1
|
Liu L, Fukuyama T, Han T, Zhang Z, Jiang L, Ding Y, Zhou X, Wang J. Observation and assessment of the immediate use of a silicon hydrogel contact lens after transepithelial corneal cross linking: a prospective study. BMC Ophthalmol 2023; 23:471. [PMID: 37985976 PMCID: PMC10662168 DOI: 10.1186/s12886-023-03217-4] [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: 09/04/2023] [Accepted: 11/10/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND Transepithelial corneal crosslinking (CXL) is a novel surgical approach for the treatment of keratoconus, which is a bilateral asymmetrical ophthalmological disease accompanied by progressive corneal ectasia. Silicon hydrogel (SiH) contact lenses have been extensively used in clinical ophthalmologic medicine, as a postoperative ophthalmological intervention. However, the ideal lens application duration after transepithelial CXL remains uncertain. Here, we aimed to investigate the effects and comfort of immediate corneal contact lens use after transepithelial CXL for keratoconus. METHODS In this prospective study, 60 patients with keratoconus who underwent transepithelial CXL treatment were enrolled from September 2021 to January 2023 with a male:female ratio of 39:21, and an average age of 25.42 ± 5.47 years. The patients were divided randomly into two groups: group A contained 30 patients wearing silicone hydrogel contact lenses for 7 days postoperatively, and group B contained 30 patients wearing the same contact lenses for 3 days. Ten subjective ophthalmologic symptoms were surveyed by the patients, including pain, photophobia, foreign body sensation, tearing, burning, blurred vision, dry eyes, difficulty opening the eyes, astringency, and stinging. Ophthalmologic signs, including corneal edema and conjunctival congestion, were recorded by a single clinician on postoperative days 1, 3, and 7. RESULTS Each surgical procedure was readily performed without complications, and both groups postoperative day 7 (P = 0.04), where group B scored (0.01 ± 0.41) lesser than group A (0.12 ± 0.29), whilst corneal edema in both groups recorded significantly different on postoperative days 5 and 7 (group A demonstrated the result of 0.17 ± 0.14 and 0.08 ± 0.11 for the respective days, whereas group B indicated 0.10 ± 0.13 and 0.03 ± 0.07 at the corresponding times). CONCLUSIONS Immediate use of silicone hydrogel corneal lenses after transepithelial CXL effectively alleviates postoperative ocular distress, particularly with a three-day use period as the ideal duration.
Collapse
Affiliation(s)
- Liu Liu
- Department of Nursing, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Teruko Fukuyama
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Tian Han
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Zhe Zhang
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Lin Jiang
- Department of Nursing, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Yanlan Ding
- Department of Nursing, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China
| | - Xingtao Zhou
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China.
| | - Jifang Wang
- Department of Nursing, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Department of Ophthalmology and Optometry, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China.
- Shanghai Research Center of Ophthalmology and Optometry, 83 Fenyang Road, Shanghai, 200031, China.
| |
Collapse
|
2
|
Nattis AS, Rosenberg ED, Rasool F. Intracanalicular dexamethasone insert for post-corneal crosslinking inflammation and pain: the LINK study. J Cataract Refract Surg 2023; 49:1114-1119. [PMID: 37532250 DOI: 10.1097/j.jcrs.0000000000001279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
PURPOSE To compare the efficacy of an intracanalicular dexamethasone insert with tapered topical steroid over 28 days after corneal cross-linking (CXL). SETTING Single private practice, outpatient setting. DESIGN Prospective observational randomized study. METHODS This prospective randomized study investigated the efficacy of a dexamethasone intracanalicular insert on post-CXL pain and inflammation in progressive keratoconus patients. 20 patients (40 eyes) were enrolled; half were randomized to the dexamethasone intracanalicular insert group; half were prescribed a 28-day topical tapering steroid regimen. All patients were evaluated for pain scores, rate of re-epithelialization, ease of the post-CXL regimen, and need for rescue pain medication after standard bilateral epithelium-off CXL on postoperative day (POD) 1, POD3, and POD4 to 7, as well as postoperative week (POW) 1, POW2, POW3, and POW4. RESULTS 20 patients (40 eyes) underwent standard-of-care epithelium-off bilateral CXL for progressive keratoconus. 10 patients were randomized to receive prednisolone eyedrops on a tapering schedule after CXL; 10 patients received dexamethasone intracanalicular inserts at the time of CXL. Regardless of the postoperative steroid regimen, there was no significant difference in the rate of re-epithelialization or use of rescue pain medication between groups. There was a nominal, however, statistical difference in pain scores between groups, favoring prednisolone eyedrops. Both groups stated no difficulty in following postoperative regimens. There were no adverse events noted in relation to treatment or the CXL procedure. CONCLUSIONS Using a dexamethasone insert to alleviate pain and inflammation can be considered as a safe and efficacious part of a post-CXL regimen.
Collapse
Affiliation(s)
- Alanna S Nattis
- From the SightMD, Babylon, New York (Nattis, Rosenberg); NYIT-COM, Old Westbury, New York (Rasool)
| | | | | |
Collapse
|
3
|
Analysis of Tear Function Outcomes following Collagen Cross-Linking Treatment in Ectatic Corneas. J Ophthalmol 2022; 2022:1910607. [PMID: 35321348 PMCID: PMC8938138 DOI: 10.1155/2022/1910607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/09/2022] [Accepted: 02/11/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose To analyze tear function outcomes following collagen cross-linking (CXL) treatment in ectatic corneas. Methods Fifty-seven eyes of 34 patients were included, and patients with keratoconus who underwent epithelium-on (epi-on) or epithelium-off (epi-off) CXL were evaluated. The following tests were performed preoperatively and at 1, 3, 6, and 12 months postoperatively: best-corrected visual acuity (BCVA), maximum keratometry value (Kmax), ocular surface disease index (OSDI) questionnaire, slit-lamp examination, tear meniscus height, first noninvasive Keratograph breakup time (1st NIKBUT), average NIKBUT, and bulbar redness. Results BCVA improved in both epi-on and epi-off groups at most follow-up points, but was not significantly different between groups. At 12-month follow-up, Kmax in the epi-on and epi-off groups improved after CXL, but there was no significant difference between the groups. The OSDI in both groups decreased after operation compared with before surgery, and there was no significant difference between the two groups. Comparing the two groups, only the change in the tear meniscus height at 6 months postoperatively was statistically significant, and the pre- and postoperative values of the two groups were within the normal range (>0.20 mm). The change was small and had no clinical significance. There was no change in the 1st NIKBUT and average NIKBUT between the epi-on and epi-off groups. A change in bulbar redness was significantly better in the epi-off group than in the epi-on group at 3 months postoperatively. Comparing the effects at 1 year postoperatively, both groups had positive results in OSDI, NIKBUT, tear meniscus height, and bulbar redness. Conclusion Both epi-on and epi-off CXL can control the progression of keratoconus, although epi-off CXL is more effective. Both methods have a positive effect on dry eye, which can improve the condition of the tear film and reduce dry eye symptoms in patients with keratoconus.
Collapse
|
4
|
Bubnova IA, Sarkisova KG. [Changes in precorneal tear film and ocular surface in keratoconic patients after corneal collagen cross-linking]. Vestn Oftalmol 2022; 138:118-123. [PMID: 35801890 DOI: 10.17116/oftalma2022138031118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The article reviews the current available data on the signs and symptoms of dry eye syndrome (DES) in patients with keratoconus (KC), describes the clinical features of DES in KC patients and the morphological features of this type of keratectasia that lead to manifestations of the «dry eye», and highlights the risk factors, consequences of therapeutic measures, concomitant ophthalmological and general somatic diseases that contribute to the development of DES in KC.
Collapse
Affiliation(s)
- I A Bubnova
- Research Institute of Eye Diseases, Moscow, Russia
| | | |
Collapse
|
5
|
van der Valk Bouman ES, Pump H, Borsook D, Severinsky B, Wisse RP, Saeed HN, Moulton EA. Pain mechanisms and management in corneal cross-linking: a review. BMJ Open Ophthalmol 2021; 6:e000878. [PMID: 34901466 PMCID: PMC8633999 DOI: 10.1136/bmjophth-2021-000878] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 11/07/2021] [Indexed: 11/17/2022] Open
Abstract
Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment for keratoconus, few reports have considered its impact on pain-related physiology in depth. This comprehensive narrative review summarises mechanisms underlying pain in CXL and clinical care possibilities, with the goal of future improvement in management of CXL-related pain. Postoperative pain associated with CXL is largely due to primary afferent nerve injury and, to a smaller extent, inflammation. Chronification of pain after CXL has not been reported, even as long-term nerve damage without regeneration following standard CXL treatment is frequently observed. The lack of pain chronification may be due to the minimally invasive nature of the procedure, with its rapidly recovering superficial corneal wound, and to the positive anti-inflammatory changes of the tear film that have been described after CXL. Different CXL approaches have been developed, with the transepithelial epithelial-on technique (epi-on) associated with less postsurgical pain than the gold standard, epithelial-off technique (epi-off). After the first few days, however, the difference in pain scores and need for analgesics between epi-on and epi-off disappear. Patients experience relatively high-intensity pain the first few days post-CXL, and many strategies for acute pain control following CXL have been studied. Currently, no method of pain management is considered superior or universally accepted. Acute pain following CXL is a recognised and clinically significant side effect, but few CXL studies have systematically investigated postoperative pain and its management. This review aims to improve patient pain outcomes following this increasingly common procedure.
Collapse
Affiliation(s)
| | | | - David Borsook
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Childrens Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Boris Severinsky
- Department of Ophthalmology, Emory Eye Center, Atlanta, Georgia, USA
| | - Robert Pl Wisse
- Department of Ophthalmology, Univerisity Medical Center, Utrecht, The Netherlands
| | - Hajirah N Saeed
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Eric A Moulton
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine; Department of Ophthalmology, Boston Childrens Hospital, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
6
|
Ondes Yilmaz F, Kepez Yildiz B, Tunc U, Kandemir Besek N, Yildirim Y, Demirok A. Comparison of topical omega-3 fatty acids with topical sodium hyaluronate after corneal crosslinking : Short term results. Ocul Immunol Inflamm 2021; 30:959-965. [PMID: 33560170 DOI: 10.1080/09273948.2020.1858117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Purpose: To evaluate the effect of topical omega 3 on ocular surface following corneal crosslinking (CXL) in keratoconus and compare with topical sodium hyaluronate.Material methods: 50 patients who underwent CXL were divided into two groups. In addition to topical steroids and antibiotics, Group A was prescribed topical omega 3; Group B was prescribed 0.3% sodium hyaluronate. Postoperatively, epithelial defect was measured everyday and at the first month corneal staining, Schirmer test was performed, tear break up time (TBUT), tear meniscus height (TMH) were measured.Results: Preoperative keratometric values were similar between groups; there was no difference in terms of corneal staining, tear film stability; epithelial closure time (p: 0.052), and postoperative pain scores between groups. At 1st month, TBUT and TMH were significantly better in Group A than Group B(p: 0.001, p: 0.047).Conclusion: Topical omega 3 increases tear film stability more prominent than sodium hyaluronate following crosslinking.
Collapse
Affiliation(s)
- Fevziye Ondes Yilmaz
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Burcin Kepez Yildiz
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ugur Tunc
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Nilay Kandemir Besek
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Yildirim
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Demirok
- Ophthalmology Department, University of Health Sciences Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
7
|
Vastardis I, Gatzioufas Z, McLintock C, Kohlhaas M, Hamada S, Lake D, Elalfy M. Tear film parameters before and after intracorneal ring segment implantation in keratoconic eyes. Eur J Ophthalmol 2020; 31:2213-2218. [PMID: 32951440 DOI: 10.1177/1120672120958301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess signs of dry eye syndrome in keratoconic eyes following intracorneal ring segment (ICRS) implantation. PATIENT AND METHODS Twenty eyes of 20 consecutive patients with keratoconus were assessed for tear film changes following ICRS implantation at 6 months postoperatively. Evaluated parameters included tear osmolarity, non-invasive tear breakup time test (NI-BUT test) and Schirmer test I and II before and after treatment. RESULTS No significant changes were found with respect to osmolarity, Schirmer I and II (p = 0.9, p < 0.64, and p < 0.91, respectively). The NITUBT was significantly lower after surgery (p = 0.04). CONCLUSION Our results suggest that implantation of ICRS does not result in a significant change in tear film osmolarity, or tear film volume nor improves the tear film stability.
Collapse
Affiliation(s)
| | - Zisis Gatzioufas
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Department of Ophthalmology, University Hospital Basel, Switzerland
| | - Cameron McLintock
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,Princess Alexandra Hospital, Brisbane, Australia
| | | | - Samer Hamada
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Damian Lake
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK
| | - Mohamed Elalfy
- Corneo-Plastic Unit, Queen Victoria Hospital, East Grinstead, UK.,The Research Institute of Ophthalmology, Cairo, Egypt
| |
Collapse
|
8
|
Nonlinear optical crosslinking (NLO CXL) for correcting refractive errors. Exp Eye Res 2020; 199:108199. [PMID: 32846150 DOI: 10.1016/j.exer.2020.108199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022]
Abstract
Ultraviolet A (UVA) light-based photoactivation of riboflavin (Rf) to induce corneal crosslinking (CXL) and mechanical stiffening is now a well-known treatment for corneal ectasia and Keratoconus that is being used in a topographically guided photorefractive intrastromal CXL (PiXL) procedure to treat low degrees of refractive errors. Alternative approaches for non-invasive treatment of refractive errors have also been proposed that use femtosecond lasers (FS) that provide much faster, more precise, and safer results than UVA CXL. One such treatment, nonlinear optical crosslinking (NLO CXL), has been able to replicate the effects of UVA CXL, while producing a smaller area of cellular damage and requiring a shorter procedure time. Unlike UVA CXL, the treatment volume of NLO CXL only occurs within the focal volume of the laser, which can be placed at any depth and scanned into any pattern for true topographically guided refractive correction. This review presents our experience with using FS lasers to photoactivate Rf and perform highly controlled corneal CXL that leads to mechanical stiffening and changes in corneal shape.
Collapse
|
9
|
Tear function and ocular surface changes following corneal collagen cross-linking treatment in keratoconus patients: 18-month results. Int Ophthalmol 2019; 40:169-177. [PMID: 31440935 DOI: 10.1007/s10792-019-01161-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 08/14/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE To investigate the long-term effects that CXL has on the tear function and ocular surface in keratoconus. METHODS Twenty-one consecutive patients (24 eyes) with progressive keratoconus scheduled for CXL were included. All patients underwent the following procedures: conjunctival impression cytology analysis, ocular surface disease index (OSDI) score, tear osmolarity test, Schirmer test, tear film breakup time (TBUT), ophthalmic surface fluorescein (Fl) staining, and topographical corneal evaluation before as well as 3 and 18 months after accelerated CXL. RESULTS There was no change in the median OSDI score, tear osmolarity test, Schirmer test, and the Fl staining score after CXL. The median TBUT increased from 9.00 s at baseline to 12.00 s at 18 months postoperative (P < 0.001). The cytological features of the temporal and superior bulbar conjunctiva deteriorated at 3 months post-CXL (P < 0.001). An improvement in impression cytology analysis of the temporal conjunctiva was noted at 18-month follow-up (P < 0.001). Significant improvements in the median maximum keratometry and mean keratometry (K-mean) readings were also noted 18 months after CXL (P < 0.001). The changes in the K-mean correlated significantly with the changes in TBUT levels at 18-month follow-up as compared to baseline (r = - 0.688, P < 0.001). CONCLUSIONS The improvement in TBUT, conjunctival squamous metaplasia, and the goblet cell density indicates a favorable effect of CXL on the ocular surface and tear film in keratoconus, presumably due to the reduced corneal irregularity after CXL.
Collapse
|
10
|
Kanellopoulos AJ. Incidence and management of symptomatic dry eye related to LASIK for myopia, with topical cyclosporine A. Clin Ophthalmol 2019; 13:545-552. [PMID: 30988596 PMCID: PMC6438263 DOI: 10.2147/opth.s188521] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Purpose To evaluate the incidence of transient dry eye associated with LASIK for myopia and the efficacy of topical cyclosporine A administration. Methods Group A was formed from 145 (82 female, 63 male) eyes that developed clinically significant dry eye within 1 month post-LASIK and were subjected to cyclosporine A treatment. A “non-symptomatic for dry eye” and age- and gender-matched group (group B) was formed from the same pool of patients to serve as control. Schirmer’s, tear film break-up time (TBUT) and Ocular Surface Disease Index (OSDI) questionnaire were evaluated. Central corneal epithelial thickness (CET) and topographic epithelial thickness variability (TVT) were evaluated as quantitative dry eye objective markers. Subjective patient survey was also assessed. Results Mean age was 39.7±6.2 years for the female and 47.67±9.5 years for the male patients, in group A. Schirmer’s test mean preoperative value was 8.4±3.1 mm; and 4.5±3.6 mm at 1 month post-LASIK. Statistically significant decrease from 1 month post-LASIK baseline was found at 12 months (8.2±2.1 mm; P=0.02). Mean preoperative TBUT value was 7.5±2.5 seconds, 6.5±3.1 seconds at 1 month postoperatively, and 7.6±2.0 seconds at 12 months postoperatively, statistically significant to baseline (P=0.04). Preoperatively, CET was 52.37±3.40 µm and TTV was 1.24±0.57 µm, 59.87±3.89 µm, and 2.74±0.57 µm at 1 month post-LASIK respectively and at 12 months, 55.42±2.75 µm and 1.39±0.96 µm. The differences in CET between 12 months post-LASIK vs baseline were statistically significant (P=0.007). The mean preoperative OSDI scores were 11.47±9.97 for group A and 11.79±10.31 for group B (P=0.782), which changed to 23.03±10.17 and 15.13±9.49 at 12 months postoperatively (P<0.05), respectively. Following commencement of cyclosporine A treatment in group A, statistically significant improvement was noted, greater than the one in group B, in all metrics at the 12-month examination in comparison to the 1-month baseline. Conclusion Topical cyclosporine A treatment is an effective alternative in the management of LASIK for myopia-related transient dry eye. Optical coherence tomography epithelial mapping may provide an objective benchmark in diagnosing and monitoring this significant disorder and its correlation with visual symptoms.
Collapse
|
11
|
Tear Function and Ocular Surface Alterations After Accelerated Corneal Collagen Cross-Linking in Progressive Keratoconus. Eye Contact Lens 2018; 43:302-307. [PMID: 27171133 DOI: 10.1097/icl.0000000000000268] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the alterations in the ocular surface and tear film parameters 3 months after accelerated corneal collagen cross-linking (A-CXL) in progressive keratoconus (KC) patients. METHODS Twenty-six patients (33 eyes total) with progressive KC were enrolled in this study. All patients were subjected to ophthalmic surface examination, such as OSDI (ocular surface disease index) scoring, the osmolarity tear test, Schirmer test, tear film breakup time (TBUT) analysis, rose bengal (RB) and fluorescein (Fl) ocular surface staining, and conjunctival impression cytology (IC) analysis, respectively. These tests were performed at baseline and 3 months after A-CXL. Nelson's grading system was used to evaluate the cell morphology and goblet cell density. RESULTS No statistically significant differences in the levels of tear osmolarity, TBUT, Schirmer test, OSDI scoring, and Fl and RB staining between pretreatment and 3 months postoperatively were observed (all P values >0.05). A statistically significant increase in superior (P=0.005) and temporal (P=0.006) IC grading was seen at the postoperative third month compared to pretreatment. CONCLUSIONS Only metaplastic changes and a reduction in the density of the goblet cells were seen in conjunctival IC, which is probably because of the toxicity of ultraviolet-A 3 months after A-CXL. However, these results do not lead to deterioration in TBUT. In this study, A-CXL has no adverse effect on ocular surface and tear function, which are important for visual quality.
Collapse
|
12
|
Gomes JAP, Azar DT, Baudouin C, Efron N, Hirayama M, Horwath-Winter J, Kim T, Mehta JS, Messmer EM, Pepose JS, Sangwan VS, Weiner AL, Wilson SE, Wolffsohn JS. TFOS DEWS II iatrogenic report. Ocul Surf 2017; 15:511-538. [PMID: 28736341 DOI: 10.1016/j.jtos.2017.05.004] [Citation(s) in RCA: 251] [Impact Index Per Article: 35.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 05/02/2017] [Indexed: 01/04/2023]
Abstract
Dry eye can be caused by a variety of iatrogenic interventions. The increasing number of patients looking for eye care or cosmetic procedures involving the eyes, together with a better understanding of the pathophysiological mechanisms of dry eye disease (DED), have led to the need for a specific report about iatrogenic dry eye within the TFOS DEWS II. Topical medications can cause DED due to their allergic, toxic and immuno-inflammatory effects on the ocular surface. Preservatives, such as benzalkonium chloride, may further aggravate DED. A variety of systemic drugs can also induce DED secondary to multiple mechanisms. Moreover, the use of contact lens induces or is associated with DED. However, one of the most emblematic situations is DED caused by surgical procedures such as corneal refractive surgery as in laser-assisted in situ keratomileusis (LASIK) and keratoplasty due to mechanisms intrinsic to the procedure (i.e. corneal nerve cutting) or even by the use of postoperative topical drugs. Cataract surgery, lid surgeries, botulinum toxin application and cosmetic procedures are also considered risk factors to iatrogenic DED, which can cause patient dissatisfaction, visual disturbance and poor surgical outcomes. This report also presents future directions to address iatrogenic DED, including the need for more in-depth epidemiological studies about the risk factors, development of less toxic medications and preservatives, as well as new techniques for less invasive eye surgeries. Novel research into detection of early dry eye prior to surgeries, efforts to establish appropriate therapeutics and a greater attempt to regulate and oversee medications, preservatives and procedures should be considered.
Collapse
Affiliation(s)
- José Alvaro P Gomes
- Dept. of Ophthalmology and Visual Sciences, Federal University of Sao Paulo/Paulista School of Medicine (UNIFESP/EPM), São Paulo, SP, Brazil.
| | - Dimitri T Azar
- University of Illinois College of Medicine, Chicago, IL, USA
| | | | - Nathan Efron
- School of Optometry and Vision Science, Queensland University of Technology, Queensland, Australia
| | - Masatoshi Hirayama
- Department of Ophthalmology, School of Medicine, Keio University, Tokyo, Japan
| | | | - Terry Kim
- Duke University School of Medicine, Durham, NC, USA; Duke University Eye Center, Durham, NC, USA
| | | | - Elisabeth M Messmer
- Department of Ophthalmology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Jay S Pepose
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Steven E Wilson
- Cole Eye Institute, The Cleveland Clinic, Cleveland, OH, USA
| | | |
Collapse
|
13
|
Rosenthal P, Borsook D, Moulton EA. Oculofacial Pain: Corneal Nerve Damage Leading to Pain Beyond the Eye. Invest Ophthalmol Vis Sci 2017; 57:5285-5287. [PMID: 27723896 PMCID: PMC5063054 DOI: 10.1167/iovs.16-20557] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The cornea is supplied principally by the ophthalmic branch of the trigeminal nerve and is the most densely innervated organ in the human body. Under normal conditions, the corneal nerve terminals incorporate sensors that monitor the thickness and integrity of the tear film, which are essential for meaningful vision. A disrupted tear film or direct noxious stimulation of these corneal nerves can produce discomfort or pain limited to the affected surface. Damage to these nerves can sometimes lead to a chronic neuropathic condition, where pain persists months following the initial insult, long after the nerves appear to have healed in the cornea itself following treatment. Neuropathic pain appears to persist indefinitely in a few patients.
Collapse
Affiliation(s)
- Perry Rosenthal
- Boston EyePain Foundation, Chestnut Hill, Massachusetts, United States
| | - David Borsook
- Center for Pain and the Brain, Boston Children's Hospital, Massachusetts General Hospital, McLean Hospital, Harvard Medical School, Boston, Massachusetts, United States 3Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston Massachusetts, United States
| | - Eric A Moulton
- Center for Pain and the Brain, Boston Children's Hospital, Massachusetts General Hospital, McLean Hospital, Harvard Medical School, Boston, Massachusetts, United States 3Department of Anesthesia, Critical Care and Pain Medicine, Boston Children's Hospital, Boston Massachusetts, United States
| |
Collapse
|
14
|
Abstract
PURPOSE To analyze the variations in tear quantity and quality after corneal collagen cross-linking (CXL) in patients with keratoconus. METHODS This is a prospective observational study of 24 eyes with keratoconus that underwent epithelium-off CXL. The variables studied were tear film osmolarity, subjective symptoms (Ocular Surface Disease Index), tear breakup time, Schirmer test (SCH) score, tear clearance, fluorescein staining, and lissamine green staining. Variables were determined preoperatively and 3, 6, and 12 months after CXL. RESULTS All the studied variables remained stable after 1-year follow-up (no significant difference in comparison with baseline values; Mann-Whitney U test). There was a positive paired correlation between the SCH score and tear clearance at 3; 0.532 (P < 0.01), 6; 0.434 (P = 0.04), and 12 months; 0.675 (P < 0.01). There was no correlation between the SCH score and tear breakup time, apart from a positive correlation at 12 months; 0.601 (P = 0.05). A negative correlation was found between osmolarity and the SCH score at 3; -0.589 (P < 0.01) and 12 months; -0.049 (P = 0.04). The Ocular Surface Disease Index did not correlate with any of the studied variables (Spearman test). CONCLUSIONS CXL, at least during the first postoperative year, does not modify the parameters currently used to evaluate tear film function. There is no correlation between objective and subjective parameters in the analysis of the tear film function.
Collapse
|
15
|
Carracedo G, Recchioni A, Alejandre-Alba N, Martin-Gil A, Batres L, Morote IJA, Pintor J. Signs and Symptoms of Dry Eye in Keratoconus Patients Before and After Intrastromal Corneal Rings Surgery. Curr Eye Res 2016; 42:513-519. [PMID: 27450910 DOI: 10.1080/02713683.2016.1200098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Based on the relationship between keratoconus and dry eye, the aim of this study was to evaluate changes in signs and symptoms of dry eye in keratoconus patients before and after intrastromal corneal ring surgery. METHODS Fifteen keratoconus patients were enrolled in Fundación Jiménez-Díaz of Madrid and University Clinic of Optometry of the Universidad Complutense de Madrid (Madrid, Spain). Tear break up time (TBUT), Schirmer test without anesthesia, corneal staining, diadenosine tetraphosphate (Ap4A) concentration, and ocular surface disease index (OSDI) were evaluated. Impression cytology combined with laser confocal microscopy was performed to evaluate goblet cell density, mucin cloud height (MCH), and cell layer thickness (CLT). All measurements were performed before (pre) surgery, 1 month (post) and 6 months after surgery (post6m). RESULTS We found no statistical differences in time in Schirmer test, TBUT, and corneal staining. OSDI scores were 44.96 ± 8.65, 26.30 ± 6.79, and 19.31 ± 4.28 for (pre), (post), and (post6m) surgery, respectively (p < 0.001). Impression cytology showed a decrease in cell density at (post6m) compared with presurgery (47.36 ± 35.15 cells/mm2 and 84.88 ± 32.08 cells/mm2, respectively, p = 0.04). At post6m, the MCH increased compared with presurgery values (13.97 ± 4.26 µm and 6.77 ± 2.51 µm, respectively, p < 0.001). There was a statistically significant increase in CLT in time. Ap4A tear concentrations were lower post6m than presurgery (1.02 ± 0.65 and 2.56 ± 1.10 µM, respectively, p < 0.001). CONCLUSION Intrastromal corneal ring surgery induces changes improving dry eye symptoms but no changes were found in signs of dry eye after surgery in keratoconus patients except for the MCH that increases drastically. More studies are needed to clarify the reason of its improvement.
Collapse
Affiliation(s)
- Gonzalo Carracedo
- a Department of Optics II (Optometry and Vision) , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain
| | - Alberto Recchioni
- a Department of Optics II (Optometry and Vision) , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain
| | | | - Alba Martin-Gil
- c Department of Biochemistry and Molecular Biology IV , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain
| | - Laura Batres
- a Department of Optics II (Optometry and Vision) , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain
| | | | - Jesús Pintor
- c Department of Biochemistry and Molecular Biology IV , Faculty of Optics and Optometry, Universidad Complutense de Madrid , Madrid , Spain
| |
Collapse
|
16
|
Arbelaez JG, Feng MT, Pena TJ, Price MO, Price FW. A year of cornea in review: 2013. Asia Pac J Ophthalmol (Phila) 2015; 4:40-50. [PMID: 26068612 DOI: 10.1097/apo.0000000000000110] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The goal of this study was to provide an update of significant corneal literature published in 2013. DESIGN This study is a systematic literature review. METHODS We conducted a systematic review of the English-language literature published from January 1, 2013, to December 31, 2013, using the following PubMed search and Medical Subject Headings terms: cornea transplantation, keratoplasty, Descemet membrane endothelial keratoplasty, Descemet stripping endothelial keratoplasty, cross linking, pre-Descemet's layer, Rho-associated kinase, keratoprosthesis, infectious keratitis, corneal dystrophy, corneal astigmatism, and keratoconus. RESULTS This review summarizes relevant and innovative original articles, review articles, and novel techniques from the following journals: American Journal of Ophthalmology, British Journal of Ophthalmology, Cornea, Graefe's Archive for Clinical and Experimental Ophthalmology, Investigative Ophthalmology & Visual Science, JAMA Ophthalmology, Journal of Cataract and Refractive Surgery, Journal of Refractive Surgery, and Ophthalmology. Case reports, abstracts, letters to the Editor, and unpublished work were excluded, as well as articles e-published ahead of print in 2012 that were discussed in the previous review. One hundred twenty-seven articles met the criteria for this review. CONCLUSIONS This review summarizes significant cornea-related literature from 2013.
Collapse
Affiliation(s)
- Juan G Arbelaez
- From the *Price Vision Group; and †Cornea Research Foundation of America, Indianapolis, IN
| | | | | | | | | |
Collapse
|
17
|
Profile of microbial keratitis after corneal collagen cross-linking. BIOMED RESEARCH INTERNATIONAL 2014; 2014:340509. [PMID: 25302296 PMCID: PMC4180902 DOI: 10.1155/2014/340509] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 08/25/2014] [Indexed: 11/24/2022]
Abstract
Purpose. To report the profile of microbial keratitis occurring after corneal collagen cross-linking (CXL) in keratoconus patients.
Methods. A retrospective analysis of 2350 patients (1715 conventional CXL, 310 transepithelial CXL, and 325 accelerated CXL) over 7 years (from January 2007 to January 2014) of progressive keratoconus, who underwent CXL at a tertiary eye care centre, was performed. Clinical findings, treatment, and course of disease of four eyes that developed postprocedural moxifloxacin resistant Staphylococcus aureus (MXRSA) infectious keratitis are highlighted. Results. Four eyes that underwent CXL (0.0017%) had corneal infiltrates. All eyes that developed keratitis had conventional CXL. Corneal infiltrates were noted on the third postoperative day. Gram's stain as well as culture reported MXRSA as the causative agent in all cases. Polymerase chain reaction (PCR) in each case was positive for eubacterial genome. All patients were treated with fortified antibiotic eye drops, following which keratitis resolved over a 6-week period with scarring. All these patients were on long-term preoperative oral/topical steroids for chronic disorders (chronic vernal keratoconjunctivitis, bronchial asthma, and chronic eczema). Conclusion. The incidence of infectious keratitis after CXL is a rare complication (0.0017%). MXRSA is a potential organism for causing post-CXL keratitis and should be identified early and treated aggressively with fortified antibiotics.
Collapse
|
18
|
Corneal collagen cross-linking with and without epithelial removal: a contralateral study with 0.5% hypotonic riboflavin solution. BIOMED RESEARCH INTERNATIONAL 2014; 2014:619398. [PMID: 25050368 PMCID: PMC4090564 DOI: 10.1155/2014/619398] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/27/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE Our main purpose was to compare safety and efficacy in the treatment of progressive keratoconus with "epithelium-on" and "epithelium-off" corneal collagen cross-linking (CXL). Our secondary purpose was to evaluate efficacy of CXL when hypotonic 0.5% riboflavin is used as photosensitizer. METHODS One eye of 20 patients with bilateral progressive keratoconus was randomly treated for "epithelium-on" CXL (group 1) while the fellow eye underwent "epithelium-off" CXL (group 2). Hypotonic 0.5% riboflavin was used in both groups. Visual acuity, refraction, corneal topography, and wavefront aberrometry were evaluated at baseline and after 1, 6, and 12 months. Specular microscopy was performed on 10 patients preoperatively and after 12 months. Postoperative pain was evaluated using a patient questionnaire. RESULTS Uncorrected and corrected distance visual acuity improved significantly in both groups. Refraction, topography, and aberrometry showed nonsignificant changes from the preoperative status throughout the 12-month follow-up in both groups. Moreover, the outcomes between the groups were comparable at all follow-up points. Endothelial cell-count was stable. Postoperative pain length was shorter in group 1 (P < 0.001). CONCLUSION "Epithelium-on" and "epithelium-off" CXL using hypotonic 0.5% riboflavin were equally safe and effective in stabilization of keratoconus. Topography and aberrometry outcomes in both groups failed to show any significant improvements. This study is registered at ClinicalTrials.gov: NCT01181219.
Collapse
|