Corneal Biomechanical Properties in Patients with Recurrent Anterior Uveitis

Quantitative changes in the corneal endothelium and central corneal thickness during anterior chamber inflammation: A systematic review and meta-analysis

PURPOSE

To establish the effects of anterior chamber inflammation (ACI) on the corneal endothelium parameters and central corneal thickness (CCT).

METHODS

We conducted a comprehensive literature review using medical databases (PubMed, EMBASE, VHL, and medRxiv) on March 8, 2023, for studies that included patients with ACI who had undergone specular microscopy or pachymetry. Case series with >10 patients, cross-sectional, case-control, and cohort studies were included. The risk of bias was assessed using CLARITY tools and validated scales such as those by Hassan Murad et al. and Hoy et al. A narrative synthesis and a quantitative standardized mean difference meta-analysis, I2 heterogeneity assessment, and publication bias tests were conducted. The study was registered in PROSPERO (CRD42023420148) and approved by the Universidad del Rosario ethical committee (DVO005 2277- CV1712).

RESULTS

Thirty-four studies, encompassing 1,388 eyes with ACI, were included. Compared with healthy controls, overall, ACI eyes show significant mean differences in endothelial parameters (endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX)) (P < 0.05). In the subgroup analysis compared with healthy controls, both active and chronic-recurrent ACI demonstrated a reduced ECD. An increased CV was observed in active, inactive, and chronic-recurrent ACI. Lower HEX was evident in inactive, acute, and chronic-recurrent ACI, while both active and acute ACI exhibited high CCT.

CONCLUSION

ACI leads to significant alterations in endothelial parameters and CCT. The primary contributors to these changes are increased IOP, uveitis duration, and intraocular surgeries. Further studies are needed to explore the impact of ACI etiology on the endothelium, potential biases in IOP measurements during acute ACI episodes, and the potential necessity for monitoring the endothelial parameters and CCT in patients with chronic ACI.

Corneal Biomechanics in Non-infectious Uveitis Measured by Corvis ST: A Pilot Study

PURPOSE

To assess differences between corneal biomechanical properties in patients with non-infectious uveitis and healthy subjects using CorVis.

METHODS

77 patients with non-infectious uveitis and 47 control subjects were recruited. Biomechanical parameters were measured: deformation amplitude (DA), A-1 length and A-2 length (L1, L2), A-1 velocity and A-2 velocity (V1, V2), peak distance (PD) and HC radius (highest concavity radius). AUC ROC and correlation between clinical variables and biomechanical properties were determined.

RESULTS

Lower HC Radius and IOPb and higher DA and V1 was found in uveitis group. Statistical differences between cases using systemic medications and those with topical treatment were found in L1. Differences were showed between those cases with active and inactive uveitis in PD, DA, V2 and L2. The biomechanical parameter with the best discriminatory capacity of uveitis disease was HC Radius.

CONCLUSION

Differences in corneal biomechanical properties between non-infectious uveitis and healthy eyes were found.

Corneal and lenticular clarity in children with inflammatory disease as assessed by Scheimpflug imaging

BACKGROUND

Corneal and lenticular optical properties are not well-documented in pediatric patients with inflammatory diseases. Here we aimed to evaluate corneal and lenticular optical density as well as corneal morphology in children with ocular and/or systemic inflammation by Scheimpflug imaging.

METHODS

Fifty-five eyes of 29 children with non-infectious uveitis, 56 eyes of 28 children with systemic inflammation without uveitis and 60 eyes of 31 healthy children were included. Corneal/lenticular optical density, corneal volume, central corneal thickness, keratometry were analyzed by Pentacam HR. Corneal endothelial cell density, hexagonal cell ratio and coefficient of variation were measured by specular microscope.

RESULTS

The mean age was 12.0±3.1 years, 11.9±4.0 years and 11.3±3.4 years whereas the female/ratio was 15/14, 15/13 and 14/17 in uveitis, systemic inflammation and control groups respectively. Uveitis type was anterior uveitis in 16 (29.1%) eyes, intermediate uveitis in 32 (58.2%) eyes and panuveitis in 7 (12.7%) eyes. Twenty-two (40%) eyes had active uveitis whereas 33 (60%) eyes had inactive uveitis. Corneal optical density was greater in uveitis group compared with other groups (p=0.001, Kruskal-Wallis test). Lenticular density and corneal parameters other than optical density were not different between the groups (p>0.05). Corneal optical density was higher in active uveitis than inactive uveitis (22/33 eyes, p=0.017).

CONCLUSION

Children with uveitis had decreased corneal clarity compared with systemic inflammation group and healthy controls, while lenticular clarity was similar between the groups. Corneal endothelial parameters did not change significantly based on ocular/systemic inflammation. Scheimpflug imaging provides objective corneal and lenticular optical density measurements.

Corneal biomechanics and cornea assessment in Fuchs heterochromic iridocyclitis patients

Aim: To evaluate cornea and corneal biomechanical properties of patients with Fuchs heterochromic iridocylitis. Materials and Methods: Fourteen FHI positive eyes (Group 1) and the contralateral healthy eyes (Group 2) were included. All patients underwent a detailed ophthalmic examination was performed. Also, Ocular Response Analyzer was used to detect corneal biomechanical properties, and specular microscopic evaluation for corneal endothelial cells count was performed. Results: The mean best corrected visual acuity and intraocular pressure were statistically similar. (p values were 0.077 and 0.557, respectively). Corneal biomechanical properties including corneal hysteresis, corneal resistance factor, IOPcc and IOPg were not statistically significant. (p values were 0.521, 0.817, 0.980 and 0.980, respectively). Mean central corneal thickness in Group 1 and 2 were 555.57±42.95 (467-626), 556.5±37.04 (480-623) micrometer, respectively. The difference was not statistically significant (p=0.959). Mean corneal endothelial cell density of Group 1 and Group 2 were 2313±420.22 (1271-2717) and 2404.42±326.75 (1566-2834) cells/mm2, respectively. The difference was not statistically significant (p=0.626). Conclusion: Conflicting with the literature, no differences were detected in corneal biomechanical properties, central corneal thickness and corneal endothelial cell density in Fuchs Heterochromic Iridocyclitis positive eyes. However, more studies with increasing number of patients are still needed.

Enhanced Ectasia Screening in Patients with Uveitis and Isolated Systemic Inflammatory Disease

PURPOSE

To investigate corneal topographic alterations in patients with uveitis and isolated systemic inflammatory disease (SID).

METHODS

This retrospective cross-sectional study included 44 patients with uveitis with anterior chamber inflammation (uveitis group), 39 subjects with isolated SID, and 91 healthy controls (control group). Topographic images were classified as "normal," "keratoconus (KC) suspect" and "KC" based on maps of axial curvature, corneal thickness, front and back elevation in combination with Belin/Ambrósio Enhanced Ectasia Display (BAD).

RESULTS

The uveitis and SID groups had higher incidence of KC (6.8% and 10.2%, respectively) and KC suspect (45.5% and 33.3%, respectively), whereas 2.2% of the control subjects had KC and 26.4% represented KC suspect (p < .05).

CONCLUSIONS

Patients with uveitis with or without SID, and isolated SID without intraocular inflammation seem to be more likely to have KC and KC suspect, which might be due to systemic and/or local inflammatory background triggering pathophysiological mechanisms underlying KC.

Corneal Biomechanical Properties and Central Corneal Thickness in Pediatric Noninfectious Uveitis: A Controlled Study

OBJECTIVE

To compare the corneal biomechanics, intraocular pressure (IOP), and central corneal thickness (CCT) of 37 patients with pediatric noninfectious uveitis with 36 healthy children.

METHODS

Corneal hysteresis (CH), corneal resistance factor (CRF), Goldmann-correlated and corneal-compensated IOP (IOPg and IOPcc, respectively), and CCT were measured.

RESULTS

The mean CRF was significantly lower in the pediatric uveitic eyes than controls (9.7±1.9 vs. 10.8±1.5 mm Hg, P=0.009), whereas there was no significant difference for mean CH, IOPg, IOPcc, and CCT between the two groups (10.1±1.9 vs. 10.8±1.7, 12.9±3.3 vs. 13.9±3.1, 13.8±2.8 vs. 13.6±3.2 mm Hg, and 550.7±49.5 vs. 555.1±33.5 μm, respectively, all P>0.05). The CCT values correlated with CH and CRF, with a Pearson correlation of 0.511 and 0.670 (P=0.013 and P<0.001, respectively), whereas disease duration did not correlate with any corneal biomechanics or CCT in pediatric uveitic eyes (all P>0.05).

CONCLUSIONS

Pediatric noninfectious uveitic eyes have lower CRF than controls but the CH, IOPg, IOPcc, and CCT values are similar.

Corneal Biomechanical Characteristics in Patıents with Behçet Disease

AIM

To examine corneal biomechanical properties, intraocular pressure, and central corneal thickness in uveitic eyes with Behçet disease (BD) and to compare them with healthy controls.

METHODS

This study included 40 eyes of 34 patients with ocular BD and 20 eyes of 20 healthy controls. Eyes with ocular BD were subdivided into active and inactive groups. Ocular response analyzer (ORA) measurements were performed on the 20 eyes of 16 patients with active BD (group 1), 20 eyes of 18 patients with inactive BD (group 2), and 20 eyes of 20 healthy volunteers who served as the control group (group 3). Corneal hysteresis (CH), corneal resistance factor (CRF), intraocular pressure (Goldmann correlated [IOPg], and corneal compensated [IOPcc]) and central corneal thickness (CCT) values were recorded.

RESULTS

Mean age of patients in groups 1, 2, and 3 was 33.81 ± 9.36, 32.38 ± 9.08, and 31.05 ± 5.85 years, respectively (p = 0.76). Mean CH, CRF, IOPg, IOPcc, and CCT values in groups 1, 2, and 3 were [8.51 ± 1.88, 9.72 ± 2.11, 19.87 ± 2.92, 16.13 ± 3.29, and 592.50 ± 39.95], [8.46 ± 1.82, 8.45 ± 1.98, 15.89 ± 2.68, 15.35 ± 2.91, and 528.35 ± 19.18], and [8.47 ± 1.48, 8.43 ± 1.58, 15.59 ± 2.74, 15.42 ± 3.19, and 526.30 ± 18.21], respectively [(p1 = 0.040, 0.904, <0.001, 0.495 and <0.001 for CRF, CH, IOPg, IOPcc and CCT in group 1, respectively), (p2 = 0.989, 0.904, 0.659, 0.989, and 0.989 for CRF, CH, IOPg, IOPcc and CCT in group 2, respectively), (p3 = 0.989, 0.904, 0.660, 0.989, and 0.989 for CRF, CH, IOPg, IOPcc and CCT in group 3, respectively)].

CONCLUSION

CRF, IOPg, and CCT values altered in active BD group when compared with inactive BD and control group (p < 0.005). Further studies are required to establish the effects of BD on corneal biomechanical properties.