Cornea最新文献

Purpose: Epidermal growth factor receptor (EGFR) signaling promotes meibomian gland (MG) epithelial and mesenchymal cell proliferation and is involved in MG morphogenesis. This study aimed to evaluate the impact of systemic EGFR inhibitor (EGFR-I) therapy on MG status using meibography, and its association with ocular surface clinical parameters.

Methods: In this prospective study, 39 patients with no prior history of ocular surface disease who were scheduled to receive systemic EGFR-I therapy for various malignancies were enrolled. All participants underwent Schirmer test, tear film break-up time, ocular surface disease index questionnaire, noninvasive tear break-up time, and noncontact meibography using Sirius topography at baseline, and at 1 and 3 months after treatment initiation. MG loss was quantified and staged based on meibographic analysis.

Results: Of the 39 participants, 28 (72%) were female and 11 (28%) were male, with a mean age of 61.8 ± 11 years. Baseline Schirmer test and tear film break-up time values (15.6 ± 4.2 mm and 13.2 ± 3.5 seconds) showed a significant reduction at 1 month (13.8 ± 3.8 mm; 11.1 ± 3.0 seconds), with a further decline observed at 3 months (8.1 ± 3.1 mm; 7.4 ± 2.7 seconds) (P < 0.001). The mean ocular surface disease index score increased from 7.7 ± 6.9 at baseline to 11.6 ± 7.3 at 1 month and 30.3 ± 14.6 at 3 months (P < 0.001). Noninvasive tear break-up time values decreased significantly at 3 months (5.9 ± 2.6 seconds) relative to baseline (11.1 ± 4.5 seconds) (P < 0.001). Meibographic assessments revealed a progressive increase in MG loss percentage and staging from baseline (14.7 ± 6.2%; stage 0.8 ± 0.5) to 1 month (21.3 ± 6.5%; stage 1.3 ± 0.4) and 3 months (31.6 ± 11%; stage 1.9 ± 0.6) (P < 0.001).

Conclusions: Systemic EGFR-I therapy may contribute to progressive MG loss, which may be associated with ocular side effects commonly observed in patients receiving these agents, including dry eye disease, blepharitis, and meibomitis. Early recognition and management of these complications by ophthalmologists may improve patient comfort and support adherence to oncologic treatment.

Purpose: The goal of this study is to review the existing evidence to quantify the impact of corneal punctate epithelial erosions (PEE) on postoperative refractive error-related patient dissatisfaction after cataract surgery.

Methods: PubMed and the Cochrane library were systematically searched for studies using the terms "dry eye" or "dry eye disease" or "punctate epithelial erosions" or "corneal staining" combined with "biometry" or "keratometry" or "cataract surgery." ChatGPT was also queried using the same search terms to identify any potentially relevant publications that might have been missed. All retrieved publications and their references were examined, and the results were tabulated.

Results: A total of 1446 abstracts were identified through online search, corresponding to 1242 unique publications. Of these, 12 studies were deemed relevant and full articles were retrieved. ChatGPT identified an additional 6 unique publications. None of the 18 studies reviewed in detail, however, quantified the impact of PEE on biometry assessments. The results of 8 studies reporting on 4 other dry eye disease parameters that informed the impact on biometry results were summarized.

Conclusions: Despite the current emphasis on optimizing corneal PEE before biometry, no studies define thresholds or metrics linked to measurable effects on postcataract visual outcomes. This review highlights the need for future studies to inform algorithms used for preoperative cataract decision making.

Purpose: To evaluate the association between corneal graft survival and glaucoma surgical procedures and medical treatment in eyes with postkeratoplasty glaucoma.

Methods: This retrospective study involved 1149 eyes that underwent penetrating keratoplasty or Descemet stripping automated endothelial keratoplasty between 2004 and 2019. They were divided into 5 groups according to the types of glaucoma treatment after keratoplasty: trabeculotomy (TLO), trabeculectomy (TLE), glaucoma drainage device, topical antiglaucoma drugs alone, and no glaucoma treatment. Eyes with trauma, infection, or rejection during the follow-up period, and those that other types of glaucoma surgery, were excluded. Graft survival and risk factors for graft failure after glaucoma treatment were analyzed using Kaplan-Meier survival analysis and the Cox proportional hazards model.

Results: The cumulative probability of graft survival at 3 years postoperatively was 87.3% in the TLO group, 58.2% in the TLE group, 68.6% in the glaucoma drainage device group, 89.1% in the topical medication group, and 96.6% in the no-treatment group (P < 0.001, log-rank test). The presence of bleb before keratoplasty [hazard ratio (HR) 3.34; 95% confidence interval (CI) 1.94-5.37; P < 0.001] and failure of intraocular pressure control after glaucoma treatment (HR 4.11; 95% CI 2.15-7.86; P < 0.001) were major risk factors for graft failure, whereas TLO was associated with a significantly lower risk of graft failure compared with TLE (HR 4.57; 95% CI 1.19-17.47; P = 0.03).

Conclusions: Our findings showed that TLO is associated with a lower risk of graft failure compared with TLE. Outflow facility reconstruction procedures, such as TLO, seem to be effective first-line surgical options for postkeratoplasty glaucoma.

Purpose: To evaluate the incidence and clinical characteristics of ocular graft-versus-host disease (oGVHD) associated with tapering of systemic immunosuppression after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods: This retrospective study included adult allo-HSCT recipients diagnosed with oGVHD during or after immunosuppression tapering at a single tertiary center (1998-2023). Data collected included transplant indications and donor characteristics, GVHD prophylaxis regimens, immunosuppression status at engraftment and at oGVHD onset, and systemic and ocular GVHD manifestations. Cumulative incidence of oGVHD was estimated using Kaplan-Meier survival analyses.

Results: Fifty-six patients (mean age, 56 ± 12 years; 59% male) developed oGVHD at a median of 9 months posttransplant (interquartile range, 6.8-13). The predominant prophylaxis regimen at engraftment was tacrolimus with methotrexate (62.5%). At the time of oGVHD diagnosis, 25.0% of patients were fully tapered off systemic immunosuppression, whereas 28.5% remained on tacrolimus monotherapy. Kaplan-Meier analysis showed a rapid rise in oGVHD incidence within the first year, with 75% of cases diagnosed by month 14. Systemic GVHD preceded ocular involvement in 62% of patients, whereas 18% developed isolated oGVHD. Most patients required escalation of ocular surface therapy-including lubrication, punctal occlusion, and topical antiinflammatory or immunomodulatory agents-although no patient required reinstatement or escalation of systemic immunosuppression solely for ocular disease.

Conclusions: oGVHD frequently emerges during the late phase of systemic immunosuppression tapering, with many cases occurring after complete discontinuation or reduction to monotherapy. Given the high incidence within the first posttransplant year and the occurrence of isolated ocular disease, these findings support routine ophthalmic evaluation for all allo-HSCT recipients as systemic immunosuppression is withdrawn. Early detection and timely escalation of topical therapy are essential to prevent ocular surface damage while permitting safe continuation of systemic tapering.

Purpose: The aim of this study was to introduce a new method to photograph the tear film lipid layer (LL) in mice and quantitatively measure lipid layer thickness (LLT).

Methods: A total of 39 Bagg albino (BALB/c) mice (5-week-old) were used in this study. The system was composed of breadboard, light-emitting diode (LED) panel, right-angle mirror, dissection microscope, complementary metal oxide semiconductor camera, and computer. The white light emitted from the LED panel caused thin-film interference in the LL of the tear film, which reflected off the mirror and produced an image on the camera sensor. For the qualitative analysis, the mice were divided into 3 groups according to the LL interference patterns. LLT was quantified by analyzing the colors in the interference patterns.

Results: Interference patterns were clearly observed in the lower half of the corneas. Based on quantitative analysis, the average LLT was 62.72 ± 10.65 nm. When the interference pattern was qualitatively classified, 7 eyes were categorized into group 1 (thin), 19 eyes into group 2 (normal), and 3 eyes into group 3 (thick). The average LLT was 54.81 ± 8.23 nm in group 1, 63.68 ± 8.73 nm in group 2, and 75.11 ± 15.48 nm in group 3, with a significant difference among the 3 groups (analysis of variance P = 0.012).

Conclusions: We successfully photographed the interference pattern caused by the tear film LL in mice and quantitatively measured the LLT using an LED panel, mirror, dissection microscope, and camera.

Purpose: To investigate the efficacy and safety of secondary surgical intervention of combined phototherapeutic keratectomy (PTK) with alcohol delamination and peripheral anterior stromal puncture (ASP) for refractory recurrent corneal erosion (RCE).

Methods: This retrospective comparative study defined refractory RCE as cases persisting for more than 6 months after primary surgical intervention. A total of 115 eyes from 115 patients with refractory RCE, treated either with (n = 92) or without (n = 23) the secondary surgical treatment combining PTK and ASP between January 2021 and January 2023, were included. The Kaplan-Meier survival analysis method was used to determine the intervention's efficacy.

Results: The mean age was 34.4 ± 10.8 years, with a predominance of male patients (60%). Over a follow-up period exceeding 1 year, the recurrence rate was markedly lower at 27.2% in the group undergoing secondary surgical treatment compared with 69.6% in those receiving conservative treatment. Kaplan-Meier survival analysis revealed significantly reduced recurrence rates in the surgical group versus the conservative treatment group (log-rank test, P = 0.007). Notably, 96% of recurrences in the surgical cohort occurred within the first 6 months postintervention, with no recurrences observed after 9 months. At the final follow-up, 12% necessitated further surgical procedures 6 months after the secondary intervention. The study reported no significant surgical complications.

Conclusions: The secondary surgical approach combining PTK with alcohol delamination and ASP presents a viable and safe treatment alternative for patients with refractory RCE, demonstrating a significant reduction in recurrence rates.

Purpose: The study aims to compare dry eye disease (DED) prevalence and severity between seropositive and seronegative Sjögren disease (SjD).

Methods: Prospective, consecutive, comparative cross-sectional cohort study. A total of 160 eyes of 80 patients with SjD by The American College of Rheumatology and the European League Against Rheumatism 2016 criteria were included: 55 seropositive and 25 seronegative SjD. Associated SjD was excluded. Patients had dry eye tests performed. Generalized estimating equations were used to account for intereye correlation of the same participant.

Results: Mean age was 52.2 ± 12.7, 96.3% were women, no differences were observed between groups ( P > 0.05). Seronegative SjD had positive minor salivary gland biopsy more often (100% vs. 82%, P = 0.024), but with lower focus score (2.0 ± 1.2 vs. 4.1 ± 3.5, P = 0.006) than seropositive SjD group. DED prevalence was similar in seropositive and seronegative SjD (92.7% and 84%; P = 0.088). Only noninvasive break-up time (NIBUT) average was significantly reduced in seropositive SjD (6.6 ± 3.2 vs. 8.8 ± 2.4, P = 0.011), and the rest of the evaluated DED tests were not significant. In the seropositive group, nonstatistically significant trends toward more severe DED signs, including matrix metalloproteinase-9, osmolarity, Schirmer I without anesthesia, fluorescein tear break-up time, NIBUT first, and Sicca Ocular Staining Score, were observed. Both groups were highly symptomatic in ocular surface disease index score (43 ± 23 vs. 46 ± 30, P = 0.779) and had a reduction in quality of life in National Eye Institute visual health questionnaire-25 test (72 ± 21 vs. 70 ± 24, P = 0.650).

Conclusions: Patients with seropositive SjD showed significantly reduced NIBUT and a trend of more severe DED signs. Patients with seronegative and seropositive SjD were similarly highly symptomatic, experienced important reductions in vision-related quality of life, and had similar DED prevalence.

Purpose: To provide a comprehensive review of keratoprosthesis (KPro), emphasizing the Boston KPro's development, design, surgical techniques, complications, and outcomes, while highlighting unresolved challenges and future research directions.

Methods: A narrative literature review was conducted to examine the evolution of KPro, assess commonly used artificial corneas, and analyze current technologies. Specific emphasis was placed on the Boston Keratoprosthesis.

Results: The review identified key areas for improvement in Boston KPro, including enhancement of titanium backplates to reduce retroprosthetic membrane formation, better adhesion between the corneal graft and backplate, and refinement of donor graft preparation to prevent corneal melting. Challenges in glaucoma monitoring because of unreliable intraocular pressure measurements were noted. Adjunctive strategies such as optimized vancomycin use, antifungal prophylaxis, drug-releasing contact lenses, and biologic therapies were explored. Cost-containment and accessibility issues were also addressed, along with emerging innovations in KPro design.

Conclusions: Keratoprosthesis represents a viable alternative for patients unsuitable for traditional corneal transplantation. Ongoing research into surgical techniques, material science, prophylaxis, and design improvements will be critical to enhancing patient outcomes, minimizing complications, and expanding global access to KPro.