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Phylactou M, Din N, Aiello F, Angunawela R. Corneal Collagen Cross-Linking for Late Onset Progressive Keratoconus in Iridocorneal Endothelial Syndrome. Cornea 2023; 42:1293-1296. [PMID: 37170404 DOI: 10.1097/ico.0000000000003258] [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: 12/16/2022] [Accepted: 01/17/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The aim of this study was to report the first case of successful use of corneal collagen cross-linking (CXL) to halt the progression of keratoconus in a patient with concurrent iridocorneal endothelial (ICE) syndrome. METHODS A 30-year-old White man was referred to our subspecialty corneal clinic for further investigation of right corectopia. The patient was asymptomatic and was otherwise fit. Slit-lamp examination revealed a right oval-shaped pupil decentered superiorly, a transillumination defect at the 5-o'clock position, minimal gutta-like changes in the corneal endothelium, and few inferior peripheral anterior synechiae. Dilated fundoscopy was normal in both eyes, with healthy optic discs, maculae, and peripheral retinae. Specular microscopy and slit-lamp findings suggested ICE syndrome. Subsequent investigation with corneal tomography showed progressive signs of inferior corneal ectasia with steepening, and thinning in the right eye, consistent with keratoconus. The left eye was unremarkable. RESULTS Epithelium-off accelerated corneal CXL was performed in the affected eye. Early post-CXL follow-up (1 week) was unremarkable, and further follow-ups were arranged at 3, 6, 12, and 24 months, respectively. In subsequent reviews, the patient's vision and corneal tomography findings were stable. CONCLUSIONS We describe the first case of corneal CXL for progressive keratoconus with ICE syndrome. co-existing keratoconus and ICE syndrome can occur, and corneal cross-linking was used successfully in this case to halt keratoconus progression. However, further studies will need to establish the impact of epithelium-off corneal cross-linking, especially in more severely affected eyes.
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Affiliation(s)
- Maria Phylactou
- Department of Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom; and
| | - Nizar Din
- Department of Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom; and
| | - Francesco Aiello
- Department of Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom; and
- Ophthalmology Unit, Department of Experimental Medicine, University of Rome "Tor Vergata," Rome, Italy
| | - Romesh Angunawela
- Department of Cornea and External Diseases, Moorfields Eye Hospital, London, United Kingdom; and
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Ye WQ, Deng YX, Zuo JJ, Zhang SD, Wang HO, Li JY, Zheng QX, Liang YB, Chen W. [Clinical characteristics of 114 patients with iridocorneal endothelial syndrome]. Zhonghua Yan Ke Za Zhi 2022; 58:35-40. [PMID: 34979791 DOI: 10.3760/cma.j.cn112142-20201231-00859] [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: 06/14/2023]
Abstract
Objective: To investigate the clinical features in patients with iridocorneal endothelial (ICE) syndrome. Methods: A retrospective case series study. Data of clinical manifestations of patients with ICE syndrome including clinical subtypes, presenting visual acuity, clinical features and secondary glaucoma were collected from January 2014 to May 2020 in the Eye Hospital, School of Ophthalmology and Optometry, Wenzhou Medical University. The Wald's Chi-square test of generalized estimating equations was performed to analyze the differences in three clinical subtypes. Results: A total of 127 eyes of 114 subjects (64 females and 50 males) were included. Mean±SD age at presentation was (49±13) years. There were 53 patients (46.5%) with Chandler's syndrome (CS), 36 patients (31.6%) with progressive iris atrophy (PIA), 24 patients (21.0%) with Cogan-Reese syndrome (CRS) and one patient (0.9%) with an undetermined subtype. And 101 patients (88.6%) had uniocular ICE syndrome. Approximately 81.7% (49/60), 56.1% (23/41) and 41.7% (10/24) of eyes presented visual acuity <0.3 in patients with CS, PIA and CRS, respectively. Corneal edema was most common in CS (52.5%, 32/61), followed by PIA (29.3%, 12/41) and CRS (20.8%, 5/24). Corectopia was found in 95.8% (23/24) of eyes with CRS, 95.1% (39/41) of eyes with PIA and 78.7% (48/61) of eyes with CS. Polycoria was observed in 29.3% (12/41) of eyes with PIA, 3.3% (2/61) of eyes with CS and 8.3% (2/24) of eyes with CRS. Ectropion uvea was most common in CRS (54.2%, 13/24), followed by 16.4% (10/61) in CS and 12.2% (5/41) in PIA. Glaucoma was found in 94 eyes (74.0%, 94/127). Among them, 60.7% (37/61) of CS, 80.5% (33/41) of PIA and 95.8% (23/24) of CRS had secondary glaucoma. The difference of presenting visual acuity, corneal edema, corectopia, polycoria, ectropion uveae and secondary glaucoma in three clinical subtypes all had statistical significance (Wald χ2=13.87, 10.77, 965.78, 11.45, 15.00, 222.04; all P<0.05). And 86.2% of eyes (81/94) had glaucoma surgeries and 41 eyes (43.6%, 41/94) had the intraocular pressure well controlled with various interventions. Conclusions: ICE syndrome is mostly uniocular and more common in middle-aged patients. CS is the most common clinical subtype with poor presenting visual acuity. About 3/4 of eyes have secondary glaucoma, and the majority of them require surgical interventions, but prognoses are discouraging.
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Affiliation(s)
- W Q Ye
- The Eye Hospital, School of Ophthalmology and Optometry, Glaucoma Research Institute, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China Deng Yuxuan is now working at the Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao 266011, China
| | - Y X Deng
- The Eye Hospital, School of Ophthalmology and Optometry, Glaucoma Research Institute, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China Deng Yuxuan is now working at the Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao 266011, China
| | - J J Zuo
- The Eye Hospital, School of Ophthalmology and Optometry, Glaucoma Research Institute, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China Deng Yuxuan is now working at the Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao 266011, China
| | - S D Zhang
- The Eye Hospital, School of Ophthalmology and Optometry, Glaucoma Research Institute, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China Deng Yuxuan is now working at the Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao 266011, China
| | - H O Wang
- The Eye Hospital, School of Ophthalmology and Optometry, Glaucoma Research Institute, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China Deng Yuxuan is now working at the Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao 266011, China
| | - J Y Li
- The Eye Hospital, School of Ophthalmology and Optometry, Glaucoma Research Institute, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China Deng Yuxuan is now working at the Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao 266011, China
| | - Q X Zheng
- The Eye Hospital, School of Ophthalmology and Optometry, Glaucoma Research Institute, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China Deng Yuxuan is now working at the Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao 266011, China
| | - Y B Liang
- The Eye Hospital, School of Ophthalmology and Optometry, Glaucoma Research Institute, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China Deng Yuxuan is now working at the Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao 266011, China
| | - W Chen
- The Eye Hospital, School of Ophthalmology and Optometry, Glaucoma Research Institute, Wenzhou Medical University, National Clinical Research Center for Ocular Diseases, Wenzhou 325027, China Deng Yuxuan is now working at the Department of Ophthalmology, Qingdao Municipal Hospital, Qingdao 266011, China
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