Cornea最新文献

Purpose: To report on optical coherence tomography angiography (OCTA) in patients with a type 1 Boston keratoprosthesis (KPro) and determine its feasibility through assessment of imaging artifacts.

Methods: KPro and non-KPro subjects were matched for age, gender, and glaucoma diagnosis. OCTA images of the peripapillary optic nerve were obtained, reviewed by 2 readers masked to the diagnosis for artifacts and usability, and used for microvascular measurements.

Results: KPro subjects (n = 18) had worse visual acuity than non-KPro (n = 36) subjects (LogMAR mean ± standard deviation 0.36 ± 0.30 vs. 0.07 ± 0.11, P < 0.001) and a greater proportion were monocular (56% vs. 3%, P < 0.001). OCTA from KPro eyes had more artifacts per scan than images from non-KPro eyes (4 ± 2 vs. 2 ± 2, P < 0.001). About 33% of KPro images were useable based on having image quality score above 40 and artifact in less than 10% of the peripapillary region. Worse visual acuity (odds ratio [OR] 0.01, 95% confidence interval [CI] 2 x 10-4-0.30, P = 0.02) and KPro (OR 0.19, 95% CI 0.05-0.63, P = 0.008) were associated with lowered likelihood of usability. Useable OCTA from 3 KPro eyes with glaucoma demonstrated microvascular defects in the inferior peripapillary region and lower vessel density and flow compared with 3 KPro eyes without glaucoma.

Conclusions: This is the first study assessing OCTA in KPro patients and identified a higher incidence of artifacts that may be associated with the KPro optic. About 33% of KPro images were useable for microvascular measurements, supporting further OCTA research in this population to assess vascular pathology of glaucoma.

Purpose: To evaluate the efficacy and safety of intense pulsed light (IPL) combined with meibomian gland expression (MGX) for the treatment of dry eye disease and meibomian gland dysfunction associated with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis.

Methods: This prospective noncomparative interventional study included 29 patients (58 eyes) who underwent 3 sessions of IPL and MGX at 2-week intervals. Subjective symptoms (ocular surface disease index score) and objective dry eye tests: matrix metalloproteinase 9, tear meniscus height, bulbar redness score, tear film lipid layer thickness (LLT), Schirmer I test, conjunctival and corneal staining, meibomian gland loss, MGX score [meibomian gland score (MGS)], and tear break-up time were assessed at the baseline and after 4, 8, and 12 weeks.

Results: Twenty-nine individuals (57 eyes) were included in this analysis. The ocular surface disease index score decreased significantly from 60.07 ± 23.34 (baseline) to 38.36 ± 22.39 (after 90 days) (P < 0.01). The fluorescein and lissamine green staining scores, MGS, and LLT improved significantly (P < 0.01). In contrast, there were no significant changes in the tear meniscus height values, matrix metalloproteinase 9 positivity, bulbar redness score, Schirmer test, meibography of the superior and inferior eyelids, and tear break-up time. Ocular or skin complications were not observed.

Conclusions: Three IPL therapy sessions followed by MGX seemed to be safe and effective in treating dry eye disease and meibomian gland dysfunction, improving vision-related quality of life, dry eye symptoms, and ocular surface signs, such as corneal and conjunctival staining scores, MGS, and LLT after 90 days in patients with chronic Stevens-Johnson syndrome and toxic epidermal necrolysis.

Purpose: Ocular rosacea is a chronic inflammatory disorder affecting the ocular surface, often associated with cutaneous rosacea. This review aims to explore its pathogenesis, treatment approaches, and future directions for management.

Methods: A review of current literature on the pathophysiology, clinical features, and treatment strategies of ocular rosacea in adults and children (pediatric blepharokeratoconjunctivitis) was conducted. Emerging research on immune dysregulation, microbiome alterations, and potential therapeutic targets was analyzed.

Results: Ocular rosacea involves dysregulation of the immune and neurovascular systems, with toll-like receptor activation and complement system involvement leading to chronic ocular surface inflammation. Alterations in the ocular microbiome have been implicated in disease progression. Treatment strategies emphasize a stepwise approach, incorporating ocular and skin hygiene, lifestyle modifications, and pharmacological interventions. Recent advancements in understanding the disease mechanisms have led to the exploration of targeted therapies, including biologics and small-molecule inhibitors.

Conclusions: Ocular rosacea remains challenging to diagnose and treat, particularly in children (pediatric blepharokeratoconjunctivitis), often leading to delayed intervention and poor outcomes. A multidisciplinary approach, including new therapeutic options, holds promise for improving patient care. Further research into the genetic and molecular basis of ocular rosacea may enable more personalized treatments.

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: To assess the impact of autologous serum (AS) tears at a 50% concentration on the ocular surface of patients with refractory dry eye disease (DED) because of Sjogren syndrome.

Methods: Twenty eyes of ten patients with severe immune-mediated DED were contralaterally randomized to receive either AS tears 50% or artificial tears between June 2021 and May 2023. Changes in tear stability, ocular surface staining, and in the morphology of the corneal sub-basal nerves were evaluated before treatment and at 1, 2, and 3 months after treatment using objective tests for DED and confocal microscopy. The microbiological safety of the used AS tears 50% was investigated using Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry.

Results: The AS tears 50% group exhibited significant improvements in tear break-up time, Schirmer test scores, visual acuity, and confocal microscopy parameters of corneal nerve health at the 3-month follow-up (P < 0.05). Corneal nerve regeneration correlated with increased tear stability and decreased ocular surface staining. Microbiological analysis identified Gram-negative bacteria in the postuse AS tears, highlighting the need for meticulous handling and storage practices.

Conclusions: Treatment with AS tears at a 50% concentration markedly enhances ocular surface health, tear stability, and visual acuity, affirming the regenerative effects on corneal nerves in severe DED. The findings advocate for the therapeutic potential of higher-concentration AS tears in DED management, albeit with strict protocols to mitigate contamination risks and ensure patient safety.

Purpose: The purpose of this study was to investigate the effect of hypoxia and hypobaric conditions on refraction and central corneal thickness on healthy corneas during an ascent without oxygen supplementation above 7000 m (23 000 ft).

Methods: Twelve multinational mountaineers were included in a prospective observational cohort study during an expedition to the Korzhenevskoi Peak (7105 m). The two patients excluded from the study had a history with keratoconus or were current wearers of rigid contact lenses. None had a history of refractive surgery or ocular disease. The central corneal thickness (CCT), the oxygen saturation, and the refraction have been recorded for each patient using portable equipment. The highest measurement has been taken at 6356 m of altitude which is the highest ophthalmologic measurement ever done.

Results: Longitudinal analysis revealed a significant increase of CCT during altitude exposure (CCTbaseline = 542± 36 μm; CCTC3 = 633 ± 30 μm) due to stromal edema reversible upon descent. The amount of decrease in oxygen saturation paralleled the increase in CCT. The refraction measurements showed a myopic shift (-1.14D) with the altitude (RBaseline = -0.41 ±2.25D; RC3 = -1.55 ± 2.41D P < 0.05).

Conclusions: Significant stromal edema was found during exposure to high altitude in healthy mountaineers. This is due to hypoxia and decreased atmospheric pressure leading to a deficiency of adenosine triphosphate. A significant and clinically relevant myopic shift, due to the stroma edema, appears above 6500 m which can explained the blurry far vision in high altitude for mountaineers without oxygen supplementation.

Purpose: Fuchs endothelial corneal dystrophy (FECD) displays a higher incidence in females than in males, yet the underlying mechanism remains unclear. This study aimed to elucidate sex-dependent differential gene expressions in corneal endothelial cells (CECs) from healthy non-FECD individuals and from patients with FECD.

Methods: RNA-Seq data from CECs of non-FECD subjects (3 males, 4 females) and FECD subjects (5 males, 5 females) were analyzed to identify differentially expressed genes (DEGs) between the sexes. We used heatmaps and principal component analysis for expression pattern visualization and Gene Ontology analysis for functional categorization of DEGs.

Results: Among the non-FECD subjects, we identified 341 DEGs-143 upregulated and 198 downregulated-in females relative to males. For FECD subjects, 309 DEGs were discovered, with 215 upregulated and 94 downregulated in females compared with males. Heatmaps exhibited hierarchical clustering by sex, whereas principal component analysis delineated distinct male and female clusters in both non-FECD and FECD cohorts. Gene Ontology enrichment analysis linked the upregulated genes in non-FECD females to steroid hormone response, and downregulated ones to cyclin-dependent protein kinase activity. In females with FECD, upregulated genes were associated with immune responses and downregulated genes with peptide hormone binding.

Conclusions: To our knowledge, these findings are the first to reveal distinct gene expression patterns in CECs between sexes. The observed variations suggest a potential genetic basis for the observed sex disparity in FECD prevalence. Further investigation is warranted to explore these associations and their implications for the pathogenesis of FECD.

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.