Cornea最新文献

Purpose: To report the long-term recurrence and complication rates after femtosecond laser-assisted pterygium excision surgery (FLAPS) with conjunctival autograft surgery.

Methods: Single-center retrospective study of consecutive cases of primary nasal and/or temporal pterygia who underwent primary pterygium excision surgery with femtosecond laser-assisted conjunctival autograft. All subjects underwent manual pterygium excision, followed by femtosecond laser (Femto LDV Z8)-assisted conjunctival autograft surgery and with follow-up duration up to 5 years. Recurrence was defined as appearance of secondary pterygium at the same location. All complications intra- and postoperative were recorded. Primary outcome measure was postoperative pterygia recurrence, and secondary outcomes assessed were the intra- and postoperative complication rates associated with FLAPS.

Results: We included 277 sequential FLAPS performed from September 2016 to September 2024. At baseline, mean (SD) age was 62.8 years (13.9); 183 males (66.1%); mean best-corrected visual acuity (BCVA) logMAR 0.23 [0.29]. A total of 200 (72.2%) were of Chinese ethnicity, with 3 (1.2%), 14 (4.9%), and 60 (21.6%) being Indian, Malay, or others. Recurrence was seen in 2/277 patients (0.72%) at 12 and 21 months, respectively, both of which were nasal pterygia, because of glue failure, but declined repeat excision surgery. There were no differences in postoperative BCVA, applanation duration, graft depth, or graft area between the groups. Cox regression analysis showed no significant association between pterygia grade or side with recurrence. Overall 5 years probability to be recurrence free was 99.20%. Five patients (1.8%) experienced dry eyes postoperatively. No intraoperative complications were seen.

Conclusions: Primary pterygium excision with femtosecond laser-assisted conjunctival autograft results in low rates of recurrence and complications.

Purpose: The purpose of this study was to identify preoperative and demographic risk factors of myopic regression 1 year after corneal refractive surgery.

Methods: A retrospective study of 2093 patients (2781 eyes) who underwent laser-assisted in situ keratomileusis (LASIK), photorefractive keratectomy (PRK), or small incision lenticule extraction (SMILE) and experienced myopic regression of ≥0.5 D 1 year after surgery was conducted.

Results: The incidence of regression at 1 year was higher in the overall SMILE group (10.1%) and steep keratometry group (9.6%) (P < 0.05). SMILE eyes with normal (9.0%) and steep corneas (18.2%) had a higher incidence of regression than those of LASIK and PRK eyes (P < 0.05). The mean magnitude of spherical equivalent (SEQ) regression for all regressed eyes was -0.63 ± 0.15 D. The overall SMILE group had a greater mean magnitude of spherical regression than the overall LASIK and PRK groups (-0.66 D vs. -0.48 D vs. -0.46 D, P < 0.05). There were no differences in cylindrical regression between any analyzed groups (P > 0.05). Female status and SEQ predicted -0.034 D [(-0.051, -0.017), P < 0.001] and -0.012 D [(-0.018, -0.006), P < 0.001] of regression, respectively. Age and preoperative Km had an odds ratio for regression of 1.033 [(1.017, 1.049), P < 0.001] and 1.109 [(1.006, 1.221), P < 0.001], respectively.

Conclusions: Risk factors of myopic regression at 1 year included older age, female sex, steep corneas, and higher preoperative SEQ. SMILE had a higher incidence and greater magnitude of regression compared with LASIK and PRK.

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: The goal of this study was to explore whether the donor history of sleep apnea affects corneal tissue evaluation parameters.

Methods: This was a retrospective study assessing the impact of donor history of sleep apnea in a dataset obtained from the Eversight Eye Bank. Comparative analysis and multivariate regression were used to assess differences in key parameters including endothelial cell density (ECD) and central corneal thickness.

Results: Data analyzed consisted of 50,170 tissues from 25,399 donors with no history of sleep apnea and 5473 tissues from 2774 donors with a history of sleep apnea. Tissue from donors with a history of sleep apnea showed lower ECD than those from donors with no history of sleep apnea (-51 cells/mm 2 , P < 0.001). Multivariate linear regression demonstrated that history of sleep apnea was a predictor of lower ECD by 13.72 cells/mm 2 ( P = 0.0264). Secondary analysis demonstrated that underweight and obese body mass indexes were significant predictors of increased ECD in donors with no history of sleep apnea ( P < 0.0001, P = 0.025, respectively). Body mass index category was not a significant predictor of ECD in donors with a history of sleep apnea. In a smaller subset of 10,756 tissues, sleep apnea was not a significant predictor of central corneal thickness.

Conclusions: This is the first study to demonstrate that a donor's history of sleep apnea is associated with a lower ECD in a large eye bank dataset. Future studies are needed to investigate whether history of sleep apnea affects posttransplantation outcomes.

Purpose: The purpose of this study was to examine the incidence of ocular, periocular, and systemic inflammatory conditions among patients with pterygium and assess if these conditions are risk factors of pterygium development.

Methods: A case-control study was conducted using electronic medical records from Clalit Health Services in Israel between 2001 and 2022. Patients diagnosed with pterygium were included; for each case, 3 controls were matched based on birth year, sex, and ethnicity. Mixed models were used to assess differences in the groups' demographic characteristics of ocular and systemic diseases. Generalized estimating equation logistic regression was used to estimate the odds ratios (ORs) and adjust for confounders.

Results: A total of 94,652 patients diagnosed with pterygium and 378,608 matched controls were included in the study. The average age of patients with pterygium was 53 ± 16 years; 54% were male. A significant association was found between pterygium and vernal keratoconjunctivitis (OR 2.12, 95% confidence interval [CI], 1.90-2.36), chronic allergic conjunctivitis (OR 1.69, 95% CI 1.58-1.82), blepharitis (OR 1.66, 95% CI 1.61-1.70), and chalazion (OR 1.27, 95% CI 1.23-1.33). A significant association was also found between pterygium and systemic conditions as unspecified systemic allergy (OR 1.08, 95% CI 1.04-1.13), asthma (OR 1.08, 95% CI 1.04-1.11), and atopic dermatitis (OR 1.14, 95% CI 1.08-1.19).

Conclusions: Various inflammatory and allergic diseases-ocular, periocular, and systemic-increase the risk of pterygium. Further research is needed to investigate the role of inflammation in pterygium development.

Purpose: Fuchs endothelial corneal dystrophy (FECD) displays a higher incidence in females than in males, yet the underlying mechanism remains unclear. This study aimed to elucidate sex-dependent differential gene expressions in corneal endothelial cells (CECs) from healthy non-FECD individuals and from patients with FECD.

Methods: RNA-Seq data from CECs of non-FECD subjects (3 males, 4 females) and FECD subjects (5 males, 5 females) were analyzed to identify differentially expressed genes (DEGs) between the sexes. We used heatmaps and principal component analysis for expression pattern visualization and Gene Ontology analysis for functional categorization of DEGs.

Results: Among the non-FECD subjects, we identified 341 DEGs-143 upregulated and 198 downregulated-in females relative to males. For FECD subjects, 309 DEGs were discovered, with 215 upregulated and 94 downregulated in females compared with males. Heatmaps exhibited hierarchical clustering by sex, whereas principal component analysis delineated distinct male and female clusters in both non-FECD and FECD cohorts. Gene Ontology enrichment analysis linked the upregulated genes in non-FECD females to steroid hormone response, and downregulated ones to cyclin-dependent protein kinase activity. In females with FECD, upregulated genes were associated with immune responses and downregulated genes with peptide hormone binding.

Conclusions: To our knowledge, these findings are the first to reveal distinct gene expression patterns in CECs between sexes. The observed variations suggest a potential genetic basis for the observed sex disparity in FECD prevalence. Further investigation is warranted to explore these associations and their implications for the pathogenesis of FECD.

Purpose: To report outcomes in patients with progressive keratoconus who underwent a standardized protocol of transepithelial phototherapeutic keratectomy (t-PTK) laser followed by accelerated corneal collagen crosslinking (CXL).

Methods: All patients with progressive keratoconus undergoing our protocol at a London clinic between 2019 and 2023 were included. The protocol involved t-PTK at 58-μm central ablation depth at a 9-mm treatment zone on the Schwind Amaris 1050RS platform. Preoperative K readings of 43.0D (both K1 and K2) were inputted for all cases. Patients then underwent CXL with a pulsed-light accelerated protocol (30 mW/cm 2 for 8 minutes of UVA exposure time with 1 second on/1 second off).

Results: Seventy-nine eyes from 55 patients were included with an average follow-up of 12 months (range 6-24 months). Both mean uncorrected distance visual acuity (UDVA) and best spectacle-corrected visual acuity improved significantly from 0.42 preoperatively to 0.29 postoperatively ( P < 0.01) and 0.11 to 0.06 postoperatively ( P < 0.01), respectively. The refractive cylinder reduced significantly from -3.07D to -2.63D ( P < 0.05). The mean Km improved from 46.15D to 45.44D ( P < 0.01) and mean Kmax from 54.03D to 52.52D ( P < 0.01). 77% of eyes (n = 61) exhibited Kmax improvement postoperatively, and 56% showed an improvement in UDVA (n = 44). 16% (n = 13) had worsening of vision, but of these, only 1 patient had visual loss of more than 2 lines. No eyes had corneal haze reported at the final follow-up, and none required additional treatment.

Conclusions: This standardized simultaneous t-PTK and CXL protocol is safe and effective for the treatment of progressive keratoconus, providing visual, refractive, and topographic improvements.

Purpose: Primary conjunctival molluscum contagiosum (MC) is rare and usually reported in patients with acquired immunodeficiency syndrome. In this study, we present a case of bilateral primary conjunctival MC in a patient with ocular graft-versus-host disease (oGVHD).

Methods: This is a case report study. Clinical evaluation, in vivo confocal microscopy imaging, and histopathology were used to confirm the diagnosis.

Results: A 38-year-old woman with a history of allogeneic bone marrow transplant and secondary chronic oGVHD presented with ocular discomfort, redness, and dryness. On examination, clusters of white gelatinous nodular lesions, stained with fluorescein and Lissamine green, were observed on the bulbar conjunctiva, along with similar solitary nodular lesions in all quadrants of both eyes. In vivo confocal microscopy revealed nests of epithelial cells with bright inclusions measuring approximately 30-35 μm. Excisional biopsy confirmed the diagnosis of MC. A 6-month post-operative follow-up showed healed conjunctiva with no recurrence and improved ocular comfort.

Conclusions: Molluscum contagiosum should be considered in the differential diagnosis of conjunctival lesions in patients with impaired immunity such as oGVHD. In diagnosing MC lesions, in vivo confocal microscopy proves to be valuable. In the absence of topical antiviral treatment, surgical excision is warranted.

Purpose: Ocular rosacea is a chronic inflammatory disorder affecting the ocular surface, often associated with cutaneous rosacea. This review aims to explore its pathogenesis, treatment approaches, and future directions for management.

Methods: A review of current literature on the pathophysiology, clinical features, and treatment strategies of ocular rosacea in adults and children (pediatric blepharokeratoconjunctivitis) was conducted. Emerging research on immune dysregulation, microbiome alterations, and potential therapeutic targets was analyzed.

Results: Ocular rosacea involves dysregulation of the immune and neurovascular systems, with toll-like receptor activation and complement system involvement leading to chronic ocular surface inflammation. Alterations in the ocular microbiome have been implicated in disease progression. Treatment strategies emphasize a stepwise approach, incorporating ocular and skin hygiene, lifestyle modifications, and pharmacological interventions. Recent advancements in understanding the disease mechanisms have led to the exploration of targeted therapies, including biologics and small-molecule inhibitors.

Conclusions: Ocular rosacea remains challenging to diagnose and treat, particularly in children (pediatric blepharokeratoconjunctivitis), often leading to delayed intervention and poor outcomes. A multidisciplinary approach, including new therapeutic options, holds promise for improving patient care. Further research into the genetic and molecular basis of ocular rosacea may enable more personalized treatments.