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Abtahi MA, Beheshtnejad AH, Latifi G, Akbari-Kamrani M, Ghafarian S, Masoomi A, Sonbolastan SA, Jahanbani-Ardakani H, Atighechian M, Banan L, Nouri H, Abtahi SH. Corneal Epithelial Thickness Mapping: A Major Review. J Ophthalmol 2024; 2024:6674747. [PMID: 38205099 PMCID: PMC10776199 DOI: 10.1155/2024/6674747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 06/27/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
The corneal epithelium (CE) is the outermost layer of the cornea with constant turnover, relative stability, remarkable plasticity, and compensatory properties to mask alterations in the underlying stroma. The advent of quantitative imaging modalities capable of producing epithelial thickness mapping (ETM) has made it possible to characterize better the different patterns of epithelial remodeling. In this comprehensive synthesis, we reviewed all available data on ETM with different methods, including very high-frequency ultrasound (VHF-US) and spectral-domain optical coherence tomography (SD-OCT) in normal individuals, corneal or systemic diseases, and corneal surgical scenarios. We excluded OCT studies that manually measured the corneal epithelial thickness (CET) (e.g., by digital calipers) or the CE (e.g., by confocal scanning or handheld pachymeters). A comparison of different CET measuring technologies and devices capable of producing thickness maps is provided. Normative data on CET and the possible effects of gender, aging, diurnal changes, refraction, and intraocular pressure are discussed. We also reviewed ETM data in several corneal disorders, including keratoconus, corneal dystrophies, recurrent epithelial erosion, herpes keratitis, keratoplasty, bullous keratopathy, carcinoma in situ, pterygium, and limbal stem cell deficiency. The available data on the potential role of ETM in indicating refractive surgeries, planning the procedure, and assessing postoperative changes are reviewed. Alterations in ETM in systemic and ocular conditions such as eyelid abnormalities and dry eye disease and the effects of contact lenses, topical medications, and cataract surgery on the ETM profile are discussed.
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Affiliation(s)
| | | | - Golshan Latifi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sadegh Ghafarian
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Masoomi
- Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | | | - Laleh Banan
- Sunshine Coast University Hospital, Brisbane, Queensland, Australia
| | - Hosein Nouri
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed-Hossein Abtahi
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yang J, Zhang X, Zhong M, Bai Y, Liu W, Hu J, Wang W. Effects of brimonidine tartrate 0.2 and 0.15% ophthalmic solution on the static and dynamic pupil characteristics. Front Med (Lausanne) 2023; 10:1160414. [PMID: 37256086 PMCID: PMC10225522 DOI: 10.3389/fmed.2023.1160414] [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: 02/07/2023] [Accepted: 04/28/2023] [Indexed: 06/01/2023] Open
Abstract
Aims To investigate the differences between 0.2 and 0.15% brimonidine tartrate eye drops for anti-mydriatic effects and the optical quality under different light conditions. Methods This prospective study involved 80 consecutive high myopia patients undergoing implantation of a V4c ICL. The patients were randomly instilled with brimonidine 0.2 and 0.15% 2 weeks postoperatively. Visual quality, pupil center, pupil size, and refraction under different light conditions were measured before and 0.5 h after brimonidine administration. A symptom questionnaire was also evaluated. Results There was no statistical difference in the static and dynamic pupil diameters and velocity after LS between the two groups (p > 0.05). The 0.2% group had significant changes in pupil center before and after treatment, while there was no obvious movement of the 0.15% group under all illumination condition (p > 0.05). The OSI after treatment of the 0.15% group was lower than that of 0.2% group (p = 0.012). The PVA9% and PVA100% of the 0.15% group was higher than that of 0.2% group in the dark (p = 0.009, p = 0.012). The HOA RMS of the 0.15% group was lower than that of 0.2% group (p = 0.016). The QIRC score in the 0.15% group was significantly higher than that in the 0.2% group (p = 0.043). Conclusion 0.15 and 0.2% brimonidine tartrate eye drops had similar anti-mydriatic ability, while 0.15% group had better visual quality than 0.2% concentration, and hardly introduced pupil shift. 0.15% brimonidine tartrate eye drops may be more suitable for patients with nocturnal glare symptoms in the early postoperative period after ICL implantation.
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Bu Q, Hu D, Zhu H, Jiang J, Su Y, Wu J, Li Z, Pan X. Swept-source optical coherence tomography and ultrasound biomicroscopy study of anterior segment parameters in primary angle-closure glaucoma. Graefes Arch Clin Exp Ophthalmol 2023; 261:1651-1658. [PMID: 36627493 DOI: 10.1007/s00417-022-05970-6] [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: 10/02/2022] [Revised: 12/12/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To evaluate the agreement between swept-source OCT (CASIA2) and UBM in primary angle-closure glaucoma. METHODS Eighty eyes of 40 participants diagnosed with primary angle-closure glaucoma were examined. Parameters measured included angle opening distance (AOD), angle recess area (ARA), trabecular iris space area (TISA), trabecular iris angle (TIA), lens vault (LV), anterior chamber depth (ACD), and anterior chamber width (ACW). Angle images of nasal, temporal, superior, and inferior were acquired by the anterior segment mode of CASIA2 and UBM. One-way analysis of variance and paired t-test were used for statistical analysis, and the agreement was analyzed by internal correlation coefficient (ICC) and Bland-Altman method. RESULTS One-way ANOVA pairwise comparison showed that CASIA2 or UBM had the narrowest superior chamber angle and the widest temporal chamber angle in patients with primary angle-closure glaucoma. The paired t-test showed that inter-device AOD, TIA, ARA, and TISA of superior chamber angle had significant differences (p < 0.001). There was no significant difference in the measured values of LV, ACD, and ACW (p > 0.05). The agreement of all parameters is good through the Bland-Altman method comparison. ICC result showed moderate agreement in other angle parameters except for superior ARA500 (0.739). CONCLUSION In the anterior chamber angle measurement process, we should pay more attention to the superior chamber angle covered by eyelids. Although the agreement is acceptable between CASIA2 and UBM, the measurements could not be considered interchangeable due to the tremendous statistical difference between the two devices.
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Affiliation(s)
- Qianwen Bu
- Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, Shandong, China
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, 5 Yanerdao Road, Qingdao, Shandong Province, 266071, China
| | - Die Hu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, 5 Yanerdao Road, Qingdao, Shandong Province, 266071, China
| | - Hai Zhu
- Department of Urology, Qingdao Municipal Hospital Affiliated to Qingdao Medical College of Qingdao University, Qingdao, Shandong, China
| | - Jianhong Jiang
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, 5 Yanerdao Road, Qingdao, Shandong Province, 266071, China
| | - Ying Su
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, 5 Yanerdao Road, Qingdao, Shandong Province, 266071, China
| | - Jingyi Wu
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, 5 Yanerdao Road, Qingdao, Shandong Province, 266071, China
| | - Zongyi Li
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, 5 Yanerdao Road, Qingdao, Shandong Province, 266071, China
| | - Xiaojing Pan
- State Key Laboratory Cultivation Base, Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, 5 Yanerdao Road, Qingdao, Shandong Province, 266071, China.
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Fineide F, Lagali N, Adil MY, Arita R, Kolko M, Vehof J, Utheim TP. Topical glaucoma medications – Clinical implications for the ocular surface. Ocul Surf 2022; 26:19-49. [DOI: 10.1016/j.jtos.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022]
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Ye Y, Xu Y, Yang Y, Fan Y, Liu P, Yu K, Yu M. Wide Corneal Epithelial Thickness Mapping in Eyes With Topical Antiglaucoma Therapy Using Optical Coherence Tomography. Transl Vis Sci Technol 2022; 11:4. [PMID: 34985508 PMCID: PMC8742533 DOI: 10.1167/tvst.11.1.4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose The purpose of this study was to assess the corneal epithelial thickness (CET) of the 9-mm diameter zone in patients treated using topical antiglaucoma medications and to evaluate the factors associated with CET changes. Methods Seventy-five patients treated using topical antiglaucoma medications and 65 healthy subjects were included in this cross-sectional study. Each patient completed the Ocular Surface Disease Index (OSDI) questionnaire and underwent examinations including the Schirmer I test, tear breakup time (TBUT), and fluorescein staining. CET mapping of the 9-mm diameter zone was performed using RTVue XR. The CET of the different analyzed zones was compared between groups. The relationship between CET and confounding factors was investigated. Results The patient group had a significantly shorter TBUT, shorter Schirmer I test, and greater fluorescein staining than those of the control group (all P < 0.05). The mean CET of patients with glaucoma was significantly lower than that of controls in the central, paracentral, mid-peripheral, and peripheral zones (all P < 0.001). Age affected the CET in the paracentral, mid-peripheral, and peripheral zones (all P < 0.01). The number of medications affected the CET in the central, paracentral, and mid-peripheral zones (all P < 0.05). The duration of treatment affected the CET in the central and peripheral zones (all P < 0.05). Conclusions Use of topical IOP-lowering medications leads to epithelial thinning in the 9-mm diameter zone in glaucomatous eyes. Epithelial protection should be considered in older patients and patients treated with multiple medications from the early stages of long-term topical antiglaucoma therapy. Translational Relevance The 9-mm diameter CET mapping by using widefield optical coherence tomography (OCT) can be a valuable and convenient method to assess the ocular surface damage in patients with topical antiglaucoma therapy.
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Affiliation(s)
- Yiming Ye
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yunzhi Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yangfan Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yanmei Fan
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Pingping Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Keming Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Minbin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
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Jin M, Wang Y, An X, Kang H, Wang Y, Wang G, Gao Y, Wu S, Reinach PS, Liu Z, Xue Y, Li C. Phenotypic and transcriptomic changes in the corneal epithelium following exposure to cigarette smoke. ENVIRONMENTAL POLLUTION (BARKING, ESSEX : 1987) 2021; 287:117540. [PMID: 34147784 DOI: 10.1016/j.envpol.2021.117540] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 06/12/2023]
Abstract
Cigarette smoke extract (CSE), a complex mixture of compounds, contributes to a range of eye diseases; however, the underlying pathophysiological responses to tobacco smoke remain ambiguous. The purpose of the present study was to evaluate the cigarette smoke-induced phenotypic and transcriptomic changes in the corneal epithelium with a view to elucidating the likely underlying mechanism. Accordingly, for the first time, we characterized the genome-wide effects of CSE on the corneal epithelium. The ocular surface of the mice in the experimental groups was exposed to CSE for 1 h per day for a period of one week, while mice in the control group were exposed to preservative-free artificial tears. Corneal fluorescein staining, in vivo confocal microscopy and scanning electron microscopy were performed to examine the corneal ultrastructure. Transcriptome sequencing and bioinformatics analysis were performed followed by RT-qPCR to validate gene expression changes. The results indicate that CSE exposure disrupted the structural integrity of the superficial epithelium, decreased the density of microvilli, and compromised the corneal epithelial barrier intactness. RNA-seq revealed 667 differentially expressed genes, and functional analysis highlighted the enhancement of several biological processes such as antioxidant activity and the response to oxidative stress. Moreover, the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis showed that glutathione metabolism and drug metabolism cytochrome P450 were the most relevant pathways contributing to the effects of CSE on the corneal epithelium. Protein-protein interaction (PPI) network analysis illustrated that GCLC, NQO1, and HMOX1 were the most relevant nodes. In conclusion, the present study indicates that CSE exposure induces changes in the phenotype and genotype of the corneal epithelium. The antioxidant response element is essential for counteracting the effects of cigarette smoke on this tissue layer. These results shed novel insights into how cigarette smoke damages this ocular surface.
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Affiliation(s)
- Mengyi Jin
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Yanzi Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Xiaoya An
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, 361102, China; School of Pharmaceutical Sciences, Xiamen University, Xiamen, 361102, China
| | - Honghua Kang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Yixin Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, 361102, China; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Guoliang Wang
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, 361102, China; School of Pharmaceutical Sciences, Xiamen University, Xiamen, 361102, China
| | - Yang Gao
- College of Environment and Ecology, Xiamen University, Xiamen, 361102, China
| | - Shuiping Wu
- College of Environment and Ecology, Xiamen University, Xiamen, 361102, China
| | - Peter S Reinach
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, 325035, China
| | - Zuguo Liu
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, 361102, China; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen, 361102, China
| | - Yuhua Xue
- School of Pharmaceutical Sciences, Xiamen University, Xiamen, 361102, China
| | - Cheng Li
- Eye Institute & Affiliated Xiamen Eye Center, School of Medicine, Xiamen University, Xiamen, 361102, China; Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, School of Medicine, Xiamen University, Xiamen, 361102, China.
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Hsieh TH, Yu HJ, Yang IH, Ho RW, Hsiao YT, Fang PC, Kuo MT. Simultaneously Monitoring Whole Corneal Injury with Corneal Optical Density and Thickness in Patients Undergoing Cataract Surgery. Diagnostics (Basel) 2021; 11:diagnostics11091639. [PMID: 34573979 PMCID: PMC8471687 DOI: 10.3390/diagnostics11091639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 02/05/2023] Open
Abstract
To pursue the least corneal implication during cataract surgery, this study aimed to monitor corneal wound injury after cataract surgery with a novel method. The prospective cohort study involved thirty-two patients, who were assessed by a Scheimpflug tomography AxL® (Oculus GmbH, Wetzlar, Germany) via the following two kinds of indices: whole corneal optical density (COD) and corneal thickness (CT), two weeks before and one month after cataract surgery. The results of the COD revealed that corneal annuli 0.0–2.0 mm and 2.0–6.0 mm, and the average and maximal values at the incisional site significantly increased postoperatively. Also, the anterior and central stroma of 0.0–2.0 mm, and all three depths of 2.0–6.0 mm, increased remarkably after the operation. For the CT, all ranges of diameters plus incisional sites showed significant increases postoperatively. Furthermore, we analyzed the differences (delta) of COD and CT between pre- and post-operation, and found significant correlations between the delta of COD and the delta of CT, regarding annuli 0.0–2.0 mm, 2.0–6.0 mm, and 6.0–10.0 mm, but no correlation at the incisional site, with either average density or maximal density, was detected. We concluded that whole COD and CT, especially at the central zones of the cornea (annulus < 6 mm), are both valuable parameters in the assessment of corneal damage post-cataract surgery, and are independent indices at the incisional site.
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Affiliation(s)
- Tzu-Han Hsieh
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City 83301, Taiwan;
| | - Hun-Ju Yu
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan; (H.-J.Y.); (I.-H.Y.); (R.-W.H.); (Y.-T.H.)
| | - I-Hui Yang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan; (H.-J.Y.); (I.-H.Y.); (R.-W.H.); (Y.-T.H.)
| | - Ren-Wen Ho
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan; (H.-J.Y.); (I.-H.Y.); (R.-W.H.); (Y.-T.H.)
| | - Yu-Ting Hsiao
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan; (H.-J.Y.); (I.-H.Y.); (R.-W.H.); (Y.-T.H.)
| | - Po-Chiung Fang
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan; (H.-J.Y.); (I.-H.Y.); (R.-W.H.); (Y.-T.H.)
- Correspondence: (P.-C.F.); (M.-T.K.)
| | - Ming-Tse Kuo
- Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan; (H.-J.Y.); (I.-H.Y.); (R.-W.H.); (Y.-T.H.)
- Correspondence: (P.-C.F.); (M.-T.K.)
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Assessment of Corneal Epithelium Thickness in Glaucomatous Patients Undergoing Medical Treatment. J Glaucoma 2021; 30:44-49. [PMID: 32969915 DOI: 10.1097/ijg.0000000000001677] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 09/03/2020] [Indexed: 11/25/2022]
Abstract
PRECIS Patients with glaucoma have reduced and irregular corneal epithelial thickness (CET) even if they do not report symptoms of dry eyes. The reduction of corneal epithelium affects equally the superior and inferior areas of the cornea. PURPOSE To evaluate CET parameters by means of anterior segment optical coherence tomography in glaucomatous patients undergoing medical treatment and compare them with CET parameters of controls. METHODS This was a cross-sectional study of 62 patients with primary open-angle or pseudoexfoliative glaucoma (study group) and 62 age-matched controls. Fourier-domain optical coherence tomography (RTVue) with a corneal adaptor module was used in the present study. Τhe pachymetry scan pattern was used to map the cornea and the software generated corneal thickness parameters were recorded. Simple comparisons between groups were performed and the correlations of CET parameters with parameters associated with medication use (treatment duration, number of medications and number of instillations) were assessed. RESULTS Mean age of the patients was 68±11.9 years in the glaucoma group and 65.5±8.5, years in the control group (P=0.17). Median number of instillations of medication was 2 (range, 1 to 6) for the glaucoma group. Central corneal thickness was 537.6±33.3 in the glaucoma group and 550.8±33.7 in the control group, respectively (P=0.028). The central CET was 48.8.±3.7 μm in the glaucoma group and 53.5±3.7 μm in the control group (P<0.001). Similarly, the average superior (2 to 7 mm) CET and the average inferior (2 to 7 mm) CET were almost equally reduced in the glaucoma group (45±4 vs. 49.6±3.3 μm, P<0.001 and 49±3.9 vs 53.5±3.7, P<0.001, respectively). No CET parameter was correlated with any of the treatment parameters. CONCLUSIONS Patients treated for glaucoma have uniformly reduced corneal epithelial thickness.
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Carnevale C, Riva I, Roberti G, Michelessi M, Tanga L, Verticchio Vercellin AC, Agnifili L, Manni G, Harris A, Quaranta L, Oddone F. Confocal Microscopy and Anterior Segment Optical Coherence Tomography Imaging of the Ocular Surface and Bleb Morphology in Medically and Surgically Treated Glaucoma Patients: A Review. Pharmaceuticals (Basel) 2021; 14:581. [PMID: 34207162 PMCID: PMC8234834 DOI: 10.3390/ph14060581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 01/21/2023] Open
Abstract
Glaucoma patients often suffer from ocular surface disease (OSD) caused by the chronic administration of topical anti-glaucoma medications, especially in cases of long-term therapy with preserved or multiple drugs. Additionally, glaucoma surgery may determine ocular surface changes related to the formation and location of the filtering bleb, the application of anti-mitotic agents, and the post-operative wound-healing processes within the conjunctiva. Recently, several studies have evaluated the role of advanced diagnostic imaging technologies such as in vivo confocal microscopy (IVCM) and anterior segment-optical coherence tomography (AS-OCT) in detecting microscopic and macroscopic features of glaucoma therapy-related OSD. Their clinical applications are still being explored, with recent particular attention paid to analyzing the effects of new drug formulations and of minimally invasive surgical procedures on the ocular surface status. In this review, we summarize the current knowledge about the main changes of the ocular surface identified at IVCM and AS-OCT in glaucoma patients under medical therapy, or after surgical treatment.
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Affiliation(s)
- Carmela Carnevale
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Ivano Riva
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (I.R.); (L.Q.)
| | - Gloria Roberti
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Manuele Michelessi
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Lucia Tanga
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
| | - Alice C. Verticchio Vercellin
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA; (A.C.V.V.); (A.H.)
| | - Luca Agnifili
- Ophthalmology Clinic, Department of Medicine and Aging Science, University G. d’Annunzio of Chieti—Pescara, 66100 Chieti, Italy;
| | - Gianluca Manni
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Viale Oxford 81, 00133 Rome, Italy
| | - Alon Harris
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY 10029, USA; (A.C.V.V.); (A.H.)
| | - Luciano Quaranta
- Department of Surgical & Clinical, Diagnostic and Pediatric Sciences, Section of Ophthalmology, University of Pavia—IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy; (I.R.); (L.Q.)
| | - Francesco Oddone
- IRCCS-Fondazione Bietti, Rome, Via Livenza, 3, 00198 Rome, Italy; (C.C.); (G.R.); (M.M.); (L.T.); (G.M.)
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Güçlü H, Çınar AK, Çınar AC, Akaray İ, Şambel Aykutlu M, Sakallıoğlu AK, Gürlü V. Corneal epithelium and limbal region alterations due to glaucoma medications evaluated by anterior segment optic coherence tomography: a case-control study. Cutan Ocul Toxicol 2021; 40:85-94. [PMID: 33719786 DOI: 10.1080/15569527.2021.1902341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
AIM To investigate the corneal epithelial and limbal epithelial alterations in patients under topical glaucoma treatment using anterior segment-OCT (AS-OCT) and to determine the changes of the limbal region due to the preservatives and glaucoma drugs, that can progress to limbal stem cell deficiency (LSCD). Limbal thickness was measured by AS-OCT to evaluate limbal cell deficiency. METHODS Forty-seven patients using topical medication for glaucoma, and 48 control subjects were enrolled in this matched case-control study. The patients were divided into four groups according to the treatment regimens. Group 1: One-drug regimen, Group 2: Two-drug regimen, Group 3: Three-drug regimen, Group 4: Four-drug regimen For the ocular surface evaluation; tear break-up time with standard fluorescein sodium sterile strip application, Schirmer test-I, Ocular Surface Disease Index Questionnaire, and AS-OCT were performed. RESULTS A total of 95 subjects were included: 47 eyes of 47 patients with glaucoma medication and 48 eyes of 48 healthy subjects. There was a statistically significant difference between patients and controls according to BUT, SCH, and OSDI (p < 0.001). The mean central corneal epithelium thickness was 48.5 ± 5.3 in patients and 54.5 ± 5.9 in controls (p < 0.001). The mean central total corneal thickness was 529.2 ± 41.2 in patients and 536 ± 35.3 in controls (p = 0.335). The mean limbal epithelium thickness was 64.1 ± 9.1 in patients and 76 ± 11.5 in controls (p < 0.001). CONCLUSION Using at least one glaucoma drug caused limbal area injury, changed ocular surface measurements, and significantly reduced the limbal epithelial thickness where the stem cells reside. The limbal epithelial thickness measurement by AS-OCT seems to be an innovative, non-invasive, and promising technique for detecting and staging corneal damage in topical glaucoma therapy.
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Affiliation(s)
- Hande Güçlü
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Ayça Küpeli Çınar
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Abdülkadir Can Çınar
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - İrfan Akaray
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
| | - Merve Şambel Aykutlu
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
| | | | - Vuslat Gürlü
- Department of Ophthalmology, Trakya University Faculty of Medicine, Edirne, Turkey
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Doğan E, Çakır BK, Aksoy NÖ, Celik E, Erkorkmaz Ü. Effects of topical antiglaucomatous medications on central corneal epithelial thickness by anterior segment optical coherence tomography. Eur J Ophthalmol 2020; 30:1519-1524. [PMID: 31964173 DOI: 10.1177/1120672120901698] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To evaluate the effect of topical antiglaucomatous medications on central corneal epithelial thickness measured by anterior segment optical coherence tomography. MATERIALS AND METHODS A total of 153 eyes of 153 patients using topical antiglaucomatous medications and 110 eyes of 110 control subjects were enrolled. Glaucoma type, duration of therapy, the number of drugs, and drops/day were noted in the patient group. Patients and control subjects underwent ocular examinations including Schirmer test, slit lamp examination for tear film break-up time, and anterior segment optical coherence tomography for central corneal thickness and central corneal epithelial thickness. Central corneal epithelial thickness and other data were evaluated separately with regard to glaucoma type, duration of therapy, the number of drops, and drugs in the patient group. RESULTS The mean ages of the patients and controls were 60.1 ± 10.8 and 58.7 ± 11.2 years, respectively. The groups were similar with regard to mean age and gender (p = 0.058, p = 0.734, respectively). The median (interquartile range) central corneal thickness was 536 (54) µm in patients and 552 (53) µm in controls (p = 0.011). The median (interquartile range) central corneal epithelial thickness of patients and controls were 56 (4) µm and 60 (8) µm, respectively (p < 0.001). The median (interquartile range) tear film break-up time and Schirmer were 12 (6) s and 10 (8) mm in patients and 16 (2) s and 18 (4) mm in controls, respectively (p < 0.001, p < 0.001). In patient group, there was no significant difference in the median central corneal thickness, central corneal epithelial thickness, and tear film break-up time in terms of glaucoma type, duration of therapy, the number of drugs, and the number of daily drops. Only the median Schirmer test was found to be statistically lower in terms of number of daily eye drops (p = 0.039). CONCLUSION Using topical antiglaucomatous medications seems to affect the central corneal epithelial thickness in glaucoma patients. Central corneal epithelial thickness was thinner in glaucoma patients than controls. Anterior segment optical coherence tomography might be helpful to evaluate the effect of antiglaucomatous medications on central corneal epithelial thickness during treatment.
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Affiliation(s)
- Emine Doğan
- Sakarya Training and Research Hospital, Department of Ophthalmology, Sakarya, Turkey
| | - Burçin Köklü Çakır
- Sakarya Training and Research Hospital, Department of Ophthalmology, Sakarya, Turkey
| | - Nilgün Özkan Aksoy
- Sakarya Training and Research Hospital, Department of Ophthalmology, Sakarya, Turkey
| | - Erkan Celik
- Sakarya University, Faculty of Medicine, Department of Biostatistics, Sakarya, Turkey
| | - Ünal Erkorkmaz
- Sakarya University, Faculty of Medicine, Department of Biostatistics, Sakarya, Turkey
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Montorio D, Cennamo G, Breve MA, Fiore U, Reibaldi M, Brescia Morra V, Cennamo G. Evaluation of corneal epithelial thickness in glaucomatous patients using anterior-segment optical coherence tomography. JOURNAL OF BIOPHOTONICS 2020; 13:e201900095. [PMID: 31593626 DOI: 10.1002/jbio.201900095] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 09/21/2019] [Accepted: 09/22/2019] [Indexed: 06/10/2023]
Abstract
The corneal epithelium represents one of the main structures that undergo degenerative alterations due to antiglaucomatous therapy. Chronic glaucoma therapy containing benzalkonium chloride induces epithelial cellular changes and inflammatory infiltration that in turn causes ocular surface changes resulting in ocular discomfort. Also, age-related changes can involve the tear film stability and the corneal epithelium surface with reduction of microvilli. The objective of this study is to gain insights about the changes in corneal epithelium in glaucomatous patients divided according to age, type and duration of therapy using anterior-segment optical coherence tomography (AS-OCT). This study evaluated a total of 81 eyes of 42 patients for whom corneal epithelium thickness (CET) was measured in different sectors of the cornea. Our results showed no significant differences in CET among patients divided according to type and duration of treatment, while younger patients showed a thinner CET in comparison with older patients. AS-OCT results demonstrated that the physiological age-related alterations contributed to corneal epithelium changes in patients undergo chronic antiglaucoma therapy.
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Affiliation(s)
- Daniela Montorio
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Gilda Cennamo
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Maria A Breve
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Ugo Fiore
- Department of Management and Quantitative Studies, Parthenope University of Naples, Naples, Italy
| | | | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Giovanni Cennamo
- Department of Neurosciences, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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