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Raiskup F, Herber R, Lenk J, Pillunat LE, Spoerl E. Crosslinking with UV-A and riboflavin in progressive keratoconus: From laboratory to clinical practice - Developments over 25 years. Prog Retin Eye Res 2024; 102:101276. [PMID: 38830532 DOI: 10.1016/j.preteyeres.2024.101276] [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: 03/31/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Abstract
Changes in the biomechanical and biochemical properties of the human cornea play an important role in the pathogenesis of ectatic diseases. A number of conditions in primarily acquired (keratoconus or pellucid marginal degeneration) or secondarily induced (iatrogenic keratectasia after refractive laser surgeries) ectatic disorders lead to decreased biomechanical stability. Corneal collagen cross-linking (CXL) represents a technique to slow or even halt the progression of ectatic pathologies. In this procedure, riboflavin is applied in combination with ultraviolet A radiation. This interaction induces the production of reactive oxygen species, which leads to the formation of additional covalent bonds between collagen molecules and subsequent biomechanical corneal strengthening. This procedure is so far the only method that partially interferes etiopathogenetically in the treatment of ectatic diseases that slows or stops the process of corneal destabilization, otherwise leading to the need for corneal transplantation. Besides, CXL process increases markedly resistance of collagenous matrix against digesting enzymes supporting its use in the treatment of corneal ulcers. Since the discovery of this therapeutic procedure and the first laboratory experiments, which confirmed the validity of this method, and the first clinical studies that proved the effectiveness and safety of the technique, it has been spread and adopted worldwide, even with further modifications. Making use of the Bunsen-Roscoe photochemical law it was possible to shorten the duration of this procedure in accelerated CXL and thus improve the clinical workflow and patient compliance while maintaining the efficacy and safety of the procedure. The indication spectrum of CXL can be further expanded by combining it with other vision-enhancing procedures such as individualized topographically-guided excimer ablation. Complementing both techniques will allow a patient with a biomechanically stable cornea to regularize it and improve visual acuity without the need for tissue transplantation, leading to a long-term improvement in quality of life.
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Affiliation(s)
- Frederik Raiskup
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Robert Herber
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Janine Lenk
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Lutz E Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Eberhard Spoerl
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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Niazi S, Doroodgar F, Nazari SH, Rahimi Y, Del Barrio JLA, Gatzioufas Z, Findl O, Vinciguerra P, Vinciguerra R, Moshirfar M, Ambrósio R, Alio JL. Refractive surgical approaches to keratoconus: A systematic review and network meta-analysis. Surv Ophthalmol 2024:S0039-6257(24)00045-6. [PMID: 38710236 DOI: 10.1016/j.survophthal.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 05/08/2024]
Abstract
Advancements in diagnostic methods and surgical techniques for keratoconus (KC) have increased non-invasive treatment options. Successful surgical planning for KC involves a combination of clinical science, empirical evidence, and surgical expertise. Assessment of disease progression is crucial, and halting the progression should be the focus if it is progressive. While surgeons used to rely on experience alone to decide the surgical method, comparing the network of primary factors, such as visual acuity, across studies can help them choose the most appropriate treatments for each patient and achieve optimal outcomes. Meticulous tabulation methods facilitate interpretation, highlighting the importance of selecting the correct surgical and rehabilitation approach based on each patient's condition and stage of the disease. We detail the outcomes of a comprehensive network meta-analysis comparing the effectiveness of various combined therapeutic refractive treatments for KC at identical stages of the disease, spanning four distinct follow-up intervals. Additionally, the comprehensive analysis suggests that for corneas with optimal best corrected visual acuity (BCVA) preoperatively (classified as regular), combining phakic intraocular lenses with intracorneal ring segments (ICRS) and corneal cross-linking (CXL) could offer the best therapeutic approach provided the disease stage does not exceed stage 3. For irregular corneas, although initial follow-ups show a significant difference in BCVA with surface ablation, longer-term follow-ups recommend combining surface ablation with ICRS and CXL, especially at higher stages.
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Affiliation(s)
- Sana Niazi
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Doroodgar
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Saeed Hashemi Nazari
- Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Yekta Rahimi
- Student Research Committee, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jorge L Alió Del Barrio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | | | - Oliver Findl
- Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, 1140, Vienna, Austria
| | - Paolo Vinciguerra
- Biomedical Sciences, Humanitas University, Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Italy
| | | | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah, Salt Lake City, Utah, USA
| | - Renato Ambrósio
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil; Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil; BrAIN: Brazilian Artificial Intelligence Networking in Medicine, Rio de Janeiro & Maceió, Brazil; Department of Ophthalmology, Federal University the state of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil; Department of Ophthalmology, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jorge L Alio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
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Mazzotta C, Stojanovic A, Romano V, Addabbo G, Borroni D, Balamoun AA, Ferrise M. Ray-Tracing Transepithelial Excimer Laser Central Corneal Remodeling Plus Pachymetry-Guided Accelerated Corneal Crosslinking for Keratoconus. Cornea 2024; 43:285-294. [PMID: 37699556 PMCID: PMC10836791 DOI: 10.1097/ico.0000000000003380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 09/14/2023]
Abstract
PURPOSE The aim of this study was to report the 12 to 96 months results of a tissue-preservation algorithm based on ray-tracing-guided transepithelial excimer laser central corneal ablation (RT t-PRK) combined with individualized pachymetry-guided accelerated crosslinking (M nomogram ACXL) in young adult patients with stable keratoconus (KC). METHODS This was a prospective interventional study including 38 eyes of 38 young adult patients (stage II KC) with a mean age of 35 years (range 26-46 years) who underwent simultaneous RT with t-PRK plus pachymetry-based ACXL in the worst eye. The treatments were performed using the iViS Suite iRES Excimer Laser (Ligi, Taranto, Italy). Ray-tracing-guided treatments were planned using the customized interactive programmed transepithelial ablation (CIPTA) 2 web software and diagnostic data were assessed by the Precisio 2 tomographer (Ligi, Taranto, Italy) and Sirius tomographer (C.S.O., Florence, Italy). The main outcome measures included uncorrected distance visual acuity, best spectacle-corrected visual acuity, Kmax, high-order aberrations, minimum corneal thickness, and posterior elevation, with a mean follow-up of 52 months (range 12-96 m). RESULTS The mean UDVA improved + 3.5 ±1.28 Snellen lines (SL); 38% gained ≥ 4 ±1.34 SLs, 35% ≥ 3 ±1.21 SLs, 22% ≥ 2 ±1.12 SLs, and 5% ≥ 1 ±0.75 SLs. The mean best spectacle-corrected visual acuity increased by + 4.3 ±1.3 SL. Sixty-eight percent gained ≥ 4 ±0.88 SLs and 30% ≥ 3 ±0.78 SL. No SLs were lost. CONCLUSIONS RT t-PRK plus ACXL significantly improved the quality of vision in patients with KC, preventing overcorrection and minimizing tissue consumption.
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Affiliation(s)
- Cosimo Mazzotta
- Department of Medicine, Surgery and Neurosciences, Postgraduate Ophthalmology School, Siena University, Italy
- Departmental Ophthalmology Unit, AUSL Toscana Sud Est, Campostaggia, Siena, Italy
- Siena Crosslinking Center, Siena, Italy
| | | | - Vito Romano
- Eye Clinic, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
- ASST Civil Hospital of Brescia, Brescia, Italy
| | - Giuseppe Addabbo
- Eye Clinic, Hospital “SS. Annunziata”, ASL Taranto, Taranto, Italy
| | - Davide Borroni
- Department of Doctoral Studies, Riga Stradins University, Riga, Latvia
| | - Ashraf Armia Balamoun
- Watany Eye Hospital (WEH), Research and Development Centre, Cairo, Egypt
- Ashraf Armia Eye Clinic, Giza, Egypt; and
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Niazi S, Gatzioufas Z, Doroodgar F, Findl O, Baradaran-Rafii A, Liechty J, Moshirfar M. Keratoconus: exploring fundamentals and future perspectives - a comprehensive systematic review. Ther Adv Ophthalmol 2024; 16:25158414241232258. [PMID: 38516169 PMCID: PMC10956165 DOI: 10.1177/25158414241232258] [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: 04/07/2023] [Accepted: 01/22/2024] [Indexed: 03/23/2024] Open
Abstract
Background New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way. Objectives This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies. Design A multidimensional comprehensive systematic narrative review. Data sources and methods A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed. Results Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes. Conclusion The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients. Trial registration The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338.
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Affiliation(s)
- Sana Niazi
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Eye Hospital Basel, Basel, Switzerland
| | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran Province, Tehran, District 6, Pour Sina St, P94V+8MF, Tehran 1416753955, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Oliver Findl
- Department of Ophthalmology, Hanusch Hospital, Vienna Institute for Research in Ocular Surgery (VIROS), Vienna, Austria
| | - Alireza Baradaran-Rafii
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jacob Liechty
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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D'Oria F, Bagaglia SA, Alio Del Barrio JL, Alessio G, Alio JL, Mazzotta C. Refractive surgical correction and treatment of keratoconus. Surv Ophthalmol 2024; 69:122-139. [PMID: 37774800 DOI: 10.1016/j.survophthal.2023.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 09/21/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023]
Abstract
Keratoconus is an ectatic corneal disorder that causes severe vision loss. Surgical options allow us to correct, partially or totally, the induced refractive error. Intracorneal ring segments (ICRS) implantation represents a minimally invasive surgical option that improves visual acuity, with a high success rate and a low overall complication rate. Corneal allogenic ICRS consists of ring segments derived from allogenic eye bank-processed donor corneas. Selective topography-guided transepithelial photorefractive or phototherapeutic keratectomy combined with CXL is another way in selected cases to improve spectacles corrected distance visual acuity. The microphotoablative remodeling of the central corneal profile is generally planned by optimizing the optical zones and minimizing tissue consumption. Phakic intraocular lens (PIOL) implant is considered in patients with stable disease and acceptable anatomical requirements. The two types of pIOLs, depending on their implantation inside the eye, are anterior chamber-pIOLs, which fixate to the anterior surface of the iris by using a polymethomethacrolate claw at the two haptics, and posterior chamber-pIOLs. In patients with both cataracts and keratoconus, the correct IOL power is difficult to obtain due to the irregular corneal shape and K values. Toric IOL is recommended, but carefully judging the topography and the possible need of subsequent keratoplasties.
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Affiliation(s)
- Francesco D'Oria
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy.
| | - Simone A Bagaglia
- Departmental Ophthalmology Unit, Sant' Andrea Hospital, USL Toscana Sud-Est, Massa Marittima, Italy
| | - Jorge L Alio Del Barrio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain
| | - Giovanni Alessio
- Section of Ophthalmology, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Jorge L Alio
- Vissum Miranza, Alicante, Spain; Division of Ophthalmology, Universidad Miguel Hernández, Alicante, Spain.
| | - Cosimo Mazzotta
- Departmental Ophthalmology Unit, AUSL Toscana Sud Est, Campostaggia, Siena, Italy; Department of Medicine, Surgery and Neurosciences, Postgraduate Ophthalmology School, Siena University, Siena, Italy; Siena Crosslinking Center, Siena, Italy
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Hafezi F, Torres-Netto EA, Hillen M. Expanding indications for corneal cross-linking. Curr Opin Ophthalmol 2023; 34:339-347. [PMID: 37097193 DOI: 10.1097/icu.0000000000000967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW The aim of this study was to summarize the recent developments in corneal cross-linking (CXL) and its indications, including corneal ectasias, refractive surgery and infectious keratitis. RECENT FINDINGS Advances in CXL technology, such as the use of higher-intensity LED ultraviolet (UV) light sources and a better understanding of the UV-riboflavin photochemical reaction, have enabled safer and more effective methods of cross-linking thin and ultra-thin corneas, and more effective accelerated transepithelial/'epi-on' CXL procedures that are beginning to supplant the Dresden protocol as the 'gold standard' CXL method. CXL is also being used in combination with laser surgery, not only to expand the patient base who can receive refractive surgery, but also to help rehabilitate vision in patients with ectasia. CXL, and CXL combined with photorefractive keratectomy (PRK), can result in corneal flattening of 1-2 D, and corneal regularization of 4-5 D, respectively. Finally, photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) has been shown to be an effective therapy for infectious keratitis, both alone, and in combination with antimicrobial drugs. SUMMARY CXL has evolved from a single technique to treat a single corneal ectasia, keratoconus, to several techniques with several indications, spanning a spectrum of corneal ectasias, as well as visual rehabilitation, refractive procedures and infectious keratitis treatment.
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Affiliation(s)
- Farhad Hafezi
- ELZA Institute, Dietikon/Zurich
- Laboratory of Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- USC Roski Eye Institute, University of Southern California, Los Angeles, California, USA
- Department of Ophthalmology, Medical University of Wenzhou, Wenzhou, China
| | - Emilio A Torres-Netto
- ELZA Institute, Dietikon/Zurich
- Laboratory of Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, Zurich
- Department of Ophthalmology, Paulista School of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil
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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.
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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
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De Bernardo M, Pagliarulo S, Rosa N. Unexpected ocular morphological changes after corneal refractive surgery: A review. Front Med (Lausanne) 2022; 9:1014277. [PMID: 36523778 PMCID: PMC9745030 DOI: 10.3389/fmed.2022.1014277] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/24/2022] [Indexed: 08/15/2023] Open
Abstract
Corneal refractive surgery (CRS) currently is widely used to correct refractive errors because of its efficacy and reliability. Several studies dealt with the corneal modification induced by this type of surgery, but it is still debated if CRS can induce unexpected changes namely anterior chamber depth (ACD) and axial length (AL). A literature review was performed, including all articles regarding CRS and eye-variations from 1999 to December 2021. Excluding articles about specific systemic conditions (e.g., pregnancy), pathological conditions, post-surgical complications or about only corneal flattening and thinning post CRS, we found nine studies that met the search criteria. We divided the found articles according to the type of surgery performed (radial keratotomy, PRK/LASEK, lasik) and analyzed the results about ACD and AL. Finally, according to the literature, we can conclude that CRS not only gives a corneal flattening, thinning and biomechanical changes, but also induces AL and ACD decrease. This makes the AL and ACD measurements obtained before CRS uselessness in case of IOL power calculation.
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Thiwa D, Linke SJ, Daxer A, Steinberg J. Continuous Intracorneal Ring Implantation in Keratoconus: Efficacy, Predictive Factors, and Complications. Clin Ophthalmol 2022; 16:3055-3067. [PMID: 36160729 PMCID: PMC9491368 DOI: 10.2147/opth.s375569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 09/02/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- David Thiwa
- University Medical Center Hamburg (UKE), Department of Ophthalmology, Hamburg, Germany
- Correspondence: David Thiwa, University Medical Center Hamburg (UKE), Department of Ophthalmology, Martinistr. 52, Hamburg, 20246, Germany, Tel +49 157 3062 3524, Fax +49 40 429 160 64, Email
| | - Stephan Johannes Linke
- University Medical Center Hamburg (UKE), Department of Ophthalmology, Hamburg, Germany
- Zentrumsehstärke – Augenarztpraxis am UKE, Hamburg, Germany
| | - Albert Daxer
- International Keratoconus Center, Wels, Austria
- Medical University of Innsbruck, Department of Ophthalmology, Innsbruck, Austria
| | - Johannes Steinberg
- University Medical Center Hamburg (UKE), Department of Ophthalmology, Hamburg, Germany
- Zentrumsehstärke – Augenarztpraxis am UKE, Hamburg, Germany
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10
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Coco G, Romano V. Corneal Disease & Transplantation. J Clin Med 2022; 11:jcm11154432. [PMID: 35956050 PMCID: PMC9369630 DOI: 10.3390/jcm11154432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Giulia Coco
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
- St. Paul’s Eye Unit, Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Vito Romano
- Department of Eye and Vision Science, University of Liverpool, Liverpool L7 8TX, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Eye Clinic, University of Brescia, 25121 Brescia, Italy
- ASST Spedali Civili di Brescia, 25123 Brescia, Italy
- Correspondence:
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Results of the Pinhole Test Correlate with Hybrid Contact Lens Visual Acuity in Patients with Visual Impairment due to Corneal Diseases. J Ophthalmol 2022; 2022:4932856. [PMID: 35783341 PMCID: PMC9249474 DOI: 10.1155/2022/4932856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 06/03/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction. Trial rigid lens fitting is considered the best approach to determine whether the correction of residual defocus and irregular astigmatism might improve the visual acuity in patients with corneal disorders including keratoconus. This study aimed to analyze the correlation between hybrid lenses and pinhole visual acuity (VA). Methods. Patients undergoing hybrid contact lens fitting at the Hygeia Clinic, Poland, were included. The VA of each patient was assessed as decimal Snellen fractions under the following conditions: (i) uncorrected VA, (ii) VA with spherocylindrical correction (i.e., corrected distance VA), (iii) VA with a single 1.2 mm pinhole occluder, and (iv) VA with the best-fitted hybrid contact lens. Pearson’s correlation coefficient r was used to assess correlations among variables. Results. This study involved 29 eyes of 19 patients, mainly with advanced keratoconus. The uncorrected VA was 0.11 ± 0.10. The pinhole test provided significantly improved VA over corrected distance VA (0.51 ± 0.29 vs. 0.31 ± 0.20, respectively;
). Similarly, the fitted hybrid contact lenses provided improved VA over corrected distance VA (0.66 ± 0.26 vs. 0.31 ± 0.20, respectively;
). The pinhole VA was strongly correlated with the hybrid contact lens VA (r = 0.8135; 95% CI: 0.61–0.92;
). The improvement in the pinhole test over corrected distance VA was moderately correlated with the improvement with the fitted lens over corrected distance VA (r = 0.6269; 95% confidence interval (CI): 0.32–0.80;
). Conclusions. A significant improvement in VA with the pinhole test is a simple predictor of general improvement with hybrid contact lenses. The pinhole test should be used in patients with corneal diseases such as keratoconus to determine whether optical aberrations associated with the disease cause their visual impairment.
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Yang K, Xu L, Wang S, Zhu M, Fan Q, Gu Y, Wang Y, Wang Q, Zhao D, Pang C, Ren S. A Bibliometric Analysis of 100 Most-Cited Articles on Corneal Cross-Linking. Front Med (Lausanne) 2022; 9:904077. [PMID: 35721090 PMCID: PMC9199002 DOI: 10.3389/fmed.2022.904077] [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: 03/25/2022] [Accepted: 05/02/2022] [Indexed: 11/13/2022] Open
Abstract
Background Highly cited papers are expected to have high-quality data that significantly contribute to the body of knowledge. The study aimed to evaluate the characters of the 100 most-cited articles on corneal cross-linking (CXL) through a bibliometric analysis. Materials and Methods The Web of Science database was searched to identify papers published from 1950 to 2020. A bibliometric analysis of the top 100-cited articles was conducted in the current study. The citation differences between basic research, clinical research, and reviews were compared by Kruskal-Wallis test. The association between citations and publication year was evaluated by Spearman correlation analysis. The VOSviewer software was used to create networks of co-authorship and keywords map. Results The median values of the number of citations, citations/year since publication, and citations since 2013 were 101, 9.5, and 11.92, respectively. A total of 61% of articles were clinical research. The citations since 2013 of clinical research were lower than basic research and the reviews (all p < 0.001). The publication year was positively correlated with the number of publications (r = 0.665, p = 0.013), and the total number of citations decreased for basic research (r = -0.447, p = 0.017), and clinical research (r = -0.433, p < 0.001). The J REFRACT SURG publishes the highest number of articles. The corresponding authors were predominantly from the Italy (N = 17), Germany (N = 16), and United States (N = 15). Spoerl Eberhard has the highest number of citations and total link strength with 15 articles. Extensive collaboration existed among the main core nodes containing "cross-linking (N = 45)," "riboflavin (N = 44)," and "ultraviolet A (UVA) (N = 42)." Conclusion The present study focused on the comprehensive analysis of the top 100-cited articles on the CXL research, providing insight into research developments over the past decades.
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Affiliation(s)
- Kaili Yang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Liyan Xu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaopei Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Meng Zhu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qi Fan
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuwei Gu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yawen Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qing Wang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Dongqing Zhao
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Chenjiu Pang
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Shengwei Ren
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Zhengzhou, China
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Nicula CA, Bulboacă AE, Nicula D, Nicula AP, Horvath KU, Bolboacă SD. Performances of Corneal Topography and Tomography in the Diagnosis of Subclinical and Clinical Keratoconus. Front Med (Lausanne) 2022; 9:904604. [PMID: 35721077 PMCID: PMC9204599 DOI: 10.3389/fmed.2022.904604] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Aim The purpose of the study was to assess the efficacy of topographical and tomographical indices given by the Pentacam (pachymetric, tomopetric, and aberometric) in clinical and subclinical keratoconus (KCN) diagnosis. Material and Methods In this observational analytic retrospective study, patients with abnormal findings in topography and tomography maps but with no signs on clinical examination (subclinical KCN group, sKCN), patients with clinical keratoconus (KCN group), and healthy subjects (Control group) were evaluated. Results The KCN group proved significantly different (p < 0.001) values of the investigated parameters than the Control group. Eleven out of 28 investigated parameters proved significantly different in the sKCN group compared to controls (p < 0.001). Two topographic measurements, namely I-S (cut-off = 1.435, a large value indicates the presence of KCN) and CCT (cut-off = 537, a small value indicates the presence of KCN), showed AUCs equal to 1 [0.999 to 1]. Six other Pentacam measurements, including Back maximum keratometry (Back Kmax) proved to be excellent parameters for case-finding and screening. In distinguishing sKCN from normal eyes, Pentacam index of vertical asymmetry (IVA), inferior-superior difference (I-S) value, thinnest point (TP), Belin Ambrosio Enhanced Ectasia Display (BAD_D) and root mean square total (RMS total) performed best. Conclusions In distinguishing sKCN from normal eyes, Back Kmax, IVA, I-S, and RMS total values demonstrated higher accuracy and utility. Six indices, namely ISV, IVA, KISA, PRC, RMS-HOA, and Back Kmax demonstrate excellent utility in case-finding and screening for clinical KCN.
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Affiliation(s)
- Cristina Ariadna Nicula
- Department of Ophthalmology, "Iuliu Haţieganu" Medicine and Pharmacy University, Cluj-Napoca, Romania.,Oculens Clinic, Cluj-Napoca, Romania
| | - Adriana Elena Bulboacă
- Department of Physiopathology, "Iuliu Haţieganu" Medicine and Pharmacy University, Cluj-Napoca, Romania
| | | | | | - Karin Ursula Horvath
- Department of Ophthalmology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania
| | - Sorana D Bolboacă
- Department of Medical Informatics and Biostatistics, "Iuliu Haţieganu" Medicine and Pharmacy University, Cluj-Napoca, Romania
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Vaidya NS, Daneshmand A, Epstein RJ, Majmudar PA, Belin MW, Parsons EC, Rubinfeld RS. Pachymetric Assessment After EpiSmart® Epithelium-on Cross-Linking for Keratoconus and Post-Surgical Ectasia. Clin Ophthalmol 2022; 16:1829-1835. [PMID: 35702687 PMCID: PMC9188777 DOI: 10.2147/opth.s359710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/26/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose To assess the change in corneal pachymetry after a novel epithelium-on (EpiSmart®) corneal crosslinking procedure (CXL). Methods Eyes treated as part of the open-label, non-controlled arm of the study “Collagen Crosslinking with Ultraviolet-A in Asymmetric Corneas” (NCT01097447) were examined at baseline, 3-, 6- and 12-months post-CXL. Thinnest pachymetry readings based on Pentacam (OCULUS GmbH, Wetzlar, Germany) were recorded. Results A total of 101 eyes met the study inclusion criteria. Thinnest pachymetric readings at baseline averaged 451 ± 50 microns. The mean (± SD) minimum thickness was 450 ± 46 microns at 3 months, 452 ± 47 microns at 6 months, and 451 ± 48 microns at 12 months post-CXL. The changes from baseline (mean ± SE) at 3, 6, and 12 months post-CXL were −1.2 ± 1.5 microns, 0.5 ± 1.6 microns, and 0.4 ± 1.6 microns, respectively. Student’s t-tests showed no statistically significant change in pachymetry from baseline for any exam period. Conclusion This study demonstrated that, after EpiSmart® epithelium-on CXL, there was no substantial corneal thinning observable on Scheimpflug tomography out to 12 months.
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Affiliation(s)
- Neel S Vaidya
- Chicago Cornea Consultants, Highland Park, IL, USA
- Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA
- Correspondence: Neel S Vaidya, Chicago Cornea Consultants, 806 Central Ave Suite 300, Highland Park, IL, 60035, USA, Email
| | | | - Randy J Epstein
- Chicago Cornea Consultants, Highland Park, IL, USA
- Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA
| | - Parag A Majmudar
- Chicago Cornea Consultants, Highland Park, IL, USA
- Department of Ophthalmology, Rush University Medical Center, Chicago, IL, USA
| | - Michael W Belin
- Department of Ophthalmology, University of Arizona, Tucson, AZ, USA
- CXL Ophthalmics, LLC, Encinitas, CA, USA
| | | | - Roy S Rubinfeld
- CXL Ophthalmics, LLC, Encinitas, CA, USA
- Department of Ophthalmology, Georgetown University Medical School/Washington Hospital Cente, Washington, DC, USA
- Re:Vision Private Practice, Rockville, MD, USA
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Nasef MH, El Emam SY, Haleem TI, Shalaby WS, Allam WA. Visual and Topographic Outcomes of Corneal Collagen Cross Linking for Post LASIK Ectasia. Clin Ophthalmol 2022; 16:2025-2032. [PMID: 35757019 PMCID: PMC9231688 DOI: 10.2147/opth.s370033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the topographic and visual outcomes of corneal cross-linking (CXL) for post-LASIK ectasia. Methods A retrospective case series of patients who had progressive post-LASIK ectasia, with at least 2 years of follow-up. They had epithelium-off CXL. Topographical and visual changes were recorded. Results The study included 21 eyes of 11 patients. At month 24, the final logMAR corrected distance visual acuity (CDVA) and spherical equivalent (SE) were stable compared to baseline (0.16, and −2.0 diopter (D), respectively). The final Kmean and Kmax were 42.5 and 47.4 D, respectively. Stability or improvement in CDVA, SE, and Kmax was seen in 17 eyes (81%). Significant corneal thinning was seen (438 vs 457 microns, p = 0.003). Thinning by 2% or more was seen in 12 eyes (57.1%). Failure of CXL was seen in 4 eyes (19%). No other ocular complications were seen. Conclusion CXL for post LASIK ectasia is a safe and effective modality. Despite corneal thinning, there was stability or improvement in topographic parameters and CDVA over the 2-year follow-up period.
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Affiliation(s)
- Mohamed H Nasef
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
- Correspondence: Mohamed H Nasef, Tanta University Ophthalmology Hospital, Tanta University Medical Campus, Al-Geish St, Tanta, Gharbia, 31527, Egypt, Tel +20 10 02826555, Email
| | - Sharif Y El Emam
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Tamer I Haleem
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Wesam S Shalaby
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Waleed A Allam
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
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Crosslinking vs. Observation in Fellow Eyes of Keratoconus Patients. J Ophthalmol 2022; 2022:4661392. [PMID: 35692966 PMCID: PMC9177316 DOI: 10.1155/2022/4661392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/09/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose To evaluate whether unilateral crosslinking (CXL) and conservative follow-up of the fellow eye is an acceptable management strategy in patients with keratoconus (KC). Methods Seventy-nine fellow eyes of KC subjects that initially underwent unilateral CXL were included. Thirty fellow eyes ultimately received CXL (group 1) whereas 49 fellow eyes were followed (group 2). Best spectacle corrected visual acuity (BSCVA) and corneal tomographic parameters were collected in all eyes preoperatively and at the last follow-up. Results Subjects who received CXL in the fellow eye (group 1) were younger than subjects who did not (group 2, p=0.026). Group 1 eyes had higher baseline K1 (p=0.026), K2 (p=0.006), Km (p=0.01), and Kmax (p=0.002) compared to group 2 eyes. Amongst the 49 naïve fellow eyes (group 2), 19 eyes showed evidence of progression. Progressing naïve eyes had higher baseline K1, K2, Km, and Kmax (p < 0.01); progressors also had thinner pachymetry at the pupil, apex, and thinnest point (p < 0.01). Baseline values of K1 ≥ 43.5 Diopter (D), K2 > 45.1D, Km > 44.3D, Kmax > 47.9D, astigmatism > 1.4D, pachymetry at the pupil <475 μm, and thinnest pachymetry <478 μm were tentative predictors of progression in the naïve fellow eye. Conclusions Unilateral CXL with vigilant follow up of the fellow eye may be an acceptable management strategy in a subset of KC eyes.
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Elkadim M, Nasef MH, Alagorie AR, Allam WA. Corneal Topographic versus Manifest Refractive Astigmatism in Patients with Keratoconus: A Retrospective Cross-Sectional Study. Clin Ophthalmol 2022; 16:2033-2039. [PMID: 35757018 PMCID: PMC9231632 DOI: 10.2147/opth.s361338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/09/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the subjective manifest astigmatism to the corneal topographic astigmatism in patients with keratoconus. Methods This retrospective study included data of 230 keratoconic eyes of 115 patients. Topographic corneal astigmatism (TA), which was measured by pentacam, was compared and correlated to manifest refractive cylinder (MRC) in terms of power, axis, vector components, and mean vector. The difference between TA and MRC was correlated to the maximum keratometric reading (Kmax) and the thinnest pachymetry location (TL), as indicators of keratoconus severity. Results There was a significant positive correlation between MRC power and TA power (p < 0.001; r = 0.58). TA power was significantly higher than MRC power (p < 0.001). A significant correlation was present between the axis of TA and MRC (r = 0.73; p < 0.001) with the axis of the MRC tending to be more vertical (more against the rule) than the axis of TA. The vector difference between TA and MRC is correlated to the Kmax (p < 0.001; r = 0.62) and TL (p < 0.001; r = 0.3). Conclusions A significant difference is present between TA and MRC in keratoconic eyes, the power of MRC tends to be less and the axis tends to be more vertical than those of TA; this difference increases as keratoconus becomes more advanced.
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Affiliation(s)
- Mohamed Elkadim
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
- Correspondence: Mohamed Elkadim, Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt, Email
| | - Mohamed H Nasef
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Waleed A Allam
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
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18
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Comparison of Long-Term Outcomes and Refractive Stability following SMILE versus SMILE Combined with Accelerated Cross-Linking (SMILE XTRA). J Ophthalmol 2022; 2022:4319785. [PMID: 35265368 PMCID: PMC8901300 DOI: 10.1155/2022/4319785] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/28/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose To compare the long-term safety, efficacy, predictability, and refractive stability following SMILE versus SMILE combined with accelerated cross-linking (SMILE XTRA), and to specifically study the regression patterns following the two procedures. Methods This retrospective study included 54 eyes of SMILE and 54 eyes of SMILE XTRA treated for normal and borderline cases of myopia/myopic astigmatism, respectively, based on certain predefined topographic features and risk factors. Patients in both the groups were matched for age and refractive error. The mean postoperative follow-up for the SMILE group was 22.18 ± 10.41 months and the SMILE XTRA group was 21.81 ± 10.19 months. Results At the end of follow-up, the mean sphere, cylinder, and SE reduced to −0.03, −0.09, and −0.08 D in the SMILE group and −0.06, −0.15, and −0.13 D in the SMILE XTRA group. 96% and 93% eyes remained within ±0.50 D in SMILE and SMILE XTRA groups, respectively, and 94% eyes maintained an UDVA of 20/20 or better in the SMILE as well as SMILE XTRA groups. Safety and efficacy indices for the SMILE group were 1.03 and 1.00. For the SMILE XTRA group, the safety and efficacy indices were 1.00 and 0.99. No eye in either group had postoperative ectasia or enhancement performed for significant residual refractive error. Conclusion Both the SMILE and SMILE XTRA groups exhibited comparable visual outcomes, safety, and efficacy. Contrary to the belief, combination of prophylactic CXL with SMILE did not result in a hyperopic shift in the long term. No eye in either group encountered postoperative ectasia; however, further follow-up is suggested to establish the long-term effects on refractive and corneal stability following SMILE XTRA, as all the eyes treated in this group were borderline.
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Merola RV, Cronemberger S, Veloso AW, Diniz-Filho A. Twenty-four hours intraocular pressure in keratoconic eyes assessed by applanation tonometry and Tono-Pen AVIA. Int J Ophthalmol 2022; 15:52-58. [PMID: 35047356 DOI: 10.18240/ijo.2022.01.08] [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: 03/27/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To assess intraocular pressure (IOP) during the daily curve of intraocular pressure (DCPo) in keratoconic eyes and compare Goldmann applanation tonometer (GAT), without and with astigmatism correction (nGAT and cGAT) and Tono-Pen AVIA (TPA) assessment methods. METHODS Thirty-nine keratoconic eyes of 24 patients were assessed. DCPo was evaluated with five IOP measurements; four were performed with a GAT (nGAT and cGAT), and a Tono-Pen AVIA (TPA) at various times throughout the day. RESULTS Mean IOP DCPo values (mm Hg) were: nGAT, 9.9±2.6; cGAT, 11.3±2.6; TPA 12.3±3.1. Mean IOP DCPo differences (mm Hg) and Spearman's correlation coefficients were as follows: cGATc-nGAT, 1.32±1.31, r s=0.879 (P<0.01); cGAT-TPA, -1.02±2.08, r s=0.723 (P<0.01); and nGAT-TPA, -2.35±2.23, r s=0.730 (P<0.01). Bland-Altman analysis for agreement between cGAT-TPA and nGAT-TPA mean IOP DCPo measurements revealed a mean difference of 1.02 (95%CI, 0.35-1.70) and 2.35 (95%CI, 1.62-3.07) mm Hg, respectively. Regression analysis yielded the following equation: TPA IOP=5.49+0.775×cGAT-0.015×ACD-0.299×corneal astig matism, which allowed us to infer TPA IOP values from other parameters. CONCLUSION In keratoconic eyes, IOP peaks of DCPo measurements are identified at 6 a.m., independent of the tonometer. The mean DCPo values are: TPA>cGAT>nGAT. IOP TPA measures are predictive of cGAT values, adjusted according to anterior chamber depth and corneal astigmatism.
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Affiliation(s)
- Rafael Vidal Merola
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
| | - Sebastião Cronemberger
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
| | - Artur William Veloso
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
| | - Alberto Diniz-Filho
- Nassim Calixto Glaucoma Service of São Geraldo Eye Hospital, Clinic Hospital, Federal University of Minas Gerais-Belo Horizonte, Belo Horizonte 30130-100, State of Minas Gerais, Brazil
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Preliminary Characterization of Predictive Factors of the Visual Change after Epi-On and Epi-Off Corneal Collagen Crosslinking Techniques. J Ophthalmol 2021; 2021:9680253. [PMID: 34917415 PMCID: PMC8670975 DOI: 10.1155/2021/9680253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/04/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To investigate the potential predictive factors of the visual change achieved with accelerated epi-on and epi-off corneal collagen crosslinking (CXL) in keratoconus. Methods This retrospective comparative study analyzed 67 eyes treated with an accelerated epithelium-on (epi-on group) and epithelium-off (epi-off group) CXL. The clinical outcomes were evaluated and compared during a 1-year follow-up. Likewise, the relationship of the change achieved with both CXL techniques in the corrected distance visual acuity (CDVA) with different preoperative data was investigated. Results The mean CDVA change at 3 months postoperatively was −0.04 ± 0.19 and −0.07 ± 0.25 in the epi-on and epi-off groups, respectively (p = 0.809). In the epi-on group, this change was significantly correlated with the preoperative apical (r = −0.375, p = 0.045) and central corneal thickness (r = −0.402, p = 0.031). In the epi-off group, the CDVA change was significantly correlated with not only the preoperative apical (r = 0.402, p = 0.028) and central corneal thickness (r = 0.367, p = 0.046) but also with some topometric and aberrometric indices (r ≤ −0.374, p ≤ 0.042). Furthermore, the change in CDVA in the epi-on group could be predicted from age, preoperative refractive astigmatism J45 component, anterior corneal asphericity, and posterior corneal high order aberration root mean square (p = 0.002, R2 = 0.503). In the epi-off group, the CDVA change could be predicted from the preoperative minimum corneal thickness and magnitude of the vertical anterior corneal primary coma component (p = 0.001, R2 = 0.446). Conclusions Clearly, different predictive factors of the visual change induced with the accelerated epi-on and epi-off CXL techniques are present, suggesting a different mechanism of action for stiffening the cornea and inducing changes in this structure.
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Nicula CA, Rednik AM, Nicula AP, Bulboaca AE, Nicula D, Horvath KU. Comparative Results Between "Epi-Off" Accelerated and "Epi-Off" Standard Corneal Collagen Crosslinking-UVA in Progressive Keratoconus - 7 Years of Follow-Up. Ther Clin Risk Manag 2021; 17:975-988. [PMID: 34522101 PMCID: PMC8434931 DOI: 10.2147/tcrm.s321410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/14/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The purpose of the present study was to assess the long-term efficiency and safety of the “epi-off” accelerated CXL (9 mW/cm2 for 10 minutes) in comparison to the standard “epi-off” CXL (3 mW/cm2 for 30 minutes) in terms of topographical and keratometric parameters, refractive data and visual outcomes at 7 years of follow-up, in progressive keratoconus. Material and Method A retrospective and comparative study was performed. A total of 183 eyes from 183 patients with documented progressive keratoconus were included in the study. The patients were divided in two groups: 93 eyes from 93 patients underwent “epi-off” standard cross-linking technique (3 mW/cm2 for 30 minutes) (S-CXL group) and 90 eyes from 90 patients underwent accelerated “epi-off” corneal CXL technique (9 mW/cm2 for 10 minutes) (A-CXL group). Results Improvements in uncorrected distance visual acuity (UDVA) were statistically significant compared to baseline values in both groups at each time-point visit (p=0.0421 at 1 year, p=0.0411 at 7 years for A-CXL and p=0.0375 at 1 year, p=0.0389 at 7 years for S-CXL). At 7 years there was a statistically significant increase in CDVA (p=0.039 in the A-CXL group and p=0.0343 in the S-CXL group at 7 years). Statistically significant reduction was noticed in Ksteep (p=0.0411 in A-CXL group and p=0.0224 in S-CXL group), Kflat (p=0.0198 in A-CXL group and p=0.008 in S-CXL group), K mean (p=0.0106 in A-CXL group and p=0.0193 in S-CXL group) and Kmax (p=0.0413 in A-CXL group and p=0.054 in S-CXL group) at 7 years, compared to baseline values, in both groups, but without any statistically difference between the two procedures, at all time-point visits (p>0.05). Conclusion The long-term outcomes of “epi-off” accelerated corneal collagen crosslinking-UVA (9 mW/cm2 for 10 minutes) are similar to standard “epi-off” corneal collagen crosslinking procedure in the treatment of progressive keratoconus.
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Affiliation(s)
- Cristina Ariadna Nicula
- Department of Ophthalmology, Medicine and Pharmacy University "Iuliu Hațieganu", Cluj-Napoca, Romania.,Oculens Clinic, Cluj-Napoca, Romania
| | - Anca Maria Rednik
- Eye County Hospital, Department of Ophthalmology, Cluj-Napoca, Romania
| | | | - Adriana Elena Bulboaca
- Department of Pathophysiology, Medicine and Pharmacy University "Iuliu Hațieganu", Cluj Napoca, Romania
| | | | - Karin Ursula Horvath
- Department of Ophthalmology, Medicine and Pharmacy Science and Technology University "George Emil Palade", Târgu Mureș, Romania
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Complications Leading to Keratoplasty among Contact Lens Users and LASIK Patients: A 10-Year Cross-Sectional Analysis. J Ophthalmol 2021; 2021:5563545. [PMID: 34426768 PMCID: PMC8380166 DOI: 10.1155/2021/5563545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To determine the incidence and outcomes in patients who underwent penetrating keratoplasty (PK) resulting from complications related to contact lens (CL) use and laser in situ keratomileusis (LASIK) in a metropolitan area of the United States. Methods Population data was obtained from the United States Census Bureau and the Centers for Disease Control. A retrospective, cross-sectional chart review was performed on all patients who underwent keratoplasty in a specific metropolitan geographic area over a ten-year period. The main outcome was best-corrected visual acuity (BCVA) at 2 years in patients who underwent PK secondary to complications related to CL use and LASIK. The secondary outcome was the relative risk of undergoing PK secondary to a complication related to CL use versus LASIK. Results The study's geographic area had 46,545 CL users in one or both eyes during any given year and 10,285 patients who underwent LASIK in one or both eyes during the study interval. There were 24 CL users (0.52 per 1,000) and 3 post-LASIK patients (0.29 per 1,000) who underwent PK secondary to complications during the study interval (OR 1.77 [0.53-5.87, 95% CI]; p=0.35). BCVA at 2 years was 1.45 [1.0-1.90] logMAR (20/564 Snellen) in the CL using cohort and 0.07 [-1.19-1.33] logMAR (20/23 Snellen) in post-LASIK cohort following PK (p=0.04). Conclusions Patients who underwent PK secondary to complications related to CL use had worse visual outcomes at 2 years compared to those related to LASIK. Complications leading to PK were rare in both cohorts, but the incidence of undergoing PK secondary to CL use trended higher than LASIK.
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Zhang Y, Chen Y. Topography-guided corneal surface laser ablation combined with simultaneous accelerated corneal collagen cross-linking for treatment of keratoconus. BMC Ophthalmol 2021; 21:286. [PMID: 34301233 PMCID: PMC8305492 DOI: 10.1186/s12886-021-02042-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/09/2021] [Indexed: 12/20/2022] Open
Abstract
Background to study the outcomes of topography-guided customized excimer laser subepithelial ablation combined with accelerated CXL for progressive keratoconus. Methods Thirty-one eyes of 30 patients with progressive keratoconus were included in this prospective study. Topography-guided excimer laser ablation without refractive correction was performed. Simultaneous accelerated collagen cross-linking with ultraviolet light of 30 mW/cm2 for 4 min was followed. Uncorrected distance visual acuity (UCVA), manifest refraction, corrected distance visual acuity (CDVA), tomograghy were examined at postoperative 1, 6, and 12 months. Results UDVA improved slightly after surgery (P > 0.05). BSCDVA improved significantly from 0.32 ± 0.20 logMAR to 0.15 ± 0.14 logMAR at postoperative 12 months (P < 0.05). During 12-month follow-ups, there were no significant differences in manifest refraction and corneal keratometry except for maximal keratometry value of the anterior surface (Kapex), which decreased significantly from 57.23 ± 5.09D to 53.13 ± 4.47D (P < 0.05). Even though the thinnest corneal thickness decreased from 465 ± 24 μm to 414 ± 35 μm (P < 0.05), curvature asymmetry index front (SIf), keratoconus vertex front (KVf) and Baiocchi Calossi Versaci index front (BCVf) decreased significantly till postoperative 12 months (P < 0.05). Corneal higher-order aberrations and coma also decreased significantly till 12 months after surgery (P < 0.05). Conclusions Topography-guided surface ablation without refractive correction combined with simultaneous accelerated collagen cross-linking provided good stability in refraction and corneal curvature, and also showed significant improvement in BSCDVA, corneal regularity and corneal optical quality.
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Affiliation(s)
- Yu Zhang
- Department of Ophthalmology, Beijing key laboratory of restoration of damaged ocular nerve, Peking University Third Hospital, 49 North Huayuan Road, Haidian District, 100191, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Beijing key laboratory of restoration of damaged ocular nerve, Peking University Third Hospital, 49 North Huayuan Road, Haidian District, 100191, Beijing, China.
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