Cornea最新文献

Purpose: To evaluate the outcomes of Simultaneous Double Lamellar Keratoplasty (SDLK) as a surgical alternative to repeat penetrating keratoplasty (PK) for cases involving both stromal pathology and endothelial graft failure.

Methods: Three patients with failed PK and evidence of both stromal and endothelial pathology underwent SDLK. The procedure combined deep anterior lamellar keratoplasty (DALK) and Descemet stripping automated endothelial keratoplasty (DSAEK) in a single operation. Outcome measures included uncorrected and corrected distance visual acuity (UDVA and CDVA), topographic astigmatism, and postoperative complications, assessed over a 24-month follow-up period.

Results: All patients achieved significant improvements in visual acuity and reduced astigmatism. Final CDVA ranged from 0.04 to 0.30 logMAR. One patient had an intraoperative microperforation, which was successfully managed. Postoperative complications included 1 case of partial DSAEK detachment, resolved with rebubbling. No graft rejections were observed. The combination of DALK and DSAEK restored corneal clarity and improved astigmatism while minimizing the risks associated with open-sky surgery.

Conclusions: SDLK offers a viable alternative to repeat PK for managing combined stromal and endothelial failure. This approach preserves structural integrity, provides superior refractive outcomes, and facilitates future lamellar interventions. Further studies are warranted to validate these findings in larger cohorts.

Purpose: The correlation between keratoconus (KC) and psychiatric disorders has been reported, but whether there is a genetic correlation between the 2 remains unclear.

Methods: We identified genetic overlaps between KC and 6 psychiatric disorders by using comprehensive summary data from genome-wide association studies. Cross-trait pleiotropic analysis uncovered shared loci and genes, whereas functional annotations and tissue-specific investigations assessed the impact of these pleiotropic genes. Finally, bidirectional Mendelian randomization was applied to explore causal relationships.

Results: Significant genetic correlation and genetic overlap were observed in 3 of the 6 trait pairs. A multiplicity study using the composite null hypothesis discovered significant possible multiplicity single nucleotide variants across 3 trait pairs, revealing 13 pleiotropic genetic loci, of which 3 were confirmed as colocalized loci with a posterior probability (PP.H4) exceeding 0.75. Significantly, numerous pleiotropic loci were identified across various paired traits, including 11p15.5 and 9q34.3. At the gene level, 137 pleiotropic genes were identified, including PDDC1, PIDD, and PNPLA2. Gene-based analyses indicated that these genes were significantly enriched in the brain and fibroblasts. Pathway analysis highlighted critical roles in Wnt/β-catenin signaling pathway. Mendelian randomization analysis further analyzed the correlation between these diseases.

Conclusions: This study offers additional evidence of a multifaceted relationship between psychiatric disorders, specifically attention-deficit/hyperactivity disorder, anorexia nervosa, and posttraumatic stress disorder, and KC. At the same time, it may facilitate novel medications and enhanced clinical treatment techniques.

Purpose: To report the clinical outcomes, microbiological profile, and efficacy of Rose Bengal photodynamic therapy (RB-PDT) as adjuvant treatment in patients with severe infectious keratitis (IK).

Methods: Prospective, noncontrolled, interventional study. Severe IK was defined as meeting ≥2 of the following: central ulcer, infiltrate ≥3 mm, presence of corneal melting or hypopyon, and lack of clinical improvement with conventional medical treatment. Clinical success was defined as avoiding a therapeutic keratoplasty (TPK).

Results: A total of 21 eyes from 21 patients underwent RB-PDT. Clinical success was achieved in 61.9%. The mean follow-up was 9 ± 3.33 months (range: 4-15). Cultured samples were positive for 27 total microorganisms, including Fusarium spp (n = 12, 44.44%), S. epidermidis (n = 4, 14.81%), Acanthamoeba (n = 2, 7.40%), Pseudomonas spp (n = 3, 11.11%), and others. Cultured samples were grouped into bacterial (44.44%), fungal (48.14%), and polymicrobial (if cultured for multiple microorganisms, 28.57%) categories for analysis. Corneal melting (57.14%), hypopyon (57.14%), and fung-ball (38.1%) were present at the initial visit. The mean time from onset to clinical success was 89.69 ± 56.59 days. In cases of clinical success, the mean time from RB-PDT to clinical success was 46.69 ± 19.47 days. There was a total of 16 additional interventions, including evisceration (2), optical penetrating keratoplasty (5), conjunctival flap (3), amniotic membrane transplant (1), and topical losartan therapy (5). Clinical variables associated with clinical failure included diabetes and fung-ball at presentation.

Conclusions: RB-PDT shows potential as an adjuvant therapy for managing severe infectious keratitis. TPK was avoided in 61.9% of cases.

Purpose: To determine the yield of culturing contact lenses (CL) and contact lens fluid/cases (CLF) to isolate recognized pathogens in suspected microbial keratitis (MK).

Methods: Data from 4298 ocular samples of MK collected at the Royal Liverpool University Hospital between January 2012 and December 2023 were reviewed. The isolation rates and proportion of recognized pathogens were compared between corneal impression membranes (CIM) and scrapes (CS), CL, and CLF. Chi-square tests and mixed-effects logistic models were used to assess differences in distribution among all isolates and subgroups of samples.

Results: The overall isolation rate was 54.1%, with CL having the highest rate ([348/466], 74.7%), followed by CIM ([1822/2940], 62%), CS ([126/566], 22.3%), and CLF ([23/317], 7.3%). CLF, however, had the highest proportion of recognized pathogens ([22/28], 78.6%), followed by CL ([269/531], 50.7%), CS ([71/142], 50%), and CIM ([728/2218], 32.8%). CIM and CS predominantly detected Gram-positive bacteria, whereas CLF had the highest rates of Acanthamoeba ([13/28], 46.4%) and fungal isolates ([4/28], 14.3%). CL and/or CLF cultures led to altered treatment in 10.5% of cases.

Conclusions: In suspected MK, culturing the CLF and CL can increase the probability of detecting a recognized pathogen that in turn may help guide treatment.

Purpose: To evaluate whether sub-Tenon triamcinolone acetonide (STTA) reduces cystoid macular edema (CME) after Descemet membrane endothelial keratoplasty (DMEK) and to identify associated risk factors.

Methods: This retrospective, multicenter observational study included 96 eyes of 78 patients who underwent DMEK in Japan and were followed for ≥12 months. Demographic, ocular, and surgical variables were collected. CME was assessed using spectral-domain optical coherence tomography. Kaplan-Meier analysis with log-rank testing compared CME-free survival between eyes with and without STTA. Cox proportional hazards regression identified risk factors. Best-corrected visual acuity at 12 months was compared between CME-positive and CME-negative eyes.

Results: CME developed in 13 eyes (13.5%). Kaplan-Meier analysis showed no significant difference in CME-free survival between STTA users (90.9%) and nonusers (84.6%) at 360 days (P = 0.593). Most CME cases occurred within 90 days postoperatively. Multivariable analysis indicated that preoperative anterior chamber depth showed a trend toward association with CME (P = 0.058), and rebubbling was independently associated with increased risk (P = 0.034). Eyes requiring ≥2 rebubbling procedures had a higher CME risk compared with eyes without rebubbling (P = 0.029). Age, STTA use, and nonsteroidal antiinflammatory drug use were not significantly associated with CME. At 12 months, best-corrected visual acuity did not differ between groups (P = 0.419).

Conclusions: STTA was not significantly associated with a lower incidence of CME after DMEK. Shallow anterior chamber depth showed a trend toward association, and rebubbling was significantly associated, suggesting the need for careful postoperative evaluation.

Purpose: To characterize the chronic ocular complications of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN), focusing on culprit medications, long-term visual outcomes, and surgical interventions in a tertiary care population.

Methods: This retrospective cross-sectional study was conducted at the Department of Ophthalmology, Federal University of São Paulo. Patients diagnosed with SJS or TEN in the chronic phase and followed for at least 12 months, between January 2012 and December 2024, were included. Clinical data, best-corrected visual acuity, ocular surface findings, implicated medications, and surgical interventions were analyzed.

Results: A total of 112 patients were included (102 with SJS and 10 with TEN). Dipyrone (metamizole) was the most commonly implicated drug (38.4%), followed by penicillin (12.5%), phenobarbital (9.8%), phenytoin (8.0%), and sulfonamides (8.0%). The most prevalent chronic ocular findings were dry eye disease (97.3%), meibomian gland dysfunction (98.2%), limbal stem cell deficiency (78.6%), trichiasis (64.3%), symblepharon (60.7%), conjunctival keratinization (55.3%), and corneal keratinization (24.1%). Visual acuity was often severely impaired. Most patients required surgical interventions (88.4%), including mucous membrane grafts, limbal stem cell transplantation, salivary gland transplantation, penetrating keratoplasty, and keratoprosthesis implantation.

Conclusions: Our findings highlight the significant burden of severe ocular surface disease, the predominance of dipyrone as a causative drug in this population, and the need for complex surgical interventions in a significant proportion of cases. These results underscore the importance of early management of ocular complications, long-term follow-up, and access to advanced therapeutic strategies.

Purpose: Corneal ectasias, such as keratoconus, exhibit altered corneal shape, structure, and biomechanics. Patients would greatly benefit from volumetric, 3-dimensional, and regional measurements of corneal stiffness for early detection and post-treatment monitoring. Current methods use indirect measurements, confounded by intraocular pressure, corneal thickness, describing a global picture of the cornea, and fail to identify crucial early localized changes. We tested the Brillouin Optical Scanner System (BOSS), which uses the Brillouin principle for noncontact focal measurement of compressibility and corneal stiffness, expressed as the 3-dimensional Brillouin Longitudinal Modulus.

Methods: We measured compressibility/corneal stiffness in 3-month and 10-month-old New Zealand white rabbits (n = 2; male = 1; female = 1). Rabbits remained awake, calm, and nonsedated. We separately analyzed ex vivo porcine corneas using BOSS (n = 28) and strip extensiometry (n = 13). The BOSS parameters were optimized for both sets of analyses.

Results: The BOSS demonstrated precise measurements in in vivo rabbits and ex vivo porcine corneas with a <2% and <4% variation from the mean. All rabbit corneas (n = 4) showed an increase in Brillouin values, demonstrating an increase in corneal stiffness over 7 months, in vivo.

Conclusions: The BOSS is capable of precise measurements and detecting subtle changes in corneal stiffness in the rabbits. The high precision and accuracy of biomechanical measurements in nonsedated rabbits will enable a reduction in preclinical animal numbers, especially for time course studies. Importantly, the ability of the BOSS to provide spatial biomechanical measurements makes it a valuable tool for early detection of asymmetric corneal ectasias and keratoconus.

Purpose: To extract microbial keratitis (MK) descriptors from clinician notes in electronic health records using Large Language Models (LLMs) with a zero-shot prompting approach and compare the descriptors with those identified by expert human annotators.

Methods: Two hundred fifteen patients with culture-proven MK seen between 2019 and 2023 at Aravind Eye Hospital, Salem, India was gathered. Free-text clinical notes from each patient's first encounter corneal examination were obtained. Each of the 3 MK descriptors-centrality, infiltrate depth, and thinning-was annotated by expert consensus and coded as 1 (present), 0 (absent), or 9 (details unavailable). GPT-4o and GPT-4o mini were prompted to extract the 3 MK descriptors. LLM responses were compared with human annotations using agreement measures such as Cohen Kappa scores at 95% confidence interval, in addition to sensitivity and specificity.

Results: GPT-4o demonstrated mean sensitivity of 92%, 86%, and 97%, for centrality, depth, and thinning, respectively, and 96%, 93%, and 99% mean specificity. Cohen Kappa scores calculated for centrality, depth, and thinning were 0.88, 0.73, and 0.88, respectively, indicating good agreement. The overall sensitivity, specificity, and Cohen Kappa of GPT-4o mini were lower compared with GPT-4o, but the difference was not statistically significant.

Conclusions: Both GPT-4o and GPT-4o mini showed good agreement with human annotations in extracting MK descriptors. Detection of MK descriptors was influenced by limitations in the quality and consistency of electronic health record documentation. The trade-off between efficiency and performance among LLM architectures remains a consideration for implementation of LLM for large-scale MK data analysis.