Cornea最新文献

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 objective of this study was to identify social risk factors (SRFs) that affect microbial keratitis (MK) care using the Penchansky-Thomas (P-T) health care access framework.

Methods: This combined retrospective and prospective cohort study recruited participants with newly diagnosed MK at an academic medical center. Participant demographic information and SRFs were collected using in-person interviews and chart review. SRFs were categorized into P-T framework domains. Primary analysis included proportion of participants reporting SRFs, distribution of reported SRFs, and demographic differences associated with SRFs using descriptive statistics, chi-square, and two-sample t tests. A subgroup analysis for participants who were lost to follow-up (LTFU) was performed.

Results: A total of 100 participants with MK were included in this study. Of the 100 participants, 60.0% reported at least 1 SRF affecting care, 42.0% reported ≥2 SRFs, and 12.0% reported ≥4 SRFs; 40.0% had no SRFs. More SRFs were reported for participants with lower income versus those with higher income ($25,000-$50,000 vs. $51,000-$100,000, P = 0.0363); there were no other demographic differences between groups. The most reported SRF was distance to appointment (45.0%). Accessibility was the most reported P-T domain (49.0%). Participants with LTFU, compared with those not LTFU, had more SRFs (100% vs. 52.4%, P = 0.0001) and reported a greater median number of SRFs (3.0 vs. 1.0, P < 0.0001).

Conclusions: SRFs affected most patients with MK, most notably accessibility and affordability. Participants with lower income had more SRFs. SRFs are linked to patients being lost to follow-up care.

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.

Purpose: Epithelial downgrowth (EDG) is a relatively infrequent complication of intraocular surgery or eye trauma. The literature is limited on this condition, and it remains a diagnostic challenge, both histologically and clinically. We have conducted a 24-year single-institution clinical and pathological retrospective review of EDG cases.

Methods: Cases of histologically suspected EDG were identified through the electronic record system at Casey Eye Institute Pathology Laboratory. Keywords entered in the search included "epithelial ingrowth" or "epithelial downgrowth" spanning the dates January 1999 to March 2023.

Results: Fifty-eight patients with suspected EDG on pathology were included in the study. Most patients had a complex surgical history, defined as 2 or more intraocular surgeries (64%; n = 37). History of nonsurgical ocular trauma was noted in 19% of cases (n = 12). The highest documented clinical presentations included corneal graft failure (52%; n = 30) and bullous keratopathy (12.5%; n = 8). Of the graft failure cases, 53% were penetrating keratoplasties (n = 16). EDG was clinically suspected in 16% of cases (n = 9). Overall, there has been an uptrend of histologically suspected cases from 1999 to present at our institute, with the highest number of suspected cases in the years 2018 to 2023 compared with the 1999 to 2005, 2006 to 2011, and 2012 to 2017 time intervals.

Conclusions: EDG is diagnostically complex, and many suggestive features on pathology are not definitive. The frequency of cases with clinical suspicion for EDG and/or histopathologic features raising consideration of EDG have increased over a 24-year period. This study underscores the need for further research to aid in definitive diagnosis of EDG.

Purpose: The purpose of this study was to report the indications and long-term anatomical and functional results of a series of children operated on by ipsilateral rotational autokeratoplasty.

Methods: This retrospective, multicenter study was based on the medical records of 33 eyes of 31 children who underwent ipsilateral rotational autokeratoplasty in 2 pediatric ophthalmology departments in Paris. The etiology of corneal opacity, preoperative and postoperative visual acuity, size of the trephine used, postoperative complications, refractive error, and duration of follow-up was retrieved. Visual acuity (VA) was converted to logarithm of the minimum angle of resolution.

Results: The most frequent indications were corneal scars after ocular trauma (21 cases, 64%), congenital corneal opacities (9 cases, 27%), and postinfectious scars (3 cases, 9%). At last follow-up, 97% of the eyes had a clear visual axis. The mean postoperative VA was 0.83, and mean postoperative astigmatism was 5.41 diopters. When available, VA of the operated eye was equal to or better than 0.3 logarithm of the minimum angle of resolution in 8 cases (32%). The factors significantly associated with a postoperative VA of 0.3 or better were a later age of onset of the opacity ( P < 0.01), a later age at surgery ( P < 0.01), and a posttraumatic mechanism ( P = 0.03). A postoperative complication was found in 13 patients (40%), and consisted most frequently in a wound leakage and/or iris hernia in the early postoperative period.

Conclusions: Ipsilateral rotational autokeratoplasty is an excellent alternative to penetrating keratoplasty in children because the anatomical result seems better and the complication rate less important than in pediatric penetrating keratoplasty, where graft rejection occurs frequently.

Purpose: To report the outcomes of a Tenon patch graft (TPG) in sealing corneal perforations in cases with resolving infectious keratitis.

Methods: This retrospective interventional study was conducted at a tertiary eye care center. All patients who underwent a TPG for corneal perforations because of clinically or/and microbiologically diagnosed infectious keratitis between 2021 and 2023 were included. The surgical technique was consistent with that used in noninfective etiology. Out of 100 cases undergoing a TPG during the same period, 15 eyes of 14 patients had corneal perforations secondary to infectious keratitis.

Results: The etiological profile included bacterial keratitis in 8, viral and fungal keratitis in 3, and Pythium keratitis in 1 eye of 15 eyes. One patient had bilateral infectious keratitis after refractive surgery. The perforations were central in 7 and paracentral in 8 eyes. Successful restoration of tectonic integrity at 1 month was achieved in 14/15 eyes (93%). One patient had a repeat perforation at 3 weeks postoperatively, which was managed with a cyanoacrylate glue application. Infection control was achieved in all cases with adjunctive topical antimicrobial therapy.

Conclusions: A TPG is a viable option for restoring globe integrity in corneal perforations encountered in resolving infectious keratitis.

Purpose: The aim of this study was to describe corneal biomechanical changes in individuals carrying the p.Ala546Asp mutation, compare those with and without visible corneal deposits, and explore their potential relevance for early biomechanical characterization.

Methods: A case series was conducted in a Mexican mestizo family with confirmed molecular diagnosis of granular corneal dystrophy type 2 (GCD2). Participants were classified into 3 groups: mutation carriers with clinically visible corneal deposits (n = 8), mutation carriers without visible deposits (n = 3), and healthy controls without the mutation (n = 20). Corneal biomechanics were evaluated using the Corvis ST system, focusing on the corneal biomechanical index (CBI), stiffness parameter at first applanation (SP-A1), Corvis biomechanical factor (CBiF), and deformation amplitude ratio (DA ratio).

Results: CBI was significantly higher in mutation carriers, regardless of deposit presence (mutation with deposits: 0.63 ± 0.23; mutation without deposits: 0.57 ± 0.25 vs. controls: 0.11 ± 0.11, P < 0.0001). SP-A1 was significantly lower in mutation carriers, suggesting early corneal stiffness alterations. No significant differences were found between mutation carriers with and without visible deposits, indicating that biomechanical changes occur before clinical deposits form.

Conclusions: The p.Ala546Asp mutation may be associated with early corneal biomechanical instability, regardless of visible deposits. These findings suggest that biomechanical assessment may aid in the description of subclinical corneal changes in GCD2 and contribute to a better understanding of biomechanical variability among mutation carriers.