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Esporcatte LPG, Salomão MQ, Lopes BT, Sena N, Machado AP, Vinciguerra P, Vinciguerra R, Ambrósio R. Keratoconus and Corneal Ectasia with Relatively Low Keratometry. Ophthalmol Ther 2024:10.1007/s40123-024-00964-5. [PMID: 38824471 DOI: 10.1007/s40123-024-00964-5] [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: 03/20/2024] [Accepted: 05/01/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION The study aims to demonstrate and estimate the prevalence of clinical corneal ectasia and keratoconus (KC) in patients with relatively low keratometry (low-K KC). METHODS In a retrospective, analytical, and non-interventionist study, one eye was randomly selected from 1054 patients from the original Tomographic Biomechanical Index (TBIv1) study and the external validation (from Rio de Janeiro, Brazil, and Milan, Italy clinics). Patients were stratified into three groups. Group 1 included 736 normal patients, and groups 2 and 3 included 318 patients with clinical KC in both eyes, divided into low-K KC (90 patients) and high-K KC (228 patients), respectively. All patients underwent a comprehensive ophthalmological evaluation along with Pentacam and Corvis ST (Oculus, Wetzlar, Germany) examinations. Cases with maximum mean zone 3 mm keratometry (Kmax zone mean 3 mm) lower than 47.6 diopters (D) were considered as low-keratometry keratoconus, and cases with Kmax zone mean 3 mm higher than 47.6 D were regarded as high-keratometry keratoconus. RESULTS Ninety (28.30%) of the 318 KC group presented ectasia with low-keratometric values (low-Kmax). The average age in the normal group was 39.28 years (range 6.99-90.12), in the low-Kmax KC group it was 37.49 (range 13.35-78.45), and in the high-Kmax KC group it was 34.22 years (range 12.7-80.34). Mean and SD values and median (range), respectively, of some corneal tomographic and biomechanical parameters evaluated from the low-Kmax KC group were as follows: Belin-Ambrósio enhanced ectasia display (BAD-D) 3.79 ± 1.62 and 3.66 (0.83-9.73); Pentacam random forest index (PRFI) 0.78 ± 0.25 and 0.91 (0.05-1); corneal biomechanical index (CBI) 0.58 ± 0.43 and 0.75 (0-1); TBI 0.93 ± 0.17 and 1 (0.35-1); and stiffness parameter at A1 (SP-A1) 86.16 ± 19.62 and 86.05 (42.94-141.66). CONCLUSION Relatively low keratometry, with a Kmax lower than 47.6 D, can occur in up to 28.30% of clinical keratoconus. These cases have a less severe presentation of the disease. Future studies involving larger populations and prospective designs are necessary to confirm the prevalence of keratoconus with low keratometry and define prognostic factors in such cases.
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Affiliation(s)
- Louise Pellegrino G Esporcatte
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rua Conde de Bonfim 211/712, Rio de Janeiro, RJ, 20520-050, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Marcella Q Salomão
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rua Conde de Bonfim 211/712, Rio de Janeiro, RJ, 20520-050, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Instituto Benjamin Constant, Rio de Janeiro, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rua Conde de Bonfim 211/712, Rio de Janeiro, RJ, 20520-050, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- School of Engineering, University of Liverpool, Liverpool, L69 3GH, UK
| | - Nelson Sena
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Aydano P Machado
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Brazilian Artificial Intelligence Networking in Medicine-BrAIN, Rio de Janeiro, Brazil
- Computing Institute, Federal University of Alagoas, Maceió, Brazil
- Brazilian Artificial Intelligence Networking in Medicine - BrAIN, Maceió, Brazil
| | - Paolo Vinciguerra
- Department of Biomedical Science, Humanitas University, Rozzano, Italy
- Eye Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Riccardo Vinciguerra
- School of Engineering, University of Liverpool, Liverpool, L69 3GH, UK
- Department of Ophthalmology, Humanitas San Pio X Hospital, Milan, Italy
| | - Renato Ambrósio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rua Conde de Bonfim 211/712, Rio de Janeiro, RJ, 20520-050, Brazil.
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil.
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
- Brazilian Artificial Intelligence Networking in Medicine-BrAIN, Rio de Janeiro, Brazil.
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
- Brazilian Artificial Intelligence Networking in Medicine - BrAIN, Maceió, Brazil.
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Mergen B, Sideroudi H, Seitz B, Flockerzi E. Altered Corneal Biomechanics According to the Biomechanical E-Staging in Pellucid Marginal Degeneration. Cornea 2024:00003226-990000000-00478. [PMID: 38334467 DOI: 10.1097/ico.0000000000003479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/03/2023] [Indexed: 02/10/2024]
Abstract
PURPOSE The purpose of this study was to investigate corneal biomechanics in pellucid marginal degeneration (PMD) compared with healthy controls using Corvis ST (Oculus, Germany) by using the new biomechanical E-staging (based on the Corvis Biomechanical Factor, the linearized Corvis Biomechanical Index) together with tomographic parameters. METHODS Corneal biomechanical and topographic data of 75 eyes of 75 patients with PMD and 75 eyes of 75 age-matched and sex-matched healthy controls were investigated. Topographic parameters (K1, K2, Kmax, central corneal thickness (CCT), and Belin/Ambrósio Deviation Index (BAD-D) were evaluated in dependence of and correlated with the biomechanically defined E-stages. Biomechanical parameters were also recorded for the 2 groups. RESULTS Patients with PMD showed higher K2, Kmax, BAD-D, and Corvis Biomechanical Factor values and a lower CCT compared with healthy controls (P < 0.001). The E-stage was positively correlated with K1, K2, Kmax, BAD-D, and intraocular pressure difference and negatively correlated with CCT. Stage-dependent analysis revealed a significant increase in K1, K2, Kmax (P < 0.001), and BAD-D (P = 0.041) in stage E3 compared with E0 and a significant decrease in stage E2 in CCT (P = 0.009) compared with E0. CONCLUSIONS This study showed that patients with PMD may have a reduced corneal stiffness compared with healthy controls which worsens with increasing E-stage. Significant changes in topographic parameters were observed at stage E2 for CCT and at stage E3 for K1, K2, Kmax, and BAD-D when compared with stage E0.
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Affiliation(s)
- Burak Mergen
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
- Department of Ophthalmology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Haris Sideroudi
- Department of Ophthalmology, Saarland University Medical Center (UKS), Homburg/Saar, Germany; and
| | - Berthold Seitz
- 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
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Esporcatte LPG, Salomão MQ, Lopes BT, Sena N, Ferreira É, Filho JBRF, Machado AP, Ambrósio R. Biomechanics in Keratoconus Diagnosis. Curr Eye Res 2023; 48:130-136. [PMID: 35184637 DOI: 10.1080/02713683.2022.2041042] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Purpose: To prospectively review the importance of biomechanical assessment in the screening, diagnosis, prognosis, individualized planning, and clinical follow-up for ectatic corneal diseases.Methods: We demonstrate two commercially available devices to assess the corneal biomechanics in vivo, the Ocular Response Analyzer (ORA, Reichester, NY, USA) and the Corvis ST (Oculus, Wetzlar, Germany). Novel devices have been demonstrated to provide in vivo biomechanical measurements, including Brillouin optical microscopy and OCT elastography. Conclusion: The integration of biomechanical data and other data from multimodal refractive imaging using artificial intelligence demonstrated the ability to enhance accuracy in diagnosing ectatic corneal diseases.
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Affiliation(s)
- Louise Pellegrino G Esporcatte
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Marcella Q Salomão
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil.,Brazilian Artificial Intelligence Networking in Medicine - BrAIN, Rio de Janeiro and Maceió, Brazil.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Instituto Benjamin Constant, Rio de Janeiro, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,School of Engineering, University of Liverpool, Liverpool, UK
| | - Nelson Sena
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Érica Ferreira
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Joao Batista R F Filho
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Aydano P Machado
- Brazilian Artificial Intelligence Networking in Medicine - BrAIN, Rio de Janeiro and Maceió, Brazil.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Computing Institute, Federal University of Alagoas, Maceió, Brazil
| | - Renato Ambrósio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil.,Brazilian Artificial Intelligence Networking in Medicine - BrAIN, Rio de Janeiro and Maceió, Brazil.,Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
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Sideroudi H, Flockerzi E, Seitz B. Differential Diagnosis of Keratoconus Based on New Technologies. Klin Monbl Augenheilkd 2023; 240:57-72. [PMID: 35940178 DOI: 10.1055/a-1920-6929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Keratoconus (KC) must be distinguished from other corneal ectatic diseases and thinning disorders for stage-appropriate and suitable management of each condition. The most relevant corneal pathologies that may imitate the tomographic KC pattern are pellucid marginal degeneration (PMD), keratoglobus, posterior keratoconus, and Fuchs-Terrien marginal degeneration (FTMD). In moderate cases of KC, differentiation is typically possible using slit lamp examination and corneal tomography with evaluation of the location of the corneal thinning region. In early cases, however, differential diagnosis may be more challenging since the cornea may look relatively normal. In severe cases, the extended area of corneal thinning also complicates differentiation. Biomicroscopic findings cannot always give all the information needed to distinguish KC from related ectatic corneal conditions. The aim of this work is to discuss contemporary techniques and findings to assist physicians to identify the correct diagnosis. Corneal topography has been used in recent decades as the main tool for imaging in ectatic corneal diseases. Moreover, Scheimpflug cameras (corneal tomographers), which analyze both anterior and posterior corneal surfaces, curvatures, pachymetry, elevation data, higher order aberrations, Fourier analysis of keratometric data, and corneal density have become the most promising tools for diagnosis and follow-up of ectatic diseases. A noninvasive air pulse tonometer in conjunction with an ultrahigh-speed Scheimpflug camera complements tomographic findings by analyzing biomechanical corneal properties. Α confocal microscopy system, which is a novel clinical technique for the study of corneal cellular structure, could contribute effectively in the same direction. Moreover, anterior segment optical coherence tomography (AS-OCT) creates cross-sections, which can be generated into a three-dimensional structure to produce corneal epithelial thickness (ET) measurements. ET mapping is increasingly recognized as a sensitive tool for the diagnosis of ocular surface disorders. Combining information of all these systems could lead to a more effective identification and differential diagnosis of ectatic corneal disorders.
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Affiliation(s)
- Haris Sideroudi
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Elias Flockerzi
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg/Saar, Germany
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Enhanced Diagnostics for Corneal Ectatic Diseases: The Whats, the Whys, and the Hows. Diagnostics (Basel) 2022; 12:diagnostics12123027. [PMID: 36553038 PMCID: PMC9776904 DOI: 10.3390/diagnostics12123027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
There are different fundamental diagnostic strategies for patients with ectatic corneal diseases (ECDs): screening, confirmation of the diagnosis, classification of the type of ECD, severity staging, prognostic assessment, and clinical follow-up. The conscious application of such strategies enables individualized treatments. The need for improved diagnostics of ECD is related to the advent of therapeutic refractive procedures that are considered prior to keratoplasty. Among such less invasive procedures, we include corneal crosslinking, customized ablations, and intracorneal ring segment implantation. Besides the paradigm shift in managing patients with ECD, enhancing the sensitivity to detect very mild forms of disease, and characterizing the inherent susceptibility for ectasia progression, became relevant for identifying patients at higher risk for progressive iatrogenic ectasia after laser vision correction (LVC). Moreover, the hypothesis that mild keratoconus is a risk factor for delivering a baby with Down's syndrome potentially augments the relevance of the diagnostics of ECD. Multimodal refractive imaging involves different technologies, including Placido-disk corneal topography, Scheimpflug 3-D tomography, segmental or layered tomography with layered epithelial thickness using OCT (optical coherence tomography), and digital very high-frequency ultrasound (VHF-US), and ocular wavefront. Corneal biomechanical assessments and genetic and molecular biology tests have translated to clinical measurements. Artificial intelligence allows for the integration of a plethora of clinical data and has proven its relevance in facilitating clinical decisions, allowing personalized or individualized treatments.
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He W, Han X, Ong JS, Hewitt AW, Mackey DA, Gharahkhani P, MacGregor S. Association of Novel Loci With Keratoconus Susceptibility in a Multitrait Genome-Wide Association Study of the UK Biobank Database and Canadian Longitudinal Study on Aging. JAMA Ophthalmol 2022; 140:568-576. [PMID: 35446358 PMCID: PMC9026225 DOI: 10.1001/jamaophthalmol.2022.0891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Keratoconus can be a debilitating corneal ectasia in which the cornea thins, bulges, and steepens into a conical shape. Early features of keratoconus include myopia and irregular astigmatism, which affect vision and can be treated with contact lenses, collagen cross-linking, or, in advanced cases, corneal transplant. Recent estimates of the prevalence of keratoconus based on results of Scheimpflug imaging in young adults are as high as 1.2%. However, obtaining very large keratoconus data sets for a genome-wide association study (GWAS) is problematic because few population studies include Scheimpflug imaging and because severe keratoconus is relatively rare. Objective To identify novel keratoconus loci using corneal resistance factor (CRF) and central corneal thickness (CCT). Design, Setting, and Participants This multitrait GWAS used European ancestry CRF data from UK Biobank (UKB) (n = 105 427) and the Canadian Longitudinal Study on Aging (CLSA) (n = 18 307) and European ancestry CCT data from the International Glaucoma Genetics Consortium (IGGC) (n = 17 803). The CRF and CCT variants in published keratoconus data sets (4669 cases and 116 547 controls) were compared. The data set from UKB was compiled March 24, 2020; data were released from the CLSA in July 2020; and IGGC data were available from May 1, 2018. Main Outcomes and Measures Association of CRF and CCT variants with keratoconus risk. Results The GWAS included 4 cohorts: 105 427 UKB European ancestry (56 134 women [53.2%] and 49 293 men [46.7%]; mean [SD] age, 57 [8] years), 5029 UKB South Asian ancestry (2368 women [47.1%] and 2661 men [52.9%]; mean [SD] age, 54 [8] years), 902 UKB East Asian ancestry (622 women [68.9%] and 280 men [31.0%]; mean [SD] age, 53 [8] years), and 18 307 CLSA European ancestry (9260 women [50.6%] and 9047 men [49.4%]; mean [SD] age, 63 [10] years) participants. A total of 369 CRF and 233 CCT loci were identified, including 36 novel CRF loci and 114 novel CCT loci. Twenty-nine CRF loci and 24 CCT loci were associated with keratoconus. Polygenic risk scores (PRS) were constructed using CRF- and CCT-associated variants and published keratoconus variants. The PRS result showed that adding a CRF- or CCT-based PRS to the keratoconus PRS from previously published variants improved the prediction area under the receiver operating characteristic curve (from 0.705 to 0.756 for CRF and from 0.715 to 0.755 for CCT). Conclusions and Relevance These findings support the use of multitrait modeling of corneal parameters in a relatively large data set to identify new keratoconus risk loci and enhance polygenic risk score models.
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Affiliation(s)
- Weixiong He
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Xikun Han
- QIMR Berghofer Medical Research Institute, Brisbane, Australia.,School of Medicine, University of Queensland, Brisbane, Australia
| | - Jue-Sheng Ong
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Alex W Hewitt
- Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Australia.,School of Medicine, Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - David A Mackey
- Lions Eye Institute, Centre for Ophthalmology and Visual Science, University of Western Australia, Perth, Australia
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Meduri A, Oliverio G, Severo AA, Camellin U, Rechichi M, Aragona P. Double safe suture during cataract surgery on post radial keratotomy patients using clear corneal incisions. Eur J Ophthalmol 2022; 32:1828-1832. [PMID: 35229692 DOI: 10.1177/11206721221083799] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE the aim of this study is to find a safer surgical approach in cataract surgery on eyes previously treated with radial keratotomy using clear corneal incisions. SETTING Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, University of Messina, Messina, Italy. DESIGN Prospective study. METHODS A prospective study was conducted on a group of 20 patients, 21 eyes with 16 RK incisions were evaluated for cataract phacoemulsification. Samples were divided into two groups: Group 1 underwent surgery with pre-operative one corneal stitch along radial keratotomy incisions near the main access site whereas Group 2 underwent modified surgery with two corneal stitches. RESULTS After surgery, visual acuity, corneal hysteresis and corneal strength was evaluated. In all cases, an increased visual acuity was observed. Group 1 showed an UCVA of logMAR 0.22 ± 0.14, while group 2 presented a logMAR of 0.1 ± 0.07. Data did not show a statistically significant difference in UCVA after surgery between the two groups (P = 0.133). Instead, a significant difference in corneal hysteresis (CH), respectively with values of 8.65 ± 1.6 mmHg in group 1 and 9.2 ± 1.8 in group 2 (P = 0.031), and a corneal resistance factor (CRF) with values of 7.87 ± 1.4 mmHg in the first group and 8.65 ± 1.6 mmHg in the second one (P = 0.039) was observed. CONCLUSIONS Double safe suture technique offers better stabilization of corneal structure during surgery in patients preventively treated with 16 incisions RK.
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Affiliation(s)
- Alessandro Meduri
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
| | - Giovanni Oliverio
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
| | - Alice Antonella Severo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
| | - Umberto Camellin
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Ophthalmology Clinic, 18980University of Messina, Messina, Italy
| | | | - Pasquale Aragona
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Regional Referral Center for the Ocular Surface Diseases, 18980University of Messina, Messina, Italy
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Peyman A, Irajpour M, Noorshargh P. Corneal cross-linking in pellucid marginal degeneration: Evaluation after five years. J Curr Ophthalmol 2022; 34:229-233. [PMID: 36147277 PMCID: PMC9487015 DOI: 10.4103/joco.joco_16_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/22/2022] [Accepted: 04/24/2022] [Indexed: 11/04/2022] Open
Abstract
Purpose: Methods: Results: Conclusion:
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Baptista PM, Ambrosio R, Oliveira L, Meneres P, Beirao JM. Corneal Biomechanical Assessment with Ultra-High-Speed Scheimpflug Imaging During Non-Contact Tonometry: A Prospective Review. Clin Ophthalmol 2021; 15:1409-1423. [PMID: 33854295 PMCID: PMC8039844 DOI: 10.2147/opth.s301179] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 03/05/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In recent years, increasing interest has arisen in the application of data from corneal biomechanics in many areas of ophthalmology, particularly to assist in the detection of early corneal ectasia or ectasia susceptibility, to predict corneal response to surgical or therapeutic interventions and in glaucoma management. Technology has evolved and, recently, the Scheimpflug principle was associated with a non-contact air-puff tonometer, allowing a thorough analysis of corneal biomechanics and a biomechanically corrected intraocular pressure assessment, opening up new perspectives both in ophthalmology and in other medical areas. Data from corneal biomechanics assessment are being integrated in artificial intelligence models in order to increase its value in clinical practice. OBJECTIVE To review the state of the art in the field of corneal biomechanics assessment with special emphasis to the technology based on ultra-high-speed Scheimpflug imaging during non-contact tonometry. SUMMARY A meticulous literature review was performed until the present day. We used 136 published manuscripts as our references. Both information from healthy individuals and descriptions of possible associations with systemic diseases are described. Additionally, it exposed information regarding several fields of ocular pathology, from cornea and ocular surface through areas of refractive surgery and glaucoma until vascular and structural diseases of the chorioretinal unit.
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Affiliation(s)
- Pedro Manuel Baptista
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Renato Ambrosio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, RJ, Brazil
- Department of Cornea and Refractive Surgery, Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Opthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Federal University of São Paulo (UNIFESP), São Paulo, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
| | - Luis Oliveira
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Pedro Meneres
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
| | - Joao Melo Beirao
- Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar (ICBAS), Porto, Portugal
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Esporcatte LPG, Salomão MQ, Lopes BT, Vinciguerra P, Vinciguerra R, Roberts C, Elsheikh A, Dawson DG, Ambrósio R. Biomechanical diagnostics of the cornea. EYE AND VISION 2020; 7:9. [PMID: 32042837 PMCID: PMC7001259 DOI: 10.1186/s40662-020-0174-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023]
Abstract
Corneal biomechanics has been a hot topic for research in contemporary ophthalmology due to its prospective applications in diagnosis, management, and treatment of several clinical conditions, including glaucoma, elective keratorefractive surgery, and different corneal diseases. The clinical biomechanical investigation has become of great importance in the setting of refractive surgery to identify patients at higher risk of developing iatrogenic ectasia after laser vision correction. This review discusses the latest developments in the detection of corneal ectatic diseases. These developments should be considered in conjunction with multimodal corneal and refractive imaging, including Placido-disk based corneal topography, Scheimpflug corneal tomography, anterior segment tomography, spectral-domain optical coherence tomography (SD-OCT), very-high-frequency ultrasound (VHF-US), ocular biometry, and ocular wavefront measurements. The ocular response analyzer (ORA) and the Corvis ST are non-contact tonometry systems that provide a clinical corneal biomechanical assessment. More recently, Brillouin optical microscopy has been demonstrated to provide in vivo biomechanical measurements. The integration of tomographic and biomechanical data into artificial intelligence techniques has demonstrated the ability to increase the accuracy to detect ectatic disease and characterize the inherent susceptibility for biomechanical failure and ectasia progression, which is a severe complication after laser vision correction.
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Affiliation(s)
- Louise Pellegrino Gomes Esporcatte
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,Instituto de Olhos Renato Ambrósio, Rua Conde de Bonfim 211 / 712, Rio de Janeiro, RJ 20520-050 Brazil.,3Department of Ophthalmology, Hospital São Vicente de Paulo, Rio de Janeiro, Brazil
| | - Marcella Q Salomão
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,Instituto de Olhos Renato Ambrósio, Rua Conde de Bonfim 211 / 712, Rio de Janeiro, RJ 20520-050 Brazil.,Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil.,5Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,Instituto Benjamin Constant, Rio de Janeiro, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,7School of Engineering, University of Liverpool, Liverpool, L69 3GH UK
| | - Paolo Vinciguerra
- 8Department of Biomedical Science, Humanitas University, Rozzano, Italy.,9Eye Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Riccardo Vinciguerra
- 7School of Engineering, University of Liverpool, Liverpool, L69 3GH UK.,Department of Ophthalmology, Humanitas San Pio X Hospital, Milan, Italy
| | - Cynthia Roberts
- 11Department of Ophthalmology and Visual Science, Department of Biomedical Engineering, The Ohio State University, Columbus, OH USA
| | - Ahmed Elsheikh
- 7School of Engineering, University of Liverpool, Liverpool, L69 3GH UK.,12School of Biological Science and Biomedical Engineering, Beihang University, Beijing, China.,13NIHR Biomedical Research Centre for Ophthalmology, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
| | - Daniel G Dawson
- 14The University of Florida Department of Ophthalmology, Gainesville, FL USA
| | - Renato Ambrósio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.,Instituto de Olhos Renato Ambrósio, Rua Conde de Bonfim 211 / 712, Rio de Janeiro, RJ 20520-050 Brazil.,Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil.,5Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.,15Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
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12
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Pellucid marginal degeneration: Detection, discrimination from other corneal ectatic disorders and progression. Cont Lens Anterior Eye 2019; 42:341-349. [DOI: 10.1016/j.clae.2018.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 11/07/2018] [Accepted: 11/15/2018] [Indexed: 02/07/2023]
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13
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De Bernardo M, Cornetta P, Marotta G, Rosa N. Corneal biomechanical parameters in pellucid marginal degeneration. J Curr Ophthalmol 2018; 30:280. [PMID: 30197962 PMCID: PMC6127370 DOI: 10.1016/j.joco.2018.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/04/2018] [Accepted: 06/04/2018] [Indexed: 11/09/2022] Open
Affiliation(s)
- Maddalena De Bernardo
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.,Head and Neck Department, A.O.U. San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Palmiro Cornetta
- Head and Neck Department, A.O.U. San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Giuseppe Marotta
- Head and Neck Department, A.O.U. San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy.,Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
| | - Nicola Rosa
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy
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14
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Abstract
PURPOSE To review and summarize the characteristics of corneal hysteresis (CH) and its relationship with glaucoma. METHODS A PubMed search was carried out using the terms "corneal hysteresis", "glaucoma", and "biomechanics". Up to March 2018, all studies published in English are included in this review. RESULTS The value of CH reflects the ability of corneal tissue to absorb and release energy during bidirectional flattening. It is an important biomechanical parameter of the cornea. The CH value of healthy adults is about 11 mmHg. The measurement of CH is reproducible and different. People have different CH values, which are determined by the shape of the individual's cornea. The study found that all types of glaucoma, including primary open angle glaucoma, angle-closure glaucoma, normal tension glaucoma, congenital glaucoma, binocular asymmetrical glaucoma, CH values are lower than normal people, therefore, CH is therefore a good indicator of glaucoma diagnosis and screening. Lower CH values are associated with thinner retinal nerve fiber layer (RNFL), larger linear cup/disk ratio (LCDR) and degree of optic disc defect. A lower CH value can also result in a lower visual field index. CH and the basic intraocular pressure play a synergistic role in the progression of glaucoma. The study found that CH can change with changes in basic intraocular pressure, means CH increases when intraocular pressure decreases, while the CH decreases conversely when intraocular pressure increases. Most clinical case studies have shown a decrease in CH after LASER refractive surgery. CH has its limitations, such as corneal damage or corneal surgery, but in general, CH is a risk factor for glaucoma progression. CONCLUSION CH is used as a predictor of glaucoma risk and may help to assess the effect of corneal thickness on intraocular pressure. The clinical significance of CH in the diagnosis and efficacy of glaucoma will become more explicit. In the future, CH can also play an important role in the diagnosis and treatment of glaucoma.
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15
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Sedaghat MR, Jabbarvand M, Askarizadeh F, Ostadimoghaddam H, Narooie-Noori F. Corneal hysteresis and corneal resistance factor in pellucid marginal corneal degeneration. J Curr Ophthalmol 2018; 30:187. [PMID: 29988910 PMCID: PMC6033785 DOI: 10.1016/j.joco.2017.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Mohamad Reza Sedaghat
- Cornea Research Center, Khatam-Al-Anbia Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Jabbarvand
- Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farshad Askarizadeh
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Ostadimoghaddam
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Foroozan Narooie-Noori
- Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
- Refractive Errors Research Center, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
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16
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Tekin K, Koc M. Corneal hysteresis and corneal resistance factor in pellucid marginal degeneration. J Curr Ophthalmol 2018; 30:186. [PMID: 29988894 PMCID: PMC6033774 DOI: 10.1016/j.joco.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 11/10/2017] [Indexed: 11/18/2022] Open
Affiliation(s)
- Kemal Tekin
- Kars State Hospital, Kars, Turkey.,Ulucanlar Eye Training and Research Hospital, Ophthalmology Department, Ankara, Turkey
| | - Mustafa Koc
- Ulucanlar Eye Training and Research Hospital, Ophthalmology Department, Ankara, Turkey
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