Cornea最新文献

Purpose: We evaluate the quality and feasibility of preloading Descemet stripping automated endothelial keratoplasty (DSAEK) grafts into a modified EndoGlide Ultrathin system for graft injection.

Methods: DSAEK grafts were prepared by experienced processing technicians at 2 separate locations, loaded into a modified EndoGlide Ultrathin, and placed in storage media. Grafts processed at one location were shipped cross-country overnight to the other location and were examined on arrival for positioning within the modified EndoGlide Ultrathin. All grafts were ejected and analyzed for endothelial cell loss (ECL) with calcein acetoxymethyl staining and FIJI segmentation. A subset of grafts was measured by optical coherence tomography for graft thickness 1 hour after cut, 1 hour after loading, and 1 day after loading.

Results: No grafts were displaced from the modified carrier over 3 shipping events (n = 9), and all grafts (n = 18) were successfully ejected. Grafts loaded into the modified carrier and ejected exhibited no more cell loss than grafts loaded into the standard carrier and removed by pull-through (14.0% ± 2.8% vs. 12.2% ± 3.4%, respectively, P = 0.24). Carrier modification skills can be successfully transferred as grafts loaded by a processing technician new to carrier modification were within the acceptable limit of 25% ECL for transplant DSAEK grafts. Graft thickness increased significantly ( P < 0.05) between the postcut and 1-hour postload measurement and the postcut and 24-hour postload measurement.

Conclusions: The EndoGlide Ultrathin can be modified to enable its use for graft injection while not compromising the ability to use the pull-through method for graft delivery. Preloaded DSAEK grafts swell significantly during the 24-hour storage period, and patterns of ECL may be linked to swelling.

Purpose: To report the management of recurrent TGF BI dystrophy after prior femtosecond-assisted anterior lamellar keratoplasty (FALK) with repeat FALK.

Methods: Clinical and histopathological study of 2 eyes of 2 patients with a recurrence of TGFBI dystrophy. Patient 1 had Reis-Buckler corneal dystrophy, and patient 2 had granular corneal dystrophy GCD type 1.

Results: Patient 1 had FALK 8 years ago, when she was 23 years old. Patient 2 had FALK 7 years ago at the age of 24 years. Slit-lamp examination showed recurrence in the subepithelial layer of the anterior lamellar graft as confluent chalky white granular deposits. Anterior segment optical coherence tomography highlighted the deposits in the subepithelial region of the anterior lamellar graft. The anterior lamellar graft with deposits was removed and replaced with another graft created using femtolaser dissection of a healthy donor. The parameters for femtosecond laser-assisted donor dissection was similar to the size and depth as the previously used donor. The best-corrected visual acuity was restored to 20/30 in patient 1 and 20/25 in patient 2. The histology of the anterior lamellar graft showed eosinophilic deposits between the epithelium and the Bowman layer in both samples. In addition, the corneal sample from patient 2 revealed Bowman layer breach at some places and few deposits at 1 edge of the lamellar graft.

Conclusions: Repeat FALK with a healthy donor is effective in the management of recurrence of deposits. The histology of the recurrence in the anterior lamellar graft revealed eosinophilic deposits predominantly between the epithelium and Bowman layer.

Purpose: This study investigated the occurrence of keratoconus among first-degree relatives of patients with keratoconus and evaluated their refractive characteristics.

Method: A cross-sectional observational study was conducted on 248 relatives of 52 patients with keratoconus in whom bilateral eye analysis was conducted. Corneal tomography was performed for all participants with a comprehensive analysis of various parameters, including K1, K2, Kmax, elevation, skewing, and thinnest location. In addition, the following data were also analyzed: uncorrected visual acuity, corrected distance visual acuity, refraction measurements alongside a slit-lamp examination, and fundus examination.

Results: Among 248 participants, 19 (7.7%) had keratoconus, 3.2% had forme fruste, and 15.3% had suspected keratoconus. Among all studied cases, 73.8% had normal corneas. Significant differences ( P = 0.001) were found in the distribution of keratoconus prevalence among brothers, mothers, sons, and sisters (13.6%, 4.3%, 5.6%, and 12.1%, respectively). The presence of refractive errors also showed significant differences between the relatives ( P = 0.03).

Conclusions: Increased keratoconus prevalence among relatives of patients with keratoconus indicates the vulnerability of this population to the development of the disease, necessitating early screening of this group for detection of keratoconus as early as possible.

Purpose: The purpose of this study was to identify trends in female representation and years since training completion among speakers and moderators at the American Academy of Ophthalmology (AAO) Annual Cornea Subspecialty Day between 2007 and 2022.

Methods: Speakers and moderators at each AAO Cornea Subspecialty Day from 2007 to 2022 were sorted by sex and year of training completion. Sex and time from training completion were identified based on the individual's institutional profile or publicly available databases.

Results: Five hundred eighty-three speakers and 48 moderators were identified from the AAO Cornea Subspecialty Day meeting archives over 15 years. Overall, women represented 199 (34.1%) speakers and 19 (39.6%) moderators. The proportion of female speakers increased from 10.0% in 2007 to 54.8% in 2022 ( P < 0.001). The ratio of female moderators increased from 4 of 21 (19.0%) in 2007 to 2014 to 15 of 27 (55.6%) in 2015 to 2022 ( P = 0.017). In years where there were less than 50% female moderators, women represented 26.3% of speakers versus 44.4% of speakers in years with greater than 50% female moderators ( P = 0.014). Female speakers were overall earlier in practice than male speakers, with fewer average years since training completion (16.4 ± 1.8 vs. 22.3 ± 2.1 years; P < 0.001).

Conclusions: Female representation among speakers and moderators at AAO's Cornea Subspecialty Day increased between 2007 and 2022. Sessions with a majority of female moderators were associated with a higher number of female speakers. Female speakers were generally earlier in their career than male speakers. These trends highlight the overall increases in female representation in academic ophthalmology.

Abstract: This concise review focuses on the latest advancements in the diagnosis and management of limbal stem cell deficiency (LSCD). Ensuring the standard of care for individuals affected by LSCD involves the crucial task for physicians to meticulously and accurately diagnose the condition and determine its specific stage. A standardized diagnostic approach forms the foundation for formulating and delivering customized therapeutic interventions to maximize treatment outcomes for each patient. In this review, we introduce a systematic diagnostic algorithm to guide the assessment of LSCD. In addition, the current management algorithm and emerging therapies for LSCD are summarized.

Purpose: To determine risk factors for meibomian gland disease and associated structural abnormalities in meibography among young medical trainees.

Methods: This study included 84 medical students and residents younger than 45 years. All participants completed an ocular history and lifestyle questionnaire and the standardized patient evaluation of eye dryness (SPEED) II questionnaire. Meibomian gland (MG) dropout and structural changes were evaluated using meibography and scored by 2 graders using meiboscores. Statistical analysis aimed to identify MG loss risk factors.

Results: Eighty-four individuals participated, and 168 meibography images were reviewed. Previous contact lens (CL) use (n = 88) demonstrated increased MG loss (P = 0.007). Correlation analysis revealed positive associations between MG loss and both frequency (Spearman r = 0.212, P = 0.003) and duration (Spearman r = 0.271, P <0.001) of CL use. Eye makeup users (n = 112) showed greater MG loss than nonusers (n = 56, P = 0.030), particularly eyeliner (n = 102) and eyeshadow (n = 100) users showing increased meiboscores (P = 0.020 and P = 0.040, respectively). Self-reported screen time and SPEED II scores did not correlate with meiboscores (P >0.05).

Conclusions: In a young trainee population, where age-related factors are reduced, previous CL use and eye makeup use are significant risk factors for MG loss. Frequency and length of CL wear affect MG dropout severity. Eye makeup usage also affected MG loss. Highlighting the incongruence of symptoms to signs, SPEED II scores showed no relationship with MG structural integrity.

Purpose: To present the clinical, topographic, and densitometry outcomes of patients with corneal fibrosis treated with topical losartan.

Methods: In this case series, patients with corneal scars treated with topical losartan 0.8 mg/mL 4 times a day for 6 months were included. Age, sex, cause of corneal opacity, months with corneal opacity, and previous topical treatment were recorded. Patients were examined at baseline and 1, 3, and 6 months after starting treatment. At each visit, uncorrected and best-corrected visual acuity, subjective refraction, intraocular pressure, slit-lamp examination, corneal tomography, and densitometry were performed. Patients were asked about drop comfort and possible side effects on a 0 to 10 self-reported scale.

Results: Eight eyes of 7 patients (4 males, 3 females, mean age 45.1 ± 12.0 years) were included. Best-corrected visual acuity logMAR was 0.28 ± 0.17 pretreatment and 0.17 ± 0.11 after 6 months of topical losartan (P = 0.358). The visual acuity of 5 eyes improved, 1 eye remained unchanged, and the vision of 2 eyes declined. No changes in topographic and densitometry parameters were noted within the cohort analyzed as a group (all P > 0.05). No systemic side effects were reported, and tolerance was from very good to excellent (all 2/10 or better).

Conclusions: No significant improvements in visual acuity and densitometry values were noted with topical losartan in this series analyzed as a group. Further research to assess the full scope of clinical applications in corneal fibrosis is needed, particularly randomized clinical trials to address the effect of time and unequivocally prove its beneficial effects.

Purpose: To identify the definitions used for progressive keratoconus in the literature.

Methods: A systematic literature review aimed to identify the definitions used for "progressive keratoconus" in the published articles. A comprehensive search from January 2018 to May 2023 was conducted across Cochrane Library, PubMed, Taylor & Francis, Web of Science, and other bibliographic databases at Oftalmosalud, Lima, Peru. The inclusion criteria were articles including patients with keratoconus without any previous surgical procedure and containing the definition of "progressive keratoconus" or "keratoconus progression" and a sample size greater than 10 eyes.

Results: A total of 221 articles were included for analysis. The 3 most frequent parameters to define progression included data from anterior curvature, pachymetry, and refraction used in 97.8% (216/221), 37.6% (83/221), and 32.1% (71/221) of the articles, respectively. Specifically, the most frequent criterion used was maximum keratometry (Kmax), used in 85.5% (189/221) of the articles. Progression was assessed between 6- and 12-month follow-up in 64.7% (143/221) of the articles. Data from posterior cornea were used in only 8.1% (18/221) of the studies. None of the studies included data from the corneal epithelium.

Conclusions: The present study demonstrates the lack of unified criteria to define progression of keratoconus and an underutilization of the technology described. It also shows that the single point Kmax measurement is the most commonly used criterion, followed by a change in refractive astigmatism and thinning at the thinnest pachymetric point.

Purpose: The objective of this study was to compare the capacity of anterior segment optical coherence tomography (AS-OCT) and Scheimpflug camera in detecting tomographic changes over 1 year in a cohort of patients with Fuchs endothelial corneal dystrophy.

Methods: We conducted a single-center prospective study which consisted of 2 identical visits spaced 1 year apart. At each visit, tomographic analyses were performed using Scheimpflug imaging (Pentacam HR, Oculus) and swept source AS-OCT (Casia SS-1000 Tomey). The resulting images were analyzed by 3 experienced independent observers. The main outcome was the agreement between the 2 devices for detecting subclinical corneal edema, as assessed using the interdevice reliability measured by the Cohen kappa coefficient. The criteria for subclinical edema were the presence of irregular isopachs, displacement of the thinnest point, and presence of posterior surface depression.

Results: We analyzed 129 eyes of 81 patients with good quality images for both devices. The overall agreement between the 2 devices to detect subclinical edema was good, but the performance was significantly different for 2 parameters (thinnest point displacement and posterior depression). The interdevice reliability was 0.84 for the loss of parallel isopachs, 0.55 for the displacement of the thinnest point, and 0.40 for the focal posterior corneal surface depression.

Conclusions: Corneal tomographic features of Fuchs endothelial corneal dystrophy can be easily quantified in clinical routine and clinical research by AS-OCT and Scheimpflug imaging, but both are not fully interchangeable. A longitudinal follow-up should always be done with the same device. Neither appears to be more sensitive than the other for detecting minimal changes over 12 months.