Cornea最新文献

Purpose: To evaluate the effect of customized corneal crosslinking on pellucid marginal degeneration (PMD).

Methods: Twenty-eight eyes with PMD were included. Fifteen eyes were treated with customized corneal crosslinking at Helsinki University Eye Hospital. Three treatment zones with different ultraviolet energy levels were planned according to corneal tomography, focusing on the inferior part of the cornea. The control group consisted of 13 conventionally crosslinked eyes. Visual acuity, refraction, and corneal tomography were obtained preoperatively and at 1 month, 6 months, and 1 year after treatment.

Results: Corneal tomography showed stability and visual acuity improvement after customized crosslinking in all but 1 patient with a 1-year follow-up. Mean change in logMAR visual acuity was -0.15 ( P = 0.02). However, the improvement in Kmax was not significant (-0.11D, P = 0.8). In the control group, the mean visual acuity did not change (-0.04, P = 0.44), although there were significant changes in keratometry (Kmax -0.81 D, P = 0.02 and Kavg -0.57 D, P = 0.007).

Conclusions: Customized corneal crosslinking can be safely used in patients with PMD. No clear advantages over standard crosslinking were observed in this study.

Purpose: To investigate the long-term outcome of surgical intervention for limbal dermoids and to evaluate the safety and efficacy of tectonic lamellar keratoplasty.

Methods: This retrospective cohort study included 86 eyes that underwent tectonic lamellar keratoplasty by 5 corneal surgeons at Kyoto Prefectural University of Medicine and Baptist Eye Institute, Kyoto, Japan, from 1992 through 2024. The study subjects were categorized into 2 groups: group A, consisting of 35 eyes that underwent amblyopia treatment, and group B, consisting of 51 eyes that did not.

Results: Kaplan-Meier survival analysis revealed 95.3% (82 of 86 eyes) maintained clear tectonic corneal grafts with healthy ocular surfaces postoperatively. Three eyes developed psudopterygium formation, and 1 eye developed a corneal infection. Improvement of 0.2 logarithm of the minimum angle of resolution units or more because of preoperative amblyopia treatment was observed in 48.6% (17 of 35 eyes) in group A. Surgical intervention resulted in an improvement of 0.2 logarithm of the minimum angle of resolution units or more in 25.7% (9 of 35 eyes) in group A, and 15.7% (8 of 51 eyes) in group B. One case of corneal infection resulted in decreased best-corrected visual acuity. No other cases exhibited best-corrected visual acuity deterioration.

Conclusions: Tectonic lamellar keratoplasty can be performed safely with very few postoperative complications, maintaining long-term corneal clarity, reasonable visual acuity, and satisfactory cosmetic results.

Purpose: The objective of this study is to enhance the efficiency and expediency of the corneal recipient selection process from extensive recipient lists by developing an interactive program that simulates the authorized operator with an artificial intelligence-based algorithm.

Methods: Taking into account the characteristics of real patients, 1000 distinct artificial corneal recipient candidates, each with 21 features, were generated as the recipient data set, and 50 distinct artificial donors, each with 5 features, were generated as the donor data set. Operators ranked the 20 most suitable corneal recipient candidates for each donor. These ranking lists, with the respective data sets, were employed during the training and inference stages of the multilayer perceptron used in machine learning. At the end of the training process, the top 20 recipient candidates identified by the operators for each donor were then compared with the top 20 recipient candidates identified by the system.

Results: The initial 11 candidates selected by the operator are endorsed by the system with a probability of at least 78%, whereas the initial 13 candidates selected by the operator are endorsed by the system with a probability of at least 67%. On average, the system identifies 17 out of 20 candidates, which corresponds to approximately 85% of all possible candidates.

Conclusions: This study has resulted in the development of an interactive program that simulates the operator. This adaptable system, which does not impose specific selection criteria, can be trained in various eye banks worldwide and has the potential for extensive use.

Purpose: To report a case of delayed onset infectious crystalline keratopathy after corneal cross-linking (CXL).

Methods: Slit-lamp examination, confocal microscopy, anterior segment optical coherence tomography imaging, and corneal culture were performed to characterize the corneal opacification.

Results: A 49-year-old man presented with progressively worsening vision in the left eye 8 months after uncomplicated epithelium-off CXL for keratoconus. Examination demonstrated focal central corneal stromal thinning with surrounding stromal opacification. Confocal microscopy did not demonstrate evidence of parasitic or fungal infection. Two months later, gray-white crystalline stromal opacities were observed surrounding the area of central stromal thinning, consistent with infectious crystalline keratopathy. Corneal scrapings of the left eye were obtained, which were positive for Enterococcus faecalis. After cessation of topical loteprednol and initiation of topical vancomycin and linezolid, the stromal infiltrate increased in size and a hypopyon developed but had resolved before the discontinuation of 7 weeks of topical antibiotic therapy. A deep anterior lamellar keratoplasty was performed 6 weeks later, with no recurrence of infection 10 months after surgery.

Conclusions: Infectious crystalline keratopathy can present more than 6 months after CXL. Progressive corneal stromal thinning associated with stromal opacification should raise suspicion of this rare late onset complication of CXL and prompt corneal scraping for stains and cultures to rule out an indolent infectious process.

Purpose: The objective of this study was to describe a postoperative clinical finding coined "sludging." Sludging is defined as a noninflammatory vascular phenomenon observed following ocular surface stem cell transplantation (OSST) characterized by dilated blood vessels localized to the graft. Also, the aim of our study was to identify associated risk factors and the impact on OSST graft outcomes.

Methods: A total of 261 eyes of 196 patients who underwent OSST to treat severe limbal stem cell deficiency from 2006 to 2016 were included in this retrospective review. Clinical characteristics were collected, including patient and donor demographics as well as clinical outcomes.

Results: The clinical features of sludging include painless dilation of blood vessels localized on the graft, with an absence of inflammation, limbal injection, and corneal epithelial abnormalities. The overall prevalence of sludging was 77 of 261 eyes (29.5%), and the mean time of appearance after OSST was 1.31 ± 1.48 years. Sludging resolved in 54 of 77 eyes (70.1%) after 0.93 ± 1.04 years. Sludging was most commonly seen after keratolimbal allograft (KLAL) (43.4%) as compared with living-related conjunctival limbal allograft (13.5%, P = 0.00012). The presence of sludging was associated with higher rates of both future graft rejection ( P = 0.0012) and graft failure ( P = 0.0053). There were no significant donor characteristics associated with developing sludging among KLAL recipients.

Conclusions: Sludging is a noninflammatory postoperative clinical finding following OSST, particularly KLAL. Prompt recognition of sludging is critical to differentiate from acute graft rejection as the management and prognosis is different.

Purpose: To evaluate the long-term visual, refractive, and tomographic outcomes of a 360-degree intracorneal ring implant for treating keratoconus (KC).

Methods: This historical cohort study included 29 eyes of 29 patients with KC who underwent MyoRing implantation. Uncorrected and best-corrected distance visual acuity, refraction, keratometry, and corneal thickness were evaluated preoperatively and at 5 and 10 years postoperatively.

Results: Significant improvements were observed in all outcome measures at 5 and 10 years postoperatively compared with the preoperative values ( P < 0.001). Uncorrected distance visual acuity improved from 1.25 ± 0.34 logarithm of the minimum angle of resolution (logMAR) preoperatively to 0.36 ± 0.24 logMAR at 5 years but showed regression to 0.48 ± 0.35 logMAR at 10 years. Corrected distance visual acuity similarly showed improvement from 0.50 ± 0.24 logMAR preoperatively to 0.18 ± 0.12 logMAR at 5 years, with some regression to 0.25 ± 0.22 logMAR at 10 years. Spherical equivalent improved from -9.38 ± 4.09 diopters (D) preoperatively to -2.70 ± 1.54 D at 5 years but regressed to -3.29 ± 2.22 D at 10 years. Although corneal flattening was observed at 5 years, a slight steepening trend was noted at 10 years. Corneal thickness exhibited an increase after 5 years ( P < 0.001), but this trend reversed by the 10-year mark.

Conclusions: MyoRing implantation demonstrated significant initial improvements in visual, refractive, and tomographic outcomes in patients with KC; however, some regression toward preoperative values was observed by the 10-year follow-up. This highlights the importance of continued monitoring to assess the long-term impact of the implant and to manage any potential late effects.

Purpose: To present the outcomes of topography-guided opposing dual-segment KeraNatural implantation in patients with keratoconus with symmetrical corneal cones.

Methods: This study evaluated 6 eyes from 5 patients who had undergone dual allogeneic intrastromal ring segment (corneal allogeneic intrastromal ring segment) opposite horizontal implantation surgery based on topographic cone location with a follow-up period ranging from 6 months to 3 years. Preoperative and postoperative measurements, including visual acuity, refractive, topographic keratometric values, and central corneal thickness, were analyzed.

Results: Corrected distance visual acuity increased from 0.93 ± 0.58 preoperatively to 0.33 ± 0.14 postoperatively and Kmax decreased from 57.87 ± 1.87 to 55.47 ± 1.62 diopters. No significant complications were reported during the follow-up period.

Conclusions: This study investigates the outcomes of dual KeraNatural implantation in patients with keratoconus with symmetrical cones. The findings from this study may yield enhanced outcomes, necessitating additional exploration and possible implementation as a new standard in keratoconus surgery.

Purpose: To initiate the process of core outcome set development for dry eye disease (DED) by conducting a systematic review of all outcomes in randomized controlled trials (RCTs) of treatments for DED. A core outcome set is an agreed-upon minimum set of outcomes that should be measured and reported in all clinical trials in a topic area.

Methods: We searched PubMed and Embase from January 1, 2016 to January 3, 2024 for RCTs of treatments for DED. Post hoc , we decided to focus on recent evidence and excluded RCTs published before 2016. Two independent investigators screened titles and abstracts (initially) and full-text articles (subsequently), resolving conflicts through discussion. We refined a previously developed outcome taxonomy for DED. We extracted all outcome domains and measurement instruments used for those domains in the included sample of RCTs.

Results: Our searches identified 6477 unique records, and we included 300 RCTs. The most frequently used outcome domains across all RCTs were tear film stability (90.6% of RCTs), overall assessment of ocular symptoms (84.3%), corneal staining score (75.7%), tear production (66.0%), conjunctival staining score (39.7%), visual acuity (35.0%), meibomian gland plugging/clogging grade (27.0%), inferior tear film meniscus height (16.0%), and adverse events (28.0%). There was considerable inconsistency regarding measurement instruments.

Conclusions: Variability in outcome measures and instruments used underscores the need for a core outcome set for DED. Our next steps are to begin prioritizing the identified outcomes for a core outcome set for DED.

Purpose: To evaluate the short- and mid-term clinical outcomes of corneal allogeneic intrastromal ring segments (CAIRS) and assess their efficacy and safety in keratoconus treatment.

Methods: Case series of 79 eyes from 71 patients with keratoconus who underwent femtosecond-assisted CAIRS implantation at the Adolphe de Rothschild Hospital Foundation, Noémie de Rothschild Institute. Preoperative and postoperative examinations were conducted at 3 and 6 months. Anterior segment optical coherence tomography and corneal tomography with aberrometric and pachymetric analyses were performed at each visit. Visual, refractive, and topographic parameters were extracted.

Results: Corrected distance visual acuity improved by 1, 2, and 3 lines or more in 33%, 44%, and 52% of cases, respectively. Significant improvements were observed in K1, K2, Km, Kmax, topographic astigmatism, sphere, cylinder, spherical equivalent, total root mean square, higher-order aberrations, vertical coma, and spherical aberrations (all P < 0.01 or P < 0.05). Eleven patients (13.9%) were dissatisfied with their outcomes. In addition, 9 patients (13.65%) experienced a loss in corrected distance visual acuity at 3 months postoperatively (6 eyes lost 1 line, and 3 lost 2 lines), yet remained satisfied with their results because of improved refraction and uncorrected vision.

Conclusions: This study is the largest to date evaluating femtosecond-assisted CAIRS implantations and highlights CAIRS as a promising treatment for keratoconus.