Cornea最新文献

Purpose: The purpose of this study was to examine Tear Film Imager (TFI, AdOM, Israel) generated parameters across controls and dry eye (DE) subgroups and examine the changes in TFI parameters with contact lens (CL) placement.

Methods: The retrospective study (n = 48) was conducted at the Miami Veterans Hospital. Symptoms were assessed through validated questionnaires and signs of tear function by tear break-up time and Schirmer scores. Participants were grouped as 1) healthy, 2) evaporative, 3) aqueous deficient, and 4) mixed DE based on tear function. Seventeen individuals had a baseline scan and a repeat scan following CL placement. Descriptives were compared across groups and over time.

Results: The median age was 27 years, 74% self-identified as White, 45% as male, and 51% as Hispanic. Subjects in the aqueous deficiency category had lower muco-aqueous layer thickness (MALT) (2672 vs. 3084 nm) but higher lipid layer thickness (47.5 vs. 38.3 nm), lipid break-up time (4.4 vs. 2 seconds), and interblink interval (13.9 vs. 5.4 seconds) compared with the evaporative group. Subjects in the evaporative group had the highest MALT values (3084 vs. 2988, 2672, 3053 nm) compared with healthy, aqueous-deficient, and mixed groups. Symptoms were not significantly correlated with TFI parameters. CL placement significantly decreased MALT values (2869 → 2175 nm, P = 0.001).

Conclusions: The TFI provides unique information regarding the dynamic function of the tear film not captured by clinical examination. TFI generated metrics demonstrate a thinner aqueous layer in individuals with aqueous deficiency but highlight a thicker aqueous layer in those with evaporative DE.

Purpose: To report an unusual case of bilateral aggressive Mooren ulcer that occurred in the setting of bilateral pterygia and showed a relentless course during pregnancy.

Methods: A 39-year-old woman of Black African ethnicity, 36-week pregnant, presented to the eye casualty with bilateral nasal corneal ulcer and associated melt around preexisting pterygia. A detailed workup including microbial evaluation, culture and sensitivity, polymerase chain reaction for herpes simplex virus, varicella zoster virus, and cytomegalovirus, inflammatory blood profile, autoimmune markers, and human leucocyte antigen (HLA) screening was undertaken. Treatment was initiated in a stepwise approach.

Results: Infections and systemic autoimmune and rheumatologic conditions were ruled out. A diagnosis of bilateral Mooren ulcer was made by exclusion. The peripheral blood was positive for HLA DQ2. As the condition seemed refractory to medical management (topical steroids and intravenous pulse methylprednisolone followed by oral prednisolone and topical cyclosporine), urgent bilateral conjunctival resection with multilayered amniotic membrane transplantation was performed to reduce the inflammatory stimulus and keratolysis. Stabilization of the condition warranted the need for systemic immunosuppressive agents. Using a multidisciplinary approach, in liaison with Obstetricians and Rheumatologists, the patient was planned for an earlier elective Cesarean section and commencement of oral mycophenolate mofetil postpartum, which aided in successful control of the disease.

Conclusions: Mooren ulcer could follow an aggressive course during pregnancy, especially in the setting of preexisting pterygium. The complex hormonal and immunological changes during pregnancy and the delivery of inflammatory mediators directly onto the cornea by pterygium could contribute to the severity. A well-planned, stepwise, and multidisciplinary management is pivotal for the treatment of this condition.

Purpose: To report the association of Pseudofilariasis as a presenting sign of Alkaptonuria.

Method: Case Report.

Results: A 49-year-old Indian man was referred because of wormlike objects in his left conjunctiva. Ocular and family history was non-contributory. He had not been to India in 15 years. Past medical history revealed hypertension, hypercholesterolemia, arthritis, and a myocardial infarct. He had undergone two stents, bilateral Achilles tendon repairs and bilateral knee replacements. ROS showed longstanding back stiffness and pain. On ocular examination the vision was 20/25 in each eye and positive findings were in the left eye bulbar conjunctival which showed stationary black vermiform (filarial in appearance) foreign bodies along with 2 small corneal limbal pigmented deposits. Conjunctival biopsy showed dilated lymph channels with interstitial proteinaceous material of a light brown color consistent with Ochronotic pigment; hence diagnostic of Alkaptonuria.

Conclusions: Pseudofilariasis may be a presenting sign of Alkaptonuria and occur years before a clinical diagnosis is made. Filariasis is always involves white worms and never black. Knowing the ophthalmic signs of this rare disease may lead to an accurate diagnosis earlier thusly avoiding unnecessary tests and examinations.

Purpose: This study aimed to compare the expression of vitamin D receptor (VDR) on the ocular surface of patients with dry eye disease (DED) and controls without ophthalmological pathologies.

Methods: Patients with DED without previous treatment were studied and compared with healthy subjects. Ocular Surface Disease Index assessement and ocular surface cytology were performed in all patients. The immunohistochemical expression of VDR was evaluated using fully automated immunohistochemistry. The evaluation involved multiplying the percentage of nuclear-labeled cells (0-100) by their intensity (0-3), resulting in a score ranging from 0 to 300 (VDR H-score). Squamous metaplasia was morphologically evaluated using liquid-phase cytology with Papanicolaou/periodic acid-Schiff staining using Nelson's grade (scale 0-3, higher grade to higher metaplastic change).

Results: Eighteen patients with DED without previous treatment and 10 healthy subjects were studied. Squamous metaplasia was observed in 74% of patients with DED, in contrast to 0% in the control group. In patients with DED, there was a lower expression of VDR than in the control group (VDR H-score: 11.2 ± 13.9 vs. 80.9 ± 56; P = 0.0001). Furthermore, an inverse correlation was observed between Nelson grade and VDR H-score ( P = 0.0001, rs = -0.71). No correlation was observed between Ocular Surface Disease Index and VDR H-score.

Conclusions: This is the first study to evaluate the VDR in patients with DED. These patients presented with a lower expression of VDR than healthy subjects. No correlation was found with more severe symptoms. Patients with DED also had a higher frequency of squamous metaplasia.

Purpose: The purpose of this study was to describe the clinical outcome of scleral staphyloma secondary to necrotizing scleritis treated with autologous pericranial grafting.

Case report: A 63-year-old woman with necrotizing scleritis and choroidal protrusion underwent homologous scleral grafting, which failed. The patient's medical management was optimized for control of her systemic inflammation, and she underwent a second surgery consisting of autologous pericranium grafted to the parietal region. A 3- × 2-cm tissue patch was harvested and sutured over the staphyloma borders with 8/0 polyglactin sutures. Complete re-epithelialization was observed at 3 weeks, the graft was well integrated, and no signs of inflammation were observed at 18 months.

Conclusions: The pericranium offers a viable alternative for scleral thinning because of necrotizing scleritis.

Purpose: Landolt ring-shaped epithelial keratopathy is a corneal disease that has only been reported in 11 Japanese patients in 2014. 1 We describe the first case of Landolt ring-shaped epithelial keratopathy in the United States in a patient of European background.

Methods: This is a single case report with longitudinal care.

Results: A 35-year-old White patient presented with a history of ocular burning, photophobia, and decreased vision. Corneal examination showed bilateral and asymmetric microcystic lesions in a unique Landolt ring (or the letter "C") shape, distributed randomly in the epithelium. Confocal microscopy revealed cellular ballooning and hyperreflective opacities in the basal layer of the corneal epithelium. The patient has had multiple recurrences of her symptoms year-round, each lasting 4 to 8 days. Topical treatment with cyclosporine, steroids, and lubrication resolved her symptoms but without complete resolution of signs on examination.

Conclusions: Our patient's clinical signs and symptoms are similar to those described previously in 11 Japanese patients. However, unlike those patients, our patient demonstrates symptomatic response to topical treatment, no seasonal association to her condition, and to date, incomplete resolution of her disease after more than 2 years. This case highlights that Landolt ring-shaped epithelial keratopathy, a novel corneal disease of unclear origin, has relevance outside of the Japanese population.

Purpose: The purpose of this study was to describe the various surgical approaches to manage stromal interface irregularity following deep anterior lamellar keratoplasty (DALK).

Methods: This interventional case series included patients requiring repeat keratoplasty procedures for stromal interface opacity and/or irregularity following DALK. The following surgical techniques with the aim of restoring transparency and regularity of the central optical zone and improving visual acuity in eyes that underwent unsuccessful DALK were performed: 1) simple anterior lamellar graft exchange, 2) repeat DALK with pneumatic dissection, 3) repeat DALK with deepening of manual lamellar dissection, 4) small diameter stripping of the central stroma-endothelium-Descemet complex and its replacement with a new endothelial lamella, and 5) 2-piece microkeratome-assisted mushroom penetrating keratoplasty. Uncorrected visual acuity (UCVA), best-corrected visual acuity (BCVA), slit-lamp examination, tonometry, and anterior corneal tomography were evaluated preoperatively, as well as 3, 6, and 12 months after surgery. Intraoperative and postoperative complications were recorded.

Results: Preoperative BCVA was less than 20/200 and improved to 20/40 or better in all cases, reaching 20/20 in 1 patient. Corneal clarity was restored in all eyes, and no recurrence of underlying disease was observed. No intraoperative or postoperative complications were reported.

Conclusions: This case series describes several successful surgical approaches to improve the transparency and regularity of stromal interface obtained after a DALK procedure; the choice of the technique should be customized for the single eyes to still maintain the advantages of lamellar or minimally invasive grafts.

Purpose: The purpose of this brief review is to analyze the outcomes of customized photorefractive keratectomy in the correction of refractive errors and irregular astigmatism after corneal graft surgery.

Methods: Two reviewers (M.S.K. and J.L.A.) independently performed a literature search in the MEDLINE/PubMed database, Google Scholar, and ResearchGate from January 2001 to October 2023. To analyze the efficacy, safety, and predictability of the procedure, primary outcomes such as mean change in uncorrected distance visual acuity, corrected distance visual acuity, and root mean square value (RMS) of higher order aberrations were studied. The complications and adverse reactions were analyzed to predict the safety of this procedure.

Results: We identified those studies where customized (topography guided/wavefront guided) photograph refractive keratectomy was performed in patients with postkeratoplasty. Significant change in uncorrected distance visual acuity, corrected distance visual acuity, RMS of higher order aberrations, refractive cylinder, and mean spherical equivalent were observed. Corneal haze was the most common complication documented; however, this was more commonly documented by authors who have not used Mitomycin C in their patients.

Conclusions: We found out that customized photograph refractive keratectomy is a safe, effective, and predictable method of treatment for refractive error and irregular astigmatism after keratoplasty.

Purpose: The purpose of this study was to determine whether there is an increased risk of mortality among individuals with keratoconus.

Methods: This was a retrospective, case-control study using the Utah Population Database. Cases were defined as individuals diagnosed with keratoconus from 1996 to 2020 and were matched 5:1 with controls on birth year, sex, whether born in Utah, and follow-up time in Utah. Individuals diagnosed with trisomy 21 or connective tissue disease were excluded. Main outcome measures were the all-cause and cause-specific mortality among keratoconus cases compared with matched controls. Cox regression models were used, additionally adjusting for race and ethnicity.

Results: A total of 7847 keratoconus cases and 38,597 controls were studied in the final analyses. The mean age at index diagnosis was 43 ± 17 years, and mean age at last follow-up was 54 ± 17 years for both cases and controls. At last follow-up, 92% of cases were living compared with 91% of controls. After adjusting for covariates, there were no significant differences in all-cause mortality ( P = 0.161), mortality from natural causes (0.222), or mortality from unnatural causes ( P = 0.494) between cases and controls. When analyzed according to specific causes of death, keratoconus cases had a higher mortality risk from diseases of the nervous system and sense organs compared with their matching controls (hazard ratio 1.59; 95% confidence interval, 1.19-2.11; P = 0.002).

Conclusions: There was no evidence of an increased risk of mortality among individuals with keratoconus. There may be an increased risk of death due to diseases of the nervous system and sense organs among individuals with keratoconus.

Purpose: To describe a novel technique in which a contact lens was used to facilitate Descemet membrane endothelial keratoplasty (DMEK) in an eye with an anterior chamber intraocular lens (ACIOL).

Methods: A 71-year-old man with a long-standing ACIOL developed bullous keratopathy. As the patient was at high risk of complications due to multiple ocular comorbidities, DMEK was performed with the ACIOL left in the anterior chamber. An inserted cosmetic contact lens was used as a platform for the graft unfolding.

Results: Partial graft detachment on the third postoperative day required rebubbling. This successfully cleared up the cornea after a few weeks. At the one-month follow-up, the uncorrected distance visual acuity improved to 20/50, with an endothelial cell loss of 35.2%. Steroid-induced ocular hypertension necessitated a trabeculectomy by the fifth postoperative month. At the sixth follow-up month, endothelial cell loss was 64%.

Conclusions: Contact lens-assisted DMEK is a safe procedure for eyes with an ACIOL. However, good foresight is needed regarding whether the ACIOL should be kept or exchanged.