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Itoi M, Itoi M. Association Between Family History and the Corneal Characteristics of Keratoconus in Japan. Eye Contact Lens 2024; 50:357-360. [PMID: 38861231 DOI: 10.1097/icl.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/12/2024]
Abstract
PURPOSE The aim of this study was to determine the association between family history and corneal characteristics of keratoconus in Japan. METHODS The clinical records of patients with keratoconus who were interviewed regarding family history of keratoconus were retrospectively reviewed. Corneal indices derived from anterior segment optical coherence tomography were compared between the positive and negative family history groups using multiple linear regression analysis adjusted with age, sex, and history of atopy and eye rubbing. RESULTS A total of 2,701 eyes, including 122 eyes with positive family history, were enrolled. Based on the adjusted multiple linear regression analysis, no significant differences were found between groups with and without a family history except for paracentral and mid-peripheral corneal thickness. The adjusted mean differences in paracentral and mid-peripheral corneal thicknesses between the two groups were -10.33 (95% confidence interval -20.29 to -0.37 P -value <0.05) and -9.78 (95% confidence interval -16.70 to -2.85, P -value <0.01), respectively. CONCLUSIONS There was no significant association between family history and corneal indices in Japanese patients with keratoconus, except for paracentral and mid-peripheral corneal thicknesses. A Japanese patient with keratoconus who had a family history showed significantly lower paracentral and mid-peripheral corneal thicknesses than those with no family history.
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Affiliation(s)
- Motohiro Itoi
- Dougenzaka Itoi Eye Clinic (M.I.), Tokyo, Japan; and School of Optometry and Vision Science (M.I.), University of New South Wales, Sydney, Australia
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Gómez C, Piñero DP, Paredes M, Alió JL, Cavas F. Study of the Influence of Boundary Conditions on Corneal Deformation Based on the Finite Element Method of a Corneal Biomechanics Model. Biomimetics (Basel) 2024; 9:73. [PMID: 38392119 PMCID: PMC10886865 DOI: 10.3390/biomimetics9020073] [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: 12/28/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
Implementing in silico corneal biomechanical models for surgery applications can be boosted by developing patient-specific finite element models adapted to clinical requirements and optimized to reduce computational times. This research proposes a novel corneal multizone-based finite element model with octants and circumferential zones of clinical interest for material definition. The proposed model was applied to four patient-specific physiological geometries of keratoconus-affected corneas. Free-stress geometries were calculated by two iterative methods, the displacements and prestress methods, and the influence of two boundary conditions: embedded and pivoting. The results showed that the displacements, stress and strain fields differed for the stress-free geometry but were similar and strongly depended on the boundary conditions for the estimated physiological geometry when considering both iterative methods. The comparison between the embedded and pivoting boundary conditions showed bigger differences in the posterior limbus zone, which remained closer in the central zone. The computational calculation times for the stress-free geometries were evaluated. The results revealed that the computational time was prolonged with disease severity, and the displacements method was faster in all the analyzed cases. Computational times can be reduced with multicore parallel calculation, which offers the possibility of applying patient-specific finite element models in clinical applications.
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Affiliation(s)
- Carmelo Gómez
- International School of Doctorate, Technical University of Cartagena, 30202 Cartagena, Spain
| | - David P Piñero
- Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 Alicante, Spain
| | - Manuel Paredes
- ICA, Université de Toulouse, UPS, INSA, ISAE-SUPAERO, MINES-ALBI, CNRS, 3 rue Caroline Aigle, 31400 Toulouse, France
| | - Jorge L Alió
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03202 Alicante, Spain
| | - Francisco Cavas
- Department of Structures, Construction and Graphic Expression, Technical University of Cartagena, 30202 Cartagena, Spain
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Vandevenne MM, Favuzza E, Veta M, Lucenteforte E, Berendschot TT, Mencucci R, Nuijts RM, Virgili G, Dickman MM. Artificial intelligence for detecting keratoconus. Cochrane Database Syst Rev 2023; 11:CD014911. [PMID: 37965960 PMCID: PMC10646985 DOI: 10.1002/14651858.cd014911.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
BACKGROUND Keratoconus remains difficult to diagnose, especially in the early stages. It is a progressive disorder of the cornea that starts at a young age. Diagnosis is based on clinical examination and corneal imaging; though in the early stages, when there are no clinical signs, diagnosis depends on the interpretation of corneal imaging (e.g. topography and tomography) by trained cornea specialists. Using artificial intelligence (AI) to analyse the corneal images and detect cases of keratoconus could help prevent visual acuity loss and even corneal transplantation. However, a missed diagnosis in people seeking refractive surgery could lead to weakening of the cornea and keratoconus-like ectasia. There is a need for a reliable overview of the accuracy of AI for detecting keratoconus and the applicability of this automated method to the clinical setting. OBJECTIVES To assess the diagnostic accuracy of artificial intelligence (AI) algorithms for detecting keratoconus in people presenting with refractive errors, especially those whose vision can no longer be fully corrected with glasses, those seeking corneal refractive surgery, and those suspected of having keratoconus. AI could help ophthalmologists, optometrists, and other eye care professionals to make decisions on referral to cornea specialists. Secondary objectives To assess the following potential causes of heterogeneity in diagnostic performance across studies. • Different AI algorithms (e.g. neural networks, decision trees, support vector machines) • Index test methodology (preprocessing techniques, core AI method, and postprocessing techniques) • Sources of input to train algorithms (topography and tomography images from Placido disc system, Scheimpflug system, slit-scanning system, or optical coherence tomography (OCT); number of training and testing cases/images; label/endpoint variable used for training) • Study setting • Study design • Ethnicity, or geographic area as its proxy • Different index test positivity criteria provided by the topography or tomography device • Reference standard, topography or tomography, one or two cornea specialists • Definition of keratoconus • Mean age of participants • Recruitment of participants • Severity of keratoconus (clinically manifest or subclinical) SEARCH METHODS: We searched CENTRAL (which contains the Cochrane Eyes and Vision Trials Register), Ovid MEDLINE, Ovid Embase, OpenGrey, the ISRCTN registry, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP). There were no date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 29 November 2022. SELECTION CRITERIA We included cross-sectional and diagnostic case-control studies that investigated AI for the diagnosis of keratoconus using topography, tomography, or both. We included studies that diagnosed manifest keratoconus, subclinical keratoconus, or both. The reference standard was the interpretation of topography or tomography images by at least two cornea specialists. DATA COLLECTION AND ANALYSIS Two review authors independently extracted the study data and assessed the quality of studies using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. When an article contained multiple AI algorithms, we selected the algorithm with the highest Youden's index. We assessed the certainty of evidence using the GRADE approach. MAIN RESULTS We included 63 studies, published between 1994 and 2022, that developed and investigated the accuracy of AI for the diagnosis of keratoconus. There were three different units of analysis in the studies: eyes, participants, and images. Forty-four studies analysed 23,771 eyes, four studies analysed 3843 participants, and 15 studies analysed 38,832 images. Fifty-four articles evaluated the detection of manifest keratoconus, defined as a cornea that showed any clinical sign of keratoconus. The accuracy of AI seems almost perfect, with a summary sensitivity of 98.6% (95% confidence interval (CI) 97.6% to 99.1%) and a summary specificity of 98.3% (95% CI 97.4% to 98.9%). However, accuracy varied across studies and the certainty of the evidence was low. Twenty-eight articles evaluated the detection of subclinical keratoconus, although the definition of subclinical varied. We grouped subclinical keratoconus, forme fruste, and very asymmetrical eyes together. The tests showed good accuracy, with a summary sensitivity of 90.0% (95% CI 84.5% to 93.8%) and a summary specificity of 95.5% (95% CI 91.9% to 97.5%). However, the certainty of the evidence was very low for sensitivity and low for specificity. In both groups, we graded most studies at high risk of bias, with high applicability concerns, in the domain of patient selection, since most were case-control studies. Moreover, we graded the certainty of evidence as low to very low due to selection bias, inconsistency, and imprecision. We could not explain the heterogeneity between the studies. The sensitivity analyses based on study design, AI algorithm, imaging technique (topography versus tomography), and data source (parameters versus images) showed no differences in the results. AUTHORS' CONCLUSIONS AI appears to be a promising triage tool in ophthalmologic practice for diagnosing keratoconus. Test accuracy was very high for manifest keratoconus and slightly lower for subclinical keratoconus, indicating a higher chance of missing a diagnosis in people without clinical signs. This could lead to progression of keratoconus or an erroneous indication for refractive surgery, which would worsen the disease. We are unable to draw clear and reliable conclusions due to the high risk of bias, the unexplained heterogeneity of the results, and high applicability concerns, all of which reduced our confidence in the evidence. Greater standardization in future research would increase the quality of studies and improve comparability between studies.
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Affiliation(s)
- Magali Ms Vandevenne
- University Eye Clinic Maastricht, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Eleonora Favuzza
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
| | - Mitko Veta
- Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands
| | - Ersilia Lucenteforte
- Department of Statistics, Computer Science and Applications «G. Parenti», University of Florence, Florence, Italy
| | - Tos Tjm Berendschot
- University Eye Clinic Maastricht, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Rita Mencucci
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
| | - Rudy Mma Nuijts
- University Eye Clinic Maastricht, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
| | - Gianni Virgili
- Department of Neurosciences, Psychology, Pharmacology and Child Health, University of Florence, Florence, Italy
- Queen's University Belfast, Belfast, UK
| | - Mor M Dickman
- University Eye Clinic Maastricht, Maastricht University Medical Center (MUMC+), Maastricht, Netherlands
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Sáez-Gutiérrez FL, Velázquez JS, Alió del Barrio JL, Alio JL, Cavas F. Novel Multivariable Evolutionary Algorithm-Based Method for Modal Reconstruction of the Corneal Surface from Sparse and Incomplete Point Clouds. Bioengineering (Basel) 2023; 10:989. [PMID: 37627874 PMCID: PMC10451391 DOI: 10.3390/bioengineering10080989] [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: 07/05/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
Three-dimensional reconstruction of the corneal surface provides a powerful tool for managing corneal diseases. This study proposes a novel method for reconstructing the corneal surface from elevation point clouds, using modal schemes capable of reproducing corneal shapes using surface polynomial functions. The multivariable polynomial fitting was performed using a non-dominated sorting multivariable genetic algorithm (NS-MVGA). Standard reconstruction methods using least-squares discrete fitting (LSQ) and sequential quadratic programming (SQP) were compared with the evolutionary algorithm-based approach. The study included 270 corneal surfaces of 135 eyes of 102 patients (ages 11-63) sorted in two groups: control (66 eyes of 33 patients) and keratoconus (KC) (69 eyes of 69 patients). Tomographic information (Sirius, Costruzione Strumenti Oftalmici, Italy) was processed using Matlab. The goodness of fit for each method was evaluated using mean squared error (MSE), measured at the same nodes where the elevation data were collected. Polynomial fitting based on NS-MVGA improves MSE values by 86% compared to LSQ-based methods in healthy patients. Moreover, this new method improves aberrated surface reconstruction by an average value of 56% if compared with LSQ-based methods in keratoconus patients. Finally, significant improvements were also found in morpho-geometric parameters, such as asphericity and corneal curvature radii.
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Affiliation(s)
- Francisco L. Sáez-Gutiérrez
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain; (F.L.S.-G.); (J.S.V.)
| | - Jose S. Velázquez
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain; (F.L.S.-G.); (J.S.V.)
| | - Jorge L. Alió del Barrio
- Division of Ophthalmology, Miguel Hernández University, 03690 Alicante, Spain; (J.L.A.d.B.); (J.L.A.)
- Keratoconus Unit of Vissum Corporation Alicante, 03690 Alicante, Spain
- Department of Refractive Surgery, Vissum Corporation Alicante, 03690 Alicante, Spain
| | - Jorge L. Alio
- Division of Ophthalmology, Miguel Hernández University, 03690 Alicante, Spain; (J.L.A.d.B.); (J.L.A.)
- Keratoconus Unit of Vissum Corporation Alicante, 03690 Alicante, Spain
- Department of Refractive Surgery, Vissum Corporation Alicante, 03690 Alicante, Spain
| | - Francisco Cavas
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain; (F.L.S.-G.); (J.S.V.)
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Toprak I, Cavas F, Velázquez JS, del Barrio JLA, Alio JL. A three-dimensional morpho-volumetric similarity study of Down syndrome keratopathy vs. keratoconus. EYE AND VISION (LONDON, ENGLAND) 2023; 10:4. [PMID: 36593521 PMCID: PMC9809058 DOI: 10.1186/s40662-022-00315-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 10/26/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND To compare and contrast morpho-volumetric features between Down syndrome (DS) cornea and non-DS keratoconic cornea by three-dimensional (3D) modelling. METHODS Forty-three subjects (43 eyes) with DS and 99 patients matching their age and sex (99 eyes) with keratoconus (KC) were included in this single-center cross-sectional study. Main outcome measures were high-order aberrations (HOA), central corneal thickness (CCT), spherical equivalent refraction, and morpho-volumetric parameters established using a 3D corneal model, such as deviation of anterior and posterior corneal apices (Dapexant/Dapexpost) and minimum thickness points (Dmctant/Dmctpost) from corneal vertex, areas of the anterior and posterior surfaces (Aant/Apost), sagittal area passing through the anterior and posterior corneal apices (Aapexant/Aapexpost) and minimum thickness point (Amctpost) and corneal volume of the complete cornea (Vtotal). RESULTS Age, gender, spherical equivalent refraction, CCT and Vtotal were similar between the net on-DS KC and DS groups (P > 0.05), while non-DS KC group had higher HOA than the DS group (P < 0.05). Dapexant, Aant, Apost and Aapexant showed higher values in the DS group than in the non-DS KC group, whereas Dapexpost showed a reduction in the DS group when compared with the non-DS KC group (P < 0.05). CONCLUSIONS This study demonstrated that anterior and posterior corneal apex dynamics were specifically different in DS subjects, as the anterior apex tends to displace more prominently when compared to that from the non-DS KC group, while the posterior apex appears to be more stable than that in non-DS KC, which also support the theory that DS patients suffer from a specific keratopathy, distinctively different to KC but strongly related to it, and probably showing a diversity of corneal phenotypes in all cases of DS.
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Affiliation(s)
- Ibrahim Toprak
- grid.411742.50000 0001 1498 3798Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Francisco Cavas
- grid.218430.c0000 0001 2153 2602Bioengineering and Applied Computational Simulation Research Group, Technical University of Cartagena, Cartagena, Spain ,grid.218430.c0000 0001 2153 2602Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, Cartagena, Spain
| | - José S. Velázquez
- grid.218430.c0000 0001 2153 2602Bioengineering and Applied Computational Simulation Research Group, Technical University of Cartagena, Cartagena, Spain ,grid.218430.c0000 0001 2153 2602Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, Cartagena, Spain
| | - Jorge L. Alio del Barrio
- grid.419256.dDepartment of Research and Development, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.419256.dCornea, Cataract and Refractive Surgery Department, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain
| | - Jorge L. Alio
- grid.419256.dDepartment of Research and Development, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.419256.dCornea, Cataract and Refractive Surgery Department, VISSUM, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain ,grid.26811.3c0000 0001 0586 4893Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, Calle Cabañal, 1, Edificio Vissum, 03016 Alicante, Spain
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Salman A, Darwish T, Badla AA, Askar M, Al-Rufayie M, Ghabra M, Haddeh Y, Kailani O, Shaaban R, Hajjo S, Hasan H, Ali A. Prevalence of Keratoconus and Keratoconus Suspect among Patients Seeking Refractive Surgery in Syria. Middle East Afr J Ophthalmol 2022; 29:181-185. [PMID: 38162559 PMCID: PMC10754103 DOI: 10.4103/meajo.meajo_50_23] [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: 03/26/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE The purpose of this study was to determine the prevalence of keratoconus (KC) and keratoconus suspect (KCS) among patients seeking refractive surgery in Syria. METHODS This is a retrospective multicenter screening study. The study was conducted in Damascus University, Tishreen University, and Tartous Specialist Eye Center (a private center). Data were collected from refractive surgery candidates referred for preoperative evaluation before laser in situ keratomileusis, photorefractive keratectomy, intrastromal corneal rings, and phakic intraocular lens implantation. Corneal parameters were obtained by Scheimpflug-Placido tomography, Sirius (CSO, Italy). RESULTS A total of 1479 patients were included in this analysis. The prevalence rates of KC and KCS were 18.19% (269/1479) and 13.52% (200/1479), respectively. In addition, patients with KC were found to have higher percentages of eye rubbing and astigmatism than suspect and normal (P < 0.0001). CONCLUSION High prevalence rate of KC was found among patients seeking refractive surgery in Syria. Although this study was carried out on a highly selective population, it may reflect a high prevalence rate in a general population in Syria.
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Affiliation(s)
| | - Taym Darwish
- Department of Ophthalmology, Tishreen University, Lattakia, Syria
| | - Abdul Aziz Badla
- Department of Ophthalmology, Sulaiman Al-Habib Hospital, Dubai, United Arab Emirates
| | - Mohammad Askar
- Department of Ophthalmology, Damascus University, Damascus, Syria
| | | | - Marwan Ghabra
- Department of Ophthalmology, Whipps Cross University Hospital, Leytonstone, London, UK
| | - Yusra Haddeh
- Department of Ophthalmology, Damascus University, Damascus, Syria
| | - Obeda Kailani
- Department of Ophthalmology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Rafea Shaaban
- Department of Ophthalmology, Tartous University, Tartous, Syria
| | - Samer Hajjo
- Department of Ophthalmology, Damascus University, Damascus, Syria
| | - Hiba Hasan
- Department of Ophthalmology, Tishreen University, Lattakia, Syria
| | - Ali Ali
- Department of Ophthalmology, Tishreen University, Lattakia, Syria
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Tafti MF, Aghamollaei H, Moghaddam MM, Jadidi K, Alio JL, Faghihi S. Emerging tissue engineering strategies for the corneal regeneration. J Tissue Eng Regen Med 2022; 16:683-706. [PMID: 35585479 DOI: 10.1002/term.3309] [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: 11/23/2021] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022]
Abstract
Cornea as the outermost layer of the eye is at risk of various genetic and environmental diseases that can damage the cornea and impair vision. Corneal transplantation is among the most applicable surgical procedures for repairing the defected tissue. However, the scarcity of healthy tissue donations as well as transplantation failure has remained as the biggest challenges in confront of corneal grafting. Therefore, alternative approaches based on stem-cell transplantation and classic regenerative medicine have been developed for corneal regeneration. In this review, the application and limitation of the recently-used advanced approaches for regeneration of cornea are discussed. Additionally, other emerging powerful techniques such as 5D printing as a new branch of scaffold-based technologies for construction of tissues other than the cornea are highlighted and suggested as alternatives for corneal reconstruction. The introduced novel techniques may have great potential for clinical applications in corneal repair including disease modeling, 3D pattern scheming, and personalized medicine.
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Affiliation(s)
- Mahsa Fallah Tafti
- Stem Cell and Regenerative Medicine Group, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
| | - Hossein Aghamollaei
- Chemical Injuries Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | | | - Khosrow Jadidi
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Jorge L Alio
- Department of Research and Development, VISSUM, Alicante, Spain.,Cornea, Cataract and Refractive Surgery Department, VISSUM, Alicante, Spain.,Department of Pathology and Surgery, Division of Ophthalmology, Faculty of Medicine, Miguel Hernández University, Alicante, Spain
| | - Shahab Faghihi
- Stem Cell and Regenerative Medicine Group, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
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Giraudet C, Diaz J, Le Tallec P, Allain JM. Multiscale mechanical model based on patient-specific geometry: Application to early keratoconus development. J Mech Behav Biomed Mater 2022; 129:105121. [DOI: 10.1016/j.jmbbm.2022.105121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 01/19/2022] [Accepted: 02/03/2022] [Indexed: 11/30/2022]
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Santodomingo-Rubido J, Carracedo G, Suzaki A, Villa-Collar C, Vincent SJ, Wolffsohn JS. Keratoconus: An updated review. Cont Lens Anterior Eye 2022; 45:101559. [PMID: 34991971 DOI: 10.1016/j.clae.2021.101559] [Citation(s) in RCA: 201] [Impact Index Per Article: 100.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 12/12/2021] [Indexed: 02/06/2023]
Abstract
Keratoconus is a bilateral and asymmetric disease which results in progressive thinning and steeping of the cornea leading to irregular astigmatism and decreased visual acuity. Traditionally, the condition has been described as a noninflammatory disease; however, more recently it has been associated with ocular inflammation. Keratoconus normally develops in the second and third decades of life and progresses until the fourth decade. The condition affects all ethnicities and both sexes. The prevalence and incidence rates of keratoconus have been estimated to be between 0.2 and 4,790 per 100,000 persons and 1.5 and 25 cases per 100,000 persons/year, respectively, with highest rates typically occurring in 20- to 30-year-olds and Middle Eastern and Asian ethnicities. Progressive stromal thinning, rupture of the anterior limiting membrane, and subsequent ectasia of the central/paracentral cornea are the most commonly observed histopathological findings. A family history of keratoconus, eye rubbing, eczema, asthma, and allergy are risk factors for developing keratoconus. Detecting keratoconus in its earliest stages remains a challenge. Corneal topography is the primary diagnostic tool for keratoconus detection. In incipient cases, however, the use of a single parameter to diagnose keratoconus is insufficient, and in addition to corneal topography, corneal pachymetry and higher order aberration data are now commonly used. Keratoconus severity and progression may be classified based on morphological features and disease evolution, ocular signs, and index-based systems. Keratoconus treatment varies depending on disease severity and progression. Mild cases are typically treated with spectacles, moderate cases with contact lenses, while severe cases that cannot be managed with scleral contact lenses may require corneal surgery. Mild to moderate cases of progressive keratoconus may also be treated surgically, most commonly with corneal cross-linking. This article provides an updated review on the definition, epidemiology, histopathology, aetiology and pathogenesis, clinical features, detection, classification, and management and treatment strategies for keratoconus.
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Affiliation(s)
| | - Gonzalo Carracedo
- Department of Optometry and Vision, Faculty of Optics and Optometry, Universidad Complutense de Madrid, Madrid, Spain
| | - Asaki Suzaki
- Clinical Research and Development Center, Menicon Co., Ltd., Nagoya, Japan
| | - Cesar Villa-Collar
- Department of Pharmacy, Biotechnology, Nutrition, Optics and Optometry, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Centre for Vision and Eye Research, Queensland University of Technology, Brisbane, Australia
| | - James S Wolffsohn
- School of optometry, Health and Life Sciences, Aston University, Birmingham B4 7ET, United Kingdom
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Abstract
ABSTRACT The advent of refractive surgery and corneal cross-linking for ectatic disease has further highlighted the need to recognize early or subclinical ectatic disease. Historical systems depend on anterior corneal changes that occur late in the disease course and are commonly associated with visual loss. Tomographic imaging allows for the acquisition of posterior corneal surface data and corneal thickness distribution. This led to the development of modalities to diagnose early or subclinical keratoconus and to screen patients for refractive surgery.This article reviews the modern methods for assessing changes in posterior corneal surface and pachymetric distribution, now accepted by the major cornea societies to be the hallmarks of ectatic disease. Screening tools utilized by the commonly used tomographic imaging devices are discussed, and the difference between screening for ectasia and diagnosing keratoconus is highlighted. The Belin ABCD staging and classification system and the ABCD Progression Display are reviewed as a new grading and monitoring system that can be used for earlier intervention and prevention of visual loss in keratoconus.
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11
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Quantitative comparison of corneal surface areas in keratoconus and normal eyes. Sci Rep 2021; 11:6840. [PMID: 33767220 PMCID: PMC7994394 DOI: 10.1038/s41598-021-86185-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 03/01/2021] [Indexed: 01/31/2023] Open
Abstract
Keratoconus is a highly prevalent corneal disorder characterized by progressive corneal thinning, steepening and irregular astigmatism. To date, pathophysiology of keratoconus development and progression remains debated. In this study, we retrospectively analysed topographic elevation maps from 3227 eyes of 3227 patients (969 keratoconus and 2258 normal eyes) to calculate anterior and posterior corneal surface area. We compared results from normal eyes and keratoconus eyes using the Mann–Whitney U test. The Kruskal–Wallis test was used to compare keratoconus stages according to the Amsler–Krumeich classification. Keratoconus eyes were shown to have statistically significantly larger corneal surface areas, measured at the central 4.0 mm and 8.0 mm, and total corneal diameter. However, no significant increase in corneal surface area was seen with increasing severity of keratoconus. We suggest that these results indicate redistribution, rather than increase, of the corneal surface area with keratoconus severity.
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Toprak I, Cavas F, Velázquez JS, Alió del Barrio JL, Alió JL. Three-Dimensional Morphogeometric and Volumetric Characterization of Cornea in Pediatric Patients With Early Keratoconus. Am J Ophthalmol 2021; 222:102-111. [PMID: 32971022 DOI: 10.1016/j.ajo.2020.09.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 09/10/2020] [Accepted: 09/14/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE To present morphogeometric and volumetric characteristics of the cornea and its diagnostic value in pediatric patients with keratoconus (KC) using 3-dimensional (3-D) corneal modeling. DESIGN Cross-sectional study. METHODS This single-center (VISSUM Innovation, Alicante, Spain) study comprised 49 eyes of 49 pediatric patients (age ≤16 years) with KC and 31 eyes of 31 healthy pediatric controls. Eyes were graded as early (n = 21) and mild KC (n = 28) based on the RETICS (Thematic Network for Co-Operative Research in Health) classification system. The 3-D corneal model was generated using raw topographic data. Deviation of anterior (Dapexant) and posterior (Dapexpost) apex and minimum thickness points (Dmctant, Dmctpost), Dapexant-Dapexpost difference, total corneal volume (Vtotal), volumetric distribution (VOLAAP, VOLPAP, and VOLMCT), and percentage of relative volume increase (VOLAAPrel, VOLPAPrel, and VOLMCTrel) between 2 consecutive radii centered to anterior/posterior apex and thinnest point were evaluated. RESULTS Dapexpost and Dapexant-Dapexpost difference were higher in the early and mild KC groups compared to the control group (P < .05). Eyes with early and mild KC had decreased Vtotal compared with the control group (P < .05). Dapexpost, Dapexant-Dapexpost difference, and VOLMCTrel between 1.0 and 1.4 mm diameters had area under receiver operating characteristics curve (AUROC) values over 0.93 in discrimination of early KC from normal. CONCLUSIONS This is the first study presenting morphogeometric and volumetric characterization of cornea in pediatric patients with early and mild KC using a 3-D corneal model. Integration of the morphogeometric and volumetric parameters to topography software can add value in early detection of KC in pediatric patients.
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Toprak I, Cavas F, Vega A, Velázquez JS, Alio del Barrio JL, Alio JL. Evidence of a Down Syndrome Keratopathy: A Three-Dimensional (3-D) Morphogeometric and Volumetric Analysis. J Pers Med 2021; 11:jpm11020082. [PMID: 33573177 PMCID: PMC7911434 DOI: 10.3390/jpm11020082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 01/06/2023] Open
Abstract
The aim of this study was to investigate whether a different and abnormal corneal profile is present in Down syndrome (DS) by personalized three-dimensional (3D) modelling. This single-centre cross-sectional study included 43 patients with DS (43 eyes) and 58 age-sex-matched control subjects (58 eyes) with normal karyotype and topography. Refraction, central corneal thickness (CCT), aberrations (high-order, coma and spherical), asphericity and morphogeometric/volumetric parameters based on a 3D corneal model that was generated from raw topographical data were evaluated. Deviation of anterior/posterior apex (Dapexant/Dapexpost) and thinnest point (Dmctant/Dmctpost) from corneal vertex, anterior/posterior surface area (Aant/Apost), sagittal area passing through the anterior/posterior apex (Aapexant/Aapexpost) and thinnest point (Amctpost), total corneal volume (Vtotal) and volumetric progression for each 0.05 mm step of the radius value centred to the thinnest point (VOLMCT) and anterior/posterior apex (VOLAAP/VOLPAP) comprised the morphogeometric/volumetric parameters. In the DS group, 58.1% of the eyes presented abnormal topography. High-order and coma aberrations, asphericity, Dapexant, Aant, Apost and Aapexant were significantly higher, whereas CCT, Aapexpost, Amctpost, Vtotal, VOLAAP, VOLPAP and VOLMCT were lower in the DS group than in the control group (p < 0.05). Dapexpost did not differ between the groups (p > 0.05). This study demonstrates that corneas of the subjects with DS are different and more aberrated than those of normal age- and sex-matched non-DS controls. Anterior corneal apex appears to be displaced in DS even with normal topography, while posterior apex seems stable although topography is abnormal. These findings may help to modify our approach in the diagnosis of keratopathy in subjects with DS.
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Affiliation(s)
- Ibrahim Toprak
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (I.T.); (A.V.); (J.L.A.d.B.)
- Department of Ophthalmology, Faculty of Medicine, Pamukkale University, Denizli 20160, Turkey
| | - Francisco Cavas
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain;
- Correspondence: ; Tel.: +34-968-338-856
| | - Alfredo Vega
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (I.T.); (A.V.); (J.L.A.d.B.)
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain;
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03016 Alicante, Spain
| | - José S. Velázquez
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain;
| | - Jorge L. Alio del Barrio
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (I.T.); (A.V.); (J.L.A.d.B.)
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain;
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03016 Alicante, Spain
| | - Jorge L. Alio
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain;
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03016 Alicante, Spain
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Toprak I, Cavas F, Velázquez JS, Alio del Barrio JL, Alio JL. Subclinical keratoconus detection with three-dimensional (3-D) morphogeometric and volumetric analysis. Acta Ophthalmol 2020; 98:e933-e942. [PMID: 32410342 DOI: 10.1111/aos.14433] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/13/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To assess the efficacy of morphogeometric and volumetric characterization of the cornea based on three-dimensional (3-D) modelling in diagnosis of subclinical keratoconus (KC). METHODS Cross-sectional study. Ninety-three eyes with subclinical KC with a best spectacle-corrected distance visual acuity ≥20/20 (grade zero KC according to the RETICS classification) and 109 control eyes were included. Computer-based 3-D corneal morphogeometric model was generated using raw topographic data. Distance-, area- and volume-based parameters were used for statistical analysis. Distance parameters included deviation of anterior (Dapexant )/posterior (Dapexpost ) apices and minimum thickness points (Dmctant , Dmctpost ) from corneal vertex, and Dapexant -Dapexpost difference. Areal variables were derived from anterior (Aant ) and posterior (Apost ) corneal surfaces, sagittal plane passing through corneal apices (Aapexant , Aapexpost ) and thinnest point (Amctant , Amctpost ). Total corneal volume (Vtotal ) and volumetric distribution (with 0.1mm steps) centred to thinnest corneal point (VOLmct ) and anterior (VOLaap )/posterior (VOLpap ) apices comprised the volume-based parameters. RESULTS In the subclinical KC group, all D values, Dapexant -Dapexpost difference, Aant , Apost and Aapexant values were higher (p < 0.001), while Aapexpost , Amctpost , Vtotal , VOLmct , VOLaap and VOLpap values were lower when compared to the control group (p < 0.001). Regression analysis-based formula correctly classified 96.8% of the eyes with subclinical KC and 94.5% of the normal ones (p < 0.0001). CONCLUSIONS Eyes with subclinical KC seem to represent asymmetrically displaced anterior and posterior corneal apex, corneal thinning and volume loss. 3-D morphogeometric and volumetric parameters and differentiation formula can be incorporated into topography software to detect subclinical KC with high sensitivity and specificity in clinical practice.
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Affiliation(s)
- Ibrahim Toprak
- Department of Research and Development VISSUM Alicante Spain
- Department of Ophthalmology Faculty of Medicine Pamukkale University Denizli Turkey
| | - Francisco Cavas
- Department of Structures, Construction and Graphical Expression Technical University of Cartagena Cartagena Spain
| | - José S. Velázquez
- Department of Structures, Construction and Graphical Expression Technical University of Cartagena Cartagena Spain
| | - Jorge L. Alio del Barrio
- Department of Research and Development VISSUM Alicante Spain
- Cornea, Cataract and Refractive Surgery Department VISSUM Alicante Spain
- Division of Ophthalmology Department of Pathology and Surgery Faculty of Medicine Miguel Hernández University Alicante Spain
| | - Jorge L. Alio
- Department of Research and Development VISSUM Alicante Spain
- Cornea, Cataract and Refractive Surgery Department VISSUM Alicante Spain
- Division of Ophthalmology Department of Pathology and Surgery Faculty of Medicine Miguel Hernández University Alicante Spain
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Relationship between Corneal Morphogeometrical Properties and Biomechanical Parameters Derived from Dynamic Bidirectional Air Applanation Measurement Procedure in Keratoconus. Diagnostics (Basel) 2020; 10:diagnostics10090640. [PMID: 32867063 PMCID: PMC7555946 DOI: 10.3390/diagnostics10090640] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023] Open
Abstract
The morphogeometric analysis of the corneal structure has become a clinically relevant diagnostic procedure in keratoconus (KC) as well as the in vivo evaluation of the corneal biomechanical properties. However, the relationship between these two types of metrics is still not well understood. The current study investigated the relationship of corneal morphogeometry and volume with two biomechanical parameters: corneal hysteresis (CH) and corneal resistance factor (CRF), both provided by an Ocular Response Analyzer (Reichert). It included 109 eyes from 109 patients (aged between 18 and 69 years) with a diagnosis of keratoconus (KC) who underwent a complete eye examination including a comprehensive corneal topographic analysis with the Sirius system (CSO). With the topographic information obtained, a morphogeometric and volumetric analysis was performed, defining different variables of clinical use. CH and CRF were found to be correlated with these variables, but this correlation was highly influenced by corneal thickness. This suggests that the mechanical properties of KC cornea contribute only in a partial and limited manner to these biomechanical parameters, being mostly influenced by morphogeometry under normal intraocular pressure levels. This would explain the limitation of CH and CRF as diagnostic tools for the detection of incipient cases of KC.
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Velázquez JS, Cavas F, Piñero DP, Cañavate FJ, Alio del Barrio J, Alio JL. Morphogeometric analysis for characterization of keratoconus considering the spatial localization and projection of apex and minimum corneal thickness point. J Adv Res 2020; 24:261-271. [PMID: 32382446 PMCID: PMC7200195 DOI: 10.1016/j.jare.2020.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 02/07/2023] Open
Abstract
This work evaluates changes in new morphogeometric indices developed considering the position of anterior and posterior corneal apex and minimum corneal thickness (MCT) point in keratoconus. This prospective comparative study included 440 eyes of 440 patients (age, 7-99 years): control (124 eyes) and keratoconus (KC) groups (316 eyes). Tomographic information (Sirius®, Costruzione Strumenti Oftalmici, Italy) was treated with SolidWorks v2013, creating the following morphogeometric parameters: geometric axis-apex line angle (GA-AP), geometric axis-MCT line angle (GA-MCT, apex line-MCT line angle (AP-MCT), and distances between apex and MCT points on the anterior (anterior AP-MCTd) and posterior corneal surface (posterior AP-MCTd). Statistically significant higher values of GA-AP, GA-MCT, AP-MCT and anterior AP-MCTd were found in the keratoconus group (p ≤ 0.001). Moderate significant correlations of corneal aberrations (r ≥ 0.587, p < 0.001) and corneal thickness parameters (r ≤ -0.414, p < 0.001) with GA-AP and AP-MCT were found. Anterior asphericity was found to be significantly correlated with anterior and posterior AP-MCTd (r ≥ 0.430, p < 0.001). Likewise, GA-AP and AP-MCT showed a good diagnostic ability for the detection of keratoconus, with optimal cutoff values of 9.61° (sensitivity 85.5%, specificity 80.3%) and 18.08° (sensitivity 80.5%, specificity 78.7%), respectively. These new morphogeometric indices allow a clinical characterization of the 3-D structural alteration occurring in keratoconus, with less coincidence in the spatial projection of the apex and MCT points of both corneal surfaces. Future studies should confirm the potential impact on the precision of these indices of the variability of posterior corneal surface measurements obtained with Scheimpflug imaging technology.
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Affiliation(s)
- Jose S. Velázquez
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain
| | - Francisco Cavas
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain
| | - David P. Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 Alicante, Spain
| | - Francisco J.F. Cañavate
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain
| | - Jorge Alio del Barrio
- Division of Ophthalmology, Miguel Hernández University, 03690 Alicante, Spain
- Keratoconus Unit of Vissum Corporation Alicante, 03690 Alicante, Spain
- Department of Refractive Surgery, Vissum Corporation Alicante, 03690 Alicante, Spain
| | - Jorge L. Alio
- Division of Ophthalmology, Miguel Hernández University, 03690 Alicante, Spain
- Keratoconus Unit of Vissum Corporation Alicante, 03690 Alicante, Spain
- Department of Refractive Surgery, Vissum Corporation Alicante, 03690 Alicante, Spain
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Alifa R, Piñero D, Velázquez J, L. Alió del Barrio J, Cavas F, Alió JL. Changes in the 3D Corneal Structure and Morphogeometric Properties in Keratoconus after Corneal Collagen Crosslinking. Diagnostics (Basel) 2020; 10:diagnostics10060397. [PMID: 32545294 PMCID: PMC7345591 DOI: 10.3390/diagnostics10060397] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 02/07/2023] Open
Abstract
Keratoconus is an ectatic disorder that is presently considered one of the most prevalent reasons for keratoplasty. Corneal collagen crosslinking (CXL) is the only proven treatment option available that is capable of halting the progression of the disease by stabilizing the cone in 90% of cases, and by also reducing refractive error and maximal keratometry. This study assesses, by means of a 3D morphogeometric analysis procedure developed by our research team, the corneal structure changes that occur immediately after CXL treatment and during a 6 month follow-up period. A total of 19 eyes from 19 patients diagnosed with keratoconus who underwent CXL were included, and several variables derived from the morphogeometric analysis were calculated and evaluated for the pre-operative, 3 month postoperative, and 6 month postoperative states. Significant reductions were detected in central corneal thickness and corneal spherical-like root mean square (RMS) 3 months after surgery, with non-significant regression of the effect afterward. Significant reductions in the total corneal area/volume were found, with some levels of regression after 6 months in certain volumetric parameters. In conclusion, the eyes with higher values for morphogeometric parameters—posterior apex deviation (PAD), anterior minimum thickness point deviation (AMTPD), and posterior minimum thickness point deviation (PMTPD)—seemed more likely to undergo aberrometric improvement as a result of CXL surgery.
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Affiliation(s)
- Ramón Alifa
- Doctorate Program in Industrial Technologies, International School of Doctorate, Technical University of Cartagena, 30202 Cartagena, Spain;
| | - David Piñero
- Group of Optics and Visual Perception, Department of Optics, Pharmacology and Anatomy, University of Alicante, 03690 Alicante, Spain;
| | - José Velázquez
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain;
| | - Jorge L. Alió del Barrio
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (J.L.A.d.B.); (J.L.A.)
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03202 Alicante, Spain
| | - Francisco Cavas
- Department of Structures, Construction and Graphical Expression, Technical University of Cartagena, 30202 Cartagena, Spain;
- Correspondence: ; Tel.: +34-968-328856
| | - Jorge L. Alió
- Department of Research and Development, VISSUM, 03016 Alicante, Spain; (J.L.A.d.B.); (J.L.A.)
- Cornea, Cataract and Refractive Surgery Department, VISSUM, 03016 Alicante, Spain
- Division of Ophthalmology, Department of Pathology and Surgery, Faculty of Medicine, Miguel Hernández University, 03202 Alicante, Spain
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Anterior and posterior ratio of corneal surface areas: A novel index for detecting early stage keratoconus. PLoS One 2020; 15:e0231074. [PMID: 32240243 PMCID: PMC7117727 DOI: 10.1371/journal.pone.0231074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/15/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the diagnostic ability of the ratio of anterior and posterior corneal surface areas (As/Ps) comparing with other keratoconus screening indices in distinguishing forme fruste keratoconus (FFKC) from normal eyes. Methods In this comparative study, 13 eyes of 13 patients with FFKC, 29 eyes of 29 patients with keratoconus (KC) and 88 eyes of 88 patients with normal subjects were involved. The As/Ps measured by the anterior segment optical coherence tomography (AS-OCT) and other indices measured by AS-OCT and rotating Scheimpflug–based corneal tomography were evaluated. The area under receiver-operating-characteristics (AU-ROC) was calculated to assess the diagnostic ability in discriminating FFKC from normal eyes. Results The As/Ps, the Belin/Ambrosio display enhanced ectasia total derivation value (BAD-D) and posterior and anterior elevation values showed the AU-ROC 0.9 or more in differentiating FFKC from normal eyes (0.980, 0.951, 0.924 and 0.903, respectively). The sensitivity and specificity were 0.92 and 0.96 for the As/Ps, 1.00 and 0.90 for BAD-D, 0.85 and 0.86 for posterior elevation value, and 0.85 and 0.96 for anterior elevation value, respectively. Conclusions Among the several indices for keratoconus screening which we evaluated, the As/Ps obtained by AS-OCT had the large AU-ROC with high sensitivity and specificity in detecting FFKC, which was comparable with BAD-D obtained by rotating Scheimpflug–based corneal tomography. The As/Ps may provide information for improving the diagnostic accuracy of KC, even in the initial stage of the disease.
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3D Printed Personalized Corneal Models as a Tool for Improving Patient’s Knowledge of an Asymmetric Disease. Symmetry (Basel) 2020. [DOI: 10.3390/sym12010151] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Additive manufacturing is a vanguard technology that is currently being used in several fields in medicine. This study aims to evaluate the viability in clinical practice of a patient-specific 3D model that helps to improve the strategies of the doctor-patient assistance. Data obtained from a corneal topographer were used to make a virtual 3D model by using CAD software, to later print this model by FDM and get an exact replica of each patient’s cornea in consultation. Used CAD and printing software were open-source, and the printing material was biodegradable and its cost was low. Clinic users gave their feedback by means of a survey about their feelings when perceiving with their senses their own printed cornea. There was 82 surveyed, 73.8% (9.74; SD: 0.45) of them considered that the model had helped them a lot to understand their disease, expressing 100% of them their intention of taking home the printed model. The majority highlighted that this new concept improves both quality and clinical service in consultation. Custom-made individualized printed models allow a new patient-oriented perspective that may improve the communication strategy from the ophthalmologist to the patient, easing patient’s understanding of their asymmetric disease and its later treatment.
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Issarti I, Consejo A, Jiménez-García M, Hershko S, Koppen C, Rozema JJ. Computer aided diagnosis for suspect keratoconus detection. Comput Biol Med 2019; 109:33-42. [DOI: 10.1016/j.compbiomed.2019.04.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 04/11/2019] [Accepted: 04/20/2019] [Indexed: 01/03/2023]
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Assessment of Pattern and Shape Symmetry of Bilateral Normal Corneas by Scheimpflug Technology. Symmetry (Basel) 2018. [DOI: 10.3390/sym10100453] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Purpose: The aim of this study was to assess bilateral symmetry in normal fellow eyes by using optical and geometric morphometric parameters. Methods: All participants underwent complete biocular examinations. Scheimpflug tomography data from 66 eyes of 33 patients were registered. The interocular symmetry was based on five patterns: morphogeometric symmetry, axial symmetry at the corneal vertex, angular-spatial symmetry, direct symmetry (equal octants), and enantiomorphism (mirror octants). Results: No statistically significant differences were found between right and left eyes in corneal morphogeometric (p ≥ 0.488) and aberrometric parameters (p ≥ 0.102). Likewise, no statistically significant differences were found in any of the axial symmetry parameters analyzed (p ≥ 0.229), except in the surface rotation angle beta (p = 0.102) and translation coordinates X0 and Y0 (p < 0.001) for the anterior corneal surface, and the rotation angle gamma (p < 0.001) for the posterior surface. Similarly, no statistically significant differences were identified for direct symmetry (p ≥ 0.20) and enantiomorphism (p ≥ 0.75), except for some elevation data in the posterior surface (p < 0.01). Conclusions: The level of symmetry of both corneas of a healthy individual is high, with only some level of disparity between fellow corneas in rotation and translation references. Abnormalities in this pattern of interocular asymmetry may be useful as a diagnostic tool.
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Study of Morpho-Geometric Variables to Improve the Diagnosis in Keratoconus with Mild Visual Limitation. Symmetry (Basel) 2018. [DOI: 10.3390/sym10080306] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The validation of new methods for the diagnosis of incipient cases of Keratoconus (KC) with mild visual limitation is of great interest in the field of ophthalmology. During the asymmetric progression of the disease, the current diagnostic indexes do not record the geometric decompensation of the corneal curvature nor the variation of the spatial profile that occurs in singular points of the cornea. The purpose of this work is to determine the structural characterization of the asymmetry of the disease by using morpho-geometric parameters in KC eyes with mild visual limitation including using an analysis of a patient-specific virtual model with the aid of computer-aided design (CAD) tools. This comparative study included 80 eyes of patients classified as mild KC according to the degree of visual limitation and a control group of 122 eyes of normal patients. The metric with the highest area under the receiver operating characteristic (ROC) curve was the posterior apex deviation. The most prominent correlation was found between the anterior and posterior deviations of the thinnest point for the mild keratoconic cases. This new custom computational approach provides the clinician with a three-dimensional view of the corneal architecture when the visual loss starts to impair.
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Camps VJ, Miret JJ, García C, Tolosa A, Piñero DP. Simulation of the Effect of Different Presbyopia-Correcting Intraocular Lenses With Eyes With Previous Laser Refractive Surgery. J Refract Surg 2018; 34:222-227. [DOI: 10.3928/1081597x-20180130-02] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 12/20/2017] [Indexed: 01/31/2023]
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Huseynli S, Salgado-Borges J, Alio JL. Comparative evaluation of Scheimpflug tomography parameters between thin non-keratoconic, subclinical keratoconic, and mild keratoconic corneas. Eur J Ophthalmol 2018; 28:521-534. [PMID: 29566542 DOI: 10.1177/1120672118760146] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate and compare the topographic and topometric parameters, thickness profile data, and data from enhanced elevation maps of thin non-keratoconic, subclinical keratoconic, and mild keratoconic corneas with the Pentacam Scheimpflug corneal tomography and to study the usefulness of different parameters to differentiate keratoconus from topographically normal thin corneas. METHODS The study included 30 eyes with subclinical keratoconus, 30 eyes with mild-stage keratoconus, and 54 healthy eyes with minimal pachymetry ≤500 µm, with a mean age of 21.19 ± 2.97, 21.75 ± 1.93, and 21.5 ± 2.95 years, respectively. The area under the receiver operating characteristic curves was used to analyze the diagnostic significance of the Pentacam parameters. RESULTS The anterior and posterior corneal elevations, pachymetric progression, the percentage of thickness increase measurements, overall D value, and topometric indices were statistically significantly higher in subclinical and mild keratoconic corneas than in normal eyes with thin cornea (p < 0.05). All these parameters had sufficient strength (area under the receiver operating characteristic curves >0.90) to differentiate clinical keratoconus. Posterior elevation showed the excellent area under the receiver operating characteristic curves with 100% sensitivity and 100% specificity for this purpose. However, among all parameters studied, the anterior elevation (0.935) showed the excellent area under the receiver operating characteristic curves to differentiate subclinical keratoconus, followed by posterior elevation (0.897), index of height decentration (0.887), and D value (0.882). CONCLUSION The parameters derived from the Scheimpflug device, such as corneal elevations and overall D value, can effectively differentiate subclinical and clinical keratoconus from non-keratoconic thin cornea eyes. However, the specificity levels of these parameters were relatively limited in the diagnosis of subclinical keratoconus.
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Affiliation(s)
- Samira Huseynli
- 1 National Ophthalmology Center named after academician Zarifa Aliyeva, Baku, Azerbaijan
| | | | - Jorge L Alio
- 3 Vissum Instituto Oftalmologico de Alicante, Universidad Miguel Hernandez, Alicante, Spain
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