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Rao GN. The 2023 Doyne Lecture-a cornea care system: evolution. Eye (Lond) 2024:10.1038/s41433-024-03206-x. [PMID: 38977821 DOI: 10.1038/s41433-024-03206-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 05/31/2024] [Accepted: 06/21/2024] [Indexed: 07/10/2024] Open
Abstract
Blindness and visual impairment affect the quality of life of the individual and their family members. Corneal opacities are a key cause of vision loss around the world, especially in low-income and middle-income countries (LMIC). Corneal blindness and vision loss impacts every age group, and the risk factors and the causes are also varied. Socio-economic factors also play a significant role in its prevalence. Preventing, treating, and managing corneal conditions in LMIC contexts can therefore be quite complex and challenging. A model of eye care delivery developed and refined over the past four decades, the L V Prasad Eye Institute's cornea care system presents an example and a sense of hope. The model takes corneal care from world-class facilities in urban locations to rural locations, overcoming a variety of challenges. The initial breakthrough came with solving and ensuring a steady supply of corneal tissue. Then to training high-quality resources, building capacity, and investing in research that translates from the bench to the bedside. A variety of innovations, both in diagnosis and the operating theatre, have paved for improved outcomes that are tailored for the contexts in which this system operates. The institute envisions a future where its work further narrows the gap in eye care disparities and leads to life-changing impact in ophthalmic care of the cornea.
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Jomar DE, Alshaikh L, Al-Swailem SA. Late-Onset Chronic Corneal Fistula Following Phototherapeutic Keratectomy: A Case Report and Importance of Early Detection. AMERICAN JOURNAL OF CASE REPORTS 2023; 24:e942279. [PMID: 38051696 PMCID: PMC10715623 DOI: 10.12659/ajcr.942279] [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: 08/23/2023] [Revised: 10/31/2023] [Accepted: 10/24/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND We report a case of late-onset chronic fistula in a decompensated cornea after multiple ocular surgeries and a recent phototherapeutic keratectomy (PTK). CASE REPORT A 73-year-old woman presented to our service with a past ocular history of bilateral chronic angle closure glaucoma and pseudophakic bullous keratopathy in the left eye. Given a history of long-term uncontrolled glaucoma with advanced disc cupping and poor visual potential, the patient underwent multiple palliative procedures, including, most recently, a PTK. Few years later she presented with a spontaneous late onset of slowly appearing corneal leak on fluorescein staining upon routine clinical examination. Corrected distance visual acuity was hand motion and intraocular pressure (IOP) was 40 mmHg in the affected eye. Serial anterior segment optical coherence tomography (AS-OCT) sections were obtained, which aided in understanding the current presentation and revealed distinctive multilayer corneal changes during the healing process. The patient was successfully managed with cyanoacrylate corneal gluing and ocular hypotensive medications, which halted the corneal leak. CONCLUSIONS We report a case of a rare finding of corneal fistula in an eye with multiple previous ocular surgeries, and provide an explanation of the possible etiopathogenesis. We also highlight the pivotal role of AS-OCT for evaluating such cases and stress the importance of early detection of similar subtle leaks in the setting of a formed anterior chamber, which can often be missed, carrying a risk of infection.
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Affiliation(s)
- Deema E. Jomar
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Lamees Alshaikh
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Samar A. Al-Swailem
- Anterior Segment Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Research Department, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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3
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Chen S, Chu X, Zhang C, Jia Z, Yang L, Yang R, Huang Y, Zhao S. Safety and Efficacy of the Phototherapeutic Keratectomy for Treatment of Recurrent Corneal Erosions: A Systematic Review and Meta-Analysis. Ophthalmic Res 2023; 66:1114-1127. [PMID: 37490883 PMCID: PMC10614516 DOI: 10.1159/000533160] [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: 02/21/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Phototherapeutic keratectomy (PTK) has been increasingly used to treat severe recurrent corneal erosion syndrome (RCES) patients who do not respond to other treatments. However, the efficacy and complication of each study are currently uncertain due to varying rates. OBJECTIVES The objective of this study was to investigate the safety and efficacy of the PTK for recurrent corneal erosions. METHODS This article performed a systematic literature research in Cochrane, Embase, PubMed, Scopus, and the Web of Science for the literature on PTK treatment of RCES until December 20, 2022. The extracted data including recurrence rate and the adverse event rate were used for meta-analysis. RESULTS The recurrence rate was 18% (95% CI, 13%-24%) (129/700 eyes). Subgroup analysis showed that the RCE recurrence was 17% (95% CI, 9%-24%) after trauma and 22% (95% CI, 11%-32%) in the corneal dystrophy group. Treatment-related adverse events included subepithelial haze, hyperopic shift, and decrease of the best spectacle-corrected visual acuity. In this study, the incidence of these events was 13% (95% CI, 6%-21%), 20% (95% CI, 11%-28%), and 11% (95% CI, 5%-16%), respectively. CONCLUSIONS PTK represented a valuable treatment option for patients with recurrent corneal erosions, especially those with traumatic injuries, which had minimal side effects.
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Affiliation(s)
- Sijing Chen
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China,
| | - Xiaoran Chu
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Chen Zhang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Zhe Jia
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Liu Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Ruibo Yang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Yue Huang
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
| | - Shaozhen Zhao
- Tianjin Key Laboratory of Retinal Functions and Diseases, Tianjin Branch of National Clinical Research Center for Ocular Disease, Eye Institute and School of Optometry, Tianjin Medical University Eye Hospital, Tianjin, China
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Heidari H, Momeni-Moghaddam H, Jadidi K, Pirhadi S, Moshirfar M. Changes in Stress-Strain Index and Corneal Biomechanics in Granular Corneal Dystrophy. J Clin Med 2022; 11:jcm11216571. [PMID: 36362797 PMCID: PMC9657534 DOI: 10.3390/jcm11216571] [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: 10/10/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
Background: The aim of this study was to assess stress-strain index (SSI) and corneal biomechanical parameters in eyes with granular corneal dystrophy (GCD). Methods: This case-control study included 12 eyes of 12 patients with GCD (mean age 45.2 ± 18.7 years) and 20 eyes of 20 healthy individuals (mean age 54.4 ± 3.8 years). In addition to SSI, dynamic corneal response (DCR) parameters were assessed at the first and second applanation, including length (AL1, AL2), velocity (AV1, AV2), time (AT1, AT2), and deformation amplitude (DA A1, DA A2), and at the highest concavity (HC) phase, including DA, peak distance (PD), radius (HCR), and DA ratio (DAR 1 and 2 mm), by Corvis ST. Central corneal thickness (CCT) and biomechanically corrected intraocular pressure (bIOP) were considered covariates in comparing DCR parameters between the two groups. Results: SSI was statistically significantly lower in eyes with GCD than in normal eyes (p = 0.04). The corneal velocity towards the first applanation was 0.02 m/s faster in the GCD eyes AV1 (0.15 ± 0.02 vs. 0.13 ± 0.02 m/s, p < 0.001) and IR (7.48 ± 1.01 vs. 6.80 ± 1.22 mm, p = 0.003) parameters were significantly higher in the GDC group, while AT1 (7.33 ± 0.66 vs. 7.47 ± 0.36 ms, p = 0.002) and HCR (7.42 ± 0.76 vs. 8.20 ± 1.08 mm, p = 0.014) were significantly lower in the normal group. Conclusions: GCD led to a change in biomechanical properties of the cornea. SSI refers to fewer stiff corneas in GDC than normal.
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Affiliation(s)
- Hamidreza Heidari
- Rehabilitation Research Center, Iran University of Medical Sciences, Tehran 14496-14535, Iran
| | - Hamed Momeni-Moghaddam
- Rehabilitation Sciences Research Center, Zahedan University of Medical Sciences, Zahedan 43463-98167, Iran
- Correspondence: (H.M.-M.); (M.M.)
| | - Khosrow Jadidi
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan 35147-99442, Iran
| | - Shiva Pirhadi
- Vision Health Research Center, Semnan University of Medical Sciences, Semnan 35147-99442, Iran
- Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran 14496-14535, Iran
| | - Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State St. #200, Draper, UT 84020, USA
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT 84132, USA
- Utah Lions Eye Bank, Murray, UT 84107, USA
- Correspondence: (H.M.-M.); (M.M.)
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5
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Yıldırım Y, Akbaş YB, Tunç U, Kepez Yıldız B, Er MO, Demirok A. Visual rehabilitation by using corneal wavefront-guided transepithelial photorefractive keratectomy for corneal opacities after epidemic keratoconjunctivitis. Int Ophthalmol 2021; 41:2149-2156. [PMID: 33730316 DOI: 10.1007/s10792-021-01772-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate long-term visual and refractive outcomes of corneal wavefront-guided transepithelial photorefractive keratectomy (t-PRK) with mitomycin C for the treatment of corneal opacities secondary to adenoviral epidemic keratoconjunctivitis. METHODS Records of patients who underwent corneal wavefront-guided t-PRK with excimer laser from January 2012 to December 2018 were retrospectively reviewed. Preoperative and postoperative uncorrected visual acuity, best-spectacle corrected visual acuity, slit-lamp biomicroscopic examination findings, manifest refraction, and corneal aberrations and fundus examination findings were evaluated. RESULTS Twenty-two eyes of 22 patients comprising 12 male (55%) and 10 female (45%) were treated. The mean age was 34.5 ± 10.8 years (range 19-55). The mean follow-up time was 34.4 ± 17.50 months (range 13-61 months). There was a statistically significant improvement in UCVA and BSCVA (p < 0.001 and p = 0.02), and there was a significant decrease in total higher-order aberrations, spherical, coma and trefoil aberration at postoperative first year (p < 0.001 in each). In two eyes of two patients, minimal haze formation was observed after the procedure, and both eyes were treated with topical steroid. No recurrence was observed in subepithelial infiltrates in any patient during long-term follow-up. CONCLUSION In long-term clinical follow-up, corneal wavefront-guided t-PRK treatment is an effective and reliable treatment method for rehabilitation of visual impairment due to corneal scars following adenoviral infections, in properly selected patients.
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Affiliation(s)
- Yusuf Yıldırım
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Bereketzade Camii Sok., No 2 Beyoglu, Istanbul, Turkey.
| | - Yusuf Berk Akbaş
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Bereketzade Camii Sok., No 2 Beyoglu, Istanbul, Turkey
| | - Uğur Tunç
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Bereketzade Camii Sok., No 2 Beyoglu, Istanbul, Turkey
| | - Burçin Kepez Yıldız
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Bereketzade Camii Sok., No 2 Beyoglu, Istanbul, Turkey
| | - Mehmet Onur Er
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Bereketzade Camii Sok., No 2 Beyoglu, Istanbul, Turkey
| | - Ahmet Demirok
- Beyoglu Eye Training and Research Hospital, University of Health Sciences, Bereketzade Camii Sok., No 2 Beyoglu, Istanbul, Turkey
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6
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Neidhart B, Kowalska M, Valentin JDP, Gall FM, Ren Q, Riedl R, Pot S, Rottmar M. Tissue Inhibitor of Metalloproteinase (TIMP) Peptidomimetic as an Adjunctive Therapy for Infectious Keratitis. Biomacromolecules 2020; 22:629-639. [PMID: 33347749 DOI: 10.1021/acs.biomac.0c01473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Matrix metalloproteinase 9 (MMP-9) has a key role in many biological processes, and while it is crucial for a normal immune response, excessive release of this enzyme can lead to severe tissue damage, as evidenced by proteolytic digestion and perforation of the cornea during infectious keratitis. Current medical management strategies for keratitis mostly focus on antibacterial effects, but largely neglect the role of excess MMP activity. Here, a cyclic tissue inhibitor of metalloproteinase (TIMP) peptidomimetic, which downregulated MMP-9 expression both at the mRNA and protein levels as well as MMP-9 activity in THP-1-derived macrophages, is reported. A similar downregulating effect could also be observed on α smooth muscle actin (α-SMA) expression in fibroblasts. Furthermore, the TIMP peptidomimetic reduced Pseudomonas aeruginosa-induced MMP-9 activity in an ex vivo porcine infectious keratitis model and histological examinations demonstrated that a decrease of corneal thickness, associated with keratitis progression, was inhibited upon peptidomimetic treatment. The presented approach to reduce MMP-9 activity thus holds great potential to decrease corneal tissue damage and improve the clinical success of current treatment strategies for infectious keratitis.
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Affiliation(s)
- Berna Neidhart
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
| | - Malwina Kowalska
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Jules D P Valentin
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
| | - Flavio Max Gall
- Institute of Chemistry and Biotechnology, Center of Organic and Medicinal Chemistry, ZHAW Zurich University of Applied Sciences, Einsiedlerstrasse 31, 8820 Wädenswil, Switzerland
| | - Qun Ren
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
| | - Rainer Riedl
- Institute of Chemistry and Biotechnology, Center of Organic and Medicinal Chemistry, ZHAW Zurich University of Applied Sciences, Einsiedlerstrasse 31, 8820 Wädenswil, Switzerland
| | - Simon Pot
- Ophthalmology Section, Equine Department, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - Markus Rottmar
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, Lerchenfeldstrasse 5, 9014 St. Gallen, Switzerland
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7
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Zeng L, Zhao J, Chen Y, Shang J, Aruma A, Zhou X. Multiple phototherapeutic keratectomy treatments in a Chinese pedigree with corneal dystrophy and an R124L mutation: a 20-year observational study. BMC Ophthalmol 2019; 19:191. [PMID: 31438893 PMCID: PMC6704665 DOI: 10.1186/s12886-019-1167-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 07/16/2019] [Indexed: 11/26/2022] Open
Abstract
Background To investigate the efficacy and safety of repeated phototherapeutic keratectomies (PTKs) during long-term treatment for corneal dystrophy (CD) in a Chinese pedigree carrying the R124L mutation in TGFBI. Methods This was a retrospective review of 20-year medical and genetic records involving five CD patients (10 eyes) from one pedigree. During this period, PTK was conducted for an eye when best-corrected distance visual acuity (BCDVA) reached > 1.0 (LogMAR), due to either primary or recurrent opacities in the cornea. All PTKs were performed by 193-nm excimer laser with or without creation of epithelial flaps. For each eye, routine measurements were conducted for the number of PTKs during follow-up, mean time to recurrence, and BCDVA pre- and post- every PTK (measurements within 3 months from each PTK). Corneal thicknesses measured after the last PTK and at the last visit were analyzed, and subjective satisfaction was assessed. Results Gene testing revealed an R124L mutation in TGFBI. During 19.60 ± 1.78 years of follow-up, PTKs were conducted twice for three eyes, three times for six eyes, and four times for one eye. After each PTK, effective visual acuity was maintained for 3.60 ± 1.12 years before significant recurrence. BCDVA improved significantly postoperatively than preoperatively for the first PTK for each eye (p < 0.001), as well as the second (p < 0.001) and third one (p < 0.001). After the last PTK and at the final visit, the thinnest corneal thickness was 371.50 ± 56.47 μm and 358.40 ± 101.11 μm, respectively. The average subjective satisfaction score was 8.60 ± 0.89. Conclusions Multiple repeated PTKs were effective and safe in a long-term study of CD patients with an R124L mutation in TGFBI.
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Affiliation(s)
- Li Zeng
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Jing Zhao
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Yingjun Chen
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Jianmin Shang
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Aruma Aruma
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China.,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China.,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China.,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China
| | - Xingtao Zhou
- Department of Ophthalmology, Eye and ENT Hospital of Fudan University, Shanghai, China. .,NHC Key Laboratory of Myopia (Fudan University), Shanghai, China. .,Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China. .,Research Center of Ophthalmology and Optometry Shanghai, Shanghai, China.
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Abstract
Phototherapeutic keratectomy is an excimer laser-based surgical procedure widely performed by corneal surgeons for treating anterior corneal stromal pathologies. Phototherapeutic keratectomy helps by ablating the corneal stroma, thereby improving corneal clarity and smoothening the surface. Transient discomfort and induced hyperopia from corneal flattening are the immediate postoperative concerns. The long-term course is often marked by the recurrence of original corneal pathology and corneal haze formation. Phototherapeutic keratectomy, however, allows for repeat stromal ablation for managing recurrences, as the corneal thickness permits, without affecting the outcome of future keratoplasty. Adjunctive methods such as topical mitomycin-C may be additionally used to reduce recurrence rates. Also, various masking agents such as carboxymethyl cellulose, sodium hyaluronate, and dextran are used in eyes with irregular corneal surface to allow for uniform stromal ablation. Overall, phototherapeutic keratectomy has provided corneal surgeons an additional surgical tool, particularly those residing in developing nations where the availability of donor corneal tissue is an important limiting factor.
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9
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Vaidyanathan U, Hopping GC, Liu HY, Somani AN, Ronquillo YC, Hoopes PC, Moshirfar M. Persistent Corneal Epithelial Defects: A Review Article. MEDICAL HYPOTHESIS, DISCOVERY & INNOVATION OPHTHALMOLOGY JOURNAL 2019; 8:163-176. [PMID: 31598519 PMCID: PMC6778469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Persistent corneal epithelial defects (PEDs or PCEDs) result from the failure of rapid re-epithelialization and closure within 10-14 days after a corneal injury, even with standard supportive treatment. Disruptions in the protective epithelial and stromal layers of the cornea can render the eye susceptible to infection, stromal ulceration, perforation, scarring, and significant vision loss. Although several therapies exist and an increasing number of novel approaches are emerging, treatment of PEDs can still be quite challenging. It is important to treat the underlying causative condition, which may include an infection, limbal stem cell deficiency, or diabetes, in order to facilitate wound healing. Standard treatments, such as bandage contact lenses (BCLs) and artificial tears (ATs), aim to provide barrier protection to the epithelial layer. Recently-developed medical treatments can target the re-epithelialization process by facilitating access to growth factors and anti-inflammatory agents, and novel surgical techniques can provide re-innervation to the cornea. PEDs should be treated within 7-10 days to avoid secondary complications. These interventions, along with a step-wise approach to management, can be useful in patients with PEDs that are refractory to standard medical treatment. In this review, we discuss the epidemiology, etiology, diagnosis, current and novel management, and prognosis of persistent epithelial defects.
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Affiliation(s)
- Uma Vaidyanathan
- McGovern Medical School, Health Science Center, University of Texas, Houston, TX, USA
| | - Grant C. Hopping
- McGovern Medical School, Health Science Center, University of Texas, Houston, TX, USA
| | - Harry Y. Liu
- McGovern Medical School, Health Science Center, University of Texas, Houston, TX, USA
| | - Anisha N. Somani
- McGovern Medical School, Health Science Center, University of Texas, Houston, TX, USA
| | | | - Phillip C. Hoopes
- Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA
| | - Majid Moshirfar
- Hoopes Durrie Rivera Research Center, Hoopes Vision, Draper, UT, USA, John A. Moran Eye Center, Department of Ophthalmology and Visual Sciences, School of Medicine, University of Utah Salt Lake City, UT, USA, Utah Lions Eye Bank, Murray, UT, USA
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10
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Optical Coherence Tomography-Guided Transepithelial Phototherapeutic Keratectomy for Central Corneal Opacity in the Pediatric Population. J Ophthalmol 2018; 2018:3923617. [PMID: 30671257 PMCID: PMC6323485 DOI: 10.1155/2018/3923617] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 11/30/2018] [Accepted: 12/05/2018] [Indexed: 11/17/2022] Open
Abstract
Purpose To report the outcomes of optical coherence tomography- (OCT-) guided transepithelial phototherapeutic keratectomy (PTK) for central corneal opacity in the pediatric population. Methods The charts of 10 eyes of 8 children aged 9 to 17 with central corneal opacity from various pathologies who underwent a standardized OCT-guided transepithelial PTK technique at a single private practice institution were retrospectively reviewed. The corneal topographic findings, OCT measurements, and visual results with refractive outcomes were analyzed 6 months after the PTK treatment. Results All 10 eyes tolerated the procedure well without any significant intraoperative or postoperative complications. Uncorrected and best spectacle-corrected visual acuity (BSCVA) significantly improved postoperatively (p < 0.0001 and p=0.0045, respectively). The absolute value of spherical equivalent on cycloplegic refraction significantly improved postoperatively as well (p=0.0014), but there were no significant changes in topographic measurements. Seven out of the 10 eyes had complete resolution of the central corneal opacity on OCT imaging. None of the subjects lost any lines of BSCVA and developed recurrence of the corneal opacity from the primary disease condition or required keratoplasty during the follow-up period. Conclusions OCT-guided transepithelial PTK can provide excellent visual outcomes in pediatric patients with central corneal opacities.
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11
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Advanced Technology IOL Cataract Surgery Optimized for Pre-existing Corneal Disease. CURRENT OPHTHALMOLOGY REPORTS 2018. [DOI: 10.1007/s40135-018-0188-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Villalón ML, Leal MDLÁ, Chávez JR, Santillán EM, Lares-Asseff I, Loera V, Valencia L, Camacho B, Alvarado B, Cervantes V, Patrón L, Almanza H. Recurrent epibulbar dermoid cyst treated with amniotic membrane implant a case report. BMC Surg 2018; 18:98. [PMID: 30428870 PMCID: PMC6236942 DOI: 10.1186/s12893-018-0426-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The dermoid cyst considered a cystic teratoma derived from embryonic germinal epithelium is a slow-growing benign tumour. Dermoid cysts may occur in the orbital and periorbital region in paediatric patients and are often recurrent. The surgical approach depends upon the site of the lesion, superficial or deep. To our knowledge, this is the first described case of a patient with resection of dermoid cyst treated with human amniotic membrane implant and topical application of 0.02% mitomycin C. CASE PRESENTATION We present a case of a 12-year-old male with a tumour in the superotemporal region of the right eye (RE). Symptoms included decreased visual acuity (VA), burning eye, foreign body sensation, and photophobia of the affected eye. A physical examination detected blepharospasm. Ophthalmic examination of his RE, fingers count from a 1-2 m distance, showed no improvement with pinhole. Visual acuity was 20/20 on the left eye (LE). The bio-microscopic examination confirmed the presence of a tumour mass (15 mm × 12 mm) on the surface of the RE, invading the superotemporal sector. The tumour had a lobulated appearance, a shiny and vascularized surface covered by conjunctiva, a pearlescent-pink colour, a medium consistency, was renitent and painless. An ultrasound scan revealed atrophy of the pigmented retinal epithelium with scleral indentation of the RE. A computed tomography (CT) scan revealed a recurrent lesion consistent with an epibulbar dermoid cyst. Surgical excision of the lesion was performed and a human amniotic membrane (HAM) graft and topical 0.02% mitomycin C (MMC) were applied. Histopathological analysis confirmed the diagnosis of recurrent dermoid cyst. CONCLUSION In this case report, we describe a case of recurrent epibulbar dermoid cyst treated with complete resection; topical MMC and HAM implant with good clinical outcome of the lesion and implant adhesion. Resection of a cyst of the ocular surface is not recommended when a large epibulbar dermoid tissue needs to be resected and no HAM graft is available.
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Affiliation(s)
- Ma Luisa Villalón
- The Californias' Children Hospital Ophthalmology Service, Av. Alejandro Von Humboldt 11431, Garita de Otay, 22509, Tijuana, BC, Mexico
| | - Ma De Los Ángeles Leal
- School of Health Sciences, Valle de Las Palmas, Autonomous University of Baja California, Blvd Universitario 1000, Valle de Las Palmas, 22260, Tijuana, BC, Mexico
| | - José R Chávez
- School of Health Sciences, Valle de Las Palmas, Autonomous University of Baja California, Blvd Universitario 1000, Valle de Las Palmas, 22260, Tijuana, BC, Mexico
| | - Eduardo M Santillán
- Fray Junípero Serra Hospital, Security and Social Services Institute for State Workers, Tijuana, Avenida De Las Palmas 1 Col Las Palmas, 22106, Tijuana, BC, Mexico
| | - Ismael Lares-Asseff
- Interdisciplinary Research Center for the Comprehensive Regional Development, Durango Module, Durango, Mexico.,National Polytechnic Institute, Sigma Street #119, Fracc. 20 de Noviembre II, C.P. 34220. Año 2009-2010, Durango Dgo., Mexico
| | - Verónica Loera
- Interdisciplinary Research Center for the Comprehensive Regional Development, Durango Module, Durango, Mexico.,National Polytechnic Institute, Sigma Street #119, Fracc. 20 de Noviembre II, C.P. 34220. Año 2009-2010, Durango Dgo., Mexico
| | - Laura Valencia
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico
| | - Blanca Camacho
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico
| | - Brenda Alvarado
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico
| | - Vilma Cervantes
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico
| | - Leslie Patrón
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico
| | - Horacio Almanza
- Department of Cellular Biology and Tissue Engineering, Faculty of Medicine and Psychology, Autonomous University of Baja California, Av. Universidad no 14418, Parque Industrial Internacional Tijuana, CP. 22390, Tijuana, BC, Mexico.
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Refractive Outcomes After Phototherapeutic Refractive Keratectomy for Granular Corneal Dystrophy. Cornea 2018; 37:548-553. [DOI: 10.1097/ico.0000000000001548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Deep Anterior Lamellar Keratoplasty After Descemet Stripping Automated Endothelial Keratoplasty. Am J Ophthalmol 2017; 175:129-136. [PMID: 28017678 DOI: 10.1016/j.ajo.2016.12.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 12/06/2016] [Accepted: 12/14/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE To report the indications and long-term outcomes of deep anterior lamellar keratoplasty (DALK) performed after Descemet stripping automated endothelial keratoplasty (DSAEK) in cases of visually significant stromal opacities. DESIGN Retrospective, interventional, consecutive case series. METHODS Setting: Private hospital. STUDY POPULATION Thirteen eyes that underwent DALK after DSAEK at our institution. Indications for DALK after DSAEK included both stromal opacities persisting after DSAEK and stromal opacities occurring secondarily in post-DSAEK corneas. DALK was always performed in a standardized fashion including exchange of a disc of full-thickness recipient cornea (up to the DSAEK stromal surface),7.0 mm in diameter, with a donor lamella obtained by microkeratome-assisted dissection, punched to 7.0 mm and sutured into place with a double running 10-0 nylon suture. MAIN OUTCOME MEASURES Best spectacle-corrected visual acuity (BSCVA), manifest refraction, and endothelial cell density (ECD). RESULTS Mean follow-up was 26 ± 18 months (range = 6-60 months). Indications for DSAEK were full-thickness graft failure (n = 8), DSAEK graft failure (n = 3), and pseudophakic bullous keratopathy (n = 2). Indications for subsequent DALK were persisting stromal opacity (n = 9) and stromal opacities newly occurred after DSAEK as a result of HSV keratitis (n = 2) or interface infection (n = 2). After complete suture removal, mean BSCVA was 20/28 (0.14 ± 0.8 logMAR) in eyes without ocular comorbidities affecting visual acuity (n = 7), while refractive astigmatism was within 4 diopter (D) in all but 1 eye (average = 3.2 ± 1.4 D). No intraoperative complications were recorded. CONCLUSIONS Performing DALK on DSAEK eliminates the need for open-sky surgery, achieving visual results comparable to those of penetrating keratoplasty, while sparing a healthy endothelial graft.
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Rathi VM, Taneja M, Murthy SI, Bagga B, Vaddavalli PK, Sangwan VS. Phototherapeutic keratectomy for recurrent granular dystrophy in postpenetrating keratoplasty eyes. Indian J Ophthalmol 2016; 64:140-4. [PMID: 27050350 PMCID: PMC4850810 DOI: 10.4103/0301-4738.179715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: The purpose is to assess the clinical and visual outcome after phototherapeutic keratectomy (PTK) procedure in eyes with prior penetrating keratoplasty (PKP) for granular corneal dystrophy (GCD) and the time of performance of repeat PTK for recurrence. Methods: PTK was performed for visually significant recurrence: A reduction in best-corrected visual acuity (BCVA) by >2 lines over BCVA before recurrence was considered as visually significant recurrence. Three eyes had amniotic membrane patch performed with PTK. The main outcome measures were a recurrence of GCD, clinical course, and visual outcome. Intervals between repeat PTK procedures were noted. Results: Six patients (n = 10 eyes; males: 4, mean age 39 ± 13.97 years) underwent PTK. The mean pachymetry before first PTK was 527.1 ± 34 microns. The mean duration between PKP and first PTK was 85.1 months (range: 37–108 months). Two and three PTK procedures were done for seven and five eyes, respectively. Mean duration between first and second and second and third PTK was 62.12 ± 34.41 and 42.8 ± 13.54 months respectively. The average cut depth was 43.66 ± 19.57, 75 ± 43.30 and 39 ± 19.79 microns after the first, second and third PTK procedures, respectively. All eyes had a corneal haze. Prefirst PTK mean BCVA was 20/200 and improved significantly after the first two PTK procedures to 20/40 and after the third PTK procedure to 20/32 (P < 0.001). Five eyes had hyperopia. One acute graft rejection was managed successfully at 5 months with medical therapy. Conclusion: Multiple PTK procedures can be performed safely with improved visual acuity in grafts without compromising graft survival.
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Affiliation(s)
- Varsha M Rathi
- Tej Kohli Cornea Institute, L. V. Prasad Eye Institute, Hyderabad, Telangana, India
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16
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Femtosecond Laser-Assisted Anterior Lamellar Keratoplasty for Recurrence of Granular Corneal Dystrophy in Postkeratoplasty Eyes. Cornea 2016; 36:300-303. [DOI: 10.1097/ico.0000000000001068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Mehlan J, Steinberg J, Traber L, Katz T, Linke SJ. Recurrence rate and subjective symptoms after standardized (Hamburg protocol) phototherapeutic keratectomy on recurrent corneal erosions. Graefes Arch Clin Exp Ophthalmol 2016; 254:2005-2009. [DOI: 10.1007/s00417-016-3470-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 06/21/2016] [Accepted: 08/09/2016] [Indexed: 11/29/2022] Open
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18
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Uveitic band keratopathy: child and adult. J Ophthalmic Inflamm Infect 2015; 5:35. [PMID: 26590046 PMCID: PMC4654727 DOI: 10.1186/s12348-015-0062-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022] Open
Abstract
Background Calcified band keratopathy is a chronic degenerative disease characterized by the deposition of gray to white opacity in superficial layers of the cornea that typically develops over months or years. It is associated with a variety of conditions, including chronic uveitis. Purpose The objective of this study is to assess visual acuity and corneal changes in patients with band keratopathy secondary to uveitis who underwent phototherapeutic keratectomy (PTK). Setting The place where this study was performed was in the Department of Ophthalmology and Visual Sciences, Federal University of Sao Paulo. Design This is a retrospective study. Methods Patients with uveitic band keratopathy were submitted to PTK. The PTK was performed using Allegreto Wave EX500, with the ablation area of 6 mm. Results Twelve patients (13 eyes) diagnosed with band keratopathy secondary to chronic uveitis were analyzed. Of the 12 patients, 8 patients were female (66 %), aged 22 years (7–53 years). From the 12 patients (13 eyes) evaluated in this study, only one patient (one eye) did not have visual improvement, due to epithelial deposits 2 weeks after PTK, and all the others benefited with the procedure. In the children group, all eyes had visual improvement, and quantitatively speaking, the children had a more significant improvement than adults. Conclusions PTK is a safe and effective procedure even for children. However, the improvement in visual acuity was restricted due to other ocular changes secondary to uveitis, such as cataract and retinal changes, or even the corneal irregularity.
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Abstract
PURPOSE To report the use of femtosecond laser platform to remove a glass foreign body (FB) and remove scar by performing sutureless lamellar keratoplasty. CASE REPORT A 34-year-old man presented with a posttraumatic anterior stromal scar and retained corneal glass FB after injury to his left eye, sustained in a prior vehicular accident. Right eye examination was essentially normal. Best-corrected visual acuity of the left eye was 20/320. He underwent femtosecond laser-assisted sutureless anterior lamellar keratoplasty using the 500-kHz femtosecond laser machine. The host bed and donor lenticule diameters were 7.9 and 7.8 mm and the thickness of the lenticule was 125 and 150 μm, respectively. The recipient lenticule was obtained by placing the lamellar incision that encompassed the FB. When the recipient lenticule was lifted, partially embedded FB present in the stroma was removed after dislodging it with a 26-gauge needle. The femtosecond-dissected donor button was placed onto the stromal bed with a snug fit. No sutures were taken. Postoperatively, best-corrected visual acuity improved to 20/50 at 1 month and 20/30 at 7 months of follow-up. CONCLUSIONS Femtosecond laser-assisted sutureless anterior lamellar keratoplasty is a promising modality for lamellar keratoplasty, and as the depth of the incision can be obtained with precision, impacted stromal FBs can be removed in a single procedure along with scars.
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Tomás-Juan J, Murueta-Goyena Larrañaga A, Hanneken L. Corneal Regeneration After Photorefractive Keratectomy: A Review. JOURNAL OF OPTOMETRY 2015; 8:149-69. [PMID: 25444646 PMCID: PMC4502084 DOI: 10.1016/j.optom.2014.09.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 08/01/2014] [Indexed: 05/20/2023]
Abstract
Photorefractive keratectomy (PRK) remodels corneal stroma to compensate refractive errors. The removal of epithelium and the ablation of stroma provoke the disruption of corneal nerves and a release of several peptides from tears, epithelium, stroma and nerves. A myriad of cytokines, growth factors, and matrix metalloproteases participate in the process of corneal wound healing. Their balance will determine if reepithelization and stromal remodeling are appropriate. The final aim is to achieve corneal transparency for restoring corneal function, and a proper visual quality. Therefore, wound-healing response is critical for a successful refractive surgery. Our goal is to provide an overview into how corneal wounding develops following PRK. We will also review the influence of intraoperative application of mitomycin C, bandage contact lenses, anti-inflammatory and other drugs in preventing corneal haze and post-PRK pain.
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Affiliation(s)
- Javier Tomás-Juan
- Department of Visual Science, VallmedicVision International Eye Clinic, Andorra.
| | | | - Ludger Hanneken
- Department of Visual Science, VallmedicVision International Eye Clinic, Andorra
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