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Csorba A, Kormányos K, Csidey M, Náray A, Kovács K, Németh O, Knézy K, Bausz M, Szigeti A, Szabó D, Corton M, Tory K, Nagy ZZ, Langenbucher A, Maka E, Szentmáry N. Examination of Subbasal Nerve Plexus and Central Corneal Stromal Microstructure in Subjects With Congenital Aniridia, Using in Vivo Confocal Laser Scanning Microscopy. Curr Eye Res 2024; 49:582-590. [PMID: 38444179 DOI: 10.1080/02713683.2024.2320779] [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: 09/05/2023] [Accepted: 02/13/2024] [Indexed: 03/07/2024]
Abstract
PURPOSE During life up to 70% of aniridia subjects develop aniridia-associated keratopathy (AAK). AAK is characterized by limbal stem cell insufficiency, impaired corneal epithelial cell differentiation and abnormal cell adhesion, which leads to centripetal spreading vascularization, conjunctivalization, and thickening of the cornea. Our aim was to examine the subbasal nerve plexus and central corneal stromal microstructure in subjects with congenital aniridia, using in vivo confocal laser scanning microscopy CLSM. METHODS 31 eyes of 18 patients (55.6% males, mean age: 25.22 ± 16.35 years) with congenital aniridia and 46 eyes of 29 healthy subjects (41.4% males, mean age 30 ± 14.82 years) were examined using the Rostock Cornea Module of Heidelberg Retina Tomograph-III. At the subbasal nerve plexus, corneal nerve fiber density (CNFD), corneal nerve fiber length (CNFL), corneal total branch density (CTBD), and corneal nerve fiber width (CNFW) were analyzed using ACCMetrics software. Keratocyte density in the anterior, middle and posterior stroma was assessed manually. RESULTS The CNFD (2.02 ± 4.08 vs 13.99 ± 6.34/mm2), CNFL (5.78 ± 2.68 vs 10.56 ± 2.82 mm/mm2) and CTBD (15.08 ± 15.62 vs 27.44 ± 15.05/mm2) were significantly lower in congenital aniridia subjects than in controls (p < 0.001 for all). CNFW was significantly higher in aniridia subjects than in controls (0.03 ± 0.004 vs 0.02 ± 0.003 mm/mm2) (p = 0.003). Keratocyte density was significantly lower in all stromal layers of aniridia subjects than in controls (p < 0.001 for all). Stromal alterations included confluent keratocytes, keratocytes with long extensions and hyperreflective dots between keratocytes in aniridia. CONCLUSIONS Decrease in CNFD, CNFL, and CTBD, as well as increase in CNFW well refer to the congenital aniridia-associated neuropathy. The decreased keratocyte density and the stromal alterations may be related to an increased cell death in congenital aniridia, nevertheless, stromal changes in different stages of AAK have to be further analyzed in detail.
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Affiliation(s)
- Anita Csorba
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Kitti Kormányos
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Mária Csidey
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Heim Pál National Pediatric Institute, Budapest, Hungary
| | - Annamária Náray
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Universität des Saarlandes - Campus Homburg, Homburg/Saar, Germany
| | - Klaudia Kovács
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Orsolya Németh
- Department of Ophthalmology, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - Krisztina Knézy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Mária Bausz
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Andrea Szigeti
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Dorottya Szabó
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Marta Corton
- Department of Genetics and Genomics, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz University Hospital, Universidad Autónoma de Madrid (IIS-FJD, UAM), Madrid, Spain
- Center for Biomedical Network Research on Rare Diseases (CIBERER), Instituto de Salud Carlos III, Madrid, Spain
| | - Kálmán Tory
- MTA-SE Lendület Nephrogenetic Laboratory, Hungarian Academy of Sciences, Budapest, Hungary
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Erika Maka
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Nóra Szentmáry
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Universität des Saarlandes - Campus Homburg, Homburg/Saar, Germany
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Li D, Tian LE, Wang X, Zhang F, Liu T, Dong Y, Lin P, Li D, Sun D, Chen M. Recurrence Characteristics on Optical Coherence Tomography and Treatments of Reis-Bücklers Corneal Dystrophy After Phototherapeutic Keratectomy or Penetrating Keratoplasty. Am J Ophthalmol 2024; 266:37-45. [PMID: 38735449 DOI: 10.1016/j.ajo.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 05/07/2024] [Accepted: 05/07/2024] [Indexed: 05/14/2024]
Abstract
PURPOSE To evaluate the recurrence characteristics on optical coherence tomography and clinical outcomes after phototherapeutic keratectomy (PTK) or penetrating keratoplasty (PKP) in patients with Reis-Bücklers corneal dystrophy (RBCD). DESIGN Retrospective interventional case series. METHODS Seventeen patients with RBCD (31 eyes, including 6 surgery-naïve eyes and 25 surgical eyes) received 44 surgical interventions from 1996 through 2022. PTK or PKP was performed as the initial surgical procedure. Significant recurrence was determined when best spectacle-corrected visual acuity decreased at least 2 lines with increased opacity in the superficial cornea. Repeated PTK or PTK on the corneal graft (CG-PTK) was considered if patients could not endure poor vision due to significant recurrence. Recurrence depth and annual increase in thickness of the central cornea and subepithelial deposits were assessed by anterior segment optical coherence tomography. RESULTS The mean follow-up time was 12.8 ± 8.5 years (range, 2.0-25.5 years). The mean logMAR best spectacle-corrected visual acuity improved from 1.24 ± 0.48 preoperatively to 0.27 ± 0.09 postoperatively in the initial PTK group (13 eyes, P < .001), from 1.84 ± 0.69 to 0.40 ± 0.13 in the PKP group (12 eyes, P < .001), from 1.04 ± 0.46 to 0.30 ± 0.07 in the repeated PTK group (12 times in 7 eyes, P < .001), and from 1.29 ± 0.43 to 0.39 ± 0.11 in the CG-PTK group (7 times in 5 eyes, P = .001). The median significant recurrence time was 27 months (95% confidence interval 23.9-30.1), 96 months (84.1-107.9), 31 months (28.8-33.1), and 24 months (19.8-28.2), respectively (P < .001). The depth of superficial deposits located between the epithelium and the anterior stroma was approximately 115 µm (85-159 µm). The annual thickening of subepithelial deposits was 14 ± 2 µm after initial PTK, 7 ± 3 µm after PKP, 14 ± 3 µm after repeated PTK, and 30 ± 11 µm after CG-PTK, compared to 4 ± 2 µm in surgery-naïve eyes (P = .002, .515, .002, <.001). The thickness of the central cornea increased by 15 ± 2 µm, 7 ± 2 µm, 15 ± 3 µm, and 31 ± 10 µm per year in the 4 surgery groups, respectively, compared to 5 ± 2 µm in surgery-naïve eyes (P = .001, .469, .001, <.001). CONCLUSIONS Better visual acuity can be achieved after PTK than PKP for treatment of RBCD. The annual thickening of subepithelial deposits may approximate an increase in central corneal thickness. The superficial distribution of subepithelial deposits makes it feasible to perform repeated PTK, even on the corneal allograft, for recurrent RBCD.
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Affiliation(s)
- Dewei Li
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - L E Tian
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Xiaochuan Wang
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Feifei Zhang
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China
| | - Ting Liu
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Yanling Dong
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Ping Lin
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China
| | - Dongfang Li
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China
| | - Dapeng Sun
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China
| | - Min Chen
- From the Qingdao Eye Hospital (D.L., L.T., X.W., F.Z., T.L., Y.D., P.L., D.L., D.S., M.C.), Shandong First Medical University, Qingdao, China; State Key Laboratory Cultivation Base (D.L., T.L., Y.D., P.L., D.L., M.C.), Shandong Provincial Key Laboratory of Ophthalmology, Eye Institute of Shandong First Medical University, Qingdao, China; School of Ophthalmology (D.L., L.T., X.W., T.L., Y.D., D.L., M.C.), Shandong First Medical University, Qingdao, China.
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Utheim TP, Chen X, Fricke O, Bergersen LH, Lagali N. Microdot Accumulation in the Anterior Cornea with Aging - Quantitative Analysis with in Vivo Confocal Microscopy. Curr Eye Res 2020; 45:1058-1064. [PMID: 32026738 DOI: 10.1080/02713683.2020.1725062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Degenerative 'microdot' deposits in healthy and hypoxic corneas are believed to represent lipofuscin-like material aggregation in the stroma. To accurately assess microdot deposits in a clinical setting, we sought to quantify these deposits for the first time using the non-invasive clinical imaging technique of in vivo confocal microscopy (IVCM). METHODS The corneas of 102 healthy subjects aged 15-88 years were examined by IVCM and microdot density was quantified using a 6-point grading scale by two masked, trained examiners. Microdot density was analyzed with respect to age, sex and stromal depth, and inter-eye and inter-observer differences were evaluated. RESULTS In healthy subjects, microdot density decreased from the anterior to posterior stroma, with the greatest accumulation observed in the most anterior stroma (subepithelial region). In this region, microdot density correlated strongly with age (P < .0001), with increased microdot deposition in older subjects (>60 years) relative to younger ones (<45 years) (P < .001). Microdot density between eyes of the same subject was highly correlated (r = 0.92, P < .0001), while no association with sex was noted (P ≥ 0.05). The mean inter-observer difference in microdot assessment was 0.62 ± 0.09 grades, with a high correlation of grading between observers (r = 0.77, P < .0001). CONCLUSIONS IVCM can be used to non-invasively quantify microdot deposits in the subepithelial corneal stroma with good inter-observer reproducibility. Microdot assessment may provide a novel means of quantifying age-related or pathologic degeneration of the corneal stroma in a clinical setting.
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Affiliation(s)
- Tor Paaske Utheim
- Department of Plastic and Reconstructive Surgery, Oslo University Hospital , Oslo, Norway.,Department of Ophthalmology, Sørlandet Hospital Arendal , Arendal, Norway
| | - Xiangjun Chen
- Department of Ophthalmology, Sørlandet Hospital Arendal , Arendal, Norway
| | - Otto Fricke
- Department of Clinical and Experimental Medicine, Linköping University , Linköping, Sweden
| | | | - Neil Lagali
- Department of Ophthalmology, Sørlandet Hospital Arendal , Arendal, Norway.,Department of Clinical and Experimental Medicine, Linköping University , Linköping, Sweden
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