Cornea最新文献

Purpose: The aim of this study was to evaluate whether serum thyroid-stimulating hormone (TSH), total T3, and free T4 levels are associated with tomographically confirmed structural progression in keratoconus.

Methods: In a prospective observational cohort, 133 eyes from 74 individuals were classified into progressive keratoconus (n = 53), stable keratoconus (n = 28), and healthy control eyes (n = 52). Progression was defined as a ≥1.0 D increase in maximum keratometry (Kmax) over 12 months. Corneal imaging and serum hormone assays (TSH, T3, T4) were performed at baseline. Group comparisons used ANOVA with Tukey post hoc testing. Pearson correlation assessed associations between hormone levels and structural parameters.

Results: The progressive group demonstrated significantly higher TSH levels (1.96 ± 0.83 mU/mL) compared with controls (1.47 ± 0.57 mU/mL; P < 0.05); stable group values were intermediate. No differences were found for T3 or T4. Correlations between TSH and steep keratometry (K2) (r = +0.27; P < 0.05) and between TSH and thinnest pachymetry (r = -0.21; P < 0.05) were statistically significant. No correlation was observed between TSH and minimum epithelial thickness, or with T3/T4 levels.

Conclusions: Elevated TSH is associated with structural progression markers in keratoconus, suggesting a systemic thyroid contribution to disease evolution. While causality is not established, these findings support endocrine screening in early or progressive keratoconus cases and warrant further mechanistic investigation.

Purpose: Descemet membrane endothelial keratoplasty (DMEK) is the preferred treatment for corneal endothelial dysfunction; nonetheless, its feasibility and outcomes in vitrectomized eyes remain uncertain. We evaluated the outcomes and surgical considerations of endothelium-in pull-through DMEK in vitrectomized eyes with bullous keratopathy.

Methods: Eight vitrectomized eyes from eight patients (mean age, 71.9 ± 15.4 years; mean follow-up, 4.9 ± 1.6 months) underwent endothelium-in pull-through DMEK using the EndoGlide between August 2023 and October 2024. Best spectacle-corrected visual acuity, endothelial cell density, central corneal thickness, and complications were recorded.

Results: In 5 eyes (62.5%), the graft unfolded smoothly; in 3 eyes (37.5%), excessive unfolding required conversion to an endothelium-out roll using the double-bubble technique. All grafts attached without rebubbling. The best spectacle-corrected visual acuity improved from 1.00 logMAR (interquartile range, 0.65-1.10) preoperatively to 0.30 (0.13-0.55) and 0.40 (0.15-0.52) logMAR at 3 and 6 months, respectively (Wilcoxon, both P < 0.05). The central corneal thickness decreased from 693.5 µm (640-788.8) to 522.5 µm (502.3-564.3) and 549 µm (542-577) at 3 and 6 months, respectively (Wilcoxon, both P < 0.05). The endothelial cell density decreased from 2737 cells/mm2 (2540-2928) preoperatively to 2412 cells/mm2 (2284-2610) and 2238 cells/mm2 (2086-2245) at 3 and 6 months, respectively; at the final follow-up, the median cell density was 2288 cells/mm2 (2200-2428), representing a 16.4% loss relative to the donor value.

Conclusions: Endothelium-in pull-through DMEK is feasible in vitrectomized eyes, achieving stable attachment with visual and anatomical improvement even when adjunctive maneuvers are required, demonstrating clinical utility in postvitrectomy corneal edema.

Purpose: The aim of this study was to assess the impact of the lenticule's position within the donor cornea on visual, refractive, and topographic outcomes in patients who undergo allogeneic corneal inlay (Allotex Inc., Boston, MA) implantation.

Methods: This retrospective data analysis included 86 patients at 5 study sites that were part of the Allotex EU multicenter clinical trial. During the study, an allogeneic corneal inlay was implanted in the nondominant eye of emmetropic patients with presbyopia. Uncorrected distance visual acuity, uncorrected intermediate visual acuity, uncorrected near visual acuity, corrected distance visual acuity, distance-corrected near visual acuity, refraction, and keratometric measurements were assessed preoperatively and at 6 months postoperatively. Correlation between the depth of the cornea from which the donor lenticule was obtained and these parameters was investigated. In addition, 3 subgroups, based on the depth of the donor lenticule (anterior, middle, and posterior), were compared.

Results: Uncorrected intermediate visual acuity, uncorrected near visual acuity, and distance-corrected near visual acuity increased while uncorrected distance visual acuity, corrected distance visual acuity, and keratometric values decreased 6 months postoperatively ( P < 0.05). No correlation was found between the clinical parameters and lenticule depth. In the subgroup analysis based on lenticule depth, there was no significant difference between the groups in the change in any parameter ( P > 0.05).

Conclusions: Lenticules obtained from different depths can be used as corneal inlays, allowing multiple patients to benefit from one donor cornea.

Purpose: To investigate the relationship between corneal sensitivity (CS), vision-related quality of life, ocular surface symptoms, and clinical severity in patients with Parkinson's disease (PwP).

Methods: Prospective observational cohort study. CS was measured using a noncontact esthesiometer. Vision-related quality of life and ocular surface symptoms were assessed with the NEI VFQ-25 and OSDI questionnaires. Parkinson's disease severity was graded with the Hoehn and Yahr (HY) scale. Associations were analyzed using Pearson correlation and ANOVA.

Results: A total of 356 eyes from 178 PwP were included. Mean age was 62.77 ± 11.34 years, and 51.4% were male. Mean CS was 6.47 ± 2.24 mBar, NEI VFQ-25 score was 67.11 ± 9.35, and OSDI score was 25.17 ± 18.19. CS was significantly associated with the NEI VFQ-25 composite score (r = 0.449, P <0.001) but not with the OSDI score (r = 0.122, P = 0.141). NEI VFQ-25 and OSDI scores showed moderate correlation (r = 0.477, P <0.001). CS also correlated with general vision, near vision, distance vision, mental health, and peripheral vision subscales (P <0.05). CS varied across HY stages (P <0.001), with stages 3 to 4 demonstrating significantly reduced sensitivity compared with stages 1 to 2 (all P <0.001).

Conclusions: CS correlates with vision-related quality of life but not directly with ocular surface symptoms in PwP. Its progressive reduction with advancing HY stages suggests potential as a surrogate marker of disease severity. CS measurements may complement quality-of-life assessments and aid in the early detection of ocular surface compromise in this population.

Purpose: The aim of this study was to describe the case of a 9-year-old girl with inferior arcus in her right cornea and discrete inferior lipid deposition in her left cornea.

Methods: Serum cholesterol and lipid levels were measured under general anesthesia for treatment with fine-needle cautery and subconjunctival bevacizumab.

Results: Serum cholesterol and low-density lipoprotein were elevated at 12 mmol/L (normal range 3-5 mmol/L) and 10.8 mmol/L (normal range <3 mmol/L), respectively. Genetic testing identified a pathogenic variant in the ATP-binding cassette subfamily G member 5 (ABCG5) gene consistent with sitosterolemia, a rare, autosomal recessive disorder of lipid metabolism. Mutations in the ABC genes result in ineffective transport of plant sterols into the intestinal lumen and their subsequent accumulation in the blood. The girl's cholesterol and lipid profile returned to normal following dietary restriction of plant sterol intake and treatment with ezetimibe 10 mg daily and atorvastatin 10 mg daily.

Conclusions: This is the first reported case of a discrete lipid deposit at the cornea in a patient with sitosterolemia. Untreated, patients with sitosterolemia can develop coronary artery disease early in life. Ophthalmologists should be aware of the potential for underlying disorders of lipid metabolism in young patients with corneal arcus and/or lipid keratopathy.

Purpose: The study investigated the frequency of self-reported symptoms and the association of clinical signs of ocular surface disease with eyelash extension wear among youthful women.

Methods: In this cross-sectional study, 416 female university students aged 18-29 years were classified into eyelash extension wearers (n = 208) and nonwearers (n = 208). Self-reported symptoms, care practices, and extension type were assessed using a questionnaire. Participants underwent slit-lamp examination for corneal integrity (Modified Oxford Scale), noninvasive tear break-up time (TBUT), and assessment of eyelashes, conjunctiva, and meibomian glands.

Results: Eyelash extension wearers reported significantly higher rates of watery eyes (38.5% vs. 21.6%; P < 0.001), natural eyelash loss (17.3% vs. 9.6%; P = 0.022), and discharge (7.7% vs. 1.0%; P = 0.002) compared with nonwearers. Clinically, wearers exhibited more eyelash abnormalities (62.2% vs. 1.9%; χ2 = 172.7, P < 0.001), reduced TBUT <10 seconds (79.8% vs. 15.4%; χ2 = 173.1, P < 0.001), greater conjunctival injection (8.7% vs. 0.5%; χ2 = 16.0, P < 0.001), and meibomian gland abnormality (8.7% vs. 3.4%; χ2 = 5.2, P = 0.023). Logistic regression revealed that extension wear was associated with approximately 22-fold higher likelihood of reduced TBUT [odds ratio (OR) = 21.74; 95% confidence interval (CI) 13.1-36.1], approximately 83-fold higher likelihood of eyelash abnormalities (OR = 83.28; 95% CI 29.8-232.9), and approximately 3-fold higher likelihood of meibomian gland abnormality (OR = 2.72; 95% CI 1.1-6.7).

Conclusions: Eyelash extension wear in young women is strongly associated with increased ocular surface symptoms and clinical signs of ocular surface disease. The findings support the need for improved consumer education, stricter product regulation, and routine ocular health screening to prevent avoidable complications among extension wearers.

Purpose: Epidermal growth factor receptor (EGFR) signaling promotes meibomian gland (MG) epithelial and mesenchymal cell proliferation and is involved in MG morphogenesis. This study aimed to evaluate the impact of systemic EGFR inhibitor (EGFR-I) therapy on MG status using meibography, and its association with ocular surface clinical parameters.

Methods: In this prospective study, 39 patients with no prior history of ocular surface disease who were scheduled to receive systemic EGFR-I therapy for various malignancies were enrolled. All participants underwent Schirmer test, tear film break-up time, ocular surface disease index questionnaire, noninvasive tear break-up time, and noncontact meibography using Sirius topography at baseline, and at 1 and 3 months after treatment initiation. MG loss was quantified and staged based on meibographic analysis.

Results: Of the 39 participants, 28 (72%) were female and 11 (28%) were male, with a mean age of 61.8 ± 11 years. Baseline Schirmer test and tear film break-up time values (15.6 ± 4.2 mm and 13.2 ± 3.5 seconds) showed a significant reduction at 1 month (13.8 ± 3.8 mm; 11.1 ± 3.0 seconds), with a further decline observed at 3 months (8.1 ± 3.1 mm; 7.4 ± 2.7 seconds) (P < 0.001). The mean ocular surface disease index score increased from 7.7 ± 6.9 at baseline to 11.6 ± 7.3 at 1 month and 30.3 ± 14.6 at 3 months (P < 0.001). Noninvasive tear break-up time values decreased significantly at 3 months (5.9 ± 2.6 seconds) relative to baseline (11.1 ± 4.5 seconds) (P < 0.001). Meibographic assessments revealed a progressive increase in MG loss percentage and staging from baseline (14.7 ± 6.2%; stage 0.8 ± 0.5) to 1 month (21.3 ± 6.5%; stage 1.3 ± 0.4) and 3 months (31.6 ± 11%; stage 1.9 ± 0.6) (P < 0.001).

Conclusions: Systemic EGFR-I therapy may contribute to progressive MG loss, which may be associated with ocular side effects commonly observed in patients receiving these agents, including dry eye disease, blepharitis, and meibomitis. Early recognition and management of these complications by ophthalmologists may improve patient comfort and support adherence to oncologic treatment.

Purpose: The goal of this study is to review the existing evidence to quantify the impact of corneal punctate epithelial erosions (PEE) on postoperative refractive error-related patient dissatisfaction after cataract surgery.

Methods: PubMed and the Cochrane library were systematically searched for studies using the terms "dry eye" or "dry eye disease" or "punctate epithelial erosions" or "corneal staining" combined with "biometry" or "keratometry" or "cataract surgery." ChatGPT was also queried using the same search terms to identify any potentially relevant publications that might have been missed. All retrieved publications and their references were examined, and the results were tabulated.

Results: A total of 1446 abstracts were identified through online search, corresponding to 1242 unique publications. Of these, 12 studies were deemed relevant and full articles were retrieved. ChatGPT identified an additional 6 unique publications. None of the 18 studies reviewed in detail, however, quantified the impact of PEE on biometry assessments. The results of 8 studies reporting on 4 other dry eye disease parameters that informed the impact on biometry results were summarized.

Conclusions: Despite the current emphasis on optimizing corneal PEE before biometry, no studies define thresholds or metrics linked to measurable effects on postcataract visual outcomes. This review highlights the need for future studies to inform algorithms used for preoperative cataract decision making.

Purpose: To evaluate the association between corneal graft survival and glaucoma surgical procedures and medical treatment in eyes with postkeratoplasty glaucoma.

Methods: This retrospective study involved 1149 eyes that underwent penetrating keratoplasty or Descemet stripping automated endothelial keratoplasty between 2004 and 2019. They were divided into 5 groups according to the types of glaucoma treatment after keratoplasty: trabeculotomy (TLO), trabeculectomy (TLE), glaucoma drainage device, topical antiglaucoma drugs alone, and no glaucoma treatment. Eyes with trauma, infection, or rejection during the follow-up period, and those that other types of glaucoma surgery, were excluded. Graft survival and risk factors for graft failure after glaucoma treatment were analyzed using Kaplan-Meier survival analysis and the Cox proportional hazards model.

Results: The cumulative probability of graft survival at 3 years postoperatively was 87.3% in the TLO group, 58.2% in the TLE group, 68.6% in the glaucoma drainage device group, 89.1% in the topical medication group, and 96.6% in the no-treatment group (P < 0.001, log-rank test). The presence of bleb before keratoplasty [hazard ratio (HR) 3.34; 95% confidence interval (CI) 1.94-5.37; P < 0.001] and failure of intraocular pressure control after glaucoma treatment (HR 4.11; 95% CI 2.15-7.86; P < 0.001) were major risk factors for graft failure, whereas TLO was associated with a significantly lower risk of graft failure compared with TLE (HR 4.57; 95% CI 1.19-17.47; P = 0.03).

Conclusions: Our findings showed that TLO is associated with a lower risk of graft failure compared with TLE. Outflow facility reconstruction procedures, such as TLO, seem to be effective first-line surgical options for postkeratoplasty glaucoma.

Purpose: To evaluate the incidence and clinical characteristics of ocular graft-versus-host disease (oGVHD) associated with tapering of systemic immunosuppression after allogeneic hematopoietic stem cell transplantation (allo-HSCT).

Methods: This retrospective study included adult allo-HSCT recipients diagnosed with oGVHD during or after immunosuppression tapering at a single tertiary center (1998-2023). Data collected included transplant indications and donor characteristics, GVHD prophylaxis regimens, immunosuppression status at engraftment and at oGVHD onset, and systemic and ocular GVHD manifestations. Cumulative incidence of oGVHD was estimated using Kaplan-Meier survival analyses.

Results: Fifty-six patients (mean age, 56 ± 12 years; 59% male) developed oGVHD at a median of 9 months posttransplant (interquartile range, 6.8-13). The predominant prophylaxis regimen at engraftment was tacrolimus with methotrexate (62.5%). At the time of oGVHD diagnosis, 25.0% of patients were fully tapered off systemic immunosuppression, whereas 28.5% remained on tacrolimus monotherapy. Kaplan-Meier analysis showed a rapid rise in oGVHD incidence within the first year, with 75% of cases diagnosed by month 14. Systemic GVHD preceded ocular involvement in 62% of patients, whereas 18% developed isolated oGVHD. Most patients required escalation of ocular surface therapy-including lubrication, punctal occlusion, and topical antiinflammatory or immunomodulatory agents-although no patient required reinstatement or escalation of systemic immunosuppression solely for ocular disease.

Conclusions: oGVHD frequently emerges during the late phase of systemic immunosuppression tapering, with many cases occurring after complete discontinuation or reduction to monotherapy. Given the high incidence within the first posttransplant year and the occurrence of isolated ocular disease, these findings support routine ophthalmic evaluation for all allo-HSCT recipients as systemic immunosuppression is withdrawn. Early detection and timely escalation of topical therapy are essential to prevent ocular surface damage while permitting safe continuation of systemic tapering.