Cornea最新文献

Purpose: This study evaluated the rate at which patients with visual impairment primarily from corneal disease were referred for low vision (LV) services and assessed the visual outcomes from completed evaluations.

Methods: This 1-year retrospective, cross-sectional study included patients with corneal disease limiting best-corrected visual acuity (BCVA) to ≤ 20/40. Outcome measures included the change in BCVA achieved after distance refraction by a LV specialist. Incremental costs per quality-adjusted life years (QALY) gained were calculated upon the better-seeing eye, by using a willingness-to-pay threshold of USD 50,000/QALY.

Results: Of 3230 patients, 143 (4.4%) had visual impairment from corneal disease. The median age of those patients was 80 years (IQR: 66-88 years) and 64.3% were male. Just over half were referred for LV evaluations (53.2%), and most completed appointments (96.1%). Patients more likely to be referred had better vision in their worse-seeing eye (0.961 logMAR vs. 1.451 logMAR, P = 0.002) and were more frequently diagnosed with corneal dystrophies, degenerations, or ectatic disease (51.3% vs. 26.9%, P = 0.003) compared with other corneal conditions, but they were less likely to have immunologic conditions (2.6% vs. 13.4%, P = 0.016). In total, two-thirds of patients achieved improved BCVA for their better-seeing eye, with 32% gaining ≥ 2 lines. This translated into an average gain of 0.04 QALYs/patient at a cost of USD 3128/QALY. The estimated net monetary benefit was USD 1923/LV evaluation completed.

Conclusions: Referring patients with corneal disease to LV services resulted in significant improvements in visual function at a reasonable cost.

Purpose: To describe 1-year changes in the cornea as assessed by anterior segment optical coherence tomography (AS-OCT) and in vivo confocal microscopy (IVCM) for participants receiving a tissue graft generated from a new manufacturing process using cultivated autologous limbal epithelial cells.

Methods: Cultivated autologous limbal epithelial cell grafts were produced in a 2-stage manufacturing process following a good manufacturing process-compliant protocol. AS-OCT and IVCM were completed at baseline and 12 months after the treatment in subsets of these participants. Secondary efficacy outcomes were determined based on improvement of central corneal epithelial morphology and thickness [corneal epithelial thickness (CET)] and presence of conjunctival or corneal cells in central cornea.

Results: Among 14 participants, 13 (93%) were male, 12 (86%) were white, the mean age was 46 ± 16 years. At baseline, CET was 53 (range: 34, 64) microns, and epithelial basal cell density was 3964 (range: 822-5788) cells/mm 2 ; the ratio of the cells at central cornea was 20% corneal and 90% conjunctival epithelial cells. At 12 months, the mean changes were 3 μm in CET ( P = 0.67), and 1967 cells/mm 2 in epithelial basal cell density ( P = 0.02); the proportion of the central cells improved to 75% corneal and 38% conjunctival epithelial cells.

Conclusions: The AS-OCT and IVCM findings are consistent with the clinical improvement, indicating the reconstitution of the corneal phenotype and clearing of the optical axis. Nevertheless, IVCM is notably more effective for in-depth analysis of the epithelial phenotype and thickness than AS-OCT.

Purpose: To compare outcomes between patients treated with a single cyanoacrylate tissue adhesive (CTA) patch for corneal thinning or perforation and those requiring multiple CTA applications.

Methods: We conducted a single-center, comparative cohort study of patients with corneal thinning or perforation treated with either a single or multiple CTA applications in Toronto, Canada, between 2006 and 2024. Primary outcomes were the need for penetrating keratoplasty (PKP) and the best-corrected visual acuity (BCVA) at final follow-up. Associations between the number of CTA applications with baseline characteristics, perforation characteristics, and final outcomes were analyzed using univariable and multivariable logistic regression models.

Results: Overall, 189 patients (median age 69.0 years; 42% female) were included, with 116 (61%) in the single CTA group and 73 (39%) in the multiple-application group (mean 2.3 ± 0.6), over a median follow-up of 4.4 months. Baseline characteristics were similar between groups. Central and paracentral corneal defects were more likely to require multiple glue applications than peripheral defects (OR = 2.92, 95% CI, 1.31-6.51, P = 0.009). No difference was observed in final BCVA between groups (median: 2.0 logarithm of the minimum angle of resolution [single] vs. 2.0 logarithm of the minimum angle of resolution [multiple]; P = 0.838). Patients receiving multiple CTA applications (48%, n = 35/73) were more likely to require PKP (OR = 2.70, 95% CI, 1.42-5.15, P = 0.003) than those treated with a single glue patch (26%, n = 30/116).

Conclusions: Multiple CTA applications were more frequently needed for central/paracentral defects and were associated with a greater likelihood of PKP. Given no significant difference in final BCVA, a conservative, stepwise management approach can be pursued without compromising long-term visual outcomes, allowing flexibility in surgical planning.

Purpose: To describe the outcomes of corneal transplantation after minimally invasive corneal neurotization (MICN) in pediatric patients.

Methods: Medical records of all children who underwent corneal transplantation post-MICN with sural nerve graft for neurotrophic keratopathy between 2015 and 2021 were reviewed retrospectively. Data collected included demographic information, ocular comorbidities, maximum corneal sensitivity by Cochet-Bonnet aesthesiometer (CBA) preoperatively and postoperatively measured in the central graft area, graft survival (primary outcome), and rejection.

Results: Of 28 eyes which underwent MICN, six underwent corneal transplant surgery (mean age 11.9 ± 4.4 years) 2.4 ± 0.4 years after initial surgery. Mean maximum recorded CBA across all quadrants before corneal transplantation was 53.3 ± 9.4 mm. Reepithelialization was observed in all eyes by postoperative month 2. Mean follow-up was 4.5 ± 2.1 years. Penetrating keratoplasty was performed in 2 cases, and deep anterior keratoplasty in four cases. Graft survival at final follow-up was 83.3%. Mean recorded central CBA after corneal transplantation was 53.8 ± 8.2 mm. No improvement was observed in visual acuity from baseline (1.2 ± 0.4 logMAR) to final postoperative follow-up (1.1 ± 0.4 logMAR; P = 0.68).

Conclusions: Corneal transplantation after corneal neurotization has survival rates >80%. Manual deep anterior keratoplasty can be performed in patients who have not undergone previous penetrating keratoplasty. Despite graft clarity, improvement in best-corrected visual acuity may be limited by amblyopia in this age group.

Purpose: Inflammatory myofibroblastic tumor (IMT) is a mesenchymal neoplasm of intermediate biological potential, predominantly affecting children and young adults. While IMT most commonly involves the lungs, abdomen, pelvis, and retroperitoneum, primary occurrences in the orbit or ocular surface are rare.

Methods: Case report.

Results: Here we present a case of a 26-year-old woman with a small, indolent conjunctival IMT harboring anaplastic lymphoma kinase rearrangement. Following surgical resection, the patient showed no evidence of recurrence after 9 months of follow-up. Notably, this report firstly provided anterior segment optical coherence tomography scan and ultrasound biomicroscope images of conjunctival IMT.

Conclusions: IMT should be considered in the differential diagnosis of localized conjunctival lesions unresponsive to steroid therapy. Anterior segment optical coherence tomography and ultrasound biomicroscope serve as valuable tools, aiding in differential diagnosis, surgical planning, and postoperative recurrence monitoring.

Purpose: To evaluate investigational use of corneal crosslinking (CXL) to treat corneal neovascularization (CNV) with or without concomitant infection.

Methods: This prospective, single-center study assessed investigational use of epithelium-off CXL with 0.1% riboflavin/20% dextran ophthalmic solution to treat various scenarios of CNV with standard 30-minute or accelerated 10-minute irradiation.

Results: The CXL treatment was investigated for 38 CNV scenarios in 37 eyes of 35 participants (2 bilateral) and was repeated once in 2 eyes and twice in 1 eye. Treatment was considered successful in 24 cases, partially successful in 1 case, and unsuccessful in 8 cases; 2 cases were lost to follow up and 3 developed complications unrelated to the CXL that precluded efficacy evaluation. The CXL was considered successful in all 4 cases treated for CNV with melting and/or cheese wiring of the recipient cornea postkeratoplasty, in 7 of 9 cases with active infection, in 5 of 10 cases treated in conjunction with penetrating keratoplasty, in 3 of 4 cases treated in conjunction with lamellar keratoplasty or wound revision, and in 6 of 11 cases without associated infection or surgery.

Conclusions: Investigational use of CXL can contribute to CNV regression in the following scenarios: postkeratoplasty corneal melting and suture cheese wiring, infectious keratitis, and combined with keratoplasty. However, it has limited, if any, benefit in treating CNV in situations where the stimulus for CNV is not eliminated, such as ongoing infection or chronic conditions such as limbal stem cell dysfunction.

Purpose: To determine the maximum extent of corneal thinning induced solely by dehydration and to establish the threshold at which corneal lysis begins, thereby refining therapeutic indications, with the aim of improving clinical management.

Methods: Dehydration was induced in 28 corneas, after 4 ex vivo experimental models. Corneal thickness was regularly measured using swept-source optical coherence tomography (OCT). Histological analysis was performed on 14 of the corneas, with computer-based counting of collagen lamellae. The remaining 14 corneas were rehydrated and remeasured using OCT.

Results: Regardless of the model, all corneas exhibited sectoral thinning, clinically resembling corneal dellen. With the most efficient dehydration model, the average minimum pachymetry was 102 ± 30 μm, with minimal values down as low as 49 μm. Computerized histological analysis confirmed that this thinning reflected a greater density of collagen lamellae and not a real loss of collagen. After rehydration, OCT showed a resolution of corneal thinning in all cases.

Conclusions: Corneal dellen thinning reflects the compaction of collagen fibers secondary to localized dehydration. Dehydration alone thinned the cornea to an average of 102 μm, and in some cases, it became as low as 49 μm. Above this threshold, corneal rehydration is sufficient to achieve full recovery.

Purpose: To evaluate postoperative visual outcomes on postoperative day 1 (POD1) after lenticule extraction in myopia astigmatism in a large cohort of over 1350 consecutive treatments.

Methods: A retrospective review chart identified 1357 eyes consecutively treated with SCHWIND ATOS using lenticule extraction for myopic astigmatism who had at least 6 months of follow-up completed and for which POD1 was completely recorded. The standard visual and refractive outcomes, and astigmatism outcomes, were analyzed on POD1. As a sanity check, the stability of defocus and uncorrected distance visual acuity (UDVA) were evaluated from day 1 to 1-year postoperative follow-ups.

Results: On POD1, 82% of the eyes achieved an UDVA of 20/20 or better, with 82% of the eyes with postoperative UDVA being the same or better than the preoperative corrected distance visual acuity baseline, and only 2% of eyes lost 2 lines of corrected distance visual acuity. Postoperative spherical equivalent (+0.15 ± 0.35D) was within 0.75 D in 98% of the cases, with excellent stability from 1-week to 1-year postoperative follow-ups (11% eyes changing by 0.5D of defocus). Postoperative refractive astigmatism at POD1 (0.01 ± 0.08 D) was highly accurate, with over 99% of the cases within 0.5 D, and 99% within 5 degrees of the attempted axis. The astigmatic correction index (1.00 ± 0.08) showed 98% of the cases within 10% deviation.

Conclusions: In this large cohort of over 1350 cases, lenticule extraction using SCHWIND ATOS is safe and effective on POD1, shows stability from 1-week to 1-year postoperative follow-ups, and suggests accurate and precise corrections for both defocus and astigmatism.

Purpose: To report clinical features of genetically confirmed x-linked endothelial corneal dystrophies using multimodal corneal imaging.

Methods: Four corneas of a 22-year-old male and a 58-year-old female patient with x-linked endothelial corneal dystrophy were examined with slit-lamp biomicroscopy, Scheimpflug tomography, anterior segment optical coherence tomography, in vivo corneal confocal microscopy, and specular microscopy. Clinical features and multimodal imaging findings were analyzed.

Results: Best-corrected visual acuity (in logMAR) was 0.2 (OD/OS) in the female, and 0.3 (OD) and 0.5 (OS) in the male. Clinical examination demonstrated moon crater-like lesions of the posterior cornea in the female patient, whereas the male patient showed diffuse stromal opacities with pronounced moon crater-like changes. Anterior segment optical coherence tomography revealed single hyperreflective lesions at the level of Descemet membrane and endothelium in the female patient (central corneal thickness: OD: 580 μm/OS: 586 μm), whereas the male patient demonstrated a stronger hyperreflective thickening of Descemet membrane (central corneal thickness: OD: 659 μm/OS: 676 μm). In vivo corneal confocal microscopy revealed corneal guttae in the female patient, whereas the male patient's findings were subepithelial and stromal hyperreflective fibrosis, parallel, thin, long hyporeflective bands within the corneal stroma, hyperreflectivity at level of Descemet membrane, and hyperreflective endothelial cells with pleomorphism, polymegethism, and enlarged nuclei. Furthermore, Descemet membrane revealed hyporeflective moon crater-like lesions with hyperreflective material in its center.

Conclusions: X-linked endothelial corneal dystrophy shares clinical and diagnostic features with other endothelial corneal dystrophies, raising the question of whether it is a distinct subtype or the result of multiple coexisting corneal dystrophies causing a heterogenous clinical picture. Additional genetic testing is necessary to identify the causative genetic background.

Purpose: The objective of this longitudinal cohort study was to identify predictors of progression to ocular graft-versus-host disease in allogeneic hematopoietic stem cell transplant recipients.

Methods: Patients (n = 49) were examined before hematopoietic stem cell transplantation (HSCT) and 3, 6, 12, 24, and 36 months after HSCT. Outcome measures included ocular surface disease index questionnaire, Schirmer I test, corneal fluorescein staining, tear break-up time, and tear cytokine concentration. Diagnosis of ocular GVHD (oGVHD) was made in accordance with the International Consensus Criteria for chronic oGVHD. A group of healthy controls (n = 20) without dry eye disease was recruited for comparison.

Results: At baseline, the intended HSCT group had a lower Schirmer test value, a higher corneal fluorescein staining score, and a lower tear film break-up time compared with the control group. There was no significant difference in ocular surface disease index score. The intended HSCT group had significantly higher tear interleukin (IL)-1, IL-6, IL-8, IL-10, interferon gamma-induced protein (IP)-10, and TNF-α concentrations at baseline. When considering an increase of at least 2 points of the International Consensus Criteria for chronic oGVHD score after HSCT to exclude preexisting dry eye disease, only 19% (n = 7) developed either probable (11%, n = 4) or definite (8%, n = 3) oGVHD. In a longitudinal analysis, a significant association between progression to oGVHD and tear IL-6, IL-8, IL-17A, and IP-10 concentration was detected.

Conclusions: This study highlights the added value of performing a baseline ophthalmological examination in intended HSCT recipients. Posttransplant oGVHD rates may be overestimated if pretransplant ocular surface disease is not considered. Longitudinal tear cytokine analysis in our cohort suggests that IL-6, IL-8, IL-17A, and IP-10 may be useful as biomarkers for oGVHD.