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Li Y, Chen A, Hong A, Xiong S, Chen X, Xie Q. Shark Cartilage-Derived Anti-Angiogenic Peptide Inhibits Corneal Neovascularization. Bioengineering (Basel) 2024; 11:693. [PMID: 39061775 PMCID: PMC11273382 DOI: 10.3390/bioengineering11070693] [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: 06/13/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 07/28/2024] Open
Abstract
Corneal neovascularization is a significant cause of vision loss, often resulting in corneal clouding and chronic inflammation. Shark cartilage is widely recognized as a significant natural source of anti-angiogenic compounds. Our previous studies have shown that a polypeptide from white-spotted catshark (Chiloscyllium plagiosum Bonnet) has the potential to inhibit the angiogenesis of breast tumors. This study applied this peptide (SAIF) to a corneal alkali injury model to assess its effect on corneal neovascularization. Results revealed that SAIF inhibits endothelial cell proliferation, migration, and tube formation. SAIF inhibited VEGF-induced angiogenesis in the matrigel plug. Using the corneal alkali injury model, SAIF significantly inhibited corneal vascular neovascularization in mice. We found that SAIF not only significantly inhibited the upregulation of pro-angiogenic factors such as VEGF, bFGF, and PDGF expression induced by alkali injury, but also promoted the expression of anti-angiogenesis factor PEDF. Moreover, we also analyzed the MMPs and TIMPs involved in extracellular matrix (ECM) remodeling, angiogenesis, and lymphangiogenesis. We found that SAIF treatment inhibited the expression of pro-angiogenic factors like MMP1, MMP2, MMP3, MMP9, MMP13, and MMP14, and promoted the expression of anti-angiogenesis factors such as MMP7, TIMP1, TIMP2, and TIMP3. In conclusion, SAIF acts as an anti-angiogenic factor to inhibit the proliferation, migration, and tube formation of endothelial cells, inhibit pro-angiogenic factors, promote anti-angiogenic factors, and regulate the expression of MMPs, ultimately inhibiting corneal neovascularization.
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Affiliation(s)
- Yunxian Li
- College of Life Science and Technology, Jinan University, Guangzhou 510632, China; (Y.L.); (A.H.); (S.X.)
| | - Aoke Chen
- National Engineering Research Center of Genetic Medicine, Guangzhou 510632, China;
- Guangdong Jida Engineering Research Center of Genetic Medicine Co., Ltd., Guangzhou 510535, China
| | - An Hong
- College of Life Science and Technology, Jinan University, Guangzhou 510632, China; (Y.L.); (A.H.); (S.X.)
- National Engineering Research Center of Genetic Medicine, Guangzhou 510632, China;
| | - Sheng Xiong
- College of Life Science and Technology, Jinan University, Guangzhou 510632, China; (Y.L.); (A.H.); (S.X.)
- National Engineering Research Center of Genetic Medicine, Guangzhou 510632, China;
| | - Xiaojia Chen
- College of Life Science and Technology, Jinan University, Guangzhou 510632, China; (Y.L.); (A.H.); (S.X.)
- National Engineering Research Center of Genetic Medicine, Guangzhou 510632, China;
| | - Qiuling Xie
- College of Life Science and Technology, Jinan University, Guangzhou 510632, China; (Y.L.); (A.H.); (S.X.)
- National Engineering Research Center of Genetic Medicine, Guangzhou 510632, China;
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Viona V, Soebijantoro I, Gondhowiardjo TD. Combined Femtosecond Laser-Assisted Keratotomy and Cataract Surgery for Enhancing Refractive Outcomes. An Indonesian Case Study. Clin Ophthalmol 2023; 17:2983-2996. [PMID: 37841901 PMCID: PMC10575482 DOI: 10.2147/opth.s416217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/04/2023] [Indexed: 10/17/2023] Open
Abstract
Purpose We evaluate the reduction of corneal astigmatism and the improvement of visual outcomes of this surgical method in the Indonesian population. We also assess the accuracy and predictability of using femtosecond laser astigmatic keratotomy (FLAK) combined with cataract surgery. Patients and Methods In a retrospective study, a total of 275 subjects (78 with against-the-rule (ATR) astigmatism, 178 with with-the-rule (WTR) astigmatism, and 19 with oblique (OBL) astigmatism) with preexisting corneal astigmatism ranging from 0.75D to 3.00D underwent FLAK. All subjects completed a 3-month follow-up. The femtosecond laser used for creating paired AK 2.2 mm, primary incision, and paracentesis incision was the FEMTO Z8 NEO from Ziemer Ophthalmic System, Switzerland. The surgical approach was guided by the "NAPA" nomogram. Results The reduction in postoperative astigmatism was 56.90% for the WTR group, 49.46% for the ATR group, and 47.33% for the oblique group. A significant reduction in astigmatism was observed at the 1-week, 1-month, and 3-month follow-up intervals in both the WTR and ATR groups. The reduction in astigmatism was more favorable in cases of moderate astigmatism within the WTR group, as compared to the ATR and oblique groups. Postoperative astigmatism reduction was found to be more predictable in the right eye than in the left eye. Conclusion The combination of FLAK can be considered as a potential method for reducing corneal astigmatism ranging from 1.00D to <3.00D. The highest reduction was observed in the WTR group, along with a higher rate of intended correction without astigmatism meridian shift in the right eye for the WTR group. However, factors such as cyclotorsion resulting from the surgical technique, alignment of docking, incision length, and preoperative astigmatism need to be taken into account for further enhancement and predictability of astigmatism reduction with this method.
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Affiliation(s)
- Viona Viona
- Department of Research, Jakarta Eye Center (JEC) Eye Hospitals and Clinics, Jakarta, Indonesia
| | - Iwan Soebijantoro
- Department of Glaucoma, Jakarta Eye Center (JEC) Eye Hospitals and Clinics, Jakarta, Indonesia
| | - Tjahjono D Gondhowiardjo
- Department of Corneal and Refractive Surgery, Jakarta Eye Center (JEC) Eye Hospitals and Clinics, Jakarta, Indonesia
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Al-Mohaimeed MM. Effect of Prophylactic Mitomycin C on Corneal Endothelium Following Transepithelial Photorefractive Keratectomy in Myopic Patients. Clin Ophthalmol 2022; 16:2813-2822. [PMID: 36046571 PMCID: PMC9423044 DOI: 10.2147/opth.s375587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/11/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose This study investigated the effect of prophylactic mitomycin C (MMC) on corneal endothelium to inhibit corneal haze formation post transepithelial photorefractive keratectomy (T-PRK). Methods A total of 120 eyes of 60 patients with low, moderate, and high myopia were subjected to T-PRK with intraoperative application of MMC (0.02%) for 30-50s. Patients' files were categorized into three groups according to ablation depths (if ≥100 µm) during T-PRK as follows: (1) Group A - low myopia without MMC, (2) Group B - low myopia with MMC, and (3) Group C - moderate/high myopia with MMC. Preoperative/surgical parameters and refractive outcomes were documented. Cell density (CD), number of cells (NUM), coefficient of variation, central corneal thickness (CCT), hexagonality (HEX/6A), average cell area (AVG), and its standard deviation (SD) were evaluated using specular microscopy preoperatively and postoperatively. Results Overall, 119 out of 120 eyes showed significant prevention of corneal haze. Groups A and C showed no significant changes in endothelial CD and NUM. Group B showed a non-significant reduction in CD. However, all three groups showed significant variations in HEX/6A, CCT, AVG, and SD. Conclusion The MMC application did not significantly affect corneal endothelial density or number and can be used safely and effectively to prevent corneal haze following T-PRK in myopia.
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Affiliation(s)
- Mansour M Al-Mohaimeed
- Department of Ophthalmology, College of Medicine, Qassim University, Qassim, Kingdom of Saudi Arabia
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Giral JB, Bloch F, Sot M, Zevering Y, El Nar A, Vermion JC, Goetz C, Lhuillier L, Perone JM. Efficacy and safety of single-step transepithelial photorefractive keratectomy with the all-surface laser ablation SCHWIND platform without mitomycin-C for high myopia: A retrospective study of 69 eyes. PLoS One 2021; 16:e0259993. [PMID: 34874947 PMCID: PMC8651116 DOI: 10.1371/journal.pone.0259993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 10/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Studies suggest that transepithelial photorefractive keratectomy (TransPRK) with the all-surface laser ablation (ASLA)-SCHWIND platform is effective and safe for both low-moderate myopia and high myopia. In most studies, mitomycin-C is administered immediately after surgery to prevent corneal opacification (haze), which is a significant complication of photorefractive keratectomy in general. However, there is evidence that adjuvant mitomycin-C induces endothelial cytotoxicity. Moreover, a recent study showed that omitting adjuvant mitomycin-C did not increase haze in low-moderate myopia. The present case-series study examined the efficacy, safety, and haze rates of eyes with high myopia that underwent ASLA-SCHWIND TransPRK without adjuvant mitomycin-C. METHODS All consecutive eyes with high myopia (≤-6 D) that were treated in 2018-2020 with the SCHWIND Amaris 500E® TransPRK excimer laser without adjuvant mitomycin-C in a tertiary-care hospital (France) and were followed up for 6 months were identified. Uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), and spherical equivalent (SE) were recorded before and after surgery. Postoperative haze was graded using the 4-grade Fantes scale. Efficacy rate (frequency of eyes with 6-month UCVA ≤0.1 logMAR), safety rate (frequency of eyes that lost <2 BSCVA lines), predictability (frequency of eyes with 6-month SE equal to target SE±0.5 D), efficacy index (mean UCVA at 6 months/preoperative BSCVA), and safety index (BSCVA at 6 months/preoperative BSCVA) were computed. RESULTS Sixty-nine eyes (38 patients) were included. Mean preoperative and 6-month SE were -7.44 and -0.05 D, respectively. Mean 6-month UCVA and BSCVA were 0.00 and -0.02 logMAR, respectively. Efficacy rate and index were 95.7% and 1.08, respectively. Safety rate and index were 95.7% and 1.13, respectively. Predictability was 85.5%. Grade 3-4 haze never arose. At 6 months, the haze rate was zero. CONCLUSIONS ASLA-SCHWIND TransPRK without mitomycin-C appears to be safe as well as effective and accurate for high myopia.
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Affiliation(s)
- Jean Baptiste Giral
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, University of Lorraine, Mercy Hospital, Metz, France
| | - Florian Bloch
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, University of Lorraine, Mercy Hospital, Metz, France
| | - Maxime Sot
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, University of Lorraine, Mercy Hospital, Metz, France
| | - Yinka Zevering
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, University of Lorraine, Mercy Hospital, Metz, France
| | - Arpine El Nar
- Clinical Research Support Unit, Metz-Thionville Regional Hospital Center, University of Lorraine, Mercy Hospital, Metz, France
| | - Jean Charles Vermion
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, University of Lorraine, Mercy Hospital, Metz, France
| | - Christophe Goetz
- Clinical Research Support Unit, Metz-Thionville Regional Hospital Center, University of Lorraine, Mercy Hospital, Metz, France
| | - Louis Lhuillier
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, University of Lorraine, Mercy Hospital, Metz, France
| | - Jean-Marc Perone
- Department of Ophthalmology, Metz-Thionville Regional Hospital Center, University of Lorraine, Mercy Hospital, Metz, France
- * E-mail:
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Han X, Liu T, Ding X, Liu J, Lin X, Wang D, Riaz M, Baird PN, Xie Z, Cheng Y, Li Y, Mori Y, Miyake M, Li H, Cheng CY, Zeng C, Ohno-Matsui K, Zhou X, Liu F, He M. Identification of novel loci influencing refractive error in East Asian populations using an extreme phenotype design. J Genet Genomics 2021; 49:54-62. [PMID: 34520856 DOI: 10.1016/j.jgg.2021.08.011] [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: 04/27/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022]
Abstract
The global "myopia boom" has raised significant international concerns. Despite a higher myopia prevalence in Asia, previous large-scale genome-wide association studies (GWASs) were mostly based on European descendants. Here, we report a GWAS of spherical equivalent (SE) in 1852 Chinese Han individuals with extreme SE from Guangzhou (631 < -6D and 574 > 0D) and Wenzhou (593 < -6D and 54 > -1.75 D), followed by a replication study in two independent cohorts with totaling 3538 East Asian individuals. The discovery GWAS and meta-analysis identify three novel loci which show genome-wide significant associations with SE, including 1q25.2 FAM163A, 10p11.22 NRP1/PRAD3, and 10p11.21 ANKRD30A/MTRNR2L7, together explaining 3.34% of SE variance. 10p11.21 was successfully replicated. The allele frequencies of all three loci show significant differences between major continental groups (P < 0.001). The SE reducing (more myopic) allele of rs10913877 (1q25.2 FAM163A) demonstrates the highest frequency in East Asians and much lower frequencies in Europeans and Africans (EAS = 0.60, EUR = 0.20, AFR = 0.18). The gene-based analysis additionally identifies three novel genes associated with SE, including EI24, LHX5 and ARPP19. These results provide new insights into myopia pathogenesis, and indicate the role of genetic heterogeneity in myopia epidemiology among different ethnicities.
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Affiliation(s)
- Xiaotong Han
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, China
| | - Tianzi Liu
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China; China National Center for Bioinformation, Beijing 100101, China
| | - Xiaohu Ding
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, China
| | - Jialin Liu
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China; China National Center for Bioinformation, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100101, China
| | - Xingyan Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, China
| | - Decai Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, China
| | - Moeen Riaz
- School of Public Health and Preventive Medicine, Monash University 3800, Australia
| | - Paul N Baird
- Department of Surgery, Ophthalmology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Zhi Xie
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, China
| | - Yuan Cheng
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China; China National Center for Bioinformation, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100101, China
| | - Yi Li
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China; China National Center for Bioinformation, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100101, China
| | - Yuki Mori
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Masahiro Miyake
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Hengtong Li
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore
| | - Ching-Yu Cheng
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore; Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore 119077, Singapore; Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore 169857, Singapore
| | - Changqing Zeng
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China; China National Center for Bioinformation, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100101, China
| | - Kyoko Ohno-Matsui
- Department of Ophthalmology and Visual Science, Tokyo Medical and Dental University, Tokyo 113-8510, Japan
| | - Xiangtian Zhou
- School of Optometry and Ophthalmology and Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang 325035, China; State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang 325035, China
| | - Fan Liu
- CAS Key Laboratory of Genomic and Precision Medicine, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100101, China; China National Center for Bioinformation, Beijing 100101, China; University of Chinese Academy of Sciences, Beijing 100101, China
| | - Mingguang He
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510000, China.
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Sia RK, Ryan DS, Stutzman RD, Pasternak JF, Eaddy JB, Logan LA, Rivers BA, Bower KS. Wavefront-guided and Wavefront-optimized LASIK: Visual and Military Task Performance Outcomes. Mil Med 2021; 186:e714-e719. [PMID: 33219659 DOI: 10.1093/milmed/usaa507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/31/2020] [Accepted: 11/05/2020] [Indexed: 11/14/2022] Open
Affiliation(s)
- Rose K Sia
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Denise S Ryan
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Richard D Stutzman
- Ophthalmology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Joseph F Pasternak
- Ophthalmology Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Jennifer B Eaddy
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Lorie A Logan
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Bruce A Rivers
- Warfighter Refractive Eye Surgery Program and Research Center, Fort Belvoir Community Hospital, Fort Belvoir, VA 22060, USA
| | - Kraig S Bower
- The Wilmer Eye Institute, Johns Hopkins University, Lutherville, MD 21093, USA
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Pertiwi ANS, Mahayana IT, Supartoto A, Goenawan W, Suhardjo. Transepithelial photorefractive keratectomy for myopia: effect of age and keratometric values. Int J Ophthalmol 2021; 14:744-749. [PMID: 34012891 DOI: 10.18240/ijo.2021.05.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 03/07/2020] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate demographic and preoperative factors increasing the risk of ametropia following transepithelial photorefractive keratectomy (transPRK) in myopia and myopic astigmatism. METHODS This retrospective cohort study included myopic eyes (-0.50 to -8.75 D) with or without astigmatism (up to 3.50 D) enrolled at Dr. Yap Eye Hospital Yogyakarta. TransPRK was performed using Technolaz 217z100 excimer laser. Subjects were clustered into ametropia and emmetropia group based on uncorrected distance visual acuities (UDVA) 3mo post-operatively. Multiple preoperative and intraoperative parameters were analyzed using Logistic regression to obtain their effect on ametropia risk following transPRK. RESULTS A total of 140 eyes of 87 consecutive subjects were studied. Prevalence of ametropia following transPRK was 20 (14.29%) eyes. Subjects in ametropia group were significantly older than the emmetropia group (31.80±14.23 vs 18.88±2.41, respectively; P<0.001). Bivariate Logistic regression analysis showed that older age (OR=1.23), higher preoperative spherical equivalent (>-6 D; OR=12.78), steeper anterior keratometric readings (Kmax>45 D and mean K>44 D; OR=4.28 and 4.35, respectively) increased the risk of ametropia following transPRK. Adjusted multivariate Logistic regression analysis showed that age was the strongest predictor for the incidence of ametropia following transPRK. Complications of transPRK were overcorrection, suspected posterior keratoectasia and accommodation insuffiency. CONCLUSION Older age can be the strongest factor for increasing ametropia risk following transPRK. Cut-off points of Kmax and mean K at 45 and 44 D respectively are proposed as the predictors for ametropia following transPRK.
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Affiliation(s)
- Amanda Nur Shinta Pertiwi
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia
| | - Indra Tri Mahayana
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia
| | - Agus Supartoto
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia.,Dr. Yap Eye Hospital, Yogyakarta 55232, Indonesia
| | - Wasisdi Goenawan
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia.,Dr. Yap Eye Hospital, Yogyakarta 55232, Indonesia
| | - Suhardjo
- Department of Ophthalmology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada-Sardjito Eye Center, Dr. Sardjito General Hospital, Yogyakarta 55284, Indonesia.,Dr. Yap Eye Hospital, Yogyakarta 55232, Indonesia
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Couture C, Desjardins P, Zaniolo K, Germain L, Guérin SL. Enhanced wound healing of tissue-engineered human corneas through altered phosphorylation of the CREB and AKT signal transduction pathways. Acta Biomater 2018; 73:312-325. [PMID: 29656072 DOI: 10.1016/j.actbio.2018.04.021] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/05/2018] [Accepted: 04/10/2018] [Indexed: 12/22/2022]
Abstract
The cornea is a transparent organ, highly specialized and unique that is continually subjected to abrasive forces and occasional mechanical or chemical trauma because of its anatomical localization. Upon injury, the extracellular matrix (ECM) rapidly changes to promote wound healing through integrin-dependent activation of specific signal transduction mediators whose contribution is to favor faster closure of the wound by altering the adhesive and migratory properties of the cells surrounding the damaged area. In this study, we exploited the human tissue-engineered cornea (hTECs) as a model to study the signal transduction pathways that participate to corneal wound healing. By exploiting both gene profiling and activated kinases arrays, we could demonstrate the occurrence of important alterations in the level of expression and activation of a few mediators from the PI3K/Akt and CREB pathways in response to the ECM remodeling taking place during wound healing of damaged hTECs. Pharmacological inhibition of CREB with C646 considerably accelerated wound closure compared to controls. This process was considerably accelerated further when both C646 and SC79, an Akt agonist, were added together to wounded hTECs. Therefore, our study demonstrate that proper corneal wound healing requires the activation of Akt together with the inhibition of CREB and that wound healing in vitro can be altered by the use of pharmacological inhibitors (such as C646) or agonists (such as SC79) of these mediators. STATEMENT OF SIGNIFICANCE Corneal wounds account for a large proportion of all visual disabilities in North America. To our knowledge, this is the first time that a tissue-engineered human cornea (hTEC) entirely produced using normal untransformed human cells is used as a biomaterial to study the signal transduction pathways that are critical to corneal wound healing. Through the use of this biomaterial, we demonstrated that human corneal epithelial cells engaged in wound healing reduce phosphorylation of the signal transduction mediator CREB while, in the mean time, they increase that of AKT. By increasing the activation of AKT together with a decrease in CREB activation, we could considerably reduce wound closure time in our punch-damaged hTECs. Considering the increasing interest given to the reconstruction of different types of tissues, we believe these results will have a strong impact on the field of tissue-engineering and biomaterials. Altering the activation status of the Akt and CREB proteins might prove to be a therapeutically interesting avenue and may also find applications in wound healing of other tissues beside the cornea, such as the skin.
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Motwani M. Treatment of high myopia/myopic astigmatism with a combination of WaveLight Contoura with LYRA protocol and wavefront-optimized treatment. Clin Ophthalmol 2018; 12:875-883. [PMID: 29785083 PMCID: PMC5953272 DOI: 10.2147/opth.s157486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of this article was to demonstrate how WaveLight Contoura and wavefront optimization (WFO) can be used together to treat high myopia/myopic astigmatism corrections. Materials and methods A retrospective analysis was conducted on 24 consecutive myopic/myopic astigmatism eyes that exceeded the Contoura labeling of -8.00 with -3.00 D of astigmatism. Residual correction after Contoura with Layer Yolked Reduction of Astigmatism protocol was treated with WFO Contoura LASIK correction. All patients had 3 months of follow-up. Accuracy to the desired refractive goal was assessed by postoperative refraction, regression, postoperative vision, and anecdotal subjective night vision quality. Results No eyes lost best-corrected visual acuity (BCVA), and 54% of eyes gained BCVA. Out of 22 distance eyes, five achieved 20/15 or better, 18 achieved 20/20 vision, two achieved 20/25, and three achieved 20/30 vision. Preoperatively, only 14 eyes could achieve 20/20 vision. No night vision issues were observed in anecdotal reporting by patients except for those who needed enhancements that had not yet been performed. Conclusion Treatment of high myopia/astigmatism with this combination of Contoura with LYRA protocol and WFO results in excellent visual outcomes, large ablation zones on topography, and few subjective reported night vision issues.
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Evaluation of Corneal Biomechanics After Excimer Laser Corneal Refractive Surgery in High Myopic Patients Using Dynamic Scheimpflug Technology. Eye Contact Lens 2018; 43:371-377. [PMID: 27243355 DOI: 10.1097/icl.0000000000000280] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the effect of femtosecond-assisted thin flap laser-assisted in situ keratomileusis (FS-LASIK) and photorefractive keratectomy with mitomycin-C (PRK-MMC) in highly myopic patients (>7.0 D [D]) on corneal biomechanical parameters. METHODS In this prospective comparative interventional case series, 60 patients (30 patients in each group) with a manifest refractive spherical equivalent (MRSE) greater than 7.0 D were enrolled. Corvis ST parameters were measured before and at 3 and 6 months postoperatively. RESULTS Preoperatively, mean MRSE was -8.65±1.51 D in FS-LASIK and -8.04±1.70 D in PRK-MMC groups (P=0.149), and corneal thickness was 570.67±36.79 μm and 507.12±32.55 μm, respectively (P<0.001). At 6 months, both groups showed significantly higher applanation (A) 2 time and A2-velocity (P<0.05 in both), whereas intraocular pressure (IOP), corrected IOP, A1 time, A1-velocity, and radius at highest concavity were significantly reduced (P<0.05 in all). In the FS-LASIK group, there was a significant increase in deformation amplitude (DA) (P=0.001), and significant decreases in A2-length (P=0.004). Peak distance increased in the PRK-MMC group (P=0.029). At 6 months, after controlling for fellow eye correlations and preoperative corneal thickness between the two groups, decreases in IOP, A1-time, A2-length and radius, and the increase in DA was greater in FS-LASIK. CONCLUSION This study demonstrated significant changes in Corvis ST ocular biomechanical metrics after both PRK-MMC and FS-LASIK in high myopic patients, indicating the significant effect of excimer laser refractive surgery on corneal biomechanical properties. However, changes that occur with FS-LASIK are more significant than with PRK-MMC. Further randomized studies are needed to better characterize the pattern of biomechanical changes associated with each type of surgery.
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Polar Value Analysis of Low to Moderate Astigmatism with Wavefront-Guided Sub-Bowman Keratomileusis. J Ophthalmol 2017; 2017:5647615. [PMID: 28831306 PMCID: PMC5558636 DOI: 10.1155/2017/5647615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/09/2017] [Accepted: 03/28/2017] [Indexed: 11/25/2022] Open
Abstract
Purpose To evaluate the astigmatic outcomes of wavefront-guided sub-Bowman keratomileusis (WFG-SBK) for low to moderate myopic astigmatism. Methods This study enrolled 100 right eyes from 100 patients who underwent WFG-SBK for the correction of myopia and astigmatism. The polar value method was performed with anterior and posterior corneal astigmatism measured with Scheimpflug camera combined with Placido corneal topography (Sirius, CSO) and refractive astigmatism preoperatively and 1 month, 3 months, and 6 months postoperatively. Results Similar results for surgically induced astigmatism (SIA) and error of the procedure in both anterior corneal astigmatism (ACA) and total ocular astigmatism (TOA). There was a minor undercorrection of the cylinder in both ACA and TOA. Posterior corneal astigmatism (PCA) showed no significant change. Conclusions Wavefront-guided SBK could provide good astigmatic outcomes for the correction of low to moderate myopic astigmatism. The surgical effects were largely attributed to the astigmatic correction of the anterior corneal surface. Posterior corneal astigmatism remained unchanged even after WFG-SBK for myopic astigmatism. Polar value analysis can be used to guide adjustments to the treatment cylinder alongside a nomogram designed to optimize postoperative astigmatic outcomes in myopic WFG-SBK.
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Liu YC, Rosman M, Mehta JS. Enhancement after Small-Incision Lenticule Extraction: Incidence, Risk Factors, and Outcomes. Ophthalmology 2017; 124:813-821. [PMID: 28318639 DOI: 10.1016/j.ophtha.2017.01.053] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/30/2017] [Accepted: 01/30/2017] [Indexed: 02/04/2023] Open
Abstract
PURPOSE To report the incidence, risk factors, and outcomes of enhancement after small-incision lenticule extraction (SMILE). DESIGN Retrospective cohort study. PARTICIPANTS Five hundred twenty-four eyes of 307 patients who underwent SMILE at Singapore National Eye Center between February 2012 and March 2016. METHODS The data collected included patient age at primary SMILE, gender, race, preoperative and postoperative manifest refraction spherical equivalent (MRSE), preoperative and postoperative uncorrected distance visual acuity and corrected distance visual acuity, the occurrence of suction loss during the procedure, and the need for enhancement. All enhancements were carried out by performing an alcohol-assisted photorefractive keratectomy (PRK) procedure with application of mitomycin C (MMC). MAIN OUTCOME MEASURES Incidence, prevalence, preoperative and intraoperative risk factors for enhancement, and outcomes after enhancement. RESULTS The prevalence of enhancement was 2.7%, and 71.4% eyes had enhancement within 1 year of primary SMILE. The incidence of enhancement was 2.1% and 2.9% at 1 and 2 years, respectively. Age older than 35 years, preoperative MRSE more than -6.00 diopters (D), preoperative myopia more than 6.00 D, preoperative astigmatism more than 3.00 D, and intraoperative suction loss were significant risk factors for enhancement after SMILE after adjusting for all other covariates (odds ratios, 5.58, 4.80, 1.41, 3.06, and 2.14, respectively; P = 0.004, 0.021, 0.022, 0.002, and 0.020, respectively). In the patients who underwent bilateral SMILE, the first-operated eye had a marginal trend toward significance for enhancement (P = 0.054). There was no gender or racial difference. In the 14 eyes requiring enhancement, the uncorrected distance visual acuity before enhancement ranged from 20/80 to 20/25, and the mean attempted enhancement spherical equivalent was -0.50±0.86 D. The uncorrected distance visual acuity improved in most patients (92.9%) after enhancement. CONCLUSIONS The 2-year incidence of enhancement after SMILE was 2.9%. Risk factors associated with enhancement included older age at SMILE procedure, greater preoperative MRSE, greater preoperative myopia, greater preoperative astigmatism, and the occurrence of intraoperative suction loss. Clinical outcomes of using PRK with application of MMC for enhancement were good.
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Affiliation(s)
- Yu-Chi Liu
- Singapore Eye Research Institute, Singapore, Republic of Singapore; Singapore National Eye Center, Singapore, Republic of Singapore
| | - Mohamad Rosman
- Singapore Eye Research Institute, Singapore, Republic of Singapore; Singapore National Eye Center, Singapore, Republic of Singapore
| | - Jodhbir S Mehta
- Singapore Eye Research Institute, Singapore, Republic of Singapore; Singapore National Eye Center, Singapore, Republic of Singapore; Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Republic of Singapore; School of Material Science & Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore, Republic of Singapore.
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Han KY, Tran JA, Chang JH, Azar DT, Zieske JD. Potential role of corneal epithelial cell-derived exosomes in corneal wound healing and neovascularization. Sci Rep 2017; 7:40548. [PMID: 28165027 PMCID: PMC5292698 DOI: 10.1038/srep40548] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 12/07/2016] [Indexed: 11/09/2022] Open
Abstract
Specific factors from the corneal epithelium underlying the stimulation of stromal fibrosis and myofibroblast formation in corneal wound healing have not been fully elucidated. Given that exosomes are known to transfer bioactive molecules among cells and play crucial roles in wound healing, angiogenesis, and cancer, we hypothesized that corneal epithelial cell-derived exosomes may gain access to the underlying stromal fibroblasts upon disruption of the epithelial basement membrane and that they induce signaling events essential for corneal wound healing. In the present study, exosome-like vesicles were observed between corneal epithelial cells and the stroma during wound healing after corneal epithelial debridement. These vesicles were also found in the stroma following anterior stromal keratectomy, in which surgical removal of the epithelium, basement membrane, and anterior stroma was performed. Exosomes secreted by mouse corneal epithelial cells were found to fuse to keratocytes in vitro and to induce myofibroblast transformation. In addition, epithelial cell-derived exosomes induced endothelial cell proliferation and ex vivo aortic ring sprouting. Our results indicate that epithelial cell-derived exosomes mediate communication between corneal epithelial cells and corneal keratocytes as well as vascular endothelial cells. These findings demonstrate that epithelial-derived exosomes may be involved in corneal wound healing and neovascularization, and thus, may serve as targets for potential therapeutic interventions.
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Affiliation(s)
- Kyu-Yeon Han
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Jennifer A Tran
- Schepens Eye Research Institute/MEE, Boston, Massachusetts, United States
| | - Jin-Hong Chang
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Dimitri T Azar
- Department of Ophthalmology and Visual Sciences, Illinois Eye and Ear Infirmary, College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - James D Zieske
- Schepens Eye Research Institute/MEE, Boston, Massachusetts, United States.,Ophthalmology, Harvard Medical School, Boston, Massachusetts, United States
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Liu YC, Ang HP, Teo EPW, Lwin NC, Yam GHF, Mehta JS. Wound healing profiles of hyperopic-small incision lenticule extraction (SMILE). Sci Rep 2016; 6:29802. [PMID: 27418330 PMCID: PMC4945911 DOI: 10.1038/srep29802] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 06/20/2016] [Indexed: 12/14/2022] Open
Abstract
Refractive surgical treatment of hyperopia still remains a challenge for refractive surgeons. A new nomogram of small incision lenticule extraction (SMILE) procedure has recently been developed for the treatment of hyperopia. In the present study, we aimed to evaluate the wound healing and inflammatory responses of this new nomogram (hyperopic-SMILE), and compared them to those of hyperopic-laser-assisted in situ keratomileusis (LASIK), using a rabbit model. A total of 26 rabbits were used, and slit lamp biomicroscopy, autorefractor/keratometer, intraocular pressure measurement, anterior segment optical coherence tomography, corneal topography, and in vivo confocal microscopy examinations were performed during the study period of 4 weeks. The corneas were then harvested and subject to immunofluorescence of markers for inflammation (CD11b), wound healing (fibronectin) and keratocyte response (HSP47). The lenticule ultrastructual changes were also analyzed by transmission electron microscopy. Out results showed that hyperopic-SMILE effectively steepened the cornea. Compared to hyperopic-LASIK, hyperopic-SMILE had less postoperative wound healing response and stromal interface reaction, especially in higher refractive correction. However, compared to myopic-SMILE, hyperopic-SMILE resulted in more central deranged collagen fibrils. These results provide more perspective into this new treatment option for hyperopia, and evidence for future laser nomogram modification.
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Affiliation(s)
- Yu-Chi Liu
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, 11 Third Hospital Ave, Singapore
| | - Heng Pei Ang
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Ericia Pei Wen Teo
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Nyein Chan Lwin
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Gary Hin Fai Yam
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore.,Singapore National Eye Centre, 11 Third Hospital Ave, Singapore.,Department of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore.,School of Material Science &Engineering and School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Ave, n3, 639798, Singapore
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Chen X, Stojanovic A, Simonsen D, Wang X, Liu Y, Utheim TP. Topography-Guided Transepithelial Surface Ablation in the Treatment of Moderate to High Astigmatism. J Refract Surg 2016; 32:418-25. [PMID: 27304606 DOI: 10.3928/1081597x-20160428-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 03/17/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To analyze the outcomes of treatment of astigmatism of 2.00 diopters (D) or greater with topography-guided transepithelial surface ablation. METHODS Retrospective analysis of a series of 206 eyes divided into two groups: myopic astigmatism (153 eyes) and mixed astigmatism (53 eyes). All cases were treated with topography-guided transepithelial surface ablation. Efficacy, safety, and predictability were evaluated, and vector analysis of cylindrical correction was performed. RESULTS The median preoperative spherical equivalent was -2.63 and -0.63 D for the myopic and mixed astigmatism groups, respectively, with median cylinder of -2.50 D. Postoperative uncorrected distance visual acuity was 20/20 or better in 92% and 83% of eyes in the myopic and mixed astigmatism groups, respectively; the corresponding efficacy indices were 1.00 and 0.96 and residual astigmatism of 0.50 D or less was present in 82.4% and 56.7% of eyes in the myopic and mixed astigmatism groups, respectively. The arithmetic mean magnitude of the difference vector was 0.38 (myopic) and 0.65 (mixed) D. Difference vector magnitude was positively correlated with the magnitude of target induced astigmatism in both groups. The geometric mean coefficient of adjustment index was 1.04 and 1.19, representing undercorrection of 4% and 19% in the myopic and mixed astigmatism groups, respectively. CONCLUSIONS Topography-guided transepithelial ablation is a safe, effective, and predictable treatment for moderate to high astigmatism. [J Refract Surg. 2016;32(6):418-425.].
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Liu YC, Teo EPW, Lwin NC, Yam GHF, Mehta JS. Early Corneal Wound Healing and Inflammatory Responses After SMILE: Comparison of the Effects of Different Refractive Corrections and Surgical Experiences. J Refract Surg 2016; 32:346-53. [DOI: 10.3928/1081597x-20160217-05] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 01/06/2016] [Indexed: 11/20/2022]
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17
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Yu CQ, Manche EE. Subjective Quality of Vision After Myopic LASIK: Prospective 1-Year Comparison of Two Wavefront-Guided Excimer Lasers. J Refract Surg 2016; 32:224-9. [PMID: 27070228 DOI: 10.3928/1081597x-20151222-03] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 11/05/2015] [Indexed: 11/20/2022]
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18
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Santos AMD, Torricelli AAM, Marino GK, Garcia R, Netto MV, Bechara SJ, Wilson SE. Femtosecond Laser-Assisted LASIK Flap Complications. J Refract Surg 2016; 32:52-9. [DOI: 10.3928/1081597x-20151119-01] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 11/01/2015] [Indexed: 01/13/2023]
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Schallhorn SC, Venter JA, Hannan SJ, Hettinger KA. Clinical outcomes of wavefront-guided laser in situ keratomileusis to treat moderate-to-high astigmatism. Clin Ophthalmol 2015. [PMID: 26203219 PMCID: PMC4508064 DOI: 10.2147/opth.s87887] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate the refractive and visual outcomes of wavefront-guided laser in situ keratomileusis (LASIK) in eyes with myopic astigmatism and cylindrical component ≥2.0 diopter (D). METHODS In this retrospective study, 611 eyes that underwent LASIK for simple or compound myopic astigmatism were analyzed. Preoperative refractive cylinder ranged from -2.00 D to -6.00 D (mean -2.76±0.81 D), and the sphere was between 0.00 D and -9.75 D (mean -2.79±2.32 D). Predictability, visual outcomes, and vector analysis of changes in refractive astigmatism were evaluated. RESULTS At 3 months after LASIK, 83.8% of eyes had uncorrected distance visual acuity of 20/20 or better, 90.3% had manifest spherical equivalent within ±0.50 D, and 79.1% had residual refractive cylinder within ±0.50 D of intended correction. The mean correction ratio for refractive cylinder was 0.92±0.14, the mean error of angle was -0.45°±2.99°, and the mean error vector was 0.37±0.38 D. A statistically significant correlation was found between the error of magnitude (arithmetic difference in the magnitudes between surgically induced refractive correction and intended refractive correction) and the intended refractive correction (r=0.26, P<0.01). CONCLUSION Wavefront-guided LASIK for the correction of myopic astigmatism is safe, effective, and predictable.
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Affiliation(s)
- Steven C Schallhorn
- University of California, San Francisco, CA, USA ; Optical Express, Glasgow, UK
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Lou Q, Wang Y, Wang Z, Liu Y, Zhang L, Zhai Y, Fang H. Investigation of aberration characteristics of eyes at a peripheral visual field by individual eye model. APPLIED OPTICS 2015; 54:5917-5923. [PMID: 26193133 DOI: 10.1364/ao.54.005917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We propose a method of constructing an individual eye model with a large visual field, and then investigate aberration characteristics of eyes in peripheral fields with constructed models. Twelve eyes of different aberrations are selected from 89 myopic eyes. It is shown that astigmatism increases as visual field in a quadratic manner. The variation tendency of defocus can be expressed by the cubic curve for 50% of eyes. For most of the eyes, the variation of spherical aberration shows a quadratic rule within ±24° visual field. Coma exhibits obvious individual differences. The impact of high-order aberrations on vision is mainly at a smaller visual field, and it becomes negligible beyond 24° visual field.
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Abstract
Femtosecond-assisted laser in-situ keratomileusis flaps have revolutionized refractive surgery since their introduction. Although these lasers are exceedingly safe, complications still do occur. This review focuses specifically on examining the literature and evidence for flap complications during femtosecond-assisted laser in-situ keratomileusis as well as their management.
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Affiliation(s)
- Deepika N Shah
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School , Boston, Massachusetts , USA
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Zhang C, Che J, Yu J, Yu L, Yu D, Zhao G. Using femtosecond laser to create customized corneal flaps for patients with low and moderate refractive error differing in corneal thickness. PLoS One 2015; 10:e0121291. [PMID: 25807232 PMCID: PMC4373722 DOI: 10.1371/journal.pone.0121291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 01/29/2015] [Indexed: 11/19/2022] Open
Abstract
This study is designed to evaluate the visual outcomes, accuracy, and predictability of corneal flaps with different thicknesses created by 60-kHz femtosecond laser according to different corneal thicknesses in the patients with low and moderate refractive error. A total of 182 eyes were divided according to the central corneal thickness (470 μm-499 μm in Group A, 500 μm-549 μm in Group B, and 550 μm-599 μm in Group C) and underwent femtosecond laser-assisted LASIK for a target corneal flap thickness (100 μm for Group A, 110 μm for Group B, and 120 μm for Group C). Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and refractive status were examined. The flap thickness of each eye was measured by anterior segment optical coherence tomography (AS-OCT) on 30 points at 1-month follow-up to assess the accuracy and predictability. Postoperatively, at least 75% of eyes had a UDVA of 20/16 or better, less than 2% of eyes lost one line, over 30% of eyes gained one or more lines in CDVA, at least 95% of eyes had astigmatism of less than 0.25 D, all eyes achieved a correction within ± 1.00 D from the target spherical equivalent refraction. The visual and refractive outcomes did not differ significantly in all groups (P >0.05). The mean flap thickness was 100.36 ± 4.32 μm (range: 95-113 μm) in Group A, 111.64 ± 3.62 μm (range: 108-125 μm) in Group B, and 122.32 ± 2.88 μm (range: 112-128 μm) in Group C. The difference at each measured point among the three groups was significant (P < 0.05). The accuracy and predictability were satisfactory in all three groups. In conclusion, this customized treatment yielded satisfactory clinical outcomes with accurate and predictable flap thickness for patients with low and moderate refractive error.
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Affiliation(s)
- Chi Zhang
- Department of Ophthalmology, The First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Jingbin Che
- Department of Ophthalmology, People’s Hospital of Laiwu, Laiwu, Shandong, China
| | - Jianhong Yu
- Department of Ophthalmology, The First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Linli Yu
- Department of Ophthalmology, The First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Dan Yu
- Department of Ophthalmology, The First People’s Hospital of Foshan, Foshan, Guangdong, China
| | - Gangping Zhao
- Department of Ophthalmology, The First People’s Hospital of Foshan, Foshan, Guangdong, China
- * E-mail:
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Yu CQ, Manche EE. Day 1 wavefront aberrometry for prediction of refractive outcomes at year 1 in myopic LASIK. J Refract Surg 2015; 31:170-4. [PMID: 25751833 DOI: 10.3928/1081597x-20150220-04] [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: 10/04/2014] [Accepted: 01/22/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine amount of change in wavefront aberrometric measurements from 1 day to 1 year after myopic LASIK. METHODS One hundred five eyes of 105 patients underwent wavefront-guided LASIK. Objective wavefront aberrometric refractions were recorded preoperatively, at postoperative day 1, and at postoperative year 1. Subjective manifest refractions were also collected at postoperative year 1. RESULTS When comparing objective wavefront aberrometric refractions at postoperative year 1 to postoperative day 1, there was a mean 0.33 diopter spherical equivalent myopic shift. There was no significant difference in the number of eyes within 1.00 diopter of emmetropia spherical equivalent measured by wavefront aberrometric refraction at postoperative day 1 or year 1. There was a correlation of R(2) = 0.14 between degree of preoperative myopia and myopic shift. Higher-order aberrations were overall not increased at day 1 but increased significantly by year 1. Objective aberrometric refractions at postoperative day 1 can be useful in prediction of long-term refractive outcomes. CONCLUSIONS There is a small myopic shift and an increase in higher-order aberrations when comparing wavefront aberrometry results at postoperative day 1 with those at postoperative 1 year.
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El Bahrawy M, Alió JL. Excimer laser 6(th) generation: state of the art and refractive surgical outcomes. EYE AND VISION (LONDON, ENGLAND) 2015; 2:6. [PMID: 26605362 PMCID: PMC4655460 DOI: 10.1186/s40662-015-0015-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 02/11/2015] [Indexed: 12/03/2022]
Abstract
After nearly three decades of innovation in excimer laser, today we are presented with a state of the art generation targeting minimally invasive refractive surgery with high speed laser, faster trackers, pupil monitoring systems and better customization profiles. These systems are capable of delivering better treatments with less induced postoperative high order aberrations. The results reported by many authors had confirmed the superiority in efficiency and safety profiles of this generation compared to previous generations. Still, current technology is facing major challenges in the correction of high hyperopic errors and in presbyopic treatments, with upgrades in ablation centration and thermal control needed, which will ensure better biomechanical results, as a step closer to perfection in refractive surgery.
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Affiliation(s)
- Mohamed El Bahrawy
- />Clinical research fellow in Vissum Corporación Alicante, Universidad Miguel Hernández, Alicante, Spain
| | - Jorge L Alió
- />Vissum Corporación Alicante, Alicante, Spain
- />Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
- />Avda de Denia s/n, Edificio Vissum, 03016 Alicante, Spain
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Pacella E, Pacella F, De Paolis G, Parisella FR, Turchetti P, Anello G, Cavallotti C. Glycosaminoglycans in the human cornea: age-related changes. OPHTHALMOLOGY AND EYE DISEASES 2015; 7:1-5. [PMID: 25674020 PMCID: PMC4310673 DOI: 10.4137/oed.s17204] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Revised: 09/16/2014] [Accepted: 09/30/2014] [Indexed: 11/05/2022]
Abstract
AIM To investigate possible age-related changes in glycosaminoglycans (GAGs) in the human cornea. The substances today called GAGs were previously referred to as mucopolysaccharides. METHODS Samples of human cornea were taken from 12 younger (age 21 ± 1.2) and 12 older (age 72 ± 1.6) male subjects. Samples were weighed, homogenized, and used for biochemical and molecular analyses. All the quantitative results were statistically analyzed. RESULTS The human cornea appears to undergo age-related changes, as evidenced by our biochemical and molecular results. The total GAG and hyaluronic acid counts were significantly higher in the younger subjects than in the older subjects. The sulfated heavy GAGs, such as chondroitin, dermatan, keratan, and heparan sulfate, were lower in the younger subjects than in the older subjects. DISCUSSION GAGs of the human cornea undergo numerous age-related changes. Their quantity is significantly altered in the elderly in comparison with younger subjects. GAGs play an important role in age-related diseases of the human cornea.
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Affiliation(s)
- Elena Pacella
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Fernanda Pacella
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Giulio De Paolis
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | | | - Paolo Turchetti
- National Institute for Health, Migration and Poverty (INMP/NIHMP), Rome, Italy
| | - Giulia Anello
- Department of Sense Organs, Faculty of Medicine and Dentistry, Sapienza University of Rome, Rome, Italy
| | - Carlo Cavallotti
- Section of Human Anatomy, Sapienza University of Rome, Rome, Italy
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Mastropasqua L, Calienno R, Lanzini M, Colasante M, Mastropasqua A, Mattei PA, Nubile M. Evaluation of corneal biomechanical properties modification after small incision lenticule extraction using Scheimpflug-based noncontact tonometer. BIOMED RESEARCH INTERNATIONAL 2014; 2014:290619. [PMID: 25309907 PMCID: PMC4163343 DOI: 10.1155/2014/290619] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/07/2014] [Indexed: 11/17/2022]
Abstract
PURPOSE To quantify the effect of small incision lenticule extraction (SMILE) on the corneal biomechanics using Scheimpflug noncontact tonometer (Corvis ST). METHODS Twenty eyes of twenty patients, evaluated as eligible for surgery, with high myopia and/or moderate myopic astigmatism, underwent small incision lenticule extraction (SMILE). All patients underwent Corvis ST preoperatively and postoperatively after 1 week, and 1 and 3 months to observe alterations of corneal biomechanical properties. The main outcome measures were Deformation Amplitude, 1st-AT, and 2nd-AT. The relationship between the amount of stroma removed and the percentage variation of the measured parameters from baseline was evaluated with generalized linear model from each time point. For completeness also intraocular pressure (IOP), central corneal thickness (CCT), and their variations after surgery were evaluated. RESULTS The ratio between the amount of removed refractive error and, respectively, changes of Deformation Amplitude, 1st-AT, and 2nd-AT were significantly modified at the 1st week after surgery (P = 0.005; P = 0.001; P = 0.024). At 1 and 3 months these values did not show statistically significant alterations. Intraocular pressure and central corneal thickness showed statistically significant changes during follow-up. CONCLUSIONS No significant modifications in biomechanical properties were observed after SMILE so this procedure could induce only minimal transient alterations of corneal biomechanics.
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Affiliation(s)
- Leonardo Mastropasqua
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
| | - Roberta Calienno
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
| | - Manuela Lanzini
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
| | - Martina Colasante
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
| | | | - Peter A. Mattei
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
| | - Mario Nubile
- Ophthalmic Clinic, University “G d'Annunzio” of Chieti-Pescara, Via dei Vestini, 66100 Chieti, Italy
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Yu CQ, Manche EE. Comparison of 2 wavefront-guided excimer lasers for myopic laser in situ keratomileusis: one-year results. J Cataract Refract Surg 2014; 40:412-22. [PMID: 24581773 DOI: 10.1016/j.jcrs.2013.08.050] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 08/20/2013] [Accepted: 08/20/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare laser in situ keratomileusis (LASIK) outcomes between 2 wavefront-guided excimer laser systems in the treatment of myopia. SETTING University eye clinic, Palo Alto, California, USA. DESIGN Prospective comparative case series. METHODS One eye of patients was treated with the Allegretto Wave Eye-Q system (small-spot scanning laser) and the fellow eye with the Visx Star Customvue S4 IR system (variable-spot scanning laser). Evaluations included measurement of uncorrected visual acuity, corrected visual acuity, and wavefront aberrometry. RESULTS One hundred eyes (50 patients) were treated. The mean preoperative spherical equivalent (SE) refraction was -3.89 diopters (D) ± 1.67 (SD) and -4.18 ± 1.73 D in the small-spot scanning laser group and variable-spot scanning laser group, respectively. There were no significant differences in preoperative higher-order aberrations (HOAs) between the groups. Twelve months postoperatively, all eyes in the small-spot scanning laser group and 92% in the variable-spot scanning laser group were within ±0.50 D of the intended correction (P = .04). At that time, the small-spot scanning laser group had significantly less spherical aberration (0.12 versus 0.15) (P = .04) and significantly less mean total higher-order root mean square (0.33 μm versus 0.40 μm) (P = .01). Subjectively, patients reported that the clarity of night and day vision was significantly better in the eye treated with the small-spot scanning laser. CONCLUSIONS The predictability and self-reported clarity of vision of wavefront-guided LASIK were better with the small-spot scanning laser. Eyes treated with the small-spot scanning laser had significantly fewer HOAs.
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Affiliation(s)
- Charles Q Yu
- From the Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California, USA
| | - Edward E Manche
- From the Byers Eye Institute at Stanford, Stanford University School of Medicine, Palo Alto, California, USA.
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Han KY, Dugas-Ford J, Seiki M, Chang JH, Azar DT. Evidence for the Involvement of MMP14 in MMP2 Processing and Recruitment in Exosomes of Corneal Fibroblasts. Invest Ophthalmol Vis Sci 2014; 56:5323-9. [PMID: 25015352 DOI: 10.1167/iovs.14-14417] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Matrix metalloproteinase (MMP) 14 has been shown to promote angiogenesis, but the underlying mechanisms are poorly understood. In this study, we investigated exosomal transport of MMP14 and its target, MMP2, from corneal fibroblasts to vascular endothelial cells as a possible mechanism governing MMP14 activity in corneal angiogenesis. METHODS We isolated MMP14-containing exosomes from corneal fibroblasts by sucrose density gradient and evaluated exosome content and purity by Western blot analysis. We then investigated exosome transport in vitro from corneal fibroblasts to two populations of vascular endothelial cells, human umbilical vein endothelial cells (HUVECs) and calf pulmonary artery endothelial cells (CPAECs). Western blot analysis and gelatin zymography were used to determine levels of MMP14 and MMP2, respectively, in exosomal fractions derived from cultured wild-type, MMP14 enzymatic domain-deficient (MMP14Δexon4), and MMP14-null corneal fibroblasts. RESULTS Matrix metalloproteinase 14-containing exosomes isolated from corneal fibroblasts were readily taken up in vitro by HUVECs and CPAECs. We found that MMP14 was enriched in exosomal fractions of cultured corneal fibroblasts. Moreover, loss of the MMP14 enzymatic domain resulted in accumulation of pro-MMP2 protein in exosomes, whereas MMP2 was nearly undetectable in exosomes of MMP14-null fibroblasts. CONCLUSIONS Our results indicate that exosomes secreted by corneal fibroblasts can transport proteins, including MMP14, to vascular endothelial cells. In addition, recruitment of MMP2 into corneal fibroblast exosomes is an active process that depends, at least in part, on the presence of MMP14. The role of exosomal MMP14 transport in corneal angiogenesis has important implications for therapeutic applications targeting angiogenic processes in the cornea.
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Affiliation(s)
- Kyu-Yeon Han
- Department of Ophthalmology and Visual Sciences Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
| | - Jennifer Dugas-Ford
- Department of Ophthalmology and Visual Sciences Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
| | - Motoharu Seiki
- Division of Cancer Cell Research, Institute of Medical Science, University of Tokyo, Minato-ku, Tokyo, Japan
| | - Jin-Hong Chang
- Department of Ophthalmology and Visual Sciences Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
| | - Dimitri T Azar
- Department of Ophthalmology and Visual Sciences Illinois Eye and Ear Infirmary, University of Illinois at Chicago, Chicago, United States
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Abstract
Corneal wound healing is a complex process: its mechanisms and the underlying genetic control are not fully understood. It involves the integrated actions of multiple growth factors, cytokines and proteases produced by epithelial cells, stromal keratocytes, inflammatory cells and lacrimal gland cells. Following an epithelial insult, multiple cytokines are released triggering a cascade of events that leads to repair the epithelial defect and remodelling of the stroma to minimize the loss of transparency and function. In this review, we examine the literature surrounding the genomics of corneal wound healing with respect to the following topics: epithelial and stromal wound healing (including inhibition); corneal neovascularisation; the role of corneal nerves in wound healing; the endothelium; the role of aquaporins and aptamers. We also examine the effect of ectasia on corneal wound healing with regard to keratoconus and following corneal surgery. A better understanding of the cellular and molecular changes that occur during repair of corneal wounds will provide the opportunity to design treatments that selectively modulate key phases of the healing process resulting in scars that more closely resemble normal corneal architecture.
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Affiliation(s)
- Nick J R Maycock
- Eye Department, Queen Alexandra Hospital, Portsmouth, UKNational Institute for Health Research (NIHR), Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
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