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Cho K, Ali M, Heckenlaible NJ, Jabbour S, Jun AS, Srikumaran D. Outcomes and Early Complications Using an Endothelium-in Pull-Through Descemet Membrane Endothelial Keratoplasty Technique With Preloaded Versus Surgeon-Loaded Donor Tissue in Fuchs Patients. Cornea 2024; 43:591-597. [PMID: 37607293 DOI: 10.1097/ico.0000000000003371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 07/18/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE This study aimed to compare outcomes and early complications using an endothelium-in pull-through Descemet membrane endothelial keratoplasty (DMEK) technique with preloaded versus surgeon-loaded donor tissue. METHODS Data from 163 eyes of 125 patients at the Wilmer Eye Institute diagnosed with Fuchs endothelial corneal dystrophy who underwent DMEK with or without cataract extraction using surgeon-loaded tissue (n = 83) or preloaded tissue (n = 80) were reviewed. Best-corrected visual acuity and early postoperative complications including small graft detachment (less than one third of the graft area), large graft detachment (more than one third), graft failure, and rebubbling were compared. RESULTS Baseline characteristics including age, sex, and visual acuity were not statistically different between the groups. Small graft detachment was observed in 18.1% of the surgeon-loaded and 22.5% of the preloaded group ( P = 0.48), whereas large detachment occurred in 12.0% and 5.0%, respectively ( P = 0.11). Among these, rebubbling was performed in 18 (21.7%) in the surgeon-loaded compared with 12 (15.0%) in the preloaded group ( P = 0.27). The rebubbling rate of the combined procedure (cataract surgery and DMEK) was 21.8% and of DMEK alone was 7.7% ( P = 0.048). Primary graft failure occurred in 2 surgeon-loaded cases (2.4%) and 1 preloaded case (1.3%) ( P = 0.58). There was no difference in postoperative best-corrected visual acuity at 1 year (logarithm of the minimum angle of resolution 0.21 ± 0.25 for the surgeon-loaded vs. 0.16 ± 0.16 for the preloaded group, P = 0.23). CONCLUSIONS DMEK surgery using preloaded endothelium-in tissue has comparable outcomes with surgeon-loaded endothelium-in tissue. However, there was a trend toward the lower rebubbling rate in DMEK alone compared with combined procedures.
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Affiliation(s)
- Kyongjin Cho
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Ophthalmology, Dankook University College of Medicine, Cheonan, Korea; and
| | - Muhammad Ali
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Samir Jabbour
- Department of Ophthalmology, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD
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Rigi M, Son HS, Moon L, Matthaei M, Srikumaran D, Jun AS, Eberhart CG, Soiberman US. Collagen type XII is undetectable in keratoconus Bowman's layer. Br J Ophthalmol 2024; 108:343-348. [PMID: 36746614 PMCID: PMC10466210 DOI: 10.1136/bjo-2022-322180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 01/21/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE Corneal biomechanical failure is the hallmark of keratoconus (KC); however, the cause of this failure remains elusive. Collagen type XII (COL12A1), which localises to Bowman's layer (BL), is thought to function in stress-bearing areas, such as BL. Given the putative protective role of COL12A1 in biomechanical stability, this study aims to characterise COL12A1 expression in all corneal layers involved in KC. METHODS TaqMan quantitative PCR was performed on 31 corneal epithelium samples of progressive KC and myopic control eyes. Tissue microarrays were constructed using full-thickness corneas from 61 KC cases during keratoplasty and 18 non-KC autopsy eyes and stained with an antibody specific to COL12A1. Additionally, COL12A1 was knocked out in vitro in immortalised HEK293 cells. RESULTS COL12A1 expression was reduced at transcript levels in KC epithelium compared with controls (ratio: 0.58, p<0.03). Immunohistochemical studies demonstrated that COL12A1 protein expression in BL was undetectable, with reduced expression in KC epithelium, basement membrane and stroma. CONCLUSIONS The apparent absence of COL12A1 in KC BL, together with the functional importance that COL12A1 is thought to have in stress bearing areas, suggests that COL12A1 may play a role in the pathogenesis of KC. Further studies are necessary to investigate the mechanisms that lead to COL12A1 dysregulation in KC.
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Affiliation(s)
- Mohammed Rigi
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Hyeck-Soo Son
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
- Department of Ophthalmology, University Hospital Heidelberg, Heidelberg, Germany
| | - Loren Moon
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Mario Matthaei
- Department of Ophthalmology, University Hospital Cologne, Cologne, Germany
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Charles G Eberhart
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Uri S Soiberman
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Thanitcul C, Awidi AA, Ladas JG, Siddiqui AA, Prescott CR, Bower KS, Jun AS, Daoud Y, Srikumaran D. Accuracy of intraocular lens formulas in combined phacovitrectomy. Int Ophthalmol 2024; 44:96. [PMID: 38372824 DOI: 10.1007/s10792-024-03019-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 01/09/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE To assess the refractive accuracy of eight intraocular lens (IOL) formulas in eyes that underwent combined phacovitrectomy. METHODS A retrospective chart review of 59 eyes that underwent uncomplicated phacovitrectomy between 2017 and 2020 at the Johns Hopkins Wilmer Eye Institute. Inclusion criteria were postoperative best corrected visual acuity of 20/40 or better within 6 months of surgery and IOL implantation in the capsular bag. The Barrett Universal II (BUII), Emmetropia Verifying Optical (EVOv2.0), Hill-Radial Basis Function (Hill-RBFv3.0), Hoffer Q, Holladay I, Kane, Ladas Super Formula (LSF), and SRK/T formulas were compared for accuracy in predicting postoperative spherical equivalents (SE) using Wilcoxon rank sum tests. Pearson's correlation coefficients were used to assess correlations between biometric parameters and errors for all formulas. RESULTS Prediction errors of SE ranged from - 1.69 to 1.43 diopters (D), mean absolute errors (MAE) ranged from 0.39 to 0.47 D, and median absolute errors (MedAE) ranged from 0.23 to 0.37 D among all formulas. The BUII had the lowest mean error (- 0.043), MAE (0.39) and MedAE (0.23). The BUII also had the highest percentage of eyes with predicted error within ± 0.25 D (51%) and ± 0.50 D (83%). Based on MedAE however, no pairwise comparisons resulted in statistically significant differences. Axial length (AL) was positively correlated with the error from the Hoffer Q and Holladay I formulas (correlation coefficients = 0.34, 0.30, p values < 0.01, 0.02 respectively). CONCLUSION While all eight IOL formulas had comparable accuracy in predicting refractive outcomes in eyes undergoing combined phacovitrectomy, the BUII and Kane formulas had a tendency to greater accuracy.
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Affiliation(s)
- Chanon Thanitcul
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Abdelhalim A Awidi
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - John G Ladas
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
- Maryland Eye Consultants and Surgeons, Silver Spring, MD, 20902, USA
| | | | - Christina R Prescott
- NYU Langone Eye Center, NYU Grossman School of Medicine, New York, NY, 10017, USA
| | - Kraig S Bower
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Yassine Daoud
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
- Cornea, Cataract, and Refractive Surgery Services, Maumenee 327, Wilmer Eye Institute, Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
- , 1106 Annapolis Road, Suite 290, Odenton, MD, 21113, USA.
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Soiberman US, Jun AS. More support for deep anterior lamellar keratoplasty over penetrating keratoplasty for keratoconus, but questions remain. Br J Ophthalmol 2023; 108:1-2. [PMID: 37890881 DOI: 10.1136/bjo-2023-324685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/03/2023] [Indexed: 10/29/2023]
Affiliation(s)
- Uri S Soiberman
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Quintero M, Mihailovic A, Sikder S, Jun AS, Daoud Y, Ramulu PY. Distinguishing Glaucoma, Cataract, and Glaucoma Suspect Based on Visual Symptoms. J Glaucoma 2023; 32:631-639. [PMID: 37311015 DOI: 10.1097/ijg.0000000000002244] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 05/06/2023] [Indexed: 06/15/2023]
Abstract
PRCIS Cataract, glaucoma, and glaucoma suspect patients report differing visual symptoms. Asking patients about their visual symptoms may provide useful diagnostic information and inform decision-making in patients with comorbid conditions. PURPOSE To compare visual symptoms in glaucoma, glaucoma suspect (controls), and cataract patients. METHODS Glaucoma, cataract, and glaucoma suspect patients at Wilmer Eye Institute responded to a questionnaire rating the frequency and severity of 28 symptoms. Univariate and multivariable logistic regression determined the symptoms that best differentiate each disease pair. RESULTS In all, 257 patients (mean age: 67.4 ± 13.4 y; 57.2% female; 41.2% employed), including 79 glaucoma, 84 cataract, and 94 glaucoma suspect patients, participated. Compared with glaucoma suspects, glaucoma patients were more likely to report poor peripheral vision (OR 11.29, 95% CI: 3.73-34.16), better vision in 1 eye (OR 5.48, 95% CI: 1.33-22.64), and light sensitivity (OR 4.85, 95% CI: 1.78-13.24), explaining 40% of the variance in diagnosis (ie, glaucoma vs. glaucoma suspect). Compared with controls, cataract patients were more likely to report light sensitivity (OR 3.33, 95% CI: 1.56-7.10) and worsening vision (OR 12.20, 95% CI: 5.33-27.89), explaining 26% of the variance in diagnosis (ie, cataract vs. glaucoma suspect). Compared with cataract patients, glaucoma patients were more likely to report poor peripheral vision (OR 7.24, 95% CI: 2.53-20.72) and missing patches (OR 4.91, 95% CI: 1.52-15.84), but less likely to report worsening vision (OR 0.08, 95% CI 0.03-0.22), explaining 33% of the variance in diagnosis (ie, glaucoma vs. cataract). CONCLUSIONS Visual symptoms distinguish disease state to a moderate degree in glaucoma, cataract, and glaucoma suspect patients. Asking about visual symptoms may serve as a useful diagnostic adjunct and inform decision-making, for example, in glaucoma patients considering cataract surgery.
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Kaufman R, Jun AS. Recent advances in cell-based regenerative therapies for corneal disease. Curr Opin Ophthalmol 2023; 34:303-310. [PMID: 37254863 DOI: 10.1097/icu.0000000000000964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE OF REVIEW With limited access of more than half the world's population to corneal transplantation, regenerative medicine may represent a promising alternative. This review explores the main advancements achieved in cell-based therapies for corneal epithelium, stroma, and endothelium during 2021-2022. RECENT FINDINGS Multiple surgical techniques have been developed for epithelial limbal stem cell replacement. Recent studies aimed to gain greater understanding and characterization of these techniques. Though no clear superiority could be demonstrated, simple limbal epithelial transplantation seems to have the most clinical and cost effectiveness. For stromal disease, autologous adipose-derived stem cells have shown favorable results. For endothelial dysfunction, the validity of intracameral cultivated allogeneic endothelial cell injection and Descemetorrhexis without endothelial keratoplasty, as well as the benefits of adjunctive rho-associated kinase inhibitors, were emphasized. SUMMARY A plethora of innovative cell-based regenerative therapies for corneal diseases have been developed in past years. While recent literature solidifies our knowledge, most studies are still in preliminary or preclinical stages. Though showing great promise, these approaches will require larger studies with better-defined endpoints to establish their benefits over currently available treatments.
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Affiliation(s)
- Ron Kaufman
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Son HS, Moon L, Wang J, Eberhart CG, Jun AS, Srikumaran D, Soiberman US. Histological Comparative Analysis of Bowman's Layer Grafts Procured Using 3 Different Techniques. Cornea 2023:00003226-990000000-00269. [PMID: 37070929 DOI: 10.1097/ico.0000000000003260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 01/20/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE The objective of this study is to perform a histological analysis of Bowman's layer (BL) grafts. METHODS BL grafts were procured from 13 human cadaver corneal tissues using 3 different donor preparation techniques. Subsequently, the grafts were fixed in 10% buffered formalin phosphate and embedded in paraffin. Hematoxylin and eosin sections of BL grafts were obtained and analyzed under a light microscope. BL and full graft thickness were measured using an image-processing software. RESULTS All 13 BL grafts contained residual anterior stromal tissue. BL stripping using Kelman-McPherson and Moorfield forceps (technique 3) achieved the thinnest graft thickness with a mean full graft thickness of 18.7 μm (95% confidence interval [CI], -9.8 to 47.2) at the thinnest point of the graft, whereas BL procurement using the Melles lamellar dissector (technique 2) led to the highest mean full graft thickness of 279.9 μm (95% CI, 251.4-308.5) even at the thinnest area of the graft. By contrast, BL dissection using a blunt dissector (technique 1) provided a mean full graft thickness of 70.2 μm (95% CI, 40.4-100.1) at the graft's thinnest point. Although peripheral graft tears occurred in 50%, 50%, and 100% of techniques 1, 2, and 3, respectively, intact 6.25-mm diameter BL grafts could be secured in 50%, 100%, and 80% of techniques 1, 2, and 3, respectively. CONCLUSIONS None of the techniques used led to the procurement of pure BL grafts devoid of the anterior stroma. Peripheral scoring with a thin needle and tissue manipulation with Kelman-McPherson and Moorfield forceps led to the thinnest grafts in this study.
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Affiliation(s)
- Hyeck-Soo Son
- *Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD
- †Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany; and
- ‡Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Loren Moon
- *Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD
- †Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany; and
- ‡Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Jiangxia Wang
- *Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD
- †Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany; and
- ‡Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Charles G Eberhart
- *Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD
- †Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany; and
- ‡Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Albert S Jun
- *Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD
- †Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany; and
- ‡Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Divya Srikumaran
- *Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD
- †Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany; and
- ‡Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Uri S Soiberman
- *Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD
- †Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany; and
- ‡Department of Biostatistics, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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Marquezan MC, Freitas DD, Majumdar S, Wang X, Elisseeff J, Guyton DL, Bower KS, Skurski ZP, Chalita MR, Belfort R, Jun AS. Corneal reshaping: an experiment with a type I collagen-based vitrigel for remodeling porcine corneas. Arq Bras Oftalmol 2023:S0004-27492023005002307. [PMID: 36995816 DOI: 10.5935/0004-2749.2022-0128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/17/2022] [Indexed: 03/31/2023] Open
Abstract
PURPOSE This study aimed to report an experiment designed to determine anatomical changes in porcine corneas following placement of a novel polymer implant into the cornea. METHODS An ex vivo porcine eye model was used. A novel type I collagen-based vitrigel implant (6 mm in diameter) was shaped with an excimer laser on the posterior surface to create three planoconcave shapes. Implants were inserted into a manually dissected stromal pocket at a depth of approximately 200 μm. Three treatment groups were defined: group A (n=3), maximal ablation depth 70 μm; Group B (n=3), maximal ablation depth 64 μm; and group C (n=3), maximal ablation depth 104 μm, with a central hole. A control group (D, n=3) was included, in which a stromal pocket was created but biomaterial was not inserted. Eyes were evaluated by optical coherence tomography (OCT) and corneal tomography. RESULTS Corneal tomography showed a trend for a decreased mean keratometry in all four groups. Optical coherence tomography showed corneas with implants placed within the anterior stroma and visible flattening, whereas the corneas in the control group did not qualitatively change shape. CONCLUSIONS The novel planoconcave biomaterial implant described herein could reshape the cornea in an ex vivo model, resulting in the flattening of the cornea. Further studies are needed using in vivo animal models to confirm such findings.
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Affiliation(s)
- Maria Carolina Marquezan
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Denise de Freitas
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Shoumyo Majumdar
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Xiaokun Wang
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jennifer Elisseeff
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Translational Tissue Engineering Center, Johns Hopkins University, Baltimore, Maryland, USA
| | - David L Guyton
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kraig Scot Bower
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Zachary P Skurski
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maria Regina Chalita
- Department of Ophthalmology, Hospital Universitário de Brasília, Universidade de Brasília, Brasília, DF, Brazil
| | - Rubens Belfort
- Department of Ophthalmology and Visual Sciences, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Son HS, Rigi M, Srikumaran D, Eberhart CG, Jun AS, Soiberman US. "Groove and Peel" Deep Anterior Lamellar Keratoplasty: How Deep Can You Go? Cornea 2023; 42:105-109. [PMID: 35965394 DOI: 10.1097/ico.0000000000003103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 06/06/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of the current research was to measure the thickness of the residual central corneal bed after performing the manual "Groove and Peel" deep anterior lamellar keratoplasty (GP-DALK) technique on human cadaveric eyes. METHODS The manual GP-DALK technique was performed on 6 human cadaver eyes by an experienced corneal surgeon. After surgery, the eye globes were fixed in 10% buffered formalin and embedded in paraffin. For each eye, 4-μm-thick hematoxylin and eosin sections involving the pupillary axis were obtained and examined. Using an image-processing software, 2 observers measured the corneal thickness of the residual central corneal bed and the peripheral corneal rims. RESULTS The overall mean central corneal bed thickness was 35.5 ± 12.9 μm, whereas the mean right and left peripheral rim thicknesses were 993.0 ± 141.1 and 989.3 ± 147.1 μm, respectively ( P = 0.0006 ). In most corneas, the level of dissection reached almost to the pre-Descemetic collagen (Dua) layer. CONCLUSIONS The GP-DALK technique is effective in removing most of the corneal stroma and may be non-inferior to "big-bubble" deep anterior lamellar keratoplasty in some cases.
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Affiliation(s)
- Hyeck-Soo Son
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD; and
- Department of Ophthalmology, University of Heidelberg, Heidelberg, Baden-Wuerttemberg, Germany
| | - Mohammed Rigi
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD; and
| | - Divya Srikumaran
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD; and
| | - Charles G Eberhart
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD; and
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD; and
| | - Uri S Soiberman
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD; and
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Chew LA, Jun AS, Barnett BP. Corneal endothelial transplantation from bench to bedside: A review of animal models and their translational value for therapeutic development. Exp Eye Res 2022; 224:109241. [PMID: 36075460 PMCID: PMC10782848 DOI: 10.1016/j.exer.2022.109241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/10/2022] [Accepted: 08/27/2022] [Indexed: 11/23/2022]
Affiliation(s)
- Lindsey A Chew
- Duke University, School of Medicine, 40 Duke Medicine Circle, 124 Davison Building, Durham, NC, 27710, USA
| | - Albert S Jun
- Wilmer Eye Institute, 1800 Orleans St., Baltimore, MD, 21287, USA
| | - Brad P Barnett
- California LASIK & Eye, 1111 Exposition Blvd., Bldg. 200 Ste. 2000, Sacramento, CA, 95815, USA.
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Sun KJ, Jun AS, Bohm K, Daroszewski D, Jabbour S. Corneal thinning following bevacizumab intrastromal injection for the treatment of idiopathic lipid keratopathy. Am J Ophthalmol Case Rep 2022; 27:101618. [PMID: 35800403 PMCID: PMC9253579 DOI: 10.1016/j.ajoc.2022.101618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 11/08/2022] Open
Abstract
Purpose To describe the occurrence of corneal thinning in a patient following intrastromal injection of bevacizumab to treat lipid keratopathy. Observations A 36-year-old female presented with decreased vision in her right eye with central posterior corneal haze and underwent a treatment regimen including artificial tears, cyclosporine 0.05% drops, prednisolone 1% and oral Valacyclovir 1g with no improvement. Neovascularization was noted at 18 months follow up and treated with intrastromal bevacizumab injections at 24 months. The feeder vessel was attenuated at 3- and 6-months post-injection, but tomography indicated sustained thinning and flattening of the cornea at the injection site contributing to the development of irregular astigmatism. Conclusions and Importance Corneal thinning is an uncommon potential side effect of intrastromal bevacizumab injection that may affect postoperative visual acuity.
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Chu HS, Peterson C, Chamling X, Berlinicke C, Zack D, Jun AS, Foster J. Integrated Stress Response Regulation of Corneal Epithelial Cell Motility and Cytokine Production. Invest Ophthalmol Vis Sci 2022; 63:1. [PMID: 35802384 PMCID: PMC9279922 DOI: 10.1167/iovs.63.8.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the effect of an active integrated stress response (ISR) on human corneal epithelial cell motility and cytokine production. Methods ISR agonists tunicamycin (TUN) and SAL003 (SAL) were used to stimulate the ISR in immortalized corneal epithelial cell lines, primary human limbal epithelial stem cells, and ex vivo human corneas. Reporter lines for ISR-associated transcription factors activating transcription factor 4 (ATF4) and XBP1 activity were generated to visualize pathway activity in response to kinase-specific agonists. Scratch assays and multiplex magnetic bead arrays were used to investigate the effects of an active ISR on scratch wounds and cytokine production. A C/EBP homologous protein (CHOP) knockout cell line was generated to investigate the effects of ISR ablation. Finally, an ISR antagonist was assayed for its ability to rescue negative phenotypic changes associated with an active ISR. Results ISR stimulation, mediated through CHOP, inhibited cell motility in both immortalized and primary human limbal epithelial cells. Scratch wounding of ex vivo corneas elicited an increase in the ISR mediators phosphorylated-eIF2α and ATF4. ISR stimulation also increased the production of vascular endothelial growth factor (VEGF) and proinflammatory cytokines. ISR ablation, through CHOP knockout or inhibition with integrated stress response inhibitor (ISRIB) rescued epithelia migration ability and reduced VEGF secretion. Conclusions We demonstrate that the ISR has dramatic effects on the ability of corneal epithelial cells to respond to wounding models and increases the production of proinflammatory and angiogenic factors. Inhibition of the ISR may provide a new therapeutic option for corneal diseases in which the ISR is implicated.
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Affiliation(s)
- Hsiao-Sang Chu
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Cornelia Peterson
- Department of Molecular and Comparative Pathology, Johns Hopkins School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Xitiz Chamling
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Cynthia Berlinicke
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Donald Zack
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Albert S Jun
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - James Foster
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States
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13
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Peterson C, Kim YC, Ensign LM, Jun AS, Foster J. Induction of the integrated stress response in the rat cornea. Exp Eye Res 2021; 210:108722. [PMID: 34370978 DOI: 10.1016/j.exer.2021.108722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 07/13/2021] [Accepted: 08/05/2021] [Indexed: 11/19/2022]
Abstract
Keratoconus (KC), a progressive, degenerative corneal disease, represents the second leading indication for corneal transplantation globally. We have previously demonstrated that components of the Integrated Stress Response (ISR) are upregulated in human keratoconic donor tissue, and treatment of normal tissue with ISR agonists attenuates collagen production. With no consistently accepted animal models available for translational KC research, we sought to establish an in vivo model based on ISR activation to elucidate its role in the development of the KC phenotype. Four-week-old female SD rats were treated with topical SAL003 formulated as a nanosuspension or vehicle every 48 h for four doses. Animals were subject to monitoring for ocular inflammation and discomfort before being euthanized at 1, 14, or 28 days after treatment was withdrawn. Schirmer's tear test, intraocular pressure, and body weight measurements were obtained at baseline and prior to euthanasia. Globes were subject to routine histopathology, immunohistochemistry for ATF4, and qPCR for Col1a1 expression. ANOVAs and Student's t tests were used to assess statistical significance (α = 0.05). SAL003 treatment did not produce any adverse ocular or systemic phenotype but did result in decreased keratocyte density. Col1a1 transcripts were reduced, corresponding to nuclear ATF4 expression within the axial cornea. In vivo topical treatment with a gel-formulated ISR agonist recapitulates key features of the activated ISR including nuclear ATF4 expression and decreased extracellular matrix (ECM) production. Exogenous ISR agonists may present one approach to establishing a rodent model for keratoconus, a charge essential for future evaluations of pathogenesis and therapeutic interventions.
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Affiliation(s)
- C Peterson
- Department of Molecular & Comparative Pathobiology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Y C Kim
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - L M Ensign
- Center for Nanomedicine at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - A S Jun
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - J Foster
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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14
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Ladas J, Ladas D, Lin SR, Devgan U, Siddiqui AA, Jun AS. Improvement of Multiple Generations of Intraocular Lens Calculation Formulae with a Novel Approach Using Artificial Intelligence. Transl Vis Sci Technol 2021; 10:7. [PMID: 34003941 PMCID: PMC7961112 DOI: 10.1167/tvst.10.3.7] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Cataract surgery is the most common eye surgery. Appropriate optimization of intraocular lens (IOL) calculation formulae can result in improved patient outcomes. The purpose of this article is to describe a methodology of optimizing existing IOL formulae and develop hybrid formulae based on artificial intelligence (AI). Methods Preoperative biometric and postoperative outcomes data were obtained from medical records at a single institution. A numeric computing environment was used to analyze these data and refine IOL formulae using supervised learning AI. The mean absolute error of each IOL formulae with and without AI enhancement was determined, as well as the number of eyes within 0.5 diopter of the predicted refraction. Results AI algorithms improved the mean absolute error as well as number of eyes within 0.5 diopters of predicted refraction for each of the formulae tested (P < 0.05). Conclusions A novel methodology is described that uses AI to improve existing IOL formulae. This methodology has the potential to improve clinical outcomes for cataract surgery patients. Translational Relevance Artificial intelligence can be used to improve existing IOL formulae.
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Affiliation(s)
- John Ladas
- Wilmer Eye Institute, Baltimore, MD, USA.,Maryland Eye Consultants and Surgeons, Silver Spring, MD, USA
| | - Donna Ladas
- Maryland Eye Consultants and Surgeons, Silver Spring, MD, USA
| | - Shawn R Lin
- Stein Eye Institute, Los Angeles, CA, USA.,Massachusetts Eye and Ear Infirmary, Boston, MA, USA
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Uehara H, Zhang X, Pereira F, Narendran S, Choi S, Bhuvanagiri S, Liu J, Ravi Kumar S, Bohner A, Carroll L, Archer B, Zhang Y, Liu W, Gao G, Ambati J, Jun AS, Ambati BK. Start codon disruption with CRISPR/Cas9 prevents murine Fuchs' endothelial corneal dystrophy. eLife 2021; 10:e55637. [PMID: 34100716 PMCID: PMC8216720 DOI: 10.7554/elife.55637] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/07/2021] [Indexed: 12/17/2022] Open
Abstract
A missense mutation of collagen type VIII alpha 2 chain (COL8A2) gene leads to early-onset Fuchs' endothelial corneal dystrophy (FECD), which progressively impairs vision through the loss of corneal endothelial cells. We demonstrate that CRISPR/Cas9-based postnatal gene editing achieves structural and functional rescue in a mouse model of FECD. A single intraocular injection of an adenovirus encoding both the Cas9 gene and guide RNA (Ad-Cas9-Col8a2gRNA) efficiently knocked down mutant COL8A2 expression in corneal endothelial cells, prevented endothelial cell loss, and rescued corneal endothelium pumping function in adult Col8a2 mutant mice. There were no adverse sequelae on histology or electroretinography. Col8a2 start codon disruption represents a non-surgical strategy to prevent vision loss in early-onset FECD. As this demonstrates the ability of Ad-Cas9-gRNA to restore the phenotype in adult post-mitotic cells, this method may be widely applicable to adult-onset diseases, even in tissues affected with disorders of non-reproducing cells.
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Affiliation(s)
- Hironori Uehara
- Phil and Penny Knight Campus for Accelerating Scientific Impact, University of OregonEugene, ORUnited States
| | - Xiaohui Zhang
- Phil and Penny Knight Campus for Accelerating Scientific Impact, University of OregonEugene, ORUnited States
| | - Felipe Pereira
- Department of Ophthalmology, University of VirginiaCharlottesvilleUnited States
| | - Siddharth Narendran
- Department of Ophthalmology, University of VirginiaCharlottesvilleUnited States
| | - Susie Choi
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of UtahSalt Lake CityUnited States
| | - Sai Bhuvanagiri
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of UtahSalt Lake CityUnited States
| | - Jinlu Liu
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of UtahSalt Lake CityUnited States
| | - Sangeetha Ravi Kumar
- Phil and Penny Knight Campus for Accelerating Scientific Impact, University of OregonEugene, ORUnited States
| | - Austin Bohner
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of UtahSalt Lake CityUnited States
| | - Lara Carroll
- Moran Eye Center, Department of Ophthalmology and Visual Sciences, University of UtahSalt Lake CityUnited States
| | - Bonnie Archer
- Phil and Penny Knight Campus for Accelerating Scientific Impact, University of OregonEugene, ORUnited States
| | - Yue Zhang
- Division of Epidemiology, Department of Internal Medicine, University of UtahSalt Lake CityUnited States
| | - Wei Liu
- Division of Epidemiology, Department of Internal Medicine, University of UtahSalt Lake CityUnited States
| | - Guangping Gao
- Gene Therapy Center, Department of Microbiology and Physiological Science Systems, University of Massachusetts Medical SchoolWorcesterUnited States
| | - Jayakrishna Ambati
- Department of Ophthalmology, University of VirginiaCharlottesvilleUnited States
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins UniversityBaltimoreUnited States
| | - Balamurali K Ambati
- Phil and Penny Knight Campus for Accelerating Scientific Impact, University of OregonEugene, ORUnited States
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16
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Foster JW, Parikh RN, Wang J, Bower KS, Matthaei M, Chakravarti S, Jun AS, Eberhart CG, Soiberman US. Transcriptomic and Immunohistochemical Analysis of Progressive Keratoconus Reveal Altered WNT10A in Epithelium and Bowman's Layer. Invest Ophthalmol Vis Sci 2021; 62:16. [PMID: 33988693 PMCID: PMC8132000 DOI: 10.1167/iovs.62.6.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Purpose To identify global gene expression changes in the corneal epithelium of keratoconus (KC) patients compared to non-KC myopic controls. Methods RNA-sequencing was performed on corneal epithelium samples of five progressive KC and five myopic control patients. Selected results were validated using TaqMan quantitative PCR (qPCR) on 31 additional independent samples, and protein level validation was conducted using western blot analysis on a subset. Immunohistochemistry was performed on tissue microarrays containing cores from over 100 KC and control cases. WNT10A transcript levels in corneal epithelium were correlated with tomographic indicators of KC disease severity in 15 eyes. Additionally, WNT10A was overexpressed in vitro in immortalized corneal epithelial cells. Results WNT10A was found to be underexpressed in KC epithelium at the transcript (ratio KC/control = 0.59, P = 0.02 per RNA-sequencing study; ratio = 0.66, P = 0.03 per qPCR) and protein (ratio = 0.07, P = 0.06) levels. Immunohistochemical analysis also indicated WNT10A protein was decreased in Bowman's layer of KC patients. In contrast, WNT10A transcript level positively correlated with increased keratometry (Kmax ρ = 0.57, P = 0.02). Finally, WNT10A positively regulated COL1A1 expression in corneal epithelial cells. Conclusions A specific Wnt ligand, WNT10A, is reduced at the mRNA and protein level in KC epithelium and Bowman's layer. This ligand positively regulates collagen type I expression in corneal epithelial cells. The results suggest that WNT10A expression in the corneal epithelium may play a role in progressive KC.
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Affiliation(s)
- James W Foster
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Rupin N Parikh
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jiangxia Wang
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Kraig S Bower
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Mario Matthaei
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Shukti Chakravarti
- Department of Ophthalmology and Pathology, NYU Langone Health, New York, New York, United States
| | - Albert S Jun
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Charles G Eberhart
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Uri S Soiberman
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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17
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Angelbello AJ, Benhamou RI, Rzuczek SG, Choudhary S, Tang Z, Chen JL, Roy M, Wang KW, Yildirim I, Jun AS, Thornton CA, Disney MD. A Small Molecule that Binds an RNA Repeat Expansion Stimulates Its Decay via the Exosome Complex. Cell Chem Biol 2020; 28:34-45.e6. [PMID: 33157036 DOI: 10.1016/j.chembiol.2020.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/08/2020] [Accepted: 10/16/2020] [Indexed: 12/12/2022]
Abstract
Many diseases are caused by toxic RNA repeats. Herein, we designed a lead small molecule that binds the structure of the r(CUG) repeat expansion [r(CUG)exp] that causes myotonic dystrophy type 1 (DM1) and Fuchs endothelial corneal dystrophy (FECD) and rescues disease biology in patient-derived cells and in vivo. Interestingly, the compound's downstream effects are different in the two diseases, owing to the location of the repeat expansion. In DM1, r(CUG)exp is harbored in the 3' untranslated region, and the compound has no effect on the mRNA's abundance. In FECD, however, r(CUG)exp is located in an intron, and the small molecule facilitates excision of the intron, which is then degraded by the RNA exosome complex. Thus, structure-specific, RNA-targeting small molecules can act disease specifically to affect biology, either by disabling the gain-of-function mechanism (DM1) or by stimulating quality control pathways to rid a disease-affected cell of a toxic RNA (FECD).
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Affiliation(s)
- Alicia J Angelbello
- Department of Chemistry, The Scripps Research Institute, Jupiter, FL 33458, USA
| | - Raphael I Benhamou
- Department of Chemistry, The Scripps Research Institute, Jupiter, FL 33458, USA
| | - Suzanne G Rzuczek
- Department of Chemistry, The Scripps Research Institute, Jupiter, FL 33458, USA
| | - Shruti Choudhary
- Department of Chemistry, The Scripps Research Institute, Jupiter, FL 33458, USA
| | - Zhenzhi Tang
- Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Jonathan L Chen
- Department of Chemistry, The Scripps Research Institute, Jupiter, FL 33458, USA
| | - Madhuparna Roy
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | - Kye Won Wang
- Department of Chemistry, Florida Atlantic University, Jupiter, FL 33458, USA
| | - Ilyas Yildirim
- Department of Chemistry, Florida Atlantic University, Jupiter, FL 33458, USA
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA
| | - Charles A Thornton
- Department of Neurology, School of Medicine and Dentistry, University of Rochester, Rochester, NY 14642, USA
| | - Matthew D Disney
- Department of Chemistry, The Scripps Research Institute, Jupiter, FL 33458, USA.
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18
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Wang KM, Jun AS, Ladas JG, Siddiqui AA, Woreta F, Srikumaran D. Reply to Comment on: Accuracy of Intraocular Lens Formulas in Eyes With Keratoconus. Am J Ophthalmol 2020; 218:355-356. [PMID: 32620263 DOI: 10.1016/j.ajo.2020.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/24/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Kendrick M Wang
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Albert S Jun
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - John G Ladas
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; Maryland Eye Consultants and Surgeons, Silver Spring, Maryland
| | - Aazim A Siddiqui
- Department of Ophthalmology and Visual Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Fasika Woreta
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Divya Srikumaran
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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19
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Ansah DO, Li X, Gehlbach PL, Jun AS, Soiberman US. Prediction error in iris suture fixated intraocular lenses and long‐term stability. Clin Exp Ophthalmol 2020; 48:1175-1182. [DOI: 10.1111/ceo.13851] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Derick O. Ansah
- The Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Ximin Li
- Department of Biostatistics Johns Hopkins Bloomberg School of Public Health Baltimore Maryland USA
| | - Peter L. Gehlbach
- The Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Albert S. Jun
- The Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore Maryland USA
| | - Uri S. Soiberman
- The Wilmer Eye Institute Johns Hopkins University School of Medicine Baltimore Maryland USA
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20
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Shinde V, Hu N, Mahale A, Maiti G, Daoud Y, Eberhart CG, Maktabi A, Jun AS, Al-Swailem SA, Chakravarti S. RNA sequencing of corneas from two keratoconus patient groups identifies potential biomarkers and decreased NRF2-antioxidant responses. Sci Rep 2020; 10:9907. [PMID: 32555404 PMCID: PMC7303170 DOI: 10.1038/s41598-020-66735-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 04/17/2020] [Indexed: 12/21/2022] Open
Abstract
Keratoconus is a highly prevalent (1 in 2000), genetically complex and multifactorial, degenerative disease of the cornea whose pathogenesis and underlying transcriptomic changes are poorly understood. To identify disease-specific changes and gene expression networks, we performed next generation RNA sequencing from individual corneas of two distinct patient populations - one from the Middle East, as keratoconus is particularly severe in this group, and the second from an African American population in the United States. We conducted a case: control RNA sequencing study of 7 African American, 12 Middle Eastern subjects, and 7 controls. A Principal Component Analysis of all expressed genes was used to ascertain differences between samples. Differentially expressed genes were identified using Cuffdiff and DESeq2 analyses, and identification of over-represented signaling pathways by Ingenuity Pathway Analysis. Although separated by geography and ancestry, key commonalities in the two patient transcriptomes speak of disease - intrinsic gene expression networks. We identified an overwhelming decrease in the expression of anti-oxidant genes regulated by NRF2 and those of the acute phase and tissue injury response pathways, in both patient groups. Concordantly, NRF2 immunofluorescence staining was decreased in patient corneas, while KEAP1, which helps to degrade NRF2, was increased. Diminished NRF2 signaling raises the possibility of NRF2 activators as future treatment strategies in keratoconus. The African American patient group showed increases in extracellular matrix transcripts that may be due to underlying profibrogenic changes in this group. Transcripts increased across all patient samples include Thrombospondin 2 (THBS2), encoding a matricellular protein, and cellular proteins, GAS1, CASR and OTOP2, and are promising biomarker candidates. Our approach of analyzing transcriptomic data from different populations and patient groups will help to develop signatures and biomarkers for keratoconus subtypes. Further, RNA sequence data on individual patients obtained from multiple studies may lead to a core keratoconus signature of deregulated genes and a better understanding of its pathogenesis.
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Affiliation(s)
- Vishal Shinde
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Nan Hu
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Alka Mahale
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - George Maiti
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA
| | - Yassine Daoud
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Charles G Eberhart
- Ophthalmology and Oncology Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Azza Maktabi
- King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Shukti Chakravarti
- Department of Ophthalmology, NYU Langone Medical Center, New York, NY, USA.
- Department of Pathology, NYU Langone Medical Center, New York, NY, USA.
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21
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Barnett BP, Akpek EK, Jun AS. Punctal eversion with silicone plug resulting in ocular surface trauma. BMJ Case Rep 2020; 13:13/5/e233808. [PMID: 32467118 DOI: 10.1136/bcr-2019-233808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Brad P Barnett
- Ophthalmology, Duke Medicine, Durham, North Carolina, USA
| | - Esen K Akpek
- Ophthalmology, Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, USA
| | - Albert S Jun
- Ophthalmology, Johns Hopkins Medicine Wilmer Eye Institute, Baltimore, Maryland, USA
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22
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Matthaei M, Hribek A, Clahsen T, Bachmann B, Cursiefen C, Jun AS. Fuchs Endothelial Corneal Dystrophy: Clinical, Genetic, Pathophysiologic, and Therapeutic Aspects. Annu Rev Vis Sci 2020; 5:151-175. [PMID: 31525145 DOI: 10.1146/annurev-vision-091718-014852] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Fuchs endothelial corneal dystrophy (FECD) is a bilateral corneal endothelial disorder and the most common cause of corneal transplantation worldwide. Professor Ernst Fuchs described the first 13 cases of FECD more than 100 years ago. Since then, we have seen far-reaching progress in its diagnosis and treatment. In the field of diagnostics, new technologies enable the development of more accurate classification systems and the more detailed breakdown of the genetic basis of FECD. Laboratory studies help in deciphering the molecular pathomechanisms. The development of minimally invasive surgical techniques leads to a continuous improvement of the postoperative result. This review highlights and discusses clinical, genetic, pathophysiologic, and therapeutic aspects of this common and important corneal disorder.
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Affiliation(s)
- Mario Matthaei
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; , , , ,
| | - Agathe Hribek
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; , , , ,
| | - Thomas Clahsen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; , , , ,
| | - Björn Bachmann
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; , , , ,
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Faculty of Medicine and University Hospital Cologne, 50937 Cologne, Germany; , , , ,
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland 21287, USA;
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23
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Soiberman US, Shehata AEM, Lu MX, Young T, Daoud YJ, Chakravarti S, Jun AS, Foster JW. Small Molecule Modulation of the Integrated Stress Response Governs the Keratoconic Phenotype In Vitro. Invest Ophthalmol Vis Sci 2019; 60:3422-3431. [PMID: 31390655 PMCID: PMC6686743 DOI: 10.1167/iovs.19-27151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose The degenerative corneal disease keratoconus is a leading indicator for corneal transplant with an unknown etiology. We recently identified the activation of the integrated stress response (ISR) in ex vivo human corneas and in vitro cell culture. Utilizing small molecules to modulate the ISR we sought to investigate the effects of stimulating the ISR in healthy cells to recapitulate aspects of the in vitro keratoconic phenotype and whether relieving the ISR signaling would recover the disease phenotype. Methods Corneal fibroblasts were extracted from patients undergoing corneal transplant or unaffected cadaverous donor limbal rings. Cells were exposed to the DNA damage-inducible protein (GADD34) inhibitor SAL003 to stimulate the ISR, or Trans-ISRIB to relieve ISR signaling pathway. Collagen production was assessed through hydroxyproline production, Sirius Red incorporation, or quantitative (q)PCR. Western blotting, hydroxyproline, and qPCR were used to assess components of the ISR pathway and collagen production. Results ISR stimulation through SAL003 resulted in significant decrease of hydroxyproline and COL1A1 transcription and eventual apoptosis in normal fibroblasts. Patient (KC) fibroblast production of hydroxyproline was increased in response to ISRIB, while matrix metalloproteinase (MMP)9 production was lowered. The prospective biomarker of keratoconus prolactin-inducible factor was also upregulated in KC fibroblast cultures in response to ISRIB. Inflammatory markers TNFα and IL-1β were unaffected. Conclusions Activation of the ISR is sufficient to recapitulate many key aspects of the KC phenotype in unaffected cells in vitro. Inhibition of the ISR also relieves many of the hallmarks of KC in affected cells. Therefore, targeting of the ISR through small molecules is a potential therapeutic path for small molecule treatment of keratoconus.
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Affiliation(s)
- Uri Simcha Soiberman
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | | | | | - Tempest Young
- Johns Hopkins University, Baltimore, Maryland, United States
| | - Yassine J Daoud
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Shukti Chakravarti
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - James William Foster
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
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DeParis SW, Zhu AY, Majumdar S, Tian J, Elisseeff J, Jun AS, Mahoney NR. Effects of collagen crosslinking on porcine and human tarsal plate. BMC Ophthalmol 2019; 19:255. [PMID: 31842794 PMCID: PMC6915903 DOI: 10.1186/s12886-019-1254-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 11/21/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Floppy eyelid syndrome is a disorder in which the tarsal plate is easily distensible and is currently treated with conservative or surgical measures. Human tarsal plate contains type I collagen, which is crosslinked in corneal tissue as a treatment for keratoconus. We hypothesized that collagen crosslinking would similarly stiffen tarsal plate tissue and investigated this in porcine and human tarsal plate specimens. METHODS Riboflavin-sensitized porcine and human tarsus samples were irradiated with ultraviolet-A light. Porcine experiments were analyzed with gross photographs, anterior segment optical computed tomography (AS-OCT) imaging, and tensile testing. A prospective study of human tarsus was performed on samples from patients undergoing wedge resection for floppy eyelid syndrome and was analyzed with AS-OCT and tensile testing. RESULTS 73 porcine adnexa and 9 patients (16 eyelids) who underwent wedge excision were included in the study. Grossly, greater stiffness was observed in crosslinked porcine tissue. AS-OCT imaging in porcine tissue showed a distinct hyperreflective band in crosslinked specimens whose area and intensity increased with longer treatment time (P = 0.003); this band was also visible in crosslinked human specimens. Tensile testing was performed, but results were not statistically significant. CONCLUSIONS AS-OCT imaging, which has not been previously described for tarsal plate, showed a characteristic change in crosslinked porcine and human specimens. Tissue stiffness was increased grossly, but changes in tensile properties were not statistically significant. Further study is warranted to determine relevance as a potential treatment for floppy eyelid syndrome.
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Affiliation(s)
- Sarah W DeParis
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Angela Y Zhu
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Shoumyo Majumdar
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Jing Tian
- Department of Biostatistics, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Jennifer Elisseeff
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287, USA.,Department of Biomedical Engineering, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Albert S Jun
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Nicholas R Mahoney
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins Hospital, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
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Zhu AY, Jun AS, Soiberman US. Combined Protocols for Corneal Collagen Cross-Linking with Photorefractive Surgery for Refractive Management of Keratoconus: Update on Techniques and Review of Literature. Ophthalmol Ther 2019; 8:15-31. [PMID: 31605317 PMCID: PMC6789054 DOI: 10.1007/s40123-019-00210-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 12/13/2022] Open
Abstract
With the development and gradual dissemination of corneal collagen cross-linking (CXL) in the twenty-first century as an early treatment for keratoconus, the management paradigm has shifted to include a greater focus on complete refractive correction for these patients. Though supplemental hard contact lens therapy remains a mainstay of visual rehabilitation in keratoconus, there has been increasing appeal in a completely surgical approach by combining CXL with adjuvant refractive procedures to both halt the ectatic process and enhance functional visual outcomes. Collectively termed "CXL plus" procedures, several combined protocols have been studied to various degrees in conjunction with CXL, involving photorefractive keratectomy (PRK), transepithelial phototherapeutic keratectomy (PTK), conductive keratoplasty (CK), intrastromal corneal ring segments (ICRS) implantation, phakic intraocular lens (PIOL) implantation, or multiple of these techniques together. The scope of this review aims to encompass a summary of current CXL protocols and present the current status of studies involving adjunctive keratorefractive procedures combined with CXL. By discussing the results to date of these CXL plus protocols, we can assess what further areas of investigation are necessary within this field as the next step to optimizing treatment modalities and outcomes for our keratoconus patients, regardless of disease severity.
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Affiliation(s)
- Angela Y Zhu
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Uri S Soiberman
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
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Foster JW, Shinde V, Soiberman US, Sathe G, Liu S, Wan J, Qian J, Dauoud Y, Pandey A, Jun AS, Chakravarti S. Integrated Stress Response and Decreased ECM in Cultured Stromal Cells From Keratoconus Corneas. Invest Ophthalmol Vis Sci 2019; 59:2977-2986. [PMID: 30029277 PMCID: PMC5995483 DOI: 10.1167/iovs.18-24367] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Keratoconus (KC) is a multifactorial disease where progressive thinning and weakening of the cornea leads to loss of visual acuity. Although the underlying etiology is poorly understood, a major endpoint is a dysfunctional stromal connective tissue matrix. Using multiple individual KC corneas, we determined that matrix production by keratocytes is severely impeded due to an altered stress response program. Methods KC and donor (DN) stromal keratocytes were cultured in low glucose serum-free medium containing insulin, selenium and transferrin. Fibronectin, collagens and proteins related to their chaperone, processing and export, matrix metalloproteinase, and stress response related proteins were investigated by immunoblotting, immunocytochemistry, hydroxyproline quantification, and gelatin zymography. Multiplexed mass spectrometry was used for global proteomic profiling of 5 individual DN and KC cell culture. Transcription of selected proteins was assayed by qPCR. Results DN and KC cells showed comparable survival and growth. However, immunoblotting of selected ECM proteins and global proteomics showed decreased fibronectin, collagens, PCOLCE, ADAMTS2, BMP1, HSP47, other structural and cytoskeletal proteins in KC. Phosphorylated (p) eIF2α, a translation regulator and its target, ATF4 were increased in KC cultured cells and corneal sections. Conclusions The profound decrease in structural proteins in cultured KC cells and increase in the p-eIF2α, and ATF4, suggest a stress related blockade in structural proteins not immediately needed for cell survival. Therefore, this cell culture system reveals an intrinsic aggravated stress response with consequent decrease in ECM proteins as potential pathogenic underpinnings in KC.
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Affiliation(s)
- James W Foster
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Vishal Shinde
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States
| | - Uri S Soiberman
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Gajanan Sathe
- Manipal Academy of Higher Education, Karnataka, India
| | - Sheng Liu
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Julius Wan
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Jiang Qian
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States
| | - Yassine Dauoud
- Department of Ophthalmology, NYU Langone Health, New York, New York, United States
| | - Akhilesh Pandey
- Department of Biological Chemistry, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Shukti Chakravarti
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.,Department of Ophthalmology, NYU Langone Health, New York, New York, United States
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Mannschreck DB, Rubinfeld RS, Soiberman US, Jun AS. Diffuse lamellar keratitis after epi-off corneal crosslinking: An under-recognized complication? Am J Ophthalmol Case Rep 2019; 13:140-142. [PMID: 30705998 PMCID: PMC6348932 DOI: 10.1016/j.ajoc.2019.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 12/09/2018] [Accepted: 01/08/2019] [Indexed: 11/03/2022] Open
Abstract
Purpose To report diffuse lamellar keratitis (DLK) occurring in an eye that underwent epithelium-off (epi-off) corneal cross-linking (CXL) as a treatment for post-surgical ectasia and the successful treatment of progressive ectasia with a novel epi-on CXL and conductive keratoplasty (CK) treatment. Observations A 42-year-old man presented with corneal ectasia in his right eye 3 years after laser in situ keratomileusis (LASIK) surgery. He underwent epi-off corneal CXL using the Dresden protocol. Grade II DLK was diagnosed within days of CXL. Despite successful treatment of DLK, best-corrected visual acuity in the right eye deteriorated over the next 4 months due to progression of ectasia and remained worse than the patient's pre-operative baseline 1 year after epi-off CXL. Because of apparent disease progression, despite his CXL treatment, the patient underwent a novel, transepithelial CXL (TE-CXL) treatment combined with conductive keratoplasty (CK). This treatment improved his vision and stabilized his ectasia without subsequent DLK. Approximately 3 years after CK and TE-CXL, his eye remains stable with 4 Snellen lines of improved vision and no progression of ectasia. Conclusion and importance Epithelium-off CXL is used increasingly to treat post-LASIK ectasia. First, in this case, DLK occurred after epi-off CXL. We suggest careful scrutiny of such cases as DLK is difficult to identify after epi-off CXL. Second, the epi-off CXL was unsuccessful in stopping the post-LASIK ectasia. Transepithelial CXL successfully treated the ongoing ectasia after resolution of the DLK with no subsequent re-occurrence of DLK. We suggest that TE-CXL may provide a successful initial treatment for post-LASIK ectasia that also minimizes the epithelial disruption that can lead to DLK.
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Affiliation(s)
- Diana B Mannschreck
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Roy S Rubinfeld
- Georgetown University Medical Center & Washington Hospital Center, Washington, DC, United States.,Re:Vision, Rockville, MD, United States.,Fairfax, VA, United States
| | - Uri S Soiberman
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Albert S Jun
- The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Leonard BC, Jalilian I, Raghunathan VK, Wang W, Jun AS, Murphy CJ, Thomasy SM. Biomechanical changes to Descemet's membrane precede endothelial cell loss in an early-onset murine model of Fuchs endothelial corneal dystrophy. Exp Eye Res 2018; 180:18-22. [PMID: 30471280 DOI: 10.1016/j.exer.2018.11.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 11/08/2018] [Accepted: 11/20/2018] [Indexed: 01/20/2023]
Abstract
Early-onset Fuchs endothelial corneal dystrophy (FECD) has been associated with nonsynonymous mutations in collagen VIII α2 (COL8A2), a key extracellular matrix (ECM) protein in Descemet's membrane (DM). Two knock-in strains of mice have been generated to each express a mutant COL8A2 protein (Col8a2L450W/L450W and Col8a2Q455K/Q455K) that recapitulate the clinical phenotype of early-onset FECD including endothelial cell loss, cellular polymegathism and pleomorphism, and guttae. Due to abnormalities in ECM protein composition and structure in FECD, the stiffness of DM in Col8a2 knock-in mice and wildtype (WT) controls was measured using atomic force microscopy at 5 and 10 months of age, coinciding with the onset of FECD phenotypic abnormalities. At 5 months, only sporadic guttae were identified via in vivo confocal microscopy (IVCM) in Col8a2Q455K/Q455K mice, otherwise both strains of Col8a2 transgenic mice were indistinguishable from WT controls in terms of endothelial cell density and size. By 10 months of age, Col8a2L450W/L450W and Col8a2Q455K/Q455K mice developed reduced corneal endothelial density, increased endothelial cell area and guttae, with the Col8a2Q455K/Q455K strain exhibiting a more severe phenotype. However, at 5 months of age, prior to the development endothelial cell abnormalities, Col8a2L450W/L450W and Col8a2Q455K/Q455K mice knock-in mice had reduced tissue stiffness of DM that was statistically significant in the Col8a2Q455K/Q455K mice when compared with wildtype controls. These data indicate that alterations in the tissue compliance of DM precede phenotypic changes in endothelial cell count and morphology, and may play a role in onset and progression of FECD.
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Affiliation(s)
- Brian C Leonard
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, United States
| | - Iman Jalilian
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, United States
| | - Vijay Krishna Raghunathan
- The Ocular Surface Institute, University of Houston, Houston, TX, United States; Department of Basic Sciences, College of Optometry, University of Houston, Houston, TX, United States; Department of Biomedical Engineering, Cullen College of Engineering, University of Houston, Houston, TX, United States
| | - Wei Wang
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, United States
| | - Christopher J Murphy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, United States; Department of Ophthalmology & Vision Sciences, School of Medicine, University of California, Davis, CA, United States
| | - Sara M Thomasy
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis, CA, United States; Department of Ophthalmology & Vision Sciences, School of Medicine, University of California, Davis, CA, United States.
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Affiliation(s)
- Angela Y. Zhu
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | | | - Albert S. Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Linz MO, Jun AS, Clever SL, Lawson SM, Sanyal A, Scott AW. Evaluation of Medical Students' Perception of an Ophthalmology Career. Ophthalmology 2018; 125:461-462. [DOI: 10.1016/j.ophtha.2017.10.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 10/13/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022] Open
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Li Z, Breitwieser FP, Lu J, Jun AS, Asnaghi L, Salzberg SL, Eberhart CG. Identifying Corneal Infections in Formalin-Fixed Specimens Using Next Generation Sequencing. Invest Ophthalmol Vis Sci 2018; 59:280-288. [PMID: 29340642 PMCID: PMC5770184 DOI: 10.1167/iovs.17-21617] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 12/06/2017] [Indexed: 12/14/2022] Open
Abstract
Purpose We test the ability of next-generation sequencing, combined with computational analysis, to identify a range of organisms causing infectious keratitis. Methods This retrospective study evaluated 16 cases of infectious keratitis and four control corneas in formalin-fixed tissues from the pathology laboratory. Infectious cases also were analyzed in the microbiology laboratory using culture, polymerase chain reaction, and direct staining. Classified sequence reads were analyzed with two different metagenomics classification engines, Kraken and Centrifuge, and visualized using the Pavian software tool. Results Sequencing generated 20 to 46 million reads per sample. On average, 96% of the reads were classified as human, 0.3% corresponded to known vectors or contaminant sequences, 1.7% represented microbial sequences, and 2.4% could not be classified. The two computational strategies successfully identified the fungal, bacterial, and amoebal pathogens in most patients, including all four bacterial and mycobacterial cases, five of six fungal cases, three of three Acanthamoeba cases, and one of three herpetic keratitis cases. In several cases, additional potential pathogens also were identified. In one case with cytomegalovirus identified by Kraken and Centrifuge, the virus was confirmed by direct testing, while two where Staphylococcus aureus or cytomegalovirus were identified by Centrifuge but not Kraken could not be confirmed. Confirmation was not attempted for an additional three potential pathogens identified by Kraken and 11 identified by Centrifuge. Conclusions Next generation sequencing combined with computational analysis can identify a wide range of pathogens in formalin-fixed corneal specimens, with potential applications in clinical diagnostics and research.
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Affiliation(s)
- Zhigang Li
- Department of Ophthalmology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Florian P. Breitwieser
- Center for Computational Biology, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Jennifer Lu
- Center for Computational Biology, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
| | - Albert S. Jun
- Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Laura Asnaghi
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States
| | - Steven L. Salzberg
- Center for Computational Biology, McKusick-Nathans Institute of Genetic Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, United States
- Departments of Computer Science and Biostatistics, Johns Hopkins University, Baltimore, Maryland, United States
| | - Charles G. Eberhart
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, United States
- Department of Ophthalmology, Johns Hopkins University, Baltimore, Maryland, United States
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Soiberman U, Foster JW, Jun AS, Chakravarti S. Pathophysiology of Keratoconus: What Do We Know Today. Open Ophthalmol J 2017; 11:252-261. [PMID: 28932341 PMCID: PMC5585454 DOI: 10.2174/1874364101711010252] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 04/01/2017] [Accepted: 06/14/2017] [Indexed: 12/19/2022] Open
Abstract
Keratoconus is a common corneal ectasia that leads to progressive visual impairment. Numerous studies have shown abnormal protein expression patterns in keratoconic corneas. However, the specific mechanisms causing this disease remain ambiguous. This review aims to provide an update on morphological studies of the keratoconic cornea, relate these early studies with current findings from proteomic, biochemical and cell culture studies and to postulate possible pathogenic pathways.
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Affiliation(s)
- Uri Soiberman
- Cornea Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - James W Foster
- Cornea Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Albert S Jun
- Cornea Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Shukti Chakravarti
- Cornea Division, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, USA
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Vedana G, Cardoso FG, Marcon AS, Araújo LEK, Zanon M, Birriel DC, Watte G, Jun AS. Cumulative sum analysis score and phacoemulsification competency learning curve. Int J Ophthalmol 2017; 10:1088-1093. [PMID: 28730111 DOI: 10.18240/ijo.2017.07.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/11/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To use the cumulative sum analysis score (CUSUM) to construct objectively the learning curve of phacoemulsification competency. METHODS Three second-year residents and an experienced consultant were monitored for a series of 70 phacoemulsification cases each and had their series analysed by CUSUM regarding posterior capsule rupture (PCR) and best-corrected visual acuity. The acceptable rate for PCR was <5% (lower limit h) and the unacceptable rate was >10% (upper limit h). The acceptable rate for best-corrected visual acuity worse than 20/40 was <10% (lower limit h) and the unacceptable rate was >20% (upper limit h). The area between lower limit h and upper limit h is called the decision interval. RESULTS There was no statistically significant difference in the mean age, sex or cataract grades between groups. The first trainee achieved PCR CUSUM competency at his 22nd case. His best-corrected visual acuity CUSUM was in the decision interval from his third case and stayed there until the end, never reaching competency. The second trainee achieved PCR CUSUM competency at his 39th case. He could reach best-corrected visual acuity CUSUM competency at his 22nd case. The third trainee achieved PCR CUSUM competency at his 41st case. He reached best-corrected visual acuity CUSUM competency at his 14th case. CONCLUSION The learning curve of competency in phacoemulsification is constructed by CUSUM and in average took 38 cases for each trainee to achieve it.
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Affiliation(s)
- Gustavo Vedana
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore 21287, USA.,Irmandade Santa Casa, Misericórdia, Porto Alegre 90020160, Brazil
| | - Filipe G Cardoso
- Irmandade Santa Casa, Misericórdia, Porto Alegre 90020160, Brazil
| | | | - Licio E K Araújo
- Irmandade Santa Casa, Misericórdia, Porto Alegre 90020160, Brazil
| | - Matheus Zanon
- Irmandade Santa Casa, Misericórdia, Porto Alegre 90020160, Brazil
| | | | - Guilherme Watte
- Federal University of Rio Grande do Sul, Porto Alegre 90035003, Brazil
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore 21287, USA
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Kim EC, Toyono T, Berlinicke CA, Zack DJ, Jurkunas U, Usui T, Jun AS. Screening and Characterization of Drugs That Protect Corneal Endothelial Cells Against Unfolded Protein Response and Oxidative Stress. Invest Ophthalmol Vis Sci 2017; 58:892-900. [PMID: 28159976 PMCID: PMC5295784 DOI: 10.1167/iovs.16-20147] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To screen for and characterize compounds that protect corneal endothelial cells against unfolded protein response (UPR) and oxidative stress. Methods Bovine corneal endothelial cells (BCECs) were treated for 48 hours with 640 compounds from a Food and Drug Administration (FDA)-approved drug library and then challenged with thapsigargin or H2O2 to induce UPR or oxidative stress, respectively. Cell viability was measured using the CellTiter-Glo survival assay. Selected “hits” were subjected to further dose-response testing, and their ability to modulate expression of UPR and oxidative stress markers was assessed by RT-PCR, Western blot, and measurement of protein carbonyl and 8-hydroxydeoxyguanosine (8-OHdG) adducts in immortalized human corneal endothelial cells (iHCECs). Results Forty-one drugs at 20 μM and 55 drugs at 100 μM increased survival of H2O2-challenged cells, and 8 drugs at 20 μM and 2 drugs at 100 μM increased survival of thapsigargin-challenged cells, compared with untreated control cells. Nicergoline, ergothioneine, nimesulide, oxotremorine, and mefenamic acid increased survival of both H2O2- and thapsigargin-challenged cells. Oxotremorine altered DNA damage inducible 3 (CHOP) gene expression, glucose-regulated protein 78 kDa (GRP78) and activating transcription factor 4 (ATF4) protein expression, and protein carbonyl and 8-OHdG levels. Mefenamic acid altered GRP78 protein expression and protein carbonyl and 8-OHdG levels. Conclusions Oxotremorine and mefenamic acid are potential survival factors for corneal endothelial cells under UPR and oxidative stress. The described assay can be further expanded to screen additional drugs for potential therapeutic effect in corneal endothelial diseases such as Fuchs' endothelial corneal dystrophy.
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Affiliation(s)
- Eun Chul Kim
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States 2Department of Ophthalmology & Visual Science, Catholic University of Korea, Seoul, Korea
| | - Tetsuya Toyono
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States 3Department of Ophthalmology, University of Tokyo, Tokyo, Japan
| | - Cynthia A Berlinicke
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Donald J Zack
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States 4Departments of Molecular Biology and Genetics, Neuroscience, and Institute of Genetic Medicine, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
| | - Ula Jurkunas
- Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts, United States
| | - Tomohiko Usui
- Department of Ophthalmology, University of Tokyo, Tokyo, Japan
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, United States
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Ladas JG, Jun AS, Devgan U. Origin of Multiple Formula Use to Calculate Intraocular Lens Power-Reply. JAMA Ophthalmol 2016; 134:848-9. [PMID: 27259075 DOI: 10.1001/jamaophthalmol.2016.1049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | | | - Uday Devgan
- Jules Stein Eye Institute, University of California, Los Angeles
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Losick VP, Jun AS, Spradling AC. Wound-Induced Polyploidization: Regulation by Hippo and JNK Signaling and Conservation in Mammals. PLoS One 2016; 11:e0151251. [PMID: 26958853 PMCID: PMC4784922 DOI: 10.1371/journal.pone.0151251] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 02/25/2016] [Indexed: 12/13/2022] Open
Abstract
Tissue integrity and homeostasis often rely on the proliferation of stem cells or differentiated cells to replace lost, aged, or damaged cells. Recently, we described an alternative source of cell replacement- the expansion of resident, non-dividing diploid cells by wound-induced polyploidization (WIP). Here we show that the magnitude of WIP is proportional to the extent of cell loss using a new semi-automated assay with single cell resolution. Hippo and JNK signaling regulate WIP; unexpectedly however, JNK signaling through AP-1 limits rather than stimulates the level of Yki activation and polyploidization in the Drosophila epidermis. We found that polyploidization also quantitatively compensates for cell loss in a mammalian tissue, mouse corneal endothelium, where increased cell death occurs with age in a mouse model of Fuchs Endothelial Corneal Dystrophy (FECD). Our results suggest that WIP is an evolutionarily conserved homeostatic mechanism that maintains the size and synthetic capacity of adult tissues.
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Affiliation(s)
- Vicki P. Losick
- Department of Embryology, Carnegie Institution for Science, Howard Hughes Medical Institute, 3250 San Martin Dr., Baltimore, MD 21218, United States of America
| | - Albert S. Jun
- Wilmer Eye Institute, Johns Hopkins School of Medicine, 400 N. Broadway, Baltimore, MD 21231, United States of America
| | - Allan C. Spradling
- Department of Embryology, Carnegie Institution for Science, Howard Hughes Medical Institute, 3250 San Martin Dr., Baltimore, MD 21218, United States of America
- * E-mail:
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Abstract
Fuchs endothelial corneal dystrophy (FECD) is the most common corneal dystrophy and frequently results in vision loss. Hallmarks of the disease include loss of corneal endothelial cells and formation of excrescences of Descemet's membrane. Later stages involve all layers of the cornea. Impairment of endothelial barrier and pump function and cell death from oxidative and unfolded protein stress contribute to disease progression. The genetic basis of FECD includes numerous genes and chromosomal loci, although alterations in the transcription factor 4 gene are associated with the majority of cases. Definitive treatment of FECD is corneal transplantation. In this paper, we highlight advances that have been made in understanding FECD's clinical features, pathophysiology, and genetics. We also discuss recent advances in endothelial keratoplasty and potential future treatments.
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Affiliation(s)
- Gustavo Vedana
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | | | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Botsford B, Vedana G, Cope L, Yiu SC, Jun AS. Comparison of 20% sulfur hexafluoride with air for intraocular tamponade in Descemet membrane endothelial keratoplasty (DMEK). Arq Bras Oftalmol 2016; 79:299-302. [DOI: 10.5935/0004-2749.20160086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 04/14/2016] [Indexed: 11/20/2022] Open
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Vianna LMM, Li HD, Holiman JD, Stoeger C, Belfort Jr. R, Jun AS. Characterization of cryopreserved primary human corneal endothelial cells cultured in human serum-supplemented media. Arq Bras Oftalmol 2016; 79:37-41. [DOI: 10.5935/0004-2749.20160011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Accepted: 11/13/2015] [Indexed: 11/20/2022] Open
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Ladas JG, Siddiqui AA, Devgan U, Jun AS. A 3-D “Super Surface” Combining Modern Intraocular Lens Formulas to Generate a “Super Formula” and Maximize Accuracy. JAMA Ophthalmol 2015; 133:1431-6. [DOI: 10.1001/jamaophthalmol.2015.3832] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- John G. Ladas
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Aazim A. Siddiqui
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Uday Devgan
- Jules Stein Eye Institute, University of California, Los Angeles, School of Medicine
| | - Albert S. Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Vianna LM, Stoeger CG, Galloway JD, Terry M, Cope L, Belfort R, Jun AS. Risk factors for eye bank preparation failure of Descemet membrane endothelial keratoplasty tissue. Am J Ophthalmol 2015; 159:829-34.e2. [PMID: 25640409 DOI: 10.1016/j.ajo.2015.01.030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 01/25/2015] [Accepted: 01/26/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE To assess the results of a single eye bank preparing a high volume of Descemet membrane endothelial keratoplasty (DMEK) tissues using multiple technicians to provide an overview of the experience and to identify possible risk factors for DMEK preparation failure. DESIGN Cross-sectional study. METHODS setting: Lions VisionGift and Wilmer Eye Institute at Johns Hopkins Hospital. STUDY POPULATION All 563 corneal tissues processed by technicians at Lions VisionGift for DMEK between October 2011 and May 2014 inclusive. OBSERVATION PROCEDURES Tissues were divided into 2 groups: DMEK preparation success and DMEK preparation failure. MAIN OUTCOME MEASURES We compared donor characteristics, including past medical history. RESULTS The overall tissue preparation failure rate was 5.2%. Univariate analysis showed diabetes mellitus (P = .000028) and its duration (P = .023), hypertension (P = .021), and hyperlipidemia or obesity (P = .0004) were more common in the failure group. Multivariate analysis showed diabetes mellitus (P = .0001) and hyperlipidemia or obesity (P = .0142) were more common in the failure group. Elimination of tissues from donors either with diabetes or with hyperlipidemia or obesity reduced the failure rate from 5.2% to 2.2%. Trends toward lower failure rates occurring with increased technician experience also were found. CONCLUSIONS Our work showed that tissues from donors with diabetes mellitus (especially with longer disease duration) and hyperlipidemia or obesity were associated with higher failure rates in DMEK preparation. Elimination of tissues from donors either with diabetes mellitus or with hyperlipidemia or obesity reduced the failure rate. In addition, our data may provide useful initial guidelines and benchmark values for eye banks seeking to establish and maintain DMEK programs.
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Vianna LMM, Leatherman J, Jun AS. Vision with Fuchs endothelial dystrophy. JAMA Ophthalmol 2015; 133:e145353. [PMID: 25856653 DOI: 10.1001/jamaophthalmol.2014.5353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Muthappan V, Paskowitz D, Kazimierczak A, Jun AS, Ladas J, Kuo IC. Measurement and use of postoperative anterior chamber depth of fellow eye in refractive outcomes. J Cataract Refract Surg 2015; 41:778-84. [DOI: 10.1016/j.jcrs.2014.08.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Revised: 07/15/2014] [Accepted: 08/12/2014] [Indexed: 11/30/2022]
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Bonfadini G, Arora K, Vianna LM, Campos M, Friedman D, Muñoz B, Jun AS. Quantitative analysis of iris parameters in keratoconus patients using optical coherence tomography. Arq Bras Oftalmol 2015; 78:305-9. [DOI: 10.5935/0004-2749.20150080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 07/06/2015] [Indexed: 11/20/2022] Open
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Matthaei M, Zhu AY, Kallay L, Eberhart CG, Cursiefen C, Jun AS. Transcript profile of cellular senescence-related genes in Fuchs endothelial corneal dystrophy. Exp Eye Res 2014; 129:13-7. [PMID: 25311168 DOI: 10.1016/j.exer.2014.10.011] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 09/03/2014] [Accepted: 10/09/2014] [Indexed: 12/13/2022]
Abstract
Fuchs endothelial corneal dystrophy (FECD) is a genetically heterogeneous disease. Hypothesizing that cellular senescence may be relevant in FECD pathogenesis, genetically undifferentiated late-onset FECD endothelial samples were analyzed to identify common changes of specific senescence-related transcripts. Total RNA was extracted from 21 FECD endothelial samples retrieved from patients undergoing lamellar keratoplasty due to clinically diagnosed end-stage FECD and from 12 endothelial samples retrieved from normal autopsy eyes. Taqman low density array (TLDA) cards were used to analyze differential expression of 89 cellular senescence-related transcripts. Result validation was performed using individual real-time PCR assays. TLDA-analysis demonstrated differential expression of 31 transcripts (fold-change >1.5; p < 0.05). Thereof, 27 showed significant up-regulation and 4 significant down-regulation. Markedly elevated mRNA-levels of the constitutively active and reactive oxygen species-generating enzyme NOX4 were found in all evaluable FECD samples. In addition, increased expression of CDKN2A and its transcriptional activators ETS1 and ARHGAP18 (SENEX) along with decreased expression of CDKN2A inhibitor ID1 were detected in FECD samples. Consistent over-expression of NOX4 in FECD endothelial samples suggests a role as pathogenic factor and as a potential new treatment target in FECD. Transcriptional up-regulation of the CDKN2A-pathway provides further evidence for increased cellular senescence in FECD endothelium.
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Affiliation(s)
- Mario Matthaei
- The Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, USA; Department of Ophthalmology, University of Cologne, Cologne, Germany; Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angela Y Zhu
- The Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Laura Kallay
- The Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Charles G Eberhart
- The Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, USA
| | - Claus Cursiefen
- Department of Ophthalmology, University of Cologne, Cologne, Germany
| | - Albert S Jun
- The Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, USA.
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Abstract
Purpose To describe a case of fungal keratitis involving an atypical organism with confirmatory in vivo confocal microscopy and to review the literature on Rhodotorula keratitis. Methods Case report and review of the medical literature. Results A 22-year-old college student was struck in the left eye with a tree branch and subsequently developed pain, redness and photophobia. Upon presentation, visual acuity was 20/200 and there was a large epithelial defect with diffuse stromal inflammation involving the anterior one-third of the cornea. Cultures of the infiltrate were performed for bacterial, viral and fungal organisms that resulted in a positive culture for Rhodotorula mucilaginosa. Fungal elements were confirmed in vivo by confocal microscopy. The patient was treated with voriconazole initially and had amphotericin added once Rhodotorula infection was confirmed. The patient responded well clinically, and one month after therapy was initiated, the corneal infiltrate had resolved leaving mild anterior stromal haze. Upon completion of therapy at three months, the patient was asymptomatic, had a clear cornea and had a best corrected visual acuity of 20/20 in the involved eye. There was no measurable change in his manifest refraction. Conclusions Prior cases of Rhodotorula keratitis most often required surgical intervention and were associated with poor outcomes. This case shows that Rhodotorula keratitis can be successfully treated with topical antifungal agents if diagnosed early and appropriate treatment is initiated promptly. We report the first case of Rhodotorula keratitis confirmed by in vivo confocal microscopy. This is also the first description of pseudomycelium formation that has not been previously described in vivo, a morphological structure that this organism rarely demonstrates. Finally, this case shows that confocal microscopy may aid in the early diagnosis and management of fungal keratitis involving this rare but potentially damaging organism.
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Affiliation(s)
| | - Rick Lee
- Johns Hopkins University, Baltimore, Md., USA
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Foster J, Wu WH, Scott SG, Bassi M, Mohan D, Daoud Y, Stark WJ, Jun AS, Chakravarti S. Transforming growth factor β and insulin signal changes in stromal fibroblasts of individual keratoconus patients. PLoS One 2014; 9:e106556. [PMID: 25247416 PMCID: PMC4172437 DOI: 10.1371/journal.pone.0106556] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 08/07/2014] [Indexed: 11/19/2022] Open
Abstract
Keratoconus (KC) is a complex thinning disease of the cornea that often requires transplantation. The underlying pathogenic molecular changes in this disease are poorly understood. Earlier studies reported oxidative stress, metabolic dysfunctions and accelerated death of stromal keratocytes in keratoconus (KC) patients. Utilizing mass spectrometry we found reduced stromal extracellular matrix (ECM) proteins in KC, suggesting ECM-regulatory changes that may be due to altered TGFβ signals. Here we investigated properties of stromal cells from donor (DN) and KC corneas grown as fibroblasts in serum containing DMEM: F12 or in serum-free medium containing insulin, transferrin, selenium (ITS). Phosphorylation of SMAD2/3 of the canonical TGFβ pathway, was high in serum-starved DN and KC fibroblast protein extracts, but pSMAD1/5/8 low at base line, was induced within 30 minutes of TGFβ1 stimulation, more so in KC than DN, suggesting a novel TGFβ1-SMAD1/5/8 axis in the cornea, that may be altered in KC. The serine/threonine kinases AKT, known to regulate proliferation, survival and biosynthetic activities of cells, were poorly activated in KC fibroblasts in high glucose media. Concordantly, alcohol dehydrogenase 1 (ADH1), an indicator of increased glucose uptake and metabolism, was reduced in KC compared to DN fibroblasts. By contrast, in low glucose (5.5 mM, normoglycemic) serum-free DMEM and ITS, cell survival and pAKT levels were comparable in KC and DN cells. Therefore, high glucose combined with serum-deprivation presents some cellular stress difficult to overcome by the KC stromal cells. Our study provides molecular insights into AKT and TGFβ signal changes in KC, and a mechanism for functional studies of stromal cells from KC corneas.
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Affiliation(s)
- James Foster
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Wai-Hong Wu
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sherri-Gae Scott
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Mehak Bassi
- All India Institute of Medical Sciences, New Delhi, India
| | - Divya Mohan
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Yassine Daoud
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Walter J. Stark
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Albert S. Jun
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Shukti Chakravarti
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- Department of Cell Biology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Mitry D, Bhogal M, Patel AK, Lee BS, Chai SM, Price MO, Price FW, Jun AS, Aldave AJ, Mehta JS, Busin M, Allan BD. Descemet stripping automated endothelial keratoplasty after failed penetrating keratoplasty: survival, rejection risk, and visual outcome. JAMA Ophthalmol 2014; 132:742-9. [PMID: 24763830 DOI: 10.1001/jamaophthalmol.2014.352] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Descemet stripping automated endothelial keratoplasty (DSAEK) for isolated endothelial dysfunction has become the preferred surgical option for many corneal surgeons. However, there are limited large-scale reports on DSAEK survival and clinical variables affecting the risk of rejection and failure after failed penetrating keratoplasty (PK). OBJECTIVE To report the survival, risk factors for graft rejection and failure, and visual outcome of DSAEK after failed PK. DESIGN, SETTING, AND PARTICIPANTS A multicenter retrospective interventional case series included patients recruited from 6 tertiary referral surgical centers: 3 in the United States, 2 in Europe, and 1 in Asia. A total of 246 consecutive eyes (246 patients) that underwent DSAEK after failed PK, with a minimum follow-up period of 1 month, was included. Data comprising demographic details, preoperative and postoperative risk factors, time to rejection, time to failure, and corrected distance visual acuity were collected. MAIN OUTCOMES AND MEASURES Cumulative probability of graft survival, hazard ratio estimates for survival, and corrected distance visual acuity were determined. RESULTS The mean (SD) recipient age was 63.2 (16.6) years and the median follow-up period was 17 months (interquartile range, 6-30 months). One-third of the grafts (n = 82) had follow-up data for more than 2 years; 18.3% had more than 1 failed PK before DSAEK. In total, 19.1% (47 of 246) of DSAEK grafts failed. The cumulative probability of DSAEK survival after a failed PK was 0.89 (95% CI, 0.84-0.92), 0.74 (95% CI, 0.64-0.81), and 0.47 (95% CI, 0.29-0.61) at 1 year, 3 years, and 5 years, respectively. Based on multivariate analysis, significant preoperative risk factors for failure were young recipient age (hazard ratio [HR], 5.18 [95% CI, 1.57-17.18]), previous tube filtration surgery (HR, 5.23 [95% CI, 1.47-7.33]), and rejection episodes before PK failure (HR, 3.28 [95% CI, 1.47-7.33]); single-surgeon centers had a protective effect. Any rejection episode prior to PK failure was a significant predictor of post-DSAEK rejection, which in turn was a significant predictor of DSAEK failure. After a median follow-up of 17 months, 33.3% of the grafts achieved 0.3 or greater logMAR (20/40) corrected distance visual acuity. CONCLUSIONS AND RELEVANCE Descemet stripping automated endothelial keratoplasty after failed PK combines greater wound stability and reduced suture-related complications, with visual outcomes and graft survival rates comparable to those of a second PK.
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Affiliation(s)
- Danny Mitry
- Department of Corneal Surgery, Moorfields Eye Hospital, London, England
| | - Maninder Bhogal
- Department of Corneal Surgery, Moorfields Eye Hospital, London, England
| | - Amit K Patel
- Department of Corneal Surgery, Birmingham Heartlands Hospital, Heart of England National Health Service Foundation Trust, Birmingham, England
| | - Bryan S Lee
- Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Shu Ming Chai
- Department of Corneal Surgery, Singapore National Eye Centre, Singapore
| | | | | | - Albert S Jun
- Wilmer Eye Institute, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Anthony J Aldave
- Jules Stein Eye Institute, University of California, Los Angeles
| | - Jodhbir S Mehta
- Department of Corneal Surgery, Singapore National Eye Centre, Singapore
| | - Massimo Busin
- Department of Corneal Surgery, Villa Serena Hospital, Forli, Italy
| | - Bruce D Allan
- Department of Corneal Surgery, Moorfields Eye Hospital, London, England
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Affiliation(s)
- Hyeck-Soo Son
- University of Heidelberg School of Medicine, Heidelberg, BW Germany
| | - Guadalupe Villarreal
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Huan Meng
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Charles G Eberhart
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
| | - Albert S Jun
- Wilmer Eye Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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