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Seeing the future: Ophthalmology gets "eye-tech" savvy with Internet of Medical Thing. 预见未来:眼科借助医疗物联网掌握 "眼科技术"。
IF 1 Q4 OPHTHALMOLOGY Pub Date : 2024-04-26 eCollection Date: 2024-07-01 DOI: 10.4103/tjo.TJO-D-24-00014
Dhruval Ashok Khurana
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引用次数: 0
Corneal transplantation surgery: Where we are and where are we going? 角膜移植手术:我们的现状和未来?
IF 1.1 Q3 Medicine Pub Date : 2024-03-15 eCollection Date: 2024-01-01 DOI: 10.4103/tjo.TJO-D-24-00009
Jorge L Alio
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引用次数: 0
Systemic treatment and surgical intervention in inflammatory Terrien disease. 炎症性特里恩病的系统治疗和手术干预。
IF 1.1 Q3 Medicine Pub Date : 2024-03-15 eCollection Date: 2024-01-01 DOI: 10.4103/tjo.TJO-D-23-00176
Francisco Arnalich-Montiel

This case report presents a unique instance of a 55-year-old male patient exhibiting features of both Terrien marginal degeneration (TMD) and Fuchs' superficial marginal keratitis. Characterized by peripheral corneal thinning vascularization, and a pseudopterygium, the patient experienced recurrent photophobia, redness, and tearing over 15 years. This case challenges the traditional distinction between TMD and Fuchs' superficial marginal keratitis, suggesting a potential common underlying disorder. Mycophenolate mofetil provided a partial response, while pseudopterygium removal led to sustained remission, emphasizing its therapeutic significance. This case highlights the first documented use of mycophenolate in TMD and supports the notion of shared vasculitic origins between TMD and Fuchs' keratitis, raising intriguing questions about targeted therapeutic interventions.

本病例报告介绍了一名 55 岁男性患者的独特病例,该患者同时具有特里恩角膜缘变性(Terrien marginal degeneration,TMD)和福氏浅缘角膜炎的特征。患者的特征是角膜周边血管变细和假性翼状胬肉,15 年来反复出现畏光、发红和流泪症状。该病例对 TMD 和 Fuchs 表浅边缘角膜炎之间的传统区别提出了质疑,提示两者可能存在共同的潜在疾病。霉酚酸酯可缓解部分症状,而切除假性翼状胬肉则可使症状持续缓解,这突出了假性翼状胬肉的治疗意义。该病例是首次在 TMD 中使用霉酚酸酯的记录,支持了 TMD 和 Fuchs 角膜炎之间有共同的血管病变起源的观点,提出了有关针对性治疗干预的有趣问题。
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引用次数: 0
Pre-Descemet's endothelial keratoplasty with glued intraocular lens implantation with pinhole pupilloplasty in a case of ocular comorbidity in achromatopsia. 在一例无色素性视网膜病变患者的眼部合并症中,采用前去角皮内皮角膜移植术和针孔瞳孔成形术植入胶合型人工晶体。
IF 1.1 Q3 Medicine Pub Date : 2024-03-15 eCollection Date: 2024-01-01 DOI: 10.4103/tjo.TJO-D-23-00172
Dhivya Ashok Kumar, Amar Agarwal, Swetha Ravichandran

Ocular comorbidities can happen as congenital defective gene associations. We present a 37-year-old female patient who was mentally challenged and had coexisting achromatopsia gene abnormality on genetic analysis. She was operated in childhood for congenital cataract, and posterior chamber intraocular lens (IOL) was implanted at 10 years of age elsewhere. The patient presented 27 years later with luxated IOL with endothelial decompensation. There was a coexisting steep and thin cornea noted on corneal topography. She was managed with pre-Descemet's endothelial keratoplasty with transpositioning of posterior chamber IOL to glued IOL with single-pass four-throw pupilloplasty. Postoperatively, the cornea was clear with centered glued IOL. The lesser postanesthetic challenges and faster rehabilitation are obtained in combination procedures with reduced complications in such rare scenarios.

眼部合并症可能与先天性缺陷基因有关。我们为您介绍一位 37 岁的女性患者,她有智力障碍,并且在基因分析中同时存在色弱基因异常。她在童年时因先天性白内障接受了手术,10 岁时在其他地方植入了后房型人工晶体(IOL)。27 年后,患者因内皮失代偿而出现人工晶体脱落。角膜地形图显示,患者的角膜陡薄。她接受了前戴斯麦内皮角膜移植术,将后房型人工晶体移位为粘连型人工晶体,并进行了单程四抛瞳孔成形术。术后,居中的胶合人工晶体使角膜变得清晰。在这种罕见的情况下,联合手术的麻醉后挑战较小,康复较快,并减少了并发症。
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引用次数: 0
Main issues in penetrating keratoplasty 穿透性角膜移植术的主要问题
IF 1.1 Q3 Medicine Pub Date : 2024-02-29 DOI: 10.4103/tjo.tjo-d-24-00001
Jorge L. Alió, Sana Niazi, Farideh Doroodgar, J. D. Barrio, Hassan Hashemi, Mohammad Ali Javadi
This review explores contemporary challenges in penetrating keratoplasty (PK), focusing on technical intricacies, technological advancements, and strategies for preventing graft rejection. A systematic literature search from January 2018 to July 2023 was conducted across PubMed, Cochrane, Web of Science, Scopus, and EMBASE. The inclusion criteria comprised studies on PK and its comparison with other corneal pathologies, with emphasis on keratoconus (KC). Two independent reviewers screened studies, extracting relevant data. The review covers PK evolution, highlighting infra-red femtosecond lasers’ impact on graft shapes, minimizing astigmatism, and enhancing wound healing. Graft rejection, a primary complication, is examined, detailing risk factors and preventive measures. Preoperative considerations, diagnostic techniques for rejection, and PK in KC are discussed. Postoperative care’s significance, including intraocular pressure monitoring and steroid administration, is emphasized. The paper concludes with a comprehensive approach to prevent graft rejection, involving topical and systemic medications. An outlook on evolving monoclonal antibody research is presented. As the field progresses, personalized approaches and ongoing therapeutic exploration are expected to refine strategies, enhancing PK outcomes.
本综述探讨了穿透性角膜移植术(PK)的当代挑战,重点关注技术的复杂性、技术的进步以及预防移植物排斥反应的策略。从 2018 年 1 月到 2023 年 7 月,我们在 PubMed、Cochrane、Web of Science、Scopus 和 EMBASE 上进行了系统的文献检索。纳入标准包括有关 PK 的研究及其与其他角膜病变的比较,重点是角膜屈光不正(KC)。两位独立审稿人对研究进行了筛选,提取了相关数据。综述涵盖了PK的演变,重点介绍了红外飞秒激光对移植物形状、散光最小化和促进伤口愈合的影响。对移植物排斥这一主要并发症进行了研究,详细介绍了风险因素和预防措施。还讨论了术前注意事项、排斥反应诊断技术和 KC 中的 PK。本文强调了术后护理的重要性,包括眼压监测和类固醇用药。最后,本文介绍了预防移植排斥反应的综合方法,包括局部用药和全身用药。本文还对不断发展的单克隆抗体研究进行了展望。随着该领域的不断进步,个性化方法和持续的治疗探索有望完善策略,提高 PK 结果。
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引用次数: 0
Bilateral keratitis associated with afatinib therapy 与阿法替尼治疗相关的双侧角膜炎
IF 1.1 Q3 Medicine Pub Date : 2024-02-23 DOI: 10.4103/tjo.tjo-d-24-00003
Ya-Tung Liu, Chen-Wei Lin, Chi-Chin Sun, Shih-Chieh Shao, Nan-Ni Chen
This case discussed a significant ocular side effect, bilateral keratitis, which could be induced by afatinib, an irreversible epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). We explored the disease progression of a 52-year-old, stage IV nasopharyngeal carcinoma male patient, who was under afatinib treatment and had experienced progressive bilateral eye dryness and tenderness on increasing afatinib from 40 mg every other day to 40 mg daily. Clinical examination noted bilateral visual acuity reduction, diffuse superficial punctate keratopathy in the right eye, and a central epithelial defect in the left eye. Seidel test results were negative for both eyes, with no corneal infiltration, lagophthalmos, anterior chamber cell precipitation, or retinal lesion. Symptoms subsequently resolved after reducing the frequency of afatinib used, along with intensive ocular hydration. In summary, this case highlighted afatinib’s potential link to bilateral keratitis, and early afatinib dose adjustment with supportive medication could significantly reverse the condition.
本病例讨论了阿法替尼(一种不可逆的表皮生长因子受体-酪氨酸激酶抑制剂(EGFR-TKI))可能诱发的严重眼部副作用--双侧角膜炎。我们对一名 52 岁的 IV 期鼻咽癌男性患者的病情进展进行了探讨。该患者正在接受阿法替尼治疗,在将阿法替尼从每隔一天服用 40 毫克增加到每天服用 40 毫克后,出现了进行性的双侧眼睛干涩和触痛。临床检查发现双侧视力下降,右眼出现弥漫性浅表点状角膜病变,左眼出现中央上皮缺损。两只眼睛的 Seidel 试验结果均为阴性,没有角膜浸润、眼睑下垂、前房细胞沉淀或视网膜病变。在减少阿法替尼的使用频率并加强眼部补水后,症状随之缓解。总之,本病例强调了阿法替尼与双侧角膜炎的潜在联系,及早调整阿法替尼剂量并使用支持性药物可显著逆转病情。
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引用次数: 0
Main issues in deep anterior lamellar keratoplasty: A systematic narrative review 深前板层角膜移植术的主要问题:系统性叙述回顾
IF 1.1 Q3 Medicine Pub Date : 2024-02-23 DOI: 10.4103/tjo.tjo-d-23-00175
Sana Niazi, J. D. Barrio, Farideh Doroodgar, Mohammad Ali Javadi, Jorge L. Alió
Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable alternative to penetrating keratoplasty (PK). This systematic review explores the intricacies of DALK, comparing its preoperative, intraoperative, and postoperative considerations with PK. Extensive literature searches revealed a wealth of data regarding DALK’s advantages and challenges, with an emphasis on graft survival, visual outcomes, and complications. In the preoperative phase, DALK showcases its versatility, catering to a wide spectrum of patients, including those with KC and ocular surface disorders. Intraoperatively, it offers innovative techniques to address emphysema, bubble formation, and Descemet’s membrane perforation, all while maintaining a strong focus on patient-centered outcomes. Postoperatively, DALK’s lower rejection rates and decreased complications underscore its potential superiority over PK, although unique challenges such as graft failure from nonimmunologic factors demand vigilant management. This comprehensive review not only serves as a valuable resource for ophthalmic surgeons but also sheds light on the evolving landscape of corneal transplantation, highlighting DALK’s role as a transformative force in the field.
深前板层角膜成形术(DALK)已成为治疗角膜病变,尤其是角膜屈光不正(KC)的一种变革性方法,为穿透性角膜成形术(PK)提供了一种可行的替代方案。本系统性综述探讨了 DALK 的复杂性,并将其术前、术中和术后注意事项与 PK 进行了比较。通过广泛的文献检索,发现了大量有关 DALK 优势和挑战的数据,重点是移植物存活率、视觉效果和并发症。在术前阶段,DALK 展示了其多功能性,可满足包括 KC 和眼表疾病患者在内的各种患者的需求。术中,它提供创新技术来解决气肿、气泡形成和 Descemet's 膜穿孔等问题,同时始终关注以患者为中心的结果。术后,DALK 的排斥率较低,并发症较少,这凸显了它与 PK 相比的潜在优势,但它也面临着一些独特的挑战,例如非免疫因素导致的移植物失败,这就要求我们提高警惕。这篇全面的综述不仅为眼科外科医生提供了宝贵的资料,还揭示了角膜移植手术不断发展的前景,突出了 DALK 作为角膜移植领域变革力量的作用。
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引用次数: 0
Outcomes of 320-degree intrastromal corneal ring segment implantation for advanced keratoconus 320 度角膜环植入术治疗晚期角膜炎的效果
IF 1.1 Q3 Medicine Pub Date : 2024-02-23 DOI: 10.4103/tjo.tjo-d-24-00004
Nan-Ni Chen, Chi-Chin Sun
The purpose of this study is to investigate visual and tomographic outcomes and complications of long-arc length intrastromal corneal ring segment (ICRS) implantation for the treatment of advanced keratoconus. This retrospective study enrolled 10 eyes of 9 subjects. All patients received 320-degree ICRS (320-ICRS) implantation with femtosecond laser-assisted technique based on their advanced grading with preoperative high keratometry (K) value, asphericity (Q), and astigmatism. Medical records and corneal tomography changes of consecutive patients were reviewed at baseline, 1, and 3 months after treatment. There are 6 female and 3 male patients with a mean age of 29.6 ± 7.8 years in this study. Mean K (Km) reduced from 59.01 ± 5.81 D preoperatively to 50.7 ± 5.3 and 50.2 ± 3.66 postoperatively (after 1 month and 3 months respectively, P < 0.001). The changes in mean K, K1, K2, and maximum K (Kmax) reading were all statistically significant (all P < 0.001). Mean uncorrected distance visual acuity (UCVA) improved from 20/400 to 20/200. Mean best-corrected distance visual acuity (BCVA) improved from 20/100 to 20/60. Both UCVA and BCVA showed a trend of improvement at postoperative month 3, though insignificant in BCVA (P = 0.114). Mean Q improved from −1.59 ± 0.62 preoperatively to −0.48 ± 1.08 and −0.11 ± 1.04 postoperatively (after 1 month and 3 months respectively, P = 0.016, 0.002). No intraoperative or postoperative complications were observed. The present results suggest that implanting a 320-ICRS is a safe and effective procedure for treating patients with advanced keratoconus. Preoperative corneal measurements and the selection of types and thickness of ICRS are important to prevent unpredictable results.
本研究的目的是调查长弧长角膜环植入术治疗晚期角膜病的视觉和断层成像结果及并发症。 这项回顾性研究共纳入了 9 名受试者的 10 只眼睛。所有患者都接受了飞秒激光辅助技术下的 320 度 ICRS(320-ICRS)植入术,这是因为他们的角膜度数(K)值、非球面度数(Q)和散光度数都较高,属于晚期分级。在基线、治疗后 1 个月和 3 个月对连续患者的病历和角膜断层扫描变化进行了审查。 本研究中共有 6 名女性和 3 名男性患者,平均年龄为(29.6 ± 7.8)岁。平均 K 值(Km)从术前的 59.01 ± 5.81 D 降至术后的 50.7 ± 5.3 和 50.2 ± 3.66(分别为 1 个月和 3 个月后,P < 0.001)。平均 K 值、K1 值、K2 值和最大 K 值 (Kmax) 读数的变化均有统计学意义(P 均 < 0.001)。平均未校正距离视力(UCVA)从 20/400 提高到 20/200。平均最佳矫正距离视力(BCVA)从 20/100 提高到 20/60。术后第 3 个月,UCVA 和 BCVA 均出现改善趋势,但 BCVA 的改善不明显(P = 0.114)。平均 Q 值从术前的 -1.59 ± 0.62 降至术后的 -0.48 ± 1.08 和 -0.11 ± 1.04(分别为术后 1 个月和 3 个月,P = 0.016,0.002)。术中和术后均未观察到并发症。 本研究结果表明,植入 320-ICRS 是治疗晚期角膜炎患者的一种安全有效的方法。术前角膜测量以及选择 ICRS 的类型和厚度对于防止出现不可预知的结果非常重要。
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引用次数: 0
Large-diameter deep anterior lamellar keratoplasty: A narrative review 大直径深前板层角膜移植术:叙述性综述
IF 1.1 Q3 Medicine Pub Date : 2024-02-23 DOI: 10.4103/tjo.tjo-d-23-00161
A. C. Yu, Andrea Sollazzo, Cristina Bovone, Massimo Busin
Deep anterior lamellar keratoplasty (DALK) involves the selective replacement of diseased corneal stroma while preserving healthy unaffected endothelium. While DALK has failed to gain widespread popularity, improved visual and refractive outcomes of large-diameter grafts, which patients directly perceive following suture removal, may represent a compelling reason to shift toward DALK. Since the unaffected host endothelium is retained, DALK offers the opportunity to use large-diameter grafts, which reliably achieves maximum visual potential without an increased risk of immune-mediated stromal rejection. In this narrative review, we evaluate the current evidence on large-diameter DALK including surgical technique and clinical outcomes.
深层前板层角膜移植术(DALK)是有选择性地更换病变角膜基质,同时保留未受影响的健康角膜内皮。虽然 DALK 未能得到广泛普及,但患者在拆线后能直接感受到大直径移植物带来的视觉和屈光效果的改善,这可能是转向 DALK 的一个令人信服的理由。由于未受影响的宿主内皮得以保留,因此 DALK 提供了使用大直径移植物的机会,既能可靠地实现最大视觉潜力,又不会增加免疫介导的基质排斥风险。在这篇叙述性综述中,我们评估了目前有关大直径 DALK 的证据,包括手术技术和临床结果。
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引用次数: 0
Biomechanical changes in keratoconus after customized stromal augmentation 定制基质增强术后角膜炎的生物力学变化
IF 1.1 Q3 Medicine Pub Date : 2024-02-20 DOI: 10.4103/tjo.tjo-d-23-00155
Sana Niazi, J. A. D. del Barrio, Farideh Doroodgar, Azad Sanginabadi, C. Alinia, S. J. Hashemian, Hassan Hashemi, Jorge L. Alió
To verify corneal biomechanical changes, poststromal augmentation using myopic small-incision lenticule extraction’s (SMILEs) lenticules in advanced keratoconus (KCN) through Corvis ST (Oculus, Wetzlar, Germany). A clinical trial enrolled 22 advanced KCN patients. We implanted lenticules exceeding 100 μ according to a nomogram and evaluated biomechanical factors through Corvis ST at 3-, 6-, and 24-month postimplantation. We examined parameters during the first applanation (A1), second applanation (A2), highest concavity (HC)/max concavity events, and Vinciguerra screening parameters, as recently established criteria derived from the ideal blend of diverse biomechanical and ocular factors and formulated through the application of logistic regression. Regression analyses explored relationships with age, mean keratometry value, thickness, sphere, cylinder, and best-corrected visual acuity. Patients were well matched for age, intraocular pressure, and central corneal thickness (CCT). The mean spherical equivalent decreased from −13.48 ± 2.86 Diopters (D) to −8.59 ± 2.17 D (P < 0.007), and mean keratometry decreased from 54.68 ± 2.77 D to 51.95 ± 2.21 D (P < 0.006). Significant increases were observed in HC time (HCT), Radius–central curvature radius at the HC state–, peak distance (PD) during HC state, CCT, first applanation time, and stiffness parameter (A1T and SP-A1), whereas HC deformation amplitude, maximum deformation amplitude ratio at 2 mm, Corvis Biomechanical Index (CBI), integrated radius (IR), second applanation deformation amplitude (A2DA), first applanation velocity and deflection amplitude (A1V and A1DeflA) significantly decreased postlenticule implantation. Multivariable regression revealed age positively correlated with SP-A1 (P = 0.003) and negatively with HC delta Arc length (P = 0.007). Mean K positively correlated with CCT (P = 0.05) and negatively with CBI (P = 0.032). Best-corrected visual acuity positively correlated with HCT (P = 0.044), and the cylinder positively correlated with PD (P = 0.05) and CCT (P = 0.05) whereas negatively with IR (P = 0.025). Stromal augmentation using myopic SMILE lenticules induces significant corneal biomechanical changes in KCN.
为了验证角膜生物力学的变化,通过 Corvis ST(Oculus,德国韦茨拉尔)使用近视小切口角膜瓣摘除术(SMILEs)角膜瓣对晚期角膜病(KCN)患者进行了角膜基质增强术。 一项临床试验招募了 22 名晚期 KCN 患者。我们根据提名图植入了超过 100 μ 的透镜,并通过 Corvis ST 评估了植入后 3 个月、6 个月和 24 个月的生物力学因素。我们检查了第一次瞳孔散大(A1)、第二次瞳孔散大(A2)、最高凹(HC)/最大凹事件期间的参数以及文琪奎拉筛查参数,这些都是最近建立的标准,这些标准来自于各种生物力学和眼部因素的理想融合,并通过应用逻辑回归进行了制定。回归分析探讨了与年龄、平均角膜测量值、厚度、球面、柱面和最佳矫正视力之间的关系。 患者的年龄、眼压和中央角膜厚度(CCT)都非常匹配。平均球面等效视力从-13.48 ± 2.86屈光度(D)下降到-8.59 ± 2.17屈光度(P < 0.007),平均角膜曲率从54.68 ± 2.77屈光度下降到51.95 ± 2.21屈光度(P < 0.006)。HC时间(HCT)、HC状态下的半径-中心曲率半径、HC状态下的峰值距离(PD)、CCT、首次角膜塑形时间和硬度参数(A1T和SP-A1)均有显著增加,而HC变形幅度、HC状态下的半径-中心曲率半径、HC状态下的峰值距离(PD)、CCT、首次角膜塑形时间和硬度参数(A1T和SP-A1)均有显著增加、而 HC 变形幅度、2 毫米处最大变形幅度比、Corvis 生物力学指数(CBI)、综合半径(IR)、第二次瞳孔散大变形幅度(A2DA)、第一次瞳孔散大速度和偏转幅度(A1V 和 A1DeflA)在支架植入后明显下降。多变量回归显示,年龄与 SP-A1 呈正相关(P = 0.003),与 HC 三角弧长度呈负相关(P = 0.007)。平均 K 值与 CCT 呈正相关(P = 0.05),与 CBI 呈负相关(P = 0.032)。最佳矫正视力与 HCT 呈正相关(P = 0.044),柱状体与 PD(P = 0.05)和 CCT(P = 0.05)呈正相关,而与 IR 呈负相关(P = 0.025)。 使用近视SMILE透镜进行基质增量可引起KCN角膜生物力学的显著变化。
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引用次数: 0
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Taiwan Journal of Ophthalmology
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