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Bamdad S, Attar A, Fallahzadeh M, Ebrahimi F, Faizabadi S, Azimi A. Does collagen cross linking have any effect on retinal circulation in patients with keratoconus? An optical coherence tomography angiography (OCTA) study. BMC Ophthalmol 2024; 24:201. [PMID: 38698363 PMCID: PMC11067113 DOI: 10.1186/s12886-024-03470-1] [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: 12/31/2023] [Accepted: 04/26/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND We aimed to employ Optical Coherence Tomography Angiography (OCTA) to comprehensively assess changes in the optic nerve head (ONH) and macular perfusion before and after the Corneal Collagen Cross-Linking (CCL) procedure in patients with keratoconus. METHODS A total of 22 keratoconus patient's candidate for CCL procedures were included based on specific criteria, with meticulous exclusion criteria in place to minimize potential confounders. Participants underwent OCTA assessments of the ONH and macula using the Spectralis OCT (Heidelberg) before CCL, as well as at 1- and 3-months post-CCL. MATLAB software was utilized for image analysis. RESULTS The mean age of the participants was 20.09 ± 6.11, including 59% male, and the mean intraocular pressure (IOP) before the surgery was 13.59 ± 2.85 mmHg. Peripapillary Retinal nerve fiber layer (ppRNFL) thickness and overall retinal thickness remained stable post-CCL. However, significant alterations were observed in macular vessel density, emphasizing regional variations in vascular response. For macular large vessel density (LVD), both superficial and deep vascular complex (SVC and DVC) demonstrated significant differences between before surgery and the 3 months post-surgery follow-up (p < 0.001 and p = 0.002, respectively). Optic nerve head markers demonstrated relative stability, except for changes in avascular complex density, which was 49.2 ± 2.2% before the surgery and decrease to 47.6 ± 1.7% three months after the operation (P-value = 0.005). CONCLUSION While CCL appears to maintain the integrity of certain ocular structures, alterations in macular perfusion post-CCL suggest potential effects on retinal blood supply. Long-term monitoring is crucial to understand the implications of these changes, particularly in the context of conditions such as diabetes.
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Affiliation(s)
- Shahram Bamdad
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Attar
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Milad Fallahzadeh
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Ebrahimi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanam Faizabadi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Azimi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
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Changes in retinal vessel and retinal layer thickness after cross-linking in keratoconus via swept-source OCT angiography. Graefes Arch Clin Exp Ophthalmol 2022; 260:3919-3925. [DOI: 10.1007/s00417-022-05749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/20/2022] [Accepted: 06/28/2022] [Indexed: 11/17/2022] Open
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Ballesteros-Sánchez A, De-Hita-Cantalejo C, Sánchez-González MC, Bautista-Llamas MJ, Sánchez-González JM, Gargallo-Martínez B. Choroidal thickness assessment in keratoconus patients treated with cross-linking compared to healthy population. Int Ophthalmol 2022; 43:1185-1192. [PMID: 36138270 PMCID: PMC10113286 DOI: 10.1007/s10792-022-02517-w] [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: 02/25/2022] [Accepted: 09/11/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE To analyze the choroidal thickness between patients with keratoconus undergoing cross-linking treatment and a healthy population, as well as to determine the factors that influence choroidal thickness. METHODS This was an observational, analytical, case-control study that was conducted from February 2021 to June 2021. Choroidal thickness was measured at different locations, including the subfoveal, nasal (1000 μm), temporal (1000 μm), superior (1000 μm) and inferior (1000 μm) locations using a Spectral-domain optical coherence tomography with enhanced depth imaging, which allowed us to obtain horizontal and vertical B-scans centered on the fovea. RESULTS This study included 21 patients with keratoconus (mean age, 21.86 ± 5.28 years) and 28 healthy patients (mean age, 24.21 ± 4.71 years). Choroidal thickness was significantly greater in patients with keratoconus than in healthy patients in each of the following measured locations: subfoveal (P < 0.001); nasal (1000 μm) (P < 0.001), temporal (1000 μm) (P < 0.001), superior (1000 μm) (P < 0.001) and inferior (1000 μm) (P < 0.001) locations. Variables such as age (ρ = - 0.09; P = 0.50) and refraction (ρ = 0.14; P = 0.34) were not found to be associated with choroidal thickness. In a stepwise multiple linear regression, the group was the single variable correlated with choroidal thickness (β = 0.88; P < 0.001). CONCLUSION Choroidal thickness is thicker in keratoconus patients treated with cross-linking than in the healthy population. This finding could be associated with inflammatory choroidal mechanisms in keratoconus patients, but more studies are needed. Age and refractive error do not seem to influence choroidal thickness.
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Affiliation(s)
- Antonio Ballesteros-Sánchez
- Department of Ophthalmology, Clínica Novovisión, Murcia, Spain
- Departament of Physics of Condensed Matter, Optics Area, University of Seville, Seville, Spain
| | | | | | | | | | - Beatriz Gargallo-Martínez
- Department of Ophthalmology, Clínica Novovisión, Murcia, Spain
- Department of Ophthalmology, Optometry, Otorhinolaryngology and Anatomic Pathology, University of Murcia, Murcia, Spain
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Ozsaygili C, Yildirim Y. Safety of accelerated corneal collagen cross-linking in keratoconus patients on the basis of macular segmentation. Int Ophthalmol 2021; 41:3759-3767. [PMID: 34247284 DOI: 10.1007/s10792-021-01945-4] [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: 12/28/2020] [Accepted: 07/05/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To investigate the safety of accelerated corneal collagen cross-linking (A-CXL) in patients with keratoconus on the basis of thickness analysis measurements of retinal layers and retinal morphology. STUDY DESIGN This was a retrospective and comparative study. METHODS The study included 64 eyes of 32 patients with keratoconus disease. One eye of the patients underwent A-CXL for progressive keratoconus (CXL group) and the fellow eye was followed due to the absence of progression. Patients with at least 1-year follow-up after A-CXL were included. Keratometry, pachymetry and corrected-distance visual acuity (CDVA) levels of the patients were compared. The segmentation analysis of the individual retinal layers of the eyes with (CXL group) and without CXL (no CXL group) was compared with spectral domain-optical coherence tomography automatic segmentation program at baseline and at the last follow-up. The thickness of the retinal nerve fiber layer, ganglion cell layer, inner plexiform layer, inner nuclear layer, outer plexiform layer, outer nuclear layer and retina pigment epithelium layer in the central 1-mm subfield defined by the ETDRS was analyzed. RESULTS The mean age of keratoconus patients was 23.9 ± 5.4 years, patients were more likely to be male (21/11, 65.6%), and the mean follow-up duration was 13.9 ± 1.5 months. When keratometry, pachymetry and CDVA levels were compared, only a significant difference was found between CDVA at the last follow-up (0.21 vs. 0.11 LogMAR). No significant difference was observed in neither retinal morphology nor segmentation of individual retinal layers at baseline and at the final evaluation (P > 0.05). CONCLUSIONS It has been observed that the A-CXL protocol did not cause a significant change in both retinal layer thickness and macular morphology.
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Affiliation(s)
- Cemal Ozsaygili
- Ophthalmology Department, Kayserı City Training and Research Hospital, Kocasinan, Kayseri, Turkey.
| | - Yener Yildirim
- Ophthalmology Department, Kayserı City Training and Research Hospital, Kocasinan, Kayseri, Turkey
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Nasrollahi K, Razmjoo F, Naderan M, Peyman A. Corneal cross-linking for keratoconus: Evaluation of the retina and choroid. Eur J Ophthalmol 2021; 32:1491-1495. [PMID: 34053332 DOI: 10.1177/11206721211021300] [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: 11/15/2022]
Abstract
PURPOSE To investigate the possible structural changes of the central choroid and retina after collagen cross-linking (CXL) in patients with progressive keratoconus (KCN). METHODS Twenty-five eyes of 25 patients were included in this study. Patients underwent enhanced depth imaging optical coherence tomography (EDI-OCT) before and 1 month after CXL. The values for central macular thickness (CMT), subfoveal choroidal thickness (CHT), and choroidal volume (CHV) were evaluated. RESULTS CMT before and after CXL was 263.24 ± 16.25 μm and 263.20 ± 16.51 μm, respectively (p = 0.98). CHT was 362.08 ± 36.80 μm and 367.84 ± 33.67 μm before and after CXL, respectively (p = 0.26). CHV was 8.74 ± 0.33 mm3 and 8.68 ± 0.36 mm3 before and after CXL, respectively (p = 0.11). There was no significant difference in the corrected distance visual acuity before and after CXL (0.06 ± 0.05 and 0.05 ± 0.05 logMAR, respectively, p = 0.65). CONCLUSION Central retinal and choroidal thicknesses are not changed after corneal cross- linking.
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Affiliation(s)
- Kobra Nasrollahi
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Razmjoo
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Morteza Naderan
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Peyman
- Isfahan Eye Research Center, Department of Ophthalmology, Isfahan University of Medical Sciences, Isfahan, Iran
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Chen JL, Hung CT, Keller JJ, Lin HC, Wu YJ. Proteomic analysis of retinal pigment epithelium cells after exposure to UVA radiation. BMC Ophthalmol 2019; 19:168. [PMID: 31375076 PMCID: PMC6679551 DOI: 10.1186/s12886-019-1151-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 06/24/2019] [Indexed: 01/09/2023] Open
Abstract
Background Age-related macular degeneration (AMD) is the primary cause of blindness and severe vision loss in developed countries and is responsible for 8.7% of blindness globally. Ultraviolet radiation can induce DNA breakdown, produce reactive oxygen species, and has been implicated as a risk factor for AMD. This study investigated the effects of UVA radiation on Human retinal pigment epithelial cell (ARPE-19) growth and protein expression. Methods ARPE-19 cells were irradiated with a UVA lamp at different doses (5, 10, 20, 30 and 40 J/cm2) from 10 cm. Cell viability was determined by MTT assay. Visual inspection was first achieved with inverted light microscopy and then the DeadEnd™ Fluorometric TUNEL System was used to observe nuclear DNA fragmentation. Flow cytometry based-Annexin V-FITC/PI double-staining was used to further quantify cellular viability. Mitochondrial membrane potential was assessed with JC-1 staining. 2D electrophoresis maps of exposed cells were compared to nonexposed cells and gel images analyzed with PDQuest 2-D Analysis Software. Spots with greater than a 1.5-fold difference were selected for LC-MS/MS analysis and some confirmed by western blot. We further investigated whether caspase activation, apoptotic-related mitochondrial proteins, and regulators of ER stress sensors were involved in UVA-induced apoptosis. Results We detected 29 differentially expressed proteins (9 up-regulated and 20 down-regulated) in the exposed cells. Some of these proteins such as CALR, GRP78, NPM, Hsp27, PDI, ATP synthase subunit alpha, PRDX1, and GAPDH are associated with anti-proliferation, induction of apoptosis, and oxidative-stress protection. We also detected altered protein expression levels among caspases (caspase 3 and 9) and in the mitochondrial (cytosolic cytochrome C, AIF, Mcl-1, Bcl-2, Bcl-xl, Bax, Bad, and p-Bad) and ER stress-related (p-PERK, p-eIF2α, ATF4 and CHOP) apoptotic pathways. Conclusions UVA irradiation suppressed the proliferation of ARPE-19 cells in a dose-dependent manner, caused quantitative loses in transmembrane potential (ΔΨm), and induced both early and late apoptosis.
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Affiliation(s)
- Jiunn-Liang Chen
- Department of Ophthalmology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Optometry, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan
| | - Chun-Tzu Hung
- Department of Ophthalmology, Yuan's General Hospital, Kaohsiung, Taiwan
| | - Joseph Jordan Keller
- College of Medicine, The Ohio State University, Columbus, OH, USA.,School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan.,International Master's Program, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsien-Chung Lin
- Department of Ophthalmology, Yuan's General Hospital, Kaohsiung, Taiwan. .,Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
| | - Yu-Jen Wu
- Department of Beauty Science, Meiho University, Pingtung, Taiwan.
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Abstract
PURPOSE There has been a recent explosion in the variety of techniques used to accomplish corneal cross-linking (CXL) for the treatment of ectatic corneal diseases. To understand the success or failure of various techniques, we review the physicochemical basis of corneal CXL and re-evaluate the current principles and long-standing conventional wisdom in the light of recent, compelling, and sometimes contradictory research. METHODS Two clinicians and a medicinal chemist developed a list of current key topics, controversies, and questions in the field of corneal CXL based on information from current literature, medical conferences, and discussions with international practitioners of CXL. RESULTS Standard corneal CXL with removal of the corneal epithelium is a safe and efficacious procedure for the treatment of corneal ectasias. However, the necessity of epithelium removal is painful for patients, involves risk and requires significant recovery time. Attempts to move to transepithelial corneal CXL have been hindered by the lack of a coherent understanding of the physicochemistry of corneal CXL. Misconceptions about the applicability of the Bunsen-Roscoe law of reciprocity and the Lambert-Beer law in CXL hamper the ability to predict the effect of ultraviolet A energy during CXL. Improved understanding of CXL may also expand the treatment group for corneal ectasia to those with thinner corneas. Finally, it is essential to understand the role of oxygen in successful CXL. CONCLUSIONS Improved understanding of the complex interactions of riboflavin, ultraviolet A energy and oxygen in corneal CXL may provide a successful route to transepithelial corneal CXL.
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Moshirfar M, Vaidyanathan U, Hopping GC, Ronquillo YC, Hoopes PC. Delayed-Onset Transient Light Sensitivity Syndrome after Corneal Collagen Cross-Linking: A Case Series. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2019; 8:250-256. [PMID: 31598524 PMCID: PMC6778466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In this case series, we report a potentially novel association of corneal collagen crosslinking (CCL) with the development of photophobia symptoms in a series of patients at a tertiary ophthalmology clinic and describe their clinical course. Photosensitivity is a rare and seemingly unpredictable complication of refractive surgery but can present as a disabling, bilateral ocular pain that requires immediate treatment. This complication, termed transient light-sensitivity syndrome (TLSS), can have a substantially delayed presentation after ocular procedures and is associated with inflammation of structures in the anterior chamber that can be imperceptible on slit-lamp examination. Traditionally, exposure to high-energy femtosecond lasers is hypothesized to create stromal gas bubbles powering postoperative inflammatory reactions. TLSS-like symptoms after CCL may be due to a secondary inflammatory response involving activated keratocytes and cytokine release. However, free radical damage from the interaction of riboflavin and ultraviolet in CCL may also drive this inflammatory process.
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Affiliation(s)
- Majid Moshirfar
- John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA,Utah Lions Eye Bank, Murray, UT, USA,Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA
| | - Uma Vaidyanathan
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Grant C. Hopping
- McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Phillip C. Hoopes
- Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA
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