Cornea最新文献

Purpose: The aim of this study was to identify factors associated with significant postoperative stromal thinning in eyes undergoing Descemet membrane endothelial keratoplasty (DMEK).

Methods: This was a retrospective, multicenter interventional study. Eyes that underwent DMEK at Royal Liverpool University Hospital (UK) and ASST Spedali Civili di Brescia (Italy) were included. Eyes were stratified into 2 groups based on the final central corneal thickness (CCT): <500 μm and ≥500 μm. Demographic, clinical, and tomographic parameters were analyzed, including age, preoperative CCT, best corrected visual acuity (BCVA), posterior and total corneal power, and donor endothelial cell density (ECD). Hyperopic shift was defined as an increase of ≥+0.5 D in posterior corneal power or a decrease of ≤-1.0 D in total corneal power.

Results: Among 150 eyes (120 patients), those with a final CCT <500 μm were significantly older (mean [SD], 74.5 [9.9] vs. 68.7 [11.5] years; P = 0.001). Hyperopic shift occurred in 43% of eyes with complete tomographic data and correlated with a greater percentage reduction in CCT after DMEK (-25.5% [15.6%] vs. -16.4% [12.4%], P = 0.02). A larger proportional CCT reduction was observed in eyes with a final CCT <500 μm and was associated with the presence of preoperative posterior stromal ripples. No significant differences were observed in final BCVA, donor ECD, or treatment center.

Conclusions: Greater reductions in corneal thickness are associated with postoperative stromal thinning and hyperopic shift after DMEK. Preoperative stromal ripples are associated with greater reductions in corneal thickness after DMEK. Stromal remodeling appears influenced by endothelial recovery and preoperative biomechanical status, supporting emerging hypotheses on keratocyte loss and osmotic imbalance.

Purpose: The aim of this study was to compare the efficacy and outcomes of cultivated oral mucosal epithelial transplantation (COMET) in limbal stem cell deficiency (LSCD) between patients with Stevens-Johnson syndrome (SJS) and those with other etiologies (non-SJS), evaluated by clinical manifestations and epithelial phenotypes.

Methods: This prospective, comparative study enrolled patients with LSCD who were scheduled for COMET. Preoperative and postoperative assessments were performed using slit-lamp microscopy, in vivo confocal microscopy (IVCM), and impression cytology with immunofluorescence staining. Successful outcomes were defined as an intact ocular surface without conjunctivalization and the presence of cornea-like epithelium detected by IVCM and/or immunofluorescence staining at the central cornea. Otherwise, the outcomes were interpreted as failure. Visual improvement and risk factors of COMET failure were analyzed.

Results: Eighteen eyes of 18 patients (7 with SJS, 11 non-SJS) were included. The median follow-up time was 15.5 months (range: 13-35 months). The overall success rate was 72.2% (13 eyes: 2 with SJS and 11 non-SJS), which was significantly lower in patients with SJS (28.6%) than in non-SJS patients (100%) (P = 0.002). Among successful cases, 60.2% showed visual improvement while the others (30.8%) remained unchanged. The risk of COMET failure was significantly associated with SJS (P = 0.002), lid margin keratinization (P = 0.023), preoperative symblepharon (P = 0.036), postoperative epithelial defects lasting more than 2 weeks (P = 0.022), and the absence of multilayered cornea-like epithelium detected by IVCM at 6 months postoperatively (P = 0.017).

Conclusions: COMET demonstrates good efficacy and favorable outcomes for LSCD, particularly in non-SJS eyes. While the success rate was excellent in non-SJS patients, the outcomes were significantly limited in those with SJS.

Purpose: The aim of this study was to compare the efficacy and safety of contact lens-assisted corneal collagen crosslinking (CXL) and hypoosmolar CXL in pediatric patients with progressive keratoconus and thin corneas.

Methods: Forty eyes of 40 progressive pediatric patients with keratoconus and thin corneas were divided into two groups: the first group underwent contact lens-assisted CXL (CL group), and the second group underwent hypoosmolar riboflavin-assisted CXL (group H). Only patients younger than 18 years with thinnest corneal pachymetry <400 μm were included. The primary outcomes measured were the changes in maximum keratometry (Kmax) on Sirius topography and in endothelial cell count at 6 months postoperatively; the secondary outcome measured was the change in best spectacle-corrected visual acuity at 6 months postoperatively. The demarcation line on anterior segment optical coherence tomography was also recorded at 1 month after CXL.

Results: Kmax showed a significant decrease at 6 months after CXL from 65.56 ± 8.19 diopters preoperatively to 63.6 ± 8.27 diopters in the CL group and from 65.61 ± 14.69 diopters preoperatively to 63.14 ± 13.69 diopters in group H. The mean demarcation line depth was 198.89 ± 42.42 μm in the CL group and 215.4 ± 59.01 μm in group H. Both groups showed no significant decrease in endothelial cell count after CXL.

Conclusions: Both methods compared above suggest a halt in the progression of keratoconus for the study duration of 6 months in pediatric patients with thin corneas, thus negating the need for corneal transplantation in these patients. Because there are limited randomized trials on management of pediatric keratoconus with thin corneas, the results of this study will be useful in guiding clinical decisions.

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.