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Zhang X, Wang Q, Cui F, Wu X, Zhang C. Mendelian randomization analysis does not reveal a causal influence between keratoconus and three major mental disorders. Front Psychiatry 2024; 15:1370670. [PMID: 39234617 PMCID: PMC11371735 DOI: 10.3389/fpsyt.2024.1370670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
Background Observational studies have suggested at a possible link between keratoconus (KC) and various mental disorders, but the exact direction of causation in these associations remains unclear. This study aims to investigate the potential causal link between KC and three prominent mental conditions: Anxiety, Depression, and Schizophrenia. Methods Using instrumental variables identified from Genome-wide association study (GWAS) data of European individuals, we conducted bidirectional two-sample Mendelian Randomization (MR) analyses to explore potential causal relationships between KC and the three major mental disorders. We primarily employed the Inverse-Variance Weighted (IVW) method to evaluate causality. In addition, we performed four supplementary MR methods (MR-Egger, Weighted Median, Simple Mode, and Weighted Mode). Furthermore, we conducted various sensitivity analyses to assess heterogeneity, horizontal pleiotropy, and result stability. Results Our findings did not reveal any concrete evidence of a causal link between KC and the three major mental disorders, namely anxiety, depression, and schizophrenia [anxiety: odds ratio (OR)=0.997, 95% confidence interval (CI)=0.988-1.008, p = 0.621; depression: OR=1.008, 95% CI=0.999-1.017, p = 0.084; schizophrenia: OR=1.002, 95% CI= 0.984-1.020, p = 0.840]. Similarly, the three major mental disorders were not caustically associated with KC [anxiety: OR=1.014, 95% CI=0.635-1.620, p = 0.953; depression: OR=1.109, 95% CI= 0.749-1.643, p = 0.604; schizophrenia: OR= 0.969, 95% CI= 0.884-1.062, p = 0.497]. The sensitivity analyses indicated that the results remained robust, with no signs of pleiotropy or heterogeneity. Conclusions Our study does not support a genetically determined significant causal connection between KC and the three major mental disorders. The increased occurrence of mental disorders observed in KC patients in observational reports likely arises from factors that can be modified. Further research is warranted to unveil the underlying mechanisms behind the associations observed in observational studies.
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Affiliation(s)
- Xueyan Zhang
- Department of Ophthalmology, The Jinan Second People's Hospital, Jinan, Shandong, China
| | - Qiaoling Wang
- Department of Ophthalmology, The Jinan Second People's Hospital, Jinan, Shandong, China
| | - Fenghua Cui
- Department of Ophthalmology, The Jinan Second People's Hospital, Jinan, Shandong, China
| | - Xuelian Wu
- Department of Ophthalmology, The Jinan Second People's Hospital, Jinan, Shandong, China
| | - Chenming Zhang
- Department of Ophthalmology, The Jinan Second People's Hospital, Jinan, Shandong, China
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2
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Al Bdour M, Sabbagh HM, Jammal HM. Multi-modal imaging for the detection of early keratoconus: a narrative review. EYE AND VISION (LONDON, ENGLAND) 2024; 11:18. [PMID: 38730479 PMCID: PMC11088107 DOI: 10.1186/s40662-024-00386-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 04/21/2024] [Indexed: 05/12/2024]
Abstract
Keratoconus is a common progressive corneal disorder that can be associated with significant ocular morbidity. Various corneal imaging techniques have been used for the diagnosis of established cases. However, in the early stages of the disease, which include subclinical keratoconus and forme fruste keratoconus, detection of such cases can be challenging. The importance of detecting such cases is very important because early intervention can halt disease progression, improve visual outcomes and prevent postrefractive surgery ectasia associated with performing corneal refractive procedures in such patients. This narrative review aimed to examine several established and evolving imaging techniques for the detection of early cases of keratoconus. The utilization of combinations of these techniques may further increase their diagnostic ability.
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Affiliation(s)
- Muawyah Al Bdour
- Department of Ophthalmology, School of Medicine, The University of Jordan, Amman, Jordan
| | - Hashem M Sabbagh
- The National Center for Diabetes Endocrinology and Genetics (NCDEG), Amman, Jordan
| | - Hisham M Jammal
- Department of Ophthalmology, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, 22110, Jordan.
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Alghamdi A, Alghamdi EA, Alghamdi A, Abusayf MM, Ahad MA. Successful Collagen Crosslinking in a Patient With Keratoconus and Systemic Scleroderma. Cureus 2024; 16:e59431. [PMID: 38826919 PMCID: PMC11140440 DOI: 10.7759/cureus.59431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 06/04/2024] Open
Abstract
Scleroderma is an autoimmune disease that affects connective tissue. Keratoconus (KC) is a rare ocular condition that may appear alongside scleroderma. Contact lenses are an essential visual aid for KC patients, especially in advanced cases. However, scleroderma patients may face difficulties using them due to finger-related disabilities. Corneal collagen cross-linking (CXL) is a crucial treatment used to prevent corneal thinning and visual deterioration in progressive KC. However, the potential trigger of corneal melt and delayed healing following CXL in KC patients with scleroderma is a matter of concern. We present a case of a patient with KC and scleroderma who underwent CXL without any complications.
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Affiliation(s)
- Ayman Alghamdi
- Oculoplastic Division, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | | | - Abdullah Alghamdi
- Community Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | | | - Muhammad A Ahad
- Cornea and External Disease Division, King Khaled Eye Specialist Hospital, Riyadh, SAU
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4
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Mikhail E, Mohebbi M, Gokhale M, Azizoglu S, Suphioglu C. Development and validation of a health practitioner survey on ocular allergy. Sci Rep 2024; 14:9932. [PMID: 38689009 PMCID: PMC11061311 DOI: 10.1038/s41598-024-60837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/28/2024] [Indexed: 05/02/2024] Open
Abstract
Survey studies have played a significant role in understanding the gaps in the knowledge and practices of health practitioners. However, there have been no such survey studies on Ocular Allergy (OA). Thus, the purpose of this study was to develop and validate a survey on OA to better understand the gaps in the diagnostic, treatment, and collaborative care approaches of health practitioners in OA. The survey is titled "Survey on Ocular Allergy for Health Practitioners (SOAHP)". SOAHP was developed in a five-stage process. First, item extraction via the use of a literature review, second, face and content validity, third, a pilot study, fourth, test-retest reliability, and fifth, finalisation of the survey. 65 items under 6 domains were initially generated in the item extraction phase. Content validity was conducted on 15 experts in the field. This was conducted twice to reach consensus whereby items and domains were added, edited, kept, or removed, resulting in 50 items under 7 domains. The pilot study was conducted on 15 participants from the five relevant health practitioner fields (Allergists/Immunologists, General Practitioners (GPs), Ophthalmologists, Optometrists and Pharmacists). This altered the survey further to 40 items under 7 domains. Test-retest reliability was conducted on 25 participants from the five health practitioner fields. Reliability was moderate to almost perfect for most (97%) investigated items. The finalised survey was 40 items under 7 domains. SOAHP is the first survey created to assess diagnostic, treatment and collaborative care approaches of Allergists/Immunologists, GPs, Ophthalmologists, Optometrists and Pharmacists on OA. SOAHP will be a useful tool in clinical research on OA.
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Affiliation(s)
- Ereeny Mikhail
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia.
- Deakin Optometry, School of Medicine, Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia.
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia.
| | - Mohammadreza Mohebbi
- Biostatistics Unit, Faculty of Health, Deakin University, Geelong, VIC, 3216, Australia
| | - Moneisha Gokhale
- Deakin Optometry, School of Medicine, Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
| | - Serap Azizoglu
- Deakin Optometry, School of Medicine, Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
| | - Cenk Suphioglu
- NeuroAllergy Research Laboratory (NARL), School of Life and Environmental Sciences, Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Deakin University, Waurn Ponds, Geelong, VIC, 3216, Australia
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Buhl L, Feldhaus L, Kassumeh S. [How to: keratoconus assessment using Scheimpflug tomography]. DIE OPHTHALMOLOGIE 2024; 121:239-244. [PMID: 38386091 DOI: 10.1007/s00347-024-02002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Lara Buhl
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland.
| | - Lukas Feldhaus
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Stefan Kassumeh
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
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Benca KK, Javorka M, Vida R, Halička J, Kralik M, Prídavková Z, Žiak P. Diagnostic Importance of OCT Pachymetry in Keratoconus. CESKA A SLOVENSKA OFTALMOLOGIE : CASOPIS CESKE OFTALMOLOGICKE SPOLECNOSTI A SLOVENSKE OFTALMOLOGICKE SPOLECNOSTI 2024; 80:24-33. [PMID: 38365579 DOI: 10.31348/2024/6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
AIMS To demonstrate changes in distance and near fusional vergence measured with prism bars, while compensating for present heterophoria using current ametropia correction. In addition, to determine the differences in values of the AC/A ratio determined by the heterophoric (calculation) and gradient methods. MATERIAL AND METHODS The basic sample includes 19 subjects with a mean age of 21.5 ±3.0 years (min. 18, max. 27). We used the Von Graefe technique for examination of distance and near phoria, and prism bars for examination of fusion vergences measured in prism diopters. We divided the basic cohort into six research sets according to the size of distance and near heterophoria. This was a cohort of patients with distance (D OR) and near orthophoria (N OR), a cohort of patients with distance (D EX) and near exophoria (N EX) and a set of patients with distance (D ES) and near esophoria (N ES). RESULTS In the case of both groups with exophoria (distance, near) we found a statistically significant result only for negative fusion vergence (NFV). There was a statistically significant increase in NFV in the sample with distance and near exophoria (D EX, p = 0.01 and B EX, p = 0.02, respectively). In our study, we also demonstrated a statistically significant difference (p < 0.001) in the values of the AC/A ratio measured by the gradient and heterophoric methods. The values determined by the gradient method are lower (3.0 ±1.1 pD/D versus 5.8 ±0.9 pD/D) than by the heterophoric method. CONCLUSION By comparing fusion vergence values in patients with exophoria and orthophoria, we demonstrated that in the presence of distance or near exophoria there is an increase in ipsilateral fusion vergence. In the case of an increase in ipsilateral fusion vergence, the finding was statistically significant both distance and near (p = 0.01 and p = 0.02, respectively). By contrast, we were unable to prove this fact in the group of patients with esophoria. In our study, we also demonstrated a statistically significant difference (p < 0.001) in the values of the AC/A ratio measured by the gradient and heterophoric methods. The values determined by the gradient method are lower (3.0 ±1.1 pD/D versus 5.8 ±0.9 pD/D) than by the heterophoric method.
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Ghorbani R, Rasouli M, Sefat F, Heidari Keshel S. Pathogenesis of Common Ocular Diseases: Emerging Trends in Extracellular Matrix Remodeling. Semin Ophthalmol 2024; 39:27-39. [PMID: 37424085 DOI: 10.1080/08820538.2023.2233601] [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] [Received: 03/08/2023] [Revised: 06/27/2023] [Accepted: 07/02/2023] [Indexed: 07/11/2023]
Abstract
The prevalence of visual impairments in human societies is worrying due to retinopathy complications of several chronic diseases such as diabetes, cardiovascular diseases, and many more that are on the rise worldwide. Since the proper function of this organ plays a pivotal role in people's quality of life, identifying factors affecting the development/exacerbation of ocular diseases is of particular interest among ophthalmology researchers. The extracellular matrix (ECM) is a reticular, three-dimensional (3D) structure that determines the shape and dimensions of tissues in the body. The ECM remodeling/hemostasis is a critical process in both physiological and pathological conditions. It consists of ECM deposition, degradation, and decrease/increase in the ECM components. However, disregulation of this process and an imbalance between the synthesis and degradation of ECM components are associated with many pathological situations, including ocular disorders. Despite the impact of ECM alterations on the development of ocular diseases, there is not much research conducted in this regard. Therefore, a better understanding in this regard, can pave the way toward discovering plausible strategies to either prevent or treat eye disorders. In this review, we will discuss the importance of ECM changes as a sentimental factor in various ocular diseases based on the research done up to now.
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Affiliation(s)
- Raziyeh Ghorbani
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Rasouli
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farshid Sefat
- Department of Biomedical and Electronics Engineering, School of Engineering, University of Bradford, Bradford, UK
- Interdisciplinary Research Centre in Polymer Science & Technology (Polymer IRC), University of Bradford, Bradford, UK
| | - Saeed Heidari Keshel
- Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Serdarov A, Bozkurt B, Karaküçük Y, Okudan S. Clinical Performance and Patient Satisfaction of Hybrid Contact Lenses in Patients with Keratoconus. Turk J Ophthalmol 2023; 53:206-212. [PMID: 37602550 PMCID: PMC10442754 DOI: 10.4274/tjo.galenos.2022.43077] [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: 04/11/2022] [Accepted: 09/30/2022] [Indexed: 08/22/2023] Open
Abstract
Objectives The aim of the study was to evaluate the fitting process, clinical performance, and patient satisfaction of hybrid contact lenses (HCL) in patients with keratoconus (KC). Materials and Methods Sixty-eight KC patients (35 female, 33 male) who were prescribed HCL were included in the study. Corneal topographic parameters, best corrected visual acuity (BCVA) with eyeglasses, the number of HCL trials, prescribed HCL base curve (BC), and visual acuity with HCL were recorded from hospital records. A contact lens satisfaction survey was sent to the patients via email or WhatsApp and the data was statistically analyzed using IBM SPSS Statistics version 22.0. Results The study included 110 eyes of 68 patients with a mean age of 27.34±8 years (range: 12-48 years). According to the Amsler-Krumeich classification, 35.5% of the eyes were stage 1, 50.9% were stage 2, and 13.5% were stage 3 or 4. Mean K1, K2, and Kmean values were 7.14±0.50 mm (range 5.72-8.30 mm), 6.63±0.49 mm (range 5.07-7.84 mm), and 6.89±0.48 mm (range 5.39-8.06 mm), respectively. The average number of lens trials was 1.59±0.82 (range 1-4). The mean BC of the prescribed HCL was 6.84±0.50 mm (range 5.60-8.00 mm). BCVA with glasses was 0.36±0.2 (range 0.05-0.8), and 0.80±0.14 (range 0.3-1.0) with HCL (p<0.0001). The overall survey score was 3.54 out of 5, the overall satisfaction score was 3.27, the average vision satisfaction score was 3.62, the average satisfaction score for lens insertion and removal was 3.01, and the average satisfaction score for lens comfort was 2.97. Conclusion Prescribed HCL BC is usually close to the topographic Kmean value and in most of the patients, fitting was successful with the first or second CL trial. The overall satisfaction score was moderate to good and the disadvantages were low comfort compared to soft CL, difficulty with insertion and removal, short lens life, and high cost.
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Affiliation(s)
- Aydogdy Serdarov
- Selçuk Univeristy Faculty of Medicine, Department of Ophthalmology, Konya, Türkiye
| | - Banu Bozkurt
- Selçuk Univeristy Faculty of Medicine, Department of Ophthalmology, Konya, Türkiye
| | - Yalçın Karaküçük
- Selçuk Univeristy Faculty of Medicine, Department of Ophthalmology, Konya, Türkiye
| | - Süleyman Okudan
- Selçuk Univeristy Faculty of Medicine, Department of Ophthalmology, Konya, Türkiye
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Alamri A, Alrizqi AA, Aljohani AA, Alzahrani DA, Alassaf OM, Hamzi YA, Alharbi NM, Alharbi BA, Taha M. Awareness of Keratoconus and Its Association With Eye Rubbing Among the Population in Aseer Province. Cureus 2023; 15:e41271. [PMID: 37533612 PMCID: PMC10391695 DOI: 10.7759/cureus.41271] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2023] [Indexed: 08/04/2023] Open
Abstract
BACKGROUND Keratoconus (KC), is a non-inflammatory, bilateral, asymmetrical, progressive disease characterized by ectasia, thinning, increasing corneal curvature, and loss of visual acuity. In Saudi Arabia, it was discovered that KC has been the main reason for corneal transplantation in the past 20 years. Eye rubbing is considered one of the most significant risk factors for KC based on available data. PARTICIPANTS AND METHODS A cross-sectional study was conducted among adults in Aseer province, Saudi Arabia in 2023. Data were collected through a pre-designed online questionnaire consisting of 17 questions divided into three sections. The questionnaire was preceded by informed consent and insured to maintain the confidentiality of the data. RESULTS A total of 498 respondents were included in this study. The majority of the study's participants were in the 18 to 25 age group and females made up the majority. The majority of participants had a university education. 41.6% of individuals reported experiencing an allergic disorder, 59.0% reported having knowledge about KC, and the overall participants' awareness regarding KC was poor at 85.74%, with the highest percentage of good awareness (22.2%) detected among the 18-25 age group. CONCLUSION The study revealed a concerning lack of awareness about KC among the population in Aseer Province, Saudi Arabia. Additionally, a significant percentage of participants engaged in eye rubbing, a behavior associated with increased risk for KC. There is a need for increased awareness about KC and the importance of avoiding eye rubbing.
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Affiliation(s)
- Abdulrahman Alamri
- Department of Ophthalmology, College of Medicine, King Khalid University, Abha, SAU
| | - Amal A Alrizqi
- Department of Medicine and Surgery, Al-Qunfudah College of Medicine, Umm Al-Qura University, Alqunfudhah, SAU
| | - Amal A Aljohani
- Department of Medicine and Surgery, Al-Qunfudah College of Medicine, Umm Al-Qura University, Alqunfudhah, SAU
| | - Danah A Alzahrani
- Department of Medicine and Surgery, College of Medicine, King Khalid University, Abha, SAU
| | - Othman M Alassaf
- Department of Medicine and Surgery, College of Medicine, University of Hail, Hail, SAU
| | - Yazeed A Hamzi
- Department of Medicine and Surgery, College of Medicine, Jazan University, Jazan, SAU
| | - Norah M Alharbi
- Department of Medicine and Surgery, Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, SAU
| | - Basil A Alharbi
- Department of Surgery, Ar Rass General Hospital, Ar Rass, SAU
| | - Medhat Taha
- Department of Anatomy, Al-Qunfudhah Medical College, Umm Al-Qura University, Makkah, SAU
- Department of Anatomy and Embryology, Faculty of Medicine, Mansoura University, Mansoura, EGY
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Ribeiro M, Barbosa C, Correia P, Torrão L, Neves Cardoso P, Moreira R, Falcão-Reis F, Falcão M, Pinheiro-Costa J. Best Fit Sphere Back and Adjusted Maximum Elevation of Corneal Back Surface as Novel Predictors of Keratoconus Progression. Clin Ophthalmol 2022; 16:4239-4248. [PMID: 36573232 PMCID: PMC9789719 DOI: 10.2147/opth.s388614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 12/06/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose We evaluated the Maximum Elevation of Corneal Back Surface adjusted to the same Best Fit Sphere Back (BFSB) between timeline measurements (AdjEleBmax) and the BFSB radius (BFSBR) itself as new tomographic parameters for documentation of ectasia progression and compare them with the most recent and reliable parameters used on keratoconus (KC) progression. Results We evaluated the performance and the ideal cutoff point of Kmax, D-index, posterior radius of curvature from the 3.0 mm centered on the thinnest point (PRC), EleBmax, BFSBR, and AdjEleBmax as isolated parameters to document KC progression (defined as a significant change in two or more variables), we found a sensitivity of 70%, 82%, 79%, 65%, 51%, and 63% and a specificity of 91%, 98%, 80%, 73%, 80%, and 84% to detect KC progression. The area under the curve (AUC) for each variable was 0.822, 0.927, 0.844, 0.690, 0.695, 0.754, respectively. Conclusion AdjEleBmax presented a greater specificity, larger AUC, and better performance compared to EleBmax without any adjustment, with similar sensitivity. Although AdjEleBmax and BFSB demonstrated smaller AUC and specificities comparing with Kmax and D-Index, AdjEleBmax still presented a good performance with a reasonable AUC. Since the shape of the posterior surface, more aspheric and curved than the anterior, may facilitate detection of change, we suggest the inclusion of AdjEleBmax in the evaluation of KC progression in conjunction with other variables to increase the reliability of our clinical evaluation and early detection of progression.
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Affiliation(s)
- Margarida Ribeiro
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal,Department of Biomedicine – Faculty of Medicine of Porto University, Porto, Portugal,Correspondence: Margarida Ribeiro, Department of Ophthalmology, Centro Hospitalar e Universitário São João, Alameda Prof. Hernâni Monteiro Porto, 4200-319, Portugal, Email
| | | | - Paulo Correia
- Faculty of Medicine of Porto University, Porto, Portugal
| | - Luís Torrão
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Pedro Neves Cardoso
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Raúl Moreira
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Fernando Falcão-Reis
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - Manuel Falcão
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal,Department of Surgery and Physiology, Faculty of Medicine of Porto University, Porto, Portugal
| | - João Pinheiro-Costa
- Department of Ophthalmology, Centro Hospitalar e Universitário São João, Porto, Portugal,Department of Biomedicine – Faculty of Medicine of Porto University, Porto, Portugal
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Nkoana PM, Moodley VR, Mashige KP. Self-reported knowledge and skills related to diagnosis and management of keratoconus among public sector optometrists in the Limpopo province, South Africa. Afr J Prim Health Care Fam Med 2022; 14:e1-e9. [PMID: 36546489 PMCID: PMC9772765 DOI: 10.4102/phcfm.v14i1.3668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Keratoconus (KC) has been regarded as a rare condition, although recent studies, including those in South Africa, suggest it is common and is increasing in prevalence. Furthermore, South African-based studies have shown that KC is normally detected at advanced or severe stages. Knowledge and skills for examination, diagnosis and management of KC by optometrists are important for the early detection and management of the disease. AIM This study aimed to evaluate self-reported knowledge and skills for examination, diagnosis and management of KC patients among public sector optometrists. SETTING Seven public hospitals of the Capricorn district of the Limpopo province, South Africa. METHODS A quantitative cross-sectional descriptive study design was used. A self-administered online questionnaire was used to collect data on demographic characteristics of participants and their knowledge, skills and practice for the diagnosis and management of KC. RESULTS Twenty-four optometrists (n = 24) with a mean age of 39 ± 5.67 years, 18 (75%) of whom were female, participated in the study. Nineteen (79%) reported that their hospitals did not have the appropriate equipment to examine, diagnose and manage KC patients. Lack of equipment, poor knowledge, skills and competencies, hospital's level of services, policy and lack of interest were cited as barriers to contact lens fittings in KC patients. Using a dichotomised summation of self-reported knowledge and skills of KC, 13 (54.2%) of the optometrists were knowledgeable and skilled on risk factors of KC and examining, diagnosing and managing KC patients. CONCLUSION A significant proportion of optometrists did not have the appropriate knowledge and skills to examine, diagnose and manage KC patients. Lack of equipment and poor knowledge and skills were the main barriers to contact lens fittings in managing KC.Contribution: This article highlights the need for the district to upskill the optometrists through a structured programme with a theory and practical component and also provide the necessary equipment to enhance patient care.
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Affiliation(s)
- Pheagane M.W. Nkoana
- Discipline of Optometry, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Department of Optometry, Faculty of Health Sciences, University of Limpopo, Polokwane, South Africa
| | - Vanessa R. Moodley
- Discipline of Optometry, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Khathutshelo P. Mashige
- Discipline of Optometry, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Piyacomn Y, Kasetsuwan N, Puangsricharern V, Reinprayoon U, Satitpitakul V, Chantaren P. Keratoconus in Thai population - a cross-sectional hospital-based study. ASIAN BIOMED 2022; 16:316-321. [PMID: 37551356 PMCID: PMC10392145 DOI: 10.1515/abm-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Background Studies in the epidemiology of keratoconus are limited in Southeast Asia. A study on the prevalence and characteristics of keratoconus in the Thai population could give a general idea of its impact. Objectives To study keratoconus prevalence in patients seeking refractive surgery and analyze the characteristics of keratoconus. Methods Medical records from April 2015 to August 2018 were retrospectively reviewed. Keratoconus and keratoconus suspect prevalence in patients seeking laser vision correction were calculated. The characteristics of keratoconus patients were reviewed. The Amsler-Krumeich classification was used to determine the stages. Topographically, the types of cones were categorized into oval, nipple, pellucid marginal degeneration (PMD)-like, and astigmatic types. Results Keratoconus and keratoconus suspect prevalence were 1.66% and 0.68%, respectively. Out of the affected patients, 73.8% were male. The mean age at diagnosis was 25.25 ± 8.35 years. The presenting symptoms were blurred vision (87%) and itching (47%). Stage 1 was predominant, found in 39% of patients (followed by stages 2, 4, and 3, respectively). Ocular findings comprised the Munson sign (14.63%), the Rizutti sign (6.94%), Fleischer ring (28.14%), Vogt striae (24.95%), corneal scar (8.63%), prominent corneal nerve (2.81%), and corneal staining (7.69%). Mean uncorrected visual acuity (logarithm of the minimum angle of resolution [logMAR]) was 0.88 ± 0.64. Mean corrected visual acuity (logMAR) was 0.40 ± 0.49. Mean Q-value was -0.92 ± 0.63. The thinnest pachymetry was 459.39 ± 56.96 microns. The mean keratometry was 49.7 ± 6.64 diopters. Topographically, the types of cones were oval (57%), astigmatic (33%), PMD-like (5%), and nipple type (4%). Conclusions Keratoconus prevalence among Thai patients seeking refractive surgery was 1.66%. Most patients were male and presented with the disease at a mild bilateral stage in their second decade of life.
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Affiliation(s)
- Yonrawee Piyacomn
- Department of Ophthalmology, Excellence Center for Cornea and Limbal Stem Cell Transplantation, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Ngamjit Kasetsuwan
- Department of Ophthalmology, Excellence Center for Cornea and Limbal Stem Cell Transplantation, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Vilavun Puangsricharern
- Department of Ophthalmology, Excellence Center for Cornea and Limbal Stem Cell Transplantation, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Usanee Reinprayoon
- Department of Ophthalmology, Excellence Center for Cornea and Limbal Stem Cell Transplantation, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Vannarut Satitpitakul
- Department of Ophthalmology, Excellence Center for Cornea and Limbal Stem Cell Transplantation, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
| | - Patchima Chantaren
- Department of Ophthalmology, Excellence Center for Cornea and Limbal Stem Cell Transplantation, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok10330, Thailand
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Said RB, Farah C, Chanbour W, Jarade E. Cataract in keratoconus: Six-month results and a comparison of standard intraocular lens power calculation formulas. Saudi J Ophthalmol 2022; 36:201-206. [PMID: 36211317 PMCID: PMC9535916 DOI: 10.4103/sjopt.sjopt_184_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 11/21/2021] [Accepted: 02/20/2022] [Indexed: 11/04/2022] Open
Abstract
PURPOSE To report the results of cataract surgeries in keratoconus patients at 1 and 6 months postoperatively, and to compare the standard intraocular lens (IOL) calculation formulas in this population. METHODS This is a retrospective study, carried out in 44 eyes of 26 patients known to have keratoconus who underwent cataract surgery at Beirut Eye and ENT Specialist Hospital between 2010 and 2021. The patients were divided into groups based on Dr Jarade updated algorithm. Visual acuities before and after cataract surgery, at 1 and 6 months were recorded, as well as spherical equivalent. The difference between the expected spherical equivalent with each formula was subtracted from the actual resultant refraction, and its absolute value deduced. The means of the values were calculated and the 4 standard formulas (SRK/T, SRK/II, Holladay, and Hoffer Q) were compared. RESULTS Six eyes had similar topographic and manifest axes (category 1) and underwent toric IOL implantation. Corrected distance visual acuity (CDVA) at 1 and 6 months was 0.2 and 0.1 logMAR, respectively. 26 eyes had mismatching axes and had monofocal IOL placement. CDVA at 1 and 6 months was 0.3. Six eyes required intrastromal corneal ring placement before operating (category 3). CDVA was 0.3 and 0.2 at 1 and 6 months, respectively. Regarding category 4, requiring keratoplasty and cataract extraction, CDVA was 0.4 at both follow-ups. No statistically significant difference was found between the different formulas. CONCLUSION Categorization of keratoconus patients gave favorable results after cataract surgery. No superior IOL formula was found.
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Affiliation(s)
- Reeda B. Said
- Department of Ophthalmology, Faculty of Medicine, Lebanese University, Beirut, Lebanon,Department of Ophthalmology, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon
| | - Chahid Farah
- Department of Ophthalmology, Faculty of Medicine, Lebanese University, Beirut, Lebanon,Department of Ophthalmology, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon
| | - Wassef Chanbour
- Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Elias Jarade
- Department of Ophthalmology, Faculty of Medicine, Lebanese University, Beirut, Lebanon,Department of Ophthalmology, Beirut Eye and ENT Specialist Hospital, Beirut, Lebanon,Mediclinic Dubai Mall, Dubai, United Arab Emirates,Address for correspondence: Dr. Elias Jarade, Beirut Eye Specialist Hospital, Al-Mathaf Square, P. O. Box 116-5311, Beirut, Lebanon. E-mail:
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Artificial Intelligence Technique of Synthesis and Characterizations for Measurement of Optical Particles in Medical Devices. Appl Bionics Biomech 2022; 2022:9103551. [PMID: 35186120 PMCID: PMC8856814 DOI: 10.1155/2022/9103551] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/12/2022] [Accepted: 01/27/2022] [Indexed: 02/03/2023] Open
Abstract
The aim of this study is to demonstrate the effect of particle size on semiconductor properties; artificial intelligence is being used for the research methods. As a result, we picked cadmium sulfide (CdS), which is a unique semiconductor material that is employed in a broad variety of current applications. Given that CdS has distinct electrical and optical characteristics, it may be employed in the production of solar cells, for example. Solar cells, as is also well known, have become an essential source of energy in the world. Within the visible range (500-700 nm), we create one layer of bulk CdS and one layer of nano-CdS air bulk CdS air and air nano-CdS air. We used a number of instrumentation methods to investigate the naked CdS nanoparticles, including XRD, SEM-EDX, UV-Vis spectroscopy, TEM, XPS, and PL spectroscopy, among others. The results show that for bulk CdS at normal incidence, the transmittance is T = 45, and for nano-CdS with particle size 3 nm, the transmittance is T = 85.8, with transverse-electric (S-polarized) and transverse-magnetic (P-polarized) transmittances of TE = 75 and TM = 80, respectively.
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15
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Changes in Corneal Morphology with Age in Asian Population: A Multicenter Study of 30,618 Cases. Adv Ther 2021; 38:5763-5776. [PMID: 34704192 PMCID: PMC8572190 DOI: 10.1007/s12325-021-01922-4] [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: 07/05/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
Introduction To evaluate normal reference ranges for corneal morphological parameters and investigate age-related changes in these parameters in Asian subjects with healthy eyes in order to provide reference data for preoperative evaluation of corneal refractive surgery and the early differential diagnosis of subclinical and asymptomatic keratoconus. Methods This cross-sectional, multicenter, observational study was conducted in five provinces of China, from January 2014 through October 2019. It is a retrospective analysis. Examiner-blinded clinical measurements were performed after stratification of the subjects into the following age groups: < 18, 18–30, 31–40, 41–50. We evaluated 30,618 healthy eyes of Chinese subjects who exhibited a normal corneal morphology, had no history of eye surgery or trauma, stopped wearing soft contact lenses for at least 2 weeks (rigid contact lenses for at least 4 weeks), and underwent topographic studies for both eyes on the same day. Results While the anterior and posterior corneal curvatures (K1 and K2) increased with age, corneal astigmatism of the anterior and posterior surfaces (ΔK) and central, minimum, and overall corneal thicknesses decreased with age. Age-related decrease of the overall corneal thickness was more obvious toward the periphery. The anterior and posterior corneal surface heights exhibited a decrease and an increase, respectively. Both index of height asymmetry (IHA) and index of vertical asymmetry (IVA) exhibited an increase with age. Conclusions The cornea exhibits overall thinning with age and gradually changes from a flat ellipse to an elongated ellipse in Asian individuals with healthy eyes. However, the anterior and posterior surfaces become smoother with age. Owing to the very large number of cases, these small differences are statistically significant. The results obtained are consistent with the hypothesis that a normal cornea seems to withstand quite well the effect of IOP, external pressures, and the natural cross-linking.
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Ozkan HH, Koc M, Kiziltoprak H, Tekin K, Aydemir E. Evaluation of topographic, tomographic, topometric, densitometric, and aberrometric features of cornea with pentacam HR system in subclinical keratoconus. Int Ophthalmol 2021; 41:1729-1741. [PMID: 33772701 DOI: 10.1007/s10792-021-01732-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 01/30/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE To investigate topographic, tomographic, topometric, densitometric, and aberrometric parameters in subclinical keratoconus with the Pentacam HR imaging system. METHODS Data of 3128 patients were evaluated, finding in 108 patients clinical keratoconus in one eye and subclinical keratoconus in the other. Corneal topographic, tomographic, topometric, densitometric, and aberrometric values obtained using the Pentacam HR imaging system were compared between clinical keratoconus, subclinical keratoconus, and normal eyes. RESULTS Comparing eyes with subclinical keratoconus and the control group, while flat K, horizontal coma, horizontal trefoil, and vertical trefoil values were similar (p > 0.05 for each), all other parameters were significantly different (p < 0.05 for each). Densitometry values of eyes with subclinical keratoconus were significantly higher in all layers of the 0-2 mm annular area and in the anterior and central layers of the 2-6 mm annular area compared to the control group (p < 0.05 for each). According to the receiver operating characteristic curve analysis, the densitometry region with the largest area under the curve was the anterior layer of the 0-2 mm annular area. The sensitivity in this region was 79.4% and the specificity 73.2% in distinguishing eyes with subclinical keratoconus from normal eyes when 19.3 GSU was considered the threshold. CONCLUSION Corneal densitometry values in the 0-2 and 2-6 mm annular areas, especially in the anterior layers, are parameters that can be used to predict and distinguish subclinical keratoconus from normal eyes.
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Affiliation(s)
- Haci Hasan Ozkan
- Ophthalmology Department, Ankara Occupational and Environmental Diseases Hospital, Ankara, Turkey.
| | - Mustafa Koc
- Ophthalmology Department, Kayseri Mayagoz Hospital, Kayseri, Turkey
| | - Hasan Kiziltoprak
- Ophthalmology Department, Adiyaman University Faculty of Medicine, Adiyaman, Turkey
| | - Kemal Tekin
- Ophthalmology Department, Hatay Mustafa Kemal University Faculty of Medicine, Hatay, Turkey
| | - Emre Aydemir
- Ophthalmology Department, Adıyaman Training and Research Hospital, Adıyaman, Turkey
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Abstract
Purpose of Review To summarize the recent advances in transcriptomics and proteomics studies of keratoconus using advanced genome-wide gene and protein expression profiling techniques. Recent Findings Second-generation sequencing including RNA sequencing has been widely used to characterize the genome-wide gene expression in corneal tissues or cells affected by keratoconus. Due to different sample types, sequencing platforms, and analysis pipeline, different lists of genes have been identified to be differentially expressed in KC-affected samples. Gene ontology and pathway/network analyses have indicated the involvement of genes related with extracellular matrix, WNT-signaling, TGFβ pathway, and NRF2-regulated network. High throughput proteomics studies using mass spectrometry have uncovered many KC-related protein molecules in pathways related with cytoskeleton, cell matrix, TGFβ signaling, and extracellular matrix remodeling, consistent with gene expression profiling. Summary Both transcriptomics and proteomics studies using genome-wide gene/protein expression profiling techniques have identified significant genes/proteins that may contribute to the pathogenesis of keratoconus. These molecules may be involved in functional categories related with extracellular matrix and TGFβ signaling. It is necessary to perform comprehensive gene/protein expression studies using larger sample size, same type of samples, up-to-date platform and bioinformatics tools.
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Xu G, Hu Y, Zhu S, Guo Y, Xiong L, Fang X, Liu J, Zhang Q, Huang N, Zhou J, Li F, Lei X, Jiang L, Wang Z. A multicenter study of interocular symmetry of corneal biometrics in Chinese myopic patients. Sci Rep 2021; 11:5536. [PMID: 33692402 PMCID: PMC7946893 DOI: 10.1038/s41598-021-84937-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/20/2021] [Indexed: 12/26/2022] Open
Abstract
It is essential to know the normal range of the interocular symmetry of the cornea (ISC) for keratoconus diagnosis and corneal substitutes design. In the present study we investigated the interocular symmetry of corneal biometrics in 6,644 Chinese myopic patients from multiple ophthalmic centers. Corneal biometrics of both eyes were exported from the Pentacam instrument. Interocular symmetry of the corneal biometrics was analyzed by Spearman's correlation test, intraclass correlation coefficient (ICC) analysis and Bland-Altman plot. Significantly strong interocular correlations were found in anterior and posterior corneal curvatures, corneal diameter, corneal thickness, corneal volume, corneal eccentricity, and corneal asphericity (r = 0.87-0.98, all P < 0.001). Moderate interocular correlations were observed in whole corneal astigmatism (r = 0.78) and posterior corneal astigmatism (r = 0.73). ICC between the right and left eyes was 0.94-0.98 for anterior and posterior corneal curvatures, corneal diameter, corneal thickness and corneal volume, 0.80-0.88 for corneal eccentricity and asphericity, and 0.73-0.79 for corneal astigmatism (all P < 0.001). Bland-Altman plot showed that the 95% limit of agreement between both eyes was narrow and symmetric in most of the corneal biometrics, suggesting strong interocular agreements in these corneal biometrics. In conclusion, significant interocular symmetry of corneal biometrics is observed in Chinese myopia patients. Extra attention should be paid to patients with interocular corneal asymmetry.
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Affiliation(s)
- Guihua Xu
- Department of Ophthalmology, Huizhou Municipal Central Hospital, Huizhou, China.,Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Yijun Hu
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China. .,Aier School of Ophthalmology, Central South University, Fourth Floor, New Century Mansion, 198 Middle Furong Road, Changsha, 410015, China.
| | - Shanqing Zhu
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Yunxiang Guo
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Lu Xiong
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China
| | - Xuejun Fang
- Aier School of Ophthalmology, Central South University, Fourth Floor, New Century Mansion, 198 Middle Furong Road, Changsha, 410015, China.,Refractive Surgery Center, Shenyang Aier Eye Hospital, Shenyang, China
| | - Jia Liu
- Refractive Surgery Center, Shenyang Aier Eye Hospital, Shenyang, China
| | - Qingsong Zhang
- Refractive Surgery Center, Wuhan Aier Eye Hospital, Wuhan, China
| | - Na Huang
- Refractive Surgery Center, Wuhan Aier Eye Hospital, Wuhan, China
| | - Jin Zhou
- Refractive Surgery Center, Chengdu Aier Eye Hospital, Chengdu, China
| | - Fangfang Li
- Refractive Surgery Center, Chengdu Aier Eye Hospital, Chengdu, China
| | - Xiaohua Lei
- Refractive Surgery Center, Hankou Aier Eye Hospital, Hainan, China
| | - Li Jiang
- Refractive Surgery Center, Hankou Aier Eye Hospital, Hainan, China
| | - Zheng Wang
- Aier Institute of Refractive Surgery, Refractive Surgery Center, Guangzhou Aier Eye Hospital, Guangzhou, China.,Aier School of Ophthalmology, Central South University, Fourth Floor, New Century Mansion, 198 Middle Furong Road, Changsha, 410015, China
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Barbot A, Park WJ, Ng CJ, Zhang RY, Huxlin KR, Tadin D, Yoon G. Functional reallocation of sensory processing resources caused by long-term neural adaptation to altered optics. eLife 2021; 10:58734. [PMID: 33616034 PMCID: PMC7963487 DOI: 10.7554/elife.58734] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022] Open
Abstract
The eye’s optics are a major determinant of visual perception. Elucidating how long-term exposure to optical defects affects visual processing is key to understanding the capacity for, and limits of, sensory plasticity. Here, we show evidence of functional reallocation of sensory processing resources following long-term exposure to poor optical quality. Using adaptive optics to bypass all optical defects, we assessed visual processing in neurotypically-developed adults with healthy eyes and with keratoconus – a corneal disease causing severe optical aberrations. Under fully-corrected optical conditions, keratoconus patients showed altered contrast sensitivity, with impaired sensitivity for fine spatial details and better-than-typical sensitivity for coarse spatial details. Both gains and losses in sensitivity were more pronounced in patients experiencing poorer optical quality in their daily life and mediated by changes in signal enhancement mechanisms. These findings show that adult neural processing adapts to better match the changes in sensory inputs caused by long-term exposure to altered optics.
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Affiliation(s)
- Antoine Barbot
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, United States.,Center for Visual Science, University of Rochester, Rochester, United States
| | - Woon Ju Park
- Brain and Cognitive Sciences, University of Rochester, Rochester, United States.,Department of Psychology, University of Washington, Seattle, United States
| | - Cherlyn J Ng
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, United States.,Center for Visual Science, University of Rochester, Rochester, United States
| | - Ru-Yuan Zhang
- Brain and Cognitive Sciences, University of Rochester, Rochester, United States.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Institute of Psychology and Behavioral Science, Shanghai Jiao Tong University, Shanghai, China
| | - Krystel R Huxlin
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, United States.,Center for Visual Science, University of Rochester, Rochester, United States.,Brain and Cognitive Sciences, University of Rochester, Rochester, United States.,Department of Neuroscience, University of Rochester, Rochester, United States
| | - Duje Tadin
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, United States.,Center for Visual Science, University of Rochester, Rochester, United States.,Brain and Cognitive Sciences, University of Rochester, Rochester, United States.,Department of Neuroscience, University of Rochester, Rochester, United States
| | - Geunyoung Yoon
- Flaum Eye Institute, University of Rochester Medical Center, Rochester, United States.,Center for Visual Science, University of Rochester, Rochester, United States
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20
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de Almeida Borges D, Alborghetti MR, Franco Paes Leme A, Ramos Domingues R, Duarte B, Veiga M, Trindade Ferrer M, Viana Wanzeler AC, Leite Arieta CE, Alves M. Tear proteomic profile in three distinct ocular surface diseases: keratoconus, pterygium, and dry eye related to graft-versus-host disease. Clin Proteomics 2020; 17:42. [PMID: 33372592 PMCID: PMC7720622 DOI: 10.1186/s12014-020-09307-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 11/27/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Diseases of the anterior segment of the eye may present different mechanisms, intensity of symptoms, and impact on the patients' quality of life and vision. The tear film is in direct contact with the ocular surface and cornea and can be easily accessed for sample collection, figuring as a promising source of potential biomarkers for diagnosis and treatment control. This study aimed to evaluate tear proteomic profile in 3 distinct ocular diseases: keratoconus (corneal ectasia), severe dry eye related to graft-versus-host-disease (tear film dysfunction and ocular inflammatory condition) and pterygium (conjunctival fibrovascular degenerative disease). METHODS Tear samples were collected from patients of each condition and a control group. By using mass spectrometric analysis combined with statistics and bioinformatics tools, a detailed comparison of protein profile was performed. RESULTS After Student's t-test analyses comparing each condition to the control group, we found the following number of differentially expressed proteins: 7 in keratoconus group, 29 in pterygium group, and 79 in GVHD group. Following multivariate analyses, we also report potential candidates as biomarkers for each disease. CONCLUSIONS We demonstrated herein that mass spectrometry-based proteomics was able to indicate proteins that differentiate three distinct ocular conditions, which is a promising tool for the diagnosis of ocular diseases.
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Affiliation(s)
- Daniel de Almeida Borges
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
| | | | - Adriana Franco Paes Leme
- Brazilian Biosciences National Laboratory (LNBio), Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, Brazil
| | - Romenia Ramos Domingues
- Brazilian Biosciences National Laboratory (LNBio), Brazilian Center for Research in Energy and Materials (CNPEM), Campinas, Brazil
| | - Bruna Duarte
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Melina Veiga
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Marilia Trindade Ferrer
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Ana Claudia Viana Wanzeler
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Carlos Eduardo Leite Arieta
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Monica Alves
- Department of Ophthalmology and Otorhinolaryngology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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21
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Masiwa LE, Moodley V. A review of corneal imaging methods for the early diagnosis of pre-clinical Keratoconus. JOURNAL OF OPTOMETRY 2020; 13:269-275. [PMID: 31917136 PMCID: PMC7520528 DOI: 10.1016/j.optom.2019.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/22/2019] [Accepted: 11/09/2019] [Indexed: 05/15/2023]
Abstract
BACKGROUND Keratoconus (KC) is a corneal ectasia characterised by steepening corneal curvature, changes in refractive error and corneal thickness that result in visual impairment. Early signs of KC include displacement of the thinnest part of the cornea from the central position, changes in the corneal epithelial layer cell distribution, variations in the anterior corneal astigmatism/posterior corneal astigmatism relationship and a variation in corneal thickness. It is important that we review the corneal imaging methods for the diagnosis of preclinical KC. METHOD An online literature search was carried out on PubMed. Only publications detailing corneal assessment procedures were considered for this review and any publication on instruments that did not generate KC predictability indices were also excluded from the review. The 308 publications were reviewed. DISCUSSION Corneal assessment techniques, with the ability to characterise both the anterior and posterior corneal surfaces, are invaluable in the diagnosis of pre-clinical KC. Reflection based and elevation based corneal imaging systems should be used in conjunction with other assessments such as higher order aberration measuring systems to improve sensitivity and reliability in the diagnosis of pre-clinical KC. Ultra high resolution ultrasound can detect pre-clinical KC. The ability to asses both the epithelium and endothelium makes anterior surface optical coherence tomography a superior technique for pre-clinical KC diagnosis. There is a positive correlation between central corneal thickness and corneal hysteresis. Corneal biomechanics should be considered in conjunction with other corneal assessments in the diagnosis of pre-clinical KC.
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Affiliation(s)
- Lynett Erita Masiwa
- Department of Ophthalmology, University of Zimbabwe, College of Health Sciences, P. O. Box A178, Avondale, Harare, Zimbabwe.
| | - Vanessa Moodley
- School of Health Sciences, Department of Optometry, University of Kwazulu Natal, Durban, South Africa
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Zhang X, Munir SZ, Sami Karim SA, Munir WM. A review of imaging modalities for detecting early keratoconus. Eye (Lond) 2020; 35:173-187. [PMID: 32678352 DOI: 10.1038/s41433-020-1039-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 05/28/2020] [Accepted: 06/10/2020] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Early identification of keratoconus is imperative for preventing iatrogenic corneal ectasia and allowing for early corneal collagen cross-linking treatments to potentially halt progression and decrease transplant burden. However, early diagnosis of keratoconus is currently a diagnostic challenge as there is no uniform screening criteria. We performed a review of the current literature to assess imaging modalities that can be used to help identify subclinical keratoconus. METHODS A Pubmed database search was conducted. We included primary and empirical studies for evaluating different modalities of screening for subclinical keratoconus. RESULTS A combination of multiple imaging tools, including corneal topography, tomography, Scheimpflug imaging, anterior segment optical coherence tomography, and in vivo confocal microscopy will allow for enhanced determination of subclinical keratoconus. In patients who are diagnostically borderline using a single screening criteria, use of additional imaging techniques can assist in diagnosis. Modalities that show promise but need further research include polarization-sensitive optical coherence tomography, Brillouin microscopy, and atomic force microscopy. CONCLUSIONS Recognition of early keratoconus can reduce risk of post-refractive ectasia and reduce transplantation burden. Though there are no current uniform screening criterion, multiple imaging modalities have shown promise in assisting with the early detection of keratoconus.
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Affiliation(s)
- Xuemin Zhang
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Saleha Z Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Syed A Sami Karim
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Wuqaas M Munir
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, MD, USA.
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Safety, Efficacy, and Predictive Factors of Conventional Epithelium-Off Corneal Crosslinking in the Treatment of Progressive Keratoconus. J Ophthalmol 2020; 2020:7487186. [PMID: 32566268 PMCID: PMC7281816 DOI: 10.1155/2020/7487186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 04/11/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022] Open
Abstract
Purpose To report predictive factors of outcome of conventional epithelium-off corneal crosslinking (CXL) in the treatment of progressive keratoconus. Methods This is a monocentric observational retrospective study conducted at Eye and Ear International Hospital, Lebanon. All patients with progressive keratoconus who underwent CXL between January 2008 and January 2016, with minimal 3-years follow-up were included. Primary treatment outcomes were maximum keratometry (K max), best-corrected distance visual acuity (CDVA), and failure. Failure was defined as an increase of 1.00 diopters (D) or more in K max and/or an increase of 0.1 logMAR or more in CDVA and conversion to corneal transplantation. Statistical analysis was done to identify predictors of treatment success. Univariate and multivariate analyses were performed to determine the correlations between baseline parameters and outcomes, and an equation for predicting K max and CDVA was created. Results 156 eyes of 102 patients were enrolled. The mean age was 23.85 ± 6.52 years. Failure occurred in 31 eyes (19.87%). Gender and thinnest pachymetry did not have any impact on postoperative outcomes. Concerning the CDVA outcome, multivariate analysis showed that a better preoperative CDVA was associated with higher improvement in CDVA, and higher baseline K max and higher posterior mean K were associated with a worse outcome CDVA. Regarding postoperative K max, a higher baseline K max, a worse baseline CDVA, and a younger age were associated with less flattening postoperatively. Conclusion CXL is a safe and effective method in treating progressive keratoconus. However, the clinical benefits can differ among patients, and in our series, a nonnegligible number of cases show a continued progression of their ectasia. Further studies to identify predictors of postoperative progression prior to the procedure could help sort out good responders to treatment.
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Karolak JA, Gambin T, Rydzanicz M, Polakowski P, Ploski R, Szaflik JP, Gajecka M. Accumulation of sequence variants in genes of Wnt signaling and focal adhesion pathways in human corneas further explains their involvement in keratoconus. PeerJ 2020; 8:e8982. [PMID: 32328353 PMCID: PMC7164425 DOI: 10.7717/peerj.8982] [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: 01/15/2020] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
Background Keratoconus (KTCN) is a protrusion and thinning of the cornea, resulting in loss of visual acuity. The etiology of KTCN remains unclear. The purpose of this study was to assess the potential involvement of new genetic variants in KTCN etiology based on both the genomic and transcriptomic findings recognized in the same corneal tissues. Methods Corneal tissues derived from five unrelated Polish individuals with KTCN were examined using exome sequencing (ES), followed by enrichment analyses. For comparison purposes, the datasets comprising ES data of five randomly selected Polish individuals without ocular abnormalities and five Polish patients with high myopia were used. Expression levels of selected genes from the overrepresented pathways were obtained from the previous RNA-Seq study. Results Exome capture discovered 117 potentially relevant variants that were further narrowed by gene overrepresentation analyses. In each of five patients, the assessment of functional interactions revealed rare (MAF ≤ 0.01) DNA variants in at least one gene from Wnt signaling (VANGL1, WNT1, PPP3CC, LRP6, FZD2) and focal adhesion (BIRC2, PAK6, COL4A4, PPP1R12A, PTK6) pathways. No genes involved in pathways enriched in KTCN corneas were overrepresented in our control sample sets. Conclusions The results of this first pilot ES profiling of human KTCN corneas emphasized that accumulation of sequence variants in several genes from Wnt signaling and/or focal adhesion pathways might cause the phenotypic effect and further points to a complex etiology of KTCN.
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Affiliation(s)
- Justyna A Karolak
- Chair and Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, Poznan, Poland.,Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
| | - Tomasz Gambin
- Institute of Computer Science, Warsaw University of Technology, Warsaw, Poland
| | | | - Piotr Polakowski
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Ploski
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | - Jacek P Szaflik
- Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland
| | - Marzena Gajecka
- Chair and Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, Poznan, Poland.,Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
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Gadelha DNB, Feitosa AFB, da Silva RG, Antunes LT, Muniz MC, de Oliveira MA, Andrade DDO, da Paz Silva NM, Cronemberger S, Schamber-Reis BLF. Screening for Novel LOX and SOD1 Variants in Keratoconus Patients from Brazil. J Ophthalmic Vis Res 2020; 15:138-148. [PMID: 32308947 PMCID: PMC7151510 DOI: 10.18502/jovr.v15i2.6730] [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: 03/11/2019] [Accepted: 12/23/2019] [Indexed: 12/29/2022] Open
Abstract
Purpose To investigate the presence of the variants of lysyl oxygenase (LOX) and superoxide dismutase 1 (SOD1) genes in Brazilian patients with advanced keratoconus. Methods Donor genomic DNA extracted from blood samples was screened for 5'UTR, exonic LOX, and SOD1 variants in a subset of 26 patients presenting with advanced keratoconus (KISA > 1000% and I–S > 2.0) by Sanger sequencing. The impact of non-synonymous amino acid changes was evaluated by SIFT, PMUT, and PolyPhen algorithms. The Mutation Taster tool was used to evaluate the potential impact of formation of new donor and acceptor splice sites in the promoter region of affected volunteers carrying sequence variants. A 7-base SOD1 deletion (IVS2 + 50del7bp) previously associated with keratoconus was screened in 140 patients presenting classical keratoconus by gel fragment analysis, and positive samples were sequenced for confirmation. Results We found an unreported missense variant in LOX exon 6 in one heterozygous patient, leading to substitution of proline with threonine at residue 392 (p. Thr392Pro) of LOX protein sequence. This mutation was predicted to be potentially damaging to LOX protein. Another LOX variant, Arg158Gln, was also detected in another patient but predicted to be non-pathogenic. Two additional new polymorphisms in LOX 5'UTR region (–116C > T and –58C > T) were found in two patients presenting with advanced keratoconus and were predicted to modulate or create donor/acceptor splice sites in LOX transcripts. Additionally, SOD1 deletion was detected in one patient presenting with severe keratoconus, not in control samples. Conclusion We described three novel LOX polymorphisms identified for the first time in Brazilian patients with advanced keratoconus, as well as a previously described SOD1 deletion strongly associated with keratoconus. A possible role of these variants in modulating transcript levels in the cornea of affected individual requires further investigation.
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Affiliation(s)
| | | | - Rafaela Gomes da Silva
- Department of Medical Genetics, School of Medical Sciences, UNIFACISA, Campina Grande, Paraíba, Brazil
| | - Luana Talita Antunes
- Department of Medical Genetics, School of Medical Sciences, UNIFACISA, Campina Grande, Paraíba, Brazil
| | - Matheus Cavalcanti Muniz
- Department of Medical Genetics, School of Medical Sciences, UNIFACISA, Campina Grande, Paraíba, Brazil
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Assessment of Visual Quality in Eyes with Forme Fruste Keratoconus and Mild and Moderate Keratoconus Based on Optical Quality Analysis System II Parameters. J Ophthalmol 2020; 2020:7505016. [PMID: 32280532 PMCID: PMC7125474 DOI: 10.1155/2020/7505016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 01/09/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose The study aimed to evaluate the visual quality of forme fruste keratoconus (FFK) and mild and moderate keratoconus by using an optical quality analysis system II (OQAS-II) and to explore the correlation between optical quality parameters and the disease progression. Methods Twenty-one normal eyes, twenty-one FFK eyes, twenty-one mild keratoconus eyes, and twenty-one moderate keratoconus eyes were included in this prospective study. The optical quality parameters, such as object scatter index (OSI), modulation transfer function cutoff (MTF cutoff), strehl ratio (SR), and OQAS-II values at contrasts of 100% (OV-100), 20% (OV-20), and 9% (OV-9), were measured by OQAS-II. The repeatability of these parameters was analyzed by intraclass correlation coefficient (ICC), repeatability coefficient (RC), and coefficient of variation (CVw). Correlations between optical quality parameters and mean central keratometry readings (Kmean) were evaluated. The sensitivity and specificity of the parameters were analyzed using the receiver operating characteristic (ROC). Results All the optical quality parameters among four groups showed good repeatability (all ICC≥0.75). The MTF cutoff, SR, OV-100, OV-20, OV-9 in FFK, mild and moderate keratoconus eyes were significantly lower than those in the normal group (all P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all Kmean) were evaluated. The sensitivity and specificity of the parameters were analyzed using the receiver operating characteristic (ROC). r = −0.710, P < 0.05). The ROC analyses of the MTF cutoff, SR, OV-100, OV-20, and OV-9 showed significant area under the curve (AUC) in discriminating FFK form normal, mild keratoconus from FFK, and moderate keratoconus from mild keratoconus (all Conclusion The repeatability of OQAS-II is good in measuring visual quality of normal as well as FFK, mild, and moderate keratoconus. The visual quality of the FFK, mild, and moderate keratoconus is worse than that in normal eyes. The OQAS-II has the potential value in screening FFK from normal eyes and might be a useful tool for evaluating the progression of keratoconus.
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Akkaya S, Ulusoy DM, Duru Z, Demirtaş AA. Long-term Outcomes of Accelerated Corneal Cross-linking in the Treatment of Keratoconus: Comparison of Hypotonic Riboflavin Solution With Standard Riboflavin Solution. J Refract Surg 2020; 36:110-117. [DOI: 10.3928/1081597x-20191218-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 12/17/2019] [Indexed: 11/20/2022]
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El-Khoury S, Abdelmassih Y, Amro M, Dirani A, Cherfan C, Jarade E. The Effect of Age on Corneal Topographic Indices, Keratometry and Visual Acuity After Combined Intrastromal Corneal Ring Segment (ICRS) Implantation and Corneal Crosslinking. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2020; 9:135-142. [PMID: 32490020 PMCID: PMC7134240] [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
We aimed to assess age-related changes in corneal topographic indices, keratometry and visual acuity after sequential intracorneal ring segment implantation (ICRS) and crosslinking (CXL). This was a retrospective matched case-control series including 26 eyes of patients ≤18 years as cases and 26 eyes of adult patients as controls. All eyes received ICRS+CXL for progressive keratoconus. Eyes were matched regarding the keratoconus parameters and the treatment (type, number and thickness of ICRS). Data was analyzed for refractive and topographic values (uncorrected and corrected distance visual acuity (UDVA; CDVA) sphere; cylinder; spherical equivalent; maximum keratometry (Kmax); flat keratometry (Kflat); steep keratometry (Ksteep); all 7 pentacam topographic indices) preoperatively and one year postoperatively. Preoperatively, there was no significant difference for any refractive, clinical or topographic parameters between the groups except for index of vertical asymmetry. After one year, children had a significantly higher improvement in Ksteep (3.05D) than adults (2.10D; P=0.036) and a trend to significance for Kflat (2.7D compared to 1.78D, respectively; P=0.081). UDVA improved by 4.3 ETDRS lines in children compared to 3.3 ETDRS lines in adults and CDVA improved by 1.7 ETDRS lines in children compared to 1.2 ETDRS lines in adults, but with no statistical significance. The effects on keratometry indicated that corneal response after ICRS and CXL for keratoconus is more pronounced in young patients than adults. This assumption is also supported by functional improvement and by the fact that a few eyes (5) of some very young patients (<13years) showed highly remarkable improvements after surgery (higher than any adult eye).
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Affiliation(s)
- Sylvain El-Khoury
- Beirut Eye Specialist Hospital, Beirut, Lebanon.,Fondation Ophtalmologique Rothschild, Department of Pediatrics and Retina, Paris, France. ,Authors contributed equally
| | - Youssef Abdelmassih
- Beirut Eye Specialist Hospital, Beirut, Lebanon.,Fondation Ophtalmologique Rothschild, Department of Pediatrics and Retina, Paris, France. ,Authors contributed equally
| | - Mazen Amro
- Beirut Eye Specialist Hospital, Beirut, Lebanon.,School of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Ali Dirani
- Beirut Eye Specialist Hospital, Beirut, Lebanon
| | | | - Elias Jarade
- Beirut Eye Specialist Hospital, Beirut, Lebanon.,Mediclinic Dubai Mall, Dubai, United Arab Emirates
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Cung LX, Nga DM, Ngan ND, Hiep NX, Quyet D, Thai TV, Nga VT, Dinh TC, Bac ND. Penetrating Keratoplasty for Keratoconus in Vietnamese Patients. Open Access Maced J Med Sci 2019; 7:4287-4291. [PMID: 32215079 PMCID: PMC7084045 DOI: 10.3889/oamjms.2019.376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Keratoconus is an ectatic corneal disorder that can impair the visual acuity. Up to now, penetrating keratoplasty (PK) remains the most common surgical procedure to treat severe keratoconus. In Vietnam, most keratoconus patients come to visit doctor at severe stage and were treated by PK, so we conduct this study. AIM To evaluate the results of PK for keratoconus in Vietnamese patients. METHODS This was a retrospective study of 31 eyes with keratoconus who underwent PK in VNIO from January 2005 to December 2014. RESULTS The average visual acuity was 0.86 ± 0.37 logMAR (20/145). In the group of patients without amblyopia, best spectacle-corrected visual acuity of 20/60 or better was recorded in 75.9% of eyes and 93.1% of eyes achieved a best corrected visual acuity with hard contact lenses of 20/40 or better. Mean postoperative corneal power was 43.8 ± 4.5D. Mean corneal astigmatism was 5.9 ± 2.7D. 94.6% of grafts remained clear. Posterior subcapsular cataract developed in 22.6% of eyes. Graft rejection was recognized in 12.9% of eyes. CONCLUSION PK is an effective procedure with high rate of graft survival for keratoconus patients. However, patients should be aware of the necessary of optical correction to gain the best VA after surgery.
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Affiliation(s)
- Le Xuan Cung
- Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | - Duong Mai Nga
- Vietnam National Institute of Ophthalmology, Hanoi, Vietnam
| | | | | | - Do Quyet
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
| | - Than Van Thai
- NTT Hi-tech Institute, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam
| | - Vu Thi Nga
- Institute for Research and Development, Duy Tan University, 03 Quang Trung, Danang, Vietnam
| | - Toi Chu Dinh
- Department of Human and Animal Physiology, Faculty of Biology, Hanoi National University of Education, Hanoi, Vietnam
| | - Nguyen Duy Bac
- Vietnam Military Medical University (VMMU), Hanoi, Vietnam
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Al-Mohaimeed MM. Combined corneal CXL and photorefractive keratectomy for treatment of keratoconus: a review. Int J Ophthalmol 2019; 12:1929-1938. [PMID: 31850179 DOI: 10.18240/ijo.2019.12.16] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/29/2019] [Indexed: 12/15/2022] Open
Abstract
Keratoconus and iatrogenic keratectasia are the corneal ectatic disorders occurring due to biomechanical weakening of the cornea resulting in distorted images, myopia, and irregular astigmatism. Corneal collagen cross-linking (CXL) is performed to arrest keratoconus successfully. The main aim of this review is to discuss the safety and efficacy of the adjuvant therapies, such as the combination of CXL and photorefractive keratectomy (PRK) for the treatment of corneal ectatic disorders. A comprehensive literature search was performed using PubMed, MEDLINE, and Scopus using keywords 'collagen' 'keratoconus', 'keratectasia', 'collagen cross-linking', and 'photorefractive keratectomy'. Search results were restricted to clinical studies published in English. Corneal CXL effectively arrests the progression of keratoconus by enhancing corneal rigidity. However, functional vision is not improved by cross-linking. Combining CXL to refractive surgeries such as topography-guided PRK or transepithelial PRK is found to be a safe and effective method in providing corneal stability as well as significantly improving functional visual acuity with few minor complications. This combined technique also prevents regression of keratoconus and reduce the risk of keratectasia. CXL combined with PRK is a promising therapeutic approach in ophthalmology that can be successfully used to treat progressive keratoconus and other corneal ectatic disorders and to enhance visual acuity.
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Affiliation(s)
- Mansour M Al-Mohaimeed
- Department of Ophthalmology, College of Medicine, Qassim University, Qassim, Buraidah 51452, Kingdom of Saudi Arabia
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Najmi H, Mobarki Y, Mania K, Altowairqi B, Basehi M, Mahfouz MS, Elmahdy M. The correlation between keratoconus and eye rubbing: a review. Int J Ophthalmol 2019; 12:1775-1781. [PMID: 31741868 PMCID: PMC6848869 DOI: 10.18240/ijo.2019.11.17] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 03/22/2019] [Indexed: 12/23/2022] Open
Abstract
Keratoconus is a non-inflammatory disorder which is gradual in development; corneal thinning and ectatic protrusion characterizes it. Keratoconus prevalence varies between different regions depending on several factors that affecting its prevalence. There are risk factors for developing keratoconus such as demographic and environmental factors. It was suggested that eye rubbing was associated with the development of keratoconus. The main aim of this review was to summarize the literature data about keratoconus and to identify the role of eye-rubbing in the aetiology of the disease. A number of 24 articles was reviewed through the PubMed, Google Scholar and Research Gates. There are many keywords used such as keratoconus, aetiology of keratoconus, eye rubbing, keratoconus prevalence, keratoconus and eye rubbing correlation. We concluded that eye rubbing causes the thinning of keratocyte, and the degree of effect of eye rubbing depends on the period and force of performing eye rubbing. It is recommended to avoid eye rubbing to prevent keratoconus, this can be achieved by avoiding itching and treating dryness of the eye and avoiding wearing eye lenses.
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Affiliation(s)
- Hatim Najmi
- Department of Ophthalmology, King Fahad Hospital of the University, Al Khobar 34445, Saudi Arabia
| | - Yara Mobarki
- King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | - Khalid Mania
- King Abdulaziz University Hospital, Jeddah 21589, Saudi Arabia
| | | | - Mohammed Basehi
- Department of Emergency, King Fahad Hospital of the University, Al Khobar 34445, Saudi Arabia
| | - Mohammed Salih Mahfouz
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Mona Elmahdy
- Department of Family and Community Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
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Vastardis I, Sagri D, Fili S, Wölfelschneider P, Kohlhaas M. Current Trends in Modern Visual Intraocular Lens Enhancement Surgery in Stable Keratoconus: A Synopsis of Do's, Don'ts and Pitfalls. Ophthalmol Ther 2019; 8:33-47. [PMID: 31605318 PMCID: PMC6789053 DOI: 10.1007/s40123-019-00212-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 10/29/2022] Open
Abstract
Keratoconus is a relatively common ectatic, non-inflammatory corneal disorder that involves gradual visual deterioration through progressive alteration of the shape of the cornea. The corneal thinning, irregular astigmatism and higher order aberrations that occur as the disease progresses pose major challenges in the visual rehabilitation of such patients. This paper summarizes the current literature regarding the results of visual enhancement procedures in patients with stable keratoconus treated with standalone anterior or posterior chamber phakic intraocular lens implantation and monofocal, toric or multifocal toric intraocular lens implantation following phacoemulsification for age-related cataract extraction or refractive lens exchange.
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Affiliation(s)
| | | | - Sofia Fili
- St Johannes Hospital, Eye Clinic, Dortmund, Germany
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Omar IAN. Keratoconus Screening Among Myopic Children. Clin Ophthalmol 2019; 13:1909-1912. [PMID: 31576107 PMCID: PMC6767970 DOI: 10.2147/opth.s225326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/12/2019] [Indexed: 01/01/2023] Open
Abstract
Aim To assess the topographic corneal changes and the incidence of keratoconus among children with high myopia. Settings It is a prospective study, in which 174 eyes of children with high myopia were studied in the period between August 2015 and June 2018. Methods All patients were examined to assess the refractive error and corneal examination using Scheimpflug camera to evaluate different corneal parameters. Results Studied children aged between 6 and 14 years (11.05±1.98). Males represented 54% of the cases (n=94). The mean spherical error was −7.75±2.97 ranging from −6 to −13.50D. The mean cylindrical error was −4.12±1.78D (−1 to −8). Regarding corneal examination, data recorded were those about maximum K reading (kmax), thinnest location, highest anterior and posterior elevation in 4mm zone, and higher-order corneal aberrations. Analysis of the obtained data revealed 16 eyes (9.2%) with keratoconus. These eyes were considered as a separate group and compared with the remaining eyes. There was significant difference in kmax (p= 0.03), anterior elevation, and posterior elevation (p=0.01 for both). Regarding myopia or astigmatism, there were no significant differences when compared with normal eyes. But high myopia with low astigmatism were found in five eyes of them (31.2%). The main statistically different aberrations were vertical coma (−2.04±0.99) (p=0.01) and spherical aberrations (−0.9±0.78) (p=0.02). Regarding gender, there were 11 eyes in boys (68.7%), and this was statistically significant (p=0.01). Vernal keratoconjunctivitis with frequent eye rubbing was found in 6 eyes (37.5%). Conclusion Children with high myopia irrespective of the degree of astigmatism may have corneal abnormalities which are more pronounced in cases with vernal keratoconjunctivitis. Corneal examination should be performed for highly myopic children to detect any corneal abnormality and to treat it as early as possible.
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Loukovitis E, Kozeis N, Gatzioufas Z, Kozei A, Tsotridou E, Stoila M, Koronis S, Sfakianakis K, Tranos P, Balidis M, Zachariadis Z, Mikropoulos DG, Anogeianakis G, Katsanos A, Konstas AG. The Proteins of Keratoconus: a Literature Review Exploring Their Contribution to the Pathophysiology of the Disease. Adv Ther 2019; 36:2205-2222. [PMID: 31363996 PMCID: PMC6822850 DOI: 10.1007/s12325-019-01026-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Keratoconus (KC) is a complex, genetically heterogeneous multifactorial degenerative disorder characterized by corneal ectasia and thinning. Its incidence is approximately 1/2000-1/50,000 in the general population. KC is associated with moderate to high myopia and irregular astigmatism, resulting in severe visual impairment. KC structural abnormalities primarily relate to the weakening of the corneal collagen. Their understanding is crucial and could contribute to effective management of the disease, such as with the aid of corneal cross-linking (CXL). The present article critically reviews the proteins involved in the pathophysiology of KC, with particular emphasis on the characteristics of collagen that pertain to CXL. METHODS PubMed, MEDLINE, Google Scholar and GeneCards databases were screened for relevant articles published in English between January 2006 and June 2018. Keyword combinations of the words "keratoconus," "risk factor(s)," "genetics," "genes," "genetic association(s)," "proteins", "collagen" and "cornea'' were used. In total, 272 articles were retrieved, reviewed and selected, with greater weight placed on more recently published evidence. Based on the reviewed literature, an attempt was made to tabulate the up- and down-regulation of genes involved in KC and their protein products and to delineate the mechanisms involved in CXL. RESULTS A total of 117 proteins and protein classes have been implicated in the pathogenesis and pathophysiology of KC. These have been tabulated in seven distinct tables according to their gene coding, their biochemistry and their metabolic control. CONCLUSION The pathogenesis and pathophysiology of KC remain enigmatic. Emerging evidence has improved our understanding of the molecular characteristics of KC and could further improve the success rate of CXL therapies.
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Moghadam RS, Akbari M, Alizadeh Y, Medghalchi A, Dalvandi R. The Outcome of Corneal Collagen Cross-Linking in Patients with Advanced Progressive Keratoconus: A 2-Year Follow-up Study. Middle East Afr J Ophthalmol 2019; 26:11-16. [PMID: 31114118 PMCID: PMC6507378 DOI: 10.4103/meajo.meajo_101_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE: The aim of this study was to evaluate the safety and efficacy of collagen cross-linking (CXL) in advanced progressive keratoconus with a maximum keratometry (Kmax) value of more than 58 diopters (D). METHODS: This prospective interventional case series involved patients with advanced progressive keratoconus with a Kmax of more than 58 D. The best-corrected visual acuity (BCVA), uncorrected visual acuity (UCVA), Kmax, mean keratometry (Kmean) value, corneal astigmatism, and thinnest corneal thickness before surgery and 24 months after CXL were determined for 30 eyes of 27 patients. A Pentacam was used to measure the paraclinical parameters. RESULTS: The mean age of the patients was 24.47 ± 3.33 years. The mean logarithm of the minimum angle of resolution (logMAR) of the uncorrected visual acuity UCVA decreased from 0.73 ± 0.36 D at baseline to 0.48 ± 0.30 D (P = 0.01), while the mean thinnest point thickness of the cornea decreased from 438.65 ± 40.11 μm to 431.43 ± 61.92 μm (P = 0.005) after 24 months. The decreases in the mean logMAR of the BCVA, Kmax and Kmean values, and corneal astigmatism were not statistically significant (P > 0.05) at the 24-month follow-up. Progression was halted in 29 eyes (96.6%); only 1 eye (3.3%) showed an increase in the Kmax value of more than 2.0 D, which was indicative of treatment failure. In contrast, most other eyes showed a decrease in the Kmax value although it was not statistically significant. There were no major complications in any of the patients during the study period. CONCLUSION: Standard CXL treatment was safe and stabilized both the visual acuity and tomographic parameters at the 2-year follow-up in eyes with advanced progressive keratoconus.
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Affiliation(s)
| | - Mitra Akbari
- Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Yousef Alizadeh
- Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | | | - Reza Dalvandi
- Eye Research Center, Guilan University of Medical Sciences, Rasht, Iran
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Barrientez B, Nicholas SE, Whelchel A, Sharif R, Hjortdal J, Karamichos D. Corneal injury: Clinical and molecular aspects. Exp Eye Res 2019; 186:107709. [PMID: 31238077 DOI: 10.1016/j.exer.2019.107709] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/03/2019] [Accepted: 06/21/2019] [Indexed: 12/13/2022]
Abstract
Currently, over 10 million people worldwide are affected by corneal blindness. Corneal trauma and disease can cause irreversible distortions to the normal structure and physiology of the cornea often leading to corneal transplantation. However, donors are in short supply and risk of rejection is an ever-present concern. Although significant progress has been made in recent years, the wound healing cascade remains complex and not fully understood. Tissue engineering and regenerative medicine are currently at the apex of investigation in the pursuit of novel corneal therapeutics. This review uniquely integrates the clinical and cellular aspects of both corneal trauma and disease and provides a comprehensive view of the most recent findings and potential therapeutics aimed at restoring corneal homeostasis.
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Affiliation(s)
- Brayden Barrientez
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Sarah E Nicholas
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Amy Whelchel
- Department of Physiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Rabab Sharif
- Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Dimitrios Karamichos
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA; Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.
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Whether Keratectasia Area Shown in Corneal Topography Is Appropriate for Evaluating the Effect of Corneal Cross-Linking for Keratoconus: A 12-Month Follow-Up Study. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1762537. [PMID: 31073520 PMCID: PMC6470445 DOI: 10.1155/2019/1762537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/03/2019] [Accepted: 03/20/2019] [Indexed: 11/24/2022]
Abstract
Purpose To analyze the keratectasia area (KEA) shown in corneal topography before and after corneal cross-linking (CXL) in patients with progressive keratoconus (KC) and figure out whether KEA is appropriate for evaluating the effect of CXL. Methods A retrospective analysis was conducted in 34 eyes from 24 progressive KC patients who have underwent CXL from 2015 to 2017. Area with K-value more than 47D shown in the corneal topography was marked and identified as KEA. Keratometry (K1, K2, and Kmax), KEA, thinnest corneal thickness (TCT), and endothelial cell density (ECD) were evaluated preoperatively or at months 3, 6, and 12 postoperatively. The changes of KEA before and after operation were evaluated. The relation of KEA and other parameters, including Kmax and TCT, was analyzed. Results Linear regression model revealed the KEA, Kmax, K1, and K2 decreased after CXL in model y = 0.9622 -0.02408 x (P<0.05), y = 0.9982 -0.003469 x(P<0.05), y = 0.9977 + -0.001347 x(P<0.05), y = 0.9992 + -0.001779 x(P<0.05) (y represents KEA, Kmax, K1, or K2; x represents time (month)). The KEA is significantly decreased in early stage (before month 3) (P<0.05); however, the Kmax, K1, and K2 have no significant decrease in early stage (P= 0.09, 0.19, 0.32). Conclusions The KEA is more sensitive than K-value in describing the morphological changes of cornea after CXL, especially in early stage after treatment.
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Loukovitis E, Sfakianakis K, Syrmakesi P, Tsotridou E, Orfanidou M, Bakaloudi DR, Stoila M, Kozei A, Koronis S, Zachariadis Z, Tranos P, Kozeis N, Balidis M, Gatzioufas Z, Fiska A, Anogeianakis G. Genetic Aspects of Keratoconus: A Literature Review Exploring Potential Genetic Contributions and Possible Genetic Relationships with Comorbidities. Ophthalmol Ther 2018; 7:263-292. [PMID: 30191404 PMCID: PMC6258591 DOI: 10.1007/s40123-018-0144-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Keratoconus (KC) is a complex, genetically heterogeneous, multifactorial degenerative disorder that is accompanied by corneal ectasia which usually progresses asymmetrically. With an incidence of approximately 1 per 2000 and 2 cases per 100,000 population presenting annually, KC follows an autosomal recessive or dominant pattern of inheritance and is, apparently, associated with genes that interact with environmental, genetic, and/or other factors. This is an important consideration in refractive surgery in the case of familial KC, given the association of KC with other genetic disorders and the imbalance between dizygotic twins. The present review attempts to identify the genetic loci contributing to the different KC clinical presentations and relate them to the common genetically determined comorbidities associated with KC. METHODS The PubMed, MEDLINE, Google Scholar, and GeneCards databases were screened for KC-related articles published in English between January 2006 and November 2017. Keyword combinations of "keratoconus," "risk factor(s)," "genetics," "genes," "genetic association(s)," and "cornea" were used. In total, 217 articles were retrieved and analyzed, with greater weight placed on the more recent literature. Further bibliographic research based on the 217 articles revealed another 124 relevant articles that were included in this review. Using the reviewed literature, an attempt was made to correlate genes and genetic risk factors with KC characteristics and genetically related comorbidities associated with KC based on genome-wide association studies, family-based linkage analysis, and candidate-gene approaches. RESULTS An association matrix between known KC-related genes and KC symptoms and/or clinical signs together with an association matrix between identified KC genes and genetically related KC comorbidities/syndromes were constructed. CONCLUSION Twenty-four genes were identified as potential contributors to KC and 49 KC-related comorbidities/syndromes were found. More than 85% of the known KC-related genes are involved in glaucoma, Down syndrome, connective tissue disorders, endothelial dystrophy, posterior polymorphous corneal dystrophy, and cataract.
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Affiliation(s)
| | - Konstantinos Sfakianakis
- Division of Surgical Anatomy, Laboratory of Anatomy, Medical School, Democritus University of Thrace, University Campus, Alexandroupolis, Greece
| | - Panagiota Syrmakesi
- AHEPA University Hospital, Thessaloníki, Greece
- Ophthalmica Eye Institute, Thessaloníki, Greece
| | - Eleni Tsotridou
- Ophthalmica Eye Institute, Thessaloníki, Greece
- Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Myrsini Orfanidou
- Ophthalmica Eye Institute, Thessaloníki, Greece
- Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Dimitra Rafailia Bakaloudi
- Ophthalmica Eye Institute, Thessaloníki, Greece
- Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Maria Stoila
- Ophthalmica Eye Institute, Thessaloníki, Greece
- Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Athina Kozei
- Ophthalmica Eye Institute, Thessaloníki, Greece
- School of Pharmacology, University of Nicosia, Makedonitissis, Nicosia, Cyprus
| | | | | | | | | | | | - Zisis Gatzioufas
- Department of Ophthalmology, Cornea, Cataract and Refractive Surgery, University Hospital Basel, Basel, Switzerland
| | - Aliki Fiska
- Laboratory of Anatomy, Medical School, Democritus University of Thrace, University Campus, Alexandroupolis, Greece
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Cagini C, Di Lascio G, Messina M, Riccitelli F, Dua HS. Correlation of central and peripheral keratometric parameters after corneal collagen cross-linking in keratoconus patients. Int Ophthalmol 2018; 39:2041-2048. [PMID: 30421316 DOI: 10.1007/s10792-018-1041-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the difference in the central and peripheral keratometric parameters in patients with keratoconus after corneal collagen cross-linking (CXL). METHODS Forty-eight eyes of 32 patients (18 males, 16-28 years) affected by progressive keratoconus in different stages of evolution underwent CXL using the standard epithelium-off protocol. Corneal thickness and corneal curvature before CXL and after 6 and 12 months using the Sirius tomographer were analyzed. The values of the mean corneal thickness at the corneal apex (CAT), center of the pupil (PCT), thinnest point (CTTL) and along concentric circles of 2, 4, 6, 8, 8.5, 9, 9.5 and 10 mm diameter were evaluated; the values of the mean curvature at the corneal apex and at the points in which the inferior, superior, nasal and temporal meridians crossed the above-mentioned concentric circles were also evaluated. RESULTS The mean preoperative values for CAT, PCT and CTTL were 461.4 ± 30.3, 475.3 ± 30.5 and 441 ± 32.0, respectively. The values after 12 months of CXL were 444.6 ± 36.2, 451.6 ± 36.7 and 418.2 ± 41.4. The peripheral corneal thickness at the eight points ranged from 479 to 733 preoperatively. At 12-month post-CXL, the values ranged from 444.6 to 734.1. The mean posterior curvature from apex to periphery ranged from - 4.5 to - 9.1 days preoperatively and from - 4.5 to - 9.2 days at 12 months. These were not statistically significant (ANOVA and unpaired T test). CONCLUSIONS Our data suggest that CXL over an 8-mm zone can stabilize the peripheral cornea. Longer-term follow-up studies on the peripheral cornea after CXL will provide useful information.
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Affiliation(s)
- C Cagini
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy.
| | - G Di Lascio
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy
| | - M Messina
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - F Riccitelli
- Ophthalmology Section, Department of Biomedical and Surgical Sciences, S. Maria della Misericordia Hospital, University of Perugia, Piazza Menghini 1, S. Andrea delle Fratte, 06156, Perugia, Italy
| | - H S Dua
- Section of Academic Ophthalmology, Division of Clinical Neuroscience, Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
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Yenihayat F, Altıntaş Ö, Kasap M, Akpınar G, Güzel N, Çelik OS. Comparative proteome analysis of the tear samples in patients with low-grade keratoconus. Int Ophthalmol 2018; 38:1895-1905. [PMID: 28785876 DOI: 10.1007/s10792-017-0672-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/01/2017] [Indexed: 12/12/2022]
Abstract
PURPOSE To elucidate the metabolic processes playing roles in the formation of keratoconus (KC). METHODS Tears samples were collected using capillary glass tubes without stimulation and without prior anesthesia from 17 patients and 16 controls. Proteomic analysis by fluorescent 2D gel electrophoresis (DIGE) coupled with MALDI-TOF/TOF was performed. The identified proteins that were differentially regulated were subjected to Ingenuity Pathway Analysis (IPA). Corneal topography analyses with Sirius topography system (Costruzioni Strumenti Oftalmici, Florence, Italy) were performed on all participants. The steepest keratometry index was lower than 50 diopters in all keratoconus patients. RESULTS DIGE analysis showed changes in abundance of nine proteins. Six of these proteins, namely serum albumin, Keratin Type II Cytoskeletal 1, IgG gamma chain-1, GAPDH, alpha-1 antitrypsin and ApoA-I, were down-regulated in the KC samples in comparison with the controls. In addition, we detected up-regulation of lysozyme C, keratin type I cytoskeletal 10 and lipocalin. The subsequent IPA predicted that NADH repair pathway is activated in the KC patients. This pathway involves generation of NADHX as a by-product via catalysis by GAPDH. NADHX is an inhibitor of several dehydrogenases and must be removed. CONCLUSION The involvement of NADHX repair pathway in KC should be investigated, since preliminary clues obtained in this study point to that direction. In particular, showing the presence of ATP-dependent NAD(P)H-hydrate dehydratase that eliminates NADHX would strengthen our findings and would be a major step toward understanding KC.
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Affiliation(s)
- Fatih Yenihayat
- Department of Ophthalmology, Kocaeli State Hospital, 41100, Kocaeli, Turkey.
| | - Özgül Altıntaş
- Department of Ophthalmology, Medical School, Acıbadem University, Istanbul, Turkey
| | - Murat Kasap
- DEKART Proteomics Laboratory, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Gürler Akpınar
- DEKART Proteomics Laboratory, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Nil Güzel
- Department of Medical Biology, Medical School, Kocaeli University, Kocaeli, Turkey
| | - Onur Sinan Çelik
- Department of Ophthalmology, Tunceli State Hospital, Tunceli, Turkey
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da Silva DC, Gadelha BNB, Feitosa AFB, da Silva RG, Albuquerque TLPE, Santos DCPF, Gadelha DNB, Fonseca Schamber-Reis BL. Analysis of VSX1 Variations in Brazilian Subjects with Keratoconus. J Ophthalmic Vis Res 2018; 13:266-273. [PMID: 30090183 PMCID: PMC6058540 DOI: 10.4103/jovr.jovr_116_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 12/10/2017] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To screen visual system homeobox 1 (VSX1) gene in Brazilian subjects affected with keratoconus (KCN). METHODS Seventy-three patients with KCN and 106 healthy controls were enrolled in this study. Patients were diagnosed with KCN based on eye examination and corneal topographic features according to Rabinowitz's criteria (K > 47.2, I-S > 1.4 and KISA > 100%). DNA from blood samples was extracted from donors, and the exons and exon-intron boundaries of VSX1 were sequenced. The potential impact of the identified amino acid changes was assessed with Poly-Phen2, SIFT, and PMUT analysis tools. Genotyping was confirmed by RLFP technique, which was also applied to genotype non-affected individuals. RESULTS We found three non-synonymous substitutions (L68H, R131S, and D105E) in VSX1 exon 1, with L68H mutation as a novel variation in this gene. In silico analysis indicated that all variations found were predicted to be probably damaging to VSX1 structure and function. Examination of R131S and L68H variations segregating in one family suggested a strong effect of these variations in increasing disease severity in the proband, which presented bilateral KCN leading to corneal grafting before the age of sixteen. We found a novel synonymous substitution (P79P) and two previously described exonic polymorphisms, with unknown roles in VSX1 pathogenesis. CONCLUSION VSX1 polymorphisms found in the Brazilian population support a genetic component in KCN pathogenesis. L68H is a novel mutation, and the phenotypic data suggest that this mutation might enhance disease severity when combined with other polymorphisms. However, further investigations are needed.
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Affiliation(s)
- Dulceria Costa da Silva
- Department of Medical Genetics, School of Medical Sciences, UNIFACISA, Campina Grande, Paraíba, Brazil
- Federal University of Paraíba, Campina Grande, Paraíba, Brazil
| | | | | | - Rafaela Gomes da Silva
- Department of Medical Genetics, School of Medical Sciences, UNIFACISA, Campina Grande, Paraíba, Brazil
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Comparison of Corneal Collagen Cross-Linking Protocols Measured With Scheimpflug Tomography. Cornea 2018; 37:870-874. [DOI: 10.1097/ico.0000000000001600] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shanti Y, Beshtawi I, Zyoud SH, Abu-Samra A, Abu-Qamar A, Barakat R, Shehada R. Characteristics of keratoconic patients at two main eye centres in Palestine: a cross-sectional study. BMC Ophthalmol 2018; 18:95. [PMID: 29661163 PMCID: PMC5902985 DOI: 10.1186/s12886-018-0762-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 04/03/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Keratoconus (KC) is a multifactorial, degenerative ectatic condition of the cornea. It usually manifests during late adolescence or the early twenties. A painless disease, KC may end with severe visual loss. The prevalence of KC in middle-eastern countries is much higher than in other regions of the world. This may be due to genetic and environmental risk factors and consanguinity. The goal of this study is to explore the demographic profile of Palestinian keratoconic patients. METHODS A retrospective study was conducted in two ophthalmology centres (Tertiary Ophthalmic Centre of An-Najah National University Hospital and An-Noor Centre at the Specialized Arab Hospital). All medical charts of keratoconic patients attending both centres over the period from 2009 to 2016 were reviewed. These patients were diagnosed by ophthalmologists depending on history, examination and Pentacam. Severity was determined using the k median index from the Pentacam map. Data analysis was carried out using SPSS Version 22. RESULTS The medical files of 936 keratoconic eyes of 505 keratoconic patients were reviewed. Their mean age at the time of diagnosis was 23.3 ranging from 8 to 62 years. Approximately 70.1% of them presented after the age of 20 years, and younger age groups were more likely to develop a severe disease stage than older ones (P = 0.001, r = - 0.108). There was a nearly equal distribution of patients between the two sexes (49.5% male, 50.5% female). On initial evaluation, the best-corrected visual acuity (BCVA) was recorded as ≥6/12 in most affected eyes (71.5%). Regarding severity, 62% presented in a mild form, while 9.9% were at a severe stage. About 88.2% presented with bilateralism. CONCLUSIONS Most of the patients in their twenties presented with a mild bilateral form of the disease. This result is compatible with published international reports. It is recommended that the results of this study be considered when establishing a screening program in Palestine. Subsequently, patients will be identified at an appropriate time where action can be taken before disease progression take place.
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Affiliation(s)
- Yousef Shanti
- 0000 0004 0631 5695grid.11942.3fPresent Address: Department of Ophthalmology, An-Najah National University Hospital, 44839 Nablus, Palestine Palestine
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, 44839 Nablus, Palestine Palestine
| | - Ithar Beshtawi
- 0000 0004 0631 5695grid.11942.3fDepartment of Optometry, College of Medicine and Health Sciences, An-Najah National University, 44839 Nablus, Palestine Palestine
| | - Sa’ed H. Zyoud
- 0000 0004 0631 5695grid.11942.3fDepartment of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, 44839 Nablus, Palestine Palestine
| | - Ahlam Abu-Samra
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, 44839 Nablus, Palestine Palestine
| | - Areen Abu-Qamar
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, 44839 Nablus, Palestine Palestine
| | - Reem Barakat
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, 44839 Nablus, Palestine Palestine
| | - Reham Shehada
- 0000 0004 0631 5695grid.11942.3fDepartment of Medicine, College of Medicine and Health Sciences, An-Najah National University, 44839 Nablus, Palestine Palestine
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Loh IP, Fan Gaskin JC, Sherwin T, McGhee CNJ. Extreme Descemet's membrane rupture with hydrops in keratoconus: Clinical and histological manifestations. Am J Ophthalmol Case Rep 2018; 10:271-275. [PMID: 29780950 PMCID: PMC5956727 DOI: 10.1016/j.ajoc.2018.04.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 03/28/2018] [Accepted: 04/03/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To study the clinical and histological manifestations of an extreme Descemet's membrane rupture as a result of keratoconus. Observations Using Periodic acid-Schiff assay to study a keratoconic cornea with an extreme rupture showed that the ruptured Descemet's membrane had retracted and folded into scrolls and ridges. The dimensions of the rupture were estimated to be 3.7mm2, and the central cornea was extremely thinned with a thickness of only 260μm. Stromal scarring and loosely packed lamellae were present anterior to the scrolls and ridges. Antibodies targetting the major components of Descemet's membrane, Laminin and type IV collagen, displayed intense labelling adjacent to the scrolls where the stroma was denuded and differential expression patterns lined the ridges. Environmental scanning electron microscopy showed possible collagen deposition at the site of rupture. Conclusions and importance The specific staining patterns of laminin and type IV collagen suggest these components have an important role in re-endothelisation of the cornea. This is the first known report of spatial resolution of the topography of the Descemet's membrane rupture established by environmental scanning electron microscopic image montage.
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Affiliation(s)
- I-Ping Loh
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Park Road, Auckland, New Zealand
| | - Jennifer C Fan Gaskin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Park Road, Auckland, New Zealand
| | - Trevor Sherwin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Park Road, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Park Road, Auckland, New Zealand
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Zhang X, Zhao J, Li M, Tian M, Shen Y, Zhou X. Conventional and transepithelial corneal cross-linking for patients with keratoconus. PLoS One 2018; 13:e0195105. [PMID: 29621306 PMCID: PMC5886478 DOI: 10.1371/journal.pone.0195105] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 03/17/2018] [Indexed: 11/19/2022] Open
Abstract
Previous studies investigating the effectiveness of conventional corneal collagen cross-linking (CXL) and transepithelial CXL in keratoconus treatment have reported conflicting outcomes. Therefore, we conducted a meta-analysis to compare the effectiveness of these treatments. We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for prospective randomized controlled trials (RCTs) with no restrictions. We included visual acuity (corrected distance visual acuity, uncorrected distance visual acuity) and corneal keratometry (K) as primary outcome parameters, and spherical equivalent, central corneal thickness (CCT), and endothelial cell density, as secondary parameters. We finally included seven reports (including six RCTs involving 305 participants and 344 eyes). Our analysis revealed significant postoperative differences in average K and CCT values between conventional and transepithelial CXL-treated patients [K: weighted mean difference (WMD) = 0.79, 95% confidence interval (CI) = 0.04-1.53, p = 0.04; CCT: WMD = 4.53, 95% CI = 0.42-8.64, p = 0.03]. In contrast, we did not find any significant differences in visual acuity, flattest K value, steepest K value, cylinder K value, apex K value, spherical equivalent, or endothelial cell density between groups. In conclusion, transepithelial CXL has a more protective influence on corneal thickness than conventional CXL, and results in lesser postoperative corneal flattening. Further investigation of the clinical outcomes of transepithelial CXL is required.
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Affiliation(s)
- Xiaoyu Zhang
- Eye and ENT Hospital of Fudan University, Myopia Key Laboratory of the Health Ministry, Shanghai, China
| | - Jing Zhao
- Eye and ENT Hospital of Fudan University, Myopia Key Laboratory of the Health Ministry, Shanghai, China
| | - Meiyan Li
- Eye and ENT Hospital of Fudan University, Myopia Key Laboratory of the Health Ministry, Shanghai, China
| | - Mi Tian
- Eye and ENT Hospital of Fudan University, Myopia Key Laboratory of the Health Ministry, Shanghai, China
| | - Yang Shen
- Eye and ENT Hospital of Fudan University, Myopia Key Laboratory of the Health Ministry, Shanghai, China
| | - Xingtao Zhou
- Eye and ENT Hospital of Fudan University, Myopia Key Laboratory of the Health Ministry, Shanghai, China
- * E-mail:
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Abstract
Corneal collagen cross-linking has become the preferred modality of treatment for corneal ectasia since its inception in late 1990s. Numerous studies have demonstrated the safety and efficacy of the conventional protocol. Our understanding of the cross-linking process is ever evolving, with its wide implications in the form of accelerated and pulsed protocols. Newer advancements in technology include various riboflavin formulations and the ability to deliver higher fluence protocols with customised irradiation patterns. A greater degree of customisation is likely the path forward, which will aim at achieving refractive improvements along with disease stability. The use of cross-linking for myopic correction is another avenue under exploration. Combination of half fluence cross-linking with refractive correction for high errors to prevent post LASIK regression is gaining interest. This review aims to highlight the various advancements in the cross-linking technology and its clinical applications.
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García B, García-Suárez O, Merayo-Lloves J, Ferrara G, Alcalde I, González J, Lisa C, Alfonso JF, Vazquez F, Quirós LM. Heparanase Overexpresses in Keratoconic Cornea and Tears Depending on the Pathologic Grade. DISEASE MARKERS 2017; 2017:3502386. [PMID: 29379222 PMCID: PMC5742882 DOI: 10.1155/2017/3502386] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 10/23/2017] [Accepted: 11/16/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Keratoconus has classically been defined as a noninflammatory disorder, although recent studies show elevated levels of inflammatory markers suggesting that keratoconus could be, at least in part, an inflammatory condition. Heparanase upregulation has been described in multiple inflammatory disorders. In this article, we study the differential expression of heparanase in cornea and tears from keratoconus patients and healthy controls. METHODS A transcriptomic approach was used employing quantitative polymerase chain reaction to analyze the expression of heparanase and heparanase 2 in stromal and epithelial corneal cells. The protein expression was analyzed by immunohistochemistry in corneal sections. Enzymatic activity in tears was measured using [3H]-labeled heparan sulfate as substrate. RESULTS Heparanase transcription was detected in stromal and epithelial cells and appeared upregulated in keratoconus. Overexpression of the enzyme was also detected by immunohistochemistry. Corneal expression of heparanase 2 was detected in some cases. Heparanase catalytic activity was found in tears and displayed a positive correlation with the degree of keratoconus. CONCLUSIONS Heparanase overexpresses in keratoconic corneas, possibly reinforcing the inflammatory condition of the pathology. The presence of heparanase activity in tears allows us to propose its use as a biomarker for the diagnosis of the disorder.
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Affiliation(s)
- Beatriz García
- Instituto Universitario Fernández Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
- Department of Functional Biology, University of Oviedo, 33006 Oviedo, Spain
| | - Olivia García-Suárez
- Instituto Universitario Fernández Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
- Department of Morphology and Cell Biology, University of Oviedo, 33006 Oviedo, Spain
| | - Jesús Merayo-Lloves
- Instituto Universitario Fernández Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Guilherme Ferrara
- Instituto Universitario Fernández Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Ignacio Alcalde
- Instituto Universitario Fernández Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Javier González
- Department of Organic and Inorganic Chemistry, University of Oviedo, 33006 Oviedo, Spain
| | - Carlos Lisa
- Instituto Universitario Fernández Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Jose F. Alfonso
- Instituto Universitario Fernández Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
| | - Fernando Vazquez
- Instituto Universitario Fernández Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
- Department of Functional Biology, University of Oviedo, 33006 Oviedo, Spain
- Department of Microbiology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Luis M. Quirós
- Instituto Universitario Fernández Vega, Universidad de Oviedo & Fundación de Investigación Oftalmológica, Oviedo, Spain
- Department of Functional Biology, University of Oviedo, 33006 Oviedo, Spain
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Althomali TA, Al-Qurashi IM, Al-Thagafi SM, Mohammed A, Almalki M. Prevalence of keratoconus among patients seeking laser vision correction in Taif area of Saudi Arabia. Saudi J Ophthalmol 2017; 32:114-118. [PMID: 29942179 PMCID: PMC6010596 DOI: 10.1016/j.sjopt.2017.11.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 09/22/2017] [Accepted: 11/12/2017] [Indexed: 01/19/2023] Open
Abstract
Purpose To determine the prevalence of keratoconus among patients seeking laser vision correction (LVC). Methods Retrospective study of 1374 eyes of 687 patients (335 males, 352 females) who underwent keratoconus screening as a part of routine preoperative evaluation prior to LVC at the Tadawi surgical centre, Taif, Saudi Arabia from January 2014 to June 2015. The diagnosis of keratoconus was based on evaluation of Pentacam derived parameters. Results Manifest keratoconus was found in 59 subjects (out of 687 subjects) representing a prevalence rate of 8.59%. Of the 687 subjects, 45 subjects (6.55%) had bilateral manifest keratoconus (manifest keratoconus in both eyes or manifest keratoconus in one eyes and sub-clinical in contralateral eye) and remaining 14 patients (2.04%) had unilateral manifest keratoconus (with normal fellow eye). Sub-clinical keratoconus was diagnosed in 65 patients representing a prevalence rate of 9.46%. Of the 687 patients, 20 cases (2.91%) with subclinical keratoconus were bilateral and 45 (6.55%) were unilateral. Overall, 19.70% males (66/335) and 16.48% (58/352) females had either manifest or sub-clinical keratoconus, representing no statistically significant difference in the gender predisposition of the keratoconus disease process (Chi Square test; p = .277). Conclusion High prevalence of keratoconus was found among patients seeking LVC. Possible factors contributing to the high prevalence were recognized to be highly selective population (patients seeking LVC for myopia/hyperopia/astigmatism), ethnicity (high prevalence of consanguinity) and geographical location (high altitude) of the study subjects.
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Affiliation(s)
- Talal A Althomali
- Surgery Ophthalmology, Taif University, Taif, Saudi Arabia.,Tadawi Surgical Center, Taif, Saudi Arabia
| | | | | | | | - Mohammed Almalki
- Surgery Ophthalmology, King Abdullah Medical City, Makkah, Saudi Arabia
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Hashmani S, Hashmani N, Memon RS. Corneal Collagen Cross-Linking Combined with an Artiflex Iris-Fixated Anterior Chamber Phakic Intraocular Lens Implantation in a Patient with Progressive Keratoconus. Case Rep Ophthalmol 2017; 8:482-488. [PMID: 29118708 PMCID: PMC5662956 DOI: 10.1159/000480728] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 08/28/2017] [Indexed: 01/04/2023] Open
Abstract
We present here the case of a 24-year-old male who experienced progressive keratoconus and vision loss which adversely affected his ability to carry out everyday tasks. This landed him in the Hashmanis Hospital for consultation. He had a preoperative best corrected visual acuity of 6/12. He underwent multiple Oculus Pentacam examinations, which showed progressive keratoconus. Corneal collagen cross-linking (CXL) was performed to stabilize his cornea and, subsequently, an Artiflex anterior chamber iris-fixated phakic intraocular lens (ACIF-PIOL) was implanted to alleviate his refractive errors. The patient achieved a postoperative uncorrected visual acuity of 6/12. This report shows that CXL combined with ACIF-PIOL can be safe and effective in those with progressive keratoconus.
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Tamayo GE, Castell C, Vargas P, Polania E, Tamayo J. High-resolution wavefront-guided surface ablation with corneal cross-linking in ectatic corneas: a pilot study. Clin Ophthalmol 2017; 11:1777-1783. [PMID: 29042747 PMCID: PMC5633298 DOI: 10.2147/opth.s140627] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose A preliminary study to evaluate the outcomes of high-resolution wavefront-guided (HRWG) photorefractive keratectomy (PRK) with simultaneous corneal cross-linking (CXL) in ectasia eyes. Methods Sixteen eyes of 11 patients (mean age 31.9±9.8 years; range: 15–48 years) with keratoconus or post-laser-assisted in situ keratomileusis ectasia underwent HRWG PRK with simultaneous CXL. Manifest refraction, uncorrected (UDVA) and corrected distance visual acuity (CDVA), and keratometric and aberrometric outcomes are reported at 12 months. Results Significant improvement was observed postoperatively in visual acuity, refraction, and keratectomy in all eyes. At postoperative 12 months, 87.5% eyes were within ±1.0 D of attempted correction and 81.25% of eyes had a postoperative UDVA of 20/32 or better. A gain of 2 or more lines of CDVA was observed in 12.5% (2/16) of eyes and there was no change in CDVA lines in 25% (4/16) eyes. A substantial reduction in higher-order aberrations was observed in all eyes postoperatively; however, the improvement was not statistically significant. Conclusion The outcomes of HRWG PRK in ectasia eyes with estimated residual stromal bed thickness of at least 350 μm (without epithelium) are promising at postoperative 1 year and provide surgeons with a valuable tool to improve vision with a high degree of refractive predictability.
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Affiliation(s)
| | | | - Pilar Vargas
- Bogota Laser Ocular Surgery Center, Bogota, Colombia
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