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Khokhar S, Rani D, Jhajharia H, Kumar S, Rathod A, Rajput S. Comparison between 80-microns versus 100-microns flap femtosecond LASIK for correction of myopia and myopic astigmatism. Indian J Ophthalmol 2024; 72:1308-1314. [PMID: 39185830 DOI: 10.4103/ijo.ijo_3213_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 05/14/2024] [Indexed: 08/27/2024] Open
Abstract
PURPOSE This study aimed to compare the safety, efficacy, and visual outcomes of 80-microns LASIK versus 100-microns LASIK in managing myopia and myopic astigmatism. The study was conducted at a tertiary care hospital in North India. METHODS This was a prospective contralateral eye study that included patients with myopia and myopic astigmatism seeking refractive correction. The eligibility criteria included normal corneal topography, an epithelial thickness less than 60 microns, a calculated percentage tissue ablation (with 100-microns flap) less than 40%, a calculated residual stromal bed thickness (with 100-microns flap) more than 300 microns, and willingness to participate and follow up. Patients with glaucoma, cataracts, other visually disabling ocular pathologies, and a history of past ocular surgery were excluded. All patients underwent LASIK with 80-microns LASIK in one eye and 100-microns LASIK in the other eye. The patients were followed up for 6 months, and the results were analyzed. RESULTS The study included 216 eyes of 108 patients. The mean preoperative spherical equivalent in the 80-microns group and the 100-microns group was -3.53 ± 1.81 and -3.69 ± 1.32 diopters, respectively (P = 0.78). The mean 6 months decimal postoperative UCVA was 0.98 ± 0.13 in the 80-microns group and 0.97 ± 0.14 in the 100-microns group (P = 0.99). The postoperative change in the higher-order aberration profile was comparable in both groups (P = 0.78). The percentage tissue ablation was significantly lower in the 80-microns group (P = 0.002). The incidence of flap micro striae and OBL was higher in the 80-microns group, while neither of these had any visual implications. CONCLUSION The study concluded that 80-microns LASIK is an efficacious and safe alternative to 100-micron LASIK, especially useful in patients with higher myopia.
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Affiliation(s)
- Sudarshan Khokhar
- Department of Ophthalmology, Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
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Alsaqr AM, Alasmi AM, Fagehi R, Ali A. Perception and awareness of the public about presbyopia and its corrective approaches in Saudi Arabia: a population-based survey. BMC Public Health 2024; 24:1950. [PMID: 39033287 PMCID: PMC11265060 DOI: 10.1186/s12889-024-19508-4] [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: 09/23/2023] [Accepted: 07/16/2024] [Indexed: 07/23/2024] Open
Abstract
BACKGROUND This study investigated patients' awareness of presbyopia and its management approaches and their preferred methods for near vision correction. METHODS In Saudi Arabia, 785 participants (aged between 35 and 60 years) completed a structured survey online, consisting of hard copies and direct interviews. The survey consisted of twenty-eight items divided into three parts. It was designed to record participants' awareness of and preferences for presbyopia and its refractive corrections. Nonparametric tests and descriptive analyses were conducted to analyse participants' responses. RESULT Approximately half of the participants had difficulty with near vision activities, such as reading newspapers or using mobile phones. Among all the participants, 76% were not aware of presbyopia. The prevalence of uncorrected presbyopia was 48% of the 785. The majority (82%) felt that spectacles were acceptable for correction of presbyopia. Most reported that they did not experience social stigma when using reading spectacles (87% of participants). When asked if they were aware of management approaches other than spectacles, 72% responded with not at all. Most participants had no earlier knowledge of the use of multifocal contact lenses or eye drops for presbyopia correction (67% and 82%, respectively). In the present study, some tendencies to use corrective approaches to presbyopia other than spectacles were noted. Finally, participants' age, sex, region, education, and income had a statistically significant impact on essential parts of their responses (p < 0.05). CONCLUSION Presbyopia is a highly prevalent age-related ocular disorder, and a significant percentage of cases are uncorrected due to a lack of awareness or reluctance to wear spectacles. More efficient health education about presbyopia and its corrective alternatives is urgently needed.
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Affiliation(s)
- Ali M Alsaqr
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia.
| | - Abdulrahman M Alasmi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Raied Fagehi
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Abusharha Ali
- Department of Optometry, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Henriquez MA, Sacoto JE, Lopez J, Chauca J, Binder PS, Izquierdo L. Morphological Features Among Gaussian, Sagittal, and Tangential Curvature Maps in Normal and Keratoconus Eyes Using Anterior Segment Optical Coherence Tomography. Eye Contact Lens 2024; 50:283-291. [PMID: 38717234 DOI: 10.1097/icl.0000000000001090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2024] [Indexed: 06/27/2024]
Abstract
PURPOSE To investigate and compare the morphological features and differences among Gaussian, Sagittal, and Tangential anterior corneal curvature maps obtained with an anterior segment optical coherence tomographer combined with a Placido disc MS-39 device in keratoconus (KC) and normal eyes. METHODS Prospective, cross-sectional study including 37 KC and 51 healthy eyes. The pattern of astigmatism and maximum keratometry (Kmax), keratometry at the thinnest point (Ktp) and 2 mm diameter (K 2mm ), and inferior-superior dioptric asymmetry values were obtained and calculated from Gaussian, Tangential, and Sagittal curvature maps using the MS-39 (CSO). RESULTS In KC eyes, an asymmetric bowtie pattern was observed in 64.86% (24/37), 64.86% (24/37), and 0% in the Sagittal, Tangential, and Gaussian maps, respectively. In normal eyes, 51.0% (26/51), 51.0% (26/51), and 0% showed a symmetric bowtie pattern in the Sagittal, Tangential, and Gaussian maps, respectively. There was a significant difference for the variables Kmax, Ktp, and K 2mm inferior among the Gaussian, Tangential, and Sagittal maps in both normal and KC groups. Sensitivity discriminating between normal and KC eyes was 100%, 97.3%, and 90.9% and specificity was 94.1%, 100%, and 100% for Kmax coming from the Tangential, Gaussian, and Sagittal maps, respectively. CONCLUSIONS Gaussian maps displayed significantly different morphological features when compared with Sagittal and Tangential maps in normal and KC eyes. Anterior curvature maps from Gaussian maps do not show the morphological pattern of symmetric bowtie in normal eyes nor asymmetric bowtie in KC eyes. Kmax from Gaussian maps are more specific, however less sensitive than Tangential maps in discriminating KC from normal eyes.
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Affiliation(s)
- Maria A Henriquez
- Research Department (M.A.H., J.E.S., J.L., J.C., L.I.), Oftalmosalud Institute of Eyes, Lima, Perú; Department of Statistics, Demography, Humanities and Social Sciences (J.C.), Universidad Peruana Cayetano Heredia, Lima, Perú; Department of Ophthalmology (P.S.B.), Gavin Herbert Eye Institute, University of California Irvine, Irvine, CA; and San Fernando School of Medicine (L.I.), Universidad Nacional Mayor de San Marcos, Lima, Perú
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Shankar S, Thacker M, Sahoo A, Aindla AR, Padala KR, Jaffet J, Bokara KK, Basu S, Singh V. Revisiting rabbit models for keratoconus: A long-term study on collagenase-induced disease progression. Exp Eye Res 2024; 241:109811. [PMID: 38350593 DOI: 10.1016/j.exer.2024.109811] [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: 10/20/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 02/15/2024]
Abstract
Keratoconus (KC) is a degenerative disorder resulting from the degradation of the stromal collagen fibril network in the cornea, leading to its thinning and conical deformation. Various studies have established animal models of KC by using the collagenase type II enzyme to gain a better understanding of the pathogenesis, however, long-term monitoring or follow-up of the models have not been reported so far. This study evaluates the long-term stability of collagenase type II-induced KC in a rabbit model. Six New Zealand rabbits were divided into 4 study groups with 3 eyes per group. The groups were control (group 1), 0.5% proparacaine + 5 min collagenase treatment on day 0 and day 30 (group 2), 0.5% proparacaine + 10 min collagenase treatment on day 0 (group 3) and, mechanical debridement + 2 min collagenase treatment on day 0 (group 4). Inflammation was observed in group 4 till week 10. Significant decrease in the central corneal thickness was observed in group 3 by week 4 (p < 0.001) however, the thickness was regained in the subsequent follow-ups in all the groups. Keratography results showed no changes in Km values but an increased astigmatic power in all groups. Scanning electron microscopy images revealed thinner collagen fibrils arranged in a mesh-like pattern above the uniform layer of the collagen lamellae in the central part of the treated corneas. Similarly, histological staining revealed loosely packed stromal fibrils in the anterior portion of the cornea which corroborates with the immunofluorescent staining results. This study revealed the remodeling of the corneal structure by eight weeks of collagenase treatment. Consequently, the possibility of creating a rabbit keratoconus model induced by collagenase may warrant further consideration.
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Affiliation(s)
- Sujithra Shankar
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, Champalimaud Translational Centre for Eye Research, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Minal Thacker
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, Champalimaud Translational Centre for Eye Research, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Abhishek Sahoo
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, Champalimaud Translational Centre for Eye Research, L.V. Prasad Eye Institute, Hyderabad, Telangana, India; UT-ORNL Graduate School of Genome Science and Technology, Bredesen Centre, University of Tennessee at Knoxville, Knoxville, USA
| | - Aniruth Reddy Aindla
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, Champalimaud Translational Centre for Eye Research, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Khyathi Ratna Padala
- CSIR-Centre for Cellular and Molecular Biology, ANNEXE II, Medical Biotechnology Complex, Uppal Road, Hyderabad, Telangana, India
| | - Jilu Jaffet
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, Champalimaud Translational Centre for Eye Research, L.V. Prasad Eye Institute, Hyderabad, Telangana, India
| | - Kiran Kumar Bokara
- CSIR-Centre for Cellular and Molecular Biology, ANNEXE II, Medical Biotechnology Complex, Uppal Road, Hyderabad, Telangana, India.
| | - Sayan Basu
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, Champalimaud Translational Centre for Eye Research, L.V. Prasad Eye Institute, Hyderabad, Telangana, India; Shantilal Shanghvi Cornea Institute, L.V. Prasad Eye Institute, Hyderabad, Telangana, India.
| | - Vivek Singh
- Centre for Ocular Regeneration, Prof. Brien Holden Eye Research Centre, Champalimaud Translational Centre for Eye Research, L.V. Prasad Eye Institute, Hyderabad, Telangana, India.
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Kovalchuk B, Khoramnia R, Son HS, Meis J, Winkler P, Naujokaitis T, Köppe MK, Auffarth GU, Augustin VA. Longitudinal Evaluation of Biomechanical Indices in Fellow Eyes of Patients With Keratoconus Classified as Having Very Asymmetric Ectasia With Normal Topography. J Refract Surg 2024; 40:e48-e56. [PMID: 38190558 DOI: 10.3928/1081597x-20231204-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
PURPOSE To evaluate the biomechanical longitudinal variability and progression of tomographically normal fellow eyes of patients with keratoconus. METHODS Of 513 patients with keratoconus, 30 patients with tomographically normal fellow eyes were included in this study. Tomographic and biomechanical parameters of the Pentacam and Corvis ST (Oculus Optikgeräte GmbH) were analyzed in multiple follow-up examinations, including the ABCD grading, Belin/Ambrósio Enhanced Ectasia total deviation index (BAD-D), Corvis Biomechanical Index (CBI), Corvis Biomechanical Factor (CBiF), and Tomographic and Biomechanical Index (TBI). A mixed regression model was applied. The results were compared to a healthy control group (n = 17) and a keratoconus group (n = 20). RESULTS Within a maximum observation period of 3.3 years, no fellow eye (0%) showed a progression to tomographically evident keratoconus. No significant change in tomographic or biomechanical parameters was detected over the study period. The indices BAD-D, CBI, CbiF, and TBI exhibited a certain variability over time, whereas the tomographic ABC parameters and maximum keratometry barely changed. This was also shown in the control group and for all parameters in the keratoconus group, except the TBI. CONCLUSIONS During the observation period none of the normal fellow eyes progressed to tomographically detectable keratoconus. However, biomechanical parameters CBI, CbiF, and TBI showed pathological values in 43.3% of eyes and certain variability. Subsequent studies with a longer observation period are warranted to confirm the biomechanical trends seen in this study and to rate the ability of single measurements to diagnose early keratoconus. [J Refract Surg. 2024;40(1):e48-e56.].
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Serramito M, Privado-Aroco A, Carracedo G. Anterior, Posterior, and Thickness Cornea Differences after Scleral Lens Wear in Post-LASIK Subjects for One Year. Healthcare (Basel) 2023; 11:2922. [PMID: 37998414 PMCID: PMC10671115 DOI: 10.3390/healthcare11222922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/02/2023] [Accepted: 11/03/2023] [Indexed: 11/25/2023] Open
Abstract
The aim of this study is to analyze the anterior and posterior corneal surface shape and the corneal thickness difference outcomes between before and after scleral lens (ScCL) wear in post-LASIK ectasia subjects for one year. Twenty eyes with post-LASIK ectasia wearing scleral lenses were evaluated in a visit before contact lens and after 1, 6, and 12 months. The study variables analyzed included the apex, nasal, temporal, inferior, and superior corneal thickness; the anterior and posterior surface corneal at corneal diameters of 8, 6, 4, and 2 mm, and high-contrast visual acuity. A statistically significant increment of corneal thickness (p < 0.05) was observed in the inferior area after 6 months and in the superior area in the 12-month follow-up after wearing ScCLs. The anterior corneal curvature presented a flattening and a statistically significant steepening (p < 0.05) in the central and peripheral radii, respectively, after one year. The posterior corneal curvature showed a significant (p < 0.05) steepening, which mainly affected the central region after one year. Despite these changes, high-contrast visual acuity with ScCL correction remained at the same values. The prolonged use of scleral lenses in post-LASIK subjects showed significant changes in the corneal curvature and thickness. These outcomes recommend more detailed and periodic topographic and vision quality checks to monitor the wear in ScCL patients.
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Affiliation(s)
- Maria Serramito
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (A.P.-A.); (G.C.)
- Ocupharm Research Group, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Ana Privado-Aroco
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (A.P.-A.); (G.C.)
- Ocupharm Research Group, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
| | - Gonzalo Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain; (A.P.-A.); (G.C.)
- Ocupharm Research Group, Faculty of Optics and Optometry, Complutense University of Madrid, 28037 Madrid, Spain
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Ambrósio R, Salomão MQ, Barros L, da Fonseca Filho JBR, Guedes J, Neto A, Machado AP, Lopes BT, Sena N, Esporcatte LPG. Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift. EYE AND VISION (LONDON, ENGLAND) 2023; 10:45. [PMID: 37919821 PMCID: PMC10623885 DOI: 10.1186/s40662-023-00363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
Different diagnostic approaches for ectatic corneal diseases (ECD) include screening, diagnosis confirmation, classification of the ECD type, severity staging, prognostic evaluation, and clinical follow-up. The comprehensive assessment must start with a directed clinical history. However, multimodal imaging tools, including Placido-disk topography, Scheimpflug three-dimensional (3D) tomography, corneal biomechanical evaluations, and layered (or segmental) tomography with epithelial thickness by optical coherence tomography (OCT), or digital very high-frequency ultrasound (dVHF-US) serve as fundamental complementary exams for measuring different characteristics of the cornea. Also, ocular wavefront analysis, axial length measurements, corneal specular or confocal microscopy, and genetic or molecular biology tests are relevant for clinical decisions. Artificial intelligence enhances interpretation and enables combining such a plethora of data, boosting accuracy and facilitating clinical decisions. The applications of diagnostic information for individualized treatments became relevant concerning the therapeutic refractive procedures that emerged as alternatives to keratoplasty. The first paradigm shift concerns the surgical management of patients with ECD with different techniques, such as crosslinking and intrastromal corneal ring segments. A second paradigm shift involved the quest for identifying patients at higher risk of progressive iatrogenic ectasia after elective refractive corrections on the cornea. Beyond augmenting the sensitivity to detect very mild (subclinical or fruste) forms of ECD, ectasia risk assessment evolved to characterize the inherent susceptibility for ectasia development and progression. Furthermore, ectasia risk is also related to environmental factors, including eye rubbing and the relational impact of the surgical procedure on the cornea.
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Affiliation(s)
- Renato Ambrósio
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil.
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil.
| | - Marcella Q Salomão
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Benjamin Constant Institute, Rio de Janeiro, Brazil
| | - Lorena Barros
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - João Batista R da Fonseca Filho
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - Jaime Guedes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
| | - Alexandre Neto
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
| | - Aydano P Machado
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Computing Institute, Federal University of Alagoas, Maceió, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Department of Ophthalmology, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Nelson Sena
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - Louise Pellegrino Gomes Esporcatte
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
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Vinciguerra R, Cancian G, Ambrósio R, Elsheikh A, Eliasy A, Lopes B, Vinciguerra P. Assessment of the specificity of corvis biomechanical index-laser vision correction (CBI-LVC) in stable corneas after phototherapeutic keratectomy. Int Ophthalmol 2023; 43:4289-4295. [PMID: 37644351 DOI: 10.1007/s10792-023-02840-w] [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: 09/15/2022] [Accepted: 07/27/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE The Corvis Biomechanical Index-Laser Vision Correction (CBI-LVC) is a biomechanical index to detect ectasia in post-refractive surgery patients (PRK, LASIK, SMILE). This study aims to evaluate the distribution of the CBI-LVC in stable patients who underwent Phototherapeutic Keratectomy (PTK) compared to PRK patients. METHODS Patients who underwent PRK and PTK performed between 2000 and 2018 in Humanitas Research Hospital, Rozzano, Milan, Italy and remained stable for at least four years post-surgery were included. All eyes were examined with the Corvis ST (Oculus, Germany), whose output allows the calculation of the CBI-LVC. The distribution and specificity of the CBI-LVC in the two populations were estimated using a Wilcoxon Mann-Whitney test and compared. RESULTS 175 eyes of 148 patients were included (85 eyes of 50 PTK patients and 90 eyes of 90 PRK patients). The distribution of CBI-LVC in the two groups showed a minor difference, with a median value in PRK patients of 0.000 (95% CI 0.000; 0.002) and 0.008 (95% CI 0.000; 0.037) in PTK patients (Mann-Whitney U test p = 0.023). The statistical analysis showed that the CBI-LVC provided a specificity of 92.22% in the PRK group, while in the PTK group it was 82.35%. Nevertheless, this difference was not statistically significant (Chi-squared test with Yates, p = 0.080). CONCLUSION CBI-LVC provided similar specificity in stable PTK patients compared to those who underwent PRK. These results suggest that the CBI-LVC could be a useful tool to aid corneal surgeons in managing PTK patients.
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Affiliation(s)
- Riccardo Vinciguerra
- Humanitas San Pio X Hospital, Via Francesco Nava 31, Milan, Italy.
- The School of Engineering, University of Liverpool, Liverpool, UK.
| | - Giuseppe Cancian
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
| | - Renato Ambrósio
- Department of Ophthalmology, The Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Department of Ophthalmology, The Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Ahmed Elsheikh
- The School of Engineering, University of Liverpool, Liverpool, UK
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, 100083, China
- NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Ashkan Eliasy
- The School of Engineering, University of Liverpool, Liverpool, UK
| | - Bernardo Lopes
- The School of Engineering, University of Liverpool, Liverpool, UK
| | - Paolo Vinciguerra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele, Milan, Italy
- Humanitas Clinical and Research Center-IRCCS, Via Manzoni 56, 20089, Rozzano, Mi, Italy
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Yang K, Fan Q, Xu L, Gu Y, Pang C, Ren S. Accuracy of tomographic and biomechanical parameters in detecting unilateral post-LASIK keratoectasia and fellow eyes. Front Bioeng Biotechnol 2023; 11:1181117. [PMID: 37334265 PMCID: PMC10272423 DOI: 10.3389/fbioe.2023.1181117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 05/22/2023] [Indexed: 06/20/2023] Open
Abstract
Background: Patients with unilateral post-LASIK keratectasia (KE) have clinical ectasia in one eye but not in the fellow eye. As serious complications, these cases are rarely reported but are worth investigating. This study aimed to explore the characteristics of unilateral KE and the accuracy of corneal tomographic and biomechanical parameters to detect KE and distinguish fellow eyes from control eyes. Methods: The study analyzed 23 KE eyes, 23 KE fellow eyes, and 48 normal eyes from age- and sex-matched patients who had undergone LASIK. The Kruskal-Wallis test and further paired comparisons were performed to compare the clinical measurements of the three groups. The receiver operating characteristic curve was used to evaluate the ability to distinguish KE and fellow eyes from the control eyes. Binary logistic regression with the forward stepwise method was performed to produce a combined index, and the DeLong test was used to compare the discriminability difference of the parameters. Results: Males accounted for 69.6% of patients with unilateral KE. The duration between corneal surgery and the onset of ectasia ranged from 4 months to 18 years, with a median time of 10 years. The KE fellow eye had a higher posterior evaluation (PE) value than the control eyes (5 vs. 2, p = 0.035). Diagnostic tests showed that PE, posterior radius of curvature (3 mm), anterior evaluation (FE), and Corvis biomechanical index-laser vision correction (CBI-LVC) were sensitive indicators for distinguishing KE in the control eyes. The ability of PE to detect the KE fellow eye from the control eye was 0.745 (0.628 and 0.841), with 73.91% sensitivity and 68.75% specificity at a cut-off value of 3. The ability of a combined index, constructed using PE and FE, to distinguish fellow eyes of KE from controls was 0.831 (0.723 and 0.909), which was higher than that of PE and FE individually (p < 0.05). Conclusion: The fellow eyes of patients with unilateral KE had significantly higher PE values than control eyes, and a combination of PE and FE enhanced this differentiation in a Chinese population. More attention should be paid to the long-term follow-up of patients after LASIK and to be wary of the occurrence of early KE.
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Wagner FM, Sekundo W. Iatrogenic Keratectasia after Refractive Surgery - Causes, Prophylaxis, Therapy. Klin Monbl Augenheilkd 2023; 240:783-794. [PMID: 37348513 DOI: 10.1055/a-2073-8478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
Iatrogenic keratectasia is induced thinning and protrusion of the cornea after laser refractive surgery. Known risk factors include an excessively thin postoperative residual stromal bed, a thicker flap, or preoperatively undetected evidence of preexisting subclinical keratoconus. The rate of post-refractive ectasia in eyes without identifiable preoperative risk factors is 20 per 100 000 eyes for photorefractive keratectomy, 90 per 100 000 eyes for laser in situ keratomileusis, and 11 per 100 000 eyes for small incision lenticule extraction. Traditional screening tools for preoperative risk include the ectasia risk score system and percentage of tissue alteration. More recent methods include corneal elastography and epithelial mapping, in addition to Artificial Intelligence methods for data analysis. Therapy includes contact lenses, cross-linking, implantation of intracorneal ring segments, penetrating or lamellar keratoplasty, and, in early studies, implantation of corneal lenticules.
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Affiliation(s)
- Felix Mathias Wagner
- Universitätsaugenklinik Mainz, Mainz, Deutschland
- Universitätsaugenklinik Marburg, Marburg, Deutschland
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11
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Lan G, Twa MD, Song C, Feng J, Huang Y, Xu J, Qin J, An L, Wei X. In vivo corneal elastography: A topical review of challenges and opportunities. Comput Struct Biotechnol J 2023; 21:2664-2687. [PMID: 37181662 PMCID: PMC10173410 DOI: 10.1016/j.csbj.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/16/2023] Open
Abstract
Clinical measurement of corneal biomechanics can aid in the early diagnosis, progression tracking, and treatment evaluation of ocular diseases. Over the past two decades, interdisciplinary collaborations between investigators in optical engineering, analytical biomechanical modeling, and clinical research has expanded our knowledge of corneal biomechanics. These advances have led to innovations in testing methods (ex vivo, and recently, in vivo) across multiple spatial and strain scales. However, in vivo measurement of corneal biomechanics remains a long-standing challenge and is currently an active area of research. Here, we review the existing and emerging approaches for in vivo corneal biomechanics evaluation, which include corneal applanation methods, such as ocular response analyzer (ORA) and corneal visualization Scheimpflug technology (Corvis ST), Brillouin microscopy, and elastography methods, and the emerging field of optical coherence elastography (OCE). We describe the fundamental concepts, analytical methods, and current clinical status for each of these methods. Finally, we discuss open questions for the current state of in vivo biomechanics assessment techniques and requirements for wider use that will further broaden our understanding of corneal biomechanics for the detection and management of ocular diseases, and improve the safety and efficacy of future clinical practice.
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Affiliation(s)
- Gongpu Lan
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, School of Physics and Optoelectronic Engineering, Foshan University, Foshan, Guangdong 528000, China
- Weiren Meditech Co., Ltd., Foshan, Guangdong 528000, China
| | - Michael D. Twa
- College of Optometry, University of Houston, Houston, TX 77204, United States
| | - Chengjin Song
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, School of Physics and Optoelectronic Engineering, Foshan University, Foshan, Guangdong 528000, China
| | - JinPing Feng
- Institute of Engineering and Technology, Hubei University of Science and Technology, Xianning, Hubei 437100, China
| | - Yanping Huang
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, School of Physics and Optoelectronic Engineering, Foshan University, Foshan, Guangdong 528000, China
- Weiren Meditech Co., Ltd., Foshan, Guangdong 528000, China
| | - Jingjiang Xu
- Guangdong-Hong Kong-Macao Intelligent Micro-Nano Optoelectronic Technology Joint Laboratory, School of Physics and Optoelectronic Engineering, Foshan University, Foshan, Guangdong 528000, China
- Weiren Meditech Co., Ltd., Foshan, Guangdong 528000, China
| | - Jia Qin
- Weiren Meditech Co., Ltd., Foshan, Guangdong 528000, China
| | - Lin An
- Weiren Meditech Co., Ltd., Foshan, Guangdong 528000, China
| | - Xunbin Wei
- Biomedical Engineering Department, Peking University, Beijing 100081, China
- International Cancer Institute, Peking University, Beijing 100191, China
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China
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12
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Oliveira TGV, da Fonseca JBR, Criado GG, Sena NB, Ambrósio R. Avaliação do conhecimento sobre cirurgia refrativa por meio de questionário eletrônico. REVISTA BRASILEIRA DE OFTALMOLOGIA 2023. [DOI: 10.37039/1982.8551.20230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
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13
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Hage A, Knoeri J, Leveziel L, Majoulet A, Buffault J, Labbé A, Baudouin C. [From ocular itching to eye rubbing: a review of the literature]. J Fr Ophtalmol 2023; 46:173-184. [PMID: 36635208 DOI: 10.1016/j.jfo.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
Ocular itching and eye rubbing are frequent complaints in an ophthalmology practice. Numerous studies address the consequences of eye rubbing, such as keratoconus. However, there are few studies concerning the pathophysiology of itching, its transmission pathways, or its interactions with eye rubbing. Through this literature review, we will address the various clinical, physiological and therapeutic aspects of this pair of symptoms with a variety of ocular consequences. We will then describe the state of the art in itching and scratching in dermatology, in order to draw a parallel between these two vicious cycles. A better understanding of the pathophysiology of ocular itching and eye rubbing, as well as new studies based on dermatological data, might allow more appropriate clinical management of our patients and their symptoms.
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Affiliation(s)
- A Hage
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France.
| | - J Knoeri
- Department of Ophthalmology V, NATIONAL Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012, Paris, France
| | - L Leveziel
- Department of Ophthalmology V, NATIONAL Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012, Paris, France
| | - A Majoulet
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France
| | - J Buffault
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France
| | - A Labbé
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvellines, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France; Sorbonne Université, inserm, CNRS, Institut de la Vision, 17, rue Moreau, 75012, Paris, France
| | - C Baudouin
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvellines, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France; Sorbonne Université, inserm, CNRS, Institut de la Vision, 17, rue Moreau, 75012, Paris, France
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Bao F, Lopes BT, Zheng X, Ji Y, Wang J, Elsheikh A. Corneal Biomechanics Losses Caused by Refractive Surgery. Curr Eye Res 2023; 48:137-143. [PMID: 36001080 DOI: 10.1080/02713683.2022.2103569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Recent advances, specifically in the understanding of the biomechanical properties of the cornea and its response to diseases and surgical interventions, have significantly improved the safety and surgical outcomes of corneal refractive surgery, whose popularity and demand continue to grow worldwide. However, iatrogenic keratectasia resulting from the deterioration in corneal biomechanics caused by surgical interventions, although rare, remains a global concern. On one hand, in vivo biomechanical evaluation, enabled by clinical imaging systems such as the ORA and the Corvis ST, has significantly improved the risk profiling of patients for iatrogenic keratectasia. That is despite the fact the biomechanical metrics provided by these systems are considered indicators of the cornea's overall stiffness rather than its intrinsic material properties. On the other hand, new surgical modalities including SMILE were introduced to offer superior biomechanical performance to LASIK, but this superiority could not be proven clinically, creating more myths than answers. The literature also includes sound evidence that tPRK provided the highest preservation of corneal biomechanics when compared to both LASIK and SMILE. The aim of this review is twofold; to discuss the importance of corneal biomechanical evaluation prior to refractive surgery, and to assess the current understanding of cornea's biomechanical deterioration caused by mainstream corneal refractive surgeries. The review has led to an observation that new imaging techniques, parameters and evaluation systems may be needed to reflect the true advantages of specific refractive techniques and when these advantages are significant enough to offer better protection against post-surgery complications.
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Affiliation(s)
- FangJun Bao
- Eye Hospital, Wenzhou Medical University, Wenzhou, China.,The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Bernardo T Lopes
- School of Engineering, University of Liverpool, Liverpool, UK.,Department of Ophthalmology, Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil
| | - XiaoBo Zheng
- Eye Hospital, Wenzhou Medical University, Wenzhou, China.,The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - YuXin Ji
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - JunJie Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China.,The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, UK.,Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.,National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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15
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Kim NE, Ahn HM, Jun I, Seo KY, Kim TI, Park SY. Thin but Nonkeratoconic Cornea: A Case Report. KOREAN JOURNAL OF OPHTHALMOLOGY 2022; 36:565-567. [PMID: 36220640 DOI: 10.3341/kjo.2022.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/19/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Na Eun Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Ikhyun Jun
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoung Yul Seo
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Im Kim
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Piao J, Wang S, Tao Y, Zhou YH, Li Y. Corneal epithelial remodeling after femtosecond laser-assisted in situ keratomileusis combined with intraoperative accelerated corneal collagen crosslinking for myopia: a retrospective study. BMC Ophthalmol 2022; 22:349. [PMID: 35987632 PMCID: PMC9392929 DOI: 10.1186/s12886-022-02570-0] [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: 11/30/2021] [Accepted: 08/10/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study analyzed regional corneal thickness remodeling, biomechanical properties, and visual outcomes after femtosecond laser-assisted in situ keratomileusis combined with intraoperative accelerated corneal collagen crosslinking (LASIK Xtra) for myopia.
Methods
This retrospective study analyzed 21 consecutive patients (18 women, three men; 42 eyes) who were treated with LASIK Xtra. All treatments were performed with ultraviolet-A (energy, 2.7 J/cm2; irradiance, 30 mW/cm2), using continuous (90 s) illumination. Postoperative values of corneal biometrics and visual outcomes were compared with preoperative values. Corneal thickness changes were evaluated using anterior segment optical coherence tomography. All patients were followed up for 12-month postoperatively. Preoperative and postoperative data were compared statistically using the paired t-test for normally distributed parameters and the Wilcoxon rank-sum test and Friedman analysis of variance with Bonferroni correction for non-normally distributed data.
Results
Uncorrected distance visual acuity (UDVA) significantly improved at 6-month after surgery (P < 0.001). The central and inner regional corneal epithelial thickness significantly increased after LASIK Xtra (P < 0.05 for all), while the peripheral corneal epithelial thickness remained stable at 12-month after surgery. There was also a statistically significant decreased in the stromal thickness at most locations (P < 0.05 for all), except in the outer superior and outer superior-temporal regions.
Conclusions
LASIK Xtra provided improvement in UDVA, corneal curvature, and corneal biomechanical stability. Because the results of this retrospective study results depended on the cohort members’ past information, it was inferred and confirmed that regular corneal thickness remodeling occurred after treatment.
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Reinstein DZ, Carp GI, Archer TJ, Vida RS, Yammouni R. Large Population Outcomes of Small Incision Lenticule Extraction in Young Myopic Patients. J Refract Surg 2022; 38:488-496. [PMID: 35947004 DOI: 10.3928/1081597x-20220623-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the outcomes of small incision lenticule extraction (SMILE) for myopia in a large population of young adults. METHODS In this retrospective case series, the patient population consisted of the first 4,138 consecutive SMILE treatments using the VisuMax femtosecond laser (Carl Zeiss Meditec) between 2012 and 2018 at the London Vision Clinic. Inclusion criteria were myopic spherical equivalent up to -9.00 diopters (D), cylinder up to 6.00 D, corrected distance visual acuity of 20/20 or better, age younger than 40 years, and follow-up of 12 months. Outcomes analysis was performed using the Standard Graphs for Reporting Refractive Surgery. RESULTS Data were available at 12 months in 3,722 eyes (90%), and 416 eyes (10%) were lost to follow-up. Mean attempted spherical equivalent refraction (SEQ) was -4.61 ± 1.84 D (range: -1.12 to -9.00 D). Mean cylinder was -0.78 ± 0.66 D (range: 0.00 to -6.00 D). Postoperatively, the mean SEQ relative to target was -0.13 ± 0.30 D (range: -1.35 to +1.25 D) and was within ±0.50 D in 88.1% and ±1.00 D in 99.6% of eyes. Uncorrected distance visual acuity was 20/20 or better in 95.4% of eyes and 20/25 or better in 98.7% of eyes. One line of CDVA was lost in 3.0% of eyes, and 0.08% (n = 3) lost two or more lines of CDVA, for which CDVA was restored following phototherapeutic keratectomy treatment. There was a statistically significant improvement of 0.05, 0.06, 0.07, and 0.07 log units for contrast sensitivity at 3, 6, 12, and 18 cycles per degree, respectively (P < .001). CONCLUSIONS SMILE achieved excellent outcomes for myopia up to -9.00 D with cylinder up to -5.50 D for a large population in patients without presbyopia. [J Refract Surg. 2022;38(8):488-496.].
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Chen H, Wang Z, Li K, Wang Y, Li X, Du L, Lin M, Savini G, Wang Q, Yu A, Chen S. Agreement Between Predicted and Actual Measured Ablation Depth After FS-LASIK Using Different Rotating Scheimpflug Cameras and OCT. Front Med (Lausanne) 2022; 9:907334. [PMID: 35665335 PMCID: PMC9160334 DOI: 10.3389/fmed.2022.907334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/26/2022] [Indexed: 11/13/2022] Open
Abstract
PurposeTo compare the predicted ablation depth (AD) with the postoperatively measured corneal ablation depth (postop-AD) at central, paracentral, and midperipheral locations using two rotating Scheimpflug analyzers and a Fourier-domain optical coherence tomographer in eyes that underwent femtosecond laser-assisted LASIK (FS-LASIK).MethodsThe values of corneal thickness were measured preoperatively and postoperatively at one and three months. The difference between preoperative and postoperative was defined as postop-AD. Measurements were performed at the corneal vertex and mid-peripheral area. The mid-peripheral corneal thickness was measured at the superior, inferior, nasal, and temporal locations at a distance of 1.0 or 2.5 mm from the corneal vertex. The predicted AD was calculated by ORK-CAM software (Schwind eye tech-solutions GmbH, Kleinostheim, Germany), and the difference between the predicted AD and postop-AD was defined as Δ-AD. Paired t-test analysis was employed to evaluate the differences, agreement was assessed by the Bland-Altman method.ResultsForty-two eyes of 42 patients were investigated. At one month, the predicted AD in the central and paracentral areas was underestimated by the Pentacam HR (Oculus, Wetzlar, Germany), Sirius (Costruzione Strumenti Oftalmici, Florence, Italy) and RTVue OCT (Optovue Inc., Freemont, CA, United States), whereas Δ-AD was negative as established by all devices and predominantly statistically significant. The Δ-AD values approximated zero at three months. The mean difference of Δ-AD at three months at the corneal vertex was 0.67 ± 9.39 mm, −7.92 ± 9.05 mm and −1.36 ± 8.31 mm, respectively. The mid-peripheral measurements had positive values at one month and even more highly positive at three months (with statistically significant differences in most of the cases). The agreement between the predicted and postop-AD was moderate with all devices, but slightly better with RTVue.ConclusionThe predicted AD seems to be underestimated in the central and paracentral corneal area and overestimated in the mid-periphery.Translational RelevanceThe study could help to partly explain and prevent the refractive errors after FS-LASIK.
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Affiliation(s)
- Hao Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ziqian Wang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Kunke Li
- Shenzhen Eye Hospital, Shenzhen Key Ophthalmic Laboratory, Jinan University, Shenzhen, China
| | - Yiran Wang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xin Li
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Lan Du
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Meimin Lin
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | | | - Qinmei Wang
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
- *Correspondence: Qinmei Wang,
| | - Ayong Yu
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Ayong Yu,
| | - Sisi Chen
- School of Ophthalmology and Optometry and Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Sisi Chen,
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Reinstein DZ, Archer TJ, Vida RS, Carp GI, Reinstein JFR, McChesney T, Potter JG. Small Incision Lenticule Extraction (SMILE) for the Correction of High Myopia With Astigmatism. J Refract Surg 2022; 38:262-271. [PMID: 35536712 DOI: 10.3928/1081597x-20220314-01] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To report the outcomes of small incision lenticule extraction (SMILE) for high myopia between -9.00 and -14.00 diopters (D). METHODS This was a prospective study of SMILE for high myopia using the VisuMax femtosecond laser (Carl Zeiss Meditec). Inclusion criteria were attempted spherical equivalent refraction (SEQ) between -9.00 and -14.00 D, cylinder up to 7.00 D, corrected distance visual acuity (CDVA) of 20/40 or better, age 21 years or older, and suitable for SMILE. The sub-lenticule thickness was 220 µm or greater, and the total uncut stromal thickness was 300 µm or greater. Patients were to be followed up for 1 year. Standard outcomes analysis was performed using 12-month data where available or 3-month data otherwise. RESULTS Of 187 eyes treated, data were available at 12 months for 181 eyes (96.8%) and 3 months for 4 eyes (2.1%), and 2 eyes (1.1%) were lost to follow-up. Mean attempted SEQ was -10.55 ± 1.00 D (range: -9.00 to -12.99 D). Mean cylinder was -1.19 ± 0.83 D (range: 0.00 to -4.00 D). Preoperative CDVA was 20/20 or better in 73% of eyes. Postoperative uncorrected distance visual acuity was 20/20 or better in 57% and 20/25 or better in 82% of eyes. Mean SEQ relative to target was -0.22 ± 0.48 D (range: -1.63 to +1.38 D), 66% ± 0.50 D and 93% ±1.00 D. Mean SEQ 12-month change was -0.08 ± 0.34 D (range: -1.75 to +0.88 D). There was loss of one line of CDVA in 4% of eyes, and no eyes lost two or more lines. Contrast sensitivity was unchanged. Patient satisfaction was 8 or more out of 10 in 94% and 6 or more in 99% of patients. CONCLUSIONS Outcomes of SMILE for myopia greater than -9.00 D at 3 to 12 months showed excellent efficacy, safety, stability, and predictability, with high patient satisfaction. [J Refract Surg. 2022;38(5):262-271.].
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Xin Y, Lopes BT, Wang J, Wu J, Zhu M, Jiang M, Miao Y, Lin H, Cao S, Zheng X, Eliasy A, Chen S, Wang Q, Ye Y, Bao F, Elsheikh A. Biomechanical Effects of tPRK, FS-LASIK, and SMILE on the Cornea. Front Bioeng Biotechnol 2022; 10:834270. [PMID: 35433653 PMCID: PMC9009506 DOI: 10.3389/fbioe.2022.834270] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose: The objective of this study is to evaluate the in vivo corneal biomechanical response to three laser refractive surgeries. Methods: Two hundred and twenty-seven patients who submitted to transepithelial photorefractive keratectomy (tPRK), femtosecond laser-assisted in-situ keratomileusis (FS-LASIK), or small-incision lenticule extraction (SMILE) were included in this study. All cases were examined with the Corvis ST preoperatively (up to 3 months) and postoperatively at 1, 3, and 6 months, and the differences in the main device parameters were assessed. The three groups were matched in age, gender ratio, corneal thickness, refractive error corrections, optical zone diameter, and intraocular pressure. They were also matched in the preoperative biomechanical metrics provided by the Corvis ST including stiffness parameter at first applanation (SP-A1), integrated inverse radius (IIR), deformation amplitude (DA), and deformation amplitude 2 mm away from apex and the apical deformation (DARatio2mm). Results: The results demonstrated a significant decrease post-operation in SP-A1 and significant increases in IIR, DA, and DARatio2mm (p < 0.05), all of which indicated reductions in overall corneal stiffness. Inter-procedure comparisons provided evidence that the smallest overall stiffness reduction was in the tPRK group, followed by the SMILE, and then the FS-LASIK group (p < 0.05). These results remained valid after correction for the change in CCT between pre and 6 months post-operation and for the percentage tissue altered. In all three surgery groups, higher degrees of refractive correction resulted in larger overall stiffness losses based on most of the biomechanical metrics. Conclusion: The corneal biomechanical response to the three surgery procedures varied significantly. With similar corneal thickness loss, the reductions in overall corneal stiffness were the highest in FS-LASIK and the lowest in tPRK.
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Affiliation(s)
- Yue Xin
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Bernardo T. Lopes
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - JunJie Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Jie Wu
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - ManMan Zhu
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - MuChen Jiang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - YuanYuan Miao
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - HuiNi Lin
- STU-CUHKJoint Shantou International Eye Center, Shantou, China
| | - Si Cao
- Wuhan Puren Hospital, Wuhan, China
| | - XiaoBo Zheng
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - Ashkan Eliasy
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
| | - ShiHao Chen
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
- *Correspondence: ShiHao Chen, ; YuFeng Ye, ; FangJun Bao,
| | - QinMei Wang
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
| | - YuFeng Ye
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- *Correspondence: ShiHao Chen, ; YuFeng Ye, ; FangJun Bao,
| | - FangJun Bao
- Eye Hospital, Wenzhou Medical University, Wenzhou, China
- The Institute of Ocular Biomechanics, Wenzhou Medical University, Wenzhou, China
- *Correspondence: ShiHao Chen, ; YuFeng Ye, ; FangJun Bao,
| | - Ahmed Elsheikh
- School of Engineering, University of Liverpool, Liverpool, United Kingdom
- National Institute for Health Research (NIHR) Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, United Kingdom
- Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
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Novel artificial intelligence index based on Scheimpflug corneal tomography to distinguish subclinical keratoconus from healthy corneas. J Cataract Refract Surg 2022; 48:1168-1174. [PMID: 35333829 DOI: 10.1097/j.jcrs.0000000000000946] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 03/19/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to assess the efficiency of an index derived from multiple logistic regression analysis (MLRA) to measure differences in corneal tomography findings between subclinical keratoconus (SKC) in one eye, corneal ectasia, and healthy corneas. SETTING Two private Brazilian ophthalmological centers. DESIGN Multicenter, case-control study. METHODS This study included 187 eyes with very asymmetric ectasia and normal corneal topography and tomography (VAE-NTT) in the VAE-NTT group (G), 2,296 eyes with healthy corneas in the control group (CG), and 410 eyes with ectasia in the ectasia group. An index, termed as Boosted Ectasia Susceptibility Tomography Index (BESTi), was derived using MLRA to identify a cutoff point to distinguish patients in the three groups. The groups were divided into two subgroups with equal number of patients: validation set and external validation (EV) set. RESULTS BESTi had an area under the curve (AUC) of 0.91 with 86.02% sensitivity (Se) and 83.97% specificity (Sp) between CG and VAE-NTT G in the EV set, which were significantly greater than those of the Belin-Ambrósio Deviation Index (BAD-D; AUC: 0.81; Se: 66.67%; Sp: 82.67%; P < .0001) and Pentacam Random Forest Index (PRFI; AUC: 0.87; Se: 78.49%; Sp: 79.88%; P = .021). CONCLUSIONS BESTi facilitated early detection of ectasia in SKC. BESTi demonstrated higher Se and Sp than PRFI and BAD-D for detecting SKC.
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Zhang C, Zhao J, Zhu Z, Li Y, Li K, Wang Y, Zheng Y. Applications of Artificial Intelligence in Myopia: Current and Future Directions. Front Med (Lausanne) 2022; 9:840498. [PMID: 35360739 PMCID: PMC8962670 DOI: 10.3389/fmed.2022.840498] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/15/2022] [Indexed: 12/17/2022] Open
Abstract
With the continuous development of computer technology, big data acquisition and imaging methods, the application of artificial intelligence (AI) in medical fields is expanding. The use of machine learning and deep learning in the diagnosis and treatment of ophthalmic diseases is becoming more widespread. As one of the main causes of visual impairment, myopia has a high global prevalence. Early screening or diagnosis of myopia, combined with other effective therapeutic interventions, is very important to maintain a patient's visual function and quality of life. Through the training of fundus photography, optical coherence tomography, and slit lamp images and through platforms provided by telemedicine, AI shows great application potential in the detection, diagnosis, progression prediction and treatment of myopia. In addition, AI models and wearable devices based on other forms of data also perform well in the behavioral intervention of myopia patients. Admittedly, there are still some challenges in the practical application of AI in myopia, such as the standardization of datasets; acceptance attitudes of users; and ethical, legal and regulatory issues. This paper reviews the clinical application status, potential challenges and future directions of AI in myopia and proposes that the establishment of an AI-integrated telemedicine platform will be a new direction for myopia management in the post-COVID-19 period.
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Menon J. Refractive Corneal surgeries: A Review. KERALA JOURNAL OF OPHTHALMOLOGY 2022. [DOI: 10.4103/kjo.kjo_21_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Lin CP, Tung HF, Chen HL, Liu YL. Corneal ectasia after an incomplete flap creation in an abandoned laser-assisted in situ keratomileusis. Taiwan J Ophthalmol 2022; 13:97-100. [DOI: 10.4103/2211-5056.364565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/07/2022] [Indexed: 12/24/2022] Open
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Zaabaar E, Kyei S, Parkson Brew MAA, Boadi-Kusi SB, Assiamah F, Asiedu K. The utility of measures of anterior segment parameters of a Pentacam Scheimpflug tomographer in discriminating high myopic astigmatism from keratoconus. PLoS One 2021; 16:e0260648. [PMID: 34855828 PMCID: PMC8638937 DOI: 10.1371/journal.pone.0260648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 11/13/2021] [Indexed: 11/20/2022] Open
Abstract
The study aimed to evaluate and compare anterior segment parameters between keratoconic eyes and eyes with high myopic astigmatism using Pentacam Scheimpflug tomography. This was a retrospective cross-sectional study that included sixty keratoconic eyes (thirty-two persons) and seventy-three eyes (forty-six persons) with high myopic astigmatism with mean ages 24.72 ± 11.65years and 26.60 ± 10.69years, respectively. Twenty-three parameters from the topographic map and fifteen parameters from the Belin-Ambrosió enhanced ectasia display map of the printouts of a Scheimpflug principle-based Pentacam tomographer were evaluated for their diagnostic accuracy using Receiver Operating Characteristic (ROC) curve. All parameters except cornea volume, anterior chamber volume, and anterior chamber angle indicated a significant difference between high myopic astigmatism and keratoconic eyes. The area under the receiver operating characteristic (AUROC) of eighteen Pentacam parameters was excellent (0.9–1.0) in discriminating keratoconus from high myopic astigmatism, out of which four {anterior minimum sagittal curvature (ant. Rmin), posterior minimum sagittal curvature (post. Rmin), maximum Ambrosió relational thickness (ART max) and total deviation value (D)} indicated excellent (>90%) sensitivity and specificity in addition to the excellent AUROC values. Topographic and Belin-Ambrosió enhanced ectasia display (BAD) maps of a Scheimpflug principle-based Pentacam tomographer are useful in enhancing the diagnosis of keratoconus and may also provide valuable information in effectively screening for keratoconus cases among refractive surgery candidates with high myopic astigmatism.
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Affiliation(s)
- Ebenezer Zaabaar
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Kyei
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
- * E-mail:
| | - Maame Ama Amamoah Parkson Brew
- Department of Imaging Technology and Sonography, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Samuel Bert Boadi-Kusi
- Department of Optometry and Vision Science, School of Allied Health Sciences, College of Health and Allied Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Frank Assiamah
- Eye Department, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Kofi Asiedu
- Eye Clinic Cosmopolitan Medical Center, Dworwulu, Accra, Ghana
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Mohammadpour M, Heirani M, Khorrami-Nejad M, Ambrósio R. Update on Pain Management After Advanced Surface Ablation. J Refract Surg 2021; 37:782-790. [PMID: 34756143 DOI: 10.3928/1081597x-20210809-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To provide an update for postoperative pain control strategies to help ophthalmic surgeons establish a more effective management plan for patients who underwent advanced surface ablation surgeries. METHODS Google Scholar, Scopus, ScienceDirect, and PubMed were the main resources used to search the medical literature. RESULTS The postoperative cornea's healing process is accompanied by intense pain as the chief complaint in the first days after the operation. Several strategies were developed to relieve postoperative pain after surface ablation procedures. These strategies included different preoperative, intraoperative, and postoperative methods. Considering the preoperative demographic and emotional factors, underlying dry eye, alternative epithelial removal techniques, bandage contact lenses, and topical or oral therapeutic agents are some examples of postoperative pain treatments after surface ablation procedures. CONCLUSIONS The current review revealed that despite the development of numerous protocols to relieve postoperative pain following surface ablations, the best approach could be a combination of different strategies. In practice, no validated and standardized strategy is available for total elimination of postoperative pain following advanced surface ablation surgeries. [J Refract Surg. 2021;37(11):782-790.].
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Duch F, López-Marín I, Alonso-Aliste F, Hernández-Barahona-Campos M, Manito SC, Sánchez-Trancón Á, Cadarso L, Sánchez-González JM, Fernández J. Influence of tomographic and biomechanical corneal indexes on myopic refractive surgery indications: A multicenter study. Eur J Ophthalmol 2021; 32:2630-2637. [PMID: 34751040 DOI: 10.1177/11206721211054725] [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: 11/15/2022]
Abstract
PURPOSE To evaluate the influence of corneal tomographic and biomechanical indexes on the refractive technique indication. METHODS A total of 251 eyes from 251 patients interested in refractive surgery were enrolled in this cross-sectional and multicenter study. Previous to the surgeon decision, a preoperative protocol was performed by refractive optometrists, containing four sections: refraction, biometry, corneal tomography and biomechanics. The refractive surgeons made a first decision based only on refraction, biometric and tomographic information. Biomechanical indexes were revealed, and refractive surgeons made a second indication. Additionally, for Laser-Assisted in-situ Keratomileusis cases, the percent tissue altered were calculated. Possible indications were no refractive surgery, photorefractive keratectomy, Laser-Assisted in-situ Keratomileusis or intraocular Collamer lens. RESULTS After the first surgery indication, the distribution was photorefractive keratectomy (47.4%), Laser-Assisted in-situ Keratomileusis (48.2%) while intraocular Collamer lens achieved 2.8%. This proportion changed significantly after the second indication regarding corneal biomechanics and photorefractive keratectomy and Laser-Assisted in-situ Keratomileusis decreased by 24% while intraocular Collamer lens increased 19%. A total of 69 eyes changed the indication (27.5%) and 182 eyes (72.5%) remained unchanged. All indications changes were from photorefractive keratectomy or Laser-Assisted in-situ Keratomileusis to intraocular Collamer lens or no surgery. Indication changes to intraocular Collamer lens were observed in 49 eyes (71%). Tomographic, biomechanical indexes, ablation depth and percent tissue altered achieved statistically significant differences between eyes without and with indication changes (all, P < .01). CONCLUSION New corneal biomechanical indexes could change the indication decision regarding biometric and tomographic data alone. Intraocular Collamer len was the preferred indication for eyes at risk of ectasia or with subclinical keratoconus due to corneal biomechanical parameters.
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Affiliation(s)
- Francesc Duch
- Refractive Surgery Department, 537040Institut Català de Retina, Spain
| | | | | | | | | | | | - Luís Cadarso
- Refractive Surgery Department, Cadarso Clinic, Spain
| | - José-María Sánchez-González
- Refractive Surgery Department, Tecnolaser Clinic Vision, Spain.,Physics of Condensed Matter Department, Optics Area, 16778University of Seville, Spain
| | - Joaquín Fernández
- Refractive Surgery Department, Qvision, 221663Vithas Virgen del Mar Hospital, Spain
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Corneal Tomography Multivariate Index (CTMVI) effectively distinguishes healthy corneas from those susceptible to ectasia. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Complications Leading to Keratoplasty among Contact Lens Users and LASIK Patients: A 10-Year Cross-Sectional Analysis. J Ophthalmol 2021; 2021:5563545. [PMID: 34426768 PMCID: PMC8380166 DOI: 10.1155/2021/5563545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To determine the incidence and outcomes in patients who underwent penetrating keratoplasty (PK) resulting from complications related to contact lens (CL) use and laser in situ keratomileusis (LASIK) in a metropolitan area of the United States. Methods Population data was obtained from the United States Census Bureau and the Centers for Disease Control. A retrospective, cross-sectional chart review was performed on all patients who underwent keratoplasty in a specific metropolitan geographic area over a ten-year period. The main outcome was best-corrected visual acuity (BCVA) at 2 years in patients who underwent PK secondary to complications related to CL use and LASIK. The secondary outcome was the relative risk of undergoing PK secondary to a complication related to CL use versus LASIK. Results The study's geographic area had 46,545 CL users in one or both eyes during any given year and 10,285 patients who underwent LASIK in one or both eyes during the study interval. There were 24 CL users (0.52 per 1,000) and 3 post-LASIK patients (0.29 per 1,000) who underwent PK secondary to complications during the study interval (OR 1.77 [0.53-5.87, 95% CI]; p=0.35). BCVA at 2 years was 1.45 [1.0-1.90] logMAR (20/564 Snellen) in the CL using cohort and 0.07 [-1.19-1.33] logMAR (20/23 Snellen) in post-LASIK cohort following PK (p=0.04). Conclusions Patients who underwent PK secondary to complications related to CL use had worse visual outcomes at 2 years compared to those related to LASIK. Complications leading to PK were rare in both cohorts, but the incidence of undergoing PK secondary to CL use trended higher than LASIK.
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Consejo A, Jiménez-García M, Issarti I, Rozema JJ. Detection of Subclinical Keratoconus With a Validated Alternative Method to Corneal Densitometry. Transl Vis Sci Technol 2021; 10:32. [PMID: 34436543 PMCID: PMC8399563 DOI: 10.1167/tvst.10.9.32] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Purpose To enhance the current standards of subclinical keratoconus screening based on the statistical modeling of the pixel intensity distribution of Scheimpflug images. Methods Scheimpflug corneal tomographies corresponding to 25 corneal meridians of 60 participants were retrospectively collected and divided into three groups: controls (20 eyes), subclinical keratoconus (20 eyes), and clinical keratoconus (20 eyes). Only right eyes were selected. After corneal segmentation, pixel intensities of the stromal tissue were statistically modeled using a Weibull probability density function from which parameter α (pixel brightness) was derived. Further, data were transformed to polar coordinates, smoothed, and interpolated to build a map of the corneal α parameter. The discriminative power of the method was analyzed using receiver operating characteristic curves. Results The proposed platform-independent method achieved a higher performance in discriminating subclinical keratoconus from control eyes (90.0% sensitivity, 95.0% specificity, 0.97 area under the curve [AUC]) than the standard method (Belin-Ambrósio enhanced ectasia display), which uses only corneal morphometry (85.0% sensitivity, 85.0% specificity, 0.80 AUC). Conclusions Analysis of light backscatter at the cornea successfully discriminates subclinical keratoconus from control eyes, upgrading the results previously reported in the literature. Translational Relevance The proposed methodology has the potential to support clinicians in the detection of keratoconus before showing clinical signs.
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Affiliation(s)
- Alejandra Consejo
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain.,Institute of Physical Chemistry, Polish Academy of Sciences, Warsaw, Poland
| | - Marta Jiménez-García
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.,Department of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ikram Issarti
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.,Department of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Jos J Rozema
- Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium.,Department of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Grassmeyer JJ, Goertz JG, Baartman BJ. Diffuse Lamellar Keratitis in a Patient Undergoing Collagen Corneal Cross-Linking 18 Years After Laser In Situ Keratomileusis Surgery. Cornea 2021; 40:917-920. [PMID: 34086008 PMCID: PMC8178513 DOI: 10.1097/ico.0000000000002653] [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: 07/12/2020] [Accepted: 11/26/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To report a case of diffuse lamellar keratitis (DLK) after corneal collagen cross-linking in an eye with a remote history of laser in situ keratomileusis (LASIK) surgery. METHODS This is a case report and literature review. RESULTS This report describes the development of unilateral stage IV DLK in a patient who underwent bilateral corneal cross-linking for corneal ectasia 18 years after LASIK surgery. The patient was treated with high-dose topical steroids that were tapered over 1 month and multiple flap lifts. The ultimate best-corrected visual outcome was 20/60. CONCLUSIONS DLK is a potential sight-threatening complication of refractive surgery that can occur at any time in the postoperative period, even years after the procedure. Undergoing a subsequent corneal procedure that may disrupt or promote inflammation within the surgical flap-stromal interface, such as corneal collagen cross-linking, is a recognized risk factor for the development of DLK. This case suggests that patients with any history of LASIK surgery undergoing corneal cross-linking or other lamellar corneal surgeries may benefit from closer follow-up (eg, daily) than patients with no history of LASIK.
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Ahmedbegovic-Pjano M, Biscevic A, Alikadic-Husovic A, Bejdic N, Bohac M. Comparison of Flap Characteristics Created with Two Different Methods in Laser in Situ Keratomileusis (LASIK). Med Arch 2021; 75:204-208. [PMID: 34483451 PMCID: PMC8385742 DOI: 10.5455/medarh.2021.75.204-208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 06/20/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The creation of corneal flap is considered to be the most critical part of laser in situ keratomileusis (LASIK) surgery. Currently, flaps can be created with mechanical micorkeratomes or femtosecond lasers. OBJECTIVE To analyze and compare flap characteristics created with two different methods for flap creation in Laser in situ keratomileusis (LASIK). METHODS This was a retrospective study. The thickness and morphology of the flap were compared between the two mechanical microkeratomes (group I - Moria M2, group II - Moria SBK One Use Plus) and femtosecond laser (group III - Ziemer Femto LDV). Central flap thickness was measured intraoperatively, while the flap profile was measured with anterior optical coherence tomography at two axes (90° and 180°) and 5 measuring points on the first day, the first week, and one month after the surgery. RESULTS Central flap thickness was 110.91±15.79 micrometers (µm) (80-164 µm) in group I, 98.08±13.33 µm (65-136 µm) in group II and 103.52±13.89 µm (66-138 µm) in group III. Anterior optical coherence tomography revealed a meniscus-shaped flap in all three groups at both axes (90° and 180°). The least variability in flap thickness was observed in group III (±6 µm). CONCLUSION All three methods of flap creation provide good shape and thickness reproducibility. Ziemer Femto LDV femtosecond laser had the least variable flap thickness in a single flap. Mechanical microkeratomes had slightly lower performance.
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Affiliation(s)
| | - Alma Biscevic
- Eye Hospital Svjetlost, Sarajevo, Bosnia and Herzegovina
- University Eye Hospital Svjetlost, School of Medicine University of Rijeka, Zagreb, Croatia
| | | | - Nita Bejdic
- Eye Hospital Svjetlost, Sarajevo, Bosnia and Herzegovina
| | - Maja Bohac
- University Eye Hospital Svjetlost, School of Medicine University of Rijeka, Zagreb, Croatia
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Greenstein SA, Hersh PS. Corneal Crosslinking for Progressive Keratoconus and Corneal Ectasia: Summary of US Multicenter and Subgroup Clinical Trials. Transl Vis Sci Technol 2021; 10:13. [PMID: 34967830 PMCID: PMC8740531 DOI: 10.1167/tvst.10.5.13] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose The multicenter studies reviewed were designed to evaluate the safety and efficacy of corneal collagen crosslinking (CXL) for the treatment of progressive keratoconus and corneal ectasia after laser refractive surgery. The results of these studies led to approval by the United States Food and Drug Agency for both conditions in 2016. This paper reviews these studies, as well as single-center substudies investigating other aspects of crosslinking outcomes. Methods As part of prospective, randomized, controlled clinical trials, the treatment group received standard CXL, and the sham control group received only riboflavin ophthalmic solution. The primary efficacy criterion was maximum keratometry (Kmax) 1 year after CXL. Secondary outcomes were corrected distance visual acuity (CDVA) and uncorrected distance visual acuity (UDVA). Safety and adverse events were analyzed. In single-center substudies, corneal topography, ocular aberrations, corneal haze measurements, corneal thickness, corneal biomechanics, subjective visual function, and outcomes predictors were also investigated. This paper presents a general review of the design and outcomes of crosslinking in these studies. Results In the crosslinking treatment group, Kmax flattened by 1.6 diopters (D) and 0.7 D in eyes with keratoconus and ectasia, respectively. In both studies, there was continued progression in the control group. The CDVA improved by an average of 5.7 logMAR letters (LL) in the keratoconus treatment group and by 5.0 LL in the ectasia group. In both studies, corneal haze was the most frequently reported crosslinking-related adverse finding. This was most prominent at 1 month and generally returned to baseline between 3 and 12 months. In general, corneal topography, ocular aberrations, and subjective visual function improved after crosslinking. Conclusions In the US multicenter trials, CXL was shown to be safe and effective in stabilizing Kmax, CDVA, and UDVA in eyes with progressive keratoconus or corneal ectasia. Translational Relevance Corneal crosslinking was originally developed in the laboratory at the University of Dresden in the late 1990s. The combination of ultraviolet-A light and riboflavin was found to be the most effective of a number of different modalities tested to increase the biomechanical strength of the cornea. The clinical study design for the US multicenter clinical trials of crosslinking demonstrated the safety and effectiveness of this technique for treatment of progressive keratoconus and corneal ectasia, bringing this important advancement to patients in the United States.
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Affiliation(s)
- Steven A Greenstein
- CLEI Center for Keratoconus, Cornea and Laser Eye Institute-Hersh Vision Group, Teaneck, NJ, USA.,Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Peter S Hersh
- CLEI Center for Keratoconus, Cornea and Laser Eye Institute-Hersh Vision Group, Teaneck, NJ, USA.,Department of Ophthalmology, Rutgers New Jersey Medical School, Newark, NJ, USA
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Baptista PM, Ambrosio R, Oliveira L, Meneres P, Beirao JM. Corneal Biomechanical Assessment with Ultra-High-Speed Scheimpflug Imaging During Non-Contact Tonometry: A Prospective Review. Clin Ophthalmol 2021; 15:1409-1423. [PMID: 33854295 PMCID: PMC8039844 DOI: 10.2147/opth.s301179] [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] [Received: 01/28/2021] [Accepted: 03/05/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In recent years, increasing interest has arisen in the application of data from corneal biomechanics in many areas of ophthalmology, particularly to assist in the detection of early corneal ectasia or ectasia susceptibility, to predict corneal response to surgical or therapeutic interventions and in glaucoma management. Technology has evolved and, recently, the Scheimpflug principle was associated with a non-contact air-puff tonometer, allowing a thorough analysis of corneal biomechanics and a biomechanically corrected intraocular pressure assessment, opening up new perspectives both in ophthalmology and in other medical areas. Data from corneal biomechanics assessment are being integrated in artificial intelligence models in order to increase its value in clinical practice. OBJECTIVE To review the state of the art in the field of corneal biomechanics assessment with special emphasis to the technology based on ultra-high-speed Scheimpflug imaging during non-contact tonometry. SUMMARY A meticulous literature review was performed until the present day. We used 136 published manuscripts as our references. Both information from healthy individuals and descriptions of possible associations with systemic diseases are described. Additionally, it exposed information regarding several fields of ocular pathology, from cornea and ocular surface through areas of refractive surgery and glaucoma until vascular and structural diseases of the chorioretinal unit.
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Affiliation(s)
- Pedro Manuel Baptista
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Renato Ambrosio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, RJ, Brazil
- Department of Cornea and Refractive Surgery, Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Opthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
| | - Luis Oliveira
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Pedro Meneres
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Joao Melo Beirao
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
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Bages-Rousselon Y, Pinkus D, Rivas M, Butron K, Robledo N, Chayet A. Eighty-micron flap femtosecond-assisted LASIK for the correction of myopia and myopic astigmatism. J Cataract Refract Surg 2021; 47:445-449. [PMID: 33196573 DOI: 10.1097/j.jcrs.0000000000000484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/29/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of 80-μm flap femtosecond laser-assisted LASIK and the early clinical and refractive outcomes in the correction of myopia and myopic astigmatism. SETTING Private practice, outpatient. DESIGN Prospective study. METHODS Patients who underwent femtosecond-assisted LASIK between February and April 2018 were included. Inclusion criteria were myopia from -1.00 to -8.00 diopters (D) and astigmatism up to -3.00 D and no previous surgeries. All patients were tested preoperatively and on day 1 and month 3 for uncorrected distance visual acuity (UDVA), manifest refraction, corrected distance visual acuity (CDVA), intraocular pressure (IOP), slitlamp and dilated fundus examination, Schirmer I test with anesthesia, and ocular surface disease index questionnaire. The FEMTO LDV Z8 was used for flap construction and the Wavelight Allegretto 400 excimer for refractive treatment. Flap thickness was measured at week 1 with anterior segment optical coherence tomography (AS-OCT). RESULTS Eighty-two eyes were included. Logarithm of the minimum angle of resolution UDVA was 1.28 ± 0.53 preoperatively, 0.02 ± 0.05 at day 1, and 0.14 ± 0.127 at month 3. There was no loss of CDVA lines. The mean flap thickness measured at 1 week with AS-OCT was 73 ± 6.7 µm. CONCLUSIONS The use of ultrathin flaps, just below Bowman's layer, with the Ziemer LDV Z8 femtosecond laser was possible, safe, reliable, and reproducible. Eighty-micron flaps allowed for excellent vision on 1 day post-LASIK and might be a good alternative to maintain an appropriate percentage of tissue altered, especially when attempting greater corrections or larger treatment zones.
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Tahvildari M, Singh RB, Saeed HN. Application of Artificial Intelligence in the Diagnosis and Management of Corneal Diseases. Semin Ophthalmol 2021; 36:641-648. [PMID: 33689543 DOI: 10.1080/08820538.2021.1893763] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Diagnosis and treatment planning in ophthalmology heavily depend on clinical examination and advanced imaging modalities, which can be time-consuming and carry the risk of human error. Artificial intelligence (AI) and deep learning (DL) are being used in different fields of ophthalmology and in particular, when running diagnostics and predicting outcomes of anterior segment surgeries. This review will evaluate the recent developments in AI for diagnostics, surgical interventions, and prognosis of corneal diseases. It also provides a brief overview of the newer AI dependent modalities in corneal diseases.
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Affiliation(s)
- Maryam Tahvildari
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
| | - Rohan Bir Singh
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA.,Department of Ophthalmology, Leiden University Medical Center, Leiden, The Netherlands
| | - Hajirah N Saeed
- Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA, USA
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Detection of Post-Laser Vision Correction Ectasia with a new Combined Biomechanical Index. J Cataract Refract Surg 2021; 47:1314-1318. [PMID: 33769761 DOI: 10.1097/j.jcrs.0000000000000629] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 02/21/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To validate and evaluate the use of a new biomechanical index known as the CBI-LVC (Corvis Biomechanical Index-Laser Vision Correction) as a method for separating stable post-LVC eyes from post-LVC eyes with ectasia. SETTING Patients were included from 10 clinics/9 countries. DESIGN Retrospective, multi-center, clinical study. METHODS The study was designed with two purposes: to develop the CBI-LVC, which combines dynamic corneal response parameters (DCR) provided by a high-speed Scheimpflug camera (Corvis ST, Oculus, Germany) and then to evaluate its ability to detect post-LVC ectasia. The CBI-LVC includes Integrated Inverse Radius, Applanation 1(A1) Velocity, A1-Deflection Amplitude, Highest Concavity-dArc Length, Deformation Amplitude ratio-2mm, and A1-ArcLength mm. Logistic regression with Wald forward stepwise approach was used to identify the optimal combination of DCRs to create the CBI-LVC, and then separate stable from LVC-induced ectasia. Eighty percent of the database was used for training the software and 20% for validation. RESULTS 736 eyes of 736 patients were included (685 stable LVC, and 51 post-LVC ectasia). The ROC curve analysis showed an AUC of 0.991 when applying CBI-LVC in the validation dataset and 0.998 in the training dataset. A cut-off of 0.2 was able to separate stable LVC from ectasia with a sensitivity of 93.3% and a specificity of 97.8%. CONCLUSIONS The CBI-LVC was highly sensitive and specific in distinguishing stable from ectatic post-LVC eyes. We suggest using CBI-LVC in routine practice, along with topography and tomography, to aid the early diagnosis of post-LVC ectasia and allow intervention prior to visually compromising progression.
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Baptista PM, Marta AA, Marques JH, Abreu AC, Monteiro S, Menéres P, Pinto MDC. The Role of Corneal Biomechanics in the Assessment of Ectasia Susceptibility Before Laser Vision Correction. Clin Ophthalmol 2021; 15:745-758. [PMID: 33642854 PMCID: PMC7903962 DOI: 10.2147/opth.s296744] [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] [Received: 12/10/2020] [Accepted: 01/20/2021] [Indexed: 01/02/2023] Open
Abstract
Purpose To describe the tomographic and corneal biomechanical status of a sample of eyes excluded from LVC and to present the differences in biomechanical behavior in relation to cutoffs of clinical- and tomography-based screening methods used in clinical practice. Patients and Methods Observational cross-sectional study including 61 eyes from 32 consecutive patients who were excluded from LVC in our department. Clinical and demographic data were collected from the patients’ clinical records. Tomographic data was assessed with a Scheimpflug camera (Pentacam, OCULUS®). Ablation depth (µm) and residual stromal bed (µm) were calculated by the WaveLight® EX500 laser system software (Alcon, EUA). The corneal biomechanical assessment was made through ultra-high speed Scheimpflug imaging during noncontact tonometry (Corvis ST, OCULUS®). Several ectasia risk scores were analyzed. Results Mean age was 31.0±6 years old and mean manifest spherical equivalent was −2.01 ± 2.3D. Belin–Ambrósio deviation index was the tomographic parameter with higher proportion of eyes within the ectasia high risk interval. In the biomechanical assessment, more than 95% of eyes met the criteria for ectasia susceptibility in four of the first generation and in two of the second generation parameters. In a cutoff based comparative analysis, eyes with Kmax ≥45.5 D, eyes with VCOMA <0 and eyes with ARTmax ≤350 presented significantly softer corneal biomechanical behavior. Conclusion The majority of eyes excluded from LVC in the present study met the criteria for ectasia susceptibility in several biomechanical parameters, validating the clinical and tomographic based screening prior to LVC in our center. Differences found in the biomechanical assessment regarding cutoffs used in clinical practice highlight its differential role in characterizing risk profile of these patients. Tomography should not be overlooked and the integration of all data, including treatment-related parameters, can be the future of risk ectasia screening prior LVC.
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Affiliation(s)
- Pedro Manuel Baptista
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Ana Ambrósio Marta
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - João Heitor Marques
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Ana Carolina Abreu
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Sílvia Monteiro
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Pedro Menéres
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal
| | - Maria do Céu Pinto
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Toprak I, Cavas F, Velázquez JS, Alio del Barrio JL, Alio JL. Subclinical keratoconus detection with three-dimensional (3-D) morphogeometric and volumetric analysis. Acta Ophthalmol 2020; 98:e933-e942. [PMID: 32410342 DOI: 10.1111/aos.14433] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/13/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess the efficacy of morphogeometric and volumetric characterization of the cornea based on three-dimensional (3-D) modelling in diagnosis of subclinical keratoconus (KC). METHODS Cross-sectional study. Ninety-three eyes with subclinical KC with a best spectacle-corrected distance visual acuity ≥20/20 (grade zero KC according to the RETICS classification) and 109 control eyes were included. Computer-based 3-D corneal morphogeometric model was generated using raw topographic data. Distance-, area- and volume-based parameters were used for statistical analysis. Distance parameters included deviation of anterior (Dapexant )/posterior (Dapexpost ) apices and minimum thickness points (Dmctant , Dmctpost ) from corneal vertex, and Dapexant -Dapexpost difference. Areal variables were derived from anterior (Aant ) and posterior (Apost ) corneal surfaces, sagittal plane passing through corneal apices (Aapexant , Aapexpost ) and thinnest point (Amctant , Amctpost ). Total corneal volume (Vtotal ) and volumetric distribution (with 0.1mm steps) centred to thinnest corneal point (VOLmct ) and anterior (VOLaap )/posterior (VOLpap ) apices comprised the volume-based parameters. RESULTS In the subclinical KC group, all D values, Dapexant -Dapexpost difference, Aant , Apost and Aapexant values were higher (p < 0.001), while Aapexpost , Amctpost , Vtotal , VOLmct , VOLaap and VOLpap values were lower when compared to the control group (p < 0.001). Regression analysis-based formula correctly classified 96.8% of the eyes with subclinical KC and 94.5% of the normal ones (p < 0.0001). CONCLUSIONS Eyes with subclinical KC seem to represent asymmetrically displaced anterior and posterior corneal apex, corneal thinning and volume loss. 3-D morphogeometric and volumetric parameters and differentiation formula can be incorporated into topography software to detect subclinical KC with high sensitivity and specificity in clinical practice.
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Affiliation(s)
- Ibrahim Toprak
- Department of Research and Development VISSUM Alicante Spain
- Department of Ophthalmology Faculty of Medicine Pamukkale University Denizli Turkey
| | - Francisco Cavas
- Department of Structures, Construction and Graphical Expression Technical University of Cartagena Cartagena Spain
| | - José S. Velázquez
- Department of Structures, Construction and Graphical Expression Technical University of Cartagena Cartagena Spain
| | - Jorge L. Alio del Barrio
- Department of Research and Development VISSUM Alicante Spain
- Cornea, Cataract and Refractive Surgery Department VISSUM Alicante Spain
- Division of Ophthalmology Department of Pathology and Surgery Faculty of Medicine Miguel Hernández University Alicante Spain
| | - Jorge L. Alio
- Department of Research and Development VISSUM Alicante Spain
- Cornea, Cataract and Refractive Surgery Department VISSUM Alicante Spain
- Division of Ophthalmology Department of Pathology and Surgery Faculty of Medicine Miguel Hernández University Alicante Spain
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Abstract
Ectatic corneal disease (ECD) comprises a group of disorders characterized by progressive thinning and subsequent bulging of the corneal structure. Different phenotypes have been recognized, including keratoglobus, pellucid marginal degeneration (PMD), and keratoconus (KC). Keratoconus has been widely investigated throughout the years, but the advent of laser refractive surgery boosted an immediate need for more knowledge and research about ectatic diseases. This article discusses nomenclature of ectatic disease, etiology and pathogenesis, along with treatment options, with special focus ok KC and forme fruste keratoconus.
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Comparison of Corneal Biomechanical Properties between Post-LASIK Ectasia and Primary Keratoconus. J Ophthalmol 2020; 2020:5291485. [PMID: 33163228 PMCID: PMC7605929 DOI: 10.1155/2020/5291485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/05/2020] [Accepted: 09/22/2020] [Indexed: 12/17/2022] Open
Abstract
Purpose To compare the corneal biomechanical properties between post-LASIK ectasia and primary keratoconus. Methods A total of 42 eyes of 42 patients with matching age and central corneal thickness (CCT) were divided into two groups according to diagnosis of post-LASIK ectasia (PLE group; n = 21; age range: 22–47 years) and primary keratoconus (KC group; n = 21; age range: 21–47 years). The corneal biomechanical properties were assessed using Scheimpflug-based technology (Corvis ST; Oculus Optikgeräte, Wetzlar, Germany). The paired t-test and linear regression analysis were performed. Results The PLE group had significantly higher mean stiffness parameter at the first applanation (SP-A1; 76.65 ± 21.66 vs 52.72 ± 13.65, p ≤ 0.001) and mean stress-strain index (SSI) (SSI: 0.78 ± 0.16 versus 0.64 ± 0.12, p=0.001) than the KC group. SP-A1 was positively correlated with CCT in the PLE group (Pearson's r = 0.816, p ≤ 0.001), but not in the KC group (Pearson's r = −0.014, p=0.952). No statistical correlation was observed between SSI and CCT in either group (Pearson's r = 0.292, p=0.199, and Pearson's r = 0.004, p=0.985, respectively). Conclusions In our case series, KC manifested more severe than PLE in biomechanical properties. Since SSI measurements were independent of corneal thickness, it can be used for corneal biomechanical assessment.
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Gab-Alla AA. Is the axial length a risk factor for post-LASIK myopic regression? Graefes Arch Clin Exp Ophthalmol 2020; 259:777-786. [PMID: 33128672 PMCID: PMC7904712 DOI: 10.1007/s00417-020-04990-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 10/09/2020] [Accepted: 10/22/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To assess the relationship between the axial length and post-LASIK regression in myopic patients. METHODS This is a retrospective case series study conducted at a private eye centre, Ismailia, Egypt. The clinical records of the patients, who experienced LASIK to correct myopia from January 2016 to January 2018, were analysed for myopic regression. The patients were operated on, examined, and followed-up 1 year by one surgeon (AAG). RESULTS This study included 1219 patients (2316 eyes) with myopia. Mean ± SD of pre-operative spherical equivalent (SE) was - 4.3 ± 2.1D, range (- 0.50 to - 10.0D). Mean ± SD age of the patients was 26.4 ± 6.8 years, range (21 to 50 years). Male to female ratio was 30.5 to 69.5%. The cumulative incidence rate of myopic regression according to the medical records of the patients was 25.12% (582 eyes out of total 2316 eyes) along the 2 years of this study (12.6% per year). Of the total patients, 14.94% had pre-operative high myopia, 35.84% had pre-operative moderate myopia, and 49.2% had pre-operative low myopia. Of the patients with myopic regression, 52.6% had pre-operative high myopia, 34% had pre-operative moderate myopia, and 13.4% had pre-operative low myopia. The mean ± SD of the axial length of the patients with myopic regression was 26.6 ± 0.44 mm, range (26.0 to 27.86 mm), while the mean ± SD of the axial length of other patients with stable refraction was 24.38 ± 0.73 mm, range (22.9 to 25.9 mm) (t test statistic = 69.3; P value < 0.001). CONCLUSIONS Pre-operative high axial length increases the risk of myopic regression after LASIK.
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Affiliation(s)
- Amr A Gab-Alla
- Faculty of Medicine, Ophthalmology Department, Suez Canal University, Ring Road, Ismailia, Egypt.
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September consultation #4. J Cataract Refract Surg 2020; 46:1321. [DOI: 10.1097/01.j.jcrs.0000717548.95221.4a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW To review the updated literature regarding eye rubbing complications and its association with ocular allergy disorders. RECENT FINDINGS Atopy and ocular allergy disorders, mainly vernal keratoconjunctivitis (VKC), are strongly associated with rubbing-related complications, most probably via itching and watery eye sensations that trigger the habit of chronic eye rubbing. Vigorous and prolonged rubbing may lead to establishment of corneal remodeling and ectatic disorders, such as keratoconus. Keratoconus development in rubbed eyes can be caused by mechanical mechanisms of corneal thinning and its loss of rigidity, by elevated temperature of the epithelium during rubbing, by increased intraocular pressure (IOP) because of distending forces, and by inflammatory molecules that may serve as a causal mediator between eye rubbing and keratoconus. Other eye rubbing complications include acute hydrops and perforation, IOP spikes, iris prolapse and iridoschisis rupture of lens capsule and IOL dislocation, and even posterior segment disorders, such as glaucomatous optic neuropathy, retinal detachment and extrusion of implanted silicone oil in the eye. SUMMARY Chronic eye rubbing in allergic eye diseases can lead to progression of keratoconus, and to other rare anterior and posterior segment complications. Strategies eliminating eye rubbing and its consequences are vital, mainly among at-risk populations, such as young children and individuals with allergic ocular disorders or corneal transplants.
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Could the percent tissue altered (PTA) index be considered as a unique factor in ectasia risk assessment? Int Ophthalmol 2020; 40:3285-3294. [PMID: 32720171 DOI: 10.1007/s10792-020-01514-1] [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: 03/19/2020] [Accepted: 07/17/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the efficacy, safety, predictability and stability of the percent tissue altered (PTA) formula in post-LASIK (laser-assisted in situ keratomileusis) ectasia risk assessment. METHODS One hundred and ninety-three eyes from 104 patients with low to moderate myopia that underwent femtosecond LASIK were included in this retrospective, observational and longitudinal study. Seventy-eight eyes were classified in the higher-PTA (> 40%) group and 115 eyes in the lower-PTA (< 40%) group. Spherical manifest refraction, cylinder manifest refraction, logMAR and Snellen previous corrected distance visual acuity (CDVA), uncorrected distance visual acuity (UDVA), anterior face Baiocchi Calossi Versaci index (BCVf) and posterior face (BCVb), central corneal thickness (CCT), estimated residual stromal bed (RSB), spherical aberration (SA) and root mean square (RMS) were reported. All patients were followed up for 4 years. RESULTS In the higher-PTA group, 97% of eyes reported UDVA 20/20 or better, and in the lower-PTA group, all eyes achieved 20/20 or better. No group reported decreased visual acuity. The higher-PTA group obtained 55% of eyes within ± 0.50 D and 90% within ± 1.00 D; and the lower-PTA group obtained 63% of eyes within ± 0.50 D and 90% within ± 1.00 D. Both groups showed a refraction correction of 0.50 D or more in 36% and 31% of eyes, in the higher-PTA and the lower-PTA groups, respectively. CONCLUSION Percent tissue altered index should not be considered as a unique variable in post-LASIK ectasia risk assessment. Ectasia susceptibility screening should integrate tomography and biomechanical variables in order to help us to decide any refractive treatment choice and increasing refractive surgery safety.
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Benozzi G, Perez C, Leiro J, Facal S, Orman B. Presbyopia Treatment With Eye Drops: An Eight Year Retrospective Study. Transl Vis Sci Technol 2020; 9:25. [PMID: 32832231 PMCID: PMC7414614 DOI: 10.1167/tvst.9.7.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/23/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the safety and efficacy across time, of patients topically treated with Benozzi's method for presbyopia. Methods A nonrandomized case series retrospective study was developed, including patients with emmetropia with binocular uncorrected distance visual acuity (UDVA) of 25/20 or better, and with uncorrected near visual acuity (UNVA) at least Jaeger 2 or worse. The study was set in Buenos Aires, Argentina, from January 2011 to June 2018, with at least 1-year follow-up. Patients were treated with pilocarpine and diclofenac preservative-free eye drops (Benozzi Method; US 8.524.758 B2, EP1.938.839 B1), and the main outcome measured was binocular UNVA at different follow-up times. Other parameters, as the UDVA and presence of side effects, were evaluated. Results A total of 910 patients were included with a mean age at baseline of 48.67 ± 3.72 years old (range, 40–59 years). The baseline UNVA was 4.74 ± 1.53 and at 8 years of follow-up was decreased to 1.36 ± 0.48 (Jaeger scale). The mean binocular UDVA at baseline was 0.00 ± 0.01 logarithm of the minimum angle of resolution (logMAR) and after 8 years of follow-up was 0.03 ± 0.04 logMAR. All side effects reported (decrease of light perception, headaches, symptoms of ocular surface dryness, and dizziness) were spontaneously resolved in patients who continued with the treatment. Conclusions The efficacy of the pharmacological treatment of presbyopia to improve the UNVA without affecting the UDVA is shown. Side effects were well tolerated and resolved before 1 year of treatment. Translational Relevance This is a nonsurgical option for patients with emmetropic presbyopia who do not wish to wear glasses, which is a pharmacological treatment with eye drops.
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Affiliation(s)
- Giovanna Benozzi
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina.,Pharmacology Unit, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Cristian Perez
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
| | - Juliana Leiro
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
| | - Sonia Facal
- Centro de Investigación Avanzada para la Presbicia, Buenos Aires, Argentina
| | - Betina Orman
- Pharmacology Unit, Facultad de Odontología, Universidad de Buenos Aires, Buenos Aires, Argentina
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Narang P. Commentary: Ectasia after keratorefractive surgery: An ounce of prevention is worth a pound of cure. Indian J Ophthalmol 2020; 68:1032. [PMID: 32461423 PMCID: PMC7508076 DOI: 10.4103/ijo.ijo_2385_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Purvasha Narang
- Cornea, Refractive and Ocular Surface Services, L.J. Eye Institute, Ambala, Haryana, India
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Yang K, Xu L, Fan Q, Gu Y, Song P, Zhang B, Zhao D, Pang C, Ren S. Evaluation of new Corvis ST parameters in normal, Post-LASIK, Post-LASIK keratectasia and keratoconus eyes. Sci Rep 2020; 10:5676. [PMID: 32231236 PMCID: PMC7105482 DOI: 10.1038/s41598-020-62825-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/17/2020] [Indexed: 12/17/2022] Open
Abstract
The aim of this study was to evaluate the distribution of new Corneal Visualisation Scheimpflug Technology (Corvis ST) parameters in normal, Post-laser in situ keratomileusis (LASIK), Post-LASIK keratectasia (KE) and keratoconus (KC) eyes, and explore the diagnostic ability of these parameters in distinguishing KE from LASIK eyes. Twenty-three normal eyes, 23 LASIK eyes, 23 KE eyes and 23 KC eyes were recruited in this study. The following new Corvis ST parameters were measured: Max Inverse Radius, deformation amplitude (DA) Ratio Max [2 mm], Pachy Slope, DA Ratio Max [1 mm], Ambrosio’s relational thickness horizontal (ARTh), Integrated Radius, stiffness parameter at first applanation (SP-A1) and Corvis biomechanical index (CBI). The general linear model, linear regression model, relation analysis and receiver operating characteristic (ROC) curve were performed. The Max Inverse Radius, DA Ratio Max [2 mm], Pachy Slope, DA Ratio Max [1 mm], Integrated Radius and CBI in LASIK eyes, KE eyes and KC eyes were higher than in normal eyes, while the ARTh and SP-A1 parameters were lower than in normal eyes. The KE eyes had higher Max Inverse Radius, DA Ratio Max [2 mm], Pachy Slope, DA Ratio Max [1 mm], Integrated Radius, and lower SP-A1 value than LASIK eyes (all P < 0.05). The central corneal thickness was related to the Pachy Slope (r = −0.485), ARTh (r = −0.766), SP-A1 (r = 0.618) in KE eyes (all P < 0.05). The area under the ROC curve of Integrated Radius, Max Inverse Radius, DA Ratio Max [2 mm] and SP-A1 were above 0.800 in identifying KE from LASIK eyes. Thus, the new Corvis ST parameters were different between LASIK and KE eyes, suggesting that they might be helpful in distinguishing KE eyes from LASIK eyes. However, a further multi-center and large sample study is necessary to confirm these findings.
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Affiliation(s)
- Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, China
| | - Peng Song
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, China
| | - Bo Zhang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, China
| | - Dongqing Zhao
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, China
| | - Chenjiu Pang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, China.
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, 450003, China.
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Ferrari G, Rama P. The keratoconus enigma: A review with emphasis on pathogenesis. Ocul Surf 2020; 18:363-373. [PMID: 32234342 DOI: 10.1016/j.jtos.2020.03.006] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/11/2020] [Accepted: 03/19/2020] [Indexed: 12/16/2022]
Abstract
PURPOSE To review the literature on the etiopathogenesis of keratoconus (KC). METHODS A literature search was conducted using PUBMED and Google Scholar for keratoconus. The authors analyzed epidemiology studies, reviews, and case reports. RESULTS Atopy and ocular surface inflammation are a common features of KC and should lead to a reconsideration of the traditional definition of KC as a "non inflammatory" condition. Co-morbidities suggest that KC may be the ocular manifestation of a systemic disease. Finally, KC shows higher prevalence in certain ethnicities, which calls into question the status of KC as a rare disease, at least in these communities. CONCLUSION We believe that future studies should test whether selected, high prevalence populations exhibit specific genetic background and/or ethno-specific environmental risk factors.
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Affiliation(s)
- Giulio Ferrari
- San Raffaele Hospital, Cornea and Ocular Surface Unit, Eye Repair Lab, Italy.
| | - Paolo Rama
- San Raffaele Hospital, Cornea and Ocular Surface Unit, Eye Repair Lab, Italy
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