); (S.N.); (S.M.); (L.V.)
| | - Sashia Bak-Nielsen
- Department of Ophthalmology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 167, 8200 Aarhus N, Denmark; (S.B.-N.); (J.H.)
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 167, 8200 Aarhus N, Denmark; (S.B.-N.); (J.H.)
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Bicer T, Imamoglu GI, Caliskan S, Bicer BK, Gurdal C. The Effects of Adjuvant Tamoxifen Use on Macula Pigment Epithelium Optical Density, Visual Acuity and Retinal Thickness in Patients with Breast Cancer. Curr Eye Res 2019; 45:623-628. [PMID: 31684771 DOI: 10.1080/02713683.2019.1687725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: We aimed to compare best corrected visual acuity, macular pigment optical density and macular thickness in patients with breast cancer, who received oral adjuvant hormone therapy.Materials and Methods: We enrolled consecutive eligible patients with breast cancer who were receiving regular medical tamoxifen treatment. The participants were divided into two groups as cases and controls. Best-corrected visual acuity and retinal thickness were examined. Macular pigment optical density was measured by fundus reflectometry using the one-wavelength reflection method. The output parameters included max optical density, mean optical density, volume and area of the right eye.Results: A total of 104 eyes, cases (n: 50) and controls (n: 54) were included in the study. Mean age in cases was 49.95 ± 9.2 years and 50.21 ± 9.3 years in controls (p = .151). The mean foveal optical density and the maximum optical density differed between cases (0.13 ± 0.03 density units (DU)/0.35 ± 0.07 DU) and controls (0.18 ± 0.04 DU/0.41 ± 0.06 DU) (p = .002/p = .009). Macular pigment optical density volume was 8102.84 ± 2412.67 in cases versus 8280.18 ± 2904.56 in controls (p = .034), and mean MPOD area was 59567.79 ± 11538.06 in cases versus 61748.14 ± 10591.19 in controls (p = .023). The best corrected visual acuity and retinal thickness were similar in both groups (p > .05).Conclusions: Patients in care of oral tamoxifen therapy were found to have significantly reduced macular pigment optical density. In addition, higher drug use duration correlated significantly with reduced macular pigment optical density, suggesting that the poor long-term effects may play a role in macular pigment absorption and incorporation in the retinal tissue.
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Affiliation(s)
- Tolga Bicer
- Department of Ophthalmology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Goksen Inanc Imamoglu
- Department of Medical Oncology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Sinan Caliskan
- Department of Ophthalmology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | | | - Canan Gurdal
- Department of Ophthalmology, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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Walter E, Matlov Kormas R, Marcovich AL, Lior Y, Sui X, Wagner D, Knyazer B. The effect of estrogen and progesterone on porcine corneal biomechanical properties. Graefes Arch Clin Exp Ophthalmol 2019; 257:2691-2695. [PMID: 31624911 DOI: 10.1007/s00417-019-04490-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 08/16/2019] [Accepted: 09/16/2019] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To determine the effect of the hormones estrogen and progesterone on the biomechanical properties of porcine corneas. METHODS Thirty fresh porcine corneas were acquired from an abattoir. The corneas were equally divided into three groups. Groups were incubated for 1 week in Eusol-C solution containing supra-physiologic concentrations of estrogen, progesterone, or control (no added hormone). After incubation, the central corneal thickness (CCT) of each cornea was measured using an electronic caliper, and then the corneas were cut into strips. The strips were then clamped in the pneumatic jaws of a computer-controlled biomaterial tester (Instron 4502, USA) and stretched at a constant rate of 1 mm/min until tissue rupture while constantly recording the stress and strain of the tissue. Stress-strain curves were plotted and Young's modulus was calculated for each corneal strip. RESULTS Average corneal thickness was 873.5 ± 143.1 μm for the control group, 928.0 ± 97.7 μm for the estrogen group, and 922.0 ± 116.7 μm for the progesterone group (data presented as mean ± SD). There was no statistically significant difference between the groups regarding the CCT (p = 0.89). The average Young's modulus was 17.00 ± 3.46 MPa for the control group, 16.95 ± 6.83 MPa for the progesterone group, and 12.33 ± 3.24 MPa for the estrogen group. The difference between the control and estrogen groups was statistically significant (p = 0.018) while the difference between the control and progesterone groups was not (p = 0.72). CONCLUSION Estrogen has a relaxing effect on the porcine cornea, resulting in reduced stiffness of the tissue. Progesterone has no significant effect on the biomechanical properties of porcine corneas. Estrogen and progesterone do not significantly affect CCT.
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Affiliation(s)
- Eyal Walter
- Department of Ophthalmology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ran Matlov Kormas
- Department of Ophthalmology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Arie L Marcovich
- Department of Ophthalmology, Kaplan Medical Center, Rehovot, Israel.,Department of Plant and Environmental Sciences, The Weizmann Institute of Science, Rehovot, Israel
| | - Yotam Lior
- Soroka Clinical Research Center, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Xiaomeng Sui
- Department of Materials and Interfaces, The Weizmann Institute of Science, Rehovot, Israel
| | - Daniel Wagner
- Department of Materials and Interfaces, The Weizmann Institute of Science, Rehovot, Israel
| | - Boris Knyazer
- Department of Ophthalmology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Ayan B, Yuksel N, Carhan A, Gumuşkaya Ocal B, Akcay E, Cagil N, Asik MD. Evaluation estrogen, progesteron and androgen receptor expressions in corneal epithelium in keratoconus. Cont Lens Anterior Eye 2019; 42:492-496. [DOI: 10.1016/j.clae.2018.11.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/21/2018] [Accepted: 11/23/2018] [Indexed: 11/27/2022]
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Tripathi R, Giuliano EA, Gafen HB, Gupta S, Martin LM, Sinha PR, Rodier JT, Fink MK, Hesemann NP, Chaurasia SS, Mohan RR. Is sex a biological variable in corneal wound healing? Exp Eye Res 2019; 187:107705. [PMID: 31226339 PMCID: PMC9250696 DOI: 10.1016/j.exer.2019.107705] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/16/2019] [Accepted: 06/17/2019] [Indexed: 01/03/2023]
Abstract
Wound healing differs significantly between men and women in a tissue-dependent manner. Dermal wounds heal faster in women whereas mucosal wounds heal faster in men. However, the effect of sex as a variable in corneal wound healing is largely unknown. The primary objective of this study was to test whether sex is a biological variable in corneal wound healing activated by the trauma or injury using an established in vivo rabbit model with male and female New Zealand White rabbits. Corneal wounds in rabbits were produced by a single topical alkali (0.5N Sodium hydroxide) application. Serial slit-lamp, stereo biomicroscopy, and applanation tonometry evaluated corneal opacity, anterior segment ocular health, and intraocular pressure (IOP), respectively, at various times during the study. Fourteen days after alkali-wound, corneal tissues were collected after humane euthanasia to examine cellular and molecular wound healing parameters. Quantitative PCR (qPCR) and immunofluorescence were used to quantify changes in the extracellular modeling protein levels of alpha-smooth muscle actin (α-SMA), Fibronectin (FN), Collagen-I (Col-I), and Transforming growth factor beta 1 (TGFβ1) involved in corneal healing. Hematoxylin and Eosin (H&E) staining was used to study histopathological changes in morphology and TUNEL assay to evaluate levels of apoptotic cell death. Male and female rabbits showed no significant differences in corneal opacity (Fantes score) or intraocular pressure (IOP) values (9.5 ± 0.5 mm Hg) in live animals. Likewise, no statistically significant sex-based differences in the mRNA levels of α-SMA (male = 5.95 ± 0.21 fold vs. female = 5.32 ± 0.043), FN (male = 3.02 ± 0.24 fold vs. female = 3.23 ± 0.27), Col-I (male = 3.12 ± 0.37 fold vs. female = 3.31 ± 0.24), TGFβ1 (male = 1.65 ± 0.06 fold vs. female = 1.59 ± 0.053); and protein levels of α-SMA (male = 74.16 ± 4.6 vs. female = 71.58 ± 7.1), FN (male = 60.11 ± 4.6 vs. female = 57.41 ± 8.3), Col-I (male = 84.11 ± 2.8 vs. female = 84.55 ± 3.6), TGFβ1 (male = 11.61 ± 2.8 vs. female = 9.5 ± 3.04) were observed. Furthermore, H&E and TUNEL analyses found no statistically significant differences in cellular structures and apoptosis, respectively, in male vs. female corneas. Consistent with earlier reports, wounded corneas showed significantly increased levels of these parameters compared to the unwounded corneas. Our data suggest that sex is not a major biological variable during active early stages of corneal wound healing in rabbits in vivo.
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Affiliation(s)
- Ratnakar Tripathi
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States
| | - Elizabeth A Giuliano
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States
| | - Hannah B Gafen
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States
| | - Suneel Gupta
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States
| | - Lynn M Martin
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States
| | - Prashant R Sinha
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States
| | - Jason T Rodier
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States; Mason Eye Institute, University of Missouri, Columbia, MO, United States
| | - Michael K Fink
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States
| | - Nathan P Hesemann
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States; Mason Eye Institute, University of Missouri, Columbia, MO, United States
| | - Shyam S Chaurasia
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States
| | - Rajiv R Mohan
- One-Health One-Medicine Ophthalmology and Vision Research Center, Department of Veterinary Medicine and Surgery, University of Missouri, Columbia, MO, United States; Harry S. Truman Memorial Veterans' Hospital, Columbia, MO, United States; Mason Eye Institute, University of Missouri, Columbia, MO, United States.
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Irani YD, Pulford E, Mortimer L, Irani S, Butler L, Klebe S, Williams KA. Sex differences in corneal neovascularization in response to superficial corneal cautery in the rat. PLoS One 2019; 14:e0221566. [PMID: 31479468 PMCID: PMC6719872 DOI: 10.1371/journal.pone.0221566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 08/10/2019] [Indexed: 12/23/2022] Open
Abstract
Sex-based differences in susceptibility have been reported for a number of neovascular ocular diseases. We quantified corneal neovascularization, induced by superficial silver nitrate cautery, in male and female inbred albino Sprague-Dawley, inbred albino Fischer 344, outbred pigmented Hooded Wistar and inbred pigmented Dark Agouti rats of a range of ages. Corneal neovascular area was quantified on haematoxylin-stained corneal flatmounts by image analysis. Pro-and anti-angiogenic gene expression was measured early in the neovascular response by quantitative real-time polymerase chain reaction. Androgen and estrogen receptor expression was assessed by immunohistochemistry. Male rats from all strains, with or without ocular pigmentation, exhibited significantly greater corneal neovascular area than females: Sprague-Dawley males 43±12% (n = 8), females 25±5% (n = 12), p = 0.001; Fischer 344 males 38±10% (n = 12) females 27±8% (n = 8) p = 0.043; Hooded Wistar males 32±6% (n = 8) females 22±5% (n = 12) p = 0.002; Dark Agouti males 37±11% (n = 9) females 26±7% (n = 9) p = 0.015. Corneal vascular endothelial cells expressed neither androgen nor estrogen receptor. The expression in cornea post-cautery of Cox-2, Vegf-a and Vegf-r2 was significantly higher in males compared with females and Vegf-r1 was significantly lower in the cornea of males compared to females, p<0.001 for each comparison. These data suggest that male corneas are primed for angiogenesis through a signalling nexus involving Cox-2, Vegf-a, and Vegf receptors 1 and 2. Our findings re-enforce that pre-clinical animal models of human diseases should account for sex-based differences in their design and highlight the need for well characterized and reproducible pre-clinical studies that include both male and female animals.
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Affiliation(s)
- Yazad D. Irani
- Discipline of Ophthalmology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Emily Pulford
- Discipline of Anatomical Pathology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Lauren Mortimer
- Discipline of Ophthalmology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- Discipline of Anatomical Pathology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Swati Irani
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Lisa Butler
- Freemasons Foundation Centre for Men's Health, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Sonja Klebe
- Discipline of Anatomical Pathology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Keryn A. Williams
- Discipline of Ophthalmology, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Moshirfar M, Rosen DB, Heiland MB, Ronquillo YC, Hoopes PC. Should I Get LASIK If I'm Breastfeeding? Ophthalmol Ther 2019; 8:349-352. [PMID: 31254257 PMCID: PMC6692418 DOI: 10.1007/s40123-019-0195-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Indexed: 11/27/2022] Open
Abstract
Changes in keratometric values and refraction can occur during pregnancy. For this reason, changing a patient's refractive prescription or undergoing corneal refractive surgery is not recommended during pregnancy. However, the extent to which these corneal changes persist during lactation is not as well reported. Pregnancy and lactation lead to hormonal changes that affect the corneal structure. LASIK, or other types of refractive surgery, is not recommended until all of the following conditions are met: cessation of lactation, the return of regular menses, and a return to pre-pregnancy refraction. Additionally, patients should be cautioned that refractive regression may occur if they become pregnant within 1 year of LASIK. FUNDING: Research to Prevent Blindness, NY, USA.
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Affiliation(s)
- Majid Moshirfar
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
- Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA.
| | - David B Rosen
- The University of Arizona College of Medicine, Phoenix, AZ, USA
| | | | | | - Phillip C Hoopes
- Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA
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Coco G, Kheirkhah A, Foulsham W, Dana R, Ciolino JB. Keratoconus progression associated with hormone replacement therapy. Am J Ophthalmol Case Rep 2019; 15:100519. [PMID: 31372581 PMCID: PMC6656926 DOI: 10.1016/j.ajoc.2019.100519] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/13/2019] [Accepted: 07/15/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose To report a postmenopausal patient with keratoconus who experienced significant progression after using hormone replacement therapy. Observations A 51-year-old woman with previously stable keratoconus presented with acute disease progression following hormone replacement therapy in the context of prophylactic hysterectomy and bilateral ovariosalpingectomy. Over a 14-month period after starting hormone therapy, the steepest K increased from 63.7D to 71.5D in the right eye and from 65.8D to 78.1D in the left eye. Conclusions Hormone replacement therapy may amplify progression of keratoconus.
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Affiliation(s)
- Giulia Coco
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Ahmad Kheirkhah
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - William Foulsham
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Reza Dana
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Joseph B. Ciolino
- Massachusetts Eye and Ear Infirmary, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
- Corresponding author. Massachusetts Eye and Ear Infirmary, 243 Charles Street, Boston, MA, 02114, USA.
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