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Guclu H, Sattarpanah S, Gurlu V. Association of Changes in Thickness of Limbal Epithelial and Stroma with Corneal Scars Detected by High-Resolution Anterior Segment Optic Coherence Tomography. Klin Monbl Augenheilkd 2024; 241:744-750. [PMID: 35504299 DOI: 10.1055/a-1842-2683] [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: 10/18/2022]
Abstract
AIM To investigate the corneal central and limbal thickness in cornea scar patients using high-resolution anterior segment optical coherence tomography (AS-OCT) and to determine the changes in the limbal region due to the corneal scar. Also, to evaluate tear film parameters in scar patients. METHODS Thirty patients with central corneal scar and 30 control subjects. The control subjects were healthy individuals who came to our clinic for routine ophthalmological examination. They were enrolled in this matched case-control study. Central epithelial thickness (ET), stromal thickness (ST), limbal epithelial thickness (LET), and limbal stromal thickness (LST) were analyzed using high-resolution AS-OCT. For evaluation of the ocular surface, the following techniques were used: tear break-up time (BUT) employing standard sterile strips of fluorescein sodium, Schirmer test-I (SCH), and the Ocular Surface Disease Index (OSDI) Questionnaire. RESULTS The mean central ET of the patient group was 51.5 ± 12.4 µm, while the mean central ET of the control group was 59.2 ± 9.0 µm. There was a statistically significant difference between patients and controls (p = 0.008). The mean LST of the patients was 747.9 ± 115.7 µm, and the mean LST of the controls was 726.3 ± 79.7 µm. There was a statistically significant difference between patients and controls according to BUT (p = 0.009) and SCH (p = 0.04). However, there was no significant difference between OSDI results of patients and controls (p = 0.08). CONCLUSION Corneal monitoring with high-resolution AS-OCT is a simple, noninvasive, useful technique for corneal scar patients. Cornea scars cause decreased ET. This result could be associated with lower tear film parameters in scar patients. The scar length is associated with higher intraocular pressure (IOP) values. Decreased LET and increased LST were detected in scar patients.
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Affiliation(s)
- Hande Guclu
- Ophthalmology, Trakya University, Faculty of Medicine, Edirne, Turkey
| | | | - Vuslat Gurlu
- Ophthalmology, Trakya University, Faculty of Medicine, Edirne, Turkey
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Cheng J, Yang L, Ye Y, He L, Chen S, Wang J. Mendelian Randomisation Analysis of Causal Association between Lifestyle, Health Factors, and Keratoconus. Bioengineering (Basel) 2024; 11:221. [PMID: 38534495 DOI: 10.3390/bioengineering11030221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 02/22/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024] Open
Abstract
Keratoconus (KC), a leading cause of vision impairment, has an unclear aetiology. This study used Mendelian randomization (MR) to explore the causal links between various factors (smoking, asthma, Down syndrome, inflammatory bowel disease, atopic dermatitis, and serum 25-hydroxyvitamin D levels) and KC. A two-sample MR design, grounded in genome-wide association study (GWAS) summary statistics, was adopted using data from FinnGen, UK Biobank, and other GWAS-related articles. The inverse-variance weighted (IVW) method was employed, complemented by the Wald ratio method for factors with only one single-nucleotide polymorphism (SNP). Sensitivity and stability were assessed through Cochrane's Q test, the MR-Egger intercept test, MR-PRESSO outlier test, and the leave-one-out analysis. The IVW results for the ORA (Ocular Response Analyzer) biomechanical parameters indicated significant associations between tobacco smoking (CH: p < 0.001; CRF: p = 0.009) and inflammatory bowel disease (CH: p = 0.032; CRF: p = 0.001) and corneal biomechanics. The Wald ratio method showed tobacco smoking was associated with a lower risk of KC (p = 0.024). Conversely, asthma (p = 0.009), atopic dermatitis (p = 0.012), inflammatory bowel disease (p = 0.017), and serum 25-hydroxyvitamin D levels (p = 0.039) were associated with a higher risk of KC by IVW, and the same applied to Down syndrome (p = 0.004) using the Wald ratio. These results underscore the role of corneal biomechanics as potential mediators in KC risk, warranting further investigation using Corvis ST and Brillouin microscopy. The findings emphasise the importance of timely screening for specific populations in KC prevention and management.
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Affiliation(s)
- Jiaxuan Cheng
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Lanting Yang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Yishan Ye
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Lvfu He
- Department of Ophthalmology, Sichuan Mental Health Center, Mianyang 621054, China
| | - Shihao Chen
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
| | - Junjie Wang
- National Engineering Research Center of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- NMPA Key Laboratory for Clinical Research and Evaluation of Medical Devices and Drug for Ophthalmic Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou 325027, China
- Department of Ophthalmology, Sichuan Mental Health Center, Mianyang 621054, China
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3
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Polania-Baron EJ, Gonzalez-Lubcke E, Graue-Hernandez EO, Ramirez-Miranda A, Navas A. Optical coherence tomography findings of cyanoacrylate glue patch in corneal perforations. Am J Ophthalmol Case Rep 2022; 27:101576. [PMID: 35599953 PMCID: PMC9121234 DOI: 10.1016/j.ajoc.2022.101576] [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: 11/05/2020] [Revised: 04/18/2022] [Accepted: 05/04/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To report a cases series of corneal perforations treated with cyanoacrylate glue patch (CGP) assessed with optical coherence tomography for monitoring corneal status in long-term follow-up examinations. Observations CPG was successfully used as primary treatment in three cases of corneal perforations. Spontaneous loosening or dislodging of the CPG did not occur in the follow-up. Anterior segment optical coherence tomography (AS-OCT) was performed to monitor wound healing at the site of perforation before considering the CGP removal. The presence of normal epithelium layer beneath the glue patch and stromal regeneration tissue were confirmed by AS-OCT, and glue patch was safely removed. Conclusions and importance The area of healing tissue beneath the CGP may not be easy to evaluate using the slit-lamp microscopy alone. AS-OCT is a useful tool in the assessment of corneal healing tissue in the presence of cyanoacrylate glue patch.
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4
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Uyar E, Sarıbaş F. Evaluating Depth and Width of Corneal Wounds Using Anterior Segment Optical Coherence Tomography After Foreign Body Removal. Semin Ophthalmol 2022; 37:774-779. [PMID: 35830289 DOI: 10.1080/08820538.2022.2100712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
PURPOSE To determine corneal foreign body (FB) location together with corneal wound depth and width by using anterior segment optical coherence tomography (AS-OCT) after uncomplicated FB removal. METHOD This prospective study was conducted with patients injured by a superficial metallic corneal FB. Under slit-lamp examination, after determining its location, the FB was removed with a 27-G needle. The depth and width of the corneal wound and the thinnest stromal thickness at the wound site were measured initially using AS-OCT. Measurements were repeated to assess the wound healing process at one week and at two months following FB removal. RESULTS Totally, 63 eyes of 63 patients were included in this study. The average age was 35.8 ± 11.0 years, and 96.8% of the patients were men. In terms of location of the FBs, 26 (41.3%) were in the central region, 21 (33.3%) were in the paracentral region, and 16 (25.4%) were in peripheral regions. The mean depth and width of the corneal wounds were 117.0 ± 42.5 µm and 332.9 ± 99.4 µm, respectively. The mean percentage of corneal wound depth was 18.9 ± 6.1%. In 20 patients who presented for follow-up, it was observed that the width of the wound increased and the thinnest stromal thickness at the wound site decreased over the two months. CONCLUSION The AS-OCT findings of the present study showed that the corneal FBs generally affected the anterior cornea with less than approximately 0.2 mm depth and 0.5 mm width. In addition, FBs were commonly located in the central and paracentral cornea.
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Affiliation(s)
- Enes Uyar
- Department of Ophthalmology, Aksaray Training and Research Hospital, Aksaray University, Aksaray, Turkey
| | - Ferhat Sarıbaş
- Department of Ophthalmology, Aksaray Training and Research Hospital, Aksaray University, Aksaray, Turkey
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Alghamdi A, Khan MS, Dakhil TA. Understanding Corneal Epithelial Thickness Mapping. Middle East Afr J Ophthalmol 2022; 29:147-155. [PMID: 37408717 PMCID: PMC10319081 DOI: 10.4103/meajo.meajo_207_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/31/2022] [Accepted: 03/06/2023] [Indexed: 07/07/2023] Open
Abstract
Corneal epithelial thickness (CET) and the regional variations in response to changes in corneal architecture and biomechanics have recently drawn the interest of corneal surgeons. Corneal epithelium possesses the tremendous capability of remodeling and changing its thickness. This remodeling of corneal epithelium takes place in response to underlying stromal irregularities which can result from a variety of corneal disorders including corneal ectasia. Measurement of CET can reveal the underlying stromal abnormalities and supplement in early diagnosis of corneal disorders especially corneal ectasia which has been one of the leading challenges in planning corneal refractive surgery. A significant number of patients ends up in ectasia after refractive surgery and the most common cause of this complication is the presence of preoperative subclinical keratoconus. Furthermore, postoperative complications of corneal refractive surgery are partly masked by epithelial remodeling and make the diagnosis and management difficult and extremely challenging. This leads not only to unpredictable visual and refractive outcome but also the need of multiple interventions to treat these complications. Although corneal tomography is considered as gold standard in the detection and diagnosis of corneal ectasia, a small number of subclinical cases may still go undetected. In this review, we have highlighted the underlying mechanism of epithelial remodeling, the devices and imaging modalities used to measure CET, and application of epithelial mapping in the diagnosis and management of various corneal disorders.
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Affiliation(s)
- Abdullah Alghamdi
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Muhammad S. Khan
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Turki A. Dakhil
- Department of Ophthalmology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Bonzano C, Olivari S, Cutolo CA, Macrì A, Sindaco D, Borroni D, Bonzano E, Traverso CE. Recombinant Human Nerve Growth Factor (Cenegermin)–Driven Corneal Wound Healing Process: An Evidence-Based Analysis. Front Pharmacol 2022; 12:760507. [PMID: 35153738 PMCID: PMC8832138 DOI: 10.3389/fphar.2021.760507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate anterior segment optical coherence tomography (AS-OCT) to detect the wound healing process as per monitoring the effectiveness of cenegermin to treat moderate to severe neurotrophic keratoplasty. Methods: A retrospective chart review was realized to identify patients treated with cenegermin at the Clinica Oculistica, University of Genoa, Italy. All patients underwent careful examinations at baseline and follow-up visits. AS-OCT scans centered on the minimum corneal thickness (CT) area were always performed. We compared findings of AS-OCT with the findings from the slit-lamp examination. A linear regression analysis was used to evaluate factors associated with corneal healing. A further analysis, including a control group treated with 50% autologous serum (AS), was done to investigate and compare the efficacy of cenegermin. Results: Data from 16 eyes were studied. The average patients' age was 60.9 ± 21.1 years; five (31.2%) eyes experienced persistent epithelial defect and 11 (68.8%) eyes had neurotrophic corneal ulcer. The average reepithelialization time was 3.9 ± 0.5 weeks in the cenegermin group versus 5.9 ± 1.9 weeks in the AS group (p < 0.01). The AS‐OCT scans revealed an average CT at the thinnest point of 276.3 ± 74.1 μm before treatment with an average increase of 176.5 ± 60.3 μm at the end of the cenegermin treatment (B = −0.15; p = 0.035). The AS-OCT percentage increase in corneal thickness between the two groups was statistically significant (p < 0.02). Conclusion: Understanding the cascade of events involved in the nerve growth factor–driven corneal wound healing process is clinically meaningful for the clinician. AS-OCT is an effective tool for systematic anterior segment imaging, allowing the detailed detection of the front-to-back layered corneal structure for quantitative analysis and monitoring of the healing process.
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Affiliation(s)
- Chiara Bonzano
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
- *Correspondence: Chiara Bonzano,
| | - Sara Olivari
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Carlo Alberto Cutolo
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Angelo Macrì
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Daniele Sindaco
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Davide Borroni
- Cornea Unit, Royal Liverpool University Hospital, Liverpool, United Kingdom
| | - Elisabetta Bonzano
- Department of Radiation Oncology, IRCCS San Matteo Polyclinic Foundation, Pavia, Italy
- PhD School in Experimental Medicine, University of Pavia, Pavia, Italy
| | - Carlo Enrico Traverso
- Eye Clinic, Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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Veerappa AM. Cascade of interactions between candidate genes reveals convergent mechanisms in keratoconus disease pathogenesis. Ophthalmic Genet 2021; 42:114-131. [PMID: 33554698 DOI: 10.1080/13816810.2020.1868013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Keratoconus is a progressive thinning, steepening and distortion of the cornea which can lead to loss of vision if left untreated. Keratoconus has a complex multifactorial etiology, with genetic and environmental components contributing to the disease pathophysiology. Studies have observed high concordance between monozygotic twins, discordance between dizygotic twins, and high familial segregation indicating the presence of a very strong genetic component in the pathogenesis of keratoconus. The use of genome-wide linkage studies on families and twins, genome-wide association studies (GWAS) on case-controls, next-generation sequencing (NGS)-based genomic screens on both familial and non-familial cohorts have led to the identification of keratoconus candidate genes with much greater success and increased resproducibility of genetic findings. This review focuses on candidate genes identified till date and attempts to understand their role in biological processes underlying keratoconus pathogenesis. In addition, using these genes I propose molecular pathways that could contribute to keratoconus pathogenesis. The pathways identified the presence of direct cross-talk between known candidate genes of keratoconus and remarkably, 28 known candidate genes have a direct relationship among themselves that involves direct protein-protein binding, regulatory activities such as activation and inhibition, chaperone, transcriptional activation/co-activation, and enzyme catalysis. This review attempts to describe these relationships and cross-talks in the context of keratoconus pathogenesis.
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Affiliation(s)
- Avinash M Veerappa
- Department of Ophthalmology, NYU Langone Medical Center, New York, New York, USA
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8
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Zhang Y, Ling Y, Zhang D, Wang M, Purslow C, Yang Y, Li C, Huang Z. Quantitative measurement of mechanical properties in wound healing processes in a corneal stroma model by using vibrational optical coherence elastography (OCE). BIOMEDICAL OPTICS EXPRESS 2021; 12:588-603. [PMID: 33659091 PMCID: PMC7899504 DOI: 10.1364/boe.404096] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 05/11/2023]
Abstract
Corneal wound healing, caused by frequent traumatic injury to the cornea and increasing numbers of refractive surgeries, has become a vital clinical problem. In the cornea, wound healing is an extremely complicated process. However, little is known about how the biomechanical changes in wound healing response of the cornea. Collagen-based hydrogels incorporating corneal cells are suitable for replicating a three-dimensional (3D) equivalent of the cornea in-vitro. In this study, the mechanical properties of corneal stroma models were quantitatively monitored by a vibrational optical coherence elastography (OCE) system during continuous culture periods. Specifically, human corneal keratocytes were seeded at 5 × 105 cells/mL in the hydrogels with a collagen concentration of 3.0 mg/mL. The elastic modulus of the unwounded constructs increased from 2.950 ± 0.2 kPa to 11.0 ± 1.4 kPa, and the maximum thickness decreased from 1.034 ± 0.1 mm to 0.464 ± 0.09 mm during a 15-day culture period. Furthermore, a traumatic wound in the construct was introduced with a size of 500 µm. The elastic modulus of the neo-tissue in the wound area increased from 1.488 ± 0.4 kPa to 6.639 ± 0.3 kPa over 13 days. This study demonstrates that the vibrational OCE system is capable of quantitative monitoring the changes in mechanical properties of a corneal stroma wound model during continuous culture periods and improves our understanding on corneal wound healing processes.
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Affiliation(s)
- Yilong Zhang
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK
| | - Yuting Ling
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK
| | - Duo Zhang
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK
| | - Mingkai Wang
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK
| | - Christine Purslow
- Thea Pharmaceuticals Ltd, Keele University Science & Innovation Park, Innovation Way, Stoke-on-Trent, ST5 5NT, UK
| | - Ying Yang
- Guy Hilton Research Center, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, ST4 7QB, UK
| | - Chunhui Li
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK
| | - Zhihong Huang
- School of Science and Engineering, University of Dundee, Dundee DD1 4HN, Scotland, UK
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9
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Guyonnet A, Desquilbet L, Faure J, Bourguet A, Donzel E, Chahory S. Outcome of medical therapy for keratomalacia in dogs. J Small Anim Pract 2020; 61:253-258. [PMID: 32065393 DOI: 10.1111/jsap.13118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2017] [Revised: 12/22/2019] [Accepted: 01/23/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To evaluate the clinical and visual outcomes following intensive medical therapy for keratomalacia in dogs. MATERIALS AND METHODS Medical records were screened to identify dogs with corneal ulcers and keratomalacia. All patients were given the same topical treatment protocol with frequent administrations of tobramycin in combination with equine serum. Surgical treatment during the first 15 days of follow-up was considered as medical treatment failure. RESULTS We report on 57 ulcers with keratomalacia from 53 dogs. Medical treatment was successful in 31 of 57 ulcers with a median healing time of 5 days (range 2 to 15 days). At 60 days after epithelialisation, 14/15 medically-treated eyes were visual. In one case, corneal perforation was observed 1 month after healing and required surgical stabilisation. CLINICAL SIGNIFICANCE Intensive medical therapy has the potential to achieve healing of some ulcers with keratomalacia. Surgical stabilisation in response to progression of stromal loss was required in less than half of the cases.
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Affiliation(s)
- A Guyonnet
- Unité d'Ophtalmologie, CHUVA, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
| | - L Desquilbet
- BioPôle, Unité de Biostatistique et d'épidémiologie, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
| | - J Faure
- Unité d'Ophtalmologie, CHUVA, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
| | - A Bourguet
- Unité d'Ophtalmologie, CHUVA, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
| | - E Donzel
- Unité d'Ophtalmologie, CHUVA, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
| | - S Chahory
- Unité d'Ophtalmologie, CHUVA, Ecole Nationale Vétérinaire d'Alfort, Maisons-Alfort, F-94700, France
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10
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Liu X, Kolli S, McDonnell P, Patel A, Quinlan M, Skym K, Denniston AK, Shah P, Williams GP. Patient priorities in herpes simplex keratitis. BMJ Open Ophthalmol 2019; 4:e000177. [PMID: 31179387 PMCID: PMC6528774 DOI: 10.1136/bmjophth-2018-000177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Objective Herpes simplex keratitis (HSK) is a sight-threatening disease and a leading cause of infectious corneal blindness. Involving patients in setting the research agenda maximises patient benefit and minimises research waste. With no published patient involvement exercises, patients' priorities in HSK are unclear. The objective of this study is to explore patients' priorities for research in HSK. Methods A literature review of publications in the year preceding recruitment of patients identified nine domains of research interest. A questionnaire was sent to participants asking them to rank these in order of priority. The ranking results were given a weighted-average score, and a thematic analysis was undertaken for the narrative data. Results Thirty-seven patients participated in the survey. Top priorities for patients were risk factors for recurrence of infection, diagnostic tests and treatment failure. The narrative data revealed three key clinical needs: difficulties in long-term symptom control, the need for rapid access care in acute infection and the desire for more accessible information. Conclusion This study highlighted three major issues in our current approach to HSK. First, there may be a misalignment between research efforts and patient priorities. Second, high-quality patient information is not widely available. This may hamper patients' abilities to make informed decisions and contribute towards research. Third, clinical service priorities are of equal importance to patients as research. Researchers and clinicians are encouraged to address both needs in parallel.
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Affiliation(s)
- Xiaoxuan Liu
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Sai Kolli
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter McDonnell
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Amit Patel
- Department of Ophthalmology, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Michael Quinlan
- Birmingham Midlands Eye Centre, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Kevin Skym
- Herpes Simplex Keratitis Patient Group, Birmingham, UK
| | - Alastair K Denniston
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Peter Shah
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Geraint P Williams
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Department of Ophthalmology, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
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11
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Comparison of Corneal Epithelial Remodeling Over 2 Years in LASIK Versus SMILE: A Contralateral Eye Study. Cornea 2018; 38:290-296. [DOI: 10.1097/ico.0000000000001821] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Wu SY, Pan CY, Shen EP, Tzeng IS, Hsu WC. The healing effect of the collagen-glycosaminoglycan copolymer on corneal thinning. BMC Ophthalmol 2018; 18:275. [PMID: 30359250 PMCID: PMC6203210 DOI: 10.1186/s12886-018-0947-3] [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: 08/08/2018] [Accepted: 10/16/2018] [Indexed: 12/13/2022] Open
Abstract
Background To study the healing processes of partial thickness wounds in the adult rabbit cornea after grafting a porous collagen-glycosaminoglycan copolymer matrix (CG). Methods In this study, the regeneration of surgically-induced rabbit corneal defect implanted with CG was investigated. The corneal partial thickness wound was created by 7.5 mm trephine. The wound was implanted with CG. Effects on wound healing was analyzed using clinical data on epithelial migration and corneal thickness, and histological data on collagen and alpha smooth muscle actin distribution. Results Compared with control group, CG induced a relatively severe inflammatory reaction in grafted cornea until the CG matrix was completely degraded. The new vessel ingrowth and stromal regeneration maintained the corneal thickness. The grafted cornea was significantly thicker (P < 0.001) than the control group. On day 90, the corneal opacity score of the control group was one and the grafted cornea was two. Conclusion CG copolymer matrix can successfully repair the damaged corneal stroma by injury, and regain its thickness. However, CG matrix induced inflammatory healing process thus causing mild corneal haziness and neovascularization.
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Affiliation(s)
- Shu-Ya Wu
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., New Taipei City 231, Taipei, Taiwan (R.O.C.)
| | | | - Elizabeth P Shen
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., New Taipei City 231, Taipei, Taiwan (R.O.C.)
| | - I-Shiang Tzeng
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Wei-Cherng Hsu
- Department of Ophthalmology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 289, Jianguo Rd., Xindian Dist., New Taipei City 231, Taipei, Taiwan (R.O.C.). .,Tzu Chi University College of Medicine, Hualien, Taiwan.
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Alzahrani K, Carley F, Brahma A, Morley D, Hillarby MC. Corneal clarity measurements in healthy volunteers across different age groups: Observational study. Medicine (Baltimore) 2017; 96:e8563. [PMID: 29145265 PMCID: PMC5704810 DOI: 10.1097/md.0000000000008563] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to standardize and investigate the changes in corneal clarity with age. Densitometry software for the Oculus Pentacam was used to examine corneal clarity at different age groups.A total of 192 eyes from 97 healthy participants were included in this cohort comparative nonrandomized, cross-sectional study. An Oculus Pentcam was used to image the cornea of healthy participants grouped by age (between 10 and 70 years old). Data from the densitometry output have been used to determine clarity in concentric zones and different depths of the cornea.Corneal densitometry (CD) across all ages showed significant differences between groups when divided into the following layers: anterior, central, and posterior or divided into 0 to 2, 2 to 6, and 6 to 10 mm concentric zones (P < .05). The most striking decrease in clarity occurred with age in all 3 layers of the periphery (6-10 mm) (P < .05). In addition, we showed that the 10 to 19-year age group had lower clarity than the 20 to 30-age group (P < .05), and after 30 years, the cornea shows a steady progression of increased or decreased clarity.The values for CD, as well as for separate subdivisions based on layer and surface area, might provide a standard for use in further studies and clinical practice. This study established that relation between CD and age is differed when the cornea is divided into layers and zones. This study suggests that there are other factors that may play an essential role in corneal clarity as well as age.
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Affiliation(s)
- Khaled Alzahrani
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester
| | | | - Arun Brahma
- Manchester Royal Eye Hospital, Manchester, UK
| | | | - M. Chantal Hillarby
- Division of Pharmacy and Optometry, School of Health Sciences, University of Manchester
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Zheng KK, Cai J, Rong SS, Peng K, Xia H, Jin C, Lu X, Liu X, Chen H, Jhanji V. Longitudinal Evaluation of Wound Healing after Penetrating Corneal Injury: Anterior Segment Optical Coherence Tomography Study. Curr Eye Res 2017. [PMID: 28632029 DOI: 10.1080/02713683.2016.1274038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Ocular imaging can enhance our understanding of wound healing. We report anterior segment optical coherence tomography (ASOCT) findings in penetrating corneal injury. METHODS Serial ASOCT was performed after repair of penetrating corneal injury. Internal aberrations of wound edges were labeled as "steps" or "gaps" on ASOCT images. The wound type was characterized as: type 1: continuous inner wound edge or step height ≤ 80 µm; type 2: step height > 80 µm; type 3: gap between wound edges; and type 4: intraocular tissue adherent to wound. Surgical outcomes of different wound types were compared. RESULTS 50 consecutive patients were included (6 females, 44 males; mean age 33 ± 12 years). The average size of wound was 4.2 ± 2.6 mm (type 1, 8 eyes; type 2, 27 eyes; type 3, 12 eyes; type 4, 3 eyes). At the end of 3 months, 70% (n = 35) of the wounds were type 1. At the end of 6 months, all type 1 wounds had healed completely, whereas about half of type 2 (48.1%) and type 3 (50%) wounds had recovered to type 1 configuration. The wound type at baseline affected the height of step (p = 0.047) and corneal thickness at 6 months (p = 0.035). CONCLUSIONS ASOCT is a useful tool for monitoring wound healing in cases with penetrating corneal injury. Majority of the wound edges appose between 3 and 6 months after trauma. In our study, baseline wound configuration affected the healing pattern.
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Affiliation(s)
- Kang Keng Zheng
- a Joint Shantou International Eye Center , Shantou University and the Chinese University of Hong Kong, Shantou , Guangdong Province , China
| | - Jianhao Cai
- a Joint Shantou International Eye Center , Shantou University and the Chinese University of Hong Kong, Shantou , Guangdong Province , China
| | - Shi Song Rong
- b Department of Ophthalmology and Visual Sciences , The Chinese University of Hong Kong , Hong Kong
| | - Kun Peng
- a Joint Shantou International Eye Center , Shantou University and the Chinese University of Hong Kong, Shantou , Guangdong Province , China
| | - Honghe Xia
- a Joint Shantou International Eye Center , Shantou University and the Chinese University of Hong Kong, Shantou , Guangdong Province , China
| | - Chuan Jin
- a Joint Shantou International Eye Center , Shantou University and the Chinese University of Hong Kong, Shantou , Guangdong Province , China
| | - Xuehui Lu
- a Joint Shantou International Eye Center , Shantou University and the Chinese University of Hong Kong, Shantou , Guangdong Province , China
| | - Xinyu Liu
- a Joint Shantou International Eye Center , Shantou University and the Chinese University of Hong Kong, Shantou , Guangdong Province , China
| | - Haoyu Chen
- a Joint Shantou International Eye Center , Shantou University and the Chinese University of Hong Kong, Shantou , Guangdong Province , China.,b Department of Ophthalmology and Visual Sciences , The Chinese University of Hong Kong , Hong Kong
| | - Vishal Jhanji
- a Joint Shantou International Eye Center , Shantou University and the Chinese University of Hong Kong, Shantou , Guangdong Province , China.,b Department of Ophthalmology and Visual Sciences , The Chinese University of Hong Kong , Hong Kong
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Zheng K, Huang H, Peng K, Cai J, Jhanji V, Chen H. Change of Optical Intensity during Healing Process of Corneal Wound on Anterior Segment Optical Coherence Tomography. Sci Rep 2016; 6:32352. [PMID: 27562349 PMCID: PMC4999820 DOI: 10.1038/srep32352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 08/08/2016] [Indexed: 02/07/2023] Open
Abstract
The purpose of this study is to investigate the process of corneal wound healing after penetrating injury with the change in optical intensity on anterior segment optical coherence tomography (AS-OCT) and to investigate factors associated with severity of corneal scar. Forty-seven eyes from 47 patients with repaired corneal laceration were included. AS-OCT was performed on 1day, 1week, 1, 3 and 6 months after primary repair. Internal aberrations of wound edges were observed on AS-OCT images. Parameters including height of steps, width of gaps, maximal corneal thickness, area and optical intensity of corneal wound/scar were measured. The relationship between the parameters at day 1 and the optical intensity at 6 months were analyzed. The results showed that optical intensity of corneal wound/scar increased from 124.1 ± 18.8 on day 1 postoperatively to 129.3 ± 18.7, 134.2 ± 23.4, 139.7 ± 26.5, 148.2 ± 26.4 at 1 week, 1 month, 3 months and 6 months postoperatively. Height of steps at 1 day after surgery was the only factor identified as correlated with optical intensity of corneal scar at 6 months (beta = 0.34, p = 0.024). The increase of optical intensity represents the process of fibrosis of corneal wound healing. Higher step after suturing is associated with more severity of corneal scar at last.
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Affiliation(s)
- Kangkeng Zheng
- Joint Shantou International Eye Center, Shantou University &the Chinese University of Hong Kong, Shantou, China
| | - Haifan Huang
- Joint Shantou International Eye Center, Shantou University &the Chinese University of Hong Kong, Shantou, China
| | - Kun Peng
- Joint Shantou International Eye Center, Shantou University &the Chinese University of Hong Kong, Shantou, China
| | - Jianhao Cai
- Joint Shantou International Eye Center, Shantou University &the Chinese University of Hong Kong, Shantou, China
| | - Vishal Jhanji
- Department of Ophthalmology and Visual Sciences, the Chinese University of Hong Kong, Hong Kong, China
| | - Haoyu Chen
- Joint Shantou International Eye Center, Shantou University &the Chinese University of Hong Kong, Shantou, China
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Kato K, Hirano K, Takashima Y, Sakamoto S, Kondo M. Histopathologic findings of perforated corneas due to ferric ion infiltration. Can J Ophthalmol 2015; 50:322-7. [PMID: 26257229 DOI: 10.1016/j.jcjo.2015.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 05/03/2015] [Accepted: 05/29/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To report the histopathologic findings of 3 corneal buttons incised from 2 patients during penetrating keratoplasty (PKP) because of corneal perforation due to corneal siderosis. METHODS Three eyes of 2 patients had accidental trauma to the corneas caused by iron fragments; the injuries were initially treated conservatively with antibiotics and therapeutic soft contact lenses. However, the corneal stroma melted and perforated, necessitating corneal transplantation. The corneal buttons removed during PKP were examined histopathologically, and the findings were compared with the slit-lamp biomicroscopic and anterior segment optical coherence tomographic (AS-OCT) findings. RESULTS Slit-lamp examinations showed that the corneal epithelium was hyperplasic around the area of perforation in 2 eyes 1 month after the injury. Wide areas of the stroma had melted, and the corneas were perforated. The corneal epithelium was atrophic in the perforated corneas 4 months after injury. Histopathologically, the corneal stroma and Descemet's membrane were stained by Prussian blue, suggesting that the ferric ions had penetrated deeper than expected by the slit-lamp examinations. The areas of Prussian blue staining corresponded well with the areas altered in the AS-OCT images. CONCLUSIONS Ferric ions penetrate much deeper into the cornea than estimated by slit-lamp biomicroscopy. The ferric ions can induce stromal melting that can lead to corneal perforation. We conclude that (i) the ferric ion-infiltrated areas can be estimated in the AS-OCT images and (ii) extensive corneal abrasion should be performed to prevent corneal melting and perforation.
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Affiliation(s)
- Kumiko Kato
- Department of Ophthalmology, Mie University School of Medicine, Tsu City, Japan.
| | - Koji Hirano
- Department of Ophthalmology, Ban Buntane Houtokukai Hospital, School of Medicine, Fujita Health University, Nagoya, Japan
| | - Yuko Takashima
- Department of Ophthalmology, Mie University School of Medicine, Tsu City, Japan
| | - Satoe Sakamoto
- Department of Ophthalmology, Mie University School of Medicine, Tsu City, Japan
| | - Mineo Kondo
- Department of Ophthalmology, Mie University School of Medicine, Tsu City, Japan
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