Cornea最新文献

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.

Purpose: The purpose of this study was to report the first documented case of peripheral corneal perforation associated with tralokinumab therapy for atopic dermatitis.

Methods: A detailed clinical examination, imaging, and comprehensive systemic workup were performed to determine the etiology. The case was managed surgically and followed postoperatively at a tertiary hospital within the Spanish National Health System.

Results: We report the case of a 66-year-old woman receiving tralokinumab for atopic dermatitis who presented with a spontaneous 10 mm peripheral corneal perforation, self-sealed by iris prolapse. Urgent surgical intervention included corneal suturing and amniotic membrane grafting. There was no evidence of trauma, infection, systemic autoimmune disease, or periocular atopic dermatitis. A comprehensive systemic workup ruled out infectious and autoimmune etiologies. Tralokinumab was discontinued in coordination with the dermatology department. The patient experienced a favorable recovery, with complete corneal healing and improvement in best-corrected visual acuity to 0.1 logMAR at 3 months.

Conclusions: This case represents the first reported instance of corneal perforation potentially related to tralokinumab. Although ocular side effects of IL-13-targeted therapies are typically mild, this report highlights the possibility of severe complications. Given the increasing use of biologic agents in dermatology, awareness of rare but potentially vision-threatening adverse effects is essential. In suspected cases, early ophthalmologic evaluation and multidisciplinary management are crucial for preventing poor outcomes in patients receiving tralokinumab.

Purpose: Iridocorneal endothelial (ICE) syndrome is a rare ocular disease affecting the anterior segment, leading to cornea edema and glaucoma. Its unclear etiology limits clinical management to symptomatic interventions. This study uses diverse methodologies to explore potential viral sequences in patients' samples and to elucidate the transcriptomic profiles of ICE cells.

Methods: We used a convenience sampling method, including all eligible patients for analysis. We reviewed polymerase chain reaction (PCR) results for herpes viruses across all samples obtained from ICE syndrome patients at our institution. To further delve into potential pathogenic involvement, we used metagenomic sequencing and whole-genome sequencing techniques on samples. We used smart-seq2 RNA sequencing to explore the transcriptomic features of ICE cells compared with normal cells.

Results: In our PCR tests involving 141 samples, only two positive results were detected in the aqueous humor. Furthermore, the application of metagenomic sequencing on three aqueous humor samples and three corneal endothelium samples, along with whole-genome sequencing on one corneal endothelium sample, yielded no evidence of viral sequences. RNA sequencing revealed upregulated cell growth and neuronal death in ICE cells, alongside downregulated expression in extracellular matrix composition, cell adhesion, and immune response functions.

Conclusions: Our findings from multiple sequencing assays consistently indicate the absence of compelling evidence supporting viral infection in patients with ICE syndrome. Furthermore, the transcriptional analysis of ICE cells reveals a distinct profile characterized by upregulated cell growth and suppressed immune response. Future studies are necessary to validate these findings and improve the generalizability of the results.

Purpose: This study examines the long-term clinical outcomes of an artificial endothelial replacement membrane implant used to treat corneal edema. It also explores the interaction between the device and the posterior surface of the cornea.

Methods: Patients suffering from late endothelial keratoplasty failure (5 patients) or bullous keratopathy (2 patients) after multiple surgeries underwent EndoArt (EyeYon Medical, Israel) implantation. Before surgery and at 1-, 3-, 6-, 12-, 18-, and 24-month intervals, corrected distance visual acuity and central corneal thickness were measured. High-resolution anterior segment optical coherence tomography images were analyzed at each interval to detect device detachment and evaluate the implant interaction with the corneal tissue over time.

Results: Corrected distance visual acuity improved from a mean of 1.32 ± 0.23 (logarithm of the Minimum Angle of Resolution) preoperatively to 0.95 ± 0.28 (logarithm of the Minimum Angle of Resolution) 2 years after surgery ( P = 0.03). Central corneal thickness significantly decreased from 805 ± 131 μm preoperatively to 577 ± 90 μm postoperatively ( P = 0.002). Four of the 7 patients experienced device detachment, requiring 1 or more rebubblings to achieve stable implant adhesion. Anterior segment optical coherence tomography showed annular fibrosis developing between the device margin and the host cornea in most patients, particularly those who had never experienced detachment.

Conclusions: This study suggests that EndoArt is effective in the long term for improving corneal transparency and visual acuity in patients with chronic corneal edema with a limited prognosis for endothelial keratoplasty. The formation of fibrotic tissue between the periphery of the device and the host cornea may explain the strong adhesion of the implant.

Purpose: To compare long-term outcomes of Descemet membrane endothelial keratoplasty (DMEK) versus Descemet stripping automated endothelial keratoplasty (DSAEK) under a failed penetrating keratoplasty (PKP) graft.

Methods: We retrospectively reviewed consecutive surgeries (Febuary 2007-September 2023) that received a DSAEK graft (n = 52) or DMEK graft (n = 51) under a failed PKP. Postoperative complication rates of primary graft failure (PGF), late endothelial graft failure, graft rejection, rebubble, and steroid response were recorded. Endothelial cell loss (ECL) at 6-month, 2-year, and 5-year postoperative visits were calculated. Graft survival time and survival probability at 5 years was determined using a Kaplan-Meier analysis. Twelve DMEK and 17 DSAEK eyes had 5-year follow-up. Eyes with a glaucoma filtration tube, trabeculectomy, or anterior chamber intraocular lens were excluded.

Results: Rebubble rate was significant between DSAEK and DMEK cohorts (5.8%, 29.4%, P = 0.0017*). Rate of rejection, late endothelial graft failure, steroid response, 6-month ECL, 2-year ECL, 5-year ECL, survival probability, and 5-year mean survival time were not significant between DSAEK and DMEK cohorts [(9.6%, 5.9%, P = 0.7155), (13.5%, 9.8%, P = 0.7602), (9.6%, 11.8%, P = 0.7602), (32.0% ± 21.0%, 41.65% ± 25.6%, P = 0.1949), (55.8% ± 21.6%, 62.5% ± 19.8%, P = 0.4463), (59.5% ± 35.0%, 72.5% ± 5.7%, P = 0.3468), (88.5%, 84.3%, P = 0.483), (53.9 ± 2.4 confidence interval, 49.1-58.6 months, 52.7 ± 2.9 confidence interval, 47.0-58.5 months)]. PGF occurred in 0/52 (0%) and 3/51 (5.9%) eyes in the DSAEK and DMEK cohorts with nonsignificant trends favoring DSAEK ( P = 0.1178).

Conclusions: The only significant difference between DSAEK and DMEK cohorts was rebubble rate. However, nonsignificant trends favored PGF and ECL in the DSAEK cohort. Further investigation is warranted to determine if DSAEK provides better short-term and similar long-term outcomes compared with DMEK under a failed PKP.

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.

Purpose: Keratoconus affects patients' quality of life. No study has assessed the multivariate determinants of quality of life using the keratoconus end points assessment questionnaire (KEPAQ).

Methods: This study included patients with keratoconus with no history of ocular surgery, who underwent clinical evaluation and tomographic imaging using a dual Scheimpflug/Placido device (Galilei G6). Emotional and functional quality of life was assessed using the KEPAQ. Multiple linear regression models were constructed for each KEPAQ subscale to adjust for confounding variables.

Results: A total of 140 surgery-naïve patients with keratoconus were included, with a median age of 39 years and a male predominance (57.1%). For the KEPAQ-E subscale, the multivariate model was significant [F(84,10) = 2.79; adjusted R 2 = 0.160, P = 0.005], showing that female sex (β = -0.41) and worse corrected distance visual acuity in the better-seeing eye (β = -0.29) were associated with lower quality of life. Including the functional subscale score significantly enhanced the model's performance (adjusted R 2 = 0.464, β = 0.60). For the KEPAQ-F subscale, the model was also significant [F(84,10) = 2.37; adjusted R 2 = 0.127, P = 0.016], with corneal astigmatism in the better-seeing eye (β = -0.30) reducing quality of life. Adding the emotional subscale score improved the model (adjusted R 2 = 0.442, β = 0.62).

Conclusions: Female sex, reduced vision, and corneal astigmatism negatively affect quality of life in patients with keratoconus. Nonetheless, patients' perceived impairment as measured in 1 subscale is a stronger predictor of overall quality of life than clinical and tomographic factors alone.

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

Methods: The Japan Cornea Society and the Keratoplasty Society of Japan 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: We report a case of spontaneous Descemet membrane detachment (DMD) in a patient with a history of necrotizing scleritis and discuss the management approach and outcome.

Methods: This was a case report and review of literature.

Results: A 50-year-old man with a history of rheumatoid arthritis, ankylosing spondylitis, and necrotizing scleritis on systemic methotrexate, rituximab, and prednisone presented with 6 weeks of photophobia, pain, and decreased vision in his left eye. Visual acuity on presentation was 20/80 in the left eye, and intraocular pressure was 18 mm Hg. Slit lamp examination demonstrated scleral injection most significantly in an area of superonasal epithelialized scleral thinning with underlying uveal visibility, indicating prior necrotizing scleritis. Bullous corneal edema extended from the limbus superonasally into the visual axis. The remainder of the anterior and posterior segment evaluations was unremarkable. Anterior segment optical coherence tomography confirmed the presence of DMD underlying the area of corneal edema. The patient was treated with an increased dose of oral prednisone with subsequent taper for systemic autoimmune control given active nonnecrotizing scleritis, followed 2 months later by air bubble injection in the anterior chamber and face-up positioning for 2 days. This led to reattachment of Descemet membrane and complete clearance of corneal edema, with improvement of vision to 20/25 on follow-up.

Conclusions: This is the first report of spontaneous DMD in a patient with a history of necrotizing scleritis. A possible mechanism may include shearing forces secondary to scleral ectasia, which may result in focal Descemet membrane tears and subsequent detachment.