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Azzopardi M, Chong YJ, Ng B, Recchioni A, Logeswaran A, Ting DSJ. Diagnosis of Acanthamoeba Keratitis: Past, Present and Future. Diagnostics (Basel) 2023; 13:2655. [PMID: 37627913 PMCID: PMC10453105 DOI: 10.3390/diagnostics13162655] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Acanthamoeba keratitis (AK) is a painful and sight-threatening parasitic corneal infection. In recent years, the incidence of AK has increased. Timely and accurate diagnosis is crucial during the management of AK, as delayed diagnosis often results in poor clinical outcomes. Currently, AK diagnosis is primarily achieved through a combination of clinical suspicion, microbiological investigations and corneal imaging. Historically, corneal scraping for microbiological culture has been considered to be the gold standard. Despite its technical ease, accessibility and cost-effectiveness, the long diagnostic turnaround time and variably low sensitivity of microbiological culture limit its use as a sole diagnostic test for AK in clinical practice. In this review, we aim to provide a comprehensive overview of the diagnostic modalities that are currently used to diagnose AK, including microscopy with staining, culture, corneal biopsy, in vivo confocal microscopy, polymerase chain reaction and anterior segment optical coherence tomography. We also highlight emerging techniques, such as next-generation sequencing and artificial intelligence-assisted models, which have the potential to transform the diagnostic landscape of AK.
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Affiliation(s)
- Matthew Azzopardi
- Department of Ophthalmology, Royal London Hospital, London E1 1BB, UK;
| | - Yu Jeat Chong
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
| | - Benjamin Ng
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
| | - Alberto Recchioni
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | | | - Darren S. J. Ting
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (B.N.); (A.R.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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2
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Hirono K, Inoue M, Tanaka S, Uchio E, Yanagi Y, Kadonosono K. ANTERIOR SEGMENT OPTICAL COHERENCE TOMOGRAPHY IN DETERMINATION OF ENTRY SITE FOR VITRECTOMY IN HIGHLY MYOPIC EYES. Retina 2023; 43:733-738. [PMID: 36812416 PMCID: PMC10125124 DOI: 10.1097/iae.0000000000003736] [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] [Indexed: 02/24/2023]
Abstract
PURPOSE To evaluate the efficacy of anterior segment optical coherent tomography (AS OCT) in estimating the length of the pars plana and optimizing the sclerotomy entry site in vitrectomy for highly myopic eyes, facilitating membrane peeling. METHODS Twenty-three eyes with myopic traction maculopathy were studied. The pars plana was examined using two methods: preoperative AS OCT and intraoperative measurement. The distance from the limbus to the ora serrata in two groups was measured to compare differences in length. The actual length of the entry site from the limbus and forceps used were noted in all eyes studied. RESULTS The mean axial length was 29.2 ± 2.3 mm for all 23 eyes. The average length between the limbus and ora serrata measured with AS OCT and intraoperative examination was 6,710 µ m (SD ± 459) and 6,671 µ m (SD ± 402), respectively, in the superotemporal region ( P > 0.05), and 6,340 µ m (SD ± 321) and 6,204 µ m (SD ± 402), respectively, in the superonasal region ( P >0.05). The mean length of the entry site from the limbus was 6.2 mm, and 28-mm forceps were used in 17 of 23 eyes (77%). CONCLUSION The length of the pars plana varies depending on the axial length of the eye. Preoperative AS OCT enables accurate measurement of the pars plana in eyes with high myopia. AS OCT examination can help determine the optimal site for sclerotomy, allowing easier access to the macular region for membrane peeling in highly myopic eyes.
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Affiliation(s)
- Kazushi Hirono
- Department of Ophthalmology and Micro-technology, Yokohama City University; and
| | - Maiko Inoue
- Department of Ophthalmology and Micro-technology, Yokohama City University; and
| | - Shin Tanaka
- Department of Ophthalmology and Micro-technology, Yokohama City University; and
| | | | - Yasuo Yanagi
- Department of Ophthalmology and Micro-technology, Yokohama City University; and
| | - Kazuaki Kadonosono
- Department of Ophthalmology and Micro-technology, Yokohama City University; and
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3
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Monroy D, Serrano A, Galor A, Karp CL. Medical treatment for ocular surface squamous neoplasia. Eye (Lond) 2023; 37:885-893. [PMID: 36754986 PMCID: PMC10050251 DOI: 10.1038/s41433-023-02434-x] [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: 02/28/2022] [Revised: 12/17/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
Ocular surface squamous neoplasia (OSSN) is the most common non-melanocytic tumour of the ocular surface. Surgical excision with wide margins using the "no-touch" method was originally the most popular treatment for OSSN. However, in the past two decades, the use of topical medications for OSSN treatment has gained a reputation amongst ophthalmologists for being an effective alternative to surgical excision. Furthermore, technological advancements, such as those seen in high-resolution optical coherence tomography (HR-OCT) for the anterior segment, have facilitated the diagnosis and monitoring of OSSN. When selecting a topical agent, interferon alpha-2b (IFNα-2b) and 5-fluorouracil (5-FU) are two of the gentlest medications used for OSSN and are often considered first line therapies due to their high-resolution rates and mild side effect profiles. Mitomycin C (MMC), on the other hand, has a highly toxic profile; therefore, while effective, in our hands it is considered as a second-line treatment for OSSN if the other modalities fail. In addition, newer and less studied agents, such as immune checkpoint inhibitors, retinoic acid, aloe vera, and anti-vascular endothelial growth factor have anti-neoplastic properties and have shown potential for the treatment of OSSN. We enclose an updated literature review of medical treatments for OSSN.
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Grants
- R01 EY026174 NEI NIH HHS
- P30 EY014801 NEI NIH HHS
- I01 BX004893 BLRD VA
- R61 EY032468 NEI NIH HHS
- I01 CX002015 CSRD VA
- The Department of Veterans Affairs, Veterans Health Administration, Office of Research and Development, Clinical Sciences R&D (CSRD) I01 CX002015 (Dr. Galor) and Biomedical Laboratory R&D (BLRD) Service I01 BX004893 (Dr. Galor), Department of Defense Gulf War Illness Research Program (GWIRP) W81XWH-20-1-0579 (Dr. Galor) and Vision Research Program (VRP) W81XWH-20-1-0820 (Dr. Galor), National Eye Institute R01EY026174 (Dr. Galor) and R61EY032468 (Dr. Galor), and Research to Prevent Blindness Unrestricted Grant (institutional).
- NIH Center Core Grant P30EY014801, RPB Unrestricted Award, Dr. Ronald and Alicia Lepke Grant, The Lee and Claire Hager Grant, The Robert Farr Family Grant, The Grant and Diana Stanton-Thornbrough Grant,The Robert Baer Family Grant, The Roberto and Antonia Menendez Grant, The Emilyn Page and Mark Feldberg Grant, The Calvin and Flavia Oak Support Fund, The Robert Farr Family Grant, The Jose Ferreira de Melo Grant, The Richard and Kathy Lesser Grant, The Honorable A. Jay Cristol Grant, The Michele and Ted Kaplan Grant, The Carol Soffer Grant, and the Richard Azar Family Grant(institutional grants).
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Affiliation(s)
- David Monroy
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andres Serrano
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY, USA
| | - Anat Galor
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL, USA
| | - Carol L Karp
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.
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Characteristics of Anterior Segment in Congenital Ectopia Lentis: An SS-OCT Study. J Ophthalmol 2022; 2022:6128832. [PMID: 35706501 PMCID: PMC9192328 DOI: 10.1155/2022/6128832] [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: 02/27/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To investigate the characteristics of anterior chamber angle parameters in congenital ectopia lentis (CEL) patients and to evaluate the sensitivity and specificity of anterior segment parameters in distinguishing CEL from healthy controls. Setting. Zhongshan Ophthalmic Center, Guangzhou, China. Design Cross-sectional study. Methods 35 CEL patients and 35 age- and sex-matched healthy controls were recruited. Axial length (AL) and anterior segment parameters including anterior chamber width (ACW), angle open distance (AOD), angle recess area (ARA), trabecular-iris space area (TISA), and trabecular-iris angle (TIA) were measured. All the above parameters and the ratio index of angle parameters, which was defined as the angle parameter value of the narrower side to that of the contralateral side, were compared between CEL and controls. Receiver operating characteristic (ROC) curves were also plotted to evaluate the diagnostic performance of anterior chamber angle parameters in CEL patients. Results All angle parameters of the contralateral side to the dislocated lens side were significantly smaller than those of the dislocated lens side in CEL (all P < 0.05). For the diagnostic performance of anterior chamber angle parameters, the ratio index of TIAr500 combined with TIAr750 had the best diagnostic performance for CEL screening (AUC = 0.798), and TIAr500 of 0.887 and TIAr750 of 0.917 were detected to be the optimal cut-off points, representing a sensitivity of 89.8% and specificity of 68.7%. Conclusion The contralateral side to the dislocated lens side in the CEL had a narrower anterior chamber angle. TIAr500 combined with TIAr750 is the optimal combination strategy for ectopia lentis screening.
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Wang L, Shen M, Shi C, Zhou Y, Chen Y, Pu J, Chen H. EE-Net: An edge-enhanced deep learning network for jointly identifying corneal micro-layers from optical coherence tomography. Biomed Signal Process Control 2022. [DOI: 10.1016/j.bspc.2021.103213] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Wang L, Shen M, Chang Q, Shi C, Chen Y, Zhou Y, Zhang Y, Pu J, Chen H. Automated delineation of corneal layers on OCT images using a boundary-guided CNN. PATTERN RECOGNITION 2021; 120:108158. [PMID: 34421131 PMCID: PMC8372529 DOI: 10.1016/j.patcog.2021.108158] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Accurate segmentation of corneal layers depicted on optical coherence tomography (OCT) images is very helpful for quantitatively assessing and diagnosing corneal diseases (e.g., keratoconus and dry eye). In this study, we presented a novel boundary-guided convolutional neural network (CNN) architecture (BG-CNN) to simultaneously extract different corneal layers and delineate their boundaries. The developed BG-CNN architecture used three convolutional blocks to construct two network modules on the basis of the classical U-Net network. We trained and validated the network on a dataset consisting of 1,712 OCT images acquired on 121 subjects using a 10-fold cross-validation method. Our experiments showed an average dice similarity coefficient (DSC) of 0.9691, an intersection over union (IOU) of 0.9411, and a Hausdorff distance (HD) of 7.4423 pixels. Compared with several other classical networks, namely U-Net, Attention U-Net, Asymmetric U-Net, BiO-Net, CE-Net, CPFnte, M-Net, and Deeplabv3, on the same dataset, the developed network demonstrated a promising performance, suggesting its unique strength in segmenting corneal layers depicted on OCT images.
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Affiliation(s)
- Lei Wang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
- Key Laboratory of Computer Network and Information Integration (Southeast University), Ministry of Education, Nanjing, China
- Corresponding author. (L. Wang)
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qian Chang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Ce Shi
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yang Chen
- Key Laboratory of Computer Network and Information Integration (Southeast University), Ministry of Education, Nanjing, China
| | - Yuheng Zhou
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yanchun Zhang
- Department of Ophthalmology, Xi’an People’s Hospital (Xi’an Fourth Hospital), Xi’an, China
| | - Jiantao Pu
- Departments of Radiology and Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213, United States
| | - Hao Chen
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, Wenzhou, China
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Bunod R, Tahiri Joutei Hassani R, Robin M, Liang H, Rabut G, Baudouin C, Labbé A. Evaluation of pterygium severity with en face anterior segment optical coherence tomography and correlations with in vivo confocal microscopy. J Fr Ophtalmol 2021; 44:1362-1369. [PMID: 34384622 DOI: 10.1016/j.jfo.2021.03.010] [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: 03/01/2021] [Accepted: 03/11/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To describe en face anterior segment optical coherence tomography (EF-OCT) characteristics of pterygia and their correlation with in vivo confocal microscopy (IVCM). PATIENTS AND METHODS In this observational case series, we prospectively included 21 eyes of 17 subjects with pterygium. All subjects underwent detailed ophthalmic examination, anterior segment photography, an ocular surface disease index (OSDI) questionnaire, IVCM, and EF-OCT. Eyes were divided into two groups according to pterygium severity (Modified Pterygium Classification System) and OSDI score. EF-OCT images for both groups were analyzed for surface area of Fuchs Patches (FP). The IVCM activity score was based on the number of inflammatory cells, blood vessels, activated keratocytes and the appearance of the cornea/pterygium at the head of the pterygium. The correlations between EF-OCT and IVCM images were then analyzed and compared in both groups. RESULTS EF-OCT permits clear visualization and evaluation of FPs and the border between the pterygium and the adjacent cornea. The severe pterygium group was characterized by irregular borders and larger FPs (0.13±0.06 mm2 versus 0.06±0.02 mm2 respectively) (P=0.003). The mean IVCM activity score was 2.36±0.81 in the severe pterygium group and 1.2±0.42 in the mild pterygium group (P=0.0013). There was a positive correlation between FP surface area and IVCM activity score. A larger FP surface area was associated with a higher activity score on IVCM. CONCLUSION EF-OCT allows good evaluation of pterygium extension, borders and FP surface area. EF-OCT analysis of pterygium could represent a simple, non-invasive and reproducible method to evaluate pterygium severity and activity.
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Affiliation(s)
- R Bunod
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France.
| | | | - M Robin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France
| | - H Liang
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France
| | - G Rabut
- CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France
| | - C Baudouin
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, University of Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
| | - A Labbé
- Department of Ophthalmology 3, Quinze-Vingts National Ophthalmology Hospital, 28, rue de Charenton, 75012 Paris, France; CHNO des Quinze-Vingts, IHU FOReSIGHT, INSERM-DGOS CIC 1423, 17, rue Moreau, 75012 Paris, France; Sorbonne Université, INSERM, CNRS, Institut de la Vision, 17, rue Moreau, 75012 Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, University of Versailles Saint-Quentin-en-Yvelines, AP-HP, 9, avenue Charles de Gaulle, 92100 Boulogne-Billancourt, France
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Hu L, Li Y, Liu Q, Xu Z, Gu J, Li A, Wang Y, Lin K, Xia J, Chen S, Lu F. Corneal Vertical and Horizontal Thickness Profiles Generated by UHR-OCT for Suspected and Subclinical Keratoconus Diagnosis. J Refract Surg 2021; 37:438-445. [PMID: 34236909 DOI: 10.3928/1081597x-20210330-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE To verify the diagnostic power of vertical and horizontal thickness profiles of the corneal sublayers generated by ultra-high resolution optical coherence tomography (UHROCT) in subclinical and suspected keratoconus. METHODS In this cross-sectional study, 25 eyes with confirmed keratoconus, 63 eyes with suspected keratoconus, 15 eyes with subclinical keratoconus, and 42 normal eyes were investigated. Vertical and horizontal thickness profiles of the corneal epithelium, Bowman's layer, and stroma were measured by UHR-OCT. Diagnostic indices included ratios of thickness distribution and multimeric discriminant functions calculated by multiple logistic regression based on them. Receiver operating characteristic curves were used to verify the predictive accuracy by the area under the curve (AUC). RESULTS Function consisting of two indices (vertical maximum ectasia index of epithelium and horizontal maximum ectasia index of Bowman's layer) performed well to discriminate subclinical keratoconus (AUC = 0.967) and suspected keratoconus (AUC = 0.932) from normal. In addition, when four indices were combined, the diagnostic power for subclinical keratoconus (AUC = 0.984) and suspected keratoconus (AUC = 0.971) was further increased. However, both binary and quaternary functions could not adequately discriminate suspected from subclinical keratoconus. CONCLUSIONS UHR-OCT-generated thickness indices from the vertical and horizontal thickness profiles of the corneal epithelium and Bowman's layer showed an evident diagnostic efficacy in discriminating suspected and subclinical keratoconus from normal eyes. The early changes in keratoconus might prefer thickness distribution in corneal sublayers rather than corneal thickness or topography. [J Refract Surg. 2021;37(7):438-445.].
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Abdelghany AA, D’Oria F, Alio Del Barrio J, Alio JL. The Value of Anterior Segment Optical Coherence Tomography in Different Types of Corneal Infections: An Update. J Clin Med 2021; 10:jcm10132841. [PMID: 34199039 PMCID: PMC8267702 DOI: 10.3390/jcm10132841] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 06/03/2021] [Accepted: 06/26/2021] [Indexed: 11/06/2022] Open
Abstract
Anterior segment optical coherence tomography (AS-OCT) is a modality that uses low-coherence interferometry to visualize and assess anterior segment ocular features, offering several advantages of being a sterile and noncontact modality that generates high-resolution cross-sectional images of the tissues. The qualitative and quantitative information provided by AS-OCT may be extremely useful for the clinician in the assessment of a wide spectrum of corneal infections, guiding in the management and follow-up of these patients. In clinical practice, infections are routinely evaluated with slit-lamp biomicroscopy, an examination and imaging modality that is limited by the physical characteristics of light. As a consequence, the depth of pathology and the eventually associated corneal edema cannot be accurately measured with the slit-lamp. Therefore, it represents a limit for the clinician, as in vivo information about corneal diseases and the response to treatment is limited. Resolution of corneal infection is characterized by an early reduction in corneal edema, followed by a later reduction in infiltration: both parameters can be routinely measured with standardized serial images by AS-OCT.
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Affiliation(s)
- Ahmed A. Abdelghany
- Ophthalmology Department, Faculty of Medicine, Minia University, Minia 61519, Egypt;
| | - Francesco D’Oria
- Section of Ophthalmology, Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari, 70124 Bari, Italy;
| | | | - Jorge L. Alio
- Vissum Miranza, Miguel Hernandez University, c/Cabañal, 1, 03016 Alicante, Spain;
- Correspondence:
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Elsawy A, Abdel-Mottaleb M. A Novel Network With Parallel Resolution Encoders for the Diagnosis of Corneal Diseases. IEEE Trans Biomed Eng 2021; 68:3671-3680. [PMID: 34014818 DOI: 10.1109/tbme.2021.3082152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To propose a deep-learning network for the diagnosis of two corneal diseases: Fuchs' endothlelial dystrophy and keratoconus, based on optical coherence tomography (OCT) images of the cornea. METHODS In this paper, we propose a novel network with parallel resolution-specific encoders and composite classification features to directly diagnose Fuchs' endothelial dystrophy and keratoconus using OCT images. Our proposed network consists of a multi-resolution input, multiple parallel encoders, and a composite of convolutional and dense features for classification. The purpose of using parallel resolution-specific encoders is to perform multi-resolution feature fusion. Also, using composite classification features enhances the dense feature learning. We implemented other related networks for comparison with our network and performed k-fold cross-validation on a dataset of 16,721 OCT images. We used saliency maps and sensitivity analysis to visualize our proposed network. RESULTS The proposed network outperformed other networks with an image classification accuracy of 0.91 and a scan classification accuracy of 0.94. The visualizations show that our network learned better features than other networks. SIGNIFICANCE The proposed methods can potentially be a step towards the early diagnosis of corneal diseases, which is necessary to prevent their progression, hence, prevent loss of vision.
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Li Y, Xu Z, Liu Q, Wang Y, Lin K, Xia J, Chen S, Hu L. Relationship between corneal biomechanical parameters and corneal sublayer thickness measured by Corvis ST and UHR-OCT in keratoconus and normal eyes. EYE AND VISION 2021; 8:2. [PMID: 33419485 PMCID: PMC7796648 DOI: 10.1186/s40662-020-00225-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/14/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND To explore the relationship between corneal biomechanical parameters and corneal sublayer thickness using corneal visualization Scheimpflug technology (Corvis ST) and ultrahigh-resolution optical coherence tomography (UHR-OCT) in clinical and suspected keratoconus and normal eyes. METHODS Cross-sectional prospective study. A total of 94 eyes of 70 participants were recruited. Twenty five eyes of 19 keratoconus patients, 52 eyes of 34 patients showing high risk of developing keratoconus according to the Belin/Ambrosio Enhanced Ectasia Display, and each eye of 17 normal subjects were enrolled. All participants underwent Corvis ST, Pentacam, and UHR-OCT examinations at the same time. Stiffness parameter A1 (SP-A1), deformation amplitude ratio (DA ratio), and other biomechanical parameters were recorded using Corvis ST. The vertical and horizontal thickness profiles of central 3 mm corneal epithelium, Bowman's layer, and stroma as measured by the perpendicular distance between the neighboring interfaces were generated using UHR-OCT. The flat keratometry and steep keratometry were obtained using Pentacam. Analysis of correlation was applied to explore the association between variables. RESULTS Most of the biomechanical parameters and corneal sublayer thickness profiles showed statistical differences among three groups. A statistically significant linear relationship was noted between SP-A1 and DA ratio in all three groups. SP-A1 was found to be positively correlated with epithelial and Bowman's layer thickness in the keratoconus (KC) group, and with stromal thickness in all three groups. In the normal and suspected keratoconus (SKC) groups, only stromal thickness was included in the stepwise linear regression to predict SP-A1, whereas in the KC group, steep keratometry and Bowman's layer thickness were included. CONCLUSIONS Significant and different correlations were noted between corneal stiffness and corneal sublayer thickness in different groups, indicating that corneal sublayers may play different roles in maintaining corneal biomechanical stability between keratoconus and normal eyes.
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Affiliation(s)
- Yong Li
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan road, Wenzhou, 325000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Zhiqiang Xu
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan road, Wenzhou, 325000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Qiaoli Liu
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan road, Wenzhou, 325000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Yuzhou Wang
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan road, Wenzhou, 325000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Kan Lin
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan road, Wenzhou, 325000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Jiahui Xia
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan road, Wenzhou, 325000, Zhejiang, China.,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China
| | - Shihao Chen
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan road, Wenzhou, 325000, Zhejiang, China. .,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
| | - Liang Hu
- School of Ophthalmology and Optometry, Eye Hospital, Wenzhou Medical University, 270 Xueyuan road, Wenzhou, 325000, Zhejiang, China. .,National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang, China.
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Venkateswaran N, Mercado C, Wall SC, Galor A, Wang J, Karp CL. High resolution anterior segment optical coherence tomography of ocular surface lesions: a review and handbook. EXPERT REVIEW OF OPHTHALMOLOGY 2020; 16:81-95. [DOI: 10.1080/17469899.2021.1851598] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Nandini Venkateswaran
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Mercado
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
- Grupo de Investigacion Escuela Barraquer, Escuela Superior de Oftalmologia del Instituto Barraquer de America, Bogota, Colombia
| | - Sarah C. Wall
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
- Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, Florida, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
| | - Carol L. Karp
- Bascom Palmer Eye Institute, Department of Ophthalmology, University of Miami, Miami, Florida, USA
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13
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Elsawy A, Gregori G, Eleiwa T, Abdel-Mottaleb M, Shousha MA. Pathological-Corneas Layer Segmentation and Thickness Measurement in OCT Images. Transl Vis Sci Technol 2020; 9:24. [PMID: 33173606 PMCID: PMC7594599 DOI: 10.1167/tvst.9.11.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 09/22/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose The purpose of this study was to propose a new algorithm for the segmentation and thickness measurement of pathological corneas with irregular layers using a two-stage graph search and ray tracing. Methods In the first stage, a graph, with only gradient edge-cost, is used to segment the air-epithelium and endothelium-aqueous boundaries. In the second stage, a graph, with gradient, directional, and multiplier edge-cost, is used to correct segmentation. The optical coherence tomography (OCT) image is flattened using the air-epithelium boundary and a graph search is used to segment the epithelium-Bowman's and Bowman's-stroma boundaries. Then, the OCT image is flattened using the endothelium-aqueous boundary and a graph search is used to segment the Descemet's membrane. Ray tracing is used to correct the inter-boundary distances, then the thickness is measured using the shortest distance. The proposed algorithm was trained and evaluated using 190 OCT images manually segmented by trained operators. Results The mean and standard deviation of the unsigned errors of the algorithm-operator and inter-operator were 0.89 ± 1.03 and 0.77 ± 0.68 pixels in segmentation and 3.62 ± 3.98 and 2.95 ± 2.52 µm in thickness measurement. Conclusions Our proposed algorithm can produce accurate segmentation and thickness measurements compared with the manual operators. Translational Relevance Our algorithm could be potentially useful in the clinical practice.
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Affiliation(s)
- Amr Elsawy
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
- Electrical and Computer Engineering, University of Miami, Miami, FL, USA
| | - Giovanni Gregori
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Taher Eleiwa
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
- Ophthalmology Department, Benha Faculty of Medicine, Egypt
| | | | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
- Electrical and Computer Engineering, University of Miami, Miami, FL, USA
- Biomedical Engineering, University of Miami, Miami, FL, USA
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14
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Eleiwa TK, Elsawy A, Syed ZA, Roongpoovapatr V, Sayed AM, Yoo SH, Abou Shousha M. In-vivo Three-dimensional Characteristics of Bowman's Layer and Endothelium/Descemet's Complex Using Corneal Microlayer Tomography in Healthy Subjects. Curr Eye Res 2020; 45:659-667. [PMID: 32064952 DOI: 10.1080/02713683.2019.1691238] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Purpose: To characterize the three-dimensional (3D) thickness profile and age-related changes of Bowman's layer (BL), and endothelium/Descemet's membrane (En/DM) complex among healthy individuals using Corneal Microlayer Tomography (CML-T), and to describe its repeatability and accuracy.Methods: Sixty-six eyes of 41 healthy volunteers; 27 eyes (< 40 years old), and 39 eyes (>40 years old) were imaged using HD-OCT. Automatic and manual segmentation of the corneal layers was performed, and 3D thickness maps were generated, using custom-built CML-T software. A regional analysis of mean thickness parameters between the 2 age groups was performed. A regression analysis was used to assess the correlation between age, and thickness maps. Intraclass Correlation Coefficients (ICC), Coefficients of Variation (COV), and Bland-Altman plots were used to assess the reliability of the repeated measurements in 198 locations.Results: CML-T successfully mapped the BL and En/DM in all included eyes. Thickness maps showed a significant increase in corneal thickness (CT), BL thickness (BMT), and En/DM complex thickness (DMT) toward the periphery with a mean difference 28 µm (p < .001), 1.1 µm (p < .001), and 1.4 µm (p < .001), respectively. There was a strong correlation between age and central DMT (r = 0.61; p < .001), while there was no correlation between age and both CT, and BMT. ICC values ranged from 0.9 (BMT) to 0.997 (DMT), and from 0.808 (BMT) to 0.979 (CT) for intraoperator repeatability of manual measurements, and the accuracy of auto matic measurements, respectively. COV values were lower than 7.5% in all cases.Conclusion: CML-T is a novel tool that can generate 3D-thickness maps of both BL and En/DM. CT, BMT, and DMT increase toward the periphery in healthy corneas. DMT increases with aging, while BMT does not. We also report excellent repeatability, accuracy and good agreement between automatic and manual measurements.
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Affiliation(s)
- Taher K Eleiwa
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Department of Ophthalmology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Amr Elsawy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Electrical and Computer Engineering, University of Miami, Miami, FL, USA
| | - Zeba A Syed
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Ahmed M Sayed
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Biomedical Engineering Department, Helwan University, Helwan, Egypt
| | - Sonia H Yoo
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL, USA.,Electrical and Computer Engineering, University of Miami, Miami, FL, USA.,Biomedical Engineering, University of Miami, Miami, FL, USA
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15
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Karp CL, Mercado C, Venkateswaran N, Ruggeri M, Galor A, Garcia A, Sivaraman KR, Fernandez MP, Bermudez A, Dubovy SR. Use of High-Resolution Optical Coherence Tomography in the Surgical Management of Ocular Surface Squamous Neoplasia: A Pilot Study. Am J Ophthalmol 2019; 206:17-31. [PMID: 31163136 DOI: 10.1016/j.ajo.2019.05.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 05/07/2019] [Accepted: 05/28/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate whether high-resolution optical coherence tomography (HR-OCT) can detect histologic tumor margins of ocular surface squamous neoplasia (OSSN). METHODS Eight eyes of 8 patients with OSSN undergoing excision were studied prospectively. Immediately before surgery, the tumor was imaged using commercially available HR-OCT to identify the conjunctival margins of the neoplastic lesion. The tumor borders of the lesion determined by HR-OCT were mapped in relation to an anatomic reference point and transferred intraoperatively. The tumor was excised with 4-mm margins from the visible edge of the lesion with a "no-touch" technique. The specimens were sent for pathologic analysis and the histologic tumor margin was compared to the HR-OCT predicted tumor border. RESULTS Mean age of the 8 patients was 67 ± 9.9 years. Seven were male, 7 were white, and, ethnically, 3 were Hispanic. All 8 tumors were bulbar and in the exposure zone. Seven tumors were limbal. Corneal extension was present in 5. Mean tumor area was 17.5 ± 11.1 mm2. Clinically, 2 of the tumors were leukoplakic, 1 papillomatous, and 3 gelatinous. A conjunctival tumor margin identified with the HR-OCT coincided with the pathologically confirmed margin mark in all eyes. CONCLUSIONS HR-OCT has the potential to predict histologic tumor margins in OSSN. Optical identification of tumor margins could potentially decrease the incidence of residual positive margins and minimize healthy tissue removal. Advances in HR-OCT technology and integration into a microscope for "real-time" imaging are needed to further improve this technique. NOTE: Publication of this article is sponsored by the American Ophthalmological Society.
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Affiliation(s)
- Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
| | - Carolina Mercado
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Nandini Venkateswaran
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marco Ruggeri
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anat Galor
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA; Miami Veteran Affairs Medical Center, Miami, Florida, USA
| | - Armando Garcia
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Kavitha R Sivaraman
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Maria Paula Fernandez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Antonio Bermudez
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA; Florida Lions Ocular Pathology Laboratory, Miami, Florida, USA
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16
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Al Bayyat G, Arreaza-Kaufman D, Venkateswaran N, Galor A, Karp CL. Update on pharmacotherapy for ocular surface squamous neoplasia. EYE AND VISION 2019; 6:24. [PMID: 31417938 PMCID: PMC6689886 DOI: 10.1186/s40662-019-0150-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 07/21/2019] [Indexed: 12/31/2022]
Abstract
The most frequently encountered non-pigmented tumor of the ocular surface is ocular surface squamous neoplasia (OSSN). Over the past two decades, the pharmacological management of OSSN has grown, with topical 5-fluorouracil, mitomycin, and interferon alpha 2b all being successfully used to treat this disease. Other agents, such as anti-vascular endothelial growth factor (VEGF), retinoic acid, cidofovir and Aloe vera, have less frequently been used in the treatment of OSSN. This review will discuss these pharmacologic agents, summarizing available data and presenting the approach to the treatment of these tumors.
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Affiliation(s)
- Ghada Al Bayyat
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
| | - Dan Arreaza-Kaufman
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
| | - Nandini Venkateswaran
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
| | - Anat Galor
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA.,Miami Veterans Hospital, Miami, FL 33125 USA
| | - Carol L Karp
- 1Bascom Palmer Eye Institute, University of Miami, 900 NW 17th Street, Miami, FL 33136 USA
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17
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Pilat AV, Proudlock FA, Shah S, Sheth V, Purohit R, Abbot J, Gottlob I. Assessment of the anterior segment of patients with primary congenital glaucoma using handheld optical coherence tomography. Eye (Lond) 2019; 33:1232-1239. [PMID: 30886322 PMCID: PMC7005739 DOI: 10.1038/s41433-019-0369-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 12/13/2022] Open
Abstract
PURPOSE To investigate the potential of handheld optical coherence tomography (HH-OCT) in assessing the anterior segment of the eye in patients with primary congenital glaucoma. DESIGN A prospective, case-controlled observational study. PARTICIPANTS Twenty-two patients with primary congenital glaucoma (PCG, 9 females and 13 males; mean age 4.36 ± 3.4 years) and age-, gender- and ethnicity-matched healthy participants. METHODS Anterior OCT was performed in all participants using a high-resolution HH SD-OCT device (Envisu 2300, Leica Microsystems, Germany) without anaesthesia or sedation. RESULTS Anterior HH-OCT in PCG visualised Haab's striae in 14.3%, uneven internal cornea in 9.5% and epithelial thickening in 11.9% of patients with central corneal thickening (CCT, p < 0.001). CCT was significantly correlated with the intraocular pressure (IOP, p < 0.001). The flat iris with a thin collarette zone was found in 59.5%, anterior iris insertion in 11.90% of eyes affected by PCG. Two independent examiners showed sensitivity and specificity of 87% and 77%, respectively, by instating iris thinning and flattening of the anterior profile. CONCLUSIONS Anterior HH-OCT has significant potential to improve diagnosis and management of PCG. Clinically relevant information can be obtained non-invasively and without sedation. High specificity makes anterior HH-OCT an important adjunct for management of PCG. Excellent visualisation of the iris insertion on OCT indicates potential for AS OCT to assist with surgical planning, including decision on the type of surgery and location of the incision.
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Affiliation(s)
| | | | - Sonal Shah
- Ophthalmology Group, University of Leicester, Leicester, UK
| | - Viral Sheth
- Ophthalmology Group, University of Leicester, Leicester, UK
| | - Ravi Purohit
- Ophthalmology Group, University of Leicester, Leicester, UK
| | - Joseph Abbot
- Ophthalmology Department, Birmingham Children's Hospital, Birmingham, UK
| | - Irene Gottlob
- Ophthalmology Group, University of Leicester, Leicester, UK.
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18
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Venkateswaran N, Mercado C, Tran AQ, Garcia A, Diaz PFM, Dubovy SR, Galor A, Karp CL. The use of high resolution anterior segment optical coherence tomography for the characterization of conjunctival lymphoma, conjunctival amyloidosis and benign reactive lymphoid hyperplasia. EYE AND VISION 2019; 6:17. [PMID: 31236423 PMCID: PMC6580598 DOI: 10.1186/s40662-019-0143-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 05/29/2019] [Indexed: 11/28/2022]
Abstract
Background Conjunctival lymphoma, conjunctival amyloidosis and benign reactive lymphoid hyperplasia (BRLH) are conditions that often have a similar appearance on the ocular surface. The use of high resolution anterior segment optical coherence tomography (HR-OCT) enables clinicians to evaluate distinctive differences in tissue morphology and cellular patterns in various ocular surface conditions. In this study, we characterize the morphological differences seen in conjunctival lymphoma, conjunctival amyloidosis and BRLH on HR-OCT imaging. Methods A retrospective chart review was performed of patients with biopsy proven conjunctival lymphoma, conjunctival amyloidosis and BRLH between 2012 and 2019 at the Bascom Palmer Eye Institute. Patients were excluded if HR-OCT imaging was not performed on initial presentation. Results Thirty-four total eyes of 27 patients were identified. Twenty eyes had conjunctival lymphoma (16 patients), 8 eyes had conjunctival amyloidosis (6 patients) and 6 eyes had BRLH (5 patients). All conditions appeared clinically as pink, red or yellow subepithelial lesions but had different features on HR-OCT. In lymphoma, HR-OCT images typically showed homogenous, dark subepithelial lesions with smooth borders, containing monomorphic dot-like infiltrates. HR-OCT images of amyloidosis typically showed heterogeneous, dark lesions with irregular borders, often containing hyperreflective linear infiltrates. HR-OCT images of BRLH showed variable infiltration of the subepithelial tissue, at times with homogenous lesions containing dot-like infiltrates like lymphoma and other times with more hyperreflective, subepithelial tissue. Flow cytometry and gene rearrangement was needed for final differentiation between BRLH and lymphoma lesions. Conclusions Distinctive features on HR-OCT of conjunctival lymphoma, conjunctival amyloidosis and BRLH can help characterize these lesions beyond what is apparent with the clinical examination. Future studies can further validate this technology’s use with more subtle and challenging lesions.
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Affiliation(s)
- Nandini Venkateswaran
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Carolina Mercado
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Ann Q Tran
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Armando Garcia
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Pedro Francisco Monsalve Diaz
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Sander R Dubovy
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
| | - Anat Galor
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA.,2Department of Ophthalmology, Miami Veterans Administration Medical Center, Miami, FL USA
| | - Carol L Karp
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, 900 NW 17th Street, Miami, FL 33136 USA
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19
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Elsawy A, Abdel-Mottaleb M, Sayed IO, Wen D, Roongpoovapatr V, Eleiwa T, Sayed AM, Raheem M, Gameiro G, Shousha MA. Automatic Segmentation of Corneal Microlayers on Optical Coherence Tomography Images. Transl Vis Sci Technol 2019; 8:39. [PMID: 31211004 PMCID: PMC6561132 DOI: 10.1167/tvst.8.3.39] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 03/25/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To propose automatic segmentation algorithm (AUS) for corneal microlayers on optical coherence tomography (OCT) images. Methods Eighty-two corneal OCT scans were obtained from 45 patients with normal and abnormal corneas. Three testing data sets totaling 75 OCT images were randomly selected. Initially, corneal epithelium and endothelium microlayers are estimated using a corneal mask and locally refined to obtain final segmentation. Flat-epithelium and flat-endothelium images are obtained and vertically projected to locate inner corneal microlayers. Inner microlayers are estimated by translating epithelium and endothelium microlayers to detected locations then refined to obtain final segmentation. Images were segmented by trained manual operators (TMOs) and by the algorithm to assess repeatability (i.e., intraoperator error), reproducibility (i.e., interoperator and segmentation errors), and running time. A random masked subjective test was conducted by corneal specialists to subjectively grade the segmentation algorithm. Results Compared with the TMOs, the AUS had significantly less mean intraoperator error (0.53 ± 1.80 vs. 2.32 ± 2.39 pixels; P < 0.0001), it had significantly different mean segmentation error (3.44 ± 3.46 vs. 2.93 ± 3.02 pixels; P < 0.0001), and it had significantly less running time per image (0.19 ± 0.07 vs. 193.95 ± 194.53 seconds; P < 0.0001). The AUS had insignificant subjective grading for microlayer-segmentation grading (4.94 ± 0.32 vs. 4.96 ± 0.24; P = 0.5081), but it had significant subjective grading for regional-segmentation grading (4.96 ± 0.26 vs. 4.79 ± 0.60; P = 0.025). Conclusions The AUS can reproduce the manual segmentation of corneal microlayers with comparable accuracy in almost real-time and with significantly better repeatability. Translational Relevance The AUS can be useful in clinical settings and can aid the diagnosis of corneal diseases by measuring thickness of segmented corneal microlayers.
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Affiliation(s)
- Amr Elsawy
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.,Electrical and Computer Engineering, University of Miami, Coral Gables, FL, USA
| | | | - Ibrahim-Osama Sayed
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Dan Wen
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | | | - Taher Eleiwa
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.,Ophthalmology Department, Benha Faculty of Medicine, Egypt
| | - Ahmed M Sayed
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.,Biomedical Engineering Department, Faculty of Engineering, Helwan University, Egypt
| | - Mariam Raheem
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Gustavo Gameiro
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Mohamed Abou Shousha
- Bascom Palmer Eye Institute, Miller School of Medicine, University of Miami, Miami, FL, USA.,Electrical and Computer Engineering, University of Miami, Coral Gables, FL, USA.,Biomedical Engineering, University of Miami, Coral Gables, FL, USA
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20
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Wang SB, Cornish EE, Grigg JR, McCluskey PJ. Anterior segment optical coherence tomography and its clinical applications. Clin Exp Optom 2019; 102:195-207. [PMID: 30635934 DOI: 10.1111/cxo.12869] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 11/05/2018] [Accepted: 11/29/2018] [Indexed: 11/29/2022] Open
Abstract
Anterior segment optical coherence tomography (AS-OCT) has become one of the cornerstones of non-contact imaging modalities for assessing such structures as the cornea, anterior chamber angle, aqueous outflow pathway, sclera, and ocular surface structures. As such, it has a broad range of clinical applications, which have been independently reported in the literature. This paper aims to present a review of extant literature on the utility of AS-OCT and its efficacy in clinical applications, and to evaluate the quality of available evidence. The following databases were searched from inception to 24 June 2018: Medline via Ovid, Cochrane Central Register of Controlled Trials, PubMed, World Health Organization International Clinical Trials Registry Platform, EMBASE, and CINAHL. Bibliographies of identified papers were hand searched. Inclusion criteria: articles describing or assessing the use of OCT for visualising the AS. The authors excluded studies without an identified primary outcome variable. One author independently selected studies, extracted data, and assessed for risk of bias using PRISMA guidelines. This review included 82 studies, of which there were 11 cohort studies, 37 case series, 10 case studies, 21 comparative observational studies, and three non-systematic review articles. Primary outcome variables included anterior chamber angle, angle opening distance, angle recess area, trabecular iris angle, trabecula-iris space area, corneal thickness, tear meniscus height, tear meniscus area, tear meniscus volume, and the morphology of AS structures, including the ocular surface, blebs, flaps, and graft sites. This review attempts to encompass the breadth and depth of evidence for AS-OCT in the arena of diagnostics, therapeutics, and prognostics. At the same time, it brings to light the dearth of high-level evidence on this topic, suggesting the important role of randomised controlled trials and meta-analyses for the future validation of this technology.
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Affiliation(s)
- Sarah B Wang
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Elisa E Cornish
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Sydney Eye Hospital Foundation, Sydney Eye Hospital, Sydney, New South Wales, Australia.,Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - John R Grigg
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Peter J McCluskey
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney Eye Hospital, Sydney, New South Wales, Australia
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21
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Demarcation Line in the Human Cornea After Surface Ablation Observed by Optical Coherence Tomography and Confocal Microscopy. Eye Contact Lens 2018; 44 Suppl 2:S19-S23. [PMID: 29210827 DOI: 10.1097/icl.0000000000000459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate the long-term changes in anterior corneal structure after surface ablation. METHODS In this retrospective study, patients who received surface ablation including laser-assisted subepithelial keratomileusis (LASEK) and epipolis laser in situ keratomileusis at the Department of Ophthalmology of Fudan University Eye and Ear, Nose and Throat (EENT) Hospital (Shanghai, People's Republic of China) were telephoned. Patients were asked to follow-up at the refractive center. Changes in the anterior cornea (from the epithelium to the anterior stroma) were examined by optical coherence tomography (OCT) and in vivo confocal microscopy. RESULTS Thirty-four eyes of 18 patients (10 years or more after operation), 16 eyes of 8 patients (4 years after operation), 12 eyes of 6 patients (1 year after operation), 8 eyes of 4 patients (6 months after operation), and 12 eyes of 6 patients (1 month after operation) were included. Under OCT, a smooth, continuous, and highly reflective demarcation line between the epithelial layer and the stroma was noted in all eyes that received surgeries more than 1 year previously. For eyes at 6 months after operation, the complete formation of this demarcation line was detected in 12.5% (1/8) of eyes and a partial formation of this demarcation line was observed in 87.5% (7/8) of eyes. A partial formation of this demarcation line was observed in 100% (12/12) of eyes in patients at 1 month after surgery. CONCLUSIONS A demarcation line in the human cornea can be detected after corneal surface ablation. It was completely formed around postoperative 6 to 12 months. The functions and components of this structure merit investigation.
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22
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Tan B, Hosseinaee Z, Han L, Kralj O, Sorbara L, Bizheva K. 250 kHz, 1.5 µm resolution SD-OCT for in-vivo cellular imaging of the human cornea. BIOMEDICAL OPTICS EXPRESS 2018; 9:6569-6583. [PMID: 31065450 PMCID: PMC6490998 DOI: 10.1364/boe.9.006569] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/20/2018] [Accepted: 11/21/2018] [Indexed: 05/18/2023]
Abstract
We present the first spectral domain optical coherence tomography (SD-OCT) system that combines an isotropic imaging resolution of ~1.5 µm in biological tissue with a 250 kHz image acquisition rate, for in vivo non-contact, volumetric imaging of the cellular structure of the human cornea. OCT images of the healthy human cornea acquired with this system reveal the cellular structure of the corneal epithelium, cellular debris and mucin clusters in the tear film, the shape, size and spatial distribution of the sub-basal corneal nerves and keratocytes in the corneal stroma, as well as reflections from endothelial nuclei. The corneal images presented here demonstrate the potential clinical value of the new high speed, high resolution OCT system for non-invasive diagnostics and monitoring the treatment of corneal diseases.
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Affiliation(s)
- Bingyao Tan
- Department of Physics and Astronomy, University of Waterloo, Ontario, N2L 3G1, Canada
- Singapore Eye Research Institute, Singapore National Eye Center, Singapore
| | - Zohreh Hosseinaee
- Department of Physics and Astronomy, University of Waterloo, Ontario, N2L 3G1, Canada
- Department of System Design Engineering, University of Waterloo, Ontario, N2L 3G1, Canada
| | - Le Han
- Department of Physics and Astronomy, University of Waterloo, Ontario, N2L 3G1, Canada
| | - Olivera Kralj
- Department of Physics and Astronomy, University of Waterloo, Ontario, N2L 3G1, Canada
| | - Luigina Sorbara
- School of Optometry and Vision Science, University of Waterloo, Ontario, N2L 3G1, Canada
| | - Kostadinka Bizheva
- Department of Physics and Astronomy, University of Waterloo, Ontario, N2L 3G1, Canada
- Department of System Design Engineering, University of Waterloo, Ontario, N2L 3G1, Canada
- School of Optometry and Vision Science, University of Waterloo, Ontario, N2L 3G1, Canada
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23
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Baghdasaryan E, Tepelus TC, Marion KM, Bagherinia H, Sadda SR, Hsu HY. Evaluation of Corneal Epithelial Thickness Imaged by High Definition Optical Coherence Tomography in Healthy Eyes. Cornea 2018; 38:62-66. [PMID: 30211744 DOI: 10.1097/ico.0000000000001745] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate corneal epithelial thickness (CET) and corneal thickness (CT) in healthy eyes using spectral domain optical coherence tomography. METHODS Thirty-six healthy eyes were imaged using the Cirrus high-definition (HD)-optical coherence tomography device. The average CET and CT were assessed using Cirrus Review Software within predefined concentric corneal ring-shaped zones. Specific regions of CET (superior, inferior, temporal, nasal, superonasal, inferotemporal, superotemporal, and inferonasal) were also assessed. The difference between zones was compared between males and females. RESULTS The average CET was 48.3, 47.1, 46.1, and 45.8 μm in the 4 concentric zones (0-2, 2-5, 5-7, and 7-9 mm), respectively (P < 0.001). The average CT was 533.5, 550.8, and 579.4 μm in the 3 zones (0-2, 2-5, and 5-7 mm), respectively (P < 0.001). There was no statistically significant correlation between CET and CT in any of the measured zones. Males had thicker corneas than did females in each of the 3 CT zones (P < 0.05), but CET did not differ significantly. The CET superonasal-inferotemporal in 2.0 to 5.0 mm and CET superotemporal-inferonasal in 5.0- to 7.0-mm zones were significantly thinner in males than in females (-1.15 vs. 0.9 μm, -3.5 vs. -1.9 μm), respectively (P < 0.05). CONCLUSIONS Optical coherence tomography-based analysis of CET reveals that it is thinner in the periphery, whereas the total corneal thickness is greater. Although total CT seems to be influenced by sex, CET is not. Regional and sex-based variations in CT may need to be considered when assessing corneal and epithelial alterations in the setting of disease.
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Affiliation(s)
- Elmira Baghdasaryan
- Doheny Eye Institute, Los Angeles, CA.,Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Tudor C Tepelus
- Doheny Eye Institute, Los Angeles, CA.,Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | | | | | - SriniVas R Sadda
- Doheny Eye Institute, Los Angeles, CA.,Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Hugo Y Hsu
- Doheny Eye Institute, Los Angeles, CA.,Department of Ophthalmology, David Geffen School of Medicine, UCLA, Los Angeles, CA
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Anterior Segment Optical Coherence Tomography (AS-OCT) in the Management of Dry Eye. Int Ophthalmol Clin 2018; 57:13-22. [PMID: 28282311 DOI: 10.1097/iio.0000000000000164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Ang M, Baskaran M, Werkmeister RM, Chua J, Schmidl D, Aranha dos Santos V, Garhöfer G, Mehta JS, Schmetterer L. Anterior segment optical coherence tomography. Prog Retin Eye Res 2018; 66:132-156. [DOI: 10.1016/j.preteyeres.2018.04.002] [Citation(s) in RCA: 216] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 02/20/2018] [Accepted: 04/04/2018] [Indexed: 02/03/2023]
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Venkateswaran N, Galor A, Wang J, Karp CL. Optical coherence tomography for ocular surface and corneal diseases: a review. EYE AND VISION 2018; 5:13. [PMID: 29942817 PMCID: PMC5996489 DOI: 10.1186/s40662-018-0107-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/27/2018] [Indexed: 01/31/2023]
Abstract
The advent of optical coherence tomography (OCT) imaging has changed the way ophthalmologists image the ocular surface and anterior segment of the eye. Its ability to obtain dynamic, high and ultra-high resolution, cross-sectional images of the ocular surface and anterior segment in a noninvasive and rapid manner allows for ease of use. In this review, we focus on the use of anterior segment OCT, which provides an “optical biopsy” or in vivo imaging of various ocular surface and corneal pathologies, allowing the clinician to diagnose diseases otherwise not visualized by traditional methods. The utility of anterior segment OCT for various anterior segment pathologies is reviewed.
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Affiliation(s)
- Nandini Venkateswaran
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, McKnight Building Room 202A, 1638 NW 10th Avenue, 900 NW 17th Street, Miami, FL 33136 USA
| | - Anat Galor
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, McKnight Building Room 202A, 1638 NW 10th Avenue, 900 NW 17th Street, Miami, FL 33136 USA.,2Department of Ophthalmology, Miami Veterans Administration Medical Center, 1201 NW 16th Street, Miami, FL 33125 USA
| | - Jianhua Wang
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, McKnight Building Room 202A, 1638 NW 10th Avenue, 900 NW 17th Street, Miami, FL 33136 USA
| | - Carol L Karp
- 1Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, McKnight Building Room 202A, 1638 NW 10th Avenue, 900 NW 17th Street, Miami, FL 33136 USA
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Han JY, Lee DC, Lee SY. Horizontal Extraocular Muscle and Scleral Anatomy in Children: A Swept-Source Anterior Segment Optical Coherence Tomography Study. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:83-88. [PMID: 29560615 PMCID: PMC5906406 DOI: 10.3341/kjo.2017.0034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/03/2017] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To evaluate the efficacy of anterior segment swept-source optical coherence tomography (SS-OCT) for examining horizontal extraocular muscle thickness, distance from the corneal limbus to the insertion of the horizontal extraocular muscle (limbus to insertion distance), and scleral thickness in Korean pediatric strabismus patients. METHODS This study included pediatric strabismus patients between 5 and 10 years of age. Children with any ocular disease other than strabismus or a history of ocular surgery were excluded. SS-OCT was used to measure horizontal extraocular muscle thickness, limbus to insertion distance, and scleral thickness. Eyes were classified into subgroups by sex, spherical equivalent of the refractive error (measured with cycloplegic refraction), and fixating/deviating eye. RESULTS One patient initially included in this study was excluded due to poor cooperation. Of the remaining 35 eyes of 20 patients, 19 eyes (54.3%) were from male patients and 16 eyes (45.7%) were from female patients. The mean patient age was 7.86 ± 1.38 years. Lateral scleral thickness was greater in male eyes than in female eyes (p = 0.048). No other differences were noted between male and female children. Additionally, there were no statistically significant differences between fixating and deviating eyes or among spherical equivalent groups for any parameter examined. CONCLUSIONS Anterior segment SS-OCT can successfully and comfortably measure horizontal extraocular muscle and scleral anatomy in children. These measurements may be helpful for treatment and follow-up of pediatric strabismus patients.
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Affiliation(s)
- Jung Yeob Han
- Department of Ophthalmology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Dong Cheol Lee
- Department of Ophthalmology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Se Youp Lee
- Department of Ophthalmology, Keimyung University Dongsan Medical Center, Daegu, Korea.
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Observation of Retrocorneal Plaques in Patients With Infectious Keratitis Using Anterior Segment Optical Coherence Tomography. Cornea 2018; 36:1237-1242. [PMID: 28704321 DOI: 10.1097/ico.0000000000001286] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE Endothelial plaques are a typical characteristic in patients with fungal keratitis. However, bacterial keratitis and herpetic keratouveitis are rarely associated with fibrin formation on the retrocorneal surface. This study was conducted to examine plaques attached to the endothelium in patients with infectious keratitis using anterior segment optical coherence tomography (AS-OCT). METHODS Seventeen patients (10 women and 7 men; mean age, 75 ± 15.5 years) suspected to have infectious keratitis with retrocorneal plaques were included. AS-OCT was used to acquire a scan of the retrocorneal plaque at the patient's first visit. RESULTS Based on the culture results and detection of viral DNA, the patients were diagnosed with fungal keratitis (6 patients), bacterial keratitis (8 patients), and herpetic keratouveitis (3 patients). Examination of the cornea using AS-OCT showed a clear boundary between the corneal endothelial surface and plaque in 8 patients with bacterial keratitis and in all patients with herpetic keratitis. Moreover, a space between the corneal endothelial surface and plaque was found in 3 patients with bacterial keratitis. In 5 patients with fungal keratitis, the AS-OCT images showed an unclear boundary between the corneal endothelial surface and plaque, and high reflection of the plaque was extended from the corneal lesion. CONCLUSIONS Endothelial plaques in patients with fungal keratitis could continue from the corneal lesion. Observation of retrocorneal plaques using AS-OCT could be used in the diagnosis of infectious keratitis.
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Jung EH, Kim JH, Kim SJ, Yu YS. Fluorescein Angiographic Abnormalities in the Contralateral Eye with Normal Fundus in Children with Unilateral Coats' Disease. KOREAN JOURNAL OF OPHTHALMOLOGY 2018; 32:65-69. [PMID: 29376220 PMCID: PMC5801092 DOI: 10.3341/kjo.2016.0092] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 03/07/2017] [Indexed: 11/23/2022] Open
Abstract
Purpose We report the detection of peripheral retinal vascular abnormalities in the fellow eye with normal fundus in children with unilateral Coats' disease. Methods The clinical records of patients diagnosed with Coats' disease were retrospectively reviewed. We recorded the subjects' characteristics and obtained fundus photography and fluorescein angiography (FA) images. The main outcome measure was peripheral vascular abnormalities in the contralateral eye with normal fundus in children with unilateral Coats' disease, observed with FA. Results Out of 47 patients with Coats' disease, two (4.3%) were diagnosed with clinically bilateral Coats' disease. Of the 45 patients with presumed unilateral Coats' disease, four (8.9%) had bilateral abnormal peripheral vasculature in FA. The mean age of these four patients was 6.4 ± 5.4 years (range, 1 to 14 years), and three patients were male (75%). All four had peripheral retinal nonperfusion, and two (50%) received laser photocoagulation due to peripheral leakage with telangiectatic vessels. Conclusions Coats' disease may more often be a bilateral disease with asymmetry than previously thought. Patients with Coats' disease should undergo careful examination of the fellow eye with FA in order to detect and treat vascular abnormalities that are not visible clinically.
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Affiliation(s)
- Eun Hye Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea
| | - Jeong Hun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Seong Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea
| | - Young Suk Yu
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea.,Seoul Artificial Eye Center, Seoul National University Hospital Clinical Research Institute, Seoul, Korea.
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Pinilla Lozano I, López de la Fuente C, Segura F, Orduna Hospital E, Sánchez-Cano A. Evaluation of anterior chamber parameters with spectral-domain optical coherence tomography. Jpn J Ophthalmol 2017; 62:209-215. [PMID: 29188463 DOI: 10.1007/s10384-017-0548-3] [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: 05/02/2017] [Accepted: 10/26/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate several anterior chamber parameters in healthy young adults using spectral-domain optical coherence tomography and to describe the repeatability and reproducibility of this method. STUDY DESIGN Prospective clinical study. METHODS Fifty-two eyes of 52 healthy volunteers were enrolled. Manual measurements of the anterior chamber angle (ACA500 and ACA750), angle opening distance (AOD500 and AOD750), angle-to-angle distance (ATA), anterior chamber width (ACW), and lens vault (LV) were obtained. RESULTS The mean nasal ACA500 was 44.87 ± 12.92°; ACA750, 43.94 ± 10.41°; AOD500, 672.54 ± 270.19 µm; AOD750, 881.87 ± 290.55 µm. The mean temporal ACA500 was 41.46 ± 11.20°; ACA750, 41.27 ± 11.31°; AOD500, 603.15 ± 232.28 µm; AOD750, 823.46 ± 308.76 µm. The differences between the corresponding nasal and temporal parameters were statistically significant. The ACW was 11.97 ± 0.42 mm, the ATA was 12.10 ± 0.43 mm, and the LV was 3.71 ± 232.93 µm. The ACA was highly associated with the LV. The intraclass correlation coefficients ranged from 0.984 to 0.999 for the intraobserver repeatability and from 0.966 to 0.998 for the interobserver reproducibility. CONCLUSIONS This study assessed anterior chamber parameters in healthy young adults using spectral-domain optical coherence tomography. This technique reveals the spatial relationships of the ocular structures, provides high-resolution images, and results in high degrees of intraobserver and interobserver repeatabilities.
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Affiliation(s)
- Isabel Pinilla Lozano
- Department of Surgery, Gynecology and Obstetrics, University of Zaragoza, Zaragoza, Spain.
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain.
- Department of Ophthalmology, Lozano Blesa University Hospital, Zaragoza, Spain.
| | - Carmen López de la Fuente
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain
| | - Francisco Segura
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain
| | - Elvira Orduna Hospital
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- Department of Physiology and Pharmacology, University of Zaragoza, Zaragoza, Spain
| | - Ana Sánchez-Cano
- Aragon Institute for Health Research (IIS Aragon), Zaragoza, Spain
- Department of Applied Physics, University of Zaragoza, Zaragoza, Spain
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31
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Mashige KP, Oduntan OA. Retinal nerve fibre layer thickness values and their associations with ocular and systemic parameters in Black South Africans. Afr Health Sci 2016; 16:1188-1194. [PMID: 28479914 DOI: 10.4314/ahs.v16i4.39] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To measure the retinal nerve fibre layer (RNFL) thickness values and investigate their associations with other parameters in healthy eyes of Black South Africans. METHODS 600 participants with healthy eyes, of whom 305 (50.83%) were males and 295 (49.17%) were females, with a mean age of 28.15 ± 13.09 years, underwent a detailed ophthalmic examination. RNFL thickness was measured by iVue SD-OCT. RESULTS The mean global RNFL thickness was 110.01 ± 7.39 µm. The RNFL was thickest inferiorly (135.06 ± 9.66 µm) and superiorly (131.72 ± 10.46 µm), thinner nasally (87.24 ± 13.22 µm), and thinnest temporally (73.63 ± 15.66 µm). Multivariate analysis showed that thicker mean global RNFL thickness was significantly associated with younger age, shorter axial length (AL) and hyperopia (p < 0.001). Mean RNFL thickness decreased by approximately 0.11 µm per year of aging life, and by 1.02 µm for each 1-mm of axial elongation. There was a 0.62 µm RNFL thickness increase for every dioptre change in spherical power towards more hyperopia. CONCLUSION Mean RNFL thickness values and their associations established in this population may be of clinical value when assessing factors that influence this parameter and diagnosing diseases affecting it.
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Anterior Segment Imaging in Ocular Surface Squamous Neoplasia. J Ophthalmol 2016; 2016:5435092. [PMID: 27800176 PMCID: PMC5069377 DOI: 10.1155/2016/5435092] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 08/15/2016] [Indexed: 12/21/2022] Open
Abstract
Recent advances in anterior segment imaging have transformed the way ocular surface squamous neoplasia (OSSN) is diagnosed and monitored. Ultrasound biomicroscopy (UBM) has been reported to be useful primarily in the assessment of intraocular invasion and metastasis. In vivo confocal microscopy (IVCM) shows enlarged and irregular nuclei with hyperreflective cells in OSSN lesions and this has been found to correlate with histopathology findings. Anterior segment optical coherence tomography (AS-OCT) demonstrates thickened hyperreflective epithelium with an abrupt transition between abnormal and normal epithelium in OSSN lesions and this has also been shown to mimic histopathology findings. Although there are limitations to each of these imaging modalities, they can be useful adjunctive tools in the diagnosis of OSSN and could greatly assist the clinician in the management of OSSN patients. Nevertheless, anterior segment imaging has not replaced histopathology's role as the gold standard in confirming diagnosis.
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Applications of Anterior Segment Optical Coherence Tomography in Cornea and Ocular Surface Diseases. J Ophthalmol 2016; 2016:4971572. [PMID: 27721988 PMCID: PMC5046038 DOI: 10.1155/2016/4971572] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/31/2016] [Indexed: 11/29/2022] Open
Abstract
Optical coherence tomography (OCT) is a noncontact technology that produces high-resolution cross-sectional images of ocular tissues. Anterior segment OCT (AS-OCT) enables the precise visualization of anterior segment structure; thus, it can be used in various corneal and ocular surface disorders. In this review, the authors will discuss the application of AS-OCT for diagnosis and management of various corneal and ocular surface disorders. Use of AS-OCT for anterior segment surgery and postoperative management will also be discussed. In addition, application of the device for research using human data and animal models will be introduced.
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Abstract
PURPOSE To describe a case of Lisch epithelial corneal dystrophy (LECD) and present its unique characteristics on high-resolution optical coherence tomography (HR-OCT). METHODS A 78-year-old man with whorled corneal epithelial opacities in the right eye was referred for the evaluation of ocular surface squamous neoplasia. Clinical evaluation, photographs, and HR-OCT images of the cornea involved were obtained and scrapings of the affected cornea were sent for histopathologic analysis. RESULTS Clinically, the patient presented with an opalescent whirling epithelium in a linear pattern encroaching on the visual axis. HR-OCT showed normal thickness epithelial hyperreflectivity of involved cornea without stromal involvement, along with sharply demarcated borders of unaffected tissue. Histopathologic findings demonstrated vacuolated periodic acid-Schiff (PAS) positive cells throughout the epithelial layers consistent with LECD. CONCLUSIONS HR-OCT was able to provide useful information to rule out ocular surface squamous neoplasia and confirm the clinical impression of LECD at the time of clinical examination. HR-OCT shows promise as an adjunctive diagnostic tool for ocular surface lesions and pathologies.
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35
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Abbott AB, Knickelbein JE, Wiley HE, Chew EY, Wong WT. Ocular von Hippel-Lindau Disease – clinical characteristics and future directions. EXPERT REVIEW OF OPHTHALMOLOGY 2016. [DOI: 10.1080/17469899.2016.1224652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Xu Z, Jiang J, Yang C, Huang S, Peng M, Li W, Cui L, Wang J, Lu F, Shen M. Value of corneal epithelial and Bowman's layer vertical thickness profiles generated by UHR-OCT for sub-clinical keratoconus diagnosis. Sci Rep 2016; 6:31550. [PMID: 27511620 PMCID: PMC4980663 DOI: 10.1038/srep31550] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 07/19/2016] [Indexed: 11/22/2022] Open
Abstract
Ultra-high resolution optical coherence tomography (UHR-OCT) can image the corneal epithelium and Bowman’s layer and measurement the thicknesses. The purpose of this study was to validate the diagnostic power of vertical thickness profiles of the corneal epithelium and Bowman’s layer imaged by UHR-OCT in the diagnosis of sub-clinical keratoconus (KC). Each eye of 37 KC patients, asymptomatic fellow eyes of 32 KC patients, and each eye of 81 normal subjects were enrolled. Vertical thickness profiles of the corneal epithelium and Bowman’s layer were measured by UHR-OCT. Diagnostic indices were calculated from vertical thickness profiles of each layer and output values of discriminant functions based on individual indices. Receiver operating characteristic curves were determined, and the accuracy of the diagnostic indices were assessed as the area under the curves (AUC). Among all of the individual indices, the maximum ectasia index for epithelium had the highest ability to discriminate sub-clinical KC from normal corneas (AUC = 0.939). The discriminant function containing maximum ectasia indices of epithelium and Bowman’s layer further increased the AUC value (AUC = 0.970) for sub-clinical KC diagnosis. UHR-OCT-derived thickness indices from the entire vertical thickness profiles of the corneal epithelium and Bowman’s layer can provide valuable diagnostic references to detect sub-clinical KC.
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Affiliation(s)
- Zhe Xu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jun Jiang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Chun Yang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Shenghai Huang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mei Peng
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Weibo Li
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lele Cui
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, USA
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
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Abstract
PURPOSE To demonstrate the use of the slitlamp photography and videography with extremely high magnifications for visualizing structures of the anterior segment of the eye. METHODS A Canon 60D digital camera with Movie Crop Function was adapted into a Nikon FS-2 slitlamp to capture still images and video clips of the structures of the anterior segment of the eye. Images obtained using the slitlamp were tested for spatial resolution. The cornea of human eyes was imaged with the slitlamp, and the structures were compared with the pictures captured using the ultra-high-resolution optical coherence tomography (UHR-OCT). The central thickness of the corneal epithelium and total cornea was obtained using the slitlamp, and the results were compared with the thickness obtained using UHR-OCT. RESULTS High-quality ocular images and higher spatial resolutions were obtained using the slitlamp with extremely high magnifications and Movie Crop Function, rather than the traditional slitlamp. The structures and characteristics of the cornea, such as the normal epithelium, abnormal epithelium of corneal intraepithelial neoplasia, laser in situ keratomileusis interface, and contact lenses, were clearly visualized using this device. These features were confirmed by comparing the obtained images with those acquired using UHR-OCT. Moreover, the tear film debris on the ocular surface and the corneal nerve in the anterior corneal stroma were also visualized. The thicknesses of the corneal epithelium and total cornea were similar to that measured using UHR-OCT (P<0.05). CONCLUSIONS We demonstrated that the slitlamp photography and videography with extremely high magnifications allow better visualization of the anterior segment structures of the eye, especially of the epithelium, when compared with the traditional slitlamp.
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Pihlblad MS, Erenler F, Sharma A, Manchandia A, Reynolds JD. Anterior Segment Optical Coherence Tomography of the Horizontal and Vertical Extraocular Muscles With Measurement of the Insertion to Limbus Distance. J Pediatr Ophthalmol Strabismus 2016; 53:141-5. [PMID: 27224947 DOI: 10.3928/01913913-20160405-05] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 01/21/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To assess the possibility of determining the insertion distance from the limbus of horizontal and vertical extraocular rectus muscles with anterior segment optical coherence tomography (AS-OCT). METHODS The right eyes of 46 patients underwent AS-OCT. The horizontal and vertical extraocular rectus muscle insertion distances from the limbus were measured in a masked fashion by two pediatric ophthalmologists. RESULTS Forty-two lateral rectus, 43 medial rectus, 35 inferior rectus, and 40 superior rectus muscles of the right eyes of 46 patients were included. Insertion to limbus measurements (mean ± SD) were as follows: lateral rectus = mean 6.8 ± 0.7 mm, range = 4.8 to 8.4 mm; medial rectus = mean 5.7 ± 0.8 mm, range = 4.3 to 7.8 mm; inferior rectus = mean 6.0 ± 0.6 mm, range = 4.8 to 7.0 mm; superior rectus = mean 6.8 ± 0.6 mm, range = 5.5 to 8.1 mm. The intraobserver and interobserver correlation coefficients for the insertion to limbus measurements of all four rectus muscles exceeded 0.75 (excellent correlation). CONCLUSIONS The study showed that AS-OCT is capable of imaging all four of the rectus muscle insertions and measuring the insertion to limbus distance, and is the second AS-OCT study to image the superior and inferior rectus muscle insertions. The insertion to limbus measurements between examiners and on repeat measurements were consistent and reproducible. The ability to accurately image extraocular rectus muscle insertions may have future implications for the preoperative procedure planning in patients who have had previous surgery. [J Pediatr Ophthalmol Strabismus. 2016;53(3):141-145.].
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López de la Fuente C, Sánchez-Cano A, Segura F, Hospital EO, Pinilla I. Evaluation of Total Corneal Thickness and Corneal Layers With Spectral-Domain Optical Coherence Tomography. J Refract Surg 2016; 32:27-32. [DOI: 10.3928/1081597x-20151207-03] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
PURPOSE:
To evaluate total corneal thickness and corneal layers in healthy young adults using spectral-domain optical coherence tomography and to describe its repeatability and reproducibility.
METHODS:
Eighty-six eyes from 86 healthy volunteers were prospectively and consecutively enrolled. Manual measurements of central corneal thickness (CCT) and central thickness of epithelium, Bowman's layer, stroma, and the Descemet–endothelium complex were performed using Spectralis OCT (Heidelberg Engineering, Heidelberg, Germany). To assess the reliability of the repeated measurements, intraclass correlation coefficients and coefficients of variation were used.
RESULTS:
Mean CCT, epithelium, Bowman's layer, stroma, and Descemet–endothelium values were 555.50 ± 29.64, 54.60 ± 4.25, 16.70 ± 1.73, 467.51 ± 28.91, and 16.74 ± 1.66
µ
m, respectively. The intraclass correlation coefficients ranged from 0.746 (Bowman's layer) to 0.999 (CCT and stroma) and from 0.483 (Bowman's layer) to 0.995 (CCT) and 0.998 (stroma) for intraobserver repeatability and interobserver reproducibility, respectively. The measurements showed coefficients of variation lower than 11% in all cases.
CONCLUSIONS:
This study establishes a normal database for corneal thickness and all its layers in healthy young adults with spectral-domain optical coherence tomography. This device exhibited a high degree of intraobserver repeatability and interobserver reproducibility for all regions except Bowman's layer.
[
J Refract Surg.
2016;32(1):27–32.]
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Agreement and reproducibility of retinal pigment epithelial detachment volumetric measurements through optical coherence tomography. Retina 2015; 35:467-72. [PMID: 25545485 DOI: 10.1097/iae.0000000000000355] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess the agreement and reproducibility of retinal pigment epithelial detachment (RPED) volumetric measurements using a commercially available optical coherence tomography software available for the Zeiss Cirrus HD-OCT. METHODS Twelve eyes of 10 patients with a diagnosis of neovascular age-related macular degeneration with RPED, seen at the New England Eye Center between October 2012 and December 2012, were enrolled in the study. Three separate scans per affected eye were obtained using the "Macular Cube 512 × 128" protocol. "Retinal pigment epithelial (RPE) elevation analysis" software was used to measure RPED volumes in the central 3-mm and 5-mm circles by calculating the volume between the "RPE fit" and "true RPE" lines. All 128 raster scans for each eye were exported into the AMIRA software for manual segmentation of RPED volumes in the central 3-mm and 5-mm circles. Interscan reproducibility and manual-to-automated agreement were assessed by intraclass correlation coefficient. Incidence of automated segmentation line error for both RPE fit and true RPE lines in the central 1 mm region was calculated. RESULTS Average RPED volumes through automated segmentation software were 0.14 mm3 and 0.21 mm3 in the central 3-mm and 5-mm circles, respectively. Manual segmentation yielded average RPED volumes of 0.50 mm3 in the 3-mm circles and 0.92 mm3 in the 5-mm circles. Manual segmentation yielded significantly greater RPED volumes compared with automated measurements (P < 0.05). Intraclass correlation coefficients across the 3 automated measurements were 0.954 and 0.983 for volume in the 3-mm and 5-mm circles, respectively. Intraclass correlation coefficients between the manual and automatic volumes were 0.296 and 0.337 for the 3-mm and 5-mm circles, respectively. In the central 1 mm region, 11 of the 12 scans had breakdown in RPE fit line, whereas 8 of the 12 scans showed true RPE line breakdown. CONCLUSION Automated "RPED elevation" software demonstrated high interscan reproducibility. However, it showed low agreement with manual measurements from high rates of segmentation line breakdown, especially at the level of the RPE fit line (91.7%). Manual measurements resulted in greater volumes compared with automated measurements.
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Axmann S, Ebneter A, Zinkernagel MS. Imaging of the Sclera in Patients with Scleritis and Episcleritis using Anterior Segment Optical Coherence Tomography. Ocul Immunol Inflamm 2015; 24:29-34. [DOI: 10.3109/09273948.2015.1025983] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Shadi Axmann
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Andreas Ebneter
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Martin S. Zinkernagel
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Switzerland
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Enhanced-depth optical coherence tomography for imaging horizontal rectus muscles in Graves’ orbitopathy. Graefes Arch Clin Exp Ophthalmol 2015; 253:1569-73. [DOI: 10.1007/s00417-015-3060-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 05/12/2015] [Accepted: 05/14/2015] [Indexed: 12/26/2022] Open
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Xu Z, Shen M, Hu L, Zhuang X, Peng M, Hu D, Liu J, Wang J, Qu J, Lu F. The Impact of Flap Creation Methods for Sub-Bowman's Keratomileusis (SBK) on the Central Thickness of Bowman's Layer. PLoS One 2015; 10:e0124996. [PMID: 25938492 PMCID: PMC4418749 DOI: 10.1371/journal.pone.0124996] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 03/19/2015] [Indexed: 11/20/2022] Open
Abstract
Purpose To determine the impact of flap creation methods for sub-Bowman’s keratomileusis (SBK) on central Bowman’s layer thickness. Methods SBK flaps were made by Moria microkeratome for 20 subjects and by femtosecond (FEMTO) laser for 21 subjects. Corneal sublayer thicknesses were measured by ultra-high resolution optical coherence tomography before SBK and at 1 day, 1 week, 2 weeks, and 1 month afterwards. Each subject was imaged twice on each visit. Thicknesses of central epithelium, Bowman’s layer, flap, and total cornea were calculated using a custom-made automated image processing algorithm. The repeatability of sublayer thickness measurements was tested by the intraclass correlation coefficient (ICC) and by the coefficient of repeatability (CoR) at 1 week post-SBK. Results ICCs of the Moria and FEMTO groups were ≥0.959 and ≥0.961 respectively for all sublayer measurements. The segmentation CoRs were less than 6.78% and 5.63% respectively. For both groups, microdistortions were present in the epithelium and Bowman’s layer after SKB. The flap thickness of the Moria group was 9.8 μm (95% confidence interval: 4.8 – 14.8μm) thinner than the FEMTO group one day after SBK (independent samples t-test, P < 0.05). Bowman’s layer became thicker by 1.6 ± 1.1 μm and 1.7 ± 1.6 μm one day post-SBK for the Moria and FEMTO groups (repeated ANOVA, P < 0.05) and then remained stable. Corneal and sublayer thickness were similar between the two groups. Conclusions Central Bowman’s layer thickness increased 1 day post-SBK. Flap creation by Moria microkeratome and femtosecond laser did not have significantly different impacts on Bowman’s layer thickness following SBK. Trial Registration Chinese Clinical Trial Registry (ChiCTR) NO: ChiCTR-OCH-14004525
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Affiliation(s)
- Zhe Xu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Liang Hu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiran Zhuang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Mei Peng
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Di Hu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jing Liu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Jianhua Wang
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States of America
| | - Jia Qu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
- * E-mail:
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Kossler AL, Wang J, Feuer W, Tse DT. Neurostimulation of the lacrimal nerve for enhanced tear production. Ophthalmic Plast Reconstr Surg 2015; 31:145-51. [PMID: 25126767 PMCID: PMC4329098 DOI: 10.1097/iop.0000000000000234] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE To design a proof-of-concept study to assess the effect of lacrimal nerve stimulation (LNS) with an implantable pulse generator (IPG) to increase aqueous tear production. METHODS Experimental animal study design of 6 Dutch Belted rabbits. Ultra high-resolution optical coherence tomography (UHR-OCT) quantified tear production by measuring the baseline tear volume of each rabbit's OD and OS. A neurostimulator was implanted adjacent to the right lacrimal nerve. After 2 minutes of LNS (100 μs, 1.6 mA, 20 Hz, 5-8 V), the tear volumes were measured with UHR-OCT. The change in tear volume was quantified and compared with the nonstimulated OS. Three rabbits underwent chronic LNS (100 μs, 1.6 mA, 10 Hz, 2 V) and their lacrimal glands were harvested for histopathologic analysis. RESULTS The UHR-OCT imaging of the OD tear volume showed a 441% average increase in tear production after LNS as a percent of baseline. After stimulation, OD had statistically significant greater increase in tear volumes than OS (p = 0.028, Wilcoxon test). Poststimulation OD tear volumes were significantly greater compared with baseline (p = 0.028, Wilcoxon test). Histopathologic examination of the lacrimal glands showed no discernible tissue damage from chronic neurostimulation. In addition, there were no gross adverse effects on the general well-being of the animals due to chronic stimulation. CONCLUSIONS LNS with an IPG appears to increase aqueous tear production. Chronic LNS showed no histopathologic lacrimal gland damage. This study suggests that LNS is a promising new treatment strategy to increase aqueous tear production.
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Affiliation(s)
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - William Feuer
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
| | - David T. Tse
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine
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Das P, Gokani A, Bagchi K, Bhaduri G, Chaudhuri S, Law S. Limbal epithelial stem-microenvironmental alteration leads to pterygium development. Mol Cell Biochem 2015; 402:123-39. [PMID: 25559558 DOI: 10.1007/s11010-014-2320-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/23/2014] [Indexed: 12/13/2022]
Abstract
Maintenance of tissue homeostasis relies on the accurate regulation of tissue specific stem cell activity which is governed by the dynamic interaction between the positive and negative feedback modulating mechanism of stem cell microenvironmental niche. Alteration or deregulation of the "stem-microenvironmental networking" provokes disease development. Limbal epithelial stem cells (LESC) are the initiator hierarchy that maintains corneal integrity. Compartmentalization of LESC within the limbal vicinity provides an opportunity to understand the stem-microenvironmental relationship. The purpose of this study was to determine the microenvironmental alteration associated with LESCs fate in pterygium condition in comparison with healthy state. Clinical observations evaluated the ocular surface disorder with respect to corneal vascularization, tear film abnormality, and thickening of limbal area in pterygium patients. Structural alteration of limbal stem/progenitor cells and its neighboring niche components were observed using histology and scanning electron microscopy. Receptor overexpression of TGFβ-R1, EGF-R1, and IL6-Rα and alteration of IL2-Rα expression pointed toward aberration of "stem-microenvironmental networking" in the limbal vicinity during disease development. Increased cell proliferation index along with TERT, Cyclin-D1, and PCNA over-expression in limbal part of pterygium epithelial cells indicated increased cellular proliferation and disturbed homeostatic equilibrium. We postulate that pterygium is associated with limbal microenvironmental anomaly where the resident epithelial cells became hyperproliferative.
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Affiliation(s)
- Prosun Das
- Stem Cell Research and Application Unit, Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine, 108 C R Avenue, Kolkata, 700073, India
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Monitor corneal epithelial healing under bandage contact lens using ultrahigh-resolution optical coherence tomography after pterygium surgery. Eye Contact Lens 2015; 40:175-80. [PMID: 24756122 DOI: 10.1097/icl.0000000000000027] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To monitor corneal epithelial healing under bandage contact lens (BCL) using ultrahigh-resolution optical coherence tomography (UHR-OCT) after pterygium surgery. METHODS Thirty-nine eyes of 39 patients undergoing pterygium excision and conjunctival autografting were randomly allocated into 2 groups: 20 eyes were covered with silicone hydrogel BCLs at the end of surgery and 19 eyes served as a control. Ultrahigh-resolution optical coherence tomography scans of the cornea were performed sequentially at 1, 2, and 3 days, and then every other day until the end of re-epithelialization after surgery. Complete epithelial healing was verified with fluorescein staining examination after removal of BCLs. Postsurgery pain was evaluated using the visual analog scale. RESULTS All BCLs were successfully fit without any contact lens-related complications. Ultrahigh-resolution optical coherence images clearly revealed the architectural features of postoperative cornea with BCL in situ and showed epithelial healing process. Ultrahigh-resolution optical coherence tomography imaging agreed with the fluorescein staining examinations in detecting corneal epithelial defect. Based on the assessment by UHR-OCT, the average time course of re-epithelialization in the BCL group was 3.9±1.2 days, whereas in the control group, it was 5.7±1.8 days (P=0.001). Visual analog scale scoring showed lower pain levels in the BCL group comparing with the control group at each point of time (all P<0.05). CONCLUSIONS Ultrahigh-resolution optical coherence tomography is an excellent tool in monitoring corneal epithelial healing under BCLs and determining the appropriate time for lens removal. Silicone hydrogel BCL is recommended as an adjuvant therapy after pterygium surgery for its efficacy in improving re-epithelialization and postoperative comfort.
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Shelton RL, Jung W, Sayegh SI, McCormick DT, Kim J, Boppart SA. Optical coherence tomography for advanced screening in the primary care office. JOURNAL OF BIOPHOTONICS 2014; 7:525-33. [PMID: 23606343 PMCID: PMC3922891 DOI: 10.1002/jbio.201200243] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2012] [Revised: 03/15/2013] [Accepted: 03/16/2013] [Indexed: 05/26/2023]
Abstract
Optical coherence tomography (OCT) has long been used as a diagnostic tool in the field of ophthalmology. The ability to observe microstructural changes in the tissues of the eye has proved very effective in diagnosing ocular disease. However, this technology has yet to be introduced into the primary care office, where indications of disease are first encountered. We have developed a portable, handheld imaging probe for use in the primary care setting and evaluated its tissue site accessibility, ability to observe diseased tissue, and screening capabilities in in vivo human patients, particularly for pathologies related to the eye, ear and skin. Various stages of diabetic retinopathy were investigated using the handheld probe and early-stage diabetic retinopathy was flagged as abnormal from the OCT images. At such early stages of disease, it is difficult to observe abnormalities with the limited tools that are currently available to primary care physicians. These results indicate that OCT shows promise to transform from being a diagnostic technology in the medical and surgical specialities to a screening technology in the primary care office and at the front-line of healthcare.
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Affiliation(s)
- Ryan L. Shelton
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL USA
| | - Woonggyu Jung
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL USA
- School of Nano-Bioscience and Chemical Engineering, Ulsan National Institute of Science and Technology, Korea
| | | | | | - Jeehyun Kim
- Department of Electrical and Computer Engineering, Kyungpook National University, Korea
| | - Stephen A. Boppart
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL USA
- Departments of Electrical and Computer Engineering, Bioengineering, and Medicine, University of Illinois at Urbana-Champaign, Urbana, IL USA
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Das SK, Gupta I, Cho YK, Zhang X, Uehara H, Muddana SK, Bernhisel AA, Archer B, Ambati BK. Vimentin knockdown decreases corneal opacity. Invest Ophthalmol Vis Sci 2014; 55:4030-40. [PMID: 24854859 DOI: 10.1167/iovs.13-13494] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Wound induced corneal fibrosis can lead to permanent visual impairment. Keratocyte activation and differentiation play a key role in fibrosis, and vimentin, a major structural type III intermediate filament, is a required component of this process. The purpose of our study was to develop a nonviral therapeutic strategy for treating corneal fibrosis in which we targeted the knockdown of vimentin. METHODS To determine the duration of plasmid expression in corneal keratocytes, we injected a naked plasmid expressing green fluorescent protein (GFP; pCMV-GFP) into an unwounded mouse corneal stroma. We then injected pCMV-GFP or plasmids expressing small hairpin RNA in the corneal wound injury model (full-thickness corneal incision) to evaluate opacification. RESULTS GFP expression peaked between days 1 and 3 and had prominent expression for 15 days. In the corneal wound injury model, we found that the GFP-positive cells demonstrated extensive dendritic-like processes that extended to adjacent cells, whereas the vimentin knockdown model showed significantly reduced corneal opacity. CONCLUSIONS These findings suggest that a nonviral gene therapeutic approach has potential for treating corneal fibrosis and ultimately reducing scarring.
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Affiliation(s)
- Subrata K Das
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Isha Gupta
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Yang Kyung Cho
- St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, South Korea
| | - Xiaohui Zhang
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Hironori Uehara
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Santosh Kumar Muddana
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Ashlie A Bernhisel
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Bonnie Archer
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
| | - Balamurali K Ambati
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, Utah, United States
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Phacoemulsification induced transient swelling of corneal Descemet's Endothelium Complex imaged with ultra-high resolution optical coherence tomography. PLoS One 2013; 8:e80986. [PMID: 24312254 PMCID: PMC3842923 DOI: 10.1371/journal.pone.0080986] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 10/17/2013] [Indexed: 11/19/2022] Open
Abstract
Purpose Thickness changes of corneal sub-layers after phacoemulsification were investigated by spectral domain ultra-high resolution optical coherence tomography (UHR-OCT). Methods The corneas (n = 26) of 26 age-related cataract surgery patients were studied. UHR-OCT was used to evaluate the thickness of Descemet’s Endothelium Complex (DEC), stroma, Bowman’s layer, epithelium, and full cornea at the center (CCT) before, one day after, and one week after surgery. Non-contact specular microscopy measured CCT, endothelial cell density, and morphology. Results The DEC, stroma, Bowman’s layer, and epithelium were visualized by UHR-OCT. Before surgery, the DEC in all cases appeared as a translucent space between two smooth opaque lines. One day after surgery, the posterior corneal surfaces in half of the eyes were wavy and irregular. Compared to the baseline, one day after surgery the thickness increases of the DEC, stroma, and CCT were 4.3 ± 2.6 µm, 25.5 ± 24.9 µm, and 32.1 ± 26.6 µm, respectively (P < 0.001). The morphology of the DEC and the CCT recovered to baseline one week after surgery (P > 0.05), but endothelial cell density was 8.7% less than at baseline. There were no significant changes in Bowman’s layer and epithelium after the operation. The pre-operative DEC thickness was positively correlated with the decreased endothelial cell density at 1 day after surgery (r = 0.55, P = 0.003). Conclusions The DEC showed edematous thickening and different degrees of morphological changes after phacoemulsification. The DEC deformation and corneal edema recovered by one week after surgery, which indicated recovery of endothelial function. UHR-OCT is a useful tool to evaluate function of the DEC after phacoemulsification. Pre-operative DEC thickness may indicate the integrity of the endothelium and could be used for predicting endothelial cell loss after phacoemulsification.
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Thomas BJ, Galor A, Nanji AA, El Sayyad F, Wang J, Dubovy SR, Joag MG, Karp CL. Ultra high-resolution anterior segment optical coherence tomography in the diagnosis and management of ocular surface squamous neoplasia. Ocul Surf 2013; 12:46-58. [PMID: 24439046 DOI: 10.1016/j.jtos.2013.11.001] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 11/03/2013] [Accepted: 11/03/2013] [Indexed: 10/26/2022]
Abstract
The development of optical coherence tomography (OCT) technology has helped to usher in a new era of in vivo diagnostic imaging of the eye. The utilization of OCT for imaging of the anterior segment and ocular surface has evolved from time-domain devices to spectral-domain devices with greater penetrance and resolution, providing novel images of anterior segment pathology to assist in diagnosis and management of disease. Ocular surface squamous neoplasia (OSSN) is one such pathology that has proven demonstrable by certain anterior segment OCT machines, specifically the newer devices capable of performing ultra high-resolution OCT (UHR-OCT). Distinctive features of OSSN on high resolution OCT allow for diagnosis and differentiation from other ocular surface pathologies. Subtle findings on these images help to characterize the OSSN lesions beyond what is apparent with the clinical examination, providing guidance for clinical management. The purpose of this review is to examine the published literature on the utilization of UHR-OCT for the diagnosis and management of OSSN, as well as to report novel uses of this technology and potential directions for its future development.
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Affiliation(s)
- Benjamin J Thomas
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Anat Galor
- Miami Veteran Affairs Medical Center, Miami, Florida, USA
| | - Afshan A Nanji
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Fouad El Sayyad
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Sander R Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA; Florida Lions Ocular Pathology Laboratory, Miami, Florida, USA
| | - Madhura G Joag
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Carol L Karp
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida, USA.
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