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Naujokaitis T, Khoramnia R, Friedrich M, Son HS, Auffarth GU, Augustin VA. Inter-zonal epithelial thickness differences for early keratoconus detection using optical coherence tomography. Eye (Lond) 2024; 38:2968-2975. [PMID: 39003429 DOI: 10.1038/s41433-024-03199-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 05/09/2024] [Accepted: 06/20/2024] [Indexed: 07/15/2024] Open
Abstract
PURPOSE To develop and test a parameter for early keratoconus screening by quantifying the localized epithelial thickness differences in keratoconic eyes. METHODS The cross-sectional study included 189 eyes of 116 subjects in total: 86 eyes of 54 keratoconus patients with bilateral ectasia and 40 eyes of 20 healthy subjects in the parameter-development dataset and 42 eyes of 21 keratoconus patients with asymmetric ectasia and 21 eyes of 21 healthy subjects in the parameter-validation dataset. Epithelial thickness maps were obtained using anterior segment optical coherence tomography and the inter-zonal epithelial thickness differences were calculated. The developed parameter was tested in keratoconus patients with asymmetric ectasia. RESULTS Compared to healthy controls, the inferior-temporal and global inter-zonal epithelial thickness differences were higher not only in eyes with tomographically significant keratoconus (median [interquartile range] of 4.42 [3.13] µm vs. 0.78 [0.42] µm, p < 0.001, and 3.05 [1.51] µm vs. 1.07 [0.26] µm, p < 0.001, respectively), but also in tomographically normal keratoconus fellow eyes (1.36 [0.85] µm vs. 0.78 [0.42] µm, p = 0.005, and 1.31 [0.32] µm vs. 1.07 [0.26] µm, p = 0.01, respectively). The inferior-temporal inter-zonal epithelial thickness differences had an area under the receiver operating characteristic curve (95% confidence interval) of 0.991 (0.972-1) for detecting tomographically significant keratoconus and 0.749 (0.598-0.901) for differentiating between tomographically normal keratoconus fellow eyes and healthy controls. CONCLUSIONS The inter-zonal epithelial thickness differences are increased in keratoconus fellow eyes which still have a normal Scheimpflug corneal tomography, and therefore may serve as a useful parameter to detect early ectatic changes.
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Affiliation(s)
- Tadas Naujokaitis
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Ramin Khoramnia
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Maximilian Friedrich
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Hyeck-Soo Son
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Gerd U Auffarth
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany
| | - Victor A Augustin
- International Vision Correction Research Centre (IVCRC), Department of Ophthalmology, University of Heidelberg, Heidelberg, Germany.
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Akbas YB, Alagoz N, Sari C, Altan C, Yasar T. Evaluation of pericardium patch graft thickness in patients with Ahmed glaucoma valve implantation: an anterior segment OCT study. Jpn J Ophthalmol 2024; 68:192-199. [PMID: 38553632 PMCID: PMC11087328 DOI: 10.1007/s10384-024-01051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/31/2024] [Indexed: 05/12/2024]
Abstract
PURPOSE To evaluate the changes in thickness of tissues, specifically the pericardium patch graft (PPG) covering the silicone tube in Ahmed Glaucoma Valve (AGV) surgery. STUDY DESIGN Prospective observational study. METHODS This study included cases with refractory glaucoma that underwent AGV implantation with PPG coverage. Conjunctival epithelium, stroma and PPG thickness covering the tube were measured using anterior segment optical coherence tomography (AS-OCT) at 1, 6 and 12 months. Additionally, the same measurements were taken 1500 µm away from the tube as a control for the central measurements. RESULTS Twenty-seven eyes of 27 patients were evaluated in the study. Although PPG thickness decreased significantly in both regions, the amount of reduction was more pronounced centrally. Centrally, the reduction rate was 21.2% and 34.8% during the 1-6 months period and 6-12 months period, while peripherally it was 3.5% and 5.1%, respectively. No change was observed in the thickness of the epithelium during the follow-up period. There was a significant thinning of the stroma in the central and peripheral regions during the 1-6 months period (30.5% and 17%, respectively). No cases of exposure were observed during the follow-up period. CONCLUSION Although the most evident thinning of the layers covering the tube was observed in the early postoperative period, PPG showed a stable decrease even in the late period. The progressive reduction in the PPG thickness observed also in the peripheral region indicates that factors beyond mechanical forces contribute to this degenerative process. AS-OCT could be a valuable non-invasive tool in clarifying this process.
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Affiliation(s)
- Yusuf Berk Akbas
- Department of Ophthalmology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey.
| | - Nese Alagoz
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Cem Sari
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Cigdem Altan
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Tekin Yasar
- Department of Ophthalmology, University of Health Sciences, Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
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Ning R, Wang Y, Xu Z, Gustafsson I, Li J, Savini G, Schiano-Lomoriello D, Xiao Y, Chen A, Wang X, Zhou X, Huang J. Assessing progression limits in different grades of keratoconus from a novel perspective: precision of measurements of the corneal epithelium. EYE AND VISION (LONDON, ENGLAND) 2024; 11:1. [PMID: 38163895 PMCID: PMC10759576 DOI: 10.1186/s40662-023-00368-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/05/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND To assess repeatability and reproducibility of corneal epithelium thickness (ET) measured by a spectral-domain optical coherence tomographer (SD-OCT)/Placido topographer (MS-39, CSO, Florence, Italy) in keratoconus (KC) population at different stages, as well as to determine the progression limits for evaluating KC progression. METHODS A total of 149 eyes were enrolled in this study, with 29 eyes in the forme fruste keratoconus (FFKC) group, 34 eyes in the mild KC group, 40 eyes in the moderate KC group, and 46 eyes in the severe KC group. Employing the within-subject standard deviation (Sw), test-retest variability (TRT), coefficient of variation (CoV), and intraclass correlation coefficient (ICC) to evaluate intraoperator repeatability and interoperator reproducibility. RESULTS The repeatability and reproducibility of MS-39 in patients with KC were acceptable, according to ICC values ranging from 0.732 to 0.954. However, patients with more severe KC and progressive peripheralization of the measurement points had higher TRTs but a thinning trend. The current study tended to set the cut-off values of mild KC, moderate KC, and severe KC to 4.9 µm, 5.2 µm, and 7.4 µm for thinnest epithelium thickness (TET). When differences between follow-ups are higher than those values, progression of the disease is possible. As for center epithelium thickness (CET), cut-off values for mild KC, moderate KC, and severe KC should be 2.8 µm, 4.4 µm, and 5.3 µm. This might be useful in the follow-up and diagnosis of keratoconus. CONCLUSIONS This study demonstrated that the precision of MS-39 was reduced in measuring more severe KC patients and more peripheral corneal points. In determining disease progression, values should be differentiated between disease-related real changes and measurement inaccuracies. Due to the large difference in ET measured by MS-39 between various stages of disease progression, it is necessary to accurately grade KC patients to avoid errors in KC clinical decision-making.
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Affiliation(s)
- Rui Ning
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yiran Wang
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Zhenyu Xu
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Ingemar Gustafsson
- Department of Clinical Sciences, Ophthalmology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jiawei Li
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | | | | | - Yichen Xiao
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Aodong Chen
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaoying Wang
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xingtao Zhou
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
| | - Jinhai Huang
- Eye Institute and Department of Ophthalmology and Vision Science, Institute for Medical and Engineering Innovation, Eye and ENT Hospital, Fudan University, N No.19 Baoqing Road, Xuhui District, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, Shanghai, China.
- NHC Key Laboratory of Myopia (Fudan University), Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.
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Benca KK, Javorka M, Vida R, Halička J, Kralik M, Prídavková Z, Žiak P. Diagnostic Importance of OCT Pachymetry in Keratoconus. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2024; 80:24-33. [PMID: 38365579 DOI: 10.31348/2024/6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
AIMS To demonstrate changes in distance and near fusional vergence measured with prism bars, while compensating for present heterophoria using current ametropia correction. In addition, to determine the differences in values of the AC/A ratio determined by the heterophoric (calculation) and gradient methods. MATERIAL AND METHODS The basic sample includes 19 subjects with a mean age of 21.5 ±3.0 years (min. 18, max. 27). We used the Von Graefe technique for examination of distance and near phoria, and prism bars for examination of fusion vergences measured in prism diopters. We divided the basic cohort into six research sets according to the size of distance and near heterophoria. This was a cohort of patients with distance (D OR) and near orthophoria (N OR), a cohort of patients with distance (D EX) and near exophoria (N EX) and a set of patients with distance (D ES) and near esophoria (N ES). RESULTS In the case of both groups with exophoria (distance, near) we found a statistically significant result only for negative fusion vergence (NFV). There was a statistically significant increase in NFV in the sample with distance and near exophoria (D EX, p = 0.01 and B EX, p = 0.02, respectively). In our study, we also demonstrated a statistically significant difference (p < 0.001) in the values of the AC/A ratio measured by the gradient and heterophoric methods. The values determined by the gradient method are lower (3.0 ±1.1 pD/D versus 5.8 ±0.9 pD/D) than by the heterophoric method. CONCLUSION By comparing fusion vergence values in patients with exophoria and orthophoria, we demonstrated that in the presence of distance or near exophoria there is an increase in ipsilateral fusion vergence. In the case of an increase in ipsilateral fusion vergence, the finding was statistically significant both distance and near (p = 0.01 and p = 0.02, respectively). By contrast, we were unable to prove this fact in the group of patients with esophoria. In our study, we also demonstrated a statistically significant difference (p < 0.001) in the values of the AC/A ratio measured by the gradient and heterophoric methods. The values determined by the gradient method are lower (3.0 ±1.1 pD/D versus 5.8 ±0.9 pD/D) than by the heterophoric method.
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Nobl M, Gerhardt M, Kassumeh S, Mohr N, Mayer W, Dirisamer M, Priglinger S, Luft N. [Steering clear of "corneal red disease"-epithelial thickness mapping for differential diagnosis of corneal ectatic disease]. DIE OPHTHALMOLOGIE 2023; 120:430-436. [PMID: 35925332 DOI: 10.1007/s00347-022-01663-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 05/04/2022] [Accepted: 05/11/2022] [Indexed: 04/29/2023]
Affiliation(s)
- Matthias Nobl
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Maximilian Gerhardt
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Stefan Kassumeh
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Niklas Mohr
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Wolfgang Mayer
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Martin Dirisamer
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
- Auge-Laser-Chirurgie, Linz, Österreich
| | - Siegfried Priglinger
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland
- Auge-Laser-Chirurgie, Linz, Österreich
| | - Nikolaus Luft
- Augenklinik und Poliklinik, Klinikum der Universität München, LMU München, Mathildenstr. 8, 80336, München, Deutschland.
- Auge-Laser-Chirurgie, Linz, Österreich.
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Asymmetric Intrastromal Corneal Ring Segments with Progressive Base Width and Thickness for Keratoconus: Evaluation of Efficacy and Analysis of Epithelial Remodeling. J Clin Med 2023; 12:jcm12041673. [PMID: 36836208 PMCID: PMC9962479 DOI: 10.3390/jcm12041673] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023] Open
Abstract
Purpose: The aim of this study is to describe visual outcomes and epithelial remodeling following the implantation of asymmetric intracorneal ring segments (ICRSs) of variable thickness and base width for the management of duck-type keratoconus. Methods: A prospective observational study of patients with duck-type keratoconus was conducted. All patients received one ICRS AJL PRO + implant (AJL Ophthalmic). We analyzed demographic and clinical data, anterior segment optical coherence tomography (AS-OCT) data and Scheimpflug camera images obtained with a Placido disc MS-39 (CSO, Firenze, Italy) one and six months after surgery to determine keratometric and aberrometric outcomes and epithelial remodeling. Results: We studied 33 keratoconic eyes. ICRS implantation significantly improved both corrected distance visual acuity (CDVA) and uncorrected distance visual acuity at six months, as assessed with the logMAR (minimum angle of resolution) system, from 0.32 ± 0.19 to 0.12 ± 0.12 (p < 0.001) and from 0.75 ± 0.38 to 0.37 ± 0.24 (p < 0.001), respectively. Overall, 87% of implanted eyes gained ≥ 1 line of CDVA, and 3% of patients (n = 1) lost one line of CDVA; 55% of eyes attained a manifest refraction spherical equivalent between +1.50 and -1.50 D. Epithelial remodeling was greater at the wider and thicker end (+11.33 µm ± 12.95; p < 0.001 relative to the initial value) than at the narrower and thinner end (+2.24 µm ± 5.67; p = 0.01). Coma aberration was significantly reduced from 1.62 ± 0.81 µm to 0.99 ± 0.59 µm (p < 0.001). Conclusions: AJL-PRO + ICRS implantation for duck-type keratoconus improves refractive, topographic, aberrometric and visual parameters and induces progressive epithelial thickening along the segment.
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Santhiago MR, Stival LR, Araujo DC, Kara-Junior N, Toledo MC. Role of Corneal Epithelial Measurements in Differentiating Eyes with Stable Keratoconus from Eyes that Are Progressing. OPHTHALMOLOGY SCIENCE 2022; 3:100256. [PMID: 36579337 PMCID: PMC9791590 DOI: 10.1016/j.xops.2022.100256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022]
Abstract
Purpose To evaluate measures of corneal epithelium in eyes that showed documented signs of keratoconus (KC) progression and compare with stable eyes and healthy controls. Also, to determine the correlation of these epithelial parameters with maximum keratometry (K max) and pachymetry. Design Prospective, observational, comparative study. Participants One-hundred and fifty eyes from 150 patients. The study included 50 eyes from patients with documented KC progression, 50 eyes with stable KC, and 50 clinically normal eyes to serve as controls. Methods A spectral-domain (SD)-OCT imaging was obtained in all eyes, and mean values were compared between the groups. The correlation of epithelial parameters with K max and thinnest pachymetry was also investigated. Main Outcome Measures For the purposes of this study, the epithelial measures maximum, minimum, superior, and inferior values as well as the difference between the minimum and maximum (min-max) and epithelial standard deviation were considered, obtained from SD-OCT and compared between groups. Measurements of the thinnest point and min-max in pachymetry were also recorded. Results The only epithelial parameter that presented a statistically significant difference between stable and progressive KC was epithelium min-max. Although stable KC presented epithelium min-max mean values of -18.2 ± 6.6, progressive KC eyes presented mean values of -23.4 ± 10.3 (P < 0.0001). Epithelial maximum (P = 0.16), minimum (P = 0.25), superior (P = 0.28), inferior (P = 0.23), and standard deviation (P = 0.25) values were not significantly different between stable and progressive eyes. Difference min-max pachymetry points in stable (-108.3 ± 33.5) and progressive KC (-115.2 ± 56.0) were not significantly different (P = 0.723). There was no significant correlation between epithelium min-max with corneal thinning (P = 0.39) or K max (P = 0.09) regardless of disease progression. Conclusions Epithelial measures are useful to identify KC eyes that are progressing; the parameters that measure the difference between min-max epithelium points were significantly different between stable and progressive groups, unlike this difference in pachymetry. Finally, this epithelial parameter seems to be independent of corneal thinning and K max. Financial Disclosures Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- Marcony R. Santhiago
- Department of Ophthalmology at University of Sao Paulo, Sao Paulo, Brazil,Correspondence: Marcony R. Santhiago, MD, PhD, Instituto Central. 255 Enéas de Carvalho Aguiar AV.–Ophthalmology Department - Federal University of Sao Paulo, Sao Paulo, Brazil.
| | - Larissa R. Stival
- Department of Ophthalmology at University of Sao Paulo, Sao Paulo, Brazil,Department of Ophthalmology, Federal University of Goias, Goiania, Brazil
| | - Daniella C. Araujo
- Department of Computer Science, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Newton Kara-Junior
- Department of Ophthalmology at University of Sao Paulo, Sao Paulo, Brazil
| | - Marcia C. Toledo
- Department of Ophthalmology, Federal University of Goias, Goiania, Brazil
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Brekelmans J, Dickman MM, Verma S, Arba‐Mosquera S, Goldschmidt R, Goz A, Brandis A, Berendschot TT, Saelens IE, Marcovich AL, Scherz A, Nuijts RM. Excimer laser-assisted corneal epithelial pattern ablation for corneal cross-linking. Acta Ophthalmol 2022; 100:422-430. [PMID: 34533277 PMCID: PMC9291225 DOI: 10.1111/aos.15021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/31/2021] [Accepted: 08/31/2021] [Indexed: 11/29/2022]
Abstract
Purpose To determine corneal cross‐linking (CXL) efficacy and chromophore penetration after excimer laser‐assisted patterned de‐epithelialization. Methods Two‐hundred‐twenty porcine eyes were de‐epithelialized ex vivo, either fully (mechanical; n = 88) or patterned (excimer laser; n = 132). Consecutively, corneas were impregnated with hypo‐ or hyperosmolar riboflavin (RF; n = 20, RF‐D; n = 40, respectively) or water‐soluble taurine (WST11; n = 40, and WST‐D; n = 40, respectively), or kept unimpregnated (n = 80). Sixty corneas were subsequently irradiated, inducing CXL, with paired contralateral eyes serving as controls. Outcome measurements included strip extensiometry to assess CXL efficacy, and spectrophotometry and fluorescence microscopy to determine stromal chromophore penetration. Results All tested chromophores induced significant CXL (p < 0.001), ranging from 7.6% to 14.6%, with similar stiffening for all formulations (p = 0.60) and both de‐epithelialization methods (p = 0.56). Light transmittance was significantly lower (p < 0.001) after full compared with patterned de‐epithelialization. Stromal chromophore penetration was comparable between fully and patterned de‐epithelialized samples, with full penetration in RD and RF‐D samples and penetration depths measuring 591.7 ± 42.8 µm and 592.9 ± 63.5 µm for WST11 (p = 0.963) and 504.2 ± 43.2 µm and 488.8 ± 93.1 µm for WST‐D (p = 0.669), respectively. Conclusions Excimer laser‐assisted patterned de‐epithelialization allows for effective CXL. Stromal chromophore concentration is, however, reduced, which may have safety implications given the need for sufficient UVA attenuation in RF/UVA CXL. The different safety profile of near‐infrared (NIR) may allow safe WST11/NIR CXL even with reduced stromal chromophore concentration values. In vivo studies are needed to evaluate the benefits and further assess safety of excimer laser‐assisted patterned de‐epithelialization for corneal CXL.
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Affiliation(s)
- Jurriaan Brekelmans
- University Eye Clinic Maastricht Maastricht University Medical Center Maastricht the Netherlands
- Department of Plant Science and Environmental Health the Weizmann Institute of Science Rehovot Israel
| | - Mor M. Dickman
- University Eye Clinic Maastricht Maastricht University Medical Center Maastricht the Netherlands
| | - Shwetabh Verma
- Department of Research and Development SCHWIND Eye‐Tech‐Solutions Kleinostheim Germany
- Experimental Radiation Oncology University Medical Center Mannheim Heidelberg Germany
- Interdisciplinary Center for Scientific Computing (IWR) Heidelberg University Heidelberg Germany
- Central Institute for Computer Engineering (ZITI) Heidelberg University Heidelberg Germany
| | - Samuel Arba‐Mosquera
- Department of Research and Development SCHWIND Eye‐Tech‐Solutions Kleinostheim Germany
| | - Ruth Goldschmidt
- Department of Plant Science and Environmental Health the Weizmann Institute of Science Rehovot Israel
| | - Alexandra Goz
- Department of Plant Science and Environmental Health the Weizmann Institute of Science Rehovot Israel
- Department of Ophthalmology Kaplan Medical Center Rehovot Israel
| | - Alexander Brandis
- Department of Biological Services the Weizmann Institute of Science Rehovot Israel
| | - Tos T.J.M. Berendschot
- University Eye Clinic Maastricht Maastricht University Medical Center Maastricht the Netherlands
| | - Isabelle E.Y. Saelens
- University Eye Clinic Maastricht Maastricht University Medical Center Maastricht the Netherlands
| | - Arie L. Marcovich
- Department of Plant Science and Environmental Health the Weizmann Institute of Science Rehovot Israel
- Department of Ophthalmology Kaplan Medical Center Rehovot Israel
| | - Avigdor Scherz
- Department of Plant Science and Environmental Health the Weizmann Institute of Science Rehovot Israel
| | - Rudy M.M.A. Nuijts
- University Eye Clinic Maastricht Maastricht University Medical Center Maastricht the Netherlands
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Comparison of Epithelial Thickness Mapping in Normal Corneas with Different Types of Astigmatism. Optom Vis Sci 2022; 99:443-448. [DOI: 10.1097/opx.0000000000001886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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10
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Pavlatos E, Harkness B, Louie D, Chamberlain W, Huang D, Li Y. Differentiating Between Contact Lens Warpage and Keratoconus Using OCT Maps of Corneal Mean Curvature and Epithelial Thickness. J Refract Surg 2022; 38:112-119. [PMID: 35156455 PMCID: PMC8870421 DOI: 10.3928/1081597x-20211116-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To formulate an Epithelial Modulation index to differentiate between eyes with contact lens warpage and keratoconus. METHODS Normal eyes and eyes with either contact lens warpage or keratoconus were scanned by a Fourier-domain optical coherence tomography (OCT) system. Maps of epithelial thickness and anterior surface mean curvature were generated and converted to deviation maps by subtracting the average maps from a healthy population. The Epithelial Modulation index was defined as the covariance between the two types of deviation maps. A logistic regression model was used to classify eyes as non-keratoconus (normal or warp-age) or keratoconus (manifest, subclinical, or forme fruste). RESULTS The average Epithelial Modulation index value for normal eyes was -0.6 ± 1.0 µm/m. Eyes with keratoconus were characterized by coincident high anterior surface mean curvature and low epithelial thickness, resulting in a high Epithelial Modulation index (manifest: 103.0 ± 82.9 µm/m, subclinical: 37.0 ± 23.0 µm/m, forme fruste: 7.3 ± 13.2 µm/m). The Epithelial Modulation index was closer to normal for eyes with warpage (-1.9 ± 4.0 µm/m). The classification accuracy of the Epithelial Modulation index during five-fold cross-validation of the logistic regression model was 100 ± 0% for normal eyes and 99.0 ± 2.0% for eyes with warpage. The accuracy was 100 ± 0%, 100 ± 0%, and 53.1 ± 1.5% for the manifest, subclinical, and forme fruste keratoconus groups, respectively. CONCLUSIONS The Epithelial Modulation index is useful in distinguishing eyes with secondary epithelial modulation (keratoconus) from those with primary epithelial deformation (contact lens-related warpage). [J Refract Surg. 2022;38(2):112-119.].
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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: 201] [Impact Index Per Article: 100.5] [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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Epithelial and stromal remodelling following femtosecond laser-assisted stromal lenticule addition keratoplasty (SLAK) for keratoconus. Sci Rep 2021; 11:2293. [PMID: 33504829 PMCID: PMC7840927 DOI: 10.1038/s41598-021-81626-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 01/04/2021] [Indexed: 11/08/2022] Open
Abstract
The purpose of this study was to evaluate corneal epithelium and stromal remodelling with anterior segment optical coherence tomography in patients who have undergone stromal lenticule addition keratoplasty (SLAK) for advanced keratoconus. This was a prospective non-comparative observational study. Fifteen eyes of 15 patients with advanced keratoconus underwent implantation with a cadaveric, donor negative meniscus-shaped intrastromal lenticule, produced with a femtosecond laser, into a stromal pocket dissected in the recipient cornea at a depth of 120 μm. Simulated keratometry, central corneal thickness (CTT), corneal thinnest point (CTP), central epithelial thickness (CET), central and peripheral lenticule thickness, anterior and posterior stromal thickness were measured. Regional central corneal epithelial thickness (CET) and variations in the inner annular area (IAT) and outer annular area (OAT) were also analysed. All parameters were measured preoperatively and 1, 3, and 6 months postoperatively. The average anterior Sim-k decreased from 59.63 ± 7.58 preoperatively to 57.19 ± 6.33 D 6 months postoperatively. CCT, CTP, CET, and OAT increased and IAT decreased significantly after 1 month. All parameters appeared unchanged at 6-months except that of OAT that further increased. Lenticule thickness was stable. In conclusion we observed that SLAK reshapes the cornea by central flattening with stromal thickening and epithelial thickness restoration.
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