Pub Date : 2019-06-01DOI: 10.5005/jp-journals-10025-1175
J. Almodin, E. Almodin, F. Almodin
Ab s t r Ac t Aim: We present a case series involving five eyes in four young patients with advanced keratoconus who were implanted with Ferrara intrastromal corneal ring segments (ICRS) followed by phakic intraocular lens (PIOLs). Background: ICRS have been used for the management of keratoconus in order to prevent further keratoconus progression and improve visual performance. Nonetheless, many patients may still suffer from moderate to high myopia after ICRS, requiring refractive error correction, which may not be achieved with glasses, contact lenses, or laser refractive surgery. For such cases, PIOLs have emerged as an alternative to correct residual refractive errors. Case description: Patients were aged between 13 years and 32 years at ICRS implantation. Around 6 months after ICRS implantation, patients were submitted to a second procedure for the implantation of an implantable collamer lens (ICL), Artisan or Artiflex PIOL to correct residual myopia. After the combined Ferrara ICRS and PIOL implantation, all treated eyes demonstrated a significant improvement in topographic findings and visual acuity, with reduced refraction and keratometric astigmatism. Conclusion: The combined procedure was successful in reshaping the cornea and improving visual acuity of patients. Clinical significance: The association of ICRS and PIOL can be an important alternative that should be considered to provide young patients with improved visual acuity in a moment of their lives when they are at their most productive.
Ab s t r Ac t目的：我们报道了一系列病例，涉及四名患有晚期圆锥角膜的年轻患者的五只眼睛，他们植入了Ferrara层内角膜环段（ICRS），然后植入了有晶状体人工晶状体（PIOLs）。背景：ICRS已用于圆锥角膜的治疗，以防止圆锥角膜的进一步发展并改善视觉表现。尽管如此，许多患者在ICRS后仍可能患有中度至高度近视，需要进行屈光不正矫正，而眼镜、隐形眼镜或激光屈光手术可能无法实现这一点。对于这种情况，PIOL已经成为校正残余折射误差的替代方案。病例描述：植入ICRS的患者年龄在13岁至32岁之间。ICRS植入后约6个月，患者接受第二次手术，植入可植入collamer晶状体（ICL）、Artisan或Artiflex PIOL，以矫正残余近视。Ferrara ICRS和PIOL联合植入后，所有接受治疗的眼睛在地形图和视力方面都有显著改善，屈光度和角膜散光减少。结论：联合手术成功地对角膜进行了整形，提高了患者的视力。临床意义：ICRS和PIOL的结合可能是一个重要的替代方案，应考虑在年轻患者生命中最富有成效的时刻为他们提供更好的视力。
{"title":"Association of Ferrara Intracorneal Ring Segments with Phakic Intraocular Lens for Improved Visual Acuity in Young Keratoconus Patients: A Case Series","authors":"J. Almodin, E. Almodin, F. Almodin","doi":"10.5005/jp-journals-10025-1175","DOIUrl":"https://doi.org/10.5005/jp-journals-10025-1175","url":null,"abstract":"Ab s t r Ac t Aim: We present a case series involving five eyes in four young patients with advanced keratoconus who were implanted with Ferrara intrastromal corneal ring segments (ICRS) followed by phakic intraocular lens (PIOLs). Background: ICRS have been used for the management of keratoconus in order to prevent further keratoconus progression and improve visual performance. Nonetheless, many patients may still suffer from moderate to high myopia after ICRS, requiring refractive error correction, which may not be achieved with glasses, contact lenses, or laser refractive surgery. For such cases, PIOLs have emerged as an alternative to correct residual refractive errors. Case description: Patients were aged between 13 years and 32 years at ICRS implantation. Around 6 months after ICRS implantation, patients were submitted to a second procedure for the implantation of an implantable collamer lens (ICL), Artisan or Artiflex PIOL to correct residual myopia. After the combined Ferrara ICRS and PIOL implantation, all treated eyes demonstrated a significant improvement in topographic findings and visual acuity, with reduced refraction and keratometric astigmatism. Conclusion: The combined procedure was successful in reshaping the cornea and improving visual acuity of patients. Clinical significance: The association of ICRS and PIOL can be an important alternative that should be considered to provide young patients with improved visual acuity in a moment of their lives when they are at their most productive.","PeriodicalId":92051,"journal":{"name":"International journal of keratoconus and ectatic corneal diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45183492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-01DOI: 10.5005/jp-journals-10025-1174
Vikas Sharma, V. Kansal, Jayd Lukenchuk, M. Dodd, M. Hackett
Ab s t r Ac t Aim: Corneal collagen cross-linking (CCL) is a procedure that exposes the cornea to ultraviolet light and/or riboflavin to halt the progression of corneal ectatic disease. Currently, most investigations using Fourier-transform infrared spectroscopy (FTIR) of corneal changes following CCL focus on corneal ultrastructure, and not on changes at the molecular level. The aim of this study was to investigate the temporal and spatial separation of corneal collagen linkages that underlie the success of CCL. Materials and methods: Controlled experimental trial. Pairs of donor globes from five patients (n = 10) were divided into interventional and control groups. Interventional group corneas (n = 5) were exposed to riboflavin 0.1% and ultraviolet-A (UVA) light according to the modified Dresden protocol, harvested, cryo-microtomed, and placed on glass slides. Control group corneas (n = 5) underwent cryo-microtoming without CCL. Molecular changes were imaged using the synchrotron mid-infrared beamline at the Canadian Light Source. Results: Fourier-transform infrared spectroscopy imaging of total protein, integrated area under the amide I band from 1,700 to 1,600 cm− 1, FTIR imaging of collagen triple helix structures, second-derivative intensity as 1,666 cm− 1, and FTIR imaging of aggregated proteins, secondderivative intensity as 1,625 cm− 1 detected no difference in intramolecular cross-links between the interventional and control corneas. The secondary structure of collagen was neither significantly altered nor was their evidence of aggregation or denaturation within the cornea. Conclusion: Our data suggest that intramolecular cross-linking does not play a major role in CCL and that it is more likely an increase in intermolecular linkages that accounts for increased corneal strength. Clinical significance: An increase in intermolecular linkages likely accounts for the increased corneal strength observed following CCL. We hope that these results will guide future work to optimize techniques for CCL.
{"title":"Analysis of the Change Induced by Riboflavin and Ultraviolet Light on Corneal Collagen by Infrared Spectrometry","authors":"Vikas Sharma, V. Kansal, Jayd Lukenchuk, M. Dodd, M. Hackett","doi":"10.5005/jp-journals-10025-1174","DOIUrl":"https://doi.org/10.5005/jp-journals-10025-1174","url":null,"abstract":"Ab s t r Ac t Aim: Corneal collagen cross-linking (CCL) is a procedure that exposes the cornea to ultraviolet light and/or riboflavin to halt the progression of corneal ectatic disease. Currently, most investigations using Fourier-transform infrared spectroscopy (FTIR) of corneal changes following CCL focus on corneal ultrastructure, and not on changes at the molecular level. The aim of this study was to investigate the temporal and spatial separation of corneal collagen linkages that underlie the success of CCL. Materials and methods: Controlled experimental trial. Pairs of donor globes from five patients (n = 10) were divided into interventional and control groups. Interventional group corneas (n = 5) were exposed to riboflavin 0.1% and ultraviolet-A (UVA) light according to the modified Dresden protocol, harvested, cryo-microtomed, and placed on glass slides. Control group corneas (n = 5) underwent cryo-microtoming without CCL. Molecular changes were imaged using the synchrotron mid-infrared beamline at the Canadian Light Source. Results: Fourier-transform infrared spectroscopy imaging of total protein, integrated area under the amide I band from 1,700 to 1,600 cm− 1, FTIR imaging of collagen triple helix structures, second-derivative intensity as 1,666 cm− 1, and FTIR imaging of aggregated proteins, secondderivative intensity as 1,625 cm− 1 detected no difference in intramolecular cross-links between the interventional and control corneas. The secondary structure of collagen was neither significantly altered nor was their evidence of aggregation or denaturation within the cornea. Conclusion: Our data suggest that intramolecular cross-linking does not play a major role in CCL and that it is more likely an increase in intermolecular linkages that accounts for increased corneal strength. Clinical significance: An increase in intermolecular linkages likely accounts for the increased corneal strength observed following CCL. We hope that these results will guide future work to optimize techniques for CCL.","PeriodicalId":92051,"journal":{"name":"International journal of keratoconus and ectatic corneal diseases","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42664191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-01DOI: 10.5005/jp-journals-10025-1173
Mohammad M. Shehadeh, Jamal A. S. Qaddumi, M. Akkawi, Dima Sadi, Ahmad R Soboh, Deyab R. Khloof, Ammar A. Aghbar
Purpose: Keratoconus is a degenerative, ectatic corneal disorder. Recently, corneal crosslinking (CXL) as a stabilizing procedure has been combined with other procedures to improve visual and refractive outcomes as in Athens and Cretan protocols. The aim of the study is to present the efficacy and safety of a modified Athens protocol over 1-year follow-up. Materials and methods: The study is a retrospective descriptive one with a total of 43 eyes (36 patients) with progressive keratoconus who underwent combined transepithelial phototherapeutic keratectomy (PTK), partial wavefront-optimized photorefractive keratectomy, and corneal collagen CXL. Visual, refractive, pachymetric and keratometric preoperative and postoperative follow-up data at 1 month, 3 months, 6 months, and 1 year were taken from patients’ medical records. Results: The mean uncorrected distance visual acuity (UDVA ) improved from (0.33 ± 0.19) preoperatively to (0.64 ± 0.27) at 1 year postoperatively and the mean corrected distance visual acuity (CDVA) from (0.62 ± 0.21) to (0.80 ± 0.20). At 1-year postoperative visit, the mean spherical and cylindrical values changed significantly from (−2.10 ± 2.45) to (−0.34 ± 2.26) and from (−3.50 ± 1.85) to (−1.23 ± 1.02), respectively. The mean steep and flat K readings significantly decreased from (50.97 ± 4.46) to (47.58 ± 5.61) and from (47.08 ± 4.02) to (44.84 ± 4.47), respectively. The mean Kmax also decreased from (56.27 ± 6.40) preoperatively to (51.22 ± 7.94) postoperatively. The thinnest corneal thickness mean was (462.49 ± 36.17 μm) preoperatively and (388.21 ± 56.64 μm) postoperatively. Conclusion: Our modified Athens protocol has shown to be safe and efficacious in the management of progressive keratoconus. Impressive improvements in visual, refractive, and keratometric values were noted. This approach offers a more tissue saving protocol than the original Athens protocol with less alteration to the surface of the cornea, which may offer more predictability and less refractive surprises.
{"title":"Efficacy of Combined Phototherapeutic Keratectomy, Wavefront-optimized Photorefractive Keratectomy and Corneal Collagen Crosslinking in the Management of Progressive Keratoconus over One-year Follow-up: Modified Athens Protocol","authors":"Mohammad M. Shehadeh, Jamal A. S. Qaddumi, M. Akkawi, Dima Sadi, Ahmad R Soboh, Deyab R. Khloof, Ammar A. Aghbar","doi":"10.5005/jp-journals-10025-1173","DOIUrl":"https://doi.org/10.5005/jp-journals-10025-1173","url":null,"abstract":"Purpose: Keratoconus is a degenerative, ectatic corneal disorder. Recently, corneal crosslinking (CXL) as a stabilizing procedure has been combined with other procedures to improve visual and refractive outcomes as in Athens and Cretan protocols. The aim of the study is to present the efficacy and safety of a modified Athens protocol over 1-year follow-up. Materials and methods: The study is a retrospective descriptive one with a total of 43 eyes (36 patients) with progressive keratoconus who underwent combined transepithelial phototherapeutic keratectomy (PTK), partial wavefront-optimized photorefractive keratectomy, and corneal collagen CXL. Visual, refractive, pachymetric and keratometric preoperative and postoperative follow-up data at 1 month, 3 months, 6 months, and 1 year were taken from patients’ medical records. Results: The mean uncorrected distance visual acuity (UDVA ) improved from (0.33 ± 0.19) preoperatively to (0.64 ± 0.27) at 1 year postoperatively and the mean corrected distance visual acuity (CDVA) from (0.62 ± 0.21) to (0.80 ± 0.20). At 1-year postoperative visit, the mean spherical and cylindrical values changed significantly from (−2.10 ± 2.45) to (−0.34 ± 2.26) and from (−3.50 ± 1.85) to (−1.23 ± 1.02), respectively. The mean steep and flat K readings significantly decreased from (50.97 ± 4.46) to (47.58 ± 5.61) and from (47.08 ± 4.02) to (44.84 ± 4.47), respectively. The mean Kmax also decreased from (56.27 ± 6.40) preoperatively to (51.22 ± 7.94) postoperatively. The thinnest corneal thickness mean was (462.49 ± 36.17 μm) preoperatively and (388.21 ± 56.64 μm) postoperatively. Conclusion: Our modified Athens protocol has shown to be safe and efficacious in the management of progressive keratoconus. Impressive improvements in visual, refractive, and keratometric values were noted. This approach offers a more tissue saving protocol than the original Athens protocol with less alteration to the surface of the cornea, which may offer more predictability and less refractive surprises.","PeriodicalId":92051,"journal":{"name":"International journal of keratoconus and ectatic corneal diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48834290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-01DOI: 10.5005/jp-journals-10025-1176
D. P. Llorens, A. Martínez-Abad
We report the long-term follow-up of two cases of untreated corneal ectasia presenting a crab claw-like sagittal and tangential topographic pattern at baseline, but without peripheral thinning. Currently, according to clinical examination, these two cases are diagnosed as pellucidlike keratoconus (PLK). The first case was a 58-year-old male who developed a true pellucid marginal degeneration (PMD) in one eye and with a nonprogressive PLK in the other eye. The second case presented was a 19-year-old male without clinical signs of ectasia at baseline that progressed to PLK with evident changes in topographic and pachymetric maps but maintaining the point of minimum corneal thickness (MCT) in the central area. The presence of two different conditions in the same patient (case 1) and the progression from inferosuperior asymmetry to the development of a crab claw-pattern (case 2) suggest that PMD, PLK, and keratoconus may be different phenotypic presentations of the same pathophysiological condition.
{"title":"Differences in the Long-term Progression Course of Two Cases of Pellucid-like Keratoconus: Are they the Same Condition with Different Phenotypic Presentation?","authors":"D. P. Llorens, A. Martínez-Abad","doi":"10.5005/jp-journals-10025-1176","DOIUrl":"https://doi.org/10.5005/jp-journals-10025-1176","url":null,"abstract":"We report the long-term follow-up of two cases of untreated corneal ectasia presenting a crab claw-like sagittal and tangential topographic pattern at baseline, but without peripheral thinning. Currently, according to clinical examination, these two cases are diagnosed as pellucidlike keratoconus (PLK). The first case was a 58-year-old male who developed a true pellucid marginal degeneration (PMD) in one eye and with a nonprogressive PLK in the other eye. The second case presented was a 19-year-old male without clinical signs of ectasia at baseline that progressed to PLK with evident changes in topographic and pachymetric maps but maintaining the point of minimum corneal thickness (MCT) in the central area. The presence of two different conditions in the same patient (case 1) and the progression from inferosuperior asymmetry to the development of a crab claw-pattern (case 2) suggest that PMD, PLK, and keratoconus may be different phenotypic presentations of the same pathophysiological condition.","PeriodicalId":92051,"journal":{"name":"International journal of keratoconus and ectatic corneal diseases","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48130287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2016-05-01DOI: 10.5005/jp-journals-10025-1123
Yelena Bykhovskaya, Anastasia Gromova, Helen P Makarenkova, Yaron S Rabinowitz
Aim: To identify changes in the expression of genes coding for extracellular matrix (ECM) proteins in patients with non-inflammatory corneal disorder keratoconus (KC), patients with corneal scarring, and normal controls.
Materials and methods: Total RNA extracted from corneal tissue of 13 KC patients, 2 patients with corneal scaring and 4 normal controls was analyzed using Human Extracellular Matrix & Adhesion Molecules Profiler PCR Array. Statistically significant changes in gene expression were identified using the Data Analysis software.
Results: Comparison of KC and control corneas with thresholds of 1.5 or greater fold change and a p-value of 0.05 or lower, revealed 21 differentially expressed genes, 16 genes were downregulated and 5 were upregulated. Among transcripts downregulated in KC patients we identified THBS1, ADAMTS1, SPP1, several collagens and integrins. We found TGFBI (BIGH3) gene was the most significantly upregulated transcript.
Conclusion: Development of keratoconus results in deregulation of gene expression of extracellular matrix and adhesion molecules.
Clinical significance: Downregulation of collagens and upregulation of TGFBI repeatedly identified in KC patients may be used as clinical markers of the disease.
{"title":"Abnormal regulation of extracellular matrix and adhesion molecules in corneas of patients with keratoconus.","authors":"Yelena Bykhovskaya, Anastasia Gromova, Helen P Makarenkova, Yaron S Rabinowitz","doi":"10.5005/jp-journals-10025-1123","DOIUrl":"https://doi.org/10.5005/jp-journals-10025-1123","url":null,"abstract":"<p><strong>Aim: </strong>To identify changes in the expression of genes coding for extracellular matrix (ECM) proteins in patients with non-inflammatory corneal disorder keratoconus (KC), patients with corneal scarring, and normal controls.</p><p><strong>Materials and methods: </strong>Total RNA extracted from corneal tissue of 13 KC patients, 2 patients with corneal scaring and 4 normal controls was analyzed using Human Extracellular Matrix & Adhesion Molecules Profiler PCR Array. Statistically significant changes in gene expression were identified using the Data Analysis software.</p><p><strong>Results: </strong>Comparison of KC and control corneas with thresholds of 1.5 or greater fold change and a p-value of 0.05 or lower, revealed 21 differentially expressed genes, 16 genes were downregulated and 5 were upregulated. Among transcripts downregulated in KC patients we identified THBS1, ADAMTS1, SPP1, several collagens and integrins. We found TGFBI (BIGH3) gene was the most significantly upregulated transcript.</p><p><strong>Conclusion: </strong>Development of keratoconus results in deregulation of gene expression of extracellular matrix and adhesion molecules.</p><p><strong>Clinical significance: </strong>Downregulation of collagens and upregulation of TGFBI repeatedly identified in KC patients may be used as clinical markers of the disease.</p>","PeriodicalId":92051,"journal":{"name":"International journal of keratoconus and ectatic corneal diseases","volume":"5 2","pages":"63-70"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5005/jp-journals-10025-1123","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35479076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：