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Singh RB, Koh S, Sharma N, Woreta FA, Hafezi F, Dua HS, Jhanji V. Keratoconus. Nat Rev Dis Primers 2024; 10:81. [PMID: 39448666 DOI: 10.1038/s41572-024-00565-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2024] [Indexed: 10/26/2024]
Abstract
Keratoconus is a progressive eye disorder primarily affecting individuals in adolescence and early adulthood. The ectatic changes in the cornea cause thinning and cone-like steepening leading to irregular astigmatism and reduced vision. Keratoconus is a complex disorder with a multifaceted aetiology and pathogenesis, including genetic, environmental, biomechanical and cellular factors. Environmental factors, such as eye rubbing, UV light exposure and contact lens wearing, are associated with disease progression. On the cellular level, a complex interplay of hormonal changes, alterations in enzymatic activity that modify extracellular membrane stiffness, and changes in biochemical and biomechanical signalling pathways disrupt collagen cross-linking within the stroma, contributing to structural integrity loss and distortion of normal corneal anatomy. Clinically, keratoconus is diagnosed through clinical examination and corneal imaging. Advanced imaging platforms have improved the detection of keratoconus, facilitating early diagnosis and monitoring of disease progression. Treatment strategies for keratoconus are tailored to disease severity and progression. In early stages, vision correction with glasses or soft contact lenses may suffice. As the condition advances, rigid gas-permeable contact lenses or scleral lenses are prescribed. Corneal cross-linking has emerged as a pivotal treatment aimed at halting the progression of corneal ectasia. In patients with keratoconus with scarring or contact lens intolerance, surgical interventions are performed.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
| | - Shizuka Koh
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Farhad Hafezi
- ELZA Institute, Zurich, Switzerland
- EMAGine AG, Zug, Switzerland
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Harminder S Dua
- Department of Ophthalmology, University of Nottingham, Nottingham, UK
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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Yüksel B, Kocakaya AE, Küsbeci T, Gümüş F. Late corneal ectasia after penetrating and deep anterior lamellar keratoplasty for keratoconus. Int J Ophthalmol 2024; 17:1828-1836. [PMID: 39430010 PMCID: PMC11422362 DOI: 10.18240/ijo.2024.10.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 07/02/2024] [Indexed: 10/22/2024] Open
Abstract
AIM To investigate tomographic features of late corneal ectasia after keratoplasty for keratoconus and compare penetrating keratoplasty (PK) and deep anterior lamellar keratoplasty (DALK) in terms of incidence, time of onset and risk factors of corneal ectasia. METHODS Sixty eyes with PK and 30 eyes with DALK operated between 1999 and 2021 were analyzed. Final Pentacam scans were evaluated together with vision and previous topographies. Main outcome measures were vision, K values, apparent thinning on graft-host cornea and the difference between opposing quadrants in the thinnest point measurements. Anterior segment optic coherence tomography was performed for further evaluation. RESULTS Mean follow-up was 127.2mo (24-282mo) in PK, and 64.3mo (24-144mo) in DALK. K max was higher in DALK (60.6 vs 56.7 D, P=0.012). Inferior recipient was thinner (595.9 µm) in PK than DALK (662.2 µm, P=0.021), due to longer follow-up. Overall corneal ectasia rate was 20.0% within 24y. Ectasia rate was the same (6.7%) in DALK 2/30 and in PK 4/60 in 10y and 13.3% in 12y (4/30 and 8/60, respectively). It increased to 23.3% (14/60) in PK over 24y. While ectasia was not seen before 7y in PK, it could be seen in DALK starting from the 5th year. The intervals between keratoplasty and ectasia were 144.5mo in PK and 99mo in DALK. Inferior recipient was significantly thinner in 18 eyes with ectasia (502.7 µm) compared to 76 non-ectasia (649.1 µm, P=0.000). Inferior graft was thinner (561.0 vs 620.4 µm, P=0.006), K max (63.3 vs 56.5 D, P=0.000), and anterior elevation was higher in ectasia (89.1 vs 48.6 µm, P=0.002). Accelerated crosslinking was performed on 5 eyes. CONCLUSION Inferior-superior recipient and inferior graft thinning on tomography, with high K max and anterior elevation emerge as the most reliable criteria for the diagnosis of late ectasia. The incidence of corneal ectasia increases with the time.
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Affiliation(s)
- Bora Yüksel
- Department of Ophthalmology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir 35110, Türkiye
| | - Arife Esra Kocakaya
- Department of Ophthalmology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir 35110, Türkiye
| | - Tuncay Küsbeci
- Department of Ophthalmology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir 35110, Türkiye
| | - Fatih Gümüş
- Department of Ophthalmology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir 35110, Türkiye
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Gadamer AM, Miklaszewski P, Janiszewska-Bil D, Lyssek-Boroń A, Dobrowolski D, Wylęgała E, Grabarek BO, Kiełbasińska A, Krysik K. Assessment of OCT and Angio-OCT Parameters in Keratoconus Patients with and without Penetrating Keratoplasty. J Clin Med 2024; 13:5111. [PMID: 39274324 PMCID: PMC11395951 DOI: 10.3390/jcm13175111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/19/2024] [Accepted: 08/27/2024] [Indexed: 09/16/2024] Open
Abstract
Background/Objectives: Keratoconus (KC) is a bilateral eye disease characterized by corneal thinning and cone-like deformation, leading to visual impairment. This study evaluated the radial peripapillary capillaries (RPCs) in keratoconus patients with and without penetrating keratoplasty (PKP) using OCT and angio-OCT, comparing the results to a control group. Methods: This retrospective study included 149 eyes, 97 from patients who underwent PKP between January 2018 and February 2023 and 52 from patients who did not undergo PKP. The control group comprised 72 patients (144 eyes) who were healthy volunteers. Measurements included the best corrected visual acuity (BCVA), the intraocular pressure (IOP), slit-lamp biomicroscopy, a fundus examination, and corneal topography, as well as OCT and angio-OCT assessments of the RPCs, retinal nerve fiber layer (RNFL), ganglion cell complex (GCC), and central retinal thickness (CRT). Statistical analyses were performed using Student's t-test and Pearson's correlation coefficient. Results: The RNFL was significantly thinner in KC eyes after PKP compared to control eyes (p < 0.001), and the CRT was significantly thicker in KC eyes after PKP compared to control eyes (p = 0.003). However, the GCC was similar across the groups (p = 0.0885). Additionally, RPCs inside the disc were significantly reduced in KC eyes after PKP compared to control eyes (p < 0.0001). A significant positive correlation was found between RPC whole vessel density and RNFL thickness as measured via angio-OCT (r = 0.308, p < 0.0001). Conclusions: This study found that the RPC density inside the disc is significantly reduced in keratoconus patients after penetrating keratoplasty, highlighting RPCs inside the disc as a potential diagnostic tool for further assessment of keratoconus.
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Affiliation(s)
- Anna Maria Gadamer
- Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland
- Department of Ophthalmology, Faculty of Medicine, Academy of Silesia, 40-555 Katowice, Poland
| | - Piotr Miklaszewski
- Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland
- Department of Ophthalmology, Faculty of Medicine, Academy of Silesia, 40-555 Katowice, Poland
| | - Dominika Janiszewska-Bil
- Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland
- Collegium Medicum, WSB University, 41-300 Dabrowa Gornicza, Poland
| | - Anita Lyssek-Boroń
- Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland
- Department of Ophthalmology, Faculty of Medicine, Academy of Silesia, 40-555 Katowice, Poland
| | - Dariusz Dobrowolski
- Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland
- Department of Ophthalmology, District Railway Hospital, 40-760 Katowice, Poland
- Department of Ophthalmology, Faculty of Medicine, Medical University of Silesia, 40-555 Katowice, Poland
| | - Edward Wylęgała
- Department of Ophthalmology, District Railway Hospital, 40-760 Katowice, Poland
- Department of Ophthalmology, Faculty of Medicine, Medical University of Silesia, 40-555 Katowice, Poland
| | | | | | - Katarzyna Krysik
- Department of Ophthalmology, St. Barbara Hospital, Trauma Centre, 41-200 Sosnowiec, Poland
- Department of Ophthalmology, Faculty of Medicine, Academy of Silesia, 40-555 Katowice, Poland
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Gururani H, Chittajallu SNSH, Doulatramani M, Chinthapenta V, Basu S, M. R. Collagen imaging reveals synergistic effects of sutures and host-donor misalignment on topographical irregularities in penetrating keratoplasty. PLoS One 2024; 19:e0308204. [PMID: 39116076 PMCID: PMC11309498 DOI: 10.1371/journal.pone.0308204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE Mitigating unwanted refractive errors is crucial for surgeons to ensure quality vision after penetrating keratoplasty (PK). The primary objective of the present study is to highlight the importance of microstructural matching of the host and the donor cornea during PK on the distribution of the corneal tissue while suturing. METHODS For this purpose, the present study undertakes an in-vitro PK model to analyse the effect of suturing and host-donor misalignment on corneal birefringence. Five groups of experiments were performed using five corneoscleral buttons. In each group, N = 16 data points (corresponding to 16 simple interrupted sutures) were assessed before and after PK with five degrees of misalignments, 0°, 30°, 45°, 60° and 90° to detect the variations in corneal birefringence post-PK. The technique of digital photoelasticity is utilized to capture the corneal birefringence experimentally. RESULTS The local and global features of corneal birefringence provided interesting insights into the nuances of corneal birefringence in PK. Statistical analysis was performed to study the effects of suturing on the birefringence around the suture bites. It was observed that the interaction of the suture tension and structural misalignment between the host and the donor cornea influences the corneal birefringence in PK. Conclusions The zero-degree structural misalignment of the host and the donor tissue is preferable to minimize the topographical irregularities and related astigmatism post-PK. The findings of the present study envisage an additional step of structurally aligning the donor tissue with the host before suturing to minimize topographical irregularities in PK.
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Affiliation(s)
- Himanshu Gururani
- Department of Mechanical and Aerospace Engineering, Micro-Mechanics Lab, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India
| | - Sai Naga Sri Harsha Chittajallu
- Department of Mechanical and Aerospace Engineering, Micro-Mechanics Lab, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India
| | - Minal Doulatramani
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Viswanath Chinthapenta
- Department of Mechanical and Aerospace Engineering, Micro-Mechanics Lab, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India
| | - Sayan Basu
- Professor Brien Holden Eye Research Centre, L V Prasad Eye Institute, Hyderabad, Telangana, India
- The Cornea Institute, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Ramji M.
- Department of Mechanical and Aerospace Engineering, Engineering Optics Lab, Indian Institute of Technology Hyderabad, Sangareddy, Telangana, India
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Bonato P, Bagno A. Replace or Regenerate? Diverse Approaches to Biomaterials for Treating Corneal Lesions. Biomimetics (Basel) 2024; 9:202. [PMID: 38667213 PMCID: PMC11047895 DOI: 10.3390/biomimetics9040202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/22/2024] [Accepted: 03/25/2024] [Indexed: 04/28/2024] Open
Abstract
The inner structures of the eye are protected by the cornea, which is a transparent membrane exposed to the external environment and subjected to the risk of lesions and diseases, sometimes resulting in impaired vision and blindness. Several eye pathologies can be treated with a keratoplasty, a surgical procedure aimed at replacing the cornea with tissues from human donors. Even though the success rate is high (up to 90% for the first graft in low-risk patients at 5-year follow-up), this approach is limited by the insufficient number of donors and several clinically relevant drawbacks. Alternatively, keratoprosthesis can be applied in an attempt to restore minimal functions of the cornea: For this reason, it is used only for high-risk patients. Recently, many biomaterials of both natural and synthetic origin have been developed as corneal substitutes to restore and replace diseased or injured corneas in low-risk patients. After illustrating the traditional clinical approaches, the present paper aims to review the most innovative solutions that have been recently proposed to regenerate the cornea, avoiding the use of donor tissues. Finally, innovative approaches to biological tissue 3D printing and xenotransplantation will be mentioned.
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Affiliation(s)
| | - Andrea Bagno
- Department of Industrial Engineering, University of Padua, 35131 Padua, Italy
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Weller JM, Hübner L, Kruse FE, Tourtas T. Characterisation of ectasia after penetrating keratoplasty in keratoconus eyes using anterior segment optical coherence tomography. Br J Ophthalmol 2024; 108:506-512. [PMID: 36941032 PMCID: PMC10958274 DOI: 10.1136/bjo-2022-322859] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/02/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND/AIMS Ectasia of the cornea can occur decades after penetrating keratoplasty (PK), especially in keratoconus eyes. The purpose of this study was to characterise ectasia after PK by morphological findings in anterior segment optical coherence tomography (AS-OCT). METHODS In this retrospective, single-centre case series, 50 eyes of 32 patients with a history of PK at an average of 25±10 years earlier were included. The eyes were classified either as ectatic (n=35) or as non-ectatic (n=15). The main parameters included central corneal thickness (CCT), lowest corneal thickness at the interface (LCTI), anterior chamber depth, graft-host interface angle at the thinnest point and host cornea-iris angle. Furthermore, steep and flat keratometry readings obtained by AS-OCT (CASIA-2, Tomey) and Scheimpflug tomography (Pentacam, Oculus) were assessed. OCT findings were correlated with clinical grading of ectasia. RESULTS There was a highly significant difference in LCTI, graft-host interface angle and anterior chamber depth (in pseudophakic eyes) between the groups. The ratio calculated by the quotient of LCTI divided by CCT was significantly lower in ectatic than non-ectatic eyes (p<0.001). In eyes with an LCTI/CCT ratio of ≤0.7, the OR for the occurrence of a clinical detectable ectasia was 2.4 (CI 1.5 to 3.7). Steep keratometry values were significantly higher in ectatic eyes. CONCLUSION AS-OCT is a helpful tool to recognise and quantify ectasia in post-PK eyes objectively.
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Affiliation(s)
- Julia M Weller
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Lisa Hübner
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Friedrich E Kruse
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Theofilos Tourtas
- Department of Ophthalmology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Niazi S, Gatzioufas Z, Doroodgar F, Findl O, Baradaran-Rafii A, Liechty J, Moshirfar M. Keratoconus: exploring fundamentals and future perspectives - a comprehensive systematic review. Ther Adv Ophthalmol 2024; 16:25158414241232258. [PMID: 38516169 PMCID: PMC10956165 DOI: 10.1177/25158414241232258] [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: 04/07/2023] [Accepted: 01/22/2024] [Indexed: 03/23/2024] Open
Abstract
Background New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way. Objectives This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies. Design A multidimensional comprehensive systematic narrative review. Data sources and methods A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed. Results Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes. Conclusion The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients. Trial registration The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338.
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Affiliation(s)
- Sana Niazi
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Ophthalmic Research Center, Research Institute for Ophthalmology and Vision Science, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Eye Hospital Basel, Basel, Switzerland
| | - Farideh Doroodgar
- Translational Ophthalmology Research Center, Tehran University of Medical Sciences, Tehran Province, Tehran, District 6, Pour Sina St, P94V+8MF, Tehran 1416753955, Iran
- Negah Aref Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Oliver Findl
- Department of Ophthalmology, Hanusch Hospital, Vienna Institute for Research in Ocular Surgery (VIROS), Vienna, Austria
| | - Alireza Baradaran-Rafii
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Jacob Liechty
- Department of Ophthalmology, Morsani College of Medicine, University of South Florida, Tampa, FL, USA
| | - Majid Moshirfar
- John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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Kapelushnik N, Avni-Zauberman N, Herber R, Berger Y, Ezra Nimni O, Abd-Elkader A, Raiskup F, Barequet IS. Corneal cross-linking for treatment of keratoconus relapse in post-keratoplasty eyes. Int Ophthalmol 2023; 43:4027-4034. [PMID: 37436552 DOI: 10.1007/s10792-023-02807-x] [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: 04/04/2023] [Accepted: 06/29/2023] [Indexed: 07/13/2023]
Abstract
PURPOSE Keratoconus relapse after penetrating keratoplasty is a rare condition that may result in severe visual deterioration and corneal graft thinning. Therefore, treatment to stabilize the cornea should be considered. The purpose of this study was to evaluate the safety and efficacy of Corneal Cross-Linking (CXL) in eyes with relapse of keratoconus after penetrating keratoplasty for keratoconus. MATERIALS AND METHODS A retrospective review of eyes that developed keratoconus relapse following a penetrating keratoplasty and treated with CXL. The main outcome measures were change in maximal keratometry (Kmax), best-corrected distance visual acuity (BCVA), thinnest corneal thickness (TCT) and central corneal thickness (CCT), and complications. RESULTS We identified 10 consecutive eyes of 9 patients. Preoperative median BCVA before the CXL and 1 year after the CXL procedure remained stable (p = 0.68). The median (IQR) of Kmax improved from 63.2 (24.9) D before the CXL procedure to 62.2 (27.1) D at 1 year postoperatively (P = 0.028). Median TCT and CCT also remained with no significant change 1 year after CXL. No complications were noted following the procedure. CONCLUSION CXL in eyes with keratoconus relapse after keratoplasty is a safe and effective procedure enabling not only visual stabilization but also might bring keratometry improvement. Routine follow-up after keratoplasty should be performed for early detection of keratoconus relapse and CXL is timely advised when such a relapse is documented.
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Affiliation(s)
- Noa Kapelushnik
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Noa Avni-Zauberman
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Robert Herber
- Department of Ophthalmology, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Yoav Berger
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Orit Ezra Nimni
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Amir Abd-Elkader
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Frederik Raiskup
- Department of Ophthalmology, University Hospital Carl Gustav Carus, Technical University, Dresden, Germany
| | - Irina S Barequet
- Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel.
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Law E, Moledina M, Sexton I, Myerscough J. High Astigmatism Secondary to Peripheral Ectasia Recurrence in Postpenetrating Keratoplasty Eyes Managed With Miniscleral Contact Lenses. Eye Contact Lens 2023; 49:417-421. [PMID: 37595277 DOI: 10.1097/icl.0000000000001022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES After penetrating keratoplasty (PK) for keratoconus, vision can be impaired by high-degree astigmatism, particularly in those patients with recurrent peripheral ectasia. Scleral contact lenses (CLs) have long been used in the management of keratoconus both in treatment-naive corneas and those postcorneal transplants. We report the use of miniscleral CLs and their related visual and clinical outcomes in a series of patients with post-PK peripheral rim ectasia. METHODS In this retrospective case series, 5 patients (7 eyes) presented because of reduced visual acuity with their spectacles/CLs and/or reduced comfort with their existing rigid gas-permeable lenses. All patients in this series underwent PK more than two decades ago for keratoconus (mean 28.7 years±7.2). All patients demonstrated characteristic thinning at the graft-host junction, with anterior chamber deepening. Central corneas had remained clear in all patients inferring high visual potential. Contact lenses used were No 7 Comfort 15 miniscleral and the Onefit MED scleral with 14.5 mm and 15.6 mm diameters, respectively. RESULTS All eyes achieved a best-corrected visual acuity of 6/9 or greater. One case had difficulty with insertion and removal and has since discontinued wearing lens at this time. All others are successfully wearing the lenses regularly. CONCLUSION Despite advances in CL design, surgical management is still required in some patients. Miniscleral CLs are effective in the refractive management of peripheral ectasia in keratoconic post-PK eyes and should be considered in such eyes before proceeding with repeat surgical intervention.
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Affiliation(s)
- Elizabeth Law
- Department of Ophthalmology (E.L., M.M., I.S., J.M.), Southend University Hospital, Southend-on-Sea, United Kingdom; and Faculty of Medicine and Dentistry (J.M.), University of Plymouth, Plymouth, United Kingdom
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Choi AJ, Hefley BS, Nicholas SE, Cunningham RL, Karamichos D. Novel Correlation between TGF-β1/-β3 and Hormone Receptors in the Human Corneal Stroma. Int J Mol Sci 2023; 24:13635. [PMID: 37686439 PMCID: PMC10487450 DOI: 10.3390/ijms241713635] [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: 07/15/2023] [Revised: 08/22/2023] [Accepted: 08/30/2023] [Indexed: 09/10/2023] Open
Abstract
This study investigated the interplay between transforming growth factor beta (TGF-β1/T1 and TGF-β3/T3), and sex hormone receptors using our 3D in vitro cornea stroma model. Primary human corneal fibroblasts (HCFs) from healthy donors were plated in transwells at 106 cells/well and cultured for four weeks. HCFs were supplemented with stable vitamin C (VitC) and stimulated with T1 or T3. 3D construct proteins were analyzed for the androgen receptor (AR), progesterone receptor (PR), estrogen receptor alpha (ERα) and beta (ERβ), luteinizing hormone receptor (LHR), follicle-stimulating hormone receptor (FSHR), gonadotropin-releasing hormone receptor (GnRHR), KiSS1-derived peptide receptor (KiSS1R/GPR54), and follicle-stimulating hormone subunit beta (FSH-B). In female constructs, T1 significantly upregulated AR, PR, ERα, FSHR, GnRHR, and KiSS1R. In male constructs, T1 significantly downregulated FSHR and FSH-B and significantly upregulated ERα, ERβ, and GnRHR. T3 caused significant upregulation in expressions PR, ERα, ERβ, LHR, FSHR, and GNRHR in female constructs, and significant downregulation of AR, ERα, and FSHR in male constructs. Semi-quantitative Western blot findings present the interplay between sex hormone receptors and TGF-β isoforms in the corneal stroma, which is influenced by sex as a biological variable (SABV). Additional studies are warranted to fully delineate their interactions and signaling mechanisms.
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Affiliation(s)
- Alexander J. Choi
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Brenna S. Hefley
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Sarah E. Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Rebecca L. Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
| | - Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX 76107, USA; (A.J.C.); (B.S.H.); (S.E.N.)
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, Fort Worth, TX 76107, USA;
- Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX 76107, USA
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11
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Deshmukh R, Ong ZZ, Rampat R, Alió del Barrio JL, Barua A, Ang M, Mehta JS, Said DG, Dua HS, Ambrósio R, Ting DSJ. Management of keratoconus: an updated review. Front Med (Lausanne) 2023; 10:1212314. [PMID: 37409272 PMCID: PMC10318194 DOI: 10.3389/fmed.2023.1212314] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 05/30/2023] [Indexed: 07/07/2023] Open
Abstract
Keratoconus is the most common corneal ectatic disorder. It is characterized by progressive corneal thinning with resultant irregular astigmatism and myopia. Its prevalence has been estimated at 1:375 to 1:2,000 people globally, with a considerably higher rate in the younger populations. Over the past two decades, there was a paradigm shift in the management of keratoconus. The treatment has expanded significantly from conservative management (e.g., spectacles and contact lenses wear) and penetrating keratoplasty to many other therapeutic and refractive modalities, including corneal cross-linking (with various protocols/techniques), combined CXL-keratorefractive surgeries, intracorneal ring segments, anterior lamellar keratoplasty, and more recently, Bowman's layer transplantation, stromal keratophakia, and stromal regeneration. Several recent large genome-wide association studies (GWAS) have identified important genetic mutations relevant to keratoconus, facilitating the development of potential gene therapy targeting keratoconus and halting the disease progression. In addition, attempts have been made to leverage the power of artificial intelligence-assisted algorithms in enabling earlier detection and progression prediction in keratoconus. In this review, we provide a comprehensive overview of the current and emerging treatment of keratoconus and propose a treatment algorithm for systematically guiding the management of this common clinical entity.
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Affiliation(s)
- Rashmi Deshmukh
- Department of Cornea and Refractive Surgery, LV Prasad Eye Institute, Hyderabad, India
| | - Zun Zheng Ong
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
| | - Radhika Rampat
- Department of Ophthalmology, Royal Free London NHS Foundation Trust, London, United Kingdom
| | - Jorge L. Alió del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum (Miranza Group), Alicante, Spain
- Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Ankur Barua
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
| | - Marcus Ang
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Jodhbir S. Mehta
- Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
| | - Dalia G. Said
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Harminder S. Dua
- Department of Ophthalmology, Queen’s Medical Centre, Nottingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Renato Ambrósio
- Department of Cornea and Refractive Surgery, Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Darren Shu Jeng Ting
- Birmingham and Midland Eye Centre, Birmingham, United Kingdom
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
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12
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Johns LK, Leon P, Cortes-Barrantes P, Hanbazazh M, Zurakowski D, Dryja TP, Ciolino JB. Recurrent keratoconus: an analysis of breaks in Bowman's layer in corneal grafts. BMJ Open Ophthalmol 2023; 8:bmjophth-2022-001225. [PMID: 37278429 DOI: 10.1136/bmjophth-2022-001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/23/2023] [Indexed: 06/07/2023] Open
Abstract
OBJECTIVE To study in a masked fashion whether an objective histological feature associated with keratoconus (KCN) occurs in donor corneas in eyes originally receiving a corneal graft for KCN. METHODS Two ocular pathologists performed a retrospective masked histological analysis of slides from donor buttons recovered from 21 eyes with a history of KCN undergoing repeat penetrating keratoplasty (failed-PK-KCN), 11 eyes that underwent their first PK due to KCN (primary KCN), and 11 eyes without history of KCN which underwent PK for other conditions (failed-PK-non-KCN). Breaks/gaps in Bowman's layer served as the pathological feature indicative of recurrent KCN. RESULTS Breaks in Bowman's layer were present in 18/21 (86%) of the failed-PK-KCN group, 10/11 (91%) of the primary KCN group, and in 3/11 (27%) of the failed-PK-non-KCN group. Pathological evidence suggests that the prevalence of breaks is significantly higher in grafted patients with a history of KCN than non-KCN controls (OR: 16.0, 95% CI 2.63 to 97.2, Fisher's exact test p=0.0018) with a conservative Bonferroni criterion of p <0.017 to account for multiple group comparisons. There was no statistically significant difference found between the failed-PK-KCN and primary KCN groups. CONCLUSIONS This study provides histological evidence that breaks and gaps in Bowman's layer, consistent with those found in primary KCN, may develop within the donor tissue in eyes with a history of KCN.
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Affiliation(s)
- Lynette K Johns
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Pia Leon
- Ospedale SS Giovanni e Paolo Venezia, Venezia, Italy
| | | | - Mehenaz Hanbazazh
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Department of Pathology, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - David Zurakowski
- Departments of Anesthesiology and Surgery, Boston Children's Hospital, Department of Anaesthesia, Harvard Medical School, Boston, Massachusetts, USA
| | - Thaddeus P Dryja
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Joseph B Ciolino
- Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, USA
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13
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Coco G, Romano V. Corneal Disease & Transplantation. J Clin Med 2022; 11:jcm11154432. [PMID: 35956050 PMCID: PMC9369630 DOI: 10.3390/jcm11154432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 02/01/2023] Open
Affiliation(s)
- Giulia Coco
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, 00133 Rome, Italy;
- St. Paul’s Eye Unit, Department of Corneal Diseases, Royal Liverpool University Hospital, Liverpool L7 8XP, UK
| | - Vito Romano
- Department of Eye and Vision Science, University of Liverpool, Liverpool L7 8TX, UK
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Eye Clinic, University of Brescia, 25121 Brescia, Italy
- ASST Spedali Civili di Brescia, 25123 Brescia, Italy
- Correspondence:
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