Cornea最新文献

Purpose: Human T-lymphotropic virus (HTLV), cytomegalovirus (CMV), and Epstein-Barr virus (EBV) each have the propensity for infection as well as the development of latency in humans. As many ocular tissue report forms provided by Eye Bank Association of America (EBAA) member eye banks list serological testing results for these viruses, the EBAA Policy and Position Review Subcommittee (PPRS) sought to investigate and clarify the implications of these results.

Methods: Current EBAA policies regarding HTLV, CMV, and EBV were reviewed. Additionally, a search of articles written in or translated into the English language regarding the aforementioned viruses with a focus on ocular infection and ocular tissue transplantation was performed on PubMed.

Results: Current EBAA policies indicate that ocular tissues from donors with seropositivity to HTLV, CMV, and/or EBV can be used for transplantation. The risk of transmission of HTLV was felt to be the most consequential, given its low seroprevalence and its association with adult T-cell lymphoma/leukemia. However, as corneal and limbal tissue are not leukocyte-rich, the risk of transmitting HTLV is low. Despite reports of the isolation of all 3 viruses in ocular tissues, a literature review did not reveal any reported cases of viral transmission through ocular tissue transplantation.

Conclusions: Ocular tissues from donors with seropositivity to HTLV, CMV, and/or EBV can be used for transplantation per current EBAA guidelines. Despite the potential for ocular infection by these viruses, there are no reported cases of viral transmission from ocular tissue transplantation, affirming the validity of the current EBAA guidelines.

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.

Purpose: To describe a new "corneal gap bridging technique" (CGBT) used in eyes requiring a penetrating keratoplasty (PKP) with a trephination diameter >8.0 mm combined with a pars plana vitrectomy (PPV) to allow for the effective application for otherwise unsuitable standard keratoprostheses.

Methods: A proof-of-concept study in 2 eyes undergoing combined PKP and PPV with corneal gap bridging technique at a tertiary university hospital. The first patient was an 88-year-old woman with infectious keratitis endophthalmitis and the second was a 34-year-old man with peripheral corneal melting and retinal detachment with subretinal proliferative vitreoretinal membrane. An Eckardt-keratoprosthesis was implanted into a donor's corneoscleral disc unsuitable for permanent transplantation because of scarring or reduced endothelial cell counts. After trephination of the host cornea, the disc is fixed to the recipient sclera with interrupted sutures, allowing optimal visualization of the posterior segment during PPV through the now centered keratoprosthesis. After PPV, the disc and prosthesis are removed, and the permanent corneal donor tissue is transplanted as in PKP.

Results: At the last follow-up, both eyes showed a clear graft with attached retina and no signs of recurrent infection.

Conclusions: The Homburger corneal bridging technique is a viable option to use the benefits of temporary keratoprostheses in eyes requiring a large-diameter PKP with combined PPV. The disc fixation is easy to perform as in PKP without a new learning curve. Further studies are needed to determine whether the improved visualization provided by this approach translates into better long-term functional and anatomical outcomes in eyes with complex pathologies.

Purpose: To describe a case series of patients with 12 fungal keratitis treated with caspofungin 0.5% eye drops.

Methods: In this study, 12 patients diagnosed with fungal keratitis were treated with topical compounded caspofungin 0.5% eye drops. The authors also reviewed the existing literature on topical caspofungin 0.5% for managing fungal keratitis.

Results: The average age of the patients was 50.16 ± 13.74 years, and the average time to presentation was 9.66 ± 6 days from the onset of symptoms. Out of the 12 patients, 10 were males, and 2 were females. Three (25%) patients had infiltrates extending up to the mid-stromal level, whereas 9 (75%) had superficial infiltration. Topical caspofungin monotherapy successfully treated the fungal infection in 8 (66.6%) patients, whereas 4 patients required additional medication and/or surgical intervention. The average size of the infiltration was 3.44 ± 1.21 mm. The group that responded to treatment had better final visual acuity compared to the nonresponding group, with values of 0.41 ± 0.48 logarithm of the minimum angle of resolution and 1.39 ± 0.10 logarithm of the minimum angle of resolution ( P -value = 0.023), respectively.

Conclusions: Topical caspofungin 0.5% is a safe and effective treatment for selected cases of fungal keratitis. However, cases with larger or deeper initial infiltrates, or those caused by Fusarium infection, may not respond adequately to topical caspofungin monotherapy.

Purpose: The aim of this study was to evaluate the activity of photoactivated 0.1% rose bengal (RB) for in vitro growth inhibition of the most prevalent fungi isolates in infectious keratitis.

Methods: Eight corneal clinical isolates were included in the experiments: Fusarium solani complex, Purpureocillium lilacinum , Candida albicans , Candida parapsilosis complex, Exophiala oligosperma , Scedosporium apiospermum complex, Aspergillus niger complex, and Curvularia geniculata . Microorganisms, previously identified by phenotypical methods, were grown and incubated at specific conditions and prepared in suspension for concentration adjustments. The following groups were evaluated in triplicate: group I, no treatment; group II, treated with RB and exposed to the dark for 30 minutes; group III, exposed to green-light light-emitting diode 7.2 mW for 30 minutes (photodynamic therapy [PDT]); and group IV, treated with RB and PDT (RB-PDT). The final work concentration was 10 4 cells per mL. The RB-PDT was combined with Amphotericin B (AmphoB) to target isolates that were not inhibited by RB-PDT alone. Plates were incubated at specific conditions and photographed after growth for pixel analyses.

Results: The growth was inhibited after RB-PDT for F. solani complex, P. lilacinum , C. albicans , C. parapsilosis complex, and E. oligosperma , and not inhibited for S. apiospermum complex, A. niger complex, and C. geniculata , even though combining RB-PDT with AmphoB.

Conclusions: RB-PDT presented good activity against five of the tested microorganisms. For the first time, we demonstrated that RB-PDT could inhibit growth of P. lilacinum , C. parapsilosis complex, E. oligosperma , and not inhibit S. apiospermum , A. niger complex, and C. geniculata , even when combined with AmphoB.