Cornea最新文献

Purpose: To present 4 family members with posterior polymorphous corneal dystrophy (PPCD), nonkeratoconic steep corneas, and myopia caused by a previously unknown genetic alteration in the ZEB1 gene.

Methods: Ophthalmic examinations and corneal curvature analyses were performed for all patients. Whole-exome targeted gene panel sequencing was performed for 1 patient. Pathogenic variant confirmation and segregation of the variant were performed for all 4 patients using Sanger sequencing.

Results: A mother and her 3 children presented with bilateral diffuse corneal opacities, vesicular aggregates at the Descemet membrane level, and endothelial stippling, compatible with the diagnosis of PPCD. All patients had steeper than average keratometry readings with normal globe axial lengths and refractive moderate to extremely high myopia, ranging from -2 to -16.5 diopters (spherical equivalent). The younger patients had more severe findings, with the youngest, an 11-month-old girl, presenting with keratometry readings of 66.72 × 69.48 @ 132 degrees and 66.10 × 67.32 @ 34 degrees in the right and left eyes, respectively. The ZEB1:c.794-1G>A; chr10-31809053G>A; NM_001174096.2 mutation was detected in all patients.

Conclusions: We describe a novel ZEB1 mutation associated with PPCD, nonkeratoconic steep corneas, and myopia. PPCD3 should be considered not only as an endothelial pathology but also as an ectatic disorder and should be ruled out in young children presenting with high myopia.

Purpose: Conjunctival autografts (CAGs) are the gold standard treatment after pterygium resection, but it is challenging to achieve consistently thin Tenon-free CAGs with manual dissection. We herein report the reproducibility and clinical outcomes of a novel algorithm to produce customizable trapezoidal CAGs using femtosecond laser (femtosecond lasers)-assisted pterygium surgery.

Methods: We first tested this algorithm in 4 pig eyes to show reproducibility. We then treated 15 pterygia of 14 patients using this algorithm. After manual pterygium excision, 7-mm x 10-mm preset trapezoidal CAGs were dissected with the Ziemer FEMTO LDV Z8 laser set at a 60 μm depth. The achieved thickness was measured with intraoperative optical coherence tomography, and the achieved area was calculated.

Results: For the pig eyes, the average CAG length and width were 9.8 ± 0.1 mm and 7.3 ± 0.04 mm, respectively, with a mean deviation of 7.3% ± 3.2% and 7.5% ± 4.1%, respectively. The mean age of the patients was 56.8 ± 7.3 years. The programmed and achieved CAG areas were 70 mm2 and 72.5 ± 3.9 mm2, respectively, with a mean deviation of 4.7% ± 4.6%. The eventual CAG thickness was 59.5 ± 3.9 μm, with a minimal deviation of 4.4% ± 4.6%. The average time to remove the FSL-prepared CAG to unfold it onto the cornea was 19.9 ± 14.9 seconds. At the postoperative month 3 follow-up, no postoperative complications or recurrences occurred, and all donor CAG sites had completely healed.

Conclusions: This novel algorithm using the FEMTO LDV Z8 in Femtosecond Laser-Assisted Pterygium Surgery provides consistent and customizable trapezoid ultrathin CAGs. Longer follow-up and larger cohorts will need to be studied for recurrence and complication rates.

Purpose: Congenital hereditary endothelial dystrophy (CHED) impairs the sensitive phase of visual development. We examined results of Descemet stripping automated endothelial keratoplasty (DSAEK) for CHED regarding the critical period for amblyogenic factors.

Methods: Retrospective analysis of 11 eyes of 6 consecutive patients with CHED younger than 8 years treated with DSAEK and a PubMed-based literature search on management and optimal timing of the intervention.

Results: Our series encompasses 11 eyes of 6 children who received 6 DSAEKs and 5 non- or partial DSAEKs. Mean age at surgery was 3.45 years (0.59-7.44). In 3 eyes, further interventions were necessary, 2 were Re-DSAEKs for early graft failure. At final visit, all 10 transplants with a follow-up >1 month were clear, and 2 corneas showed slight stromal opacification. Final visual acuity was 0.8-0.2 logMAR (mean 0.49) in 9 eyes with sufficient follow-up time in cooperative patients. Mean follow-up was 47 months. Six eyes showed postoperative hyperopia > 5D. We found literature reports on 58 DSAEK/non-DSAEK procedures in 36 children with CHED under 8 years, including 11 children under 2 years. Data show a trend for better visual outcomes of DSAEK in CHED at younger age. Non-DSAEKs seem to be associated with more graft complications.

Conclusions: DSAEK for CHED in young children is an option for achieving corneal transparency with a trend toward better outcomes of surgery at younger age. The special features of amblyopia in CHED make studies with follow-up times to reach age for reliable acuity testing and recovery from amblyopia worthwhile.

Purpose: To describe a three-phase surgical approach for managing progressive visual decline in a patient with myopia magna and a history of epikeratophakia.

Methods: A 55-year-old woman with previous epikeratophakia surgery in both eyes experienced progressive visual deterioration. The three-phase approach included: (1) removal of the epikeratophakia lenticule, (2) cataract extraction with intraocular lens implantation, and (3) transepithelial topography-guided photorefractive keratectomy (trans-PRK). Preoperative and postoperative refraction, corneal topography, and visual acuity were assessed.

Results: After trans-PRK, the right eye exhibited regularization of the corneal surface, with a final best spectacle-corrected acuity of 0.15 logMAR. A similar two-phase approach without lenticule removal was applied to the left eye, resulting in improved visual outcomes.

Conclusions: A three-phase surgical approach combining lenticule removal, cataract surgery, and topography-guided PRK offers a potential pathway for visual improvement in patients with phakic postepikeratophakia.

Purpose: To report the indications, postoperative visual outcomes, and long-term graft survival of primary pediatric keratoplasties performed at a single tertiary care center.

Methods: We conducted a retrospective review of pediatric patients (16 years and younger) who underwent surgical intervention for corneal opacity at a tertiary care center to evaluate long-term graft survival and visual rehabilitation.

Results: Seventy-three eyes of 46 patients met inclusion criteria. The mean patient age at the time of transplantation was 7.44 years (range, 5 months-15.72 years), and the average follow-up time was 5.82 years. Forty eyes (56%) had graft failure occurring at a mean time of 16.33 months (range, 27 days-12.58 years), of which 25 eyes (62.5%) underwent repeat keratoplasty. Cumulative graft survival probabilities at 1, 3, 5, and 7 years after keratoplasty were 60%, 55%, 44%, and 44%, respectively. Cox proportional hazards regression analysis showed Black ethnicity [hazard ratio (HR) = 4.72; confidence interval (CI), 1.16-19.23], mixed/other ethnicity (HR = 6.67, CI, 1.58-28.16), and keratoplasty in combination with another procedure (HR = 2.88; CI, 1.35-6.15) as significant risk factors of graft failure. 47 eyes (64%) achieved ambulatory vision (20/800 or better) at the last follow-up. Age younger than 5 years at time of keratoplasty was associated with better visual outcomes in patients with congenital disease (P = 0.0017).

Conclusions: Pediatric keratoplasty has a high rate of graft failure but can achieve ambulatory vision in >60% of patients. Keratoplasty outcomes are improved in non-Hispanic, White patients and when the intervention is performed alone. Younger age at time of keratoplasty for congenital conditions improves the likelihood of overall visual rehabilitation.

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 evaluate postoperative visual outcomes on postoperative day 1 (POD1) after lenticule extraction in myopia astigmatism in a large cohort of over 1350 consecutive treatments.

Methods: A retrospective review chart identified 1357 eyes consecutively treated with SCHWIND ATOS using lenticule extraction for myopic astigmatism who had at least 6 months of follow-up completed and for which POD1 was completely recorded. The standard visual and refractive outcomes, and astigmatism outcomes, were analyzed on POD1. As a sanity check, the stability of defocus and uncorrected distance visual acuity (UDVA) were evaluated from day 1 to 1-year postoperative follow-ups.

Results: On POD1, 82% of the eyes achieved an UDVA of 20/20 or better, with 82% of the eyes with postoperative UDVA being the same or better than the preoperative corrected distance visual acuity baseline, and only 2% of eyes lost 2 lines of corrected distance visual acuity. Postoperative spherical equivalent (+0.15 ± 0.35D) was within 0.75 D in 98% of the cases, with excellent stability from 1-week to 1-year postoperative follow-ups (11% eyes changing by 0.5D of defocus). Postoperative refractive astigmatism at POD1 (0.01 ± 0.08 D) was highly accurate, with over 99% of the cases within 0.5 D, and 99% within 5 degrees of the attempted axis. The astigmatic correction index (1.00 ± 0.08) showed 98% of the cases within 10% deviation.

Conclusions: In this large cohort of over 1350 cases, lenticule extraction using SCHWIND ATOS is safe and effective on POD1, shows stability from 1-week to 1-year postoperative follow-ups, and suggests accurate and precise corrections for both defocus and astigmatism.

Purpose: To evaluate outcome and incidence of ocular hypertension after Descemet membrane endothelial keratoplasty (DMEK) and DMEK combined with cataract surgery (triple DMEK) after Nd:YAG laser iridotomy (IO) and surgical iridectomy (IE).

Methods: This is a single-center, retrospective cohort study of patients who underwent DMEK or triple DMEK surgery at the Department of Ophthalmology, University Hospital Düsseldorf, Germany, from January 2018 to June 2020 and had received either a prophylactic preoperative IO or an intraoperative IE. Patient demographic data; best corrected visual acuity; central corneal thickness; intraocular pressure (IOP); endothelial cell density; and complications such as occurrence of early postoperative IOP elevation, macular edema, rebubbling rate, and incidence of glaucoma were analyzed.

Results: A total of 75 patients were included in each study arm with a follow-up of 22.04 ± 12.8 months. Best corrected visual acuity significantly increased postoperatively in both cohorts without significant differences. Early postoperative IOP elevation due to pupillary block was significantly more common in eyes with IO (33.3%, n = 25) than with IE (2.67%, n = 2, P < 0.001). The incidence of de novo glaucoma was 5.34% in both cohorts without significant differences in prevalence at the last follow-up (YAG IO cohort: 17.3%, IE cohort: 14.7%, P > 0.05). Rebubbling was required in 16% (n = 12) of eyes in each cohort (P > 0.999).

Conclusions: Postoperative pupillary block after DMEK occurs significantly more often after preoperative Nd:YAG laser iridotomy compared with surgical intraoperative iridectomy but does not negatively affect long-term visual outcome or glaucoma incidence after DMEK.