Cornea最新文献

Purpose: The aim of this study was to report the outcomes of "peeling-off spiral" deep anterior lamellar keratoplasty (DALK), a manual DALK technique that allows for a deep, fast, and reliable stromal removal, taking advantage of the lowest adhesion among the posterior stromal lamellae.

Methods: This was a retrospective case series of patients who underwent "peeling-off spiral" DALK between January 2014 and September 2024, with at least 1 year of follow-up. Indications for DALK, intraoperative and postoperative complications, residual recipient bed thickness, and postoperative best corrected visual acuity (BCVA) at 1 year of follow-up were evaluated.

Results: A total of 149 DALK eyes (122 patients) underwent "peeling-off spiral" DALK for corneal ectasia (87 eyes), stromal scar (31 eyes), and active infection (31 eyes). In cases of previous hydrops or full-thickness penetrating corneal wound (9 eyes), a modified "assisted peeling-off spiral" DALK procedure was performed, where the peeling of the stroma was aided by a crescent blade to reduce the pulling force and avoid enlargement of the preexisting DM break. Six intraoperative ruptures were recorded (4%); however, 3 were preexisting DM breaks from previous hydrops, 2 were reopenings of previous full-thickness corneal penetrating wounds, and only 1 (0.7% of cases without preexisting breaks) was a new intraoperative DM rupture. The mean residual recipient bed thickness was 40.1 μm at 1 day postoperatively (range 21-131 μm) and 28.4 μm (range 17-85 μm) at 3 months postoperatively. The mean postoperative BSCVA at 1 year of follow-up was 0.73 ± 0.19 (range 0.4-1.0).

Conclusions: "Peeling-off spiral" DALK is a valuable and reliable manual technique that achieves a deep stromal plane, with favorable visual outcomes and a low rate of complications.

Purpose: To characterize, for the first time, corneal sensory nerve functionality in congenital aniridia by assessing mechanical and cold corneal sensitivity, reflex tearing, and basal blinking and tearing.

Methods: A cohort of fourteen pediatric and adult patients with PAX6-related aniridia was enrolled in the study. Mechanical sensitivity (noncontact gas esthesiometer) and cold sensitivity (4°C drops) were quantified using a 0 to 10 verbal numerical scale (VNS). Spontaneous blinking, basal, and CO2-induced reflex tearing were also measured. Data were stratified by age, aniridia-associated keratopathy (AAK), and PAX6 mutation type-reduced expression or loss-of-function (LOF) genetic variants-and compared with healthy controls (n = 9).

Results: Mechanical sensitivity to high-intensity stimuli was reduced in patients with aniridia, particularly in adults (2.2 ± 0.3 VNS, P = 0.02), those with severe AAK (2.4 ± 0.4 VNS, P = 0.09), and patients with LOF mutations (2.4 ± 0.2 VNS, P = 0.05) compared with controls (3.9 ± 0.5 VNS). Cold sensitivity was also reduced in adult patients (5.5 ± 0.5 vs. 3.8 ± 0.6 VNS, P = 0.05) and severe AAK (3.2 ± 0.8 VNS, P = 0.01). Reflex tearing values exhibited variability but trended lower in patients than controls, and tearing reserve (reflex minus basal tearing) was significantly reduced (12.7 ± 3.8 vs. 1.9 ± 1.9 mm, P = 0.02). Basal blinking and tearing were not significantly different.

Conclusions: These findings suggest impaired mechano-nociceptors, polymodal nociceptors, and cold thermoreceptors function in congenital aniridia, with severity increasing with age and AAK grade. LOF mutation results show a trend with greater deficits than reduced expression variants, highlighting a critical role of PAX6 in corneal sensory integrity.

Purpose: To study the use of autologous injectable platelet-rich fibrin (iPRF) and tranexamic acid (TA) for conjunctival autograft (CAG) adherence during pterygium surgery.

Methods: This case series report included 212 primary nasal pterygiums from 205 patients who underwent pterygium excision with conjunctival autograft fixation using iPRF and TA operated by a single surgeon at 1 center. Surgical time, postoperative graft stability, and recurrence were assessed, and outcomes were compared with literature reports of autologous blood (ATB) and commercial fibrin glue (FG).

Results: The average age was 57.8 years (range 33-75 years). The average surgical duration was 15.3 minutes (12.2-21.4 minutes). Graft dislodgement was noted in 1 eye (0.47%) on day 1, requiring reprocedure. Recurrence was observed in 2 patients (0.94%), mild graft edema in 68 eyes (32.07%), late spontaneous hemorrhage under CAG in 34 eyes (16%), and graft retraction in 2 eyes (0.94%). No postoperative infections, local inflammation, thrombotic complications, or systemic adverse effects were observed. The recurrence rates were lower than those reported for ATB. Unlike FG, iPRF contains platelets and leukocytes, which contribute to angiogenesis and wound healing. The addition of TA stabilizes the fibrin network by inhibiting fibrinolysis, thereby enhancing the adhesion. The cost incurred when using iPRF was 50x lower than that of Baxter Tisseel.

Conclusions: iPRF combined with TA is a safe, autologous, and cost-effective alternative to ATB, sutures, and FG for CAG fixation in pterygium surgery. Larger randomized controlled trials are required to validate the findings of this novel method.

Purpose: The aim of this study was to analyze the influence of donor characteristics and tissue preservation conditions on the scrolling behavior of grafts in Descemet membrane endothelial keratoplasty (DMEK).

Methods: This retrospective, single-center study included 3150 consecutive DMEK grafts after uneventful preparation for DMEK surgery. The grafts were prepared from either organ-cultured corneoscleral buttons (n = 1414) or corneoscleral buttons stored in Optisol-GS (n = 1736). The main donor characteristics were age, endothelial cell density, death-to-preservation time, preservation method, and storage duration. The thickness of Descemet membrane (DM) was analyzed in a subgroup of 74 grafts using transmission electron microscopy. Scrolling behavior was quantified as roll width using calipers (mm).

Results: Older donor grafts exhibited less pronounced scrolling, with a significant correlation between donor age and roll width (r = 0.561, P < 0.001, R2 = 0.308). Organ-cultured grafts exhibited larger roll widths (1.764 ± 0.65 mm) than Optisol-GS-stored grafts (1.516 ± 0.51 mm; P < 0.001). A significant correlation was found between DM thickness and roll width (Spearman ρ = 0.562, P < 0.001, R2 = 0.312), while DM thickness was also significantly correlated with donor age (r = 0.545, P < 0.001, R2 = 0.304).

Conclusions: In this large cohort of DMEK grafts, donor age was confirmed as the most decisive factor influencing the scrolling behavior of DMEK grafts, with younger tissues demonstrating tighter scroll formation while the correlation gradually weakened in older donor groups. The DM thickness was confirmed as an independent contributor, as thicker membranes were associated with less tightly scrolled grafts.

Purpose: To investigate dysregulated ion channels and epithelial-to-mesenchymal transition (EMT) genes in Fuchs endothelial corneal dystrophy (FECD) and to identify potential drugs interacting with dysregulated ion channels.

Methods: Five RNA-sequencing datasets from patients with FECD were analyzed with DESeq2 to identify differentially expressed genes. Dysregulated ion channels and EMT-related genes underwent enrichment analysis and EMT scoring via the KS method. Coexpression patterns were identified using weighted gene coexpression network analysis. A pathway map highlighted altered cellular processes in FECD, and potential drugs were identified using the Drug-Gene Interaction Database. Molecular docking assessed binding of drugs with TRPV4 and TRPM8. Selected gene expression changes were validated by quantitative real-time polymerase chain reaction.

Results: Analysis identified 12,550 differentially expressed genes, including 229 ion channels (157 up-regulated, 72 down-regulated) and 502 EMT-related genes (304 up-regulated, 198 down-regulated). Functional enrichment revealed disrupted biological processes including interleukin-1 production and extracellular matrix organization organization. Coexpression analysis uncovered 2 modules linked to apoptosis and senescence. Up-regulated transient receptor potential cation (TRP) cation channels correlated with elevated senescence; altered NFKBIA, NFKB1, and TNFSF10 expression with endothelial apoptosis. We identified 1052 drugs targeting 133 dysregulated ion channels and performed docking analysis for TRP channels. Experimental validation confirmed altered expression of TRPV1, CDKN2A, and KRT7.

Conclusions: Dysregulated TRP cation channels contribute to cellular senescence and peripheral sensitization in FECD, whereas altered apoptotic regulators drive corneal endothelial cell death. Most likely, these pathways represent potential targets for treatment of patients with FECD.

Purpose: To identify clinical factors influencing corneal endothelial damage during international transportation by evaluating the condition of donor corneas upon arrival in Japan, representing the real-world scenario faced by importing countries.

Methods: We analyzed 194 donor corneas (from 102 donors; mean age 29.8 years) transported from 3 US eye banks to Japan. All corneas underwent trypan blue staining (0.4%) to quantify endothelial damage, with damaged areas manually traced and analyzed using custom Python-based image analysis. Univariate and multivariate analyses using generalized linear mixed models identified predictors of endothelial damage, with donors stratified into high- and low-damage groups based on median staining rates.

Results: Most corneas (62.4%) showed minimal damage (<2% trypan blue-positive area), whereas 4.1% exhibited extensive damage (>10%). Multivariate analysis identified the following 4 independent predictors of increased endothelial damage: eye bank source (eye bank C vs. A: odds ratio [OR] 4.67, 95% confidence interval [CI] 1.08 to 20.07, P = 0.039), younger donor age (≥31 vs. <31 years: OR 0.40, 95% CI 0.17-0.93, P = 0.033), donor race (Black vs. White: OR 3.44, 95% CI 1.28-9.25, P = 0.014), and cause of death (gastrointestinal disorder vs. cardiovascular disease: OR 4.92, 95% CI 1.35-17.95, P = 0.016; malignant tumor vs. cardiovascular disease: OR 14.32, 95% CI 3.01-68.13, P <0.001). Neither time from death to donation nor preservation duration predicted damage, validating current temporal protocols.

Conclusions: This study identifies real-world factors influencing endothelial integrity in internationally transported donor corneas, addressing an underrecognized aspect of global eye banking.

Purpose: To evaluate clinical outcomes of conjunctival flap surgery in the management of refractory infectious keratitis at a tertiary care center.

Methods: This retrospective, single-center case series included patients who underwent complete or partial conjunctival flaps for infectious keratitis at the Bascom Palmer Eye Institute between January 2015 and March 2023. Cases were identified via Current Procedural Terminology codes and confirmed by chart review. Surgical success was defined as infection resolution without further surgery or ongoing antimicrobial therapy. Independent samples t tests and χ2 tests compared continuous and categorical variables, respectively. Kaplan-Meier survival analysis evaluated time to resolution, with group differences assessed using log-rank and generalized Wilcoxon tests.

Results: Nine patients (43%) received complete flaps, and 12 (57%) received partial flaps. Surgical success was achieved in 55.6% of complete flaps and 66.7% of partial flaps. Larger ulcer area was associated with flap failure (P = 0.021). Best-corrected visual acuity at last follow-up was better (P = 0.043) among partial flap cases (1.7 ± 1.0 logMAR) compared with those of complete flaps (2.7 ± 0.7 logMAR). Kaplan-Meier survival analysis showed that time to resolution differed by flap type according to the Wilcoxon test (P = 0.029) and a trend toward significance by the log-rank test (P = 0.053), suggesting earlier resolution among partial flap cases.

Conclusions: Conjunctival flaps achieved infection resolution in most cases of refractory infectious keratitis, with partial flaps showing slightly higher overall success and earlier resolution. These findings support conjunctival flaps as a salvage option, particularly in resource-limited or refractory settings, although further prospective evaluation is warranted.