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Berger T, Hasenfus A, Bredrup C, Gatzioufas Z, Flockerzi F, Käsmann-Kellner B, Daas L, Flockerzi E, Knappskog PM, Stang E, Seitz B. Long-Term Follow-Up of Pediatric Excimer Laser-Assisted Penetrating Keratoplasty for Congenital Stromal Corneal Dystrophy. Cornea 2024; 43:784-789. [PMID: 38437155 DOI: 10.1097/ico.0000000000003519] [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: 05/12/2023] [Accepted: 01/22/2024] [Indexed: 03/06/2024]
Abstract
PURPOSE The purpose of this study was to highlight characteristic clinical and microscopic findings and report the long-term follow-up of pediatric excimer laser-assisted penetrating keratoplasty (excimer-PKP) for congenital stromal corneal dystrophy (CSCD). METHODS A 2-year-old Greek child presented with CSCD at our department. Clinical examination showed bilateral flake-like whitish corneal opacities affecting the entire corneal stroma up to the limbus. Genetic testing identified a mutation of the decorin gene (c.962delA). The variant was not present in the parents and represented a de novo mutation. The uncorrected visual acuity was 20/100 in both eyes. Excimer-PKP (8.0/8.1 mm) was performed on the right eye at the age of 2.5 years and on the left eye at the age of 3 years. Postoperatively, alternating occlusion treatment was performed. RESULTS The light microscopic examination demonstrated a disorganized extracellular matrix of the corneal stroma characterized by a prominent irregular arrangement of stromal collagen lamellae with large interlamellar clefts containing ground substance, highlighted by periodic acid-Schiff- and Alcian blue-positive reaction detecting acid mucopolysaccharides. Electron microscopy showed disorganization and caliber variation of collagen lamellae and thin filaments within an electron-lucent ground substance. The postoperative course was unremarkable. Both grafts remained completely clear 14 years postoperatively. Corneal tomography showed moderate regular astigmatism with normal corneal thickness. The corrected distance visual acuity was 20/25 in both eyes. CONCLUSIONS Excimer-PKP for CSCD might be associated with excellent long-term results and a good prognosis, particularly when the primary surgery is performed at a very young age. However, this requires close postoperative follow-up examinations by an experienced pediatric ophthalmologist to avoid severe amblyopia.
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Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Andrea Hasenfus
- Institute of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Cecilie Bredrup
- Department of Ophthalmology, Haukeland University Hospital, Bergen, Norway
| | - Zisis Gatzioufas
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
| | - Fidelis Flockerzi
- Institute of Pathology, Saarland University Medical Center, Homburg/Saar, Germany
| | | | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Per M Knappskog
- Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway; and
| | - Espen Stang
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
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Scorsetti MM, Eguiza VS, Durán JA. Manual Superficial Keratectomy Is the First Choice Treatment for Salzmann Nodular Degeneration. Cornea 2024; 43:716-719. [PMID: 37889535 DOI: 10.1097/ico.0000000000003413] [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: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE This study aimed to describe the optical and topographic changes after manual superficial keratectomy (MSK) for Salzmann nodular degeneration. METHODS This was a descriptive, retrospective study. All patients with a clinical diagnosis of Salzmann nodular degeneration were examined at the Cornea Service of the Instituto Clínico Quirúrgico de Oftalmología (ICQO), Bilbao, Spain, and treated with MSK after presenting ocular discomfort and/or decreased visual acuity. The clinical characteristics (including anterior segment optical coherence tomography and Pentacam topography), treatment regimens, surgical procedures, and outcomes were recorded. Descriptive statistics were constructed using mean ± SD, minimum, maximum, and median. The Shapiro-Wilk normality test was used. The Student t test was used to determine significance. RESULTS Ten eyes of 9 patients were included in this study: 6 patients (66.6%) were female and 3 were male (33.3%). The mean age was 62.2 years, and the follow-up time was between 5 and 21 months. The best-corrected visual acuity before MSK was 0.20 LogMAR (median) and improved to 0.10 after the surgical procedure. The mean spherical equivalent was reduced from -0.23 ± 3.39 D preoperatively to -1.3 ± 3.0 D postoperatively. Astigmatism decreased between 0.5 and 3.75 D. Topographic irregularity normalized total root mean square from 11,596.4 ± 6854.01 to 4817.2 ± 2725.68 μm. CONCLUSIONS MSK is an effective and safe technique for the treatment of Salzmann nodular degeneration when the Bowman layer is preserved. Anterior segment optical coherence tomography and corneal topography are essential tools for the surgical plan and for the detection of corneal aberrations.
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Affiliation(s)
| | - V Sergio Eguiza
- Instituto Clínico-Quirúrgico de Oftalmología, Bilbao, Spain; and
| | - Juan A Durán
- Instituto Clínico-Quirúrgico de Oftalmología, Bilbao, Spain; and
- Universidad del País Vasco, Leioa, Spain
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Zhang SJ, Wang LF, Xiao Z, Liu ZQ, Xing C, Li Q, Sun HJ, Yang ZZ, Lyu LN, Peng XY. Analysis of Radial Peripapillary Capillary Density in Patients with Bietti Crystalline Dystrophy by Optical Coherence Tomography Angiography. Biomed Environ Sci 2022; 35:107-114. [PMID: 35197175 DOI: 10.3967/bes2022.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 09/14/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE We wanted to investigate the radial peripapillary capillary (RPC) network in patients with Bietti crystalline dystrophy (BCD). METHODS We compared RPC densities in the disk and different peripapillary regions, obtained using optical coherence tomography angiography in 22 patients with BCD (37 eyes) and 22 healthy subjects (37 eyes). The BCD group was then divided into Stage 2 and Stage 3 subgroups based on Yuzawa staging, comparing the RPC densities of the two. RESULTS The disk area RPC density was 38.8% ± 6.3% in the BCD group and 49.2% ± 6.1% in the control group ( P < 0.001), and peripapillary region RPC density was significantly lower in the BCD group than in the control group (49.1% ± 4.7% and 54.1% ± 3.0%, respectively, P < 0.001). There were no significant RPC density differences between the tempo quadrant and inside disk of Stages 2 and 3 subgroups; the other areas showed a significantly lower RPC density in Stage 3 than in Stage 2 BCD. CONCLUSION The BCD group RPC density was significantly lower than the control group. The reduction of RPC density in the tempo quadrant occurred mainly in the Stage 1 BCD. In contrast, the reduction of RPC density in superior, inferior, and nasal quadrants occurred mainly in Stage 2.
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Affiliation(s)
- Sheng Juan Zhang
- Beijing Institute of Ophthalmology, Beijing Ophthalmology, and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China;Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Li Fei Wang
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Zhe Xiao
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Zhi Qiang Liu
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Chen Xing
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Qian Li
- Beijing Institute of Ophthalmology, Beijing Ophthalmology, and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
| | - Hui Jing Sun
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Zan Zhang Yang
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Li Na Lyu
- Hebei Provincial Key Laboratory of Ophthalmology, Hebei Provincial Eye Institute, Hebei Provincial Eye Hospital, Xingtai 054001, Hebei, China
| | - Xiao Yan Peng
- Beijing Institute of Ophthalmology, Beijing Ophthalmology, and Visual Science Key Laboratory, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100005, China
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Abstract
PURPOSE The purpose of this study was to report a large series of patients with peripheral hypertrophic subepithelial corneal degeneration (PHSCD) and differentiate the condition from Salzmann nodular degeneration (SND). METHODS We retrospectively reviewed the charts of 49 patients diagnosed with PHSCD and reported their clinical, refractive, and topographic/tomographic findings. RESULTS Most of the eyes were white and quiet. Minimal variable injection was present in a few eyes usually in the presence of pseudopterygium. Typical corneal involvement consists of peripheral circumferential-elevated whitish subepithelial opacities with fine superficial vessels along the limbus and linear deposits of iron in the epithelium along the central edge of the opacification. The typical topographic/tomographic findings consist of flattening directly over the corneal opacification with central flattening aligning with the axis of the opacification. In all subjects, the mean refractive astigmatism was significantly less than the mean topographic/tomographic Sim K astigmatism. Thirty-five eyes underwent surgical excision. The surgical eyes demonstrated significantly less astigmatism and better best-spectacle corrected visual acuity than pre-op. Moreover, all the eyes that underwent surgery for discomfort experienced significant improvement in their symptoms. Histopathology of the keratectomy specimens demonstrated paucicellular subepithelial fibrosis with overlying epithelium that was variable in caliber. CONCLUSIONS PHSCD is distinct from SND, primarily occurring in middle-aged women, bilateral and fairly symmetric with larger more peripheral opacities than SND, and absence of inflammatory signs and symptoms.
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Affiliation(s)
- Irving M Raber
- Cornea Service, Wills Eye Hospital, Philadelphia, PA; and
| | - Ralph C Eagle
- Department of Pathology, Wills Eye Hospital, Philadelphia, PA
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Abstract
PURPOSE To compare changes of chorioretinal blood perfusion between Bietti crystalline dystrophy (BCD) and typical retinitis pigmentosa and perform a staging and a longitudinal analysis of chorioretinal perfusion in BCD. METHODS Twenty-eight patients with BCD (56 eyes), 28 patients with typical retinitis pigmentosa (56 eyes), and 28 healthy subjects (56 eyes) were enrolled. Macular structural parameters and subfoveal choroidal thickness were measured using optical coherence tomography. Retinal vessel and perfusion densities were calculated using optical coherence tomography angiography. Choroidal blood perfusion was assessed through indocyanine green angiography. The results of the BCD group were compared with those of the retinitis pigmentosa and control groups and followed by a staging and a longitudinal analysis of BCD. RESULTS Macular structural and perfusion parameters were decreased less in the BCD group than those in the retinitis pigmentosa group. Subfoveal choroidal thickness was significantly thinner in the BCD group, with a remarkable choroidal perfusion deficit using indocyanine green angiography. The staging analysis revealed damage of both retinal and choroidal perfusion in BCD; however, the longitudinal analysis showed the impairment of choroidal perfusion outweighed retinal. CONCLUSION Both retinal and choroidal blood perfusion are impaired in BCD, but choroidal perfusion deficit caused by CYP4V2 mutations may play a more vital pathologic role.
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Affiliation(s)
- Yufei Xu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Zuoxin Qin
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Nan Wu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Tongtao Zhao
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Peng Gu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Bangqi Ren
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Lin Li
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Xiaohong Meng
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
| | - Yong Liu
- Southwest Hospital/Southwest Eye Hospital, Third Military Medical University (Army Medical University), Chongqing, China; and
- Key Lab of Visual Damage and Regeneration & Restoration of Chongqing, Chongqing, China
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Narvaez J, Chang M, Ing J, De Chance D, Narvaez JJ. Simplified, Readily Available Method for the Treatment of Band Keratopathy With Ethylenediaminetetraacetic Acid. Cornea 2021; 40:1360-1362. [PMID: 34481414 PMCID: PMC8423137 DOI: 10.1097/ico.0000000000002635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 10/13/2020] [Accepted: 11/02/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare 3 methods for creating ethylenediaminetetraacetic acid (EDTA) solution using readily available Vacutainer tubes for the treatment of band keratopathy. METHODS All 3 protocols used commercially available Vacutainer blood collection tubes coated with K2EDTA. An osmometer was used to measure and compare the concentration of EDTA created using 3 different protocols. The time required for preparation of the solution was measured and compared to evaluate its efficiency for everyday clinical use. In addition, volume of EDTA solution obtained was measured for method 1. The most promising protocol for clinical use was then used for treatment of a series of patients. RESULTS Average osmolarity was 532, 285, and 422 for methods 1, 2, and 3, respectively (ANOVA P < 0.01, all Tukey honestly significant difference P < 0.01). For the respective mixtures, average concentration was 65, 35, and 52 mg/mL, and average time to create solution was 189, 38, and 83 seconds (ANOVA P < 0.01, all Tukey honestly significant difference P < 0.01). The most promising, method 3, was found to be safe and effective in removing calcium from the corneal stroma in a series of 5 patients with 6 eyes treated. It also yielded 25% more solution for clinical use than method 1. CONCLUSIONS Method 3 using a single 10-mL Vacutainer tube with 18 mg of K2-EDTA had the best balance of effective concentration of EDTA, time to preparation, and simplicity of methodology, when compared with previously published methods 1 and 2. It also yielded a greater final volume of solution.
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Affiliation(s)
- Julio Narvaez
- Delta Eye Medical Group, Stockton, Lodi, and Tracy, CA
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA
| | - Matthew Chang
- Loma Linda University School of Medicine, Loma Linda, CA; and
| | - Jeffrey Ing
- Department of Ophthalmology, Loma Linda University, Loma Linda, CA
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Duong AT, Mandel Foley L, Galloway J, Sales CS, Tran KD. Tissue Loss, Processing Time, and Primary Graft Failure in Eye Bank-Prepared Descemet Membrane Endothelial Keratoplasty Grafts Before and After Prestripped to Preloaded Graft Transition. Cornea 2021; 40:710-714. [PMID: 32947404 DOI: 10.1097/ico.0000000000002531] [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: 05/11/2020] [Accepted: 07/29/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To examine tissue loss rates, processing time, and primary graft failure (PGF) of "prestripped-only" Descemet membrane endothelial keratoplasty (DMEK) grafts at a single eye bank and how these parameters changed after the introduction of steps to preload tissue among experienced processors. METHODS Tissue loss and processing time during DMEK graft preparation as well as PGF were analyzed retrospectively at a single eye bank between 2012 and 2018. Outcomes were assessed in consecutive grafts before and after the introduction of preloading to the eye bank's standard operating procedure. RESULTS A total of 1326 grafts were analyzed, composed of the first 663 preloaded DMEK grafts and, for comparison, the 663 DMEK grafts processed immediately before starting the preloaded service. Mean processing time increased from 17.0 ± 3.9 minutes to 26.0 ± 5.4 minutes with the advent of preloading (P < 0.01). Initially, average processing time increased dramatically, with a maximum processing time of 51 minutes, before regressing to the average. No significant difference in the rate of tissue wastage was observed before versus after the implementation of preloaded DMEK (1.2% vs. 1.7%, P = 0.48). PGF occurred in 7 grafts before the preloaded service and 10 grafts after starting the service (1.6% vs. 2.3%, P = 0.47). CONCLUSIONS Preloading does not affect tissue wastage for experienced technicians or the PGF rate but increases processing time. Eye banks that are considering adding preloading to their standard operating procedure may need to account for longer processing times in their daily operations.
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Affiliation(s)
- Andrew T Duong
- Department of Ophthalmology, Weill Cornell Medicine, New York, NY
| | | | | | - Christopher S Sales
- Department of Ophthalmology, Weill Cornell Medicine, New York, NY
- Lions VisionGift, Portland, OR
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Singh S, Das S, Kannabiran C, Jakati S, Chaurasia S. Macular Corneal Dystrophy: An Updated Review. Curr Eye Res 2021; 46:765-770. [PMID: 33171054 DOI: 10.1080/02713683.2020.1849727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/28/2020] [Revised: 10/16/2020] [Accepted: 11/01/2020] [Indexed: 01/11/2023]
Abstract
Macular Corneal Dystrophy is an autosomal recessive form of corneal dystrophy due to a mutation in CHST6 gene, which results in abnormal proteoglycan synthesis. There is accumulation of abnormal glycosaminoglycans in the corneal stroma and endothelium. The deposition results in progressive loss of corneal transparency and visual acuity. The histopathology shows characteristic alcian blue positive deposits. Management in the cases with visual loss requires keratoplasty either full thickness or lamellar. The decision about the ideal type of keratoplasty depends on age and pre-operative clinical features. Although prognosis after keratoplasty is good, recurrences can occur. Future research should be targeted towards gene therapy in this condition.
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Affiliation(s)
- Shalini Singh
- Cornea and Anterior Segment Services, LVPEI, Hyderabad, India
| | - Sujata Das
- Cornea and Anterior Segment Services, LVPEI, Bhubneshwar, India
| | - Chitra Kannabiran
- Kallam Anji Reddy Molecular Genetics Laboratory, Prof Brien Holden Eye Research Centre, Hyderabad, India
| | - Saumya Jakati
- Ophthalmic Pathology Laboratory, LVPEI, Hyderabad, India
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Green DJ, Lenassi E, Manning CS, McGaughey D, Sharma V, Black GC, Ellingford JM, Sergouniotis PI. North Carolina Macular Dystrophy: Phenotypic Variability and Computational Analysis of Disease-Associated Noncoding Variants. Invest Ophthalmol Vis Sci 2021; 62:16. [PMID: 34125159 PMCID: PMC8212441 DOI: 10.1167/iovs.62.7.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Indexed: 01/02/2023] Open
Abstract
Purpose North Carolina macular dystrophy (NCMD) is an autosomal dominant, congenital disorder affecting the central retina. Here, we report clinical and genetic findings in three families segregating NCMD and use epigenomic datasets from human tissues to gain insights into the effect of NCMD-implicated variants. Methods Clinical assessment and genetic testing were performed. Publicly available transcriptomic and epigenomic datasets were analyzed and the activity-by-contact method for scoring enhancer elements and linking them to target genes was used. Results A previously described, heterozygous, noncoding variant upstream of the PRDM13 gene was detected in all six affected study participants (chr6:100,040,987G>C [GRCh37/hg19]). Interfamilial and intrafamilial variability were observed; the visual acuity ranged from 0.0 to 1.6 LogMAR and fundoscopic findings ranged from visually insignificant, confluent, drusen-like macular deposits to coloboma-like macular lesions. Variable degrees of peripheral retinal spots (which were easily detected on widefield retinal imaging) were observed in all study subjects. Notably, a 6-year-old patient developed choroidal neovascularization and required treatment with intravitreal bevacizumab injections. Computational analysis of the five single nucleotide variants that have been implicated in NCMD revealed that these noncoding changes lie within two putative enhancer elements; these elements are predicted to interact with PRDM13 in the developing human retina. PRDM13 was found to be expressed in the fetal retina, with greatest expression in the amacrine precursor cell population. Conclusions We provide further evidence supporting the role of PRDM13 dysregulation in the pathogenesis of NCMD and highlight the usefulness of widefield retinal imaging in individuals suspected to have this condition.
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Affiliation(s)
- David J Green
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Eva Lenassi
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Cerys S Manning
- Division of Developmental Biology and Medicine, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - David McGaughey
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, United States
| | - Vinod Sharma
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Graeme C Black
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Jamie M Ellingford
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Panagiotis I Sergouniotis
- Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
- Manchester Centre for Genomic Medicine, St Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, United Kingdom
- Institute of Biochemistry and Molecular Genetics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Das AV, Chaurasia S. Clinical Profile and Demographic Distribution of Corneal Dystrophies in India: A Study of 4198 Patients. Cornea 2021; 40:548-553. [PMID: 32740009 DOI: 10.1097/ico.0000000000002450] [Citation(s) in RCA: 6] [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: 04/17/2020] [Accepted: 06/03/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the clinical profile and demographic distribution of corneal dystrophy in patients presenting to a multitier ophthalmology hospital network in India. METHODS This cross-sectional hospital-based study included 2,151,584 new patients presenting between March 2012 and December 2019 (∼8 year period). Patients with a clinical diagnosis of corneal dystrophy in at least 1 eye were included as cases. The data were collected by using an electronic medical record system. RESULTS Overall, 4198 new patients (0.20%) were diagnosed with corneal dystrophy. The prevalence rates were 0.19% in children (age < 16 years) and 0.20% in adults. Most patients were women (51.86%). The mean age of the patients was 43.61 ± 21.39 years. Most patients (18.79%) were between 61 and 70 years of age. The most common anatomical location of the dystrophy was endothelium (51.71%), followed by stroma (43.55%) and Bowman membrane/epithelium (4.73%). The most common corneal dystrophy was Fuch endothelial corneal dystrophy (41.89%). Most eyes had mild or no visual impairment (43.43%). Of the 8193 eyes, 998 eyes (12.18%) underwent a corneal surgery. Among those who underwent surgical intervention, endothelial keratoplasty was the most commonly performed surgical procedure (52%), followed by penetrating keratoplasty (22%). CONCLUSIONS Corneal dystrophy is a rare disease, affecting patients seeking eye care in India. Endothelial dystrophies were the most common, followed by stromal dystrophies. Among the stromal dystrophies, macular dystrophy was the most common. At initial presentation, visual impairment was mild to moderate in most patients, and surgical intervention was needed in 12.18% of the eyes during the study period.
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Affiliation(s)
- Anthony Vipin Das
- Department of eyeSmart EMR & AEye, L V Prasad Eye Institute, Hyderabad, Telangana, India; and
| | - Sunita Chaurasia
- Cornea and Anterior Segment Services, L V Prasad Eye Institute, Hyderabad, Telangana, India
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Chacra LM, Arba-Mosquera S, Awwad ST. Customized Ablation Area PTK as a Technique for Salzmann's Degeneration and Other Focal Stromal Pathologies. J Refract Surg 2021; 36:340-344. [PMID: 32396646 DOI: 10.3928/1081597x-20200226-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/25/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE To introduce a customized ablation area photo-therapeutic keratectomy (PTK) technique that uses a preoperatively generated laser ablation profile to accurately match and ablate the area of the pathology. METHODS A case of mid-peripheral Salzmann's nodular degeneration causing recurrent epithelial erosion is described. The white-to-white distance, on a slit-lamp image of the patient's eye, was measured by a Placido and dual-Scheimpflug analyzer and used as a scale on a Java-based image processing program to extrapolate the focal corneal pathology's vertical and horizontal dimensions on the corneal plane. The lesion's depth was measured by corneal optical coherence tomography (OCT). Customized ablation area transepithelial PTK, tailored to the exact dimensions of the pathology was then performed in one pass, regionally ablating the area of the pathology only. RESULTS Complete epithelial healing was observed by the next day with unaltered visual acuity of 20/20. Corneal OCT performed at 1 and 3 months postoperatively showed near-complete resolution of the lesion. The patient was followed up for a total of 6 months with no reported symptoms of corneal erosions. CONCLUSIONS The application of a customized laser ablation area in the treatment of Salzmann's nodular degeneration and other focal stromal pathologies avoids unnecessary epithelial and stromal ablation. This contributes to faster visual recovery and less refractive impact, especially for peripheral lesions. [J Refract Surg. 2020;36(5):340-344.].
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Ruutila M, Fagerholm P, Lagali N, Hjortdal J, Bram T, Moilanen J, Kivelä TT. Diagnostic Criteria for Terrien Marginal Degeneration: Nordic Terrien Degeneration Study. Cornea 2021; 40:133-141. [PMID: 33155577 DOI: 10.1097/ico.0000000000002427] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 02/19/2020] [Accepted: 05/15/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To refine the diagnostic criteria for Terrien marginal degeneration (TMD) based on experience in 3 Nordic countries. METHODS This is a retrospective, multicenter, hospital-based cross-sectional study of 49 eyes of 29 white patients in tertiary referral centers in Finland, Sweden, and Denmark from 1998 to January 2018. The median follow-up was 3 years. Symptoms, best corrected visual acuity, astigmatism, corneal thickness, curvature and cavities, stage, and progression were analyzed. RESULTS TMD was diagnosed equally likely between 15 and 86 years of age (median, 47 years). Twenty patients (69%) had bilateral disease, and 62% were men. Seventeen patients (59%) had symptoms including blurred vision and ocular surface disease symptoms without inflammatory signs. Eight patients (28%) had slightly reduced corneal sensitivity. Median best corrected visual acuity was 20/25 (range, 20/16-20/200) and astigmatism was 2.6 diopters (D) (range, 0-10) with a mean progression of 0.41 D per year (range, 0-5.4). Age and astigmatism were not correlated. All eyes had peripheral vascularization, lipid deposits, and hyperreflectivity throughout thinned peripheral stroma and its anterior edge. The thinning progressed in 15 patients (52%). Of 26 patients, 8 (31%) had single or confluent paralimbal intrastromal cavities, most commonly superiorly. By Süveges classification, the stage was 2 (92%) or 3 (8%). Minimum corneal thickness and corneal curvature were loosely associated, leading to different stages in Wang classification in 34 eyes (69%). CONCLUSIONS TMD is defined by peripheral corneal thinning, superficial neovascularization, lipid deposition at the leading edge, absence of ulceration and inflammation, and frequently cavitation. The most sensitive way to follow its progression is anterior segment optical coherence tomography.
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Affiliation(s)
- Minna Ruutila
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Per Fagerholm
- Department of Ophthalmology, Linköping University Hospital, Linköping, Sweden; and
| | - Neil Lagali
- Department of Ophthalmology, Linköping University Hospital, Linköping, Sweden; and
| | - Jesper Hjortdal
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Thue Bram
- Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark
| | - Jukka Moilanen
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tero T Kivelä
- Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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13
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Javaid A, Orakzai AA. Harboyan Syndrome. J Ayub Med Coll Abbottabad 2020; 32(Suppl 1):S701-S703. [PMID: 33754535] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Harboyan syndrome is a degenerative corneal disorder characterized by congenital hereditary endothelial dystrophy along with progressive, post lingual sensorineural hearing loss. We present the case of a 16-year-old female, who came to us for her follow up after surgical correction for bilateral corneal opacities (bilateral keratplasy) and use of hearing aid for SNHL. Her symptoms resolved significantly. Currently, she's living a healthy life after being treated for Harboyan syndrome. Physical examination and laboratory investigations ruled out other causes (eg: Congenital cataracts, Peters anomaly, Sclerocornea) and the diagnosis of Harboyan syndrome was established.
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Affiliation(s)
- Ayesha Javaid
- Department of Ophthalmology, Khyber Teaching Hospital, Peshawar, Pakistan
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14
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Feizi S, Karjou Z, Abbasi H, Javadi MA, Azari AA. Characterization of In Vivo Biomechanical Properties in Macular Corneal Dystrophy. Am J Ophthalmol 2020; 215:8-13. [PMID: 32205123 DOI: 10.1016/j.ajo.2020.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 11/04/2019] [Revised: 02/29/2020] [Accepted: 03/05/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE To measure and compare corneal biomechanics in patients with macular corneal dystrophy (MCD), versus those who underwent penetrating keratoplasty (PK) for MCD, versus normal subjects. DESIGN Cross-sectional study. METHODS This study enrolled 24 eyes with MCD, 25 eyes that underwent PK in patients with preoperative diagnosis of MCD, and 28 normal eyes. The ocular response analyzer was used to measure corneal biomechanical properties, including corneal resistance factor (CRF) and corneal hysteresis (CH). Intraocular pressure (IOP) was measured using a Goldmann applanation tonometer, and central corneal thickness (CCT) was measured using an ultrasonic pachymeter. The CCT, CRF, CH, and IOP were compared among the study group. RESULTS CCT was significantly lower in the MCD group (423 ± 47 mμ) than in the PK group (541 ± 31 mμ; P < .001) and the controls (540 ± 26 mμ; P < .001). Meanwhile, CCT was comparable between the PK and control groups (P = .98). CRF did not differ between the MCD (8.34 ± 2.12 mm Hg) and the PK (8.66 ± 1.66 mm Hg) groups (P = .89); however, both of these groups had lower CRF values than the control (9.76 ± 1.83 mm Hg, P = .02) group. No significant differences were observed among the 3 groups in CH (P = .13). IOP values did not differ between the MCD (11.25 ± 1.69 mm Hg) and PK (12.0 ± 2.67 mm Hg) groups (P = .95); however, the IOP values for both of these groups differed significantly from those of the controls (13.46 ± 2.17 mm Hg; P = .006). CONCLUSIONS CRF was significantly reduced in MCD and did not return to normal values even after PK. The reduced corneal rigidity could result in underestimating IOP in patients with MCD and in those undergoing PK for this stromal dystrophy.
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Affiliation(s)
- Sepehr Feizi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Zahra Karjou
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Abbasi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Javadi
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir A Azari
- Ophthalmic Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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15
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Namburi P, Khateb S, Meyer S, Bentovim T, Ratnapriya R, Khramushin A, Swaroop A, Schueler-Furman O, Banin E, Sharon D. A unique PRDM13-associated variant in a Georgian Jewish family with probable North Carolina macular dystrophy and the possible contribution of a unique CFH variant. Mol Vis 2020; 26:299-310. [PMID: 32476814 PMCID: PMC7245606] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 04/14/2020] [Indexed: 12/04/2022] Open
Abstract
Purpose North Carolina macular dystrophy (NCMD) is an autosomal dominant maculopathy that is considered a non-progressive developmental disorder with variable expressivity. Our study aimed to clinically and genetically characterize macular dystrophy in a family (MOL1154) consisting of six affected subjects with a highly variable maculopathy phenotype in which no correlation between age and severity exists. Methods Clinical characterization included visual acuity testing and electroretinography. Genetic analysis included Sanger sequencing and whole exome sequencing (WES). Results WES analysis performed on DNA samples from two individuals revealed a heterozygous deletion of six nucleotides [c.2247_2252del; p.(Leu750_Lys751del)] in the CFH gene. Co-segregation analysis revealed that five of the six NCMD affected subjects carried this deletion, while one individual who had a relatively mild phenotype compatible with dry age-related macular degeneration (AMD) did not carry it. We subsequently analyzed the upstream region of PRDM13 that has previously been reported to be associated with NCMD and identified a unique heterozygous transversion (chr6:100040974A>C) located within the previously described suspected control region in all six affected individuals. This transversion is likely to cause NCMD. Conclusions NCMD has a wide spectrum of clinical phenotypes that can overlap with AMD, making it challenging to correctly diagnose affected individuals and family members. The DNA sequence variant we found in the CFH gene of some of the affected family members may suggest some role as a modifier gene. However, this variant still does not explain the huge phenotypic variability of NCMD and needs to be studied in other and larger populations.
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Affiliation(s)
- Prasanthi Namburi
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University Jerusalem, Jerusalem, Israel
| | - Samer Khateb
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University Jerusalem, Jerusalem, Israel
| | - Segev Meyer
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University Jerusalem, Jerusalem, Israel
| | - Tom Bentovim
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University Jerusalem, Jerusalem, Israel
| | - Rinki Ratnapriya
- Neurobiology-Neurodegeneration & Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Alisa Khramushin
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Anand Swaroop
- Neurobiology-Neurodegeneration & Repair Laboratory, National Eye Institute, National Institutes of Health, Bethesda, MD
| | - Ora Schueler-Furman
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Eyal Banin
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University Jerusalem, Jerusalem, Israel
| | - Dror Sharon
- Department of Ophthalmology, Hadassah Medical Center, Faculty of Medicine, The Hebrew University Jerusalem, Jerusalem, Israel
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Alió Del Barrio JL, Chung DD, Al-Shymali O, Barrington A, Jatavallabhula K, Swamy VS, Yébana P, Angélica Henríquez-Recine M, Boto-de-Los-Bueis A, Alió JL, Aldave AJ. Punctiform and Polychromatic Pre-Descemet Corneal Dystrophy: Clinical Evaluation and Identification of the Genetic Basis. Am J Ophthalmol 2020; 212:88-97. [PMID: 31782998 DOI: 10.1016/j.ajo.2019.11.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE This study reports the clinical features and genetic bases of 3 previously unreported families with punctiform and polychromatic pre-Descemet corneal dystrophy (PPPCD). DESIGN Observational case series. METHODS Full ophthalmic assessment was performed for members of 3 unreported families with PPPCD. Structural and biomechanical alterations of the cornea were screened. Whole exome sequencing (WES) was performed in the first family. Novel or rare variants that segregated with the affected status were screened in the other 2 families using Sanger sequencing. Identified variants that segregated with the affected status in all families were characterized by using in silico prediction tools and/or in vitro splice assays. Additionally, 2 previously reported PPPCD families were screened for variants identified in the 3 unreported PPPCD families. RESULTS PPPCD was diagnosed in 12 of the 21 examined members of the 3 unreported families. The only refractive, topographic, or biomechanical abnormality associated with PPPCD was a significantly increased corneal stiffness. WES and Sanger sequencing identified 2 variants that segregated with the affected status in all 3 families: a rare intronic PDZD8 c.872+10A>T variant and a novel missense PRDX3 c.568G>C (p.Asp190His) variant. The same PRDX3 variant was identified in the previously reported PPPCD family expressing the common PPPCD phenotype and was predicted by in silico prediction tools to be damaging to protein function. CONCLUSIONS PPPCD is associated with an alteration of corneal biomechanics and a novel missense variant in PRDX3. Screening of additional families will determine whether all families demonstrate a PRDX3 variant or whether locus heterogeneity may exist for PPPCD.
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Affiliation(s)
- Jorge L Alió Del Barrio
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain; Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Doug D Chung
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Olena Al-Shymali
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain
| | - Alice Barrington
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Kavya Jatavallabhula
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Vinay S Swamy
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Pilar Yébana
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain
| | | | | | - Jorge L Alió
- Cornea, Cataract and Refractive Surgery Unit, Vissum Corporación, Alicante, Spain; Division of Ophthalmology, School of Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Anthony J Aldave
- Stein Eye Institute, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA.
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17
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Kalinnikov Y, Leontyeva G, Zinovyeva A, Nevrov D. Simultaneous Implantation of Refractive Lenticule and Intracorneal Ring Segment in the Management of Pellucid Marginal Degeneration. J Refract Surg 2020; 35:606-609. [PMID: 31498419 DOI: 10.3928/1081597x-20190812-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/12/2019] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe a patient with pellucid macular degeneration suffering from visual deterioration due to high irregular astigmatism and intolerant to contact lenses, who underwent a new surgical procedure that combined intrastromal lamellar keratoplasty and a 359° intracorneal ring segment implantation, enabling both ametropia and corneal thinning correction. METHODS Case report. RESULTS Refractive lenticule obtained during a myopic small incision lenticule extraction procedure was used as the donor lamellar graft. The technique described allowed for partial cylinder reduction and reinforcement of the thinned cornea. Uncorrected distance visual acuity improved from 0.02 to 0.5 (decimal) and corrected distance visual acuity improved from 0.4 to 0.7 with a decrease of 4.50 diopters in corneal astigmatism. CONCLUSIONS Despite the lack of long-term observation, the new technique described in this case report was successful for this specific patient and therefore might be effective and safe in severe stages of disease. [J Refract Surg. 2019;35(9):606-609.].
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18
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Yang F, Hong J, Xiao G, Feng Y, Peng R, Wang M, Qu H. Descemet Stripping Endothelial Keratoplasty in Pediatric Patients with Congenital Hereditary Endothelial Dystrophy. Am J Ophthalmol 2020; 209:132-140. [PMID: 31465754 DOI: 10.1016/j.ajo.2019.08.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [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: 02/25/2019] [Revised: 06/11/2019] [Accepted: 08/16/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE To report the long-term outcomes of Descemet stripping endothelial keratoplasty (DSEK) with suture-assisted donor lenticule insertion performed in different age groups for pediatric patients with congenital hereditary endothelial dystrophy (CHED). DESIGN Retrospective case series. METHODS Pediatric patients with CHED who underwent DSEK from January 2010 to January 2016 were enrolled. Patients were divided into 2 groups according to their ages: the infant group and the child group. Long-term clinical outcomes and complications were compared. RESULTS Thirty eyes of 16 patients were included: 19 eyes (10 patients) in the child group and 11 eyes (6 patients) in the infant group. The average duration of follow-up was 4.08 ± 1.90 years (range 2.5-8.5 years). Corneal transparency scores of the 2 groups on postoperative day 7 were not statistically different. The average postoperative best-corrected visual acuity (BCVA) in the infant group (logMAR 0.32 ± 0.11) was better than that in the child group (logMAR 0.54 ± 0.20; (P = .01). Thirty-three percent of cases in the child group and 86% of cases in the infant group had postoperative BCVA achieved or better than logMAR 0.4. Average endothelial cell loss in the child group was 31.21% ± 9.17%. Lenticule detachment occurred in 3 cases in the child group. CONCLUSIONS Improved visual outcomes could be achieved in infant patients with CHED after DSEK without significant complications. Suture-assisted donor lenticule insertion techniques, Descemet membrane stripping, and postoperative sedation are advocated technical points.
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Affiliation(s)
- Fan Yang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Bei Jing, China
| | - Jing Hong
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Bei Jing, China.
| | - Gege Xiao
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Bei Jing, China
| | - Yun Feng
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Bei Jing, China
| | - Rongmei Peng
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Bei Jing, China
| | - Minshu Wang
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Bei Jing, China
| | - Hongqiang Qu
- Department of Ophthalmology, Peking University Third Hospital, Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Bei Jing, China
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Abstract
Salzmann's nodular degeneration (SND) typically occurs in patients who are female, 50-60 years old, and have a history of corneal inflammation and irritation. Multiple case reports have documented associations between SND and trachoma, viral infections, trauma, contact lens wear, corneal surgeries and corneal exposure. The authors describe a patient with bilateral SND confirmed by anterior segment optical coherence tomography (OCT) imaging in the context of thyroid eye disease (TED) and history of LASIK. Treatment involved propylthiouracil (PTU), artificial tear use, loteprednol etabonate ophthalmic gel, eyelid taping and selenium supplementation and prospective superficial keratectomy with diamond burr polish.
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Affiliation(s)
- Michael C Yang
- a David Geffen School of Medicine, University of California , Los Angeles , CA , USA
| | - Saba Al-Hashimi
- b Division of Cornea, External Ocular Disease & Refractive Surgery, Stein Eye Institute, University of California , Los Angeles , CA , USA
| | - Daniel B Rootman
- a David Geffen School of Medicine, University of California , Los Angeles , CA , USA
- c Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California , Los Angeles , CA , USA
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20
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Jun I, Jung JW, Choi YJ, Kim TI, Seo KY, Kim EK. Long-term Clinical Outcomes of Phototherapeutic Keratectomy in Corneas With Granular Corneal Dystrophy Type 2 Exacerbated After LASIK. J Refract Surg 2018; 34:132-139. [PMID: 29425392 DOI: 10.3928/1081597x-20171220-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/08/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the long-term clinical outcomes and recurrence patterns of phototherapeutic keratectomy (PTK) in patients with granular corneal dystrophy type 2 (GCD2) exacerbated after LASIK. METHODS Fifty-one patients (76 eyes) with GCD2 exacerbated after LASIK who underwent PTK between January 2007 and February 2017 were included. Participants underwent ophthalmic examination, including slit-lamp microscopy, corrected distance visual acuity (CDVA), slit-lamp photography, and Fourier domain optical coherence tomography at preoperative and postoperative visits. PTK was performed using VISX S4 IR (VISX, Inc., Santa Clara, CA). Visual acuity, complications, interval, and contributing factors of recurrence were evaluated. RESULTS The follow-up period ranged from 1 to 108 months (mean: 35.22 months). The mean logMAR CDVA was 0.55 ± 0.43 (Snellen equivalent 20/80) preoperatively and 0.09 ± 0.43 (Snellen equivalent 20/25) at 3 months postoperatively. Forty-five (61.6%) eyes developed biomicroscopic recurrence at a mean of 18.6 months after PTK; 20 (27.4%) eyes developed significant recurrence at a mean of 31.3 months after PTK. The flap removal group demonstrated better CDVA at 3 years after surgery and lower recurrence and complication rates than the flap conservation group. Multivariate analysis revealed that flap removal remarkably reduced the risk of both any sign of and significant recurrence. CONCLUSIONS PTK improved corneal transparency and visual acuity in patients with GCD2 exacerbated after LASIK, although GCD2 eventually recurred. PTK with flap removal was superior to PTK with flap conservation in terms of visual acuity, recurrence, and complications. [J Refract Surg. 2018;34(2):132-139.].
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21
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Naz S, Sharif S, Kaul H, Kaleem A, Tehseen A. Prevalence of stromal corneal dystrophies in Lahore. J PAK MED ASSOC 2018; 68:663-665. [PMID: 29808064] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
To determine the prevalence of Stromal Corneal Dystrophies (SCDs) in patient from Lahore hospitals. The study was performed between November, 2014 to July 2015 at the Layton Rahmatullah Benevolent Trust Hospital, Mughal Hospital, Mayo Hospital and General Hospital, Lahore. For the clinical evaluation of SCD by ophthalmologists examination of cornea was done by biomicroscopy, specular microscopy, topography, keratometry, orbscan and far visual acuity. Fifty cases of SCDs were recognized from Lahore, matching to hospital prevalence of 0.4%. The variables examined were age, gender, main complaint, corneal thickness, intraocular pressure and far visual acuity. SCDs are predominant in age group of 40-50 years. SCDs are more in male (n=30) as compared to females (n=20). Careful clinical evaluation, genotyping, governmental approval and subsequent development of human clinical trials of possible therapies and treatments should be taken to continue making improvement and effective control of SCDs.
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Affiliation(s)
| | - Saima Sharif
- Department of Zoology, Lahore College for Women University, Lahore
| | - Haiba Kaul
- Department of Livestock Production, Genetics Division, University of Veterinry and Animal Sciences, Ravi Campus, Pattoki
| | - Afshan Kaleem
- Department of Biotechnology, Lahore College for Women University, Lahore
| | - Amina Tehseen
- Department of Biotechnology, Lahore College for Women University, Lahore
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22
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Abstract
Retinal phenotypes of the PPCD1 mouse, a mouse model of posterior polymorphous corneal dystrophy, have been characterized. PPCD1 mice on the DBA/2J background (D2.Ppcd1) have previously been reported to develop an enlarged anterior chamber due to epithelialization and proliferation of the corneal endothelium and subsequent blockage of the iridocorneal angle. Results presented here show that D2.Ppcd1 mice develop increased intraocular pressure (IOP), with measurements at three months of age revealing significant increases in IOP. Significant retinal ganglion cell layer cell loss is observed at five months of age. D2.Ppcd1 animals also exhibit marked degeneration of the outer nuclear layer in association with hyperplasia of the retinal pigment epithelium. Evidence of retinal detachment is present as early as three weeks of age. By 3.5 months of age, focal areas of outer nuclear layer loss are observed. Although the GpnmbR150X mutation leads to increased IOP and glaucoma in DBA/2J mice, development of anterior segment and retinal defects in D2.Ppcd1 animals does not depend upon presence of the GpnmbR150X mutation.
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Affiliation(s)
- Anna L. Shen
- The McArdle Laboratory for Cancer Research, Department of Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail: (CAB); (ALS)
| | - Susan M. Moran
- The McArdle Laboratory for Cancer Research, Department of Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Edward A. Glover
- The McArdle Laboratory for Cancer Research, Department of Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Leandro B. Teixeira
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Christopher A. Bradfield
- The McArdle Laboratory for Cancer Research, Department of Oncology, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- McPherson Eye Research Institute, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Wisconsin Institute for Discovery, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail: (CAB); (ALS)
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Vázquez N, Chacón M, Rodríguez-Barrientos CA, Merayo-Lloves J, Naveiras M, Baamonde B, Alfonso JF, Zambrano-Andazol I, Riestra AC, Meana Á. Human Bone Derived Collagen for the Development of an Artificial Corneal Endothelial Graft. In Vivo Results in a Rabbit Model. PLoS One 2016; 11:e0167578. [PMID: 27907157 PMCID: PMC5131948 DOI: 10.1371/journal.pone.0167578] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 06/23/2016] [Accepted: 11/16/2016] [Indexed: 12/13/2022] Open
Abstract
Corneal keratoplasty (penetrating or lamellar) using cadaveric human tissue, is nowadays the main treatment for corneal endotelial dysfunctions. However, there is a worldwide shortage of donor corneas available for transplantation and about 53% of the world's population have no access to corneal transplantation. Generating a complete cornea by tissue engineering is still a tough goal, but an endothelial lamellar graft might be an easier task. In this study, we developed a tissue engineered corneal endothelium by culturing human corneal endothelial cells on a human purified type I collagen membrane. Human corneal endothelial cells were cultured from corneal rims after corneal penetrating keratoplasty and type I collagen was isolated from remnant cancellous bone chips. Isolated type I collagen was analyzed by western blot, liquid chromatography -mass spectrometry and quantified using the exponentially modified protein abundance index. Later on, collagen solution was casted at room temperature obtaining an optically transparent and mechanically manageable membrane that supports the growth of human and rabbit corneal endothelial cells which expressed characteristic markers of corneal endothelium: zonula ocluddens-1 and Na+/K+ ATPase. To evaluate the therapeutic efficiency of our artificial endothelial grafts, human purified type I collagen membranes cultured with rabbit corneal endothelial cells were transplanted in New Zealand white rabbits that were kept under a minimal immunosuppression regimen. Transplanted corneas maintained transparency for as long as 6 weeks without obvious edema or immune rejection and maintaining the same endothelial markers that in a healthy cornea. In conclusion, it is possible to develop an artificial human corneal endothelial graft using remnant tissues that are not employed in transplant procedures. This artificial endothelial graft can restore the integrality of corneal endothelium in an experimental model of endothelial dysfunction. This strategy could supply extra endothelial tissue and compensate the deficit of cadaveric grafts for corneal endothelial transplantation.
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Affiliation(s)
- Natalia Vázquez
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
| | - Manuel Chacón
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
| | | | | | - Miguel Naveiras
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
| | - Begoña Baamonde
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
- Hospital Universitario Central de Asturias (Spain)
| | - Jose F. Alfonso
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
| | | | - Ana C. Riestra
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
| | - Álvaro Meana
- Instituto Universitario Fernández-Vega. Universidad de Oviedo (Spain)
- CIBER on rare disease–CIBERer. Instituto de Investigaciones Sanitarias de la Fundación Jiménez Díaz–IIS-FJD (Spain)
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Abstract
Corneal dystrophies are a group of inherited disorders affecting the cornea, many of which lead to visual impairment. The International Committee for Classification of Corneal Dystrophies has established criteria to clarify the status of the various corneal dystrophies, which include the knowledge of the underlying genetics. In this review, we discuss the International Committee for Classification of Corneal Dystrophies category 1 (second edition) corneal dystrophies, for which a clear genetic link has been established. We highlight the various mechanisms underlying corneal dystrophy pathology, including structural disorganization, instability or maladhesion, aberrant protein stability and deposition, abnormal cellular proliferation or apoptosis, and dysfunction of normal enzymatic processes. Understanding these genetic mechanisms is essential for designing targets for therapeutic intervention, especially in the age of gene therapy and gene editing.
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Affiliation(s)
- Verity Frances Oliver
- From the *Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; and †Eye Department, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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Abstract
Bietti crystalline dystrophy (BCD) is an inherited retinal degenerative disease characterized by crystalline deposits in the retina, followed by progressive atrophy of the retinal pigment epithelium (RPE), choriocapillaris, and photoreceptors. CYP4V2 has been identified as the causative gene for BCD. The CYP4V2 gene belongs to the cytochrome P450 superfamily and encodes for fatty acid ω-hydroxylase of both saturated and unsaturated fatty acids. The CYP4V2 protein is localized most abundantly within the endoplasmic reticulum in the RPE and is postulated to play a role in the physiological lipid recycling system between the RPE and photoreceptors to maintain visual function. Electroretinographic assessments have revealed progressive dysfunction of rod and cone photoreceptors in patients with BCD. Several genotypes have been associated with more severe phenotypes based on clinical and electrophysiological findings. With the advent of multimodal imaging with spectral domain optical coherence tomography, fundus autofluorescence, and adaptive optics scanning laser ophthalmoscopy, more precise delineation of BCD severity and progression is now possible, allowing for the potential future development of targets for gene therapy.
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Affiliation(s)
- Danny S C Ng
- From the *Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong; and †2010 Retina and Macula Centre, Kowloon, Hong Kong
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Spadea L, Maraone G, Cagini C. Sliding Keratoplasty Followed by Transepithelial Iontophoresis Collagen Cross-linking for Pellucid Marginal Degeneration. J Refract Surg 2016; 32:47-50. [PMID: 26812714 DOI: 10.3928/1081597x-20151119-02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 11/10/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To describe the changes in visual acuity and topographic analysis in a patient affected by advanced pellucid marginal degeneration (PMD). METHODS A 59-year-old woman with bilateral PMD who was contact lens intolerant was treated by sliding keratoplasty before and 3 months after transepithelial (epi-on) iontophoresis collagen cross-linking (I-CXL) in one eye. Corrected distance visual acuity (CDVA), spherical equivalent and cylinder refraction, corneal topography, ultrasound pachymetry, and endothelial cell count were assessed at baseline and up to 12 months postoperatively. RESULTS After 1 year of follow-up, CDVA increased from 20/200 to 20/50 and the videokeratographic patterns significantly improved. Endothelial cell counts did not change significantly (P > .05). CONCLUSIONS Sliding keratoplasty combined with I-CXL was safe and effective in the treatment of advanced PMD.
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Turnbull AMJ, Tsatsos M, Hossain PN, Anderson DF. Determinants of visual quality after endothelial keratoplasty. Surv Ophthalmol 2015; 61:257-71. [PMID: 26708363 DOI: 10.1016/j.survophthal.2015.12.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 06/26/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 11/19/2022]
Abstract
Endothelial keratoplasty is now favored over full-thickness penetrating keratoplasty for corneal decompensation secondary to endothelial dysfunction. Although endothelial keratoplasty has evolved as surgeons strive to improve outcomes, fewer patients than expected achieve best corrected visual acuity of 20/20 despite healthy grafts and no ocular comorbidities. Reasons for this remain unclear, with theories including anterior stromal changes, differences in graft thickness and regularity, induced high-order aberrations, and the nature of the graft-host interface. Newer iterations of endothelial keratoplasty such as thin manual Descemet stripping endothelial keratoplasty, ultrathin automated Descemet stripping endothelial keratoplasty, and Descemet membrane endothelial keratoplasty have achieved rates of 20/20 acuity of approximately 50%, comparable to modern cataract surgery, and it may be that a ceiling exists, particularly in the older age group of patients. Establishing the relative contribution of the factors that determine visual quality following endothelial keratoplasty will help drive further innovation, optimizing visual and patient-reported outcomes while improving surgical efficacy and safety.
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Affiliation(s)
- Andrew M J Turnbull
- Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK.
| | - Michael Tsatsos
- Moorfields Eye Hospital, London, UK; Modern Eye Centre, Thessaloniki, Greece
| | - Parwez N Hossain
- Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK; Division of Infection, Inflammation and Immunity, Faculty of Medicine, University of Southampton, Southampton, UK
| | - David F Anderson
- Department of Ophthalmology, Cornea and External Disease Service, University Hospital Southampton, Southampton, UK; University of Southampton, Southampton, UK
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Rodríguez-Calvo-de-Mora M, Quilendrino R, Ham L, Liarakos VS, van Dijk K, Baydoun L, Dapena I, Oellerich S, Melles GRJ. Clinical outcome of 500 consecutive cases undergoing Descemet's membrane endothelial keratoplasty. Ophthalmology 2014; 122:464-70. [PMID: 25439596 DOI: 10.1016/j.ophtha.2014.09.004] [Citation(s) in RCA: 158] [Impact Index Per Article: 15.8] [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: 01/21/2014] [Revised: 08/11/2014] [Accepted: 09/01/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To evaluate the clinical outcome of 500 consecutive cases after Descemet's membrane endothelial keratoplasty (DMEK) and the effect of technique standardization. DESIGN Prospective, interventional case series at a tertiary referral center. PARTICIPANTS A total of 500 eyes of 393 patients who underwent DMEK for Fuchs' endothelial corneal dystrophy, bullous keratopathy, or previous corneal transplant failure. METHODS Best-corrected visual acuity (BCVA), endothelial cell density (ECD), pachymetry, and intraoperative and postoperative complications were evaluated before and 1, 3, and 6 months after DMEK. MAIN OUTCOME MEASURES Comparison between 2 groups (group I: cases 1-250, outcome of "early surgeries" during transition to technique standardization; group II: cases 251-500, outcome of "late surgeries" after technique standardization). RESULTS At 6 months, 75% of eyes reached a BCVA of ≥20/25 (≥0.8), 41% of eyes achieved ≥20/20 (≥1.0), and 13% of eyes achieved ≥20/18 (≥1.2) (n=418) when excluding eyes with ocular comorbidities (n=57). When including all available eyes at 6 months (n=475), 66% of eyes reached a BCVA of ≥20/25 (≥0.8), and 36% of eyes achieved ≥20/20 (≥1.0). Mean ECD decreased by 37% (±18%) to 1600 (±490) cells/mm2 (n=447) at 6 months (P<0.001). Postoperative pachymetry averaged 525 (±46) μm compared with 667 (±92) μm preoperatively (P<0.001). None of these parameters differed among the 2 groups (P>0.05). (Partial) graft detachment presented in 79 eyes (15.8%), and 26 eyes (5.2%) required a secondary surgery within the first 6 months (re-bubbling in 15, secondary keratoplasty in 11). With technique standardization, the postoperative complication rate decreased from 23.2% to 10% (P<0.001) and the rate of secondary surgeries decreased from 6.8% to 3.6% (P=0.10). CONCLUSIONS In comparison with earlier endothelial keratoplasty techniques, DMEK may consistently give higher visual outcomes and faster visual rehabilitation. When used for the extended spectrum of endothelial pathologies, DMEK proved feasible with a relatively low risk of complications. Technique standardization may have contributed to a lower graft detachment rate and a relatively low secondary intervention rate. As such, DMEK may become the first choice of treatment in corneal endothelial disease.
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Affiliation(s)
- Marina Rodríguez-Calvo-de-Mora
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Ruth Quilendrino
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Lisanne Ham
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands
| | - Vasilios S Liarakos
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Korine van Dijk
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Lamis Baydoun
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Isabel Dapena
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Silke Oellerich
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands; Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands; Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands.
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Abstract
PURPOSE The aim of this study was to use Fourier domain optical coherence tomography to predict transepithelial phototherapeutic keratectomy outcomes. METHODS This is a prospective case series. Subjects with anterior stromal corneal opacities underwent an excimer laser phototherapeutic keratectomy (PTK) combined with a photorefractive keratectomy using the VISX S4 excimer laser (AMO, Inc, Santa Ana, CA). Preoperative and postoperative Fourier domain optical coherence tomography images were used to develop a simulation algorithm to predict treatment outcomes. Main outcome measures included preoperative and postoperative uncorrected distance visual acuities and corrected distance visual acuity. RESULTS Nine eyes of 8 patients were treated. The nominal ablation depth was 75 to 177 μm centrally and 62 to 185 μm peripherally. Measured PTK ablation depths were 20% higher centrally and 26% higher peripherally, compared with those for laser settings. Postoperatively, the mean uncorrected distance visual acuity was 20/41 (range, 20/25-20/80) compared with 20/103 (range, 20/60-20/400) preoperatively. The mean corrected distance visual acuity was 20/29 (range, 20/15-20/60) compared with 20/45 (range, 20/30-20/80) preoperatively. The MRSE was +1.38 ± 2.37 diopters (D) compared with -2.59 ± 2.83 D (mean ± SD). The mean astigmatism magnitude was 1.14 ± 0.83 D compared with 1.40 ± 1.18 D preoperatively. Postoperative MRSE correlated strongly with ablation settings, central and peripheral epithelial thickness (r = 0.99, P < 0.00001). Central islands remained difficult to predict and limited visual outcomes in some cases. CONCLUSIONS Optical coherence tomography measurements of opacity depth and 3-dimensional ablation simulation provide valuable guidance in PTK planning. Post-PTK refraction may be predicted with a regression formula that uses epithelial thickness measurements obtained by optical coherence tomography. The laser ablation rates described in this study apply only to the VISX laser.
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Affiliation(s)
- Catherine Cleary
- Center for Ophthalmic Optics and Lasers (www.COOLLab.net ), Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Yan Li
- Center for Ophthalmic Optics and Lasers (www.COOLLab.net ), Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Maolong Tang
- Center for Ophthalmic Optics and Lasers (www.COOLLab.net ), Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Nehal Samy El Gendy
- Center for Ophthalmic Optics and Lasers (www.COOLLab.net ), Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
- Department of Ophthalmology, Kaser Al Aini School of medicine, Cairo University, Cairo, Egypt
| | - David Huang
- Center for Ophthalmic Optics and Lasers (www.COOLLab.net ), Doheny Eye Institute and Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Khor WB, Han SB, Mehta JS, Tan DTH. Descemet stripping automated endothelial keratoplasty with a donor insertion device: clinical results and complications in 100 eyes. Am J Ophthalmol 2013; 156:773-9. [PMID: 23831219 DOI: 10.1016/j.ajo.2013.05.012] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [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: 03/08/2013] [Revised: 05/10/2013] [Accepted: 05/16/2013] [Indexed: 01/25/2023]
Abstract
PURPOSE To study the clinical outcomes of Descemet stripping automated endothelial keratoplasty (DSAEK) with the EndoGlide donor insertion device. DESIGN Retrospective interventional case series. METHODS We included 100 eyes that underwent DSAEK for Fuchs endothelial dystrophy or pseudophakic bullous keratopathy (PBK) at a single institution. Eyes with anterior segment pathology or previous intraocular surgery (except for uncomplicated cataract surgery) were excluded. Preoperative data included visual acuity and donor endothelial cell density by specular microscopy. The main outcome measures were postoperative best spectacle-corrected visual acuity (BSCVA) and endothelial cell loss at 3, 6, and 12 months. RESULTS There were 59 eyes with Fuchs dystrophy and 41 eyes with PBK. In eyes without vision-limiting pathology, the median postoperative BSCVA was consistently 20/40 (range 20/20-20/400) at 3 months (n = 61 eyes), 6 months (n = 55 eyes), and 12 months (n = 48 eyes). Endothelial cell loss was 13.7% at 3 months (n = 57), 13.5% at 6 months (n = 61), and 14.9% at 12 months (n = 53). Primary graft failure occurred in 1 eye, attributable to incorrect use of the insertion device. Two eyes with complete donor dislocation were rebubbled successfully. The most common complication was glaucoma/ocular hypertension in 29 eyes (34.1%) without prior glaucoma and treatment escalation in 6 eyes (40.0%) with prior glaucoma. Of the 78 eyes with 12 months follow-up, 2 (2.6%) developed endothelial rejection, and 1 (1.3%) subsequently failed. CONCLUSIONS The use of this donor insertion device during DSAEK demonstrates good outcomes and potentially low endothelial cell loss at up to 12 months after surgery.
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Affiliation(s)
- Wei-Boon Khor
- Singapore National Eye Centre, Singapore; Singapore Eye Research Institute, Singapore
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Hieda O, Kawasaki S, Wakimasu K, Yamasaki K, Inatomi T, Kinoshita S. Clinical outcomes of phototherapeutic keratectomy in eyes with Thiel-Behnke corneal dystrophy. Am J Ophthalmol 2013; 155:66-72.e1. [PMID: 22967865 DOI: 10.1016/j.ajo.2012.06.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [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: 03/19/2012] [Revised: 06/22/2012] [Accepted: 06/25/2012] [Indexed: 11/15/2022]
Abstract
PURPOSE To investigate the functional and morphologic midterm outcome of phototherapeutic keratectomy (PTK) for Thiel-Behnke corneal dystrophy diagnosed by gene-mutation analysis. DESIGN Retrospective, single-center clinical study. METHODS Between July 2001 and May 2010, 10 consecutive PTKs were performed in 10 eyes of 5 patients (2 male, 3 female; mean age: 55 ± 13 years) with superficially accentuated opacities caused by Thiel-Behnke corneal dystrophy and were followed up for at least 12 months (range: 12-108 months). Main outcome measures included (1) best-corrected visual acuity (BCVA), (2) uncorrected visual acuity (UCVA), (3) spherical equivalent, and (4) recurrence rate. The probability of recurrence of Thiel-Behnke corneal dystrophy after PTK was calculated using the Kaplan-Meier method for survival analysis. RESULTS The p.Arg555Gln mutation was found within the TGFBI gene in all 5 patients. Average logarithm of minimal angle of resolution (logMAR) BCVA change was -0.55 ± 0.26. Average logarithm UCVA change was -0.54 ± 0.31. In 5 of the 10 eyes, recurrence of central superficial opacification was clinically identified during the follow-up periods, and in 4 of those 5 eyes, the level of the recurrence was so significant that the visual acuity was reduced more than 2 lines. The maximum follow-up period of the 1 eye without significant post-PTK recurrence was 108 months. CONCLUSIONS PTK is a successful therapy for Thiel-Behnke corneal dystrophy, and results in midterm stable visual acuity and corneal transparency. Unlike in Reis-Bücklers corneal dystrophy cases, PTK delays the need for more invasive surgical intervention in Thiel-Behnke corneal dystrophy.
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Affiliation(s)
- Osamu Hieda
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
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Querques G, Guigui B, Leveziel N, Querques L, Bandello F, Souied EH. Multimodal morphological and functional characterization of Malattia Leventinese. Graefes Arch Clin Exp Ophthalmol 2012; 251:705-14. [PMID: 22814526 DOI: 10.1007/s00417-012-2106-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 06/22/2012] [Accepted: 06/30/2012] [Indexed: 11/28/2022] Open
Affiliation(s)
- Giuseppe Querques
- Department of Ophthalmology, University Paris Est Creteil, Centre Hospitalier Intercommunal de Creteil, 40 Avenue de Verdun, 94000 Creteil, France.
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Liu DN, Liu Y, Meng XH, Yin ZQ. The characterization of functional disturbances in Chinese patients with Bietti's crystalline dystrophy at different fundus stages. Graefes Arch Clin Exp Ophthalmol 2011; 250:191-200. [PMID: 21892605 DOI: 10.1007/s00417-011-1809-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [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: 05/18/2011] [Revised: 08/07/2011] [Accepted: 08/15/2011] [Indexed: 11/27/2022] Open
Abstract
PURPOSE The aim of this study was to characterize the functional and clinical disturbances and screen the optimal functional tests in assessing Bietti's crystalline dystrophy (BCD) patients by a cross-sectional method. METHODS The clinical characteristics of BCD were studied in 15 Chinese patients using fundoscopy, fundus fluorescein angiography (FFA), and autofluorescence (AF). The functional features were evaluated by full-field electroretinography (fERG), 85º and 30º perimetry, multifocal ERG (mERG), and chromatic pupillometry. RESULTS The 15 patients were separated into three clinical stages according to their fundus features. fERG- and mERG- showed reduced reponses in the early stages. Substages could be further defined according to the fERG results in the intermediate stages. Reduced pupillary light reflex (PLR) activities with blue-and white-light stumili existed in all patients. The most reduced PLR activities were elicited in the advanced stage of patients who had other nonresponsive functional tests. CONCLUSIONS This study identified the most sensitive functional methods for assessing BCD patients, and the significance of PLR in the advanced stages. In addition, the defined-substages can help us understand the disease more clearly.
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Affiliation(s)
- Dan Ning Liu
- Southwest Hospital, Southwest Eye Hospital, Third Military Medical University, Chongqing 400038, China
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Belin MW, Khachikian SS, Ambrosio R. The use of intracorneal rings for pellucid marginal degeneration. Am J Ophthalmol 2011; 151:558-9; author reply 559. [PMID: 21335111 DOI: 10.1016/j.ajo.2010.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 09/21/2010] [Accepted: 10/22/2010] [Indexed: 11/28/2022]
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Kubaloglu A, Sari ES, Cinar Y, Koytak A, Kurnaz E, Piñero DP, Ozerturk Y. A single 210-degree arc length intrastromal corneal ring implantation for the management of pellucid marginal corneal degeneration. Am J Ophthalmol 2010; 150:185-192.e1. [PMID: 20570241 DOI: 10.1016/j.ajo.2010.03.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [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: 10/06/2009] [Revised: 03/08/2010] [Accepted: 03/10/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the visual and refractive outcomes of 210-degree arc length intrastromal corneal ring segment (ICRS) implantation in eyes with pellucid marginal corneal degeneration (PMCD). DESIGN Retrospective, consecutive case series. METHODS Sixteen consecutive eyes of 10 patients who underwent a single 210-degree ICRS implantation by femtosecond laser for the management of PMCD and completed at least 1 year follow-up were included. A complete ophthalmic examination was performed preoperatively and postoperatively, including uncorrected visual acuity (UCVA), best spectacle-corrected visual acuity (BSCVA), manifest spherical and cylindrical refractions, spherical equivalent, and keratometric readings. RESULTS The mean follow-up period was 30.7 months (range 12 to 36 months). No intraoperative complication was observed. White deposits around the segments were noted in 2 of 16 eyes (12.5%) at the first postoperative year. The mean UCVA showed significant improvement, from 1.69 +/- 1.02 logarithm of the minimal angle of resolution (logMAR) preoperatively to 0.64 +/- 0.43 logMAR at the 36th month (n = 11, P < .001). The mean preoperative BSCVA was 0.88 +/- 0.68 logMAR; after 36 months, this improved to 0.35 +/- 0.34 (P < .001). At the 36th month, UCVA was improved in all eyes (n = 11, range: gain of 1 to 6 lines), whereas BSCVA was improved in 9 eyes (81.8%, range: gain of 2 to 7 lines) and remained unchanged in 2 eyes (18.1%); UCVA was 20/40 or better in 3 eyes (27%) and BSCVA was 20/40 or better in 8 eyes (72.7%). There was a significant reduction in the spherical equivalent refractive error, from -4.40 +/- 1.85 diopters (D) preoperatively to -1.86 +/- 0.60 D (P < .001), and the mean maximum keratometric power decreased from 49.70 +/- 4.32 D to 46.08 +/- 2.84 D (P < .001) after 36 months. The mean cylindrical refraction decreased from -4.39 +/- 1.86 D preoperatively to -2.38 +/- 1.35 D at 36 months (P < .001). CONCLUSION A single 210-degree arc length ICRS implantation using a femtosecond laser for patients with PMCD provides good visual and refractive outcomes.
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Affiliation(s)
- Anil Kubaloglu
- Dr Lütfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey
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Belliveau MJ, Rocha G, Manchur A, Brownstein S. Bilateral Descemet's stripping with endothelial keratoplasy for posterior polymorphous corneal dystrophy in a young phakic patient. Can J Ophthalmol 2010; 45:180-181. [PMID: 20689573 DOI: 10.1139/i09-199] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Kinoshita S. [Research and development for treating devastating corneal diseases]. Nippon Ganka Gakkai Zasshi 2010; 114:161-201. [PMID: 20387535] [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] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
In order to develop new therapeutic modalities for corneal diseases, it is essential to combine cutting-edge translational research based upon liberal original ideas obtained from clinical experience with state-of-the-art basic science and technology. Here, I describe seven important research projects on which our group has been working. 1. Elucidation of the pathogenesis in gelatinous drop-like corneal dystrophy(GDLD). Due to loss of function of the tumor-associated calcium signal transducer 2 (TACSTD2), a responsible gene for this dystrophy, tight-junction-related proteins cease to function, resulting in severe corneal epithelial barrier impairment. As a result, various proteins contained in tear fluid continuously penetrate into the corneal stroma, promoting the development of massive amyloid deposits. 2. The development of cultivated mucosal epithelial transplantation: A landmark surgery, involving the transplantation of cultivated mucosal epithelial cells from in vitro to in vivo, now recognized as the next generation of ocular surface reconstruction. We began performing cultivated allocorneal epithelial transplantations in 1999, and cultivated auto-corneal and auto-oral mucosal epithelial transplantations in 2002. These proved to be very effective in the reconstruction of both the corneal surface and the conjunctival fornix. 3. Elucidation of the pathogenesis of Stevens-Johnson syndrome: Studies have shown that there is a close relationship between corneal epithelial stem cell loss and the associated degree of visual impairment. We discovered that a steroid pulse therapy at the acute phase aimed at minimizing stem cell loss is very effective in restoring visual acuity. This implies that inhibition of the cytokine storm is essential for the treatment of acute-phase Stevens-Johnson syndrome. The innate immunity abnormality seems to be heavily involved at the onset of this devastating disease. 4. Elucidation of the involvement of EP3 and toll like receptor 3 (TLR3) in inflammatory ocular surface reactions : We discovered that EP3, one of the prostanoid receptors expressed by ocular surface epithelium, has a dramatic inhibitory effect on ocular surface inflammation in a mouse model. Since EP3 is also expressed in human ocular surface epithelium, and since abnormality of its single nucleotide polymorphisms (SNPs) is involved in some ocular surface inflammatory diseases, we theorized that an allergic reaction may be negatively regulated by EP3 which is predominantly expressed by the ocular surface epithelium. Our findings show that this is similarly true for TLR3, which, conversely, upregulates ocular surface inflammation. 5. Functional regulation of the ocular surface epithelium: Our findings show that intracellular glutathione (GSH) content in the ocular surface epithelium regulates its intracellular redox state. For instance, the GSH content of the conjunctival epithelium decreases in dry eye diseases, yet recovers after the surgical insertion of a punctal plug. Since various amino acids are also heavily involved in the regulation of cellular functions, we investigated the profile of amino acids contained in tear fluids. Our results indicate that there is a marked difference in amino acid profiles between tear fluids and plasma. Furthermore, we found that several amino acids are up-regulated in inflamed eyes, probably due to an oxidative redox response. 6. The development of new therapeutic modalities for corneal edema: We are developing a new therapeutic modality of cultivated corneal endothelial transplantation using methods based on regenerative medicine. For instance, our findings show that cultivated corneal endothelial sheet transplantation in monkeys maintains corneal transparency for at least four years after transplantation. The supplementation of a Rho kinase (ROCK) inhibitor in the culture media produces an excellent result in culturing human corneal endothelium, maintaining a normal-looking endothelial cell morphology. The use of a ROCK inhibitor, both for cultivated endothelial cell injection into the anterior chamber and for use as a topical application, may prove to be a potential tool for the treatment of corneal endothelial dysfunction. 7. The development of a new type of tear function test : The results of our investigations show that the time-dependent changes of tear film lipid layer (TFLL) spread are compatible with the Voigt model of viscoelasticity, and that the initial velocity of the TFLL spread after a blink decreases in proportion to the decrease in tear volume. Thus, a lipid-layer analysis will become an important tear analysis tool. The above are projects representing the way we believe new treatments for severe corneal diseases are heading.
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Affiliation(s)
- Shigeru Kinoshita
- Department of Ophthalmology, Kyoto Prefectural University of Medicine, Japan.
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Abstract
PURPOSE This paper reviews current knowledge about the pathogenesis, clinical manifestations and treatment of lattice corneal dystrophy, gelsolin type (LCD2, Meretoja's syndrome). METHODS Material is derived from literature searches, a case study of a Finnish patient living in Sweden, and interviews in Helsinki with Professor Ahti Tarkkanen and Dr Sari Kiuru-Enari, both of whom have extensive first-hand experience in treating patients with the disease. RESULTS The disease is now reported from several countries in Europe, as well as Japan, the USA and Iran. Treatment is symptomatic and is based on eye lubrication combined with rigorous monitoring of intraocular pressure to reduce corneal haze and postpone the need for keratoplasty. When systemic symptoms occur, the ophthalmologist should consult other specialists. CONCLUSIONS The disease is probably under-reported and is almost certainly to be found in more countries, including Sweden. Every ophthalmologist should be vigilant and consider this diagnosis when discovering a corneal lattice dystrophy, especially because the disease is an inherited, lifelong chronic condition with systemic symptoms.
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Affiliation(s)
- Christian Carrwik
- Department of Ophthalmology, Sahlgrenska University Hospital, Mölndal, Gothenburg, Sweden
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Hammar B, Björck E, Lind H, Lagerstedt K, Dellby A, Fagerholm P. Dystrophia Helsinglandica: a new type of hereditary corneal recurrent erosions with late subepithelial fibrosis. Acta Ophthalmol 2009; 87:659-65. [PMID: 18700883 DOI: 10.1111/j.1755-3768.2008.01308.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To describe the phenotype of an autosomal-dominant corneal dystrophy with an early onset of recurrent corneal erosions and development of subepithelial fibrosis in the cornea, and also to exclude genetic linkage to known corneal dystrophies with autosomal-dominant inheritance and clinical resemblance. METHODS We describe the medical history and clinical findings in individuals from a seven-generation family with recurrent corneal erosions. A total of 43 individuals were evaluated by ophthalmological examination. Genomic DNA was prepared from peripheral blood and polymorphic microsatellite markers were analysed to study haplotypes surrounding genes causing corneal dystrophies with similar phenotypes. RESULTS Erosive symptoms usually lasted for between 1 and 10 days. By the age of 7 almost all of the affected individuals suffered from recurrent corneal erosions. The attacks generally declined in frequency and intensity from the late 20s, but all examined individuals had developed subepithelial fibrosis by the age of 37. The fibrosis generally started in the mid periphery and was followed in some family members by central fibrosis and the development of gelatinous superficial elevations. Only a marginal reduction of visual acuity was seen in a few individuals. The affected individuals did not share haplotypes for genetic microsatellite markers surrounding genes that are known to cause autosomal-dominant corneal dystrophies. CONCLUSION We describe a new type of autosomal-dominant corneal disorder with recurrent corneal erosions and subepithelial fibrosis not significantly affecting visual acuity.
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Affiliation(s)
- Björn Hammar
- Department of Ophthalmology, Faculty of Health Sciences, University Hospital, Linköping, Sweden.
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Awwad ST, Di Pascuale MA, Hogan RN, Forstot SL, McCulley JP, Cavanagh HD. Avellino corneal dystrophy worsening after laser in situ keratomileusis: further clinicopathologic observations and proposed pathogenesis. Am J Ophthalmol 2008; 145:656-61. [PMID: 18243154 DOI: 10.1016/j.ajo.2007.12.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2007] [Revised: 12/03/2007] [Accepted: 12/05/2007] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the nature of the deposits in Avellino corneal dystrophy (ACD) worsening after laser in situ keratomileusis (LASIK), and suggest a mechanism for histopathogenesis. DESIGN Interventional case report. METHODS A 28-year-old woman previously diagnosed with bilateral ACD underwent bilateral LASIK. The corneal dystrophy progressively worsened bilaterally, one year later. A penetrating keratoplasty was subsequently performed on the right eye at 31 years of age, and in the left eye a year later. The clinical and histopathologic findings of the corneal graft of the right eye were reported in the literature, with positivity to the Masson trichrome stain, negative staining with Congo red, and heterozygosity for the Arg124His mutation by serum DNA studies. Histopathologic studies of the corneal graft of the left eye were conducted at the University of Texas Southwestern Medical Center. RESULTS Histopathologic examination of the excised cornea showed the Masson trichrome positive deposits present from underneath the Bowman layer to the LASIK interface, with absence of deposits posterior to the latter. In contrast to the prior report describing findings in the corneal graft of the left eye, the deposits stained lightly with Congo red, but failed to show birefringence under polarized light, or fluorescence with thioflavin T. CONCLUSION Accelerated deposits developing after LASIK in ACD eyes seem to harbor pre-amyloid features. The epithelium is likely to be the culprit, in a pathway independent of with human transforming growth hormone beta (TGF-beta), with deposits developing in the anterior stroma and the stromal interface.
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Affiliation(s)
- Shady T Awwad
- Cornea, External Diseases, and Refractive Surgery, University of Texas Southwestern Medical Center, Dallas, Texas 75390, USA
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Dupps WJ, Qian Y, Meisler DM. Multivariate model of refractive shift in Descemet-stripping automated endothelial keratoplasty. J Cataract Refract Surg 2008; 34:578-84. [PMID: 18361978 PMCID: PMC2796246 DOI: 10.1016/j.jcrs.2007.11.045] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2007] [Accepted: 11/28/2007] [Indexed: 11/26/2022]
Abstract
PURPOSE To relate in situ graft shape in Descemet-stripping automated endothelial keratoplasty (DSAEK) to surgically induced refractive error. SETTING Academic eye institute. METHODS High frequency arc-scanning ultrasound was performed in 7 patients enrolled in a prospective study of microkeratome-assisted endothelial keratoplasty approved by the Investigative Review Board. A region of interest spanning the horizontal meridian was defined for analysis of epithelial, host, graft, and total corneal thicknesses. Graft thickness profiles were fit by quadratic polynomials where the 2nd-order coefficients represent the posterior corneal curvature contributed by the graft. The curvature coefficient and central graft thickness were analyzed as predictors of induced refractive error. RESULTS At final follow-up (mean 5.9 months +/- 3.2 [SD]), 3 patients had a hyperopic shift (+2.50 diopters [D] each), 3 had insignificant (< 0.50 D) refractive shifts, and 1 had a myopic shift. In the group with hyperopic shift, a negative lens effect was predicted by positive curvature coefficients, representing grafts that were thinner centrally than peripherally (mean +22.72 microm/mm(2); range +4.95 to +45.17 microm/mm(2)). In the group with minimal refractive shift, coefficients were less positive (mean +7.28 microm/mm(2); range +2.01 to +13.82 microm/mm(2)). The patient with a myopic shift (-1.00 D) had the only negative curvature coefficient (-0.64 microm/mm(2)). In a 2-predictor model of refractive shift, central graft thickness and the curvature coefficient together accounted for 86% of the variance in the refractive response to DSAEK (P = .025). CONCLUSION Nonuniform thickness profiles and variable central graft thicknesses both contribute to refractive shift after DSAEK.
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Affiliation(s)
- William J Dupps
- Cole Eye Insitute, Cleveland Clinic, 9500 Euclid Avenue/i-32, Cleveland, OH 44195, USA.
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Orlov PI. [Infrared radiothermometry in the differential diagnosis of dystrophic and inflammatory diseases of the anterior eye]. Vestn Oftalmol 2008; 124:19-22. [PMID: 18488464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The possibilities of using infrared teleradiothermometry in the differential diagnosis of inflammatory and dystrophic diseases in the eyeball have been studied. The paper presents the physical bases of the technique, the procedure of measurements, and data on superficial eye temperature in health and in some pathological processes.
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Castrogiovanni P, Imbesi R, D'Amico F, Mazzone V, Cavallaro N. Is the lattice dystrophy of the cornea due to developmental anomalies of neural crest cells during embryogenesis (neurocristopathies)? Ital J Anat Embryol 2007; 112:255-266. [PMID: 18333410] [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] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
With the present paper authors try to give an embryological approach in understanding etiopathogenesis of lattice corneal dystrophy (LCD). The case of a 41-years-old man affected by isolated LCD has been examined at the Ophtalmologic Clinic of the University of Catania, Italy. Sore cornea has been excised during cornea transplantation, and it has been examined by transmission electron microscopy (TEM). Results confirm classic submicroscopic findings described in literature. However these findings offer possibility to consider an embryological interpretation of LCD pathogenesis. Our findings with those of literature put forward hypothesis of a hereditary etiopathogenetical role exerted by keratocytes, direct derivatives of neural crest cells during embryogenesis, probably via an abnormal gene expression in producing proteinaceous precursor of amyloid substance (APP). LCD could be considered a neurocristopathy.
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Abstract
PURPOSE To evaluate the surgical outcome of deep anterior lamellar keratoplasty (DALK) in Korean patients with Avellino dystrophy. METHODS A retrospective study was performed in 4 eyes (4 patients) with recurrent Avellino dystrophy after phototherapeutic keratectomy (PTK). Genetic study was performed on 2 patients to confirm the diagnosis. Partial-thickness donor cornea (devoid of endothelium and Descemet membrane) was transplanted onto a recipient bed after deep lamellar dissection and removal of recipient stroma. Visual acuity, refractive error, keratometry values, topographic astigmatism, and complications were evaluated after a follow-up period of at least 14 months. RESULTS The mean age of the patients was 52.5 +/- 3.32 years, and the mean follow-up period was 17.5 +/- 3.11 months. Visual acuity was improved to > or = 20/25 in all cases. Postoperative topographic astigmatism ranged from 1.2 to 4.9 D. In 1 case, double anterior chamber developed after the operation, which resolved after gas injection into the anterior chamber. During the follow-up period, there were no signs of graft rejection, and all grafts were transparent except one, in which small opacity recurred in the peripheral corneal stroma 13 months postoperatively. CONCLUSIONS DALK is considered a good primary surgical option in patients with recurrent Avellino dystrophy after PTK.
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Affiliation(s)
- Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Cohen EJ. Debridement for visual symptoms resulting from anterior basement membrane corneal dystrophy. Am J Ophthalmol 2007; 144:288-9. [PMID: 17659958 DOI: 10.1016/j.ajo.2007.05.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Revised: 05/16/2007] [Accepted: 05/16/2007] [Indexed: 10/23/2022]
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Itty S, Hamilton SS, Baratz KH, Diehl NN, Maguire LJ. Outcomes of epithelial debridement for anterior basement membrane dystrophy. Am J Ophthalmol 2007; 144:217-221. [PMID: 17553446 DOI: 10.1016/j.ajo.2007.04.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [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: 01/07/2007] [Revised: 04/12/2007] [Accepted: 04/15/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE To evaluate the outcomes of simple mechanical debridement for the management of anterior basement membrane dystrophy (ABMD) in a cohort of patients treated primarily for visual symptoms. DESIGN Retrospective, observational case series. METHODS setting: Single center. study population: Seventy-four eyes of 55 patients treated with mechanical epithelial debridement over a 15-year period. observation procedures: We recorded symptoms, pre- and postoperative best-corrected visual acuity (BCVA), surgical technique, complications, and evidence of disease recurrence. main outcome measures: Mean best-corrected logMAR acuity and refractive errors, compared by using paired t tests or Wilcoxon signed-rank tests. Interval to recurrence of ABMD was determined by using Kaplan-Meier estimates. RESULTS Mean patient age was 74 years, and 80% were female. Visual difficulty was reported by the patient before the procedure in 61 eyes (82%), and erosion symptoms alone were noted before the procedure in the remaining 13 eyes. Mean BCVA improved from 20/44 before surgery to 20/30 (P = .0001) at the early follow-up visit and 20/33 (P = .0001) at the last follow-up (mean = 33 months). The mean refractive spherical equivalent changed -0.6 diopters (range, -4.75 to +2.0 diopters). No infections or persistent epithelial defects occurred. The most common postoperative complication was subepithelial haze, occurring in 19 eyes (26%). The five-year cumulative probability of recurrence of ABMD was 44.7%. CONCLUSIONS Our results with this simple technique are comparable to outcomes reported with other procedures used to treat ABMD. We recommend manual debridement as an effective option for ABMD affecting visual acuity.
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Affiliation(s)
- Sujit Itty
- Mayo Clinic College of Medicine, Mayo Medical School, Rochester, MN 55902, USA
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Thapa N, Lee BH, Kim IS. TGFBIp/betaig-h3 protein: a versatile matrix molecule induced by TGF-beta. Int J Biochem Cell Biol 2007; 39:2183-94. [PMID: 17659994 DOI: 10.1016/j.biocel.2007.06.004] [Citation(s) in RCA: 147] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Revised: 06/05/2007] [Accepted: 06/05/2007] [Indexed: 11/27/2022]
Abstract
TGFBIp/betaig-h3 protein is an extracellular matrix molecule initially cloned from human adenocarcinoma cells treated with TGF-beta. Its precise function remains obscure but a number of studies have demonstrated it to be an intriguingly versatile molecule role in a wide range of physiological and pathological conditions. To date, the most extensively studied and reported action of TGFBIp/betaig-h3 protein is in corneal dystrophy and several excellent reviews are available on this. Work from various laboratories on this molecule has compiled a tremendous amount of information over the past decade and a half. Here we review the current understanding on TGFBIp/betaig-h3 protein and its functions in morphogenesis, extracellular matrix interactions, adhesion/migration, corneal dystrophy, tumorigenesis, angiogenesis, nephropathies, osteogenesis, wound healing and inflammation.
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Affiliation(s)
- Narendra Thapa
- Cell and Matrix Research Institute, Department of Biochemistry and Cell Biology, School of Medicine, Kyungpook National University, 101 Dongin-Dong, Jung-gu, Daegu 700-422, Republic of Korea
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Zhang B, Yao YF, Zhou P. Two novel mutations identified in two Chinese gelatinous drop-like corneal dystrophy families. Mol Vis 2007; 13:988-92. [PMID: 17653040 PMCID: PMC2774463] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
PURPOSE To identify the genetic defect in the TACSTD2 gene that causes gelatinous drop-like corneal dystrophy (GDLD) in two unrelated consanguineous Chinese families. METHODS Genomic DNA was prepared from leukocytes of peripheral venous blood. The coding region of the TACSTD2 gene was evaluated by means of polymerase chain reaction and direct sequencing. RESULTS Sequencing of the TACSTD2 gene of the two probands revealed two novel homozygous frameshift mutations: c.84insG and c.480delC. The identified molecular defect cosegregates with the disease among affected members of the families and is not found in 50 unaffected controls. CONCLUSIONS This study reports two novel mutations in two GDLD families and expands the spectrum of mutations in TACSTD2 gene that may cause pathological corneal amyloidosis.
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Affiliation(s)
- Bei Zhang
- Department of Ophthalmology, Affiliated Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, PR China
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Szentmáry N, Takács L, Berta A, Szende B, Süveges I, Módis L. Cell proliferation and apoptosis in stromal corneal dystrophies. Histol Histopathol 2007; 22:837-45. [PMID: 17503340 DOI: 10.14670/hh-22.837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of our study was to evaluate corneal cell proliferation and apoptosis in cases of granular, macular and lattice dystrophy, and to provide evidence which may help to clarify whether apoptosis is a pathogenic factor in any of these dystrophies. The study group comprised 39 eyes (from 33 patients) which had undergone penetrating keratoplasty (PK) for stromal dystrophies: these comprised 12 eyes (from 9 patients, 55.5% males) with granular dystrophy, 13 eyes (12 patients, 33.3% males) with macular dystrophy, and 14 eyes (13 patients, 61.5% males) with lattice type I dystrophy. A further 4 corneal buttons from enucleated eyes of 4 patients with choroideal melanoma served as controls. Immunocytochemical analysis of Ki67 (DNAcon Kit, DakoCytomation A/S, Glostrup, Denmark) was used for evaluation of cell proliferation. Apoptosis was detected by use of the TUNEL (terminal deoxyribonucleotidyl transferase-mediated dUTP-digoxigenin nick-end labelling) assay method (Apoptag reagent, Q-Biogene, Strasbourg, France). Statistical comparisons were made using the Mann-Whitney test. No Ki67-positive cells were detected in the study-group or control corneas. In control corneas no apoptotic activity was found. In the study group the mean (normalised) apoptotic keratocyte number was 1.1+/-1.7 in granular dystrophy and 0.5+/-1.1 in lattice type I dystrophy (p = 0.36, 0.63 respectively). Compared to the controls, the difference was statistically significant only for macular dystrophy (1.6+/-1.2; p = 0.01). Keratocyte apoptosis seems to be a concomitant or pathogenic factor in macular dystrophy. However, the pathways that are triggered to result in increased apoptotic cell death remain to be clarified.
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Affiliation(s)
- N Szentmáry
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary.
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Weiss JS. Visual morbidity in thirty-four families with Schnyder crystalline corneal dystrophy (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc 2007; 105:616-648. [PMID: 18427632 PMCID: PMC2258126] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE To assess the findings, visual morbidity, and surgical intervention in Schnyder crystalline corneal dystrophy (SCCD). METHODS Retrospective case series of 115 affected individuals from 34 SCCD families identified since 1989. Age, uncorrected visual acuity, best-corrected visual acuity (BCVA), corneal findings, and ocular surgery were recorded. Prospective phone, e-mail, or written contact provided updated information. Patients were divided into 3 age categories for statistical analysis: less than 26 years of age, 26 to 39 years of age, and 40 years of age and older. RESULTS Mean age on initial examination was 38.8 +/- 20.4 (range, 2-81) with follow-up of 55 of 79 (70%) of American patients. While there were no statistical significant correlations between logMAR visual acuity and age (logMAR BCVA =.033 + .002 x age; R =.21), the linear regression showed the trend of worse visual acuity with age. BCVA at > or =40 years was decreased compared to <40 (P < .0001), although mean BCVA was > 20/30 in both groups. Twenty-nine of 115 patients had corneal surgery with 5 phototherapeutic keratectomy (3 patients), and 39 penetrating keratoplasty (PKP) (27 patients). PKP was reported in 20 of 37 (54%) patients > or =50 years and 10 of 13 (77%) of patients > or =70. BCVA 1 year prior to PKP in 15 eyes (9 patients) ranged from 20/25 to 20/400 including 7 eyes with other ocular pathology. BCVA in the remaining 8 eyes was 20/25 to 20/70 with 3 of these 4 patients reporting preoperative glare. Chart and phone survey suggested increasing difficulty with photopic vision with aging. CONCLUSION Although excellent scotopic vision continues until middle age in SCCD, most patients had PKP by the 7th decade. SCCD causes progressive corneal opacification, which may result in glare and disproportionate loss of photopic vision.
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Affiliation(s)
- Jayne S Weiss
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan, USA
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