1
|
Deshmukh R, Ong ZZ, Rampat R, Alió del Barrio JL, Barua A, Ang M, Mehta JS, Said DG, Dua HS, Ambrósio R, Ting DSJ. Management of keratoconus: an updated review. Front Med (Lausanne) 2023; 10:1212314. [PMID: 37409272 PMCID: PMC10318194 DOI: 10.3389/fmed.2023.1212314] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Keratoconus is the most common corneal ectatic disorder. It is characterized by progressive corneal thinning with resultant irregular astigmatism and myopia. Its prevalence has been estimated at 1:375 to 1:2,000 people globally, with a considerably higher rate in the younger populations. Over the past two decades, there was a paradigm shift in the management of keratoconus. The treatment has expanded significantly from conservative management (e.g., spectacles and contact lenses wear) and penetrating keratoplasty to many other therapeutic and refractive modalities, including corneal cross-linking (with various protocols/techniques), combined CXL-keratorefractive surgeries, intracorneal ring segments, anterior lamellar keratoplasty, and more recently, Bowman's layer transplantation, stromal keratophakia, and stromal regeneration. Several recent large genome-wide association studies (GWAS) have identified important genetic mutations relevant to keratoconus, facilitating the development of potential gene therapy targeting keratoconus and halting the disease progression. In addition, attempts have been made to leverage the power of artificial intelligence-assisted algorithms in enabling earlier detection and progression prediction in keratoconus. In this review, we provide a comprehensive overview of the current and emerging treatment of keratoconus and propose a treatment algorithm for systematically guiding the management of this common clinical entity.
Collapse
Affiliation(s)
- Rashmi Deshmukh
- Department of Cornea and Refractive Surgery, LV Prasad Eye Institute, Hyderabad, India
| | - Zun Zheng Ong
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Radhika Rampat
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jorge L. Alió del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Ankur Barua
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Dalia G. Said
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Harminder S. Dua
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Renato Ambrósio
- Department of Cornea and Refractive Surgery, Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Darren Shu Jeng Ting
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
2
|
Bandeira F, Grottone GT, Covre JL, Cristovam PC, Loureiro RR, Pinheiro FI, Casaroli-Marano RP, Donato W, Gomes JÁP. A Framework for Human Corneal Endothelial Cell Culture and Preliminary Wound Model Experiments with a New Cell Tracking Approach. Int J Mol Sci 2023; 24:ijms24032982. [PMID: 36769303 PMCID: PMC9917640 DOI: 10.3390/ijms24032982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/21/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
Cell injection therapy is emerging as an alternative to treat corneal endothelial dysfunction (CED) and to avoid corneal scarring due to bullous keratopathy. However, establishing a standardized culture procedure that provides appropriate cell yield while retaining functional features remains a challenge. Here, we describe a detailed framework obtained from in vitro culture of human corneal endothelial cells (HCECs) and comparative in vivo experimental models for CED treatment with a new cell tracking approach. Two digestion methods were compared regarding HCEC morphology and adhesion. The effect of Y-27632 (ROCKi) supplementation on final cell yield was also assessed. Cell adhesion efficacy with two cell delivery systems (superparamagnetic embedding and cell suspension) was evaluated in an ex vivo human cornea model and in an in vivo rabbit CED model. The injection of supplemented culture medium or balanced salt solution (BSS) was used for the positive and negative controls, respectively. HCEC isolation with collagenase resulted in better morphology and adhesion of cultured HCEC when compared to EDTA. Y-27632 supplementation resulted in a 2.6-fold increase in final cell yield compared to the control. Ex vivo and in vivo adhesion with both cell delivery systems was confirmed by cell tracker fluorescence detection. Corneal edema and opacity improved in both animal groups treated with cultured HCEC. The corneas in the control groups remained opaque. Both HCEC delivery systems seemed comparable as treatments for CED and for the prevention of corneal scarring.
Collapse
Affiliation(s)
- Francisco Bandeira
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04023-062, Brazil
- Medicine School, Barcelona University, 08007 Barcelona, Spain
- Correspondence: ; Tel.: +55-2197-2355-742
| | | | - Joyce Luciana Covre
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | | | - Renata Ruoco Loureiro
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - Francisco Irochima Pinheiro
- Biotechnology Post-Graduate Program, Potiguar University, Natal 59082-902, Brazil
- Department of Surgery, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
| | | | - Waleska Donato
- Department of Ophthalmology, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | | |
Collapse
|
3
|
Song M, Chen T, Moktar A, Chan E, Chong EW, Daniell M, Sahebjada S. Diagnosis and Management of Keratoconus-A Narrative Review of Clinicians' Perspectives. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121973. [PMID: 36553416 PMCID: PMC9777227 DOI: 10.3390/children9121973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/23/2022]
Abstract
This review discusses the current practices, attitudes, and trends in diagnosing and managing keratoconus (KC) in adults and children by optometrists and ophthalmologists in order to highlight the differences on a global scale. Two independent reviewers searched the electronic databases and grey literature for all potential articles published from 1 January 2000 to 1 June 2022 on management of KC. Keywords used in searches included "keratoconus", "diagnosis", "management", "treatment", "attitude", "practices", "opinion", "optometrist", "ophthalmologist", "consensus", and "protocol". A total of 19 articles was included in this review-12 from the database search and seven from the grey literature. Although a common stepwise approach of non-surgical management was noted, there were differences in the rates of prescribing rigid gas permeable lenses. Furthermore, while clinicians agreed on the need for early diagnosis, the timeline and type of referral varied significantly. A similar discordance was found in the milestones for surgical intervention and preferred surgical techniques. Practice patterns in keratoconus diagnosis and management vary throughout the world. Multiple recommendations and suggestions to minimise the differences have been provided in the literature, with the main themes being improvement in education, interdisciplinary patient care, and further research to reach consensus.
Collapse
Affiliation(s)
- Minji Song
- Centre for Eye Research Australia, Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Tanya Chen
- Centre for Eye Research Australia, Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Adam Moktar
- Centre for Eye Research Australia, Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC 3010, Australia
| | - Elsie Chan
- Centre for Eye Research Australia, Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC 3010, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia
| | - Elaine W Chong
- Centre for Eye Research Australia, Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC 3010, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia
| | - Mark Daniell
- Centre for Eye Research Australia, Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC 3010, Australia
- Royal Victorian Eye and Ear Hospital, Melbourne, VIC 3002, Australia
| | - Srujana Sahebjada
- Centre for Eye Research Australia, Melbourne, VIC 3002, Australia
- Ophthalmology, Department of Surgery, The University of Melbourne, Melbourne, VIC 3010, Australia
- Correspondence:
| |
Collapse
|
4
|
Moriyama AS, Erbs Pessoa JL, Silva Bessa TR, Pereira NC, Mehta JS, Hofling-Lima AL, Dos Santos Forseto A. The Impact of the COVID-19 Pandemic on Corneal Transplantation in Brazil. Cornea 2022; 41:322-327. [PMID: 34864797 DOI: 10.1097/ico.0000000000002949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 10/15/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the impact of the coronavirus disease 2019 pandemic on corneal transplantation (CT) in Brazil. METHODS Data from patients who underwent CT at the Hospital Oftalmológico de Sorocaba (HOS), Brazil, were analyzed. National and state numbers of keratoplasties, patients added to the CT waiting list, and total patients on the waiting list were also obtained. Baseline prepandemic (from January 1, 2019, to March 31, 2020) data were compared with 2 time frames of the coronavirus disease 2019 pandemic: elective CT suspension period (between April 1, 2020, and September 31, 2020) and after elective CT resumption (between October 1, 2020, and April 30, 2021). RESULTS Despite elective CT resumption after the moratorium, the monthly CT rates did not return to baseline at HOS (-14.7%, P = 0.007), São Paulo state (-19.1%, P = 0.001), or Brazil (-30.1%, P < 0.001). The waiting list increased significantly regionally (P < 0.001) and nationally (P < 0.001). Among optical keratoplasties performed at HOS after resuming elective CTs, the proportion of endothelial keratoplasties declined from 38.2% to 30.0% (P < 0.001), whereas penetrating keratoplasties increased from 33.2% to 39.5% (P < 0.001) when comparing with prepandemic data. CONCLUSIONS Keratoplasty numbers dropped significantly locally, regionally, and nationally. Hence, the CT waiting lists had a progressive increase, with significant long-term implications. An estimated increment on monthly CT rates of approximately 34% in São Paulo state, and 91% in Brazil, is required for the CT waiting list to get back to prepandemic numbers over the next 2 years.
Collapse
Affiliation(s)
- Aline Silveira Moriyama
- Hospital Oftalmológico de Sorocaba/Banco de Olhos de Sorocaba (Sorocaba Eye Hospital/ Sorocaba Eye Bank), Sorocaba, Brazil
- Escola Paulista de Medicina, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - João Luís Erbs Pessoa
- Central Estadual de Transplantes (São Paulo State Transplants Center), Secretaria da Saúde Do Estado de São Paulo (São Paulo State Secretary of Health), São Paulo, Brazil
| | - Taciana Ribeiro Silva Bessa
- Coordenação Geral, Sistema Nacional de Transplantes (General Coordination, Brazilian National Transplant System), Ministério da Saúde (Ministry of Health), Brasilia, Brazil
| | - Nicolas Cesário Pereira
- Hospital Oftalmológico de Sorocaba/Banco de Olhos de Sorocaba (Sorocaba Eye Hospital/ Sorocaba Eye Bank), Sorocaba, Brazil
| | - Jodhbir Singh Mehta
- Singapore National Eye Centre, Singapore, Singapore; and
- Singapore Eye Research Institute, Singapore, Singapore
| | - Ana Luisa Hofling-Lima
- Escola Paulista de Medicina, Department of Ophthalmology and Visual Sciences, Federal University of São Paulo, São Paulo, Brazil
| | - Adriana Dos Santos Forseto
- Hospital Oftalmológico de Sorocaba/Banco de Olhos de Sorocaba (Sorocaba Eye Hospital/ Sorocaba Eye Bank), Sorocaba, Brazil
| |
Collapse
|