Cornea最新文献

Purpose: The purpose of this study was to evaluate and compare the anatomic characteristics of eyes with Fuchs endothelial corneal dystrophy (FECD) with eyes without FECD.

Methods: This study was a retrospective chart review performed at an academic medical center. Patients with FECD were identified through a search of the electronic medical records. Eligible patients underwent Scheimpflug imaging and optical biometry and were compared with age and sex-matched control subjects who underwent similar testing in preparation for cataract surgery. Several measurements of the cornea, anterior chamber, and eyes were evaluated using multivariable linear regression models and multivariable logistic regression models.

Results: A total of 404 eyes (202 eyes with FECD and 202 control eyes) were included in this study. Compared with controls, eyes with FECD had shallower AC depths, lower AC volumes, and narrower angles. Conversely, the spherical equivalent before cataract surgery, corneal pachymetry, and corneal volume were higher in eyes with FECD. On Scheimpflug imaging analysis, these anatomical differences were present in FECD eyes with and without corneal edema. After adjusting for sex, these differences remained statistically significant. Shorter axial length was found to be statistically significant in male eyes but not in female eyes with FECD.

Conclusions: This study reports new ocular characteristics in FECD eyes with and without edema. Optical biometry and Scheimpflug imaging established that the anatomic findings in eyes with FECD were not simply due to the larger volume of an edematous cornea but rather unique to eyes with FECD. These findings will provide reliable, normative data for future studies examining surgical, medical, and anatomical factors in FECD.

Purpose: To investigate long-term corneal biomechanical changes and influencing factors of lenticule intrastromal keratoplasty (LIKE) in the treatment of hyperopia.

Methods: 9 eyes of 9 patients with a mean age of 34.00 ± 9.34 years were included. Full-scale examinations were conducted on all patients preoperatively and during 2 years of follow-ups. Topographical and biomechanical parameters were evaluated with Pentacam and Corvis ST preoperatively and during all follow-up visits.

Results: All surgeries were uneventful without complications. The safety index was 1.27 ± 0.64 and the efficacy index was 0.96 ± 0.62 at the last follow-up. The central corneal thickness (CCT) (P < 0.05*) and the thinnest corneal thickness (TCT) (P < 0.05*) significantly increased 2 years postoperatively while the Ambrosio relational thickness horizontal (ARTh) (P < 0.05*) and the Corvis biomechanical index (CBI) (P < 0.05*) decreased. The deformation amplitude ratio (DA ratio), the stiffness parameter at the first applanation (SP-A1), the stress-strain index, and the posterior elevation (PE) remained stable 2 years after LIKE. The DA ratio was negatively correlated with the CCT and the TCT (r = -0.54, P = 0.019*; r = -0.59, P = 0.009*) while the SP-A1 was positively correlated with the CCT and the TCT (r = 0.84, P < 0.001*; r = 0.87, P < 0.001*). The ARTh was positively correlated with the TCT (r = 0.47, P = 0.049*), and the CBI was positively correlated with the PE (r = 0.63, P = 0.005*).

Conclusions: LIKE for the correction of hyperopia is safe and effective in the long term. The PE remained stable and the CBI improved 2 years postoperatively.

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: The purpose of this study was to describe a patient with a primary CD4+ T-cell lymphoproliferative disorder of conjunctiva.

Methods: Case report and review of the literature.

Results: An 81-year-old man was referred for asymptomatic bilateral conjunctival masses that on biopsy revealed a proliferation of mature CD4+ lymphocytes associated with T-cell receptor γ gene rearrangement. The histopathology and immunophenotypic profile in the absence of disease elsewhere bore resemblance to primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder.

Conclusions: In 2016, the World Health Organization reclassified primary cutaneous CD4+ small/medium T-cell lymphoma to a lymphoproliferative disorder because neither dissemination nor death had been documented. This case displays similarities with the latter but has nonconforming features. Multicentric clonal expansion of T cells do not inevitably indicate lymphoma. Lymphoproliferative disorders that display features of reactive hyperplasia and lymphoma and are not easily classified need to be carefully monitored.

Purpose: To report the results of a national survey on corneal transplantation in Japan.

Methods: The Japan Cornea Society conducted a national survey on corneal transplantation performed from 2017 to 2019. Data from various institutions were collected through an online database and subsequently analyzed.

Results: In total, 4951 cases from 44 facilities were documented. The leading cause of corneal transplantation was corneal edema (CE), which accounted for 39.3% of cases, followed by repeat keratoplasty at 27.7%. Among CE cases, postcataract surgery was the most prevalent (25.1%), followed by postglaucoma surgery (20.8%) and laser iridotomy-induced CE (18.2%). Fuchs endothelial corneal dystrophy was the fourth most common cause (10.9%). Regarding surgical methods, Descemet stripping automated endothelial keratoplasty was the most common, used in 41.3% of procedures, followed by penetrating keratoplasty at 37.1%. Deep anterior lamellar keratoplasty and Descemet membrane endothelial keratoplasty were used in 8.1% and 2.6% of cases, respectively. One year after transplantation, graft clarity was maintained in 80.5% of cases, and regrafting was necessary in 15.2% of instances.

Conclusions: The national survey reveals that CE is the most frequent indication for corneal transplantation in Japan. Increases in cases from glaucoma surgery and Fuchs endothelial corneal dystrophy were noted among patients with CE. Endothelial keratoplasty, especially Descemet stripping automated endothelial keratoplasty, is now the preferred surgical technique for these transplants.

Purpose: To assess the clinical utility of the clustered regularly interspaced short palindromic repeats/Cas12a-based RID-MyC assay in diagnosing Fungal Keratitis (FK) in cases where conventional smear and culture methods fail to identify the causative pathogen.

Methods: This retrospective case series included 5 patients with clinically suspected FK and negative smear and culture results who were evaluated in the Cornea Department at Aravind Eye Hospital, Coimbatore, India, between January 1, 2024, and March 31, 2024. The primary outcome was the diagnostic performance of the RID-MyC assay in detecting fungal nucleic acids in cases of suspected FK with negative smear and culture results. In vivo confocal microscopy served as a reference standard to validate the RID-MyC assay findings.

Results: The RID-MyC assay successfully detected fungal nucleic acids in 3 cases, corroborated by in vivo confocal microscopy findings suggestive of fungal filaments, leading to targeted antifungal therapy and resolution of the infections. In addition, 2 cases tested negative for fungal nucleic acids, aligning with clinical and confocal evidence of nonfungal etiology, thus guiding appropriate alternative treatments that led to clinical improvement.

Conclusions: The RID-MyC assay demonstrates clinical utility in diagnosing FK in scenarios where conventional smear and culture methods prove inadequate, such as in cases with prior antifungal therapy or polymicrobial infections. This assay facilitates accurate diagnosis and timely initiation of appropriate antifungal treatment without the need for sophisticated equipment or expertise, making it particularly valuable in resource-limited settings.

Purpose: To investigate intereye agreement in dry-eye disease (DED) signs in the Dry Eye Assessment and Management study.

Methods: Tear break-up time (TBUT), Schirmer test, conjunctival staining, corneal staining, meibomian gland dysfunction (MGD), and tear osmolarity were measured at baseline, 3, 6, and 12 months. Intereye agreement was assessed by intraclass correlation coefficient, weighted kappa, and percentage of participants with absolute intereye difference (AID) exceeding a clinically significant threshold (2 points for conjunctival staining and MGD, 2 seconds for TBUT, 3 points for corneal staining, 5 mm/5 minutes for Schirmer test, and 8 mOsms/L for osmolarity). The worse eye at each visit for each DED sign was determined as the eye with a sign worse than the contralateral eye by at least the clinically significant threshold.

Results: DED signs had moderate-to-good intereye agreement with intraclass correlation coefficient ranging from 0.45 (tear osmolarity) to 0.81 (corneal staining and Schirmer test) and weighted kappa from 0.58 (plugging) to 0.69 (lid secretion). Percentage of participants exceeding threshold AID was 15% to 20% for conjunctival staining, 11% to 15% for TBUT, 17% to 21% for MGD, 13% to 18% for corneal staining, 21% to 23% for Schirmer test, and 44% to 47% for osmolarity. The eye with a worse DED sign ranged between 36% (TBUT) and 80% (osmolarity) of participants.

Conclusions: Participants demonstrated moderate-to-good intereye agreement, yet a substantial portion showed clinically significant intereye differences in each sign. The worse eye was not the same eye in the majority during follow-up. These findings suggest considering signs from both eyes in future DED trials.

Purpose: To evaluate the rate of and risk factors for rhegmatogenous retinal detachment (RRD) after Descemet membrane endothelial keratoplasty (DMEK) either alone or in combination with cataract surgery.

Design: Retrospective analysis of prospective database.

Methods: Consecutive eyes with Fuchs endothelial corneal dystrophy that received DMEK surgery with a minimum follow-up of 1 year between July 2011 and January 2021 at the Department of Ophthalmology at the University of Cologne were analyzed. Exclusion criteria were complicated history including repeat DMEK within 1-year, previous retinal or glaucoma surgery, complicated phacoemulsification, congenital cataract, history of trauma.

Results: From 3858 consecutive DMEKs, 1961 patients were identified suitable for analysis. 846 (43.1%) were pseudophakic DMEK, 91 (4.6%) phakic DMEK and 1,024 (52.2%) combined with cataract surgery. RRD occurred in 13 eyes (12 patients). Within two years after DMEK RRD occurred in 0.49% and 0.47% after DMEK and DMEK with cataract surgery, respectively. Mean age of 59.24 ± 8.42 years with subsequent RRD was significantly lower than overall 68.81 ± 9.89 years (t-test two-tailed; p < 0.001). The spherical equivalent was -4.69 ± 3.98 D (range -9.00 to 0.5) in RRD after pseudophakic DMEK compared to -2.79 ± 3.54 D (range -7.5 to 0.75) in combined procedures. Re-bubbling had no influence on RRD rate.

Conclusions: DMEK alone or in combination with cataract surgery showed similar postoperative RRD rates in the first two years, generally in the range of pseudophakic RRDs. Risk factors such as myopia and younger age could be identified. Re-bubbling has no influence on RRD rates.

Purpose: The purpose of this study was to report clinical characteristics and outcomes of surgical repair for patients with traumatic dehiscence of penetrating keratoplasty (PKP) grafts.

Methods: Retrospective, consecutive chart review of patients evaluated at Bascom Palmer Eye Institute between 2015 and 2020 with traumatic dehiscence of penetrating keratoplasty grafts.

Results: The study cohort consisted of 65 eyes of 65 patients. The mean age at presentation was 72 years (SD 18), with a male predominance (65%). The most common indications for PKP included keratoconus (42%), corneal scar (31%), and Fuchs corneal dystrophy (8%). Dehiscence occurred as a result of blunt trauma in 94% of cases, and the mean wound length was 6.4 clock hours (SD 2.4), with a predominance of inferior dehiscence. The mean presenting visual acuity (VA) was 2.45 logMAR (SD 0.41), and the mean final VA was 2.17 logMAR (SD 0.99). Graft failure occurred in 64% of patients, and 22% underwent repeat PKP. When stratified by indication for corneal transplantation (keratoconus vs. other), there was no significant difference in graft age at the time of rupture, final VA, rate of graft failure, or rate of repeat PKP.

Conclusions: Traumatic dehiscence of corneal grafts remains a rare but serious subtype of ocular trauma with generally poor visual prognoses. Presenting VA along with severity of trauma and posterior segment involvement tend to be the worst prognostic factors in final visual outcome.