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Hamon L, Pfahl LJ, Flockerzi E, Berger T, Langenbucher A, Seitz B, Daas L. Implantation of Intracorneal Ring Segments in Keratectasia: Effects on Corneal Biomechanics in 112 Eyes. Cornea 2024; 43:702-709. [PMID: 37921596 DOI: 10.1097/ico.0000000000003419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/24/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE The aim of this study was to analyze changes in corneal biomechanical properties after implantation of intracorneal ring segments (ICRSs) in keratectasia. METHODS This retrospective single-center study included 112 patient eyes that underwent femtosecond laser-assisted ICRS implantation (Intacs SK; Addition Technology Inc, Des Plaines, IL) for keratectasia. Biomechanical analysis was performed using the Ocular Response Analyzer (ORA; Reichert Inc, Depew, NY), with determination of corneal resistance factor, corneal hysteresis, and Keratoconus Match Index, as well as by Corvis ST (OCULUS, Wetzlar, Germany), with determination of stiffness parameter A1, Ambrosio relational thickness to the horizontal profile (Arth), integrated radius, deformation amplitude ratio, and stress-strain index as well as Corvis Biomechanical Index and Tomographic Biomechanical Index. Data collection was performed preoperatively and 6 months postoperatively for ORA and Corvis ST and additionally after 1 and 2 years for ORA. RESULTS The corneal resistance factor decreased significantly postoperatively (5.8 ± 1.7 mm Hg) compared with preoperatively (6.75 ± 3.7 mm Hg; P = 0.021) and increased again during follow-up (6.2 ± 1.9 mm Hg; P = 0.024), without regaining preoperative values. Corneal hysteresis and Keratoconus Match Index did not change significantly. Stiffness parameter A1 ( P = 0.045) increased significantly after ICRS implantation and Arth decreased significantly from 181 ± 85 to 150 ± 92 ( P = 0.016). However, there was no significant postoperative change for others Corvis parameters. CONCLUSIONS Corneal biomechanical properties showed inconsistent changes after ICRS implantation. Classical corneal biomechanical parameters (using single central air-puff tonometers) do not seem to be suitable for follow-up after ICRS implantation.
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Affiliation(s)
- Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
| | - Luisa J Pfahl
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
| | - Tim Berger
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
| | - Achim Langenbucher
- Institute for Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
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Flockerzi E, Berger T, Seitz B, Hamon L, Daas L. Evaluation of dynamic corneal response parameters and the biomechanical E-staging after Intacs® SK implantation in keratoconus. Indian J Ophthalmol 2024; 72:S495-S500. [PMID: 38648457 DOI: 10.4103/ijo.ijo_2944_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/29/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE This retrospective longitudinal study evaluated the biomechanical E-staging in KC corneas before and after intracorneal ring segment (ICRS) implantation (Intacs® SK, Addition Technology, Illinois, United States). METHODS Biomechanical E-staging for ectatic corneal diseases was applied retrospectively on 49 KC corneas of 41 patients who underwent ICRS implantation. The main outcome parameters included the Corvis Biomechanical Factor (CBiF, the linearized Corvis Biomechanical Index and the biomechanical parameters included), the resulting biomechanical E-staging, the stress-strain index, thinnest corneal thickness (TCT), maximal anterior keratometry (Kmax), and the anterior radius of curvature (ARC). They were evaluated at 1.9 ± 1.1 months preoperatively and postoperatively after 2.8 ± 0.7, 5.8 ± 1.0, and 10.6 ± 2.3 months. RESULTS The CBiF decreased (4.9 ± 0.5 | 4.7 ± 0.5, P = 0.0013), and the E-staging increased significantly (2.8 ± 0.8 | 3.1 ± 0.9, P = 0.0012, paired t-test) from preoperatively to the first postoperative follow-up. The difference remained significant after 6 months; however, there was no more difference after 11 months. TCT was stable, whereas Kmax and ARC significantly decreased after ICRS implantation (TCT: 464 ± 49, 470 ± 51, 467 ± 38, 461 ± 48; Kmax: 56.3 ± 4.5, 54.7 ± 4.5, 54.2 ± 4.8, 54.1 ± 4.3; ARC: 51.5 ± 3.4, 48.3 ± 3.8, 48.6 ± 3.0, 48.6 ± 3.2 preoperatively and 3, 6, and 11 months postoperatively, respectively). Besides Kmax and ARC, Ambrósio's relational thickness to the horizontal profile (ARTh) was the only parameter that was significantly lower than preoperatively at any follow-up (P ≤ 0.0024, Wilcoxon matched-pairs test). CONCLUSION Intacs® SK implantation results in an increasing biomechanical E-staging in the first postoperative months with stabilization near preoperative values after 1 year. Significantly lower ARTh values at any follow-up document the ICRS effect and contribute to a slightly higher postoperative biomechanical E-staging value.
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Affiliation(s)
- Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
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Ahmet S, Yayla Akincilar G, Kirgiz A, Kandemir Besek N, Kemer Atik B, Topcu H, Gumus Kasapoglu G. Long-term results of accelerated corneal collagen crosslinking in paediatric patients with progressive keratoconus: 10-year follow-up. Eye (Lond) 2024:10.1038/s41433-024-03064-7. [PMID: 38609652 DOI: 10.1038/s41433-024-03064-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/06/2024] [Accepted: 04/02/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES To evaluate the 10-year visual, refractive, and tomographic outcomes of epithelium-off accelerated corneal collagen cross-linking (ACCL) in paediatric patients with progressive keratoconus (KC) and to compare the stages in terms of re-progression. METHODS Patients under 18 years of age with progressive KC who underwent ACCL between 2010 and 2012 and completed at least 10 years of follow-up were included in this retrospective study. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), refractive errors, and corneal tomography parameters were evaluated preoperatively and at 1, 5, and 10 years postoperatively. The effect of stage and age on re-progression was analysed. RESULTS The study included 175 eyes of 97 patients (mean age: 14.46 ± 2.17 years). Improvement in UDVA and CDVA was observed in all postoperative periods compared to the preoperative period (each p-value < 0.05). The increase in spherical equivalent (SE), flattening of keratometry values, and decrease in thinnest corneal thickness (TCT) were statistically significant in the tenth year compared to preoperatively (each p-value < 0.05). Re-progression was observed in 16 eyes (9.14%). Haze was observed in 13 eyes (7.43%), 4 of which were permanent. Deep anterior lamellar keratoplasty was performed in 3 eyes (1.7%) and a second ACCL in 3 eyes (1.7%). CONCLUSIONS ACCL is an effective and safe long-term strategy to prevent progression of KC in paediatric patients. In the light of this study with a 10-year follow-up re-progression rate of 9.14%, long-term follow-up of patients after ACCL for possible re-progression and the need for re-CCL or keratoplasty may be recommended.
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Affiliation(s)
- Sibel Ahmet
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey.
| | - Gizem Yayla Akincilar
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Ahmet Kirgiz
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Nilay Kandemir Besek
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Burcu Kemer Atik
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Husna Topcu
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Gunes Gumus Kasapoglu
- University of Health Sciences, Beyoglu Eye Training and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
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4
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Buhl L, Feldhaus L, Kassumeh S. [How to: keratoconus assessment using Scheimpflug tomography]. DIE OPHTHALMOLOGIE 2024; 121:239-244. [PMID: 38386091 DOI: 10.1007/s00347-024-02002-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2024] [Indexed: 02/23/2024]
Affiliation(s)
- Lara Buhl
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland.
| | - Lukas Feldhaus
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
| | - Stefan Kassumeh
- Augenklinik und Poliklinik, LMU Klinikum, LMU München, Mathildenstr. 8, 80336, München, Deutschland
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Valeille A, Ouilhon C, Subtil F, Hacard F, Jaulent C, Bérard F, Nicolas JF, Fauquert JL, Nosbaum A. Comprehensive Ophthalmological Evaluation in Atopic Dermatitis. Dermatology 2024; 240:434-442. [PMID: 38354719 DOI: 10.1159/000536233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/07/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Atopic dermatitis (AD), a chronic type 2 inflammatory skin disease, is frequently associated with ocular surface diseases (OSD) which may appear or worsen under anti-type 2-targeted treatments. However, the exact prevalence of OSD and the ophthalmology referral criteria remain ill-defined in AD patients before initiating such biotherapies. We aimed to characterize the prevalence, the nature and the factors related to OSD development in AD that may justify an ophthalmological management. METHODS A total of 98 consecutive AD inpatients without biological treatment were retrospectively included. These were systematically evaluated by an ophthalmologist during their dermatological care. Clinical and laboratory data were analysed to characterize OSD and their risk factors. RESULTS OSD were found in 83/98 AD patients (85%); mainly dry eye syndrome (64%, 63/98), allergic conjunctivitis (42%, 41/98), posterior (33%, 32/98), and anterior blepharitis (27%, 26/98). In AD patients without ocular symptoms, OSDs were also frequently found (63%, 12/19) and were mostly mild. Risk factors for OSD were history of allergic rhinitis, allergic sensitization, head and neck AD, ocular symptoms (foreign body sensation in the eye, burning, itching, photophobia), and total IgE level >3,000 kU/L. CONCLUSION The prevalence of OSD was high, even in asymptomatic patients. The risk factors identified may indicate the need for ophthalmological examination for therapeutic management, especially when biological agents targeting type 2 inflammation are considered.
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Affiliation(s)
- Anaïs Valeille
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Immunology and Allergy Clinic, University Claude Bernard Lyon 1, Lyon, France
| | - Coralie Ouilhon
- Ophthalmology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
| | - Fabien Subtil
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, University of Lyon, University Lyon 1, Villeurbanne, France
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
| | - Florence Hacard
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Immunology and Allergy Clinic, University Claude Bernard Lyon 1, Lyon, France
- Ophthalmology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, University of Lyon, University Lyon 1, Villeurbanne, France
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
- CIRI (International Center for Infectiology Research) INSERM U1111, Lyon Higher Normal School, University Claude Bernard Lyon 1, Lyon, France
| | - Coline Jaulent
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
| | - Fréderic Bérard
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Immunology and Allergy Clinic, University Claude Bernard Lyon 1, Lyon, France
- Ophthalmology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, University of Lyon, University Lyon 1, Villeurbanne, France
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
- CIRI (International Center for Infectiology Research) INSERM U1111, Lyon Higher Normal School, University Claude Bernard Lyon 1, Lyon, France
| | - Jean-François Nicolas
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Immunology and Allergy Clinic, University Claude Bernard Lyon 1, Lyon, France
- Ophthalmology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, University of Lyon, University Lyon 1, Villeurbanne, France
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
- CIRI (International Center for Infectiology Research) INSERM U1111, Lyon Higher Normal School, University Claude Bernard Lyon 1, Lyon, France
| | - Jean-Luc Fauquert
- Pediatric Allergy Unit, Clermont-Ferrand University Hospital, University Hospital Center Estaing, Clermont-Ferrand, France
| | - Audrey Nosbaum
- Allergy and Clinical Immunology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Immunology and Allergy Clinic, University Claude Bernard Lyon 1, Lyon, France
- Ophthalmology Department, Lyon South University Hospital Center, Hospices Civils de Lyon, Lyon, France
- Laboratoire de Biométrie et Biologie Évolutive, CNRS, University of Lyon, University Lyon 1, Villeurbanne, France
- Biostatistics Department, Hospices Civils de Lyon, Lyon, France
- CIRI (International Center for Infectiology Research) INSERM U1111, Lyon Higher Normal School, University Claude Bernard Lyon 1, Lyon, France
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Seitz B, Turner C, Hamon L, Sneyers A, Alles F, Maamri A, Goebels-Kummerow S, Fiorentzis M, Bechrakis NE. Leadership in ophthalmology training : Opportunities and risks of medical specialist education. DIE OPHTHALMOLOGIE 2024; 121:48-60. [PMID: 38212434 DOI: 10.1007/s00347-023-01972-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/12/2023] [Indexed: 01/13/2024]
Abstract
Medical specialist training requires constant improvement and adaptation of the contents to the current situation. Nowadays, young physicians have the opportunity to select among the most renowned institutions and can choose the one most qualified for their training. Hospitals on the other hand still have the desire to recruit highly qualified physicians for their resident programs, which requires a good, well-rounded and reliable offer by the department under good leadership. Thus, among other issues a modern and multilingual homepage is already an important instrument for successfully addressing applicants and winning them over for the department. In addition to a well-planned and structured training plan (e.g., the "Homburg Curriculum") and a so-called "resident guide", many other additional offers are nowadays part of a successful training, such as structured internal and external specialist training courses, well thought out research concepts available to all interested parties, wet labs for practical exercises on pig's eyes and as the latest most innovative addition, a virtual reality simulator. Due to a structured curriculum with regular continuous education during the daily early morning meetings and an exchange program with another university eye hospital, not only the residents can benefit but ultimately also the department itself. In addition, future specialists are involved in the respective organization (so-called "service teams") from the very beginning. This conveys a great deal of knowledge and expertise but also organizational skills and thus improves the quality of training. In any case, standardized residency training with a view beyond the horizon, which is transparently organized and reliably carried out, improves the quality of training in order to become a certified ophthalmologist and increases the satisfaction of the residents. A department which is committed and can offer a wide range of services will benefit from motivated and satisfied employees in a good interpersonal climate, which in the end benefits not only the team but also the patients.
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Affiliation(s)
- Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Germany.
| | - Christina Turner
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Germany
| | - Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Germany
| | - Albéric Sneyers
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Germany
| | - Felix Alles
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Germany
| | - Amine Maamri
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Germany
| | - Susanne Goebels-Kummerow
- Department of Ophthalmology, Saarland University Medical Center, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Germany
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Berger T, Flockerzi E, Daas L, Hamon L, Khattabi Z, Berger M, Seitz B. [Modern corneal diagnostics as the key for the correct classification of the disease and optimal treatment decisions]. DIE OPHTHALMOLOGIE 2023; 120:1238-1250. [PMID: 37707672 DOI: 10.1007/s00347-023-01919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/15/2023]
Abstract
Corneal diseases include a wide spectrum of different manifestations (inflammatory/noninflammatory) that need to be accurately classified for precise diagnosis and targeted treatment. In addition to the anamnesis and slit lamp biomicroscopy, further device-based examinations can be performed to narrow down the diagnosis. Nowadays, modern corneal imaging provides a variety of technologies, such as topography, tomography, in vivo confocal microscopy and analysis of biomechanics, which are able to reliably classify different pathologies. Knowledge of the available examination modalities helps to guide differential diagnostic considerations, facilitating the indication for stage-appropriate microsurgical intervention.
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Affiliation(s)
- Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland.
| | - Elias Flockerzi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Loïc Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Zaynab Khattabi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Maximilian Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
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Feld S, Flockerzi E, Daas L, Xanthopoulou K, Sideroudi H, Langenbucher A, Seitz B. [Corneal biomechanics before and after cross-linking in patients with keratoconus]. DIE OPHTHALMOLOGIE 2023; 120:940-946. [PMID: 37043004 DOI: 10.1007/s00347-023-01839-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 02/10/2023] [Accepted: 03/01/2023] [Indexed: 04/13/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the effect of corneal cross-linking (CXL) on corneal biomechanics and visual acuity. PATIENTS AND METHODS The examination results before and after CXL in 56 eyes of 56 patients between 2017 and 2021 were evaluated retrospectively. The last preoperative examination was compared to the postoperative follow-up values after 6 and 12 months. The main outcome measures included various biomechanical parameters from the Corvis ST (CST), Pentacam and the visual acuity (logMAR, "logarithm of the Minimal Angle of Resolution"). For longitudinal evaluation, a general linear model for repeated measurements was used. A p-value of less than 0.05 was considered to show a statistically significant result. Bonferroni correction was applied for multiple comparisons. RESULTS The maximum corneal refractive power Kmax decreased slightly without statistical significance from 57.1 ± 6.1 diopters (dpt) to 56.6 ± 6.3 dpt after 6 months (p = 0.076) and 56.8 ± 6.6 dpt after 12 months (p = 0.443). The Pentacam parameter Belin/Ambrósio Enhanced Ectasia Total Deviation Display (BAD D) showed a statistically significant increase from the preoperative value of 8.4 ± 3.7 to the postoperative value of 9.1 ± 3.6 after 6 months (p < 0.001) and to 8.9 ± 3.5 after 12 months (p = 0.051). The CST parameter Ambrósio's relational thickness to horizontal profile (ARTh) decreased statistically significantly from 229.9 ± 109.6 to 204.8 ± 84.9 at 6 months (p = 0.017) and 205.3 ± 93.7 at 12 months (p = 0.022). The CST parameter stiffness parameter A1 (SP A1) increased slightly from the preoperative value 69.9 ± 17.2 to 70.4 ± 17.2 after 6 months (p = 1) and 71 ± 18.2 after 1 year (p = 1). Mean best-corrected visual acuity (logMAR) showed an improvement from 0.39 ± 0.3 to 0.34 ± 0.3 at 6 months (p = 0.286) and to 0.31 ± 0.3 at 12 months (p = 0.077). Regarding the ABCD classification, the parameters were determined preoperatively with an average of A2B3C1D2. They showed the same value of A2B3C1D2 after 6 and 12 months. CONCLUSION In progressive keratoconus, corneal cross-linking has the potential to positively influence the biomechanics of the cornea and visual acuity as a low complication treatment option.
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Affiliation(s)
- S Feld
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland.
| | - E Flockerzi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - L Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - K Xanthopoulou
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - H Sideroudi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
| | - A Langenbucher
- Institut für Experimentelle Ophthalmologie, Universität des Saarlandes, Homburg/Saar, Deutschland
| | - B Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Kirrberger Str. 100, 66424, Homburg/Saar, Deutschland
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9
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Seitz B, Turner C, Hamon L, Sneyers A, Alles F, Maamri A, Goebels-Kummerow S, Fiorentzis M, Bechrakis NE. [Leadership in ophthalmology training : Opportunities and risks of medical specialist education]. DIE OPHTHALMOLOGIE 2023; 120:906-919. [PMID: 37584714 DOI: 10.1007/s00347-023-01910-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/17/2023]
Abstract
Medical specialist training requires constant improvement and adaptation of the contents to the current situation. Nowadays, young physicians have the opportunity to select among the most renowned institutions and can choose the best qualified for their training. Hospitals on the other hand still have the desire to recruit highly qualified physicians for continuing education, which requires a good, well-rounded and reliable offer by the department under good leadership. Thus, among other issues a modern and multilingual homepage is already an important instrument for successfully addressing applicants and winning them over for the department. In addition to a well-planned and structured training plan (e.g., the Homburg curriculum) and a so-called resident guide, many other additional offers are nowadays part of a successful training, such as structured internal and external continuing education, well thought out research concepts available to all interested parties, wet labs for practical exercises on pig's eyes and as the latest most innovative addition, a virtual reality simulator. Due to a structured curriculum with regular continuous education during the daily early morning meetings and an exchange program with another university eye hospital, not only the residents can benefit but ultimately also the department itself. In addition, future specialists are involved in the respective organization (so-called service teams) from the very beginning. This conveys a great deal of knowledge and expertise but also organizational skills and thus improves the quality of training. In any case, standardized residency training with a view beyond the horizon, which is transparently organized and reliably carried out, improves the quality of training in order to become a certified ophthalmologist and increases the satisfaction of the residents. A department which is committed and can offer a wide range of services will benefit from motivated and satisfied employees in a good interpersonal climate, which in the end benefits not only the team but also the patients.
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Affiliation(s)
- Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Deutschland.
| | - Christina Turner
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Deutschland
| | - Loïc Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Deutschland
| | - Albéric Sneyers
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Deutschland
| | - Felix Alles
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Deutschland
| | - Amine Maamri
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Deutschland
| | - Susanne Goebels-Kummerow
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes UKS, Kirrberger Str. 100, Geb. 22, 66424, Homburg/Saar, Deutschland
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Sideroudi H, Flockerzi E, Daas L, Jullien T, Xanthopoulou K, Hamon L, Seitz B. Baseline Characteristics of 1976 Patients With Ectatic Corneal Disorders at a Single Center From 2010 to 2021: A Cross-Sectional Study of the Homburg Keratoconus Center. Eye Contact Lens 2023; 49:392-398. [PMID: 37458424 DOI: 10.1097/icl.0000000000001014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 08/26/2023]
Abstract
OBJECTIVES The study objective was to analyze the baseline characteristics of keratoconus (KC) patients at the Homburg Keratoconus Center from 2010 to 2021. METHODS This cross-sectional study included 3,674 eyes, with analysis of demographics, clinical findings, visual function, endothelial measurements, and topographic, tomographic, and corneal biomechanical data from the first visit. RESULTS Mean patient age was 36.3±13.8 years. The mean uncorrected distance visual acuity in log of minimal angle of resolution was 0.60 (20/80, Snellen equivalent), and the corrected mean was 0.3 (20/40). Of 1976 patients, 48.9% reported eye rubbing. Mean values (ranges) were 49.4±6.3 (36.3-78.0) D for steep keratometry, 462.4±66.0 (48.0-659.0) μm for thinnest corneal thickness, 9.7±8.7 (-0.5 to 88.8) for Belin/Ambrósio enhanced ectasia total deviation, 0.8±0.4 (0.0-1.0) for the Corvis biomechanical index, 0.9±0.2 (0.0-1.0) for the tomographic biomechanical index, 0.1±0.5 (-0.9 to 2.0) for the KC match index, 8.3±1.8 (2.2-17.7) mm Hg for corneal hysteresis, 7.1±2.2 (0.0-17.0) mm Hg for corneal resistance factor, and 2,562.9±326.3 (1,011-3,937) cells/mm2 for endothelial cell density. The average ABCDE KC stage was A2B3C1D1E2. Distance-corrected visual acuity correlated strongly with topometric, tomographic, and biomechanical data ( P <0.001). CONCLUSIONS This comprehensive description of baseline features of KC patients at a tertiary center provides a reference for further longitudinal and international multicentric studies.
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Affiliation(s)
- Haris Sideroudi
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany
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11
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Berger T, Seitz B, Hamon L, Flockerzi F, Schlötzer-Schrehardt U, Daas L. Ultrastructural Examination of the Corneal Interface after Predescemetic Deep Anterior Lamellar Keratoplasty (DALK) - A Case Report with Light and Transmission Electron Microscopy. Klin Monbl Augenheilkd 2023; 240:1010-1016. [PMID: 35320861 DOI: 10.1055/a-1745-9140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To examine corneal buttons with light and transmission electron microscopy (TEM) to visualize the interface area and highlight the ultrastructural corneal changes after deep anterior lamellar keratoplasty (DALK). METHODS Two patients underwent excimer laser-assisted penetrating repeat keratoplasty after predescemetic DALK. The corneal buttons were examined by light microscopy and TEM. RESULTS The light microscopic examination of the corneal buttons revealed fragments of a second Descemet's membrane in the central and midperipheral areas (Case 1). In both cases, visualization of the interface area was not possible by light microscopy. The donor and host stroma were tightly attached without dehiscence. TEM identified the interface area by irregularities in the collagen distribution between the donor and host stroma. The thickness of the remaining recipient corneal stroma measured approximately 30 µm (Case 1) and 100 µm (Case 2), respectively. In the host stroma, TEM revealed the absence or degeneration of keratocytes, accumulation of amorphous material between the collagen lamellae, and vacuolar inclusions dispersed in the stroma, forming a band-like zone anterior to Descemet's membrane. CONCLUSION The interface area after DALK has been mainly investigated by in vivo confocal microscopy. Light microscopy and TEM findings indicate remodeling processes after DALK that are associated with increased keratocyte degeneration and structural alterations of the extracellular matrix in the host stroma. The choice of surgical method may influence the postoperative morphological and functional outcome since these findings were primarily apparent in the remaining host stroma. Therefore, complete exposure of Descemet's membrane is an important prognostic factor for the postoperative visual outcome.
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Affiliation(s)
- Tim Berger
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Loïc Hamon
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | - Fidelis Flockerzi
- Institut für Allgemeine und Spezielle Pathologie, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
| | | | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Germany
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12
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Seitz B, Maier PC, Geerling G. [Cutting Edge Keratokonus]. Klin Monbl Augenheilkd 2023; 240:749-750. [PMID: 37348511 DOI: 10.1055/a-2065-2736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
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13
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Bachmann BO, Matthaei M, Schlereth S, Cursiefen C. Corneal Hydrops - Aetiology and Advanced Therapeutic Strategies. Klin Monbl Augenheilkd 2023. [PMID: 37146638 DOI: 10.1055/a-2048-6703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Acute hydrops refers to sudden corneal edema caused by rupture of Descemet's membrane (DM) - often in progressive keratectasia. It leads to a sudden decrease in visual acuity, pain, and foreign body sensation as well as an increased glare sensation. Acute hydrops usually heals with scarring within months, but complications such as corneal perforation, infectious keratitis, and corneal vascularization may occur. The prevalence in keratoconus patients is 2.6 to 2.8%. Risk factors include keratoconjunctivitis vernalis, atopic dermatitis, high keratometry, male gender, and eye rubbing. Keratoplasty should be avoided in the acute phase. The prognosis of the graft is reduced, and after scar healing of the hydrops, wearing contact lenses or glasses may be possible again. Conservative therapy alone with lubricants and hyperosmolar eye drops, prophylactic antibiotic eye drops to prevent superinfection, and topical steroids was long considered the only possible form of treatment. However, healing under conservative therapy takes an average of over 100 days. In the meantime, there are different surgical strategies that rapidly shorten the healing and thus the recovery phase of the patients to a few days. If the DM is detached without tension, a simple injection of gas into the anterior chamber can already lead to reattachment and thus to almost immediate deswelling of the cornea. If the DM is under tension, predescemetal sutures combined with a gas injection into the anterior chamber can flatten the cornea and reattach the DM. Mini-Descemet membrane endothelial keratoplasty (mini-DMEK) allows for sutureless closure of the DM defect by transplantation of a small (< 5 mm) graft. In cases of particularly large DM tears and very pronounced hydrops, suture loosening and relapse may occur after the placement of predescemetal sutures. Mini-DMEK can then lead to permanent healing, but in contrast to simple corneal sutures, it is usually performed under general anesthesia and by aid of intraoperative optical coherence tomography. The very good results with regard to the rapid healing prove that surgical therapy makes sense in the vast majority of patients with acute hydrops and should be initiated quickly.
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Affiliation(s)
- Björn O Bachmann
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Deutschland
| | - Mario Matthaei
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Deutschland
| | - Simona Schlereth
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Deutschland
| | - Claus Cursiefen
- Zentrum für Augenheilkunde, Universitätsklinikum Köln, Deutschland
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Wei J, He R, Wang X, Song Y, Yao J, Liu X, Yang X, Chen W, Li X. The Corneal Ectasia Model of Rabbit: A Validity and Stability Study. Bioengineering (Basel) 2023; 10:bioengineering10040479. [PMID: 37106666 PMCID: PMC10135747 DOI: 10.3390/bioengineering10040479] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 04/14/2023] [Indexed: 04/29/2023] Open
Abstract
Keratoconus is a bilateral progressive degenerative corneal disease characterized by localized corneal thinning and dilatation. The pathogenesis of keratoconus is not fully elucidated. To gain a better understanding of the pathophysiology of this disease and to explore potential treatments, animal models are essential for basic research. Several attempts have been made to establish animal models of corneal ectasia by using collagenase. However, continuous changes of the cornea have not been well-tracked for the model. In this study, corneal morphology and biomechanical behavior in vivo were determined before and after collagenase Ⅱ treatment at 2, 4, and 8 weeks. The elastic modulus and histology of cornea tissues ex vivo were measured at 8 weeks postoperatively. The results showed that the posterior corneal curvature (Km B) increased and central corneal thickness (CCT) decreased after collagenase treatment. The mechanical properties of ectatic corneas weakened significantly and the collagen fiber interval in the stromal layer was increased and disorganized. This study provides insights into the changes of corneal morphology and biomechanical properties in a rabbit model of corneal ectasia. Changes observed at 8 weeks indicated that the cornea was still undergoing remodeling.
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Affiliation(s)
- Junchao Wei
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
| | - Rui He
- School of Ophthalmology, Shanxi Medical University, Taiyuan 030002, China
| | - Xiaogang Wang
- School of Ophthalmology, Shanxi Medical University, Taiyuan 030002, China
| | - Yaowen Song
- School of Ophthalmology, Shanxi Medical University, Taiyuan 030002, China
| | - Jinhan Yao
- School of Ophthalmology, Shanxi Medical University, Taiyuan 030002, China
| | - Xiaona Liu
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
| | - Xin Yang
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
| | - Weiyi Chen
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
| | - Xiaona Li
- College of Biomedical Engineering, Taiyuan University of Technology, Taiyuan 030024, China
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Berger T, Szentmáry N, Chai N, Flockerzi E, Daas L, Stachon T, Seitz B. In Vitro Expression Analysis of Cytokines and ROS-Related Genes in Human Corneal Fibroblasts and Keratocytes of Healthy and Keratoconus Corneas. Ocul Immunol Inflamm 2023:1-10. [PMID: 36799910 DOI: 10.1080/09273948.2023.2176325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
PURPOSE To investigate expression of cytokines and ROS-related genes in stromal cells of healthy and keratoconus (KC) corneas. METHODS Expression analysis was performed for cytokines including several interleukins (IL), Tumor necrosis factor-α (TNF-α), Transforming growth factor-β1 (TGF-β1), Interferon-γ (IFN-γ) and ROS-related genes such as Catalase, Glutathione peroxidase 1, NADPH oxidase 1, superoxide dismutase 1 in corneal fibroblasts (HCFs/KC-HCFs) or keratocytes (Keratocytes/KC-Keratocytes) by qPCR and ELISA. RESULTS Gene and protein expression of most inflammatory markers was decreased in keratocytes compared to fibroblasts, whereas no differences were found between healthy and keratoconus cells for the majority of cytokines measured. TNF-α expression was increased at gene (KC keratocytes) and protein levels (supernatant of Keratocytes/KC-Keratocytes) compared to corneal fibroblasts. No differential expression of ROS-related genes was detected between healthy and diseased cells in both fibroblasts and keratocytes. CONCLUSION Increased expression of several inflammatory markers described as altered in KC was not evident in KC cells in vitro.
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Affiliation(s)
- Tim Berger
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Ning Chai
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Tanja Stachon
- Dr. Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Saarland University, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
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Flockerzi E, Xanthopoulou K, Daas L, Feld S, Langenbucher A, Seitz B. Evaluation of Dynamic Corneal Response Parameters and the Biomechanical E-Staging After Accelerated Corneal Cross-Linking in Keratoconus. Asia Pac J Ophthalmol (Phila) 2022; 11:514-520. [PMID: 36417675 DOI: 10.1097/apo.0000000000000580] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 09/29/2022] [Indexed: 11/24/2022] Open
Abstract
PURPOSE This study evaluated the biomechanical E-staging in progressive keratoconus (KC) corneas before and after epithelium-off accelerated corneal cross-linking (CXL, 9 mW/cm2, 10 min, 5.4 J/cm2). DESIGN German university-based retrospective longitudinal cohort study. METHODS The biomechanical E-staging for ectatic corneal diseases was applied retrospectively on 49 progressive KC corneas of 41 patients who underwent CXL. Main outcome parameters included the Corvis Biomechanical Factor (CBiF, the linearized Corvis Biomechanical Index), the biomechanical E-staging (E1 to E4 result of dividing the CBiF value range into 5 groups), maximal anterior keratometry (Kmax), anterior radius of curvature (ARC), and thinnest corneal thickness (TCT). They were evaluated at 2.1±2.0 months preoperatively (n=49 corneas, 41 patients) and postoperatively after 5.4±1.4, 11.3±1.8, and 23.4±1.6 months. RESULTS The CBiF decreased (5.1±0.5 | 5.0±0.5, P=0.0338) and the E-staging increased significantly (2.4±0.9 | 2.6±0.8, P=0.0035) from preoperatively to the first postoperative follow-up. The difference was not significant after 11 months and there were same values after 23 months. Kmax, ARC, and TCT slightly decreased (Kmax: 56.9±6.3, 54.3±5.1, 56.2±6.6, 54.0±5.2; ARC: 49.8±3.5, 48.9±3.2, 50.8±5.6, 49.0±3.7; TCT: 470±34, 454±36, 459±35, 466±39; preoperatively and 5, 11, and 23 months postoperatively). A postoperatively decreased TCT was associated with an increased E-stage, whereas an equal or increased TCT measurement after CXL was associated with equal or lower E-staging results. CONCLUSIONS The biomechanical E-staging in KC corneas is influenced by TCT measurements and increases within the first postoperative months after CXL. On the long term, it indicates a postoperative KC stabilization, with comparable E-values to preoperatively at 11 and 23 months after CXL.
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Affiliation(s)
- Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | | | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Simon Feld
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Achim Langenbucher
- Institute of Experimental Ophthalmology, Saarland University Medical Center, Homburg, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg, Germany
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Liu X, Li H, Qu S, Yu Q, Lin H, Bi YL. Different compression sutures combined with intracameral air injection for acute corneal hydrops. Int J Ophthalmol 2022; 15:1538-1543. [PMID: 36124186 DOI: 10.18240/ijo.2022.09.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 09/22/2021] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the efficacy and safety of full-thickness sutures combined with intracameral air injection (FTS-AI) versus pre-Descemet's membrane sutures combined with intracameral air injection (PDS-AI) in the management of acute corneal hydrops in keratoconus. METHODS The research included 8 patients (8 eyes) suffering from acute corneal hydrops caused by keratoconus. Four patients were randomly assigned to FTS-AI. And the other four were randomly assigned to PDS-AI. Corneal oedema, visual acuity, corneal thickness were assessed during follow-up. RESULTS The demographics, preoperative duration of symptoms and severity of corneal hydrops between the two groups were not significantly different. The mean corneal oedema resolution time after FTS-AI and PDS-AI were 11±1.15 and 15±1.41d, respectively (P=0.005). The maximum corneal thickness of the scarred region decreased in both groups at one week postoperatively (P<0.05). No obvious difference was found in the mean maximal corneal thickness between the two groups postoperatively. The BCVA improved significantly after FTS-AI and PDS-AI at three months postoperatively. No obvious difference was found in the BCVA after FTS-AI and PDS-AI at three months postoperatively. CONCLUSION FTS-AI and PDS-AI are safe and effective therapies to accelerate the resolution of corneal oedema in acute corneal hydrops secondary to keratoconus. Despite faster resolution of corneal oedema in the FTS-AI group, we recommend PDS-AI to avoid potential endothelium cell damage.
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Affiliation(s)
- Xin Liu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China.,Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou Province, China
| | - Hua Li
- Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou Province, China
| | - Shen Qu
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Qiao Yu
- Department of Ophthalmology, Guizhou Provincial People's Hospital, Guiyang 550002, Guizhou Province, China
| | - Hui Lin
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
| | - Yan-Long Bi
- Department of Ophthalmology, Tongji Hospital, School of Medicine, Tongji University, Shanghai 200092, China
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Single-cell atlas of keratoconus corneas revealed aberrant transcriptional signatures and implicated mechanical stretch as a trigger for keratoconus pathogenesis. Cell Discov 2022; 8:66. [PMID: 35821117 PMCID: PMC9276680 DOI: 10.1038/s41421-022-00397-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 03/15/2022] [Indexed: 12/22/2022] Open
Abstract
Keratoconus is a common ectatic corneal disorder in adolescents and young adults that can lead to progressive visual impairment or even legal blindness. Despite the high prevalence, its etiology is not fully understood. In this study, we performed single-cell RNA sequencing (scRNA-Seq) analysis on 39,214 cells from central corneas of patients with keratoconus and healthy individuals, to define the involvement of each cell type during disease progression. We confirmed the central role of corneal stromal cells in this disease, where dysregulation of collagen and extracellular matrix (ECM) occurred. Differential gene expression and histological analyses revealed two potential novel markers for keratoconus stromal cells, namely CTSD and CTSK. Intriguingly, we detected elevated levels of YAP1 and TEAD1, the master regulators of biomechanical homeostasis, in keratoconus stromal cells. Cyclical mechanical experiments implicated the mechanical stretch in prompting protease production in corneal stromal cells during keratoconus progression. In the epithelial cells of keratoconus corneas, we observed reduced basal cells and abnormally differentiated superficial cells, unraveling the corneal epithelial lesions that were usually neglected in clinical diagnosis. In addition, several elevated cytokines in immune cells of keratoconus samples supported the involvement of inflammatory response in the progression of keratoconus. Finally, we revealed the dysregulated cell-cell communications in keratoconus, and found that only few ligand-receptor interactions were gained but a large fraction of interactional pairs was erased in keratoconus, especially for those related to protease inhibition and anti-inflammatory process. Taken together, this study facilitates the understanding of molecular mechanisms underlying keratoconus pathogenesis, providing insights into keratoconus diagnosis and potential interventions.
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Seitz B, Daas L, Wykrota AA, Flockerzi E, Suffo S. Graft Failure after PKP and DMEK: What is the Best Option? Klin Monbl Augenheilkd 2022; 239:775-785. [PMID: 35488100 DOI: 10.1055/a-1774-4862] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Corneal transplantation is the most commonly performed human tissue transplantation procedure worldwide. Due to the large number of grafts, corneal graft failure has become one of the most common indications for corneal transplantation for immunological and non-immunological reasons (e.g. recurrence of underlying disease, high intraocular pressure, grafted guttae, transmitted HSV or CMV infection). The relatively recently developed lamellar grafting techniques have introduced certain potential complications that may lead to graft failure and require approaches other than penetrating keratoplasty for re-grafting. On the other hand, these new lamellar techniques also offer new possibilities for salvaging failed penetrating grafts, with potential advantages over successive penetrating keratoplasties, such as lower intraoperative risks, faster visual rehabilitation and reduced risk of immune reaction. Today, the patient with good healing who is satisfied with his graft before endothelial decompensation, with low astigmatism and no stromal scars, represents the optimal condition for DMEK after PKP. This can also be combined with phacoemulsification (so-called triple DMEK). Otherwise, a penetrating re-keratoplasty with a larger graft (typically excimer laser repeat PKP 8.5/8.6 mm) is performed to treat edema, scars and irregular astigmatism simultaneously. The medical history carries weight in this decision! Re-DMEK in case of graft failure after DMEK and DSAEK does not require any modification of the standard technique and leads to good visual acuity results if performed quickly. If there is clear stromal scarring after multiple (external) DMEKs, PKP can also be considered to rectify the situation. Otherwise causeless recurrent graft failures must suggest herpetic or CMV endotheliitis and, after PCR analysis of the aqueous humour aspirate, be treated appropriately with medication.
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Affiliation(s)
- Berthold Seitz
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland
| | - Loay Daas
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland
| | - Agata Anna Wykrota
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland
| | - Elias Flockerzi
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland
| | - Shady Suffo
- Klinik für Augenheilkunde, Universitätsklinikum des Saarlandes (UKS), Homburg (Saar), Deutschland
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20
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Hamon L, Schlötzer-Schrehardt U, Flockerzi FA, Seitz B, Daas L. Morphological characterization and clinical effects of stromal alterations after intracorneal ring segment implantation in keratoconus. Graefes Arch Clin Exp Ophthalmol 2022; 260:2299-2308. [PMID: 35106630 PMCID: PMC9203383 DOI: 10.1007/s00417-022-05572-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/16/2022] [Accepted: 01/20/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE To analyze the histological and (ultra)structural stromal tissue changes after femtosecond (Fs) laser-assisted intracorneal ring segment (ICRS) implantation and their refractive and topographic effects in patients with keratoconus. METHODS This monocentric retrospective case series included 15 consecutive patients with clinical peri-segmental lamellar channel deposits after treatment with Fs-ICRS implantation for keratoconus. The stromal changes were investigated using in vivo confocal microscopy. Two patients underwent a penetrating keratoplasty after the Fs-ICRS implantation; the explanted corneas were processed for histopathology and transmission electron microscopy (TEM). Refractive and topographic effects were investigated comparing the uncorrected (UDVA) and corrected (CDVA) distance visual acuity, spherical equivalent (SE), flat (K1), steep (K2), and steepest (Kmax) keratometry before and after detection of lamellar channel deposits. RESULTS In vivo confocal microscopy revealed diffuse linear and focal granular hyperreflective structures. Histologically, there was mild proliferation of fibroblasts and fibrosis. TEM demonstrated focal accumulations of degenerated keratocytes with cytoplasmic lipid inclusions. There were no significant changes for UDVA (Δ = 0.0 ± 0.2 logMAR; p = 0.67), CDVA (Δ = 0.0 ± 0.1 logMAR; p = 0.32), SE (Δ 0.1 ± 0.9 D; p = 0.22), K1 (Δ = 0.3 ± 1.0 D; p = 0.28), K2 (Δ = 0.1 ± 0.9 D; p = 0.51), and Kmax (Δ = 0.3 ± 1.5 D; p = 0.17). CONCLUSIONS Two types of structural stromal changes were identified: (1) diffuse peri-segmental fibrosis and (2) lamellar channel deposits. These structural changes showed no evidence of a relevant refractive or topographic effect.
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Affiliation(s)
- Loïc Hamon
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Bld. 22, 66421 Homburg, Saar Germany
| | - Ursula Schlötzer-Schrehardt
- Department of Ophthalmology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Fidelis A. Flockerzi
- Department of Pathology, Saarland University Medical Center (UKS), Homburg, Saar Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Bld. 22, 66421 Homburg, Saar Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Medical Center (UKS), Kirrberger Straße 100, Bld. 22, 66421 Homburg, Saar Germany
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21
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Hamon L, Seitz B, Daas L. Intrastromal fibrosis and lipid deposits twenty years after intracorneal ring segments implantation for treatment of mild myopia. J Fr Ophtalmol 2021; 45:147-150. [PMID: 34802752 DOI: 10.1016/j.jfo.2021.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/25/2021] [Accepted: 06/04/2021] [Indexed: 10/19/2022]
Affiliation(s)
- L Hamon
- Centre Hospitalier Universitaire de la Sarre (UKS), Homburg/Saar, Germany.
| | - B Seitz
- Centre Hospitalier Universitaire de la Sarre (UKS), Homburg/Saar, Germany
| | - L Daas
- Centre Hospitalier Universitaire de la Sarre (UKS), Homburg/Saar, Germany
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