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Wan Q, Wei R, Ma K, Yin H, Deng YP, Tang J. Deep Learning-Based Automatic Diagnosis of Keratoconus with Corneal Endothelium Image. Ophthalmol Ther 2023; 12:3047-3065. [PMID: 37665500 PMCID: PMC10640564 DOI: 10.1007/s40123-023-00795-w] [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: 05/11/2023] [Accepted: 08/15/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION The primary objective of this study was to develop an end-to-end model that can accurately identify corneal endothelial cells and diagnose keratoconus based on corneal endothelial images acquired from a non-contact specular microscope. METHODS This was a retrospective case-control study performed at the Refractive Surgery Center of West China Hospital. A total of 403 keratoconus eyes (221 patients) and 370 myopic eyes (185 normal controls) were consecutively recruited from January 2021 to September 2022. Specular microscopy was used to image and measure the morphometric parameters of the corneal endothelial cells. A Fully Convolutional Network model with a ResNet50 (FCN_ResNet50) was established to perform the endothelial segmentation. The images were then classified using an ensemble machine learning system consisting of four pre-trained deep learning networks: DenseNet121, ResNet50, Inception_v3, and MobileNet_v2. The performance of the models was evaluated based on different metrics, such as accuracy, intersection over union (IoU), and mean IoU. RESULTS We established a fully end-to-end deep-learning model for the segmentation of endothelial and diagnosis of keratoconus. For endothelial segmentation, the accuracy of the FCN_ResNet50 model achieved near 90% with mean IoU converging to about 80%. The ensemble machine learning system can achieve over 92% accuracy, and > 98% area under curve (AUC) values to diagnose keratoconus with endothelial cell images. In addition, we constructed a diagnostic model based on deep-learning features and developed an associated nomogram which manifested an excellent performance for diagnosis and monitoring the progression of keratoconus. CONCLUSIONS Our research developed an end-to-end model to automatically identify and assess corneal endothelial morphological changes in keratoconus eyes. Moreover, we also constructed a novel nomogram, which can provide valuable information for the diagnosis, monitoring, and management of the disease.
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Affiliation(s)
- Qi Wan
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ran Wei
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ke Ma
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hongbo Yin
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Ping Deng
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
| | - Jing Tang
- Department of Ophthalmology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Corneal densitometry in bilateral keratoconus patients with unilateral corneal Vogt’s striae: a contralateral eye study. Int Ophthalmol 2022; 43:885-897. [PMID: 36153430 DOI: 10.1007/s10792-022-02491-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 08/20/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE To investigate corneal densitometry and correlations with corneal morphological parameters in patients with bilateral keratoconus (KC) with unilateral Vogt's striae. METHODS This prospective contralateral study enrolled 112 patients (224 eyes) with evident KC characteristics (corneal topography with asymmetric bow-tie pattern, inferior steepening), and at least one KC sign (conical protrusion of the cornea at the apex, corneal stromal thinning, Fleischer ring, Vogt's striae) on slit-lamp examination. Corneal densitometry and morphological parameters were measured using Pentacam HR. RESULTS The mean age was 23.93 ± 6.81 years. Fifty-two (23.22%), 111 (49.55%), and 61 (27.23%) eyes were in mild, moderate, and severe groups, respectively. Corneal densitometry values of the anterior 0-2 mm and 2-6 mm, intermediate 0-2 mm and 2-6 mm, posterior 2-6 mm, and total cornea 2-6 mm were significantly higher in eyes with Vogt's striae (P < 0.05), whereas those of the anterior 6-10 mm, posterior 0-2 mm, and total cornea 6-10 mm were significantly lower in eyes with Vogt's striae (P < 0.05). Anterior 0-2 mm and total cornea 2-6 mm corneal densitometry values were positively correlated with anterior K1 (A-K1), K2 (A-K2), Km (A-Km), Kmax (A-Kmax), anterior corneal elevation, and posterior corneal elevation (P < 0.05), and negatively correlated with central corneal thickness and thinnest corneal thickness in eyes with Vogt's striae (P < 0.05). A-K2, A-Km, and A-Kmax were significantly correlated with the densitometry values of the anterior 0-2 mm and intermediate 0-2 mm in eyes without Vogt's striae (P < 0.05). CONCLUSION Vogt's striae mainly occur on the anterior and intermediate layers during KC progression.
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Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review. Cont Lens Anterior Eye 2022; 45:101559. [PMID: 34991971 DOI: 10.1016/j.clae.2021.101559] [Citation(s) in RCA: 189] [Impact Index Per Article: 94.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023]
Abstract
Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.
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Affiliation(s)
| | - Gonzalo Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Asaki Suzaki
- Clinical Research and Development Center, Menicon Co., Ltd., Nagoya, Japan
| | - Cesar Villa-Collar
- Department of Pharmacy, Biotechnology, Nutrition, Optics and Optometry, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - James S Wolffsohn
- School of optometry, Health and Life Sciences, Aston University, Birmingham B4 7ET, United Kingdom
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Shah Z, Shilpy N, Purohit D, Singh S. Assessment and Correlation of Corneal Endothelial Cell Changes in Different Stages of Keratoconus in Non-contact Lens Wearers. Optom Vis Sci 2021; 98:1295-1298. [PMID: 34510150 DOI: 10.1097/opx.0000000000001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
SIGNIFICANCE The endothelial changes in keratoconus are of interest because these can affect the surgical plan in management. Previously, many studies have evaluated the endothelium in eyes with keratoconus, but there is no common consensus on change in endothelial cell density (ECD) with studies showing variable results. PURPOSE This study aimed to compare and correlate endothelial cell parameters in different stages of keratoconus using specular microscope. METHODS This cross-sectional, cohort, comparative study included 162 eyes of 96 patients with keratoconus in one or both eyes. Corneal endothelial cell parameters were assessed with SP-1P specular microscope (Topcon Co., Tokyo, Japan). Corneal topography and thickness data were obtained from Sirius tomographer (Costruzione Strumenti Oftalmici, Florence, Italy). Eyes were divided into keratoconus stage 0 to 4 according to ABCD classification. Comparison and correlation of endothelial cell parameters in different stages were done. RESULTS There were 21.6% eyes (35) in stage 0, 29.6% eyes (48) in stage 1, 29.0% eyes (47) in stage 2, and 19.8% eyes (32) in stage 3 of keratoconus. Measurement was not possible in stage 4 keratoconus. Among the stages 0, 1, 2, and 3, the ECD was 3024, 3051, 3025, and 3043 cells/mm2; coefficient of variation was 27.2, 27.6, 26.8, and 27.4; and frequency of hexagon cells was 61.5, 63.7, 63.3, and 62.3, respectively (P > .05). The number of analyzed cells was 232, 209, 185, and 169 in stages 0, 1, 2, and 3, respectively (P < .001). No significant difference was found in minimum, maximum, and average cell area between the stages (P > .05). A weak Spearman rank correlation of ECD, coefficient of variation, and frequency of hexagon cells was found between eyes with keratoconus stages 0 and 1 and stages 2 and 3 (r = -0.05, P = .65; r = -0.11, P = .37; r = 0.05, P = .67, respectively). No significant correlation was found in the number of cells analyzed and minimum, maximum, and average cell area between the stages (P > .05). CONCLUSIONS Endothelial cell parameters do not show any significant changes and correlation up to stage 3 of keratoconus in non-contact lens wearers.
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Affiliation(s)
| | - Neha Shilpy
- Regional Institute of Ophthalmology, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Dipali Purohit
- Department of Refractive Surgery, Shree C. H. Nagri Eye Hospital, Ahmedabad, Gujarat, India
| | - Shwetambari Singh
- Department of Refractive Surgery, Shree C. H. Nagri Eye Hospital, Ahmedabad, Gujarat, India
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Elmassry A, Osman A, Sabry M, Elmassry M, Katkat M, Hatata MY, El-Kateb M. Corneal endothelial cells changes in different stages of Keratoconus: a multi-Centre clinical study. BMC Ophthalmol 2021; 21:143. [PMID: 33743631 PMCID: PMC7981969 DOI: 10.1186/s12886-021-01913-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/12/2021] [Indexed: 12/21/2022] Open
Abstract
Purpose To assess the corneal endothelial cells morphology and count in keratoconus patients and their correlation with different stages of keratoconus. Methods Prospective non randomized multi-centric clinical study included 150 eyes of 150 keratoconus patients. Four centers in Egypt participated in this study included: Departments of Ophthalmology in Alexandria University, Tanta University and Port Said University and Alex I-Care hospital. Pentacam (Wavelight Oculyzer II) and specular microscopy (Tomey EM-3000) were done to all eyes. Keratoconic eyes were classified according to Amsler classification into stage 1, 2 and 3. Stage 1 included 99 eyes, stage 2 included 32 eyes & stage 3 included 19 eyes. Results The mean age of keratoconus patients was 24.07 ± 6.154 years. Forty five cases were males (30%) and 105 cases were females (70%). There was statistically significant difference in endothelial cell density (p < 0.001) and coefficient of variation (p = 0.012) between different stages of keratoconus eyes. Regarding cell surface area, there was statistically significant difference in cell surface area between different stages of keratoconus eyes (p < 0.001). In addition, for cell morphology, there was statistically significant difference between different stages of keratoconus eyes (p < 0.001). Conclusions Qualitative and quantitative structural changes were seen in endothelial cells of keratoconus eyes by using specular microscopy. For stages 1 and 2, keratoconus may not affect the corneal endothelim significantly. The endothelium in stage 3 shows significant changes regarding polymegathism and pleomorphism.
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Affiliation(s)
- Ahmed Elmassry
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Champollion Street, Al Attarin, Alexandria, Egypt.
| | - Ahmed Osman
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Champollion Street, Al Attarin, Alexandria, Egypt
| | - Moataz Sabry
- Department of Ophthalmology, Tanta University, Tanta, Egypt
| | - Mohamed Elmassry
- Department of Ophthalmology, Port Said University, Port Fuad, Egypt
| | - Mai Katkat
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Champollion Street, Al Attarin, Alexandria, Egypt.,Alex I-Care Hospital, Alexandria, Egypt
| | - Mohamed Yousry Hatata
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Champollion Street, Al Attarin, Alexandria, Egypt
| | - Mohamed El-Kateb
- Department of Ophthalmology, Faculty of Medicine, Alexandria University, Champollion Street, Al Attarin, Alexandria, Egypt.,Alex I-Care Hospital, Alexandria, Egypt
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Schroeter A, Kropp M, Cvejic Z, Thumann G, Pajic B. Comparison of Femtosecond Laser-Assisted and Ultrasound-Assisted Cataract Surgery with Focus on Endothelial Analysis. SENSORS 2021; 21:s21030996. [PMID: 33540680 PMCID: PMC7867300 DOI: 10.3390/s21030996] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/26/2021] [Accepted: 01/29/2021] [Indexed: 12/11/2022]
Abstract
Femtosecond laser-assisted cataract surgery has the potential to make critical steps of cataract surgery easier and safer, and reduce endothelial cell loss, thus, improving postoperative outcomes. This study compared FLACS with the conventional method in terms of endothelial cells behavior, clinical outcomes, and capsulotomy precision. METHODS In a single-center, randomized controlled study, 130 patients with cataracta senilis received FLACS or conventional cataract surgery. RESULTS A significant endothelial cell loss was observed postoperatively, compared to the preoperative values in both groups. The endothelial cell counts was significantly better in the FLACS group in cataract grade 2 (p = 0.048) patients, compared to conventionally at 4 weeks. The effective phaco time was notably shorter in grade 2 of the FLACS group (p = 0.007) compared to the conventional. However, no statistically significant differences were found for the whole sample, including all cataract grades, due to the overall cataract density in the FLACS group being significantly higher (2.60 ± 0.58, p < 0.001) as compared to conventional methods (2.23 ± 0.42). CONCLUSIONS Low energy FLACS provides a better result compared to endothelial cell loss, size, and shape variations, as well as in effective phaco time within certain cataract grade subgroups. A complete comparison between two groups was not possible because of the higher cataract grade in the FLACS. FLACS displayed a positive effect on endothelial cell preservation and was proven to be much more precise.
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Affiliation(s)
- Anna Schroeter
- Department of Ophthalmology, Basel University Hospital, Mittlerestr str. 91, 4056 Basel, Switzerland;
| | - Martina Kropp
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland; (M.K.); (G.T.)
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Zeljka Cvejic
- Department of Physics, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia;
| | - Gabriele Thumann
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland; (M.K.); (G.T.)
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Bojan Pajic
- Division of Ophthalmology, Department of Clinical Neurosciences, Geneva University Hospitals, 1205 Geneva, Switzerland; (M.K.); (G.T.)
- Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Physics, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovica 4, 21000 Novi Sad, Serbia;
- Eye Clinic Orasis, Swiss Eye Research Foundation, 5734 Reinach, Switzerland
- Faculty of Medicine of the Military Medical Academy, University of Defence, 11000 Belgrade, Serbia
- Correspondence: ; Tel.: +41-62-765-60-80
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Barrientez B, Nicholas SE, Whelchel A, Sharif R, Hjortdal J, Karamichos D. Corneal injury: Clinical and molecular aspects. Exp Eye Res 2019; 186:107709. [PMID: 31238077 DOI: 10.1016/j.exer.2019.107709] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/03/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022]
Abstract
Currently, over 10 million people worldwide are affected by corneal blindness. Corneal trauma and disease can cause irreversible distortions to the normal structure and physiology of the cornea often leading to corneal transplantation. However, donors are in short supply and risk of rejection is an ever-present concern. Although significant progress has been made in recent years, the wound healing cascade remains complex and not fully understood. Tissue engineering and regenerative medicine are currently at the apex of investigation in the pursuit of novel corneal therapeutics. This review uniquely integrates the clinical and cellular aspects of both corneal trauma and disease and provides a comprehensive view of the most recent findings and potential therapeutics aimed at restoring corneal homeostasis.
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Affiliation(s)
- Brayden Barrientez
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Sarah E Nicholas
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Amy Whelchel
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Rabab Sharif
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Dimitrios Karamichos
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA; Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
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A contralateral eye study comparing characteristics of corneal endothelial cells in bilateral keratoconus patients with unilateral corneal Vogt's striae. J Curr Ophthalmol 2018; 30:228-233. [PMID: 30197952 PMCID: PMC6127361 DOI: 10.1016/j.joco.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/16/2018] [Accepted: 01/27/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose The aim of this study was to analyze and compare corneal endothelial cell morphology and characteristics in bilateral keratoconus (KCN) patients with unilateral Vogt's striae. Methods Fifty patients aged 20–38 years were recruited in this cross-sectional contralateral eye study. In this study, corneal endothelial cell parameters were evaluated in patients with bilateral KCN and unilateral Vogt's striae using the Topcon SP2000P specular microscope (Topcon, Tokyo, Japan). Results In the current study, there were no significant differences in corneal endothelial cell parameters including endothelial cell density (ECD), hexagonal cell ratio (HEX), and coefficient of variance of cell size (CV) between the KCN groups with and without Vogt's striae, [(2968.34 ± 276.65 vs. 2980.05 ± 253.30, P = 0.618), (51.88 ± 13.57 vs. 53.24 ± 9.31, P = 0.658), and (32.50 ± 5.40 vs. 32.97 ± 4.07, P = 0.467), respectively]. Also, among study groups with and without Vogt's striae, ECD did not correlate with anterior chamber depth (ACD) [(P = 0.564, r = 0.09), (P = 0.219, r = −0.18), respectively], maximum keratometry (Kmax) [(P = 0.215, r = 0.18), (P = 0.898, r = 0.02), respectively], and central corneal thickness (CCT) [(P = 0.989, r = −0.02), (P = 0.643, r = −0.07), respectively]. Our results showed significant differences in corrected and uncorrected distance visual acuity (UDVA), cycloplegic refractive error components (calculated by vectorial analysis), CCT, and Kmax between two study groups (all P < 0.05) except for J45 (Jackson cross cylinder, axes at 45 and 135°) (P = 0.131). Conclusions We were not able to find the statistically significant differences in ECD, HEX, and CV between KCN eyes with and without Vogt's striae. Despite clinical and tomographic results, it seems that Vogt's striae cannot cause deterioration in the corneal endothelial morphology.
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Goebels S, Eppig T, Seitz B, Szentmàry N, Cayless A, Langenbucher A. Endothelial alterations in 712 keratoconus patients. Acta Ophthalmol 2018; 96:e134-e139. [PMID: 28597601 DOI: 10.1111/aos.13471] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 03/24/2017] [Indexed: 01/18/2023]
Abstract
PURPOSE To investigate the effect of the severity of keratoconus on the corneal endothelium using specular microscopy. METHODS Seven hundred and twelve eyes from the Homburg Keratoconus Center (HKC) database were included in this retrospective study. Corneal endothelium was evaluated using the Tomey EM-3000 specular microscope. Keratoconus-related topographic and tomographic data were obtained from Scheimpflug-based tomography (Oculus Pentacam® HR). Eyes were classified into stages 0 (healthy) to 4 (severe keratoconus) according to the Topographic Keratoconus Classification (TKC). Subgroups were analysed based on contact lens (CL) type (none/rigid/soft). RESULTS The frequencies of keratoconus stages 0/1/2/3/4 according to TKC were 169/94/206/166/77. The endothelial cell density (ECD) for the endothelial cell area for TKC 0/1/2/3/4 was 2611/2624/2557/2487/2401 cells per mm² and the coefficient of variation (CV) was 40.9/40.0/41.6/46.2/49.0%, respectively. The more severe the keratoconus stage, the lower the endothelial cell count (p < 0.001) and the higher the CV (p < 0.001). No contact lens wearing was noted in 207 eyes (NoCL), rigid CL in 200 (RCL) and soft CL in 54 (SCL). CD for NoCL/RCL/SCL was 2523/2533/2644 per mm² and CV was 41.8/54.1/43.1%, respectively. A significant difference in CV was found between NoCL and RCL (p = 0.02), and no significant difference in CV was found between NoCL and SCL (p = 0.07). Endothelial cell density (ECD) did not differ significantly between NoCL and RCL or SCL. CONCLUSION Endothelial cell density (ECD) decreases and CV increases significantly with increasing tomographic severity of keratoconus. In patients with RCL compared to eyes without CL wear, we found a statistically significantly higher CV in the endothelial cell size.
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Affiliation(s)
- Susanne Goebels
- Department of Ophthalmology; Saarland University Medical Center; Homburg Germany
| | - Timo Eppig
- Department of Experimental Ophthalmology; Saarland University; Homburg Germany
| | - Berthold Seitz
- Department of Ophthalmology; Saarland University Medical Center; Homburg Germany
| | - Nòra Szentmàry
- Department of Ophthalmology; Saarland University Medical Center; Homburg Germany
- Department of Ophthalmology; Semmelweis University; Budapest Hungary
| | - Alan Cayless
- Department of Physical Sciences; Open University; Milton Keynes UK
| | - Achim Langenbucher
- Department of Experimental Ophthalmology; Saarland University; Homburg Germany
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Bozkurt B, Yılmaz M, Meşen A, Kamış Ü, Ekinci Köktekir B, Okudan S. Correlation of Corneal Endothelial Cell Density with Corneal Tomographic Parameters in Eyes with Keratoconus. Turk J Ophthalmol 2017; 47:255-260. [PMID: 29109893 PMCID: PMC5661174 DOI: 10.4274/tjo.22800] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/24/2017] [Indexed: 12/01/2022] Open
Abstract
Objectives: To examine changes in corneal endothelial cell density (ECD) in different stages of keratoconus and evaluate its correlation with corneal tomographic parameters. Materials and Methods: Two hundred six patients with keratoconus were enrolled in the study. Corneal topography was performed by Sirius (CSO, Italy), which has a rotating Scheimpflug camera and a Placido disc topographer. Automatic endothelial analysis was done with the non-contact endothelial microscope (20x probe) of Confoscan-4 (NIDEK, Japan). The eyes were classified into stages based on steepest keratometric value as follows: mild <45 D; moderate 45-52 D; severe >52 D and according to thinnest cornea thickness (TCT) as <400 μm, 400-450 μm, and >450 μm. Tomographic and endothelial cell parameters were compared among the groups using Kruskal-Wallis test and the correlations between them were analyzed using Spearman correlation. Results: The study included 391 eyes of 100 male (24.29±7.7 years, range 11-47 years) and 106 female (26.26±7.5 years, range 13-45 years) patients (p=0.07). Mean ECD values were 2628±262 cells/mm2, 2541.9±260.4 cells/mm2, and 2414.6±384.3 cells/mm2 in mild, moderate, and severe keratoconus, respectively (p<0.001) and 2592.3±277 cells/mm2, 2502±307 cells/mm2 and 2348±296 cells/mm2 in corneas with TCT values >450 µm, 400-450 µm, and <400 µm, respectively (p<0.001). ECD showed significant negative correlation with keratometric and elevation parameters and positive correlation with pachymetric parameters (p<0.05). Conclusion: As endothelial cell numbers seem to decrease with the progression of keratoconus, specular/confocal microscopy screening should be carried out, especially in eyes with advanced stages and corneas with TCT <400 µm.
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Affiliation(s)
- Banu Bozkurt
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Mevlüt Yılmaz
- Dr. Munif İslamoğlu State Hospital, Ophthalmology Clinic, Kastamonu, Turkey
| | - Ali Meşen
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
| | - Ümit Kamış
- Dünyagöz Hospital, Ophthalmology Clinic, Konya, Turkey
| | | | - Süleyman Okudan
- Selçuk University Faculty of Medicine, Department of Ophthalmology, Konya, Turkey
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Molecular and Histopathological Changes Associated with Keratoconus. BIOMED RESEARCH INTERNATIONAL 2017; 2017:7803029. [PMID: 28251158 PMCID: PMC5303843 DOI: 10.1155/2017/7803029] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/16/2016] [Accepted: 01/04/2017] [Indexed: 12/13/2022]
Abstract
Keratoconus (KC) is a corneal thinning disorder that leads to loss of visual acuity through ectasia, opacity, and irregular astigmatism. It is one of the leading indicators for corneal transplantation in the Western countries. KC usually starts at puberty and progresses until the third or fourth decade; however its progression differs among patients. In the keratoconic cornea, all layers except the endothelium have been shown to have histopathological structural changes. Despite numerous studies in the last several decades, the mechanisms of KC development and progression remain unclear. Both genetic and environmental factors may contribute to the pathogenesis of KC. Many previous articles have reviewed the genetic aspects of KC, but in this review we summarize the histopathological features of different layers of cornea and discuss the differentially expressed proteins in the KC-affected cornea. This summary will help emphasize the major molecular defects in KC and identify additional research areas related to KC, potentially opening up possibilities for novel methods of KC prevention and therapeutic intervention.
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Mooren P, Gobin L, Bostan N, Wouters K, Zakaria N, Mathysen DGP, Koppen C. Evaluation of UVA Cytotoxicity for Human Endothelium in an Ex Vivo Corneal Cross-linking Experimental Setting. J Refract Surg 2016; 32:41-6. [PMID: 26812713 DOI: 10.3928/1081597x-20151207-05] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 09/22/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate endothelial cytotoxicity after exposure of human corneas to ultraviolet-A (UVA) (λ = 365 nm; 5.4 J/cm(2)) in an experimental ex vivo corneal cross-linking setting. METHODS Sixteen pairs of human donor corneas were cut into two pieces. One piece of each cornea was treated with 0.025% riboflavin solution prior to UVA irradiation (5 minutes; 18 mW/cm(2)), whereas the other piece was not irradiated but treated with riboflavin (right eye) or preservation medium (left eye). By irradiating from the endothelial side, the UVA dosage applied to endothelial cells exceeded at least eight times the cytotoxic threshold established in animal models (0.65 J/cm(2)). Endothelial cell counts were performed by two independent investigators after storage (4 to 5 days at 31 °C) and staining (trypan blue, alizarin red). Normality (Q-Q plot; Shapiro-Wilk test) and equivalence (mixed-effects modeling with a 10% equivalence threshold) of the endothelial cell counts of the different groups were evaluated. RESULTS Equivalence of mean endothelial cell density between both groups was observed: 2,237 ± 208 cells/mm(2) in UVA-irradiated pieces and 2,290 ± 281 cells/mm(2) in control pieces (mean difference of 53 ± 240 cells/mm(2) between both groups). CONCLUSIONS Despite direct irradiation of human donor endothelium using the clinical dosage for cross-linking, equivalence in endothelial cell counts was observed between irradiated tissues and controls. Ex vivo human corneal endothelial cells seem to be far more resistant to riboflavin-enhanced UVA irradiation than previously estimated by animal experiments.
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Arnalich-Montiel F, Alió Del Barrio JL, Alió JL. Corneal surgery in keratoconus: which type, which technique, which outcomes? EYE AND VISION 2016; 3:2. [PMID: 26783544 PMCID: PMC4716637 DOI: 10.1186/s40662-016-0033-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 01/09/2016] [Indexed: 12/13/2022]
Abstract
Keratoconus is a disease characterized by progressive thinning, bulging, and distortion of the cornea. Advanced cases usually present with loss of vision due to high irregular astigmatism. A majority of these cases require surgical intervention. This review provides an update on the current treatment modalities of corneal surgery available for the management of advanced corneal ectasias.
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Affiliation(s)
- Francisco Arnalich-Montiel
- IRYCIS. Ophthalmology Department, Ramón y Cajal University Hospital, Madrid, Spain ; Cornea Unit, Hospital Vissum Madrid, Madrid, Spain
| | - Jorge L Alió Del Barrio
- Cornea and External Diseases Service, Moorfields Eye Hospital, London, UK ; Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain
| | - Jorge L Alió
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain ; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Parker JS, van Dijk K, Melles GRJ. Treatment options for advanced keratoconus: A review. Surv Ophthalmol 2015; 60:459-80. [PMID: 26077628 DOI: 10.1016/j.survophthal.2015.02.004] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
Traditionally, the mainstay of treatment for advanced keratoconus (KC) has been either penetrating or deep anterior lamellar keratoplasty (PK or DALK, respectively). The success of both operations, however, has been somewhat tempered by potential difficulties and complications, both intraoperatively and postoperatively. These include suture and wound-healing problems, progression of disease in the recipient rim, allograft reaction, and persistent irregular astigmatism. Taken together, these have been the inspiration for an ongoing search for less troublesome therapeutic alternatives. These include ultraviolet crosslinking and intracorneal ring segments, both of which were originally constrained in their indication exclusively to eyes with mild to moderate disease. More recently, Bowman layer transplantation has been introduced for reversing corneal ectasia in eyes with advanced KC, re-enabling comfortable contact lens wear and permitting PK and DALK to be postponed or avoided entirely. We offer a summary of the current and emerging treatment options for advanced KC, aiming to provide the corneal specialist useful information in selecting the optimal therapy for individual patients.
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Affiliation(s)
- Jack S Parker
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; UAB Callahan Eye Hospital, Birmingham, Alabama, USA
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, The Netherlands; Melles Cornea Clinic, Rotterdam, The Netherlands; Amnitrans EyeBank, Rotterdam, The Netherlands.
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