Cornea最新文献

Purpose: To compare the impact of simultaneous topography-guided photorefractive keratectomy (TG-PRK) on corneal haze in patients undergoing accelerated corneal cross-linking (CXL) for keratoconus, using corneal densitometry.

Methods: Retrospective, case-control study comparing patients undergoing accelerated CXL alone (CXL group) or combined CXL and TG-PRK (TG-PRK group). All patients performed PTK-assisted 50-μm deepithelization, followed by 10-minute ultraviolet-A exposure at 10 mW/cm 2 (6 J/cm 2 total dose). In the TG-PRK group, patients had simultaneous TG-PRK ablation for topographic regularization. Corneal densitometry was measured preoperatively, at 3 months, and at 1 year postoperatively using a Scheimpflug device. Changes in densitometry values across different corneal regions were analyzed to assess haze evolution.

Results: A total of 106 eyes were included, with 50 eyes in the CXL group and 56 eyes in the TG-PRK group. At 3 months and 1 year postoperatively, patients in the TG-PRK group exhibited significantly higher corneal densitometry values across all areas of the anterior and central middle stroma ( P < 0.001). By 1 year, densitometry values in both groups had largely returned to baseline, except for the central 2 mm of the anterior cornea in the TG-PRK group. Patients with greater flattening had significantly more haze after CXL with TG-PRK, but no correlation was found between haze formation and changes in visual acuity in both groups.

Conclusions: Simultaneous TG-PRK and CXL result in more significant and prolonged corneal haze compared with CXL alone. Haze improves over time but persists longer in the combined procedure. Corneal densitometry is valuable for assessing haze and optimizing patient management.

Purpose: To evaluate the morphology of donor grafts and limbal microstructure after keratolimbal allograft (KLAL) surgery using anterior segment optical coherence tomography (AS-OCT) and to explore the relationship between graft shape and clinical outcomes.

Methods: This retrospective study included patients with limbal stem cell deficiency from severe ocular surface burns who underwent KLAL with or without concurrent keratoplasty. AS-OCT was used to assess graft morphology and the graft-recipient interface. Grafts were classified into 3 types-wedge-shaped, trapezoidal, and irregular-shaped-based on AS-OCT imaging. Postoperative clinical outcomes, including neovascularization, conjunctivalization, and corneal opacity, were recorded and compared across graft types.

Results: Among 26 eyes from 23 patients, wedge-shaped grafts showed significantly higher success rates, with fewer complications of neovascularization, conjunctivalization, and corneal opacity, compared with trapezoidal and irregular-shaped grafts. Specifically, wedge-shaped grafts had superior outcomes in neovascularization (vs. trapezoidal: χ 2 = 5.658, P = 0.017; vs. irregular: χ 2 = 6.062, P = 0.014), conjunctivalization (vs. trapezoidal: χ 2 = 5.855, P = 0.016; vs. irregular: χ 2 = 6.814, P = 0.009), and corneal opacity (vs. trapezoidal: χ 2 = 7.088, P = 0.008). AS-OCT imaging showed closer adherence of wedge-shaped grafts to the recipient bed, potentially enhancing stability, whereas trapezoidal and irregular-shaped grafts exhibited gaps that may hinder attachment.

Conclusions: AS-OCT imaging effectively visualizes donor graft morphology and graft-recipient microstructure, providing insights into KLAL outcomes. Wedge-shaped grafts, which align more closely with natural limbal anatomy, show greater ocular surface stability.

Purpose: In contrast to adult patients, corneal transplants performed in pediatric patients tend to fare poorly, with relatively higher graft failure rates. The purpose of this study was to analyze the indications and outcomes of pediatric patients undergoing penetrating keratoplasty (PK).

Methods: This retrospective cohort study included children ≤18 years in the IRIS Registry (Intelligent Research in Sight) who underwent PK (January 1, 2013-December 31, 2020). Corneal graft failure was identified using International Classification of Diseases codes. The Kaplan-Meier estimated 5-year cumulative incidence of graft failure after PK. Hazard ratios (HR) derived from multivariable Cox regression models were used to evaluate the association of graft failure with sociodemographic and clinical factors.

Results: Five hundred forty-four children underwent PK (median age 15 years; 43% [234] female). Indications for surgery included nontraumatic acquired (58%, N = 318), congenital (18%, N = 100), other (9.6%, N = 52), and traumatic acquired (8.6%, N = 47). The cumulative incidence of graft failure within 5 years of PK was 50% (95% confidence intervals [CI], 45%-56%). The incidences did not differ between patients in various etiology groups. Graft failure was associated with glaucoma (HR, 1.46; 95% CI, 1.05-2.01; P = 0.023), dry eye disease (HR, 1.86; 95% CI, 1.18-2.92; P = 0.007), and corneal neovascularization (HR, 1.76; 95% CI, 1.00-3.08; P = 0.050).

Conclusions: Approximately half of children undergoing PK in the IRIS Registry experienced graft failure within 5 years of transplantation. The association of graft failure with ocular conditions such as glaucoma and dry eye disease suggests potential avenues to decrease the high incidence of graft failure in this population.

Purpose: Migratory Serpiginous Corneal Epitheliopathy (MSCE) is a rare condition characterized by migrating corneal epithelial lesions with a serpiginous or amoeboid-shaped appearance. Its etiology remains poorly understood, and the condition often presents a diagnostic and therapeutic challenge. Here, we report a case of a recurrent, unilateral MSCE-like lesion in a 25-year-old woman not responding to standard treatments, including repeated corneal debridement, bandage contact lens placement, and superficial keratectomy with postoperative slow tapering of steroids.

Methods: Eventually, microbiological testing of corneal epithelial scrapings obtained during a repeat superficial keratectomy revealed the presence of HSV-1 on both immunofluorescence assay and polymerase chain reaction. Although histopathology did not show classical features of HSV, viral cytopathic effects like perinuclear haloes were noted in some epithelial cells.

Results: Based on these findings, our patient was started on topical antiviral therapy (3% acyclovir eye ointment, 5 times daily for 1 month). This led to complete resolution of the lesion, with no recurrence at the last follow-up, 9 months after initiating topical antivirals.

Conclusions: To our knowledge, this is the first reported case associating HSV to MSCE, emphasizing the importance of considering viral etiologies and microbiological evaluation, including virology in atypical, recurrent corneal epitheliopathies.

Purpose: To determine the incidence, seasonality, geographic distribution, and risk factors for emergency department presentations with corneal ulcers and perforated corneal ulcers.

Methods: Retrospective, population-based cohort study of corneal ulcers in California from 2012 to 2021. Overall and stratified yearly incidence rates, seasonality, individual-level and postal code-level risk factors for perforation, and geographic clustering were evaluated.

Results: This study included 31,019 emergency department (ED) visits for corneal ulcers, with 263 cases coded as perforated corneal ulcers. The average yearly incidence was 7.94 (95% confidence interval, 7.85-8.03) per 100,000 people for ED-diagnosed corneal ulcers and 0.67 (95% confidence interval, 0.59-0.76) per 1,000,000 people for perforated corneal ulcers. Male patients, Black patients, and primary English-speaking patients had the highest incidences across sociodemographic groups. For ED-diagnosed corneal ulcers, the incidence was highest among individuals aged 20 to 60 and for perforated corneal ulcers the incidence was highest among individuals over age 75. Significant geographic clustering was observed, with hotspots in the Central Valley and inland Northern and Southern California. Visits were seasonal, with incidence peaking in July and lowest in February. Increasing age, Spanish as a preferred language, and having health insurance were significant risk factors for presenting with a perforated corneal ulcer. Indicators of low socioeconomic status were associated with higher rates of corneal ulcers.

Conclusions: The incidence of ED-diagnosed corneal ulcers in California increased over the study period with a notable seasonal pattern. Higher rates were observed in Black individuals and in areas with lower socioeconomic status, providing evidence of health disparities and identifying potential targets for public health interventions.

Purpose: To assess rates of steroid-induced ocular hypertension, de novo glaucoma, and rejection episodes with long term, off-label use of fluorometholone 0.1% after Descemet membrane endothelial keratoplasty (DMEK) in patients without preexisting glaucoma.

Methods: We retrospectively reviewed records of 250 patients without previous glaucoma, who underwent DMEK between 2015 and 2019, used prednisolone acetate 1% for 2 months, and then switched to fluorometholone 0.1%, used indefinitely. Subjects with prior penetrating keratoplasty or <5-year follow-up were excluded. Main outcomes were rates of postoperative steroid-induced ocular hypertension, glaucoma, and rejection episodes, assessed with Kaplan-Meier analysis, taking follow-up into consideration.

Results: The indications for DMEK were Fuchs dystrophy (94%), failed endothelial keratoplasty (4%), and secondary corneal edema (2%). The median patient age was 67 years (range 35-89 years), and median follow-up was 7 years (range 5-9 years). The cumulative rate of steroid-induced ocular hypertension was 2% at 1 year, 5% at 5 years, and 7% at 8 years. The cumulative rate of glaucoma was 2% at 1 year, 4% at 5 years, and 4% at 8 years; all cases of de novo glaucoma were managed medically and did not require surgical intervention. The cumulative rate of definite rejection episodes was 1% at 1 year, 1% at 5 years, and 2% at 8 years.

Conclusions: Long-term use of fluorometholone 0.1% after DMEK results in low rates of steroid induced ocular hypertension, de novo glaucoma, and immunologic rejection in patients without prior glaucoma.

Purpose: The aim of this study was to describe the surgical approach and outcomes of artificial endothelial layer (EndoArt) implantation in chronic corneal edema.

Methods: Fifteen eyes of 15 patients with chronic corneal edema were implanted with an artificial endothelial keratoprosthesis (EndoArt, EyeYon Medical, Israel) several months (range: 2-108 months; mean: 42.7 ± 38.5 months) after at least one Descemet membrane endothelial keratoplasty failure or as a first-line procedure to improve anterior segment visibility ahead of a second procedure (phaco + Descemet membrane endothelial keratoplasty) in outpatient procedures. A 20% SF 6 -air mixture was used as a tamponade to secure the EndoArt in place. The number of transfixing sutures (1-4) was based on surgeon judgment and preference, considering patient-specific anatomical factors such as aphakia or previous graft configuration. The original technique used only 1 suture. Measured outcomes included changes in central corneal thickness, best corrected visual acuity (logMAR), rebubbling rate, and postoperative complications.

Results: The preoperative mean central corneal thickness (844 ± 236 µm) decreased significantly postoperatively in all patients (607 μm ± 251 μm at the last visit (1 to 6 months), reduction of 28%, P -value <0.05). Ten eyes (66.7%) required at least 1 rebubbling. Three eyes required more than 2 rebubblings. Eighty percent of patients (12/15) were pseudophakic at the time of surgery.The mean best corrected visual acuity improved significantly from 2.13 ± 0.19 logMAR preoperatively to 1.84 ± 0.53 logMAR at the final follow-up ( P -value <0.05). Postoperative complications included intraocular pressure elevation (33%), partial implant detachment (66.7%), 1 intraoperative posterior dislocation, and 1 case of retinal detachment.

Conclusions: EndoArt may represent a therapeutic option for chronic corneal edema in complex cases where conventional endothelial keratoplasty has failed or carries a high risk of failure. It improves visual acuity and significantly reduces corneal thickness within 3 to 6 months of surgery.

Purpose: To characterize Acanthamoeba isolates from patients with Acanthamoeba keratitis (AK) at the subgenotypic level, and to determine the distribution of genotypes and subgenotypes associated with clinical infections.

Methods: Corneal scrapings from clinically diagnosed patients with AK were subjected to molecular genotyping. DNA was extracted and amplified using PCR targeting the 18S ribosomal RNA gene. Sequencing data were analyzed, and phylogenetic trees were constructed using MEGA X software to determine species, genotypes, and subgenotypes.

Results: Eight species of Acanthamoeba were identified: Acanthamoeba castellanii (38%), Acanthamoeba culbertsoni (25%), Acanthamoeba polyphaga (13%), Acanthamoeba hatchetti (6%), Acanthamoeba triangularis (6%), Acanthamoeba jacobsi (6%), Acanthamoeba healyi (3%), and Acanthamoeba spp. (3%). Genotypic analysis revealed 4 major genotypes: T4 (72%), T10 (19%), T12 (3%), and T15 (6%). The predominant T4 genotype was further classified into 5 subgenotypes: T4A, T4B, T4C, T4D, and T4F.

Conclusions: This study highlights the genetic diversity of Acanthamoeba in AK cases, with a predominance of the T4 genotype and its subgenotypes. Subgenotypic classification provides enhanced resolution in molecular epidemiology and may contribute to understanding pathogenicity and clinical outcomes in AK.

Purpose: To present a novel case of corneal subepithelial drug deposits secondary to oral niraparib, a newly approved medication for maintenance therapy for ovarian cancer.

Methods: Case report.

Results: A 73-year-old woman presented to our eye clinic with blurred vision after commencement of oral niraparib. Slit-lamp examination, anterior segment optical coherence tomography, and Scheimpflug tomography demonstrated bilateral predominantly peripheral, subepithelial corneal hyperreflective lesions consistent with drug deposits. Systemic workup excluded paraproteinemic keratopathy. In the presence of concurrent cataracts, the visual impact of these deposits was unclear. Because of ill health, the niraparib treatment was continued by the oncologists, and the ocular conditions were managed conservatively with topical lubrication. No progress of corneal deposits was observed.

Conclusions: Niraparib therapy may be associated with corneal drug deposition. The pattern of subepithelial drug deposition seen in this case is distinct to other commonly reported drug deposits.

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.