Cornea最新文献

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 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: 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.

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 evaluate associations between sociodemographic factors and surgical management in patients with Fuchs Endothelial Corneal Dystrophy (FECD).

Methods: Patients >40 years old with FECD diagnosis and subsequent corneal edema between 2007 and 2020 were identified from the American Academy of Ophthalmology IRIS Registry (Intelligent Research in Sight). Multivariable Cox proportional hazards models were fit to examine the relationships between sociodemographic variables and time from FECD diagnosis to penetrating keratoplasty (PK) and endothelial keratoplasty (EK)/PK.

Results: A total of 20,366 patients with FECD diagnosis and subsequent corneal edema were identified. Of the 4313 patients who underwent either EK or PK (any surgery), 374 patients underwent PK, 4037 underwent EK, and 98 received both interventions. After controlling for age, sex, and insurance status, Black or African American patients were 1.48 times as likely (hazard ratio 1.48, 95% confidence intervals (CI), 1.06-2.07) to undergo PK as compared with White patients and were less likely to receive any surgery (HR 0.83, 95% CI, 0.74-0.94). Asian patients were less likely (HR: 0.57, 95% CI, 0.43-0.75) to undergo any surgery. Female patients were more likely to undergo PK and less likely to undergo any surgery than male patients, and older patients were less likely to undergo any surgery with each increasing decade of life. There were no significant differences when stratified by insurance type.

Conclusions: Age, sex, race and ethnicity, and insurance type are associated with varying rates of different surgical interventions for FECD.

Purpose: Description of clinical profile, surgical technique, and outcomes in patients having severe entropion secondary to cicatricial ocular surface disorders, who underwent entropion repair and posterior lamellar augmentation using auricular cartilage graft.

Methods: A retrospective review of electronic medical records was performed over a 4-year period (August 2019-August 2023) to identify cases with entropion and cicatrizing ocular surface disorders that had undergone entropion repair with auricular cartilage grafting.

Results: Seventeen eyelids of 15 patients were included. The average age of the study population was 33.17 ± 16.8 years, with an almost equal male to female ratio (8 male, 7 females). Lower eyelid was more commonly involved (n = 11, 64.7%) than the upper eyelid (n = 6). Steven-Johnson syndrome (n = 11, 64.7%) was the most frequent etiology. Two patients (13.3%) underwent bilateral surgical repair, whereas in 5 eyelids (29.4%), the procedure was combined with lid margin mucous membrane grafting at the same sitting. Cartilage graft was harvested through posterior auricular approach in all cases. Postoperatively, entropion correction was achieved in 16 eyelids (94.1%), and postoperative improvement in ocular surface scoring was noted in 11 eyelids (64.7%). Improvement in visual acuity postoperatively was noted in 52.9% eyes. Over an average follow-up of 16.64 months, 1 eyelid (5.8%) required additional everting sutures and 1 eyelid (5.8%) needed trimming of the graft.

Conclusions: Cartilage graft-aided entropion surgery is a viable and satisfactory management option in severe cicatricial entropion in ocular surface disorders and can be combined with lid margin mucous membrane grafting for simultaneous correction of lid margin keratinization. Auricular cartilage is a versatile graft with easy harvesting and minimal donor-site morbidity.

Purpose: Down syndrome is one of the strongest risk factors of keratoconus. Corneal collagen crosslinking (CXL) is the standard-of-care treatment to reduce progression, but there is limited published literature about CXL in patients with Down syndrome. We sought to describe outcomes of epithelium-off CXL under general anesthesia in patients with Down syndrome and keratoconus.

Methods: We conducted a retrospective descriptive case series at a single tertiary pediatric hospital. Standard epithelium-off Dresden protocol CXL under general anesthesia was performed in all cases. Preoperative and postoperative corneal characteristics were obtained. All perioperative and postoperative complications were reported.

Results: Between August 2020 and February 2024, CXL was performed on 34 eyes of 20 patients with Down syndrome. The mean age was 20.2 years at the time of crosslinking. The mean preoperative Kmax was 62.3 diopters (range 45.5-95.4), with a mean preoperative central corneal thickness of 466 μm (range 306-538). Visual acuity post procedure in patients seen 1 week postoperatively was stable to improved. One eye developed corneal edema that resolved within 3 weeks postoperatively, and another was found to have new apical scarring a year after the procedure. No other complications were noted.

Conclusions: Keratoconus was diagnosed at an advanced stage in most of the patients with Down syndrome in our cohort. Epithelium-off CXL under general anesthesia was well tolerated. Though follow-up was limited, our results suggest that CXL is feasible and effective in keratoconus associated with Down syndrome.

Purpose: To report a case of Fabry disease (FD) in a female patient with a novel heterozygous deletion in the galactosidase A (GLA) gene.

Methods: A 35-year-old woman with a prior diagnosis of FD confirmed by genetic testing presented with eye irritation, progressive vision loss, and systemic symptoms. Comprehensive ophthalmologic evaluation included slit-lamp biomicroscopy, fundoscopy, visual field testing, optical coherence tomography (OCT), and OCT angiography (OCTA) of both posterior and anterior segments was performed.

Results: Bilateral corneal verticillata was observed on slit-lamp examination. OCT and OCTA of the macula revealed intact retinal structures. Despite normal conjunctival and episcleral vessels on clinical examination, anterior segment OCTA showed mild conjunctival vessel tortuosity. Genetic testing of blood sample identified a novel heterozygous deletion frameshift mutation in the GLA gene (c.816delC, p.Phe273LeufsTer9). Systemic evaluations confirmed multiorgan involvement, including hypertension, renal microalbuminuria, cardiac abnormalities, pulmonary dysfunction, and hyperprolactinemia.

Conclusions: Corneal verticillata is a hallmark ocular finding in FD. Anterior segment OCTA can reveal subtle vascular abnormalities not detectable through routine examination. The identification of a novel GLA likely pathogenic variant expands the genetic spectrum of FD.

Purpose: To evaluate Descemet membrane endothelial keratoplasty (DMEK) for failed endothelial keratoplasty (EK).

Methods: We reviewed 362 consecutive DMEK cases for failed EK (Descemet stripping endothelial keratoplasty (DSEK) or DMEK), 118 for early EK failure, and 244 for late failure in 333 eyes of 323 patients without penetrating keratoplasty. Rejection and graft survival rates were assessed with Kaplan-Meier analysis.

Results: Overall, 85% of cases had 1 prior EK and 15% had 2 to 5. The rate of medically or surgically managed glaucoma was 21% in eyes with 1 failed EK, 51% in eyes with 2, and 80% in eyes with ≥3, P <0.0001. The mean postoperative corrected visual acuity was 20/25 ± 1 line at 1 and 5 years in eyes without vision-limiting comorbidity. The 5-year rejection episode rate was 4%. One- and 5-year survival rates of DMEK regrafts for early failure of an initial EK were 98% and 94%, respectively. One- and 5-year survival rates among all cases of DMEK for EK failure were 96% and 91% in eyes not treated for glaucoma preoperatively, 88% and 81% in eyes with medically managed glaucoma, and 88% and 30% in eyes with a trabeculectomy or tube shunt.

Conclusions: DMEK for failed EK provided rapid visual rehabilitation with low risk of rejection. Graft survival was associated with glaucoma status and original indication for keratoplasty, with Fuchs dystrophy having the most favorable prognosis. Survival rates were highest in eyes treated for early failure of an initial EK.