Cornea最新文献

Purpose: To validate a French version of the Visual Function and Corneal Health Status (V-FUCHS) instrument in Fuchs endothelial corneal dystrophy (FECD) and to correlate questionnaire scores with objective measurements of best-corrected visual acuity (BCVA) and intraocular straylight.

Methods: The original V-FUCHS 15-item instrument was designed to assess VA and glare in patients with FECD. It was translated from English to French and back translated to English by independent translators. The questionnaire was administered on 2 occasions (4 weeks apart), and BCVA, modified Krachmer grade, and straylight were measured. Construct validity, internal consistency, test-retest reliability, and predictive validity were assessed.

Results: A total of 159 subjects, aged 41 to 86 years, were prospectively recruited from July 2019 to October 2020 and classified into 6 groups: mild, moderate, or advanced FECD; unilateral or bilateral Descemet membrane endothelial keratoplasty for FECD; and healthy controls (n = 35). Construct validity was confirmed by item response theory model. Cronbach alpha demonstrated excellent internal consistency (VA: 0.91, glare: 0.88), and intraclass correlations showed good test-retest reliability (VA: 0.75 and glare: 0.82). Significant correlations were observed between both VA and glare factors and the modified Krachmer grade, BCVA, and straylight.

Conclusions: The proposed French version of the V-FUCHS instrument provides a valid and reliable tool for the assessment of visual disability in patients with FECD. This questionnaire bridges the gap between self-reported FECD symptoms and objective clinical measurements, which may prove useful to optimize the timing of surgery and to assess postoperative improvement in symptoms.

Purpose: The purpose of this study was to examine the direct impact on carbon emissions attributed to the use of fluorinated gases in endothelial keratoplasty (EK) procedures using gas tamponade and to evaluate the respective carbon footprint of different gas delivery systems used in EK procedures.

Methods: In this retrospective, single-center environmental impact study, all corneal procedures using fluorinated gases between January 2021 and January 2024 at the Royal Liverpool University Hospital were reviewed and included. The CO2 equivalent emissions were calculated based on the mass of each fluorinated gas used, following the guidelines of the Intergovernmental Panel on Climate Change.

Results: Of 357 total procedures (160 Descemet membrane endothelial keratoplasty [44.8%], 118 Descemet stripping automated endothelial keratoplasty [33.1%], and 79 rebubbling [22.1%]), single-use sulfur hexafluoride (SF6) canisters were used in 278 (77.9%) procedures. SF6 canisters used in corneal transplantation emitted nearly 1.5 tons of CO2 over 3 years. The 30-mL canisters emitted twice the CO2 per GBP compared to SF6 15-mL canisters and 4 times that of C2F6 or C3F8 15-mL canisters.

Conclusions: Fluorinated gas use in corneal transplantation has a significant environmental impact, which can be reduced by the use of smaller single-use canisters with lower carbon footprint, although manufacturing and disposal concerns remain. Our findings advocate for a more environmentally conscious approach to EK, favoring the use of smaller, more cost-efficient canisters and considering air as an alternative tamponade where possible.

Purpose: The aim of this study was to compare clinical characteristics and high-resolution optical coherence tomography (HR-OCT) findings between corneal ocular surface squamous neoplasia (OSSN) and corneal pannus.

Methods: Retrospective study of 9 individuals, 3 with lesions histologically confirmed to be OSSN, 3 with lesions histologically confirmed to be pannus, 1 with lesions histologically confirmed to be OSSN followed by pannus, and 2 with long-standing, nonchanging lesions clinically diagnosed as pannus. All individuals presented to the Miami Veterans Affairs Medical Center eye clinic or Bascom Palmer Eye Institute between 2015 and 2023. Clinical characteristics and HR-OCT findings were evaluated and compared.

Results: Mean age of the population was 72.8 ± 5.1 years, 100% self-identified as male, 100% as White, and 11.1% as Hispanic. Clinically, all lesions appeared as whitish, opalescent, variably vascularized opacities extending from the limbus. None of the OSSN cases had vessels that extended to the border, whereas 4 cases of pannus (67%) had at least 1 vessel that reached the border. On HR-OCT, epithelial hyperreflectivity was observed in all cases of OSSN and pannus. Epithelial thickening was observed in all cases of OSSN, but in none of the cases of pannus. An important distinction between the 2 groups was the transition between normal and abnormal epithelium. All cases of OSSN had a vertical transition, whereas all cases of pannus had an angled transition.

Conclusions: Corneal OSSN and corneal pannus can both present with clinical findings of an opalescent lesion and may have overlapping findings on HR-OCT. Although both entities may show epithelial hyperreflectivity on HR-OCT, OSSN demonstrates an abrupt transition at a vertical, 90 degrees angle perpendicular to the Bowman layer, whereas pannus appears as an angled transition around 45 degrees. Therefore, the angle of transition between normal and abnormal epithelium can be useful in distinguishing between the 2 entities.

Purpose: The purpose of this study was to evaluate the pharmacogenomics of response to topical ocular tumor necrosis factor α (TNFα) inhibitor licaminlimab in patients with DED.

Methods: Three single-nucleotide polymorphisms (SNPs) associated with Sjögren syndrome, 3 in the TNFα gene and 1 in the TNF receptor 1 (TNFR1) gene, were assessed for association with response to licaminlimab in participants from a randomized, vehicle-controlled, Phase 2 study in which adults with DED and severe ocular discomfort persisting despite treatment with artificial tears received licaminlimab or vehicle for 6 weeks. Response was assessed for change from baseline in Global Ocular Discomfort score at Day 29 of treatment. The pharmacogenomic analysis was a prospectively specified exploratory objective of the study. mRNA expression for TNFα, interleukin (IL) 1β, and IL8 in conjunctival epithelium cells was determined. The relationship between SNPs and response to licaminlimab was assessed using a mixed model repeated measures analysis.

Results: SNP rs1800693 in the TNFR1 gene showed a significant effect on response to licaminlimab ( P < 0.0001, initial association test); no effect was seen for any of the other SNPs tested. The CC genotype of rs1800693 was associated with much greater response to licaminlimab than the CT or TT genotypes: LS mean changes from baseline to Day 29 in Global Ocular Discomfort score were -29.5, -0.09, and -3.90, in patients with the CC, CT, and TT genotypes, respectively ( P < 0.0001). No significant effect was observed in vehicle-treated patients. Improvements from baseline were seen in 3/4 licaminlimab-treated participants with the CC genotype. Conjunctival epithelium cell levels of mRNA for TNFα, IL1β, and IL8 decreased from baseline in participants with the CC genotype, but not with the CT or TT genotypes. Between-genotype differences in mRNA levels were not observed in participants receiving vehicle.

Conclusions: The CC genotype of rs1800693, relatively common in patients with DED, was strongly associated with response to licaminlimab and decreased inflammatory cytokine gene expression in ocular surface cells during treatment. This study is one of the first to our knowledge to investigate pharmacogenomics in the treatment of DED.

Purpose: The purpose of this study was to investigate dynamic changes in corneal epithelial thickness (ET) after hyperopic small incision lenticule extraction (SMILE).

Methods: This observational study included 18 eyes of 16 patients who were scheduled for hyperopic SMILE. High-resolution spectral-domain optical coherence tomography and a custom image segmentation algorithm were applied to measure corneal dynamic ET over a central 6 mm area. ET was analyzed among different corneal sectors (central, pericentral, and peripheral) at baseline and multiple postoperative time points (1 day, 1 month, 6 months, 2 years, and 4 years). Correlation analysis was performed between ET changes and preoperative and intraoperative parameters.

Results: The mean spherical equivalent of hyperopia correction was +2.64 ± 1.00 D, and the average age of enrolled 16 patients was 32.4 ± 10.8 years. At the last follow-up, 72% of eyes kept or improved corrected distance visual acuity, with 2 eyes that lost 2 lines. 72% of eyes were within ±1.0 D of target refraction, and 56% were within ±0.5 D. Average ET decreased by 11.0% (5.9 ± 2.3 μm) from 53.2 ± 3.5 μm to 47.4 ± 4.2 μm 4 years postoperatively (P<0.001). The ET at center 2 mm decreased most significantly by 14.5% (7.9 ± 2.9 μm), followed by the pericentral area by 10.5% (5.6 ± 2.3 μm). ET and front corneal curvature stabilized 1 month after surgery. No correlation was found between refraction regression and ET changes.

Conclusions: Hyperopic SMILE induced significant central ET thinning. ET remodeling in the 6 mm area stabilized after 1 month and did not underlie refractive changes.

Purpose: The aim of this study was to describe our technique for performing femtosecond laser (FSL)-assisted mushroom configuration in deep anterior lamellar keratoplasty (DALK).

Methods: We describe our surgical technique for a mushroom-configuration DALK using a femtosecond laser (FSL) both to prepare the graft and to perform a precut of the recipient cornea, as well as the steps for the dissection of the recipient cornea and for donor cornea implantation. Moreover, we show the parameters of energy and spot separation and the external and internal diameters as well as the thickness of the external and internal keratotomy.

Results: We performed a retrospective case series study of 20 patients with a mean follow-up of 4.36 ± 2.54 years. The indication for surgery was leukoma in 15 cases (75%), keratoconus in 4 cases (20%), and stromal corneal dystrophy in 1 case (5%). Four cases had to be converted to penetrating keratoplasty. The overall results were as follows: The mean preoperative corrected distance visual acuity increased from 0.11 ± 0.09 (0.01-0.30) to 0.78 ± 0.22 (0.30-1.0) with spectacles and to 0.92 ± 0.13 (0.5-1.0) with a gas permeable contact lens. The mean final cylinder was 3.90 ± 1.86 (1.25-7.0). The mean endothelial cell count at 6 months was 2033.83 ± 570.53 cells/mm 2 (930-3207), and the mean final spherical equivalent was -4.67 ± 2.91 (-0.25 to -9.00).

Conclusions: FSL-assisted technology is useful to achieve a predictable and safe procedure when using mushroom configuration to perform DALK. Our conversion rate from DALK to penetrating keratoplasty was similar to or even lower than that reported in the literature. In the successful DALK cases, the visual and refractive results were similar to those reported in other studies using FSL-assisted DALK (with a standard or mushroom configuration).