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Iritas Ɪ, Karaca ZY, Keskin Perk FFN, Yesilkaya EC, Burke Z, Tanriverdi C, Kilic A. Early results of allograft intrastromal ring segment for keratoconus. J Fr Ophtalmol 2025; 48:104505. [PMID: 40153935 DOI: 10.1016/j.jfo.2025.104505] [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: 08/10/2024] [Revised: 11/18/2024] [Accepted: 12/19/2024] [Indexed: 04/01/2025]
Abstract
PURPOSE This study aimed to determine the efficacy of a novel nomogram for implanting allograft intrastromal ring segments in keratoconus patients. MATERIALS AND METHODS The study included 86 eyes of 86 patients who were followed for 6 months. Patients were treated using the Istanbul nomogram, which is used to guide the creation of corneal tunnels, utilizing a femtosecond laser, with dimensions of 4×7.5mm and a depth of 200μm. Sterile allograft corneal rings (KeraNatural™) were implanted at the precise location of the cone. Pre- and postoperative measurements of SE, CDVA, UDVA, keratometry values, and topographic map parameters were compared. Additionally, an online protractor was used to measure the angle of the cone and the angle of the implanted allograft ring. RESULTS After surgery, there was significant improvement in SE, CDVA, UCVA, keratometry values, and topographic map parameters, including anterior map elevation (AME), posterior map elevation (PME), and best-fit sphere (BFS) anterior and posterior (P<0.001). In addition, a statistically significant correlation was found between the cone angle and KeraNatural™ length (P<0.001). CONCLUSION Our findings highlight the importance of considering the cone angle and KeraNatural™ length in preoperative evaluations. These parameters might help predict potential visual acuity outcomes and tailor surgical plans according to individual patient needs. The stability of most visual parameters over six months reaffirms the long-term efficacy of surgical interventions. The KeraNatural™ used in this study is safe and effective in keratoconus patients and provides an opportunity to avoid keratoplasty.
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Affiliation(s)
- Ɪ Iritas
- St Mary's Hospital Ophthalmology Department, Newport, Isle of Wight, United Kingdom.
| | - Z Y Karaca
- Medipol University Hospital Ophthalmology Department, Istanbul, Turkey
| | | | | | - Z Burke
- Medipol University Hospital Ophthalmology Department, Istanbul, Turkey
| | - C Tanriverdi
- Medipol University Hospital Ophthalmology Department, Istanbul, Turkey
| | - A Kilic
- Swiss Vision Group, Private Clinic, Istanbul, Turkey
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Bartolomeo N, Pederzolli M, Palombella S, Fonteyne P, Suanno G, Tilaro G, de Pretis S, Borgo F, Bertuzzi F, Senni C, De Micheli M, Bandello F, Ferrari G. The Effects of Vitamin D on Keratoconus Progression. Am J Ophthalmol 2025; 276:235-251. [PMID: 40245974 DOI: 10.1016/j.ajo.2025.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2024] [Revised: 04/03/2025] [Accepted: 04/07/2025] [Indexed: 04/19/2025]
Abstract
PURPOSE The aim of this study was to assess whether vitamin D (Vit D) supplementation affects local disease progression, as well as systemic inflammation, collagen degradation, and oxidative stress in adolescents affected by keratoconus (KC) and Vit D deficiency. DESIGN Prospective, interventional single-center study. SUBJECTS Forty patients (age range, 12.2-19.9) presenting with both KC and Vit D insufficiency (<30 ng/mL) were included in the study. METHODS Vit D was prescribed for 6 months as per standard of care. Follow-up visits were scheduled for 12 months. Each visit included the measurement of best spectacle-corrected visual acuity, maximal keratometry (Kmax), and thinnest corneal thickness. Blood samples were collected at month 0 and month 6 to measure Vit D levels and systemic biomarkers of inflammation, collagen degradation, and oxidative stress by ELISA or real-time polymerase chain reaction; full RNA sequencing was performed on 20 patients at month 0 and month 6. MAIN OUTCOME MEASURES The primary outcome of the study was the percentage of patients with a Kmax progression less than 1 diopter (D) throughout the entire study (ie, stable patients). RESULTS Overall, 65% of patients remained stable (75% of eyes) after 12 months. Specifically, best spectacle-corrected visual acuity, Kmax, and thinnest corneal thickness rates remained stable during the 12-month observational period. ELISA performed on blood plasma showed that Vit D upregulated the expression of Vit D binding protein. QPCR performed on peripheral leukocytes showed an increase in the expression of VDR and CD14 with no changes in the principal enzymes involved in Vit D activation/deactivation. ELISA and qPCR showed the modulation of collagen degradation and collagen crosslinking. Subgroup analysis with RNA sequencing showed differential response to Vit D treatment. Responder patients showed downregulation in inflammatory and platelet activation pathways, and upregulation of proteoglycan metabolism/biosynthesis enrichment. CONCLUSIONS Our findings support the hypothesis that Vit D supplementation can affect KC progression in adolescent patients with Vit D insufficiency possibly through the modulation of systemic inflammation, inhibition of collagen degradation, and promotion of proteoglycan synthesis. Our results strongly suggest that KC may be the ocular manifestation of a systemic disorder.
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Affiliation(s)
- Nicolò Bartolomeo
- From the Eye Repair Unit, Division of Neuroscience (N.B., S.P., P.F., G.S., G.T., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Matteo Pederzolli
- Ophthalmology Unit (M.P., F.B., C.S., F.B., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Silvia Palombella
- From the Eye Repair Unit, Division of Neuroscience (N.B., S.P., P.F., G.S., G.T., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Philippe Fonteyne
- From the Eye Repair Unit, Division of Neuroscience (N.B., S.P., P.F., G.S., G.T., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giuseppe Suanno
- From the Eye Repair Unit, Division of Neuroscience (N.B., S.P., P.F., G.S., G.T., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (G.S., F.B., and G.F.), Milan, Italy
| | - Gianluca Tilaro
- From the Eye Repair Unit, Division of Neuroscience (N.B., S.P., P.F., G.S., G.T., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Stefano de Pretis
- Center for Omics Sciences (S.d.P. and F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesca Borgo
- Center for Omics Sciences (S.d.P. and F.B.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Bertuzzi
- Ophthalmology Unit (M.P., F.B., C.S., F.B., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlotta Senni
- Ophthalmology Unit (M.P., F.B., C.S., F.B., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Francesco Bandello
- Ophthalmology Unit (M.P., F.B., C.S., F.B., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (G.S., F.B., and G.F.), Milan, Italy
| | - Giulio Ferrari
- From the Eye Repair Unit, Division of Neuroscience (N.B., S.P., P.F., G.S., G.T., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Ophthalmology Unit (M.P., F.B., C.S., F.B., and G.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University (G.S., F.B., and G.F.), Milan, Italy.
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Roszkowska AM, Camellin U, Franchina F, Alunni-Fegatelli D, Lombardo G, Serrao S, Mencucci R, Vestri A, Lombardo M. Tear levels of apoptotic, matrix-degrading and antioxidant biomarkers in patients with and without keratoconus: A cross sectional study. Cont Lens Anterior Eye 2025; 48:102315. [PMID: 39424461 DOI: 10.1016/j.clae.2024.102315] [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: 08/20/2023] [Revised: 08/27/2024] [Accepted: 10/05/2024] [Indexed: 10/21/2024]
Abstract
PURPOSE To assess the tear levels of a set of apoptotic, matrix-degrading and antioxidant biomarkers, including Metalloproteinase 9 (MMP9), High Mobility Group Box 1 (HMGB1) and Superoxide Dismutase 3-Extracellular (SOD3). METHODS Sandwich-ELISA commercial kits were used to test the expression of the three tear biomarkers in the lacrimal fluid of eligible participants. Linear logistic regression analysis was performed todetermine whether the set of tear biomarkers could be associated with clinically manifest keratoconus. ROC curve analysis using 10-fold cross-validation was performedto evaluate the prediction accuracy of the model. RESULTS Eighty-one participants aged 30-48 years old were enrolled in this study; 48 were patients with keratoconus and 33 were age-matched healthy subjects. The linear combination of the three tear biomarkers levels (AUC = 0.811; CI 95 %: 0.712-0.911) accurately indicated the existence of keratoconus; higher levels of MMP9 (Odd Ratio: 1.069; CI 95 %: 1.029-1.130) and HMGB1 (OR: 1.011; CI 95 %: 1.003-1.022) and lower levels of SOD3 (OR: 0.994; CI 95 %: 0.989-0.997) were significantly associated with a higher probability of keratoconus. CONCLUSION Multivariable analysis of the set of tear levels of MMP9, HMGB1 and SOD3 biomarkers confirmed a chronic state of inflammation in the ocular surface of patients with keratoconus.
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Affiliation(s)
- Anna Maria Roszkowska
- Ophthalmology Clinic, Department of Biomedical Sciences, University of Messina, Italy; Ophthalmology Department, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Poland.
| | - Umberto Camellin
- Ophthalmology Clinic, Department of Biomedical Sciences, University of Messina, Italy
| | - Francesco Franchina
- Ophthalmology Clinic, Department of Biomedical Sciences, University of Messina, Italy
| | - Danilo Alunni-Fegatelli
- Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Piazzale Aldo Moro 5, 00185 Rome, Italy; Department of Life Sciences, Health and Health Professions, Link Campus University, Via del Casale di S. Pio V, 44, 00165 Roma, Italy
| | - Giuseppe Lombardo
- CNR-IPCF, Istituto per i Processi Chimico-Fisici, Viale F. Stagno D'Alcontres 37, 98158 Messina, Italy; Vision Engineering Italy Srl, Via Livenza 3, 00198 Rome, Italy
| | - Sebastiano Serrao
- Vision Engineering Italy Srl, Via Livenza 3, 00198 Rome, Italy; Studio Italiano di Oftalmologia, Via Livenza 3, 00198 Rome, Italy
| | - Rita Mencucci
- SOD Oculistica, AOU Careggi, Università di Firenze, Largo Brambilla 3, 50134 Firenze, Italy
| | - Annarita Vestri
- Department of Public Health and Infectious Diseases, University of Rome "La Sapienza", Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Marco Lombardo
- Vision Engineering Italy Srl, Via Livenza 3, 00198 Rome, Italy; Studio Italiano di Oftalmologia, Via Livenza 3, 00198 Rome, Italy
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Hwang Y, Kang SJ, Kang J, Choi J, Kim SJ, Jang S. DNA repair and disease: insights from the human DNA glycosylase NEIL family. Exp Mol Med 2025; 57:524-532. [PMID: 40033009 PMCID: PMC11958798 DOI: 10.1038/s12276-025-01417-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 11/27/2024] [Accepted: 12/11/2024] [Indexed: 03/05/2025] Open
Abstract
The base excision repair pathway protects DNA from base damage via oxidation, deamination, alkylation and methylation. DNA glycosylases are key enzymes that recognize damaged bases in a lesion-specific manner and initiate the base excision repair process. Among these, the endonuclease VIII-like 1-3 (NEIL1-3) family, which is found in mammalian genomes, is a homolog of bacterial DNA glycosylases known as Fpg/Nei. NEIL enzymes have similar structures and substrates but with slight differences. When repair proteins are impaired, the accumulation of damaged bases can lead to increased genomic instability, which is implicated in various pathologies, including cancer and neurodegeneration. Notably, mutations in these proteins also influence a range of other diseases and inflammation. This review focuses on the influence of the NEIL family on human health across different organ systems. Investigating the relationship between NEIL mutations and diseases can improve our understanding of how these enzymes affect the human body. This information is crucial for understanding the basic mechanisms of DNA repair and enabling the development of novel inhibitors or gene therapies that target only these enzymes. Understanding the role of the NEIL family provides insights into novel therapies and improves our ability to combat genetic diseases.
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Affiliation(s)
- Yuna Hwang
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
- Graduate Program in Innovative Biomaterials Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Su-Jin Kang
- College of Pharmacy, Dongduk Women's University, Seoul, Republic of Korea
| | - Jieun Kang
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
- Graduate Program in Innovative Biomaterials Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Jeongwoo Choi
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea
- Graduate Program in Innovative Biomaterials Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Seung-Jin Kim
- Department of Biochemistry, College of Natural Sciences, Kangwon National University, Chuncheon, Republic of Korea.
| | - Sunbok Jang
- College of Pharmacy, Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul, Republic of Korea.
- Graduate Program in Innovative Biomaterials Convergence, Ewha Womans University, Seoul, Republic of Korea.
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Gupta Y, Shanmugam C, K P, Mandal S, Tandon R, Sharma N. Pediatric keratoconus. Surv Ophthalmol 2025; 70:296-330. [PMID: 39396644 DOI: 10.1016/j.survophthal.2024.10.003] [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: 01/07/2024] [Revised: 10/07/2024] [Accepted: 10/07/2024] [Indexed: 10/15/2024]
Abstract
Keratoconus is a common pediatric corneal disease, leading to vision impairment and amblyopia. Compared to its adult counterpart, pediatric keratoconus has an advanced presentation, rapid progression, higher incidence of complications such as corneal hydrops, and greater potential impact on the quality of life. It typically manifests during puberty and can evolve rapidly to more severe stages if left untreated. This rapid progression underscores the importance of early diagnosis through regular screening in pediatric populations and vigilant monitoring of pediatric keratoconus suspects. Concomitant ocular allergies, ocular anomalies, systemic diseases (e.g. syndromes), and poor compliance with contact lenses might impede prompt intervention and frequently postpone rehabilitation. Corneal collagen crosslinking is a crucial intervention in the management of pediatric keratoconus because it strengthens the corneal microstructure and halts the disease progression. When conservative measures fail, keratoplasty remains a viable option with generally favorable outcomes, though with unique challenges in post-operative care, including concerns related to sutures, long-term graft survival and need for repeated examinations under anesthesia. A multidisciplinary approach involving ophthalmologists, optometrists, pediatricians, and other healthcare professionals, focusing on early diagnosis and timely intervention, is essential for the comprehensive management of pediatric keratoconus and to mitigate its impact on children's lives.
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Affiliation(s)
- Yogita Gupta
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Chandradevi Shanmugam
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Priyadarshini K
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Sohini Mandal
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India; LV Prasad Eye Institute, Bhubaneswar, Odisha, India
| | - Radhika Tandon
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, Delhi, India.
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Fantaci B, Rodriguez Matas JF, Squartecchia V, Vavassori L, Calvo B. Unraveling the impact of laser refractive surgery on corneal ectasia: an in silico study. Front Bioeng Biotechnol 2025; 13:1548539. [PMID: 40078792 PMCID: PMC11897516 DOI: 10.3389/fbioe.2025.1548539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2024] [Accepted: 02/04/2025] [Indexed: 03/14/2025] Open
Abstract
Introduction Laser refractive surgeries are a safe option for low-to-moderate refractive corrections, providing excellent visual outcomes. Over the years, various procedures have been introduced into clinical practice, but the most performed today remain Photorefractive Keratectomy (PRK), Laser In-Situ Keratomileusis (LASIK), and Small Incision Lenticule Extraction (SMILE). Although laser refractive treatments are considered safe, clinicians have focused on the risk of post-surgical ectasia, a rare but serious complication. Ectasia is characterized by progressive corneal thinning and steepening, leading to vision distortion, irregular astigmatism, and in some cases, a reduction of visual acuity. It is still debated whether laser refractive surgeries can cause ectasia as an iatrogenic condition or merely accelerate the progression of an underlying corneal pathology, not detected during pre-surgical screening. The proposed work investigates the relationship among three laser refractive surgeries (PRK, LASIK and SMILE), currently performed in clinical practice, and ectasia onset and progression by means of an in silico analysis. Methods An average 3D finite-element corneal model is developed and a pathological area, characterized by reduced stiffness of varying severity grades, is defined to analyze its influence on ectasia development and progression in the pre-surgical state. Three laser treatments (PRK, LASIK and SMILE) are simulated on healthy and pathological models. Pre- and post-surgical conditions are compared to check whether any procedure worsens the pre-surgical pathological state. The optomechanical effect of each procedure on the cornea is analyzed at both healthy and pathological conditions and compared to establish which refractive procedure mostly affects corneal structure. Results and discussion While the three refractive procedures showed different behaviors in terms of mechanical changes affecting the cornea, from an optical perspective, as the pathology severity worsened, none of the surgeries caused a worsening in the cone's severity with respect to pre-surgical pathological conditions. This result suggests that surgeries may have a limited role in causing post-surgical ectasia, as it seems more plausible that they accelerate the progression of an underlying pathological condition. Among the three procedures, PRK was found to be the least invasive treatment from a mechanical perspective, while SMILE showed the greatest impact on the posterior surface, suggesting a potential long-term risk for ectasia progression.
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Affiliation(s)
- Benedetta Fantaci
- Aragon Institute of Research Engineering (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - José Félix Rodriguez Matas
- LaBS, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Vittoria Squartecchia
- LaBS, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Lucia Vavassori
- LaBS, Department of Chemistry, Materials and Chemical Engineering “Giulio Natta”, Politecnico di Milano, Milan, Italy
| | - Begoña Calvo
- Aragon Institute of Research Engineering (I3A), Universidad de Zaragoza, Zaragoza, Spain
- Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre (CIBER-BBN), Universidad de Zaragoza, Zaragoza, Spain
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Touriño-Peralba R, Rodríguez-Lago J, Lamas-Francis D, Martínez-Pérez L, Rodríguez-Ares T. Demographic and topographic findings suggesting poor response to crosslinking-iontophoresis in patients with progressive keratoconus. Int Ophthalmol 2025; 45:69. [PMID: 39928056 PMCID: PMC11811480 DOI: 10.1007/s10792-025-03421-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Accepted: 01/19/2025] [Indexed: 02/11/2025]
Abstract
PURPOSE To evaluate demographic and tomographical parameters in predicting treatment response following transepithelial iontophoresis-assisted corneal cross-linking (I-CXL) for progressive keratoconus. METHODS Forty eyes (20 aged < 19 years and 20 aged ≥ 19 years) underwent I-CXL treatment between 2016 and 2022. Progression criteria based on the ABCD system, changes in asphericity (Q), demographic factors and keratoconus phenotypes were evaluated. Subjects were followed for 24 months after procedure. RESULTS Sixty percent of participants were male. The mean age at the time of treatment was 21.0 ± 6.0 years. All tomographical values showed progression after 2 years of follow-up (p < 0.05), particularly during the first 6 months, except for anterior curvature. Within the ABCD grading system, we observed: A) an increase in anterior curvature, more evident with lower initial values; B) an increase in posterior curvature, more pronounced with higher initial values. Two years after I-CXL, 20% of subjects met progression criteria in two or more parameters, with 62.5% being under 19 years of age. Patients with a family history of corneal ectasia exhibited a mean KMax progression of 1.94D ± 1.88, (p = 0.046). Only phenotypes 3 and 4 showed progression. Although patients under 19 years showed greater progression in all tomographical variables at the end of the study, this difference was not statistically significant. CONCLUSION Treatment with I-CXL did not stop progression in the variables studied two years after the procedure in an effective manner, especially in patients younger than 19 years. A family history of corneal ectasia and subtype 4 keratoconus predicted a less favourable response to I-CXL.
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Affiliation(s)
- Rosario Touriño-Peralba
- Ocular Surface and Cornea Service, Department of Ophthalmology, University Hospital of Santiago de Compostela, Rúa Ramón Baltar s/n. PC: 15.706, Santiago de Compostela, A Coruna, Spain.
- Department of Surgery, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Julio Rodríguez-Lago
- Ocular Surface and Cornea Service, Department of Ophthalmology, University Hospital of Santiago de Compostela, Rúa Ramón Baltar s/n. PC: 15.706, Santiago de Compostela, A Coruna, Spain
| | - David Lamas-Francis
- Ocular Surface and Cornea Service, Department of Ophthalmology, University Hospital of Santiago de Compostela, Rúa Ramón Baltar s/n. PC: 15.706, Santiago de Compostela, A Coruna, Spain
| | - Laura Martínez-Pérez
- Ocular Surface and Cornea Service, Department of Ophthalmology, University Hospital of Santiago de Compostela, Rúa Ramón Baltar s/n. PC: 15.706, Santiago de Compostela, A Coruna, Spain
| | - Teresa Rodríguez-Ares
- Ocular Surface and Cornea Service, Department of Ophthalmology, University Hospital of Santiago de Compostela, Rúa Ramón Baltar s/n. PC: 15.706, Santiago de Compostela, A Coruna, Spain
- Department of Surgery, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
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Shabani H, De Ridder J, Asaad MA, Bramer WM, Meester-Smoor MA, Geerards AAJM, Klaver CCW, Ramdas WD, van Dooren BTH. Climate Determinants of Keratoconus: Insights From a Systematic Review of Prevalence. Invest Ophthalmol Vis Sci 2025; 66:30. [PMID: 39932473 PMCID: PMC11817973 DOI: 10.1167/iovs.66.2.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2024] [Accepted: 01/08/2025] [Indexed: 02/14/2025] Open
Abstract
Purpose The reported prevalence of keratoconus varies widely worldwide, but the causes of this variation are not well understood. We therefore aimed to explore the potential impact of local climate variables on keratoconus prevalence. Methods The worldwide prevalence of clinical keratoconus in the general population was systematically reviewed. In each eligible prevalence area, four climate variables deemed possibly relevant to keratoconus were assessed: daily maximum temperature, relative humidity, ultraviolet radiation, and wind speed. Climate variables were calculated using worldwide gridded climate datasets from the European Center of Medium-Range Weather Forecasts. Population density weighting was applied to enhance exposure accuracy. The average of each climate variable was calculated over the 10 years preceding data collection of each study. The potential impact of those climate variables was investigated using multiple linear regression adjusted for the gross domestic product per capita (based on purchasing power parity) with the natural logarithm of prevalence as the outcome variable. Results Sixteen eligible studies were identified. After filtering to retain one prevalence estimate per region, 11 studies including datapoints from 61 areas were analyzed. The median (interquartile range) prevalence of keratoconus was 0.10% (0.07%-0.19%). Multiple regression revealed a significant negative association between humidity and keratoconus prevalence (β = -0.03; 95% confidence interval, -0.06 to -0.01; P = 0.004). In contrast, the other analyzed climate variables were not significantly associated with keratoconus prevalence. Conclusions Using global gridded climate maps, we observed a significant and biologically plausible link between low humidity and keratoconus. This suggests that humidification could benefit patients and at-risk groups.
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Affiliation(s)
- Hasan Shabani
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Cornea Center, The Rotterdam Eye Hospital, Rotterdam, the Netherlands
| | - Job De Ridder
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mohammad Ali Asaad
- Experimental Eye Research Institute, University Eye Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Wichor M. Bramer
- Medical Library, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Magda A. Meester-Smoor
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | | | - Caroline C. W. Klaver
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Ophthalmology, Radboud University Medical Center, Nijmegen, the Netherlands
- Institute of Molecular and Clinical Ophthalmology, University of Basel, Basel, Switzerland
| | - Wishal D. Ramdas
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Bart T. H. van Dooren
- Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Ophthalmology, Amphia Hospital, Breda, the Netherlands
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Singh RB, Koh S, Sharma N, Woreta FA, Hafezi F, Dua HS, Jhanji V. Keratoconus. Nat Rev Dis Primers 2024; 10:81. [PMID: 39448666 DOI: 10.1038/s41572-024-00565-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2024] [Indexed: 10/26/2024]
Abstract
Keratoconus is a progressive eye disorder primarily affecting individuals in adolescence and early adulthood. The ectatic changes in the cornea cause thinning and cone-like steepening leading to irregular astigmatism and reduced vision. Keratoconus is a complex disorder with a multifaceted aetiology and pathogenesis, including genetic, environmental, biomechanical and cellular factors. Environmental factors, such as eye rubbing, UV light exposure and contact lens wearing, are associated with disease progression. On the cellular level, a complex interplay of hormonal changes, alterations in enzymatic activity that modify extracellular membrane stiffness, and changes in biochemical and biomechanical signalling pathways disrupt collagen cross-linking within the stroma, contributing to structural integrity loss and distortion of normal corneal anatomy. Clinically, keratoconus is diagnosed through clinical examination and corneal imaging. Advanced imaging platforms have improved the detection of keratoconus, facilitating early diagnosis and monitoring of disease progression. Treatment strategies for keratoconus are tailored to disease severity and progression. In early stages, vision correction with glasses or soft contact lenses may suffice. As the condition advances, rigid gas-permeable contact lenses or scleral lenses are prescribed. Corneal cross-linking has emerged as a pivotal treatment aimed at halting the progression of corneal ectasia. In patients with keratoconus with scarring or contact lens intolerance, surgical interventions are performed.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
- Department of Ophthalmology, Leiden University Medical Center, Leiden, Netherlands
| | - Shizuka Koh
- Department of Innovative Visual Science, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Namrata Sharma
- Dr. Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Fasika A Woreta
- Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Farhad Hafezi
- ELZA Institute, Zurich, Switzerland
- EMAGine AG, Zug, Switzerland
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY, USA
| | - Harminder S Dua
- Department of Ophthalmology, University of Nottingham, Nottingham, UK
| | - Vishal Jhanji
- Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
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10
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Chang Y, Huang T, Yang S, Li Y, Chen D. Causal Association Between Atopic Dermatitis and Keratoconus: A Mendelian Randomization Study. Transl Vis Sci Technol 2024; 13:13. [PMID: 39240549 PMCID: PMC11382964 DOI: 10.1167/tvst.13.9.13] [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: 09/07/2024] Open
Abstract
Purpose Although many studies have indicated that atopic dermatitis (AD) could contribute to the risk of keratoconus (KC), the causality between AD and KC remains controversial. This study aimed to explore the potential causal associations between AD and KC. Methods Instrumental variables for both exposures and outcomes were obtained from large-scale genome-wide association study summary statistics from previous meta-analyses. Mendelian randomization (MR) was applied to infer causal associations between AD and KC. Our main analyses were conducted by inverse-variance weighted (IVW) method multiplicative random effect model, complemented with additional five models and sensitivity analyses. Reverse MR analysis was applied to determine the direction of the causal association between AD and KC. Results Both IVW and weighted median methods revealed a causal effect of AD on KC (IVW odds ratio [OR], 1.475; P = 4.16 × 10-4; weighted median OR, 1.351; P = 7.65 × 10-3). The weighted mode, simple mode, and MR Egger methods demonstrated consistent direction of causality. Evidence from all sensitivity analyses further supported these associations. Reverse MR analyses did not suggest causal effects of KC on AD. Conclusions This study supported a significant causal effect of AD on KC, and reverse MR analysis proved that the causal association was unilateral. Translational Relevance This study provides valid evidence that regular ophthalmic examinations are recommended for patients with AD to detect and prevent KC at an early stage.
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Affiliation(s)
- Yuan Chang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tianze Huang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shan Yang
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Di Chen
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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11
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Fantaci B, Calvo B, Rodríguez JF. Modeling biological growth of human keratoconus: On the effect of tissue degradation, location and size. Comput Biol Med 2024; 180:108976. [PMID: 39116714 DOI: 10.1016/j.compbiomed.2024.108976] [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: 05/20/2024] [Revised: 07/17/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
Keratoconus is a non-inflammatory bilateral disease, that usually occurs in the inferior-temporal region, where the cornea bulges out and becomes thinner, due to the gradual loss of structural organization in corneal tissue. Degenerated extracellular matrix and fibers breakage have been observed in keratoconic corneas, that may promote the progression of the pathology. While keratoconus histopathology has been widely described in literature, its etiology is still not clear. Being able to fully understand keratoconus growing process could be crucial to detect its development and improve prevention strategies. This work proposes a novel continuum-based keratoconus growth model. The proposed framework accounts for the structural changes occurring in the underlying tissue during the progression of the disease, as indicated in experiments. The developed formulation is able to replicate the typical bulging and thinning of keratoconic corneas, as well as different forms in terms of shape, as they are commonly classified in clinics (nipple, oval and globus cones). The cone that is obtained constitutes a permanent deformed state, not pressure dependent. The resulting model may help to better understand the etiology of the behavior of this disease with the aim of improving the diagnosis and the treatment of the pathology.
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Affiliation(s)
- Benedetta Fantaci
- Aragon Institute of Research Engineering (I3A), Universidad de Zaragoza, Zaragoza, Spain.
| | - Begoña Calvo
- Aragon Institute of Research Engineering (I3A), Universidad de Zaragoza, Zaragoza, Spain; Bioengineering, Biomaterials and Nanomedicine Networking Biomedical Research Centre (CIBER-BBN), Universidad de Zaragoza, Zaragoza, Spain
| | - José Félix Rodríguez
- LaBS, Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
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12
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Raiskup F, Herber R, Lenk J, Pillunat LE, Spoerl E. Crosslinking with UV-A and riboflavin in progressive keratoconus: From laboratory to clinical practice - Developments over 25 years. Prog Retin Eye Res 2024; 102:101276. [PMID: 38830532 DOI: 10.1016/j.preteyeres.2024.101276] [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: 03/31/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/05/2024]
Abstract
Changes in the biomechanical and biochemical properties of the human cornea play an important role in the pathogenesis of ectatic diseases. A number of conditions in primarily acquired (keratoconus or pellucid marginal degeneration) or secondarily induced (iatrogenic keratectasia after refractive laser surgeries) ectatic disorders lead to decreased biomechanical stability. Corneal collagen cross-linking (CXL) represents a technique to slow or even halt the progression of ectatic pathologies. In this procedure, riboflavin is applied in combination with ultraviolet A radiation. This interaction induces the production of reactive oxygen species, which leads to the formation of additional covalent bonds between collagen molecules and subsequent biomechanical corneal strengthening. This procedure is so far the only method that partially interferes etiopathogenetically in the treatment of ectatic diseases that slows or stops the process of corneal destabilization, otherwise leading to the need for corneal transplantation. Besides, CXL process increases markedly resistance of collagenous matrix against digesting enzymes supporting its use in the treatment of corneal ulcers. Since the discovery of this therapeutic procedure and the first laboratory experiments, which confirmed the validity of this method, and the first clinical studies that proved the effectiveness and safety of the technique, it has been spread and adopted worldwide, even with further modifications. Making use of the Bunsen-Roscoe photochemical law it was possible to shorten the duration of this procedure in accelerated CXL and thus improve the clinical workflow and patient compliance while maintaining the efficacy and safety of the procedure. The indication spectrum of CXL can be further expanded by combining it with other vision-enhancing procedures such as individualized topographically-guided excimer ablation. Complementing both techniques will allow a patient with a biomechanically stable cornea to regularize it and improve visual acuity without the need for tissue transplantation, leading to a long-term improvement in quality of life.
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Affiliation(s)
- Frederik Raiskup
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany.
| | - Robert Herber
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Janine Lenk
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Lutz E Pillunat
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
| | - Eberhard Spoerl
- Department of Ophthalmology, University Hospital Carl Gustav Carus, TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany
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13
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Zhang X, Wang Q, Cui F, Wu X, Zhang C. Mendelian randomization analysis does not reveal a causal influence between keratoconus and three major mental disorders. Front Psychiatry 2024; 15:1370670. [PMID: 39234617 PMCID: PMC11371735 DOI: 10.3389/fpsyt.2024.1370670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Accepted: 08/05/2024] [Indexed: 09/06/2024] Open
Abstract
Background Observational studies have suggested at a possible link between keratoconus (KC) and various mental disorders, but the exact direction of causation in these associations remains unclear. This study aims to investigate the potential causal link between KC and three prominent mental conditions: Anxiety, Depression, and Schizophrenia. Methods Using instrumental variables identified from Genome-wide association study (GWAS) data of European individuals, we conducted bidirectional two-sample Mendelian Randomization (MR) analyses to explore potential causal relationships between KC and the three major mental disorders. We primarily employed the Inverse-Variance Weighted (IVW) method to evaluate causality. In addition, we performed four supplementary MR methods (MR-Egger, Weighted Median, Simple Mode, and Weighted Mode). Furthermore, we conducted various sensitivity analyses to assess heterogeneity, horizontal pleiotropy, and result stability. Results Our findings did not reveal any concrete evidence of a causal link between KC and the three major mental disorders, namely anxiety, depression, and schizophrenia [anxiety: odds ratio (OR)=0.997, 95% confidence interval (CI)=0.988-1.008, p = 0.621; depression: OR=1.008, 95% CI=0.999-1.017, p = 0.084; schizophrenia: OR=1.002, 95% CI= 0.984-1.020, p = 0.840]. Similarly, the three major mental disorders were not caustically associated with KC [anxiety: OR=1.014, 95% CI=0.635-1.620, p = 0.953; depression: OR=1.109, 95% CI= 0.749-1.643, p = 0.604; schizophrenia: OR= 0.969, 95% CI= 0.884-1.062, p = 0.497]. The sensitivity analyses indicated that the results remained robust, with no signs of pleiotropy or heterogeneity. Conclusions Our study does not support a genetically determined significant causal connection between KC and the three major mental disorders. The increased occurrence of mental disorders observed in KC patients in observational reports likely arises from factors that can be modified. Further research is warranted to unveil the underlying mechanisms behind the associations observed in observational studies.
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Affiliation(s)
- Xueyan Zhang
- Department of Ophthalmology, The Jinan Second People's Hospital, Jinan, Shandong, China
| | - Qiaoling Wang
- Department of Ophthalmology, The Jinan Second People's Hospital, Jinan, Shandong, China
| | - Fenghua Cui
- Department of Ophthalmology, The Jinan Second People's Hospital, Jinan, Shandong, China
| | - Xuelian Wu
- Department of Ophthalmology, The Jinan Second People's Hospital, Jinan, Shandong, China
| | - Chenming Zhang
- Department of Ophthalmology, The Jinan Second People's Hospital, Jinan, Shandong, China
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14
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Lombardo M, Alunni Fegatelli D, Serrao S, Vestri A, Lombardo G. Estimated prevalence of keratoconus in the largest metropolitan area of Italy. Eur J Ophthalmol 2024; 34:649-655. [PMID: 38425220 DOI: 10.1177/11206721241235984] [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] [Indexed: 03/02/2024]
Abstract
PURPOSE To estimate the prevalence of keratoconus in a population of subjects undergoing first eye examination in an eye clinic in Italy. METHODS A single-center, cross-sectional, study was conducted involving patients who underwent first eye examination at an eye clinic in Rome between September 2021 and June 2022. The prevalence of keratoconus was determined by Placido-disk corneal topography using the maximum keratometry (Kmax) value and the Cone Magnitude and Location Index (CLMI) for keratoconus screening. Subjective analysis was performed by two experienced corneal specialists, who classified the outcome into two groups: normal and keratoconus. Risk factors, including family history of keratoconus, allergy or atopy, thyroid disease, eye rubbing habit and gender were also examined. RESULTS A total of 512 subjects between 7 and 81 years old were evaluated. The inter-observer agreement to classify subjects in normal or keratoconus group was excellent (k = 1.0); the estimated prevalence in the specific population was 2.1%. Presence of positive family history (9% of keratoconus vs 5% normal), concomitant allergy or atopy (27% vs 9%) and eye rubbing habit (18% vs 4%) were associated with a higher risk of disease. CONCLUSION This study reported a high estimated prevalence of keratoconus in a metropolitan area of Italy, as found in recent studies in the Mediterranean and Middle East countries. Screening for keratoconus is highly recommendable and easily feasible with corneal topography under expert supervision and may be indicated primarily in young population to improve early detection and prompt therapeutic management for halting disease progression.
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Affiliation(s)
- Marco Lombardo
- Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy
- Vision Engineering Italy srl, Via Livenza 3, 00198, Rome, Italy
| | - Danilo Alunni Fegatelli
- Department of Public health and Infectious diseases, University of Rome "La Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Sebastiano Serrao
- Studio Italiano di Oftalmologia, Via Livenza 3, 00198, Rome, Italy
- Vision Engineering Italy srl, Via Livenza 3, 00198, Rome, Italy
| | - Annarita Vestri
- Department of Public health and Infectious diseases, University of Rome "La Sapienza", Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Giuseppe Lombardo
- Vision Engineering Italy srl, Via Livenza 3, 00198, Rome, Italy
- CNR-IPCF, Istituto per i Processi Chimico-Fisici, Viale F. Stagno D'Alcontres 37, 98158, Messina, Italy
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15
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Acar Eser N, Dikmetas O, Kocabeyoglu S, Tan C, Irkec M. Evaluation of Keratoconus Disease with Tear Cytokine and Chemokine Levels Before and After Corneal Cross-Linking Treatment. Ocul Immunol Inflamm 2024; 32:269-275. [PMID: 36745704 DOI: 10.1080/09273948.2023.2165950] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 12/06/2022] [Accepted: 01/03/2023] [Indexed: 02/08/2023]
Abstract
OBJECTIVES To compare tear cytokine and chemokine levels of keratoconus (KC) patients with controls to perceive etiology distinctly and to clarify the molecular changes after cross-linking (CXL). METHODS Tear samples were gathered from 34 participants in this prospective study. Participants underwent anterior and posterior segment examinations with slit-lamp biomicroscopy. Patients were assessed by corneal topography before and 3 months after CXL. Flat (K1), steep (K2), and average keratometry (Kmean), cylinder (CYL), and central corneal thickness (CCT) values were evaluated. After 3 months from CXL, samples were re-collected, and comparisons were made with preoperative values. RESULTS Levels of IFN-gamma, IL-8, IL-12, IL-17, TNF-α, IL-4 and IL-13 were detected higher in KC patients (p= 0.008, p= 0.047, p= 0.001, p= 0.001, p= 0.001, p= 0.001, p= 0.027, respectively). After CXL IL-4, IL-5, IL-6, IL-7, IL-8, TNF-α levels showed significant decrease (p= 0.005, p= 0.045, p= 0.010, p= 0.022, p= 0.001, p=0.002, respectively). As for the topographic measurements, postoperative CCT values were increased whereas Kmean reduced after CXL (p < 0.001, p = 0.015, respectively). (p= 0.001, p= 0.027, respectively). CONCLUSION Our findings imply that inflammation plays a key role in the development of KC and that this link is influenced by CXL therapy.
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Affiliation(s)
- Nazan Acar Eser
- Department of Ophthalmology, Ulucanlar Eye Training and Research Hospital, University of Health Science, Ankara, Turkey
| | - Ozlem Dikmetas
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Sibel Kocabeyoglu
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Cagman Tan
- Department of Pediatrics Immunology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Murat Irkec
- Department of Ophthalmology, Hacettepe University School of Medicine, Ankara, Turkey
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16
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Liu R, Ma R, Yan X. Balanced activation of Nrf-2/ARE mediates the protective effect of sulforaphane on keratoconus in the cell mechanical microenvironment. Sci Rep 2024; 14:6937. [PMID: 38521828 PMCID: PMC10960822 DOI: 10.1038/s41598-024-57596-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 03/20/2024] [Indexed: 03/25/2024] Open
Abstract
Keratoconus (KC) is a progressive degenerative disease that usually occurs bilaterally and is characterized by corneal thinning and apical protrusion of the cornea. Oxidative stress is an indicator of the accumulation of reactive oxygen species (ROS), and KC keratocytes exhibit increased ROS production compared with that of normal keratocytes. Therefore, oxidative stress in KC keratocytes may play a major role in the development and progression of KC. Here, we investigated the protective effect of sulforaphane (SF) antioxidants using a hydrogel-simulated model of the cell mechanical microenvironment of KC. The stiffness of the KC matrix microenvironment in vitro was 16.70 kPa and the stiffness of the normal matrix microenvironment was 34.88 kPa. Human keratocytes (HKs) were cultured for 24 h before observation or drug treatment with H2O2 in the presence or absence of SF. The levels of oxidative stress, nuclear factor E2-related factor 2 (Nrf-2) and antioxidant response element (ARE) were detected. The high-stress state of HKs in the mechanical microenvironment of KC cells compensates for the activation of the Nrf-2/ARE signaling pathway. H2O2 leads to increased oxidative stress and decreased levels of antioxidant proteins in KC. In summary, SF can reduce endogenous and exogenous oxidative stress and increase the antioxidant capacity of cells.
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Affiliation(s)
- Ruixing Liu
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, People's Republic of China
- People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou, 450003, People's Republic of China
| | - Ruojun Ma
- People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Henan Eye Hospital, Zhengzhou, 450003, People's Republic of China
| | - Xiaoming Yan
- Department of Ophthalmology, Peking University First Hospital, Beijing, 100034, People's Republic of China.
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17
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Anisimov SI, Micovic S, Anisimova NS. [Aberrometry in the diagnosis and treatment of keratoconus]. Vestn Oftalmol 2024; 140:162-168. [PMID: 39569790 DOI: 10.17116/oftalma2024140051162] [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] [Indexed: 11/22/2024]
Abstract
Keratoconus (KC) is a bilateral progressive disease that often begins in young adulthood. Advanced KC significantly impairs patients' quality of life, making early detection of the condition a critical goal for specialists. Early identification of KC greatly influences both the treatment strategy and the outcomes. This review focuses on the ocular wavefront in KC, which is of interest from the perspective of early diagnosis. The article outlines the nature of optical aberrations in the eye, particularly in KC, and the principles of wavefront aberration analysis. An increase in higher-order aberrations is one of the earliest signs of incipient KC and a key contributor to reduced visual quality. Some of the widely used KC treatment methods, such as corneal cross-linking and the implantation of intracorneal segments, has been established to positively impact many aspects of KC pathogenesis, including reduction in higher-order aberrations, which in turn improves visual quality. Monitoring of the outcomes of treatment or optical correction in KC using higher-order aberrations is a delicate approach, as vision improvements following treatment are often unexplained by routine eye examination methods. However, the choice of the optimal method of visual rehabilitation for KC patients remains unresolved. Efforts to find new treatment methods, primarily through combinations and modifications of existing techniques, are ongoing. The article discusses this promising approach of using wavefront as an additional criterion for assessing the performance of the optical system in the diagnosis, treatment, and optical correction of KC.
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Affiliation(s)
- S I Anisimov
- Russian University of Medicine, Moscow, Russia
- OOO Glaznoy centr "Vostok-Prozreniye", Moscow, Russia
| | - S Micovic
- Russian University of Medicine, Moscow, Russia
- OOO Glaznoy centr "Vostok-Prozreniye", Moscow, Russia
| | - N S Anisimova
- Russian University of Medicine, Moscow, Russia
- OOO Glaznoy centr "Vostok-Prozreniye", Moscow, Russia
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18
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Garlı M, Küsbeci T, Aydın F, Akmaz O. The effect of hyperbaric oxygen therapy on corneal endothelial structure and anterior segment parameters. Cutan Ocul Toxicol 2023; 42:243-247. [PMID: 37531136 DOI: 10.1080/15569527.2023.2243499] [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: 04/13/2023] [Revised: 07/05/2023] [Accepted: 07/29/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE To assess the effect of hyperbaric oxygen therapy (HBOT) on corneal endothelial structure and anterior segment parameters in healthy eyes. METHODS 17 eyes of 17 patients who were scheduled to receive HBOT for other than ophthalmologic indications were investigated in this prospective study. Central corneal thickness (CCT) and corneal endothelial properties were evaluated using a specular microscope. Endothelial cell density (ECD), average cell area (AVG), coefficient of variation in cell size (CV), percentage of hexagonal cells (HEX), CCT, intraocular pressure (IOP), spherical equivalent (SE), axial length (AL) and anterior chamber depth (ACD) values were measured before the HBOT, after the 1st session, and after the 20th session of therapy. RESULTS 47% of the patients (n = 8) received HBOT because of avascular necrosis, 35% (n = 6) due to sudden hearing loss, 12% (n = 2) for diabetic foot, and 6% (n = 1) for wound infection. The mean IOP was 14,80 mmHg before HBOT, 14,20 mmHg after the 1st session, and 13,73 mmHg after the 20th session. The mean ACD was 3,38 mm before HBOT, 3,34 mm after the 1st session, and 3,16 mm after the 20th session. Although the mean IOP and ACD decreased after HBOT sessions, it was not statistically significant (p > 0.05). A significant reduction was observed in SE values after 20 sessions of HBOT compared to the values measured before HBOT (p = 0,009). The mean ECD was 2572,53 ± 261,51 cells/mm2 before HBOT, 2554,47 ± 236,13 after the 1st session, and 2563,13 ± 226,92 after the 20th session. When the corneal properties measured before and after HBOT sessions were compared, no significant difference was found in terms of CCT, ECD, AVG, CV, and HEX (p > 0.05). CONCLUSION We observed no significant change in CCT, corneal endothelial layer properties, and anterior segment morphology after the 1st session, and after the 20th session of HBOT. Although HBOT reduced IOP and ACD, it was not statistically significant. HBOT may lead to a significant decrease in SE values after the 20th session.
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Affiliation(s)
- Murat Garlı
- Department of Ophthalmology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Tuncay Küsbeci
- Department of Ophthalmology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Figen Aydın
- Department of Underwater Medicine and Hyperbaric Medicine, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
| | - Okan Akmaz
- Department of Ophthalmology, University of Health Sciences, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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19
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Böhm EW, Buonfiglio F, Voigt AM, Bachmann P, Safi T, Pfeiffer N, Gericke A. Oxidative stress in the eye and its role in the pathophysiology of ocular diseases. Redox Biol 2023; 68:102967. [PMID: 38006824 PMCID: PMC10701459 DOI: 10.1016/j.redox.2023.102967] [Citation(s) in RCA: 74] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/10/2023] [Accepted: 11/14/2023] [Indexed: 11/27/2023] Open
Abstract
Oxidative stress occurs through an imbalance between the generation of reactive oxygen species (ROS) and the antioxidant defense mechanisms of cells. The eye is particularly exposed to oxidative stress because of its permanent exposure to light and due to several structures having high metabolic activities. The anterior part of the eye is highly exposed to ultraviolet (UV) radiation and possesses a complex antioxidant defense system to protect the retina from UV radiation. The posterior part of the eye exhibits high metabolic rates and oxygen consumption leading subsequently to a high production rate of ROS. Furthermore, inflammation, aging, genetic factors, and environmental pollution, are all elements promoting ROS generation and impairing antioxidant defense mechanisms and thereby representing risk factors leading to oxidative stress. An abnormal redox status was shown to be involved in the pathophysiology of various ocular diseases in the anterior and posterior segment of the eye. In this review, we aim to summarize the mechanisms of oxidative stress in ocular diseases to provide an updated understanding on the pathogenesis of common diseases affecting the ocular surface, the lens, the retina, and the optic nerve. Moreover, we discuss potential therapeutic approaches aimed at reducing oxidative stress in this context.
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Affiliation(s)
- Elsa Wilma Böhm
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
| | - Francesco Buonfiglio
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Anna Maria Voigt
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Philipp Bachmann
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Tarek Safi
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Norbert Pfeiffer
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Adrian Gericke
- Department of Ophthalmology, University Medical Center, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany.
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Sozer O, Ozalp O, Atalay E, Demir SS, Alatas İO, Yildirim N. Comparison of blood levels of vitamin B12, folic acid, riboflavin, and homocysteine in keratoconus and healthy subjects. J Cataract Refract Surg 2023; 49:589-594. [PMID: 36745841 DOI: 10.1097/j.jcrs.0000000000001160] [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: 10/03/2022] [Accepted: 01/30/2023] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate blood levels of vitamin B12, folic acid, riboflavin, and homocysteine in keratoconus (KC) and healthy subjects. SETTING Eskişehir Osmangazi University, Eskişehir, Turkey. DESIGN Cross-sectional study. METHODS 100 KC patients (patient group) between the ages of 18 to 35 years and 200 healthy individuals (control group) in the same age range were included in the Eskişehir Osmangazi University Hospital Eye Clinic between October 2019 and March 2020. In all cases, a complete ophthalmologic examination and corneal tomography evaluation with a Pentacam Scheimpflug camera were performed. In blood samples, vitamin B12 and folic acid levels were measured using an electrochemiluminescence immunoassay analyzer, and homocysteine and riboflavin levels were measured using high-performance liquid chromatography. Chi-square tests were used in the analysis of categorical variables, and Mann-Whitney U and Kruskal-Wallis tests were used in the analysis of numerical variables. RESULTS Homocysteine (13.0 ± 6.6 vs 12.1 ± 5.4 μmol/L, P = .190), vitamin B12 (313.5 ± 119.4 vs 322.9 ± 128.3 pg/mL, P = .619), and folic acid (7.0 ± 2.7 vs 7.4 ± 2.9 ng/mL, P = .230) levels were not different between KC (100 eyes of 100 subjects) and control (200 eyes of 200 subjects) groups. The mean riboflavin level was 84.0 ± 21.8 μg/L in the patient group and 183.6 ± 74.3 μg/L in the control group, with a significant difference between the 2 groups ( P < .001). Riboflavin levels were below 180 μg/L in 99% (n = 99) of the cases in the KC group and 53.5% (n = 107) in the control group ( P < .001). CONCLUSIONS Low blood riboflavin levels in KC patients may be a possible risk factor in the pathogenesis of KC.
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Affiliation(s)
- Omer Sozer
- From the Ophthalmology Clinic, Emirdag State Hospital, Afyonkarahisar, Turkey (Sozer); Ophthalmology Clinic, Private Gürlife Hospital, Eskişehir, Turkey (Ozalp); Department of Ophthalmology, Eskişehir Osmangazi University Medical School, Eskişehir, Turkey (Atalay, Yildirim); Medical Biochemistry Clinic, Sandikli State Hospital, Afyonkarahisar, Turkey (Demir); Department of Medical Biochemistry, Eskişehir Osmangazi University Medical School, Eskişehir, Turkey (Alatas)
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21
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Deitel CM, Chen KH, Uber IC. Possible association of keratoconus progression with gender-affirming hormone therapy: A case report. Am J Ophthalmol Case Rep 2023; 30:101850. [PMID: 37131527 PMCID: PMC10149176 DOI: 10.1016/j.ajoc.2023.101850] [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: 08/13/2021] [Revised: 01/22/2023] [Accepted: 04/04/2023] [Indexed: 05/04/2023] Open
Abstract
Purpose To present a case of keratoconus progression following gender-affirming hormone therapy. Observations A 28-year-old male-to-female transgender patient with potential past ocular history of subclinical keratoconus presented with subacute worsening myopia of both eyes (OU), 4 months after initiation of gender-affirming hormone therapy. A diagnosis of keratoconus was established based on slit-lamp exam and computerized corneal tomography. Notable indices were central corneal thinning and inferior steepening OU with maximum corneal curvatures of 58.3 D of the right eye (OD) and 77.7 D of the left eye (OS) and thinnest corneal thickness of 440 μm OD and 397 μm OS. After 8 months of continued hormone therapy, the patient's keratoconus continued to progress and thus corneal crosslinking was recommended and performed. Conclusions Keratoconus progression and relapse has been suggested to have an association with sex hormone changes. We report a case of keratoconus progression following gender-affirming hormone therapy in a transgender patient. Our findings continue to support a correlative relationship between sex hormones and corneal ectasia pathophysiology. Further studies are needed to determine causality and to investigate the utility of screening corneal structure prior to the initiation of gender-affirming hormone therapies.
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Affiliation(s)
| | - Kevin H. Chen
- Corresponding author. Kevin Chen Mailing address: Naval Medical Center Portsmouth, 620 John Paul Jones Cir, Portsmouth, VA, 23708, USA.
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22
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Hage A, Knoeri J, Leveziel L, Majoulet A, Buffault J, Labbé A, Baudouin C. [From ocular itching to eye rubbing: a review of the literature]. J Fr Ophtalmol 2023; 46:173-184. [PMID: 36635208 DOI: 10.1016/j.jfo.2022.09.009] [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: 05/02/2022] [Revised: 09/20/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Abstract
Ocular itching and eye rubbing are frequent complaints in an ophthalmology practice. Numerous studies address the consequences of eye rubbing, such as keratoconus. However, there are few studies concerning the pathophysiology of itching, its transmission pathways, or its interactions with eye rubbing. Through this literature review, we will address the various clinical, physiological and therapeutic aspects of this pair of symptoms with a variety of ocular consequences. We will then describe the state of the art in itching and scratching in dermatology, in order to draw a parallel between these two vicious cycles. A better understanding of the pathophysiology of ocular itching and eye rubbing, as well as new studies based on dermatological data, might allow more appropriate clinical management of our patients and their symptoms.
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Affiliation(s)
- A Hage
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France.
| | - J Knoeri
- Department of Ophthalmology V, NATIONAL Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012, Paris, France
| | - L Leveziel
- Department of Ophthalmology V, NATIONAL Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, 28, rue de Charenton, 75012, Paris, France
| | - A Majoulet
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France
| | - J Buffault
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France
| | - A Labbé
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvellines, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France; Sorbonne Université, inserm, CNRS, Institut de la Vision, 17, rue Moreau, 75012, Paris, France
| | - C Baudouin
- Department of Ophthalmology III, National Hospital Centre for Ophthalmology Quinze-Vingts, IHU FOReSIGHT, Service 3-Pr Christophe Baudouin, 28, rue de Charenton, 75012, Paris, France; Department of Ophthalmology, Ambroise Paré Hospital, AP-HP, Université de Versailles Saint-Quentin en Yvellines, 9, avenue Charles de Gaulle, 92100, Boulogne-Billancourt, France; Sorbonne Université, inserm, CNRS, Institut de la Vision, 17, rue Moreau, 75012, Paris, France
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23
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Jaskiewicz K, Maleszka-Kurpiel M, Michalski A, Ploski R, Rydzanicz M, Gajecka M. Non-allergic eye rubbing is a major behavioral risk factor for keratoconus. PLoS One 2023; 18:e0284454. [PMID: 37053215 PMCID: PMC10101517 DOI: 10.1371/journal.pone.0284454] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 04/01/2023] [Indexed: 04/14/2023] Open
Abstract
Since the environmental, behavioral, and socioeconomic factors in the etiology of keratoconus (KTCN) remain poorly understood, we characterized them as features influencing KTCN phenotype, and especially affecting the corneal epithelium (CE). In this case-control study, 118 KTCN patients and 73 controls were clinically examined and the Questionnaire covering the aforementioned aspects was completed and then statistically elaborated. Selected KTCN-specific findings were correlated with the outcomes of the RNA-seq assessment of the CE samples. Male sex, eye rubbing, time of using a computer after work, and dust in the working environment, were the substantial KTCN risk factors identified in multivariate analysis, with ORs of 8.66, 7.36, 2.35, and 5.25, respectively. Analyses for genes whose expression in the CE was correlated with the eye rubbing manner showed the enrichment in apoptosis (TP53, BCL2L1), chaperon-related (TLN1, CTDSP2, SRPRA), unfolded protein response (NFYA, TLN1, CTDSP2, SRPRA), cell adhesion (TGFBI, PTPN1, PDPK1), and cellular stress (TFDP1, SRPRA, CAPZB) pathways. Genes whose expression was extrapolated to the allergy status didn't contribute to IgE-related or other inflammatory pathways. Presented findings support the hypothesis of chronic mechanical corneal trauma in KTCN. Eye-rubbing causes CE damage and triggers cellular stress which through its influence on cell apoptosis, migration, and adhesion affects the KTCN phenotype.
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Affiliation(s)
| | - Magdalena Maleszka-Kurpiel
- Optegra Eye Health Care Clinic in Poznan, Poznan, Poland
- Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, Poznan, Poland
| | - Andrzej Michalski
- Chair of Ophthalmology and Optometry, Poznan University of Medical Sciences, Poznan, Poland
| | - Rafal Ploski
- Department of Medical Genetics, Medical University of Warsaw, Warsaw, Poland
| | | | - Marzena Gajecka
- Institute of Human Genetics, Polish Academy of Sciences, Poznan, Poland
- Chair and Department of Genetics and Pharmaceutical Microbiology, Poznan University of Medical Sciences, Poznan, Poland
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24
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Lasagni Vitar RM, Fonteyne P, Knutsson KA, Bertuzzi F, Galli L, Rama P, Ferrari G. Vitamin D Supplementation Impacts Systemic Biomarkers of Collagen Degradation and Copper Metabolism in Patients With Keratoconus. Transl Vis Sci Technol 2022; 11:16. [PMID: 36580321 PMCID: PMC9804020 DOI: 10.1167/tvst.11.12.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Purpose To evaluate the impact of vitamin D (Vit D) supplementation on systemic biomarkers of collagen degradation, inflammation, oxidative stress, and copper metabolism in adolescent patients with keratoconus (KC). Methods This was a prospective observational pilot study. Twenty patients (age range, 16-19 years) presenting KC and Vit D insufficiency (<30 ng/mL) were included. Vit D supplementation was prescribed by their general practitioner as per the standard of care. Patients were followed up for 12 months. At each visit, best spectacle-corrected visual acuity (BSCVA), maximal keratometry (Kmax), and thinnest corneal thickness (TCT) were evaluated. The primary outcome of the study was the proportion of patients with Kmax progression of less than 1 D throughout the 12-month follow-up time. Blood samples were collected at different time points to evaluate Vit D levels and systemic markers of collagen degradation, inflammation, oxidative stress, and copper metabolism by ELISA or RT-PCR. Results Lower Vit D levels in the plasma were correlated with higher levels of systemic biomarkers of collagen degradation. Vit D supplementation increased the cell availability of copper. Moreover, stabilization of KC progression was found in 60% of patients (72% of eyes) after 12 months with Vit D supplementation. BSCVA, Kmax, and TCT rates remained stable during the observation period. Conclusions Our findings support that Vit D administration could affect ocular and systemic biomarkers in KC and illuminate a possible mechanism that can be used to develop new treatment alternatives. Translational Relevance Although KC therapy currently relies exclusively on surgical procedures, Vit D supplementation may offer a non-invasive and inexpensive alternative with minimal associated side effects.
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Affiliation(s)
- Romina Mayra Lasagni Vitar
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Philippe Fonteyne
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Karl Anders Knutsson
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Federico Bertuzzi
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Galli
- Infectious Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Rama
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Giulio Ferrari
- Cornea and Ocular Surface Disease Unit, Eye Repair Lab, IRCCS San Raffaele Scientific Institute, Milan, Italy
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25
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Dogan B, Bozdogan YC, Gedik B, Erol MK, Bulut M, Duman F. Optic disc and retinal vessel densities assessment by optical coherence tomography angiography in patients with keratoconus. Photodiagnosis Photodyn Ther 2022; 41:103218. [PMID: 36462703 DOI: 10.1016/j.pdpdt.2022.103218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/13/2022] [Accepted: 11/29/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND This study aimed to evaluate retinal and optic disc vascular changes in patients with keratoconus (KC) using optical coherence tomography angiography (OCTA). METHODS Thirty-two eyes of 22 patients with KC and 24 eyes of 24 age- and sex-matched healthy controls were included in this study. Corneal topography and OCTA were performed. Quantitative vessel density of the macular superficial capillary plexus (SCP), macular deep capillary plexus (DCP), and radial peripapillary capillaries (RPC); choriocapillaris flow area; and choroidal thickness were compared between the KC and control groups. RESULTS SCP and DCP vessel densities showed a significant reduction in the KC group compared to that in the control group (p < 0.001 and p < 0.001 in the whole image and parafovea, respectively). Choriocapillaris flow area was significantly higher in patients with KC than in the control group (p = 0.003). The foveal avascular zone area did not significantly differ between the two groups (p = 0.949). RPC inside disc vessel density was significantly decreased in the KC group compared to that in the control group (p < 0.001). CONCLUSION This study revealed important macular, choroidal, and optic disc vessel densities changes in patients with KC. Macular whole vessel density and parafoveal vessel density of the SCP and DCP decreased, while choriocapillaris flow area increased in patients with KC.
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Affiliation(s)
- Berna Dogan
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey.
| | - Yigit Caglar Bozdogan
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Birumut Gedik
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Muhammet Kazim Erol
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Mehmet Bulut
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Fulya Duman
- Department of Ophthalmology, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
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Winiarczyk M, Biela K, Michalak K, Winiarczyk D, Mackiewicz J. Changes in Tear Proteomic Profile in Ocular Diseases. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13341. [PMID: 36293921 PMCID: PMC9603516 DOI: 10.3390/ijerph192013341] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
The search for proteomic biomarkers in ocular disease is one of the most important research directions in recent years. Reliable biomarkers can be an immense adjuvant for both diagnostic and therapeutic approaches. There is no more readily available ocular tissue for proteomic analysis than tear film, which makes an interesting target for the biomarker search. Tear film is a complex fluid consisting of a superficial lipid layer, which covers the aqueous-mucous layer. Its complexity makes it a perfect candidate for all the "omics" approaches. Glaucoma, cataract, age-related macular degeneration, and other diseases are commonly thought to have a multifactorial background. Currently, no reliable non-invasive tests are available that would help physicians with screening and further patient management. The aim of the study is to present modern methods of measuring biomarkers in tears, with particular emphasis on spectrometric methods, and to discuss their diagnostic and therapeutic usefulness.
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Affiliation(s)
- Mateusz Winiarczyk
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-059 Lublin, Poland
| | - Katarzyna Biela
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-059 Lublin, Poland
- Department of Ophthalmology, Provincial Hospital of Zamosc, 22-400 Zamosc, Poland
| | - Katarzyna Michalak
- Department of Epizootiology, University of Life Sciences of Lublin, 20-400 Lublin, Poland
| | - Dagmara Winiarczyk
- Department of Internal Diseases of Small Animals, University of Life Sciences of Lublin, 20-400 Lublin, Poland
| | - Jerzy Mackiewicz
- Department of Vitreoretinal Surgery, Medical University of Lublin, 20-059 Lublin, Poland
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27
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Salman A, Darwish T, Badla AA, Askar M, Al-Rufayie M, Ghabra M, Haddeh Y, Kailani O, Shaaban R, Hajjo S, Hasan H, Ali A. Prevalence of Keratoconus and Keratoconus Suspect among Patients Seeking Refractive Surgery in Syria. Middle East Afr J Ophthalmol 2022; 29:181-185. [PMID: 38162559 PMCID: PMC10754103 DOI: 10.4103/meajo.meajo_50_23] [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: 03/26/2023] [Revised: 05/14/2023] [Accepted: 05/16/2023] [Indexed: 01/03/2024] Open
Abstract
PURPOSE The purpose of this study was to determine the prevalence of keratoconus (KC) and keratoconus suspect (KCS) among patients seeking refractive surgery in Syria. METHODS This is a retrospective multicenter screening study. The study was conducted in Damascus University, Tishreen University, and Tartous Specialist Eye Center (a private center). Data were collected from refractive surgery candidates referred for preoperative evaluation before laser in situ keratomileusis, photorefractive keratectomy, intrastromal corneal rings, and phakic intraocular lens implantation. Corneal parameters were obtained by Scheimpflug-Placido tomography, Sirius (CSO, Italy). RESULTS A total of 1479 patients were included in this analysis. The prevalence rates of KC and KCS were 18.19% (269/1479) and 13.52% (200/1479), respectively. In addition, patients with KC were found to have higher percentages of eye rubbing and astigmatism than suspect and normal (P < 0.0001). CONCLUSION High prevalence rate of KC was found among patients seeking refractive surgery in Syria. Although this study was carried out on a highly selective population, it may reflect a high prevalence rate in a general population in Syria.
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Affiliation(s)
| | - Taym Darwish
- Department of Ophthalmology, Tishreen University, Lattakia, Syria
| | - Abdul Aziz Badla
- Department of Ophthalmology, Sulaiman Al-Habib Hospital, Dubai, United Arab Emirates
| | - Mohammad Askar
- Department of Ophthalmology, Damascus University, Damascus, Syria
| | | | - Marwan Ghabra
- Department of Ophthalmology, Whipps Cross University Hospital, Leytonstone, London, UK
| | - Yusra Haddeh
- Department of Ophthalmology, Damascus University, Damascus, Syria
| | - Obeda Kailani
- Department of Ophthalmology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Rafea Shaaban
- Department of Ophthalmology, Tartous University, Tartous, Syria
| | - Samer Hajjo
- Department of Ophthalmology, Damascus University, Damascus, Syria
| | - Hiba Hasan
- Department of Ophthalmology, Tishreen University, Lattakia, Syria
| | - Ali Ali
- Department of Ophthalmology, Tishreen University, Lattakia, Syria
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Prevalence of Keratoconus in a Population-Based Study in Syria. J Ophthalmol 2022; 2022:6064533. [PMID: 35783343 PMCID: PMC9246644 DOI: 10.1155/2022/6064533] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/02/2022] [Indexed: 11/17/2022] Open
Abstract
Aim To determine the prevalence and associations of keratoconus (KC) in a university student population in Syria. Methods A prospective multicentre cross-sectional cohort study was conducted at two universities in Syria. Student volunteers were recruited from Tishreen University (Latakia governorate) and Damascus University (Damascus governorate). All participants underwent a comprehensive ocular examination. Placido/Scheimpflug-based corneal imaging using the Sirius (CSO, Florence. Italy), and a questionnaire to evaluate the baseline characteristics and medical history, as well as to highlight possible risk factors of KC. Univariate and bivariate analyses were performed. Results The estimated prevalence of KC among all subjects was 1.43% (n = 12). A strong association between eye rubbing and keratoconus was found (OR 9.33, 95% CI 2.94–29.63, P < 0.001). Damascus University participants had a higher prevalence of KC than Tishreen University. However, the difference was not statistically significant. Conclusion The prevalence of keratoconus in this Syrian student population was 1.43%. The results of this study demonstrate a high prevalence of keratoconus in the study population. Early detection of keratoconus through screening may yield benefits in preventing devastating sequelae of KC in populations with a high prevalence.
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29
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Nicula CA, Bulboacă AE, Nicula D, Nicula AP, Horvath KU, Bolboacă SD. Performances of Corneal Topography and Tomography in the Diagnosis of Subclinical and Clinical Keratoconus. Front Med (Lausanne) 2022; 9:904604. [PMID: 35721077 PMCID: PMC9204599 DOI: 10.3389/fmed.2022.904604] [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: 03/25/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Aim The purpose of the study was to assess the efficacy of topographical and tomographical indices given by the Pentacam (pachymetric, tomopetric, and aberometric) in clinical and subclinical keratoconus (KCN) diagnosis. Material and Methods In this observational analytic retrospective study, patients with abnormal findings in topography and tomography maps but with no signs on clinical examination (subclinical KCN group, sKCN), patients with clinical keratoconus (KCN group), and healthy subjects (Control group) were evaluated. Results The KCN group proved significantly different (p < 0.001) values of the investigated parameters than the Control group. Eleven out of 28 investigated parameters proved significantly different in the sKCN group compared to controls (p < 0.001). Two topographic measurements, namely I-S (cut-off = 1.435, a large value indicates the presence of KCN) and CCT (cut-off = 537, a small value indicates the presence of KCN), showed AUCs equal to 1 [0.999 to 1]. Six other Pentacam measurements, including Back maximum keratometry (Back Kmax) proved to be excellent parameters for case-finding and screening. In distinguishing sKCN from normal eyes, Pentacam index of vertical asymmetry (IVA), inferior-superior difference (I-S) value, thinnest point (TP), Belin Ambrosio Enhanced Ectasia Display (BAD_D) and root mean square total (RMS total) performed best. Conclusions In distinguishing sKCN from normal eyes, Back Kmax, IVA, I-S, and RMS total values demonstrated higher accuracy and utility. Six indices, namely ISV, IVA, KISA, PRC, RMS-HOA, and Back Kmax demonstrate excellent utility in case-finding and screening for clinical KCN.
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Affiliation(s)
- Cristina Ariadna Nicula
- Department of Ophthalmology, "Iuliu Haţieganu" Medicine and Pharmacy University, Cluj-Napoca, Romania.,Oculens Clinic, Cluj-Napoca, Romania
| | - Adriana Elena Bulboacă
- Department of Physiopathology, "Iuliu Haţieganu" Medicine and Pharmacy University, Cluj-Napoca, Romania
| | | | | | - Karin Ursula Horvath
- Department of Ophthalmology, "George Emil Palade" University of Medicine, Pharmacy, Sciences and Technology, Târgu Mureş, Romania
| | - Sorana D Bolboacă
- Department of Medical Informatics and Biostatistics, "Iuliu Haţieganu" Medicine and Pharmacy University, Cluj-Napoca, Romania
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30
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Jamali H, Heydari M, Masihpour N, Khosravi A, Zare M, Shams M, Omrani GR. Serum androgens and prolactin levels in patients with keratoconus. Clin Exp Optom 2022:1-5. [PMID: 35680612 DOI: 10.1080/08164622.2022.2081067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
CLINICAL RELEVANCE There is growing evidence for the involvement of sex hormones in the pathogenesis of keratoconus. BACKGROUND This study aimed to evaluate serum androgen and prolactin levels in patients suffering from keratoconus. METHODS One hundred and two subjects were enrolled in the keratoconus (76 patients) and control (26 subjects) groups in a cross-sectional survey. Topographic evaluation of the cornea was undertaken for all enrolled participants. Serum testosterone, dehydroepiandrosterone sulphate (DHEAS), prolactin (PRL), luteinising hormone (LH), and follicle-stimulating hormone (FSH) were measured in all subjects. RESULTS There was no significant difference in demographic characteristics between the study groups. Significantly higher mean serum levels of DHEAS (3.71 ± 2.23 vs. 2.53 ± 1.77 µg/mL; P = 0.009) and T (6.18 ± 3.80 vs. 1.57 ± 1.76 ng/mL; P < 0.001) were observed in men with keratoconus compared to controls. In females, there were also higher mean levels of DHEAS (2.40 ± 1.57 vs. 2.18 ± 0.72 µg/mL; P = 0.355) and T (0.78 ± 0.96 vs. 0.32 ± 0.13 ng/mL; P < 0.001) in patients with keratoconus but only T level reached the statistically significant level of difference. Also, the mean serum PRL level was significantly higher in women with keratoconus compared to control (13.33 ± 17.85 vs. 4.63 ± 3.10 ng/mL; P < 0.001). There was no significant difference between serum FSH and LH levels between study groups. CONCLUSION In patients with keratoconus, serum PRL in females and serum androgen levels in both genders are elevated.
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Affiliation(s)
- Hossein Jamali
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Heydari
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nasrin Masihpour
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.,Infectious Ophthalmologic Research Center, Imam Khomeini Hospital Clinical Research Development Unit, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Amir Khosravi
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mousa Zare
- Poostchi Ophthalmology Research Center, Department of Ophthalmology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mesbah Shams
- Endocrinology and Metabolism Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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31
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Monteiro de Barros MR, Chakravarti S. Pathogenesis of keratoconus: NRF2-antioxidant, extracellular matrix and cellular dysfunctions. Exp Eye Res 2022; 219:109062. [PMID: 35385756 PMCID: PMC12056795 DOI: 10.1016/j.exer.2022.109062] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/19/2022] [Accepted: 03/30/2022] [Indexed: 11/04/2022]
Abstract
Keratoconus (KC) is a degenerative disease associated with cell and extracellular matrix (ECM) loss that causes gradual thinning and steepening of the cornea and loss of vision. Collagen cross linking with ultraviolet light treatment can strengthen the ECM and delay weakening of the cornea, but severe cases require corneal transplantation. KC is multifactorial and multigenic, but its pathophysiology is still an enigma. Multiple approaches are being pursued to elucidate the molecular changes that underlie the corneal phenotype to identify relevant genes for tailored candidate searches and to develop potential biomarkers and targets for therapeutic interventions. Recent proteomic and transcriptomic studies suggest dysregulations in oxidative stress, NRF2-regulated antioxidant programs, WNT-signaling, TGF-β, ECM and matrix metalloproteinases. This review aims to provide a broad update on the transcriptomic and proteomic studies of KC with a focus on findings that relate to oxidative stress, and dysregulations in cellular and extracellular matrix functions.
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Affiliation(s)
| | - Shukti Chakravarti
- Department of Ophthalmology, NYU Grossman School of Medicine, NY, 10016, USA; Department of Pathology, NYU Grossman School of Medicine, NY, 10016, USA.
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Lasagni Vitar RM, Bonelli F, Rama P, Ferrari G. Nutritional and Metabolic Imbalance in Keratoconus. Nutrients 2022; 14:nu14040913. [PMID: 35215563 PMCID: PMC8876314 DOI: 10.3390/nu14040913] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 02/18/2022] [Indexed: 12/31/2022] Open
Abstract
Keratoconus (KC) is a progressive corneal degeneration characterized by structural changes consisting of progressive thinning and steepening of the cornea. These alterations result in biomechanical weakening and, clinically, in vision loss. While the etiology of KC has been the object of study for over a century, no single agent has been found. Recent reviews suggest that KC is a multifactorial disease that is associated with a wide variety of genetic and environmental factors. While KC is typically considered a disease of the cornea, associations with systemic conditions have been well described over the years. In particular, nutritional and metabolic imbalance, such as the redox status, hormones, metabolites, and micronutrients (vitamins and metal ions), can deeply influence KC initiation and progression. In this paper, we comprehensively review the different nutritional (vitamins and minerals) and metabolic (hormones and metabolites) factors that are altered in KC, discussing their possible implication in the pathophysiology of the disease.
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Affiliation(s)
| | | | | | - Giulio Ferrari
- Correspondence: ; Tel.: +39-02-26436186; Fax: +39-02-26436164
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Abstract
Functional status and biological properties of connective tissues significantly depend on the mineral elements involved in their metabolism. Connective tissue portion of the corneal stroma makes up most of its thickness; pathological changes in collagen fibers and the stroma can cause a range of corneal diseases, some of which are specifically associated with disorders of mineral metabolism. The article considers impairments of mineral metabolism as possible pathophysiological mechanisms in certain diseases and disorders of the cornea, and describes in detail the abnormalities associated with mineral dysmetabolism observed in patients with keratoconus.
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Affiliation(s)
- L S Pateyuk
- Research Institute of Eye Disease, Moscow, Russia
| | - A M Subbot
- Research Institute of Eye Disease, Moscow, Russia
| | - A V Kobzeva
- Research Institute of Eye Disease, Moscow, Russia
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Karamichos D, Escandon P, Vasini B, Nicholas SE, Van L, Dang DH, Cunningham RL, Riaz KM. Anterior pituitary, sex hormones, and keratoconus: Beyond traditional targets. Prog Retin Eye Res 2021; 88:101016. [PMID: 34740824 PMCID: PMC9058044 DOI: 10.1016/j.preteyeres.2021.101016] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 12/13/2022]
Abstract
"The Diseases of the Horny-coat of The Eye", known today as keratoconus, is a progressive, multifactorial, non-inflammatory ectatic corneal disorder that is characterized by steepening (bulging) and thinning of the cornea, irregular astigmatism, myopia, and scarring that can cause devastating vision loss. The significant socioeconomic impact of the disease is immeasurable, as patients with keratoconus can have difficulties securing certain jobs or even joining the military. Despite the introduction of corneal crosslinking and improvements in scleral contact lens designs, corneal transplants remain the main surgical intervention for treating keratoconus refractory to medical therapy and visual rehabilitation. To-date, the etiology and pathogenesis of keratoconus remains unclear. Research studies have increased exponentially over the years, highlighting the clinical significance and international interest in this disease. Hormonal imbalances have been linked to keratoconus, both clinically and experimentally, with both sexes affected. However, it is unclear how (molecular/cellular signaling) or when (age/disease stage(s)) those hormones affect the keratoconic cornea. Previous studies have categorized the human cornea as an extragonadal tissue, showing modulation of the gonadotropins, specifically luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Studies herein provide new data (both in vitro and in vivo) to further delineate the role of hormones/gonadotropins in the keratoconus pathobiology, and propose the existence of a new axis named the Hypothalamic-Pituitary-Adrenal-Corneal (HPAC) axis.
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Affiliation(s)
- Dimitrios Karamichos
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA.
| | - Paulina Escandon
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Brenda Vasini
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Sarah E Nicholas
- North Texas Eye Research Institute, University of North Texas Health Science Center, 3430 Camp Bowie Blvd, Fort Worth, TX, 76107, USA; Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Lyly Van
- University of Oklahoma Health Sciences Center, 940 Stanton L Young, Oklahoma City, OK, USA; Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Deanna H Dang
- College of Medicine, University of Oklahoma Health Sciences Center, 940 Stanton L Young, Oklahoma City, OK, USA
| | - Rebecca L Cunningham
- Department of Pharmaceutical Sciences, University of North Texas Health Science Center, 3500 Camp Bowie Blvd, Fort Worth, TX, 76107, USA
| | - Kamran M Riaz
- Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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35
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Navel V, Malecaze J, Pereira B, Baker JS, Malecaze F, Sapin V, Chiambaretta F, Dutheil F. Oxidative and antioxidative stress markers in keratoconus: a systematic review and meta-analysis. Acta Ophthalmol 2021; 99:e777-e794. [PMID: 33354927 DOI: 10.1111/aos.14714] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 11/20/2020] [Indexed: 12/13/2022]
Abstract
PURPOSE To conduct a systematic review and meta-analysis on the levels of oxidative stress markers and antioxidants in keratoconus compared to healthy subject. METHOD The PubMed, Cochrane Library, Embase, Science Direct and Google Scholar databases were searched on 1st June 2020 for studies reporting oxidative and antioxidative stress markers in keratoconus and healthy controls. Main meta-analysis was stratified by type of biomarkers, type of samples (tears, cornea, aqueous humour and blood) and type of corneal samples (stromal cells, epithelium and endothelium). RESULTS We included 36 articles, for a total of 1328 keratoconus patients and 1208 healthy controls. There is an overall increase in oxidative stress markers in keratoconus compared with healthy controls (standard mean deviation (SMD) = 0.94, 95% confidence interval (95% CI) 0.55-1.33), with a significant increase in reactive oxygen and nitrogen species (1.09, 0.41-1.78) and malondialdehyde (1.78, 0.83-2.73). There is an overall decrease in antioxidants in keratoconus compared with healthy controls (-0.63, -0.89 to -0.36), with a significant decrease in total antioxidant capacity/status (-1.65, -2.88 to -0.43), aldehyde/NADPH dehydrogenase (-0.77, -1.38 to -0.17), lactoferrin/transferrin/albumin (-1.92, -2.96 to -0.89) and selenium/zinc (-1.42, -2.23 to -0.61). Oxidative stress markers were higher in tears and in cornea of keratoconus than in aqueous humour, and antioxidants were decreased in tears, aqueous humour and blood without difference between sample type. Oxidative stress markers increased in stromal cells and antioxidants decreased in endothelium. CONCLUSION Oxidative stress markers and antioxidants were dysregulated in keratoconus, involving an imbalance of redox homeostasis in tears, cornea, aqueous humour and blood.
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Affiliation(s)
- Valentin Navel
- Ophthalmology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
| | - Jean Malecaze
- Ophthalmology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
| | - Bruno Pereira
- Clinical Research and Innovation Direction CHU Clermont–Ferrand University Hospital of Clermont Ferrand Clermont‐Ferrand France
| | - Julien S. Baker
- Department of Sport, Physical Education and Health Centre for Health and Exercise Science Research Hong Kong Baptist University Kowloon Tong Hong Kong
| | - François Malecaze
- Ophthalmology Department Pierre‐Paul Riquet Hospital University Hospital of Toulouse Toulouse France
| | - Vincent Sapin
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
- Medical Biochemistry and Molecular Biology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
| | - Frédéric Chiambaretta
- Ophthalmology CHU Clermont‐Ferrand University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
- Genetic Reproduction and Development Laboratory (GReD) Translational Approach to Epithelial Injury and Repair Team CNRS UMR 6293 INSERM U1103 Université Clermont Auvergne Clermont‐Ferrand France
| | - Frédéric Dutheil
- Preventive and Occupational Medicine CNRS, LaPSCo Physiological and Psychosocial Stress CHU Clermont‐Ferrand Université Clermont Auvergne University Hospital of Clermont‐Ferrand Clermont‐Ferrand France
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36
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Adverse events after riboflavin/UV-A corneal cross-linking: a literature review. Int Ophthalmol 2021; 42:337-348. [PMID: 34448966 DOI: 10.1007/s10792-021-02019-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/12/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Riboflavin/UV-A corneal cross-linking (CXL) for treating keratoconus and iatrogenic corneal ectasia has been well-established as first treatment option to stabilize corneal tissue biomechanical instability. Although the plethora of clinical studies has been published into the field, there is no systematic review assessing the type and frequency of adverse events after CXL. METHODS A systemic literature review on clinical safety and adverse events after CXL in patients with keratoconus and corneal ectasia was performed using PubMed. A literature search was performed for relevant peer-reviewed publications. The main outcome measures extracted from the articles were adverse events, endothelial cell density, corrected distance visual acuity and maximum simulated keratometry. RESULTS The most frequent adverse events after CXL were corneal haze and corneal edema, which were mild and transient. The severe adverse events were infrequent (cumulative incidence: < 1.3%) after CXL. The clinical benefits of CXL highly outweighed the risks for the treatment of keratoconus and corneal ectasia. CONCLUSIONS The severe adverse events with permanent sequelae are infrequent after CXL and all are associated with corneal de-epithelialization, such as infectious keratitis and corneal scarring.
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Liu R, Yan X. Oxidative stress in corneal stromal cells contributes to the development of keratoconus in a rabbit model. Eur J Ophthalmol 2021; 31:3518-3524. [PMID: 34213382 DOI: 10.1177/11206721211028745] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate the role of oxidative stress in keratocytes in the pathogenesis of keratoconus (KC) using the rabbit cornea as a model. METHODS Immerse the rabbit cornea in collagenase type II solution at room temperature for 30 min in the KC group. The central cornea thickness (CCT), and mean keratometry (Km) were examined before and after the procedure. Reactive oxygen species (ROS), the nuclear translocation of nuclear factor E2-related factor 2 (NRF-2), the expression of heme oxygenase-1 (HO-1) protein, and nicotinamide adenine dinucleotide phosphate (NADPH) Oxidase (NOX) family members NOX-2 and NOX-4 protein levels were examined by immunohistochemistry analysis and Western Blot. The expression levels of HO-1, NOX-2, NOX-4, and NRF-2 mRNA were quantitatively detected by Real-time PCR. RESULTS A significant increase in Km and a significant decrease in CCT were observed in the KC group compared with the control group after the surgery (both p < 0.001). Immunofluorescence staining showed the rabbit KC model induced a significant increase in ROS production (p < 0.001). The expression of HO-1, NOX-2, NOX-4, and NRF-2 proteins in the KC group were significantly higher than those in the control group (all p < 0.001). RT-PCR results showed the levels of HO-1, NOX-2, NOX-4, and NRF-2 mRNA in KC groups were all significantly increased compared with control groups (all p < 0.05). CONCLUSIONS Oxidative stress and compensatory activation of antioxidant proteins suggest oxidative stress injury in corneal stromal cells plays an important role in the development of KC in a rabbit model.
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Affiliation(s)
- Ruixing Liu
- Henan Provincial People's Hospital, Henan Eye Hospital, Henan Eye Institute, People's Hospital of Zhengzhou University, Henan University People's Hospital, Zhengzhou, Henan, China.,Department of Ophthalmology, The First Hospital of Peking University, Beijing, China
| | - Xiaoming Yan
- Department of Ophthalmology, The First Hospital of Peking University, Beijing, China
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38
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Tunç U, Yıldırım Y, Çelebi ARC, Kepez Yıldız B. Potential role of ocular surface microbiota in keratoconus etiopathogenesis. EXPERT REVIEW OF OPHTHALMOLOGY 2021. [DOI: 10.1080/17469899.2021.1942844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Uğur Tunç
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Ophthalmology, Istanbul, Turkey
| | - Yusuf Yıldırım
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Ophthalmology, Istanbul, Turkey
| | | | - Burçin Kepez Yıldız
- University of Health Sciences, Beyoğlu Eye Training and Research Hospital, Ophthalmology, Istanbul, Turkey
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39
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Corneal transplantation for keratoconus in South Korea. Sci Rep 2021; 11:12580. [PMID: 34131255 PMCID: PMC8206092 DOI: 10.1038/s41598-021-92133-y] [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: 04/04/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
This nationwide population-based study investigated the incidence rate of and risk factors for the progression to corneal transplantation in patients with keratoconus in South Korea using claims data from the Health Insurance Review and Assessment service. Among the entire South Korean population, 10,612 patients newly diagnosed with keratoconus between January 2010 and June 2015 were identified and included in the study. During the study period, 124 patients (1.17%) underwent corneal transplantation, with an average follow-up period of 2.97 ± 1.59 years. The incidence rate of corneal transplantation in patients with keratoconus was 4.46 cases per 1000 person-years. The rate of corneal transplantation for keratoconus was relatively low in South Korea compared to other countries. Multivariate Cox regression analysis revealed that male sex (HR 2.37; 95% CI 1.61–3.50; P < 0.001), severe atopic dermatitis (HR 2.32; 95% CI 1.02–5.28; P = 0.044), obstructive sleep apnea (HR 9.78; 95% CI 1.36–70.10; P = 0.023), and intellectual disability (HR 4.48; 95% CI 1.33–15.11; P = 0.016) significantly increased the risk of progression to corneal transplantation. In patients with keratoconus, male sex, severe atopic dermatitis, obstructive sleep apnea, and intellectual disability were associated with an increased risk of corneal transplantation.
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40
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Harati-Sadegh M, Sargazi S, Khorasani M, Ansari-Moghaddam A, Mirinejad S, Sheervalilou R, Saravani R. IL1A and IL1B gene polymorphisms and keratoconus susceptibility: evidence from an updated meta-analysis. Ophthalmic Genet 2021; 42:503-513. [PMID: 33978542 DOI: 10.1080/13816810.2021.1925926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Several single-nucleotide polymorphisms (SNPs) in IL1B genes have been associated with KTCN. However, the results of these studies were not conclusive. This meta-analysis association study is aimed to quantitatively estimate the association of IL1B rs16944 (g.4490T>C) and rs1143627 (g.4970C>T), and IL1A rs2071376 (c.615 + 169C>A) polymorphisms with KTCN susceptibility.Materials and Methods: Systematic literature search was performed in Web of Science, MEDLINE, PubMed, Scopus, and Google Scholar databases. The odds ratios (ORs) and 95% confidence intervals (CI) were calculated assuming different contrasted genetic models.Results: The reference T allele of IL1B (g.4490T>C) polymorphism was significantly associated with decreased KTCN risk under all assessed genetic models. Regarding the reference C allele of IL1B (g.4970C>T) polymorphism, decreased risk of KTCN was found. The reference C allele of IL1A (c.615 + 169C>A) polymorphism conferred a decreased risk of KTCN under heterozygous codominant (AC vs. AA), homozygous codominant (CC vs. AA), and dominant (AC+CC vs. AA) genetic models. The pooling estimates showed that the T C haplotype was associated with a significant increase in KTCN risk. In contrast, the T T haplotype was correlated with a decreased risk of KTCN. With the assumption of a prior probability of 0.25, the false-positive report probability (FPRP) values were less than 0.2, indicating the observed significant associations were notable.Conclusion: These findings propose that the studied IL1B polymorphisms and the IL1A variation have opposite effects on KTCN susceptibility. More large-scale replication studies are warranted to illuminate the precise role of these SNPs on the etiology of eye disorders.
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Affiliation(s)
- Mahdiyeh Harati-Sadegh
- Genetic of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Saman Sargazi
- Cellular and Molecular Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Milad Khorasani
- Department of Clinical Biochemistry, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
| | | | - Shekoufeh Mirinejad
- Cellular and Molecular Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
| | | | - Ramin Saravani
- Cellular and Molecular Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran.,Department of Clinical Biochemistry, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
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Cheung IM, Mcghee CN, Sherwin T. A new perspective on the pathobiology of keratoconus: interplay of stromal wound healing and reactive species‐associated processes. Clin Exp Optom 2021; 96:188-96. [DOI: 10.1111/cxo.12025] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 10/30/2012] [Indexed: 12/13/2022] Open
Affiliation(s)
- Isabella My Cheung
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand,
| | - Charles Nj Mcghee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand,
| | - Trevor Sherwin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand,
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42
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Cheung IMY, Mcghee CNJ, Sherwin T. Beneficial effect of the antioxidant riboflavin on gene expression of extracellular matrix elements, antioxidants and oxidases in keratoconic stromal cells. Clin Exp Optom 2021; 97:349-55. [DOI: 10.1111/cxo.12138] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2013] [Revised: 11/28/2013] [Accepted: 12/04/2013] [Indexed: 12/23/2022] Open
Affiliation(s)
- Isabella M Y Cheung
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand,
| | - Charles N J Mcghee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand,
| | - Trevor Sherwin
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand,
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43
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Mahmoud S, El-Massry A, Goweida MB, Ahmed I. Pediatric Keratoconus in A Tertiary Eye Center in Alexandria: A Cross-sectional Study. Ophthalmic Epidemiol 2021; 29:49-56. [PMID: 33752567 DOI: 10.1080/09286586.2021.1892154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE: To describe the clinical presentation, risk factors, and treatment choices documented in a pediatric keratoconus population treated at a tertiary referral center in Alexandria, Egypt.METHODS: A cross-sectional study of 80 patients with keratoconus aged 18 years or younger referred to the cornea clinic at the Alexandria University Main Hospital between July 2018 and October 2019 was included. Patients' history, initial presentation, best spectacle corrected visual acuity (BSCVA), clinical signs, topographic data, and treatment were recorded.RESULTS: Thirty patients were younger than 14 years and 50 were 14 years or older. Elements of the initial presentation included decreased vision in 26 patients, itching in 20 patients, both visual impairment and itching in 16 patients, accidental discovery during vision screening at school in 15 patients, and hydrops in three patients. All patients had bilateral keratoconus, except for four patients who had previously been treated by keratoplasty (n = 156 eyes). The mean logMAR BSCVA was 0.79 ± 0.63. The mean of the average keratometry (AveK), maximum keratometry (Kmax), central corneal thickness (CCT) and thinnest pachymetry reading were 51.16 ± 7.31 D, 59.18 ± 10.38 D, 458.44 ± 55.87 µ 440.08 ± 60.18 µ, respectively. 57 eyes (36%) had stage 1 disease, 43 eyes (28%) had stage 2 disease, 17 eyes (11%) had stage 3 disease and 39 eyes (25%) had stage 4 disease, respectively. No statistically significant differences in the LogMAR BSCVA, keratometry values, CCT, thinnest pachymetry reading, and the Amsler-Krumeich (AK) staging existed between the two age groups or between boys and girls. Crosslinking was indicated in 69 eyes (44%), while keratoplasty was the only viable solution for 39 eyes (25%), with three patients requiring keratoplasty in both eyes.CONCLUSION: Keratoconus in children can result in severe loss of vision. Keratoconus screening programs in elementary schools should be considered in populations with a high incidence of keratoconus for early detection and adequate intervention.
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Affiliation(s)
- Shahira Mahmoud
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ahmed El-Massry
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | - Islam Ahmed
- Ophthalmology Department, Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Shinde V, Sobreira N, Wohler ES, Maiti G, Hu N, Silvestri G, George S, Jackson J, Chakravarti A, Willoughby CE, Chakravarti S. Pathogenic alleles in microtubule, secretory granule and extracellular matrix-related genes in familial keratoconus. Hum Mol Genet 2021; 30:658-671. [PMID: 33729517 DOI: 10.1093/hmg/ddab075] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 03/03/2021] [Accepted: 03/05/2021] [Indexed: 12/30/2022] Open
Abstract
Keratoconus is a common corneal defect with a complex genetic basis. By whole exome sequencing of affected members from 11 multiplex families of European ancestry, we identified 23 rare, heterozygous, potentially pathogenic variants in 8 genes. These include nonsynonymous single amino acid substitutions in HSPG2, EML6 and CENPF in two families each, and in NBEAL2, LRP1B, PIK3CG and MRGPRD in three families each; ITGAX had nonsynonymous single amino acid substitutions in two families and an indel with a base substitution producing a nonsense allele in the third family. Only HSPG2, EML6 and CENPF have been associated with ocular phenotypes previously. With the exception of MRGPRD and ITGAX, we detected the transcript and encoded protein of the remaining genes in the cornea and corneal cell cultures. Cultured stromal cells showed cytoplasmic punctate staining of NBEAL2, staining of the fibrillar cytoskeletal network by EML6, while CENPF localized to the basal body of primary cilia. We inhibited the expression of HSPG2, EML6, NBEAL2 and CENPF in stromal cell cultures and assayed for the expression of COL1A1 as a readout of corneal matrix production. An upregulation in COL1A1 after siRNA inhibition indicated their functional link to stromal cell biology. For ITGAX, encoding a leukocyte integrin, we assayed its level in the sera of 3 affected families compared with 10 unrelated controls to detect an increase in all affecteds. Our study identified genes that regulate the cytoskeleton, protein trafficking and secretion, barrier tissue function and response to injury and inflammation, as being relevant to keratoconus.
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Affiliation(s)
- Vishal Shinde
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Nara Sobreira
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Elizabeth S Wohler
- McKusick-Nathans Department of Genetic Medicine, Johns Hopkins University, Baltimore, MD 21287, USA
| | - George Maiti
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Nan Hu
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Giuliana Silvestri
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast BT12 6BA UK
| | - Sonia George
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast BT12 6BA UK
| | - Jonathan Jackson
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast BT12 6BA UK
| | - Aravinda Chakravarti
- Center for Human Genetics and Genomics, NYU Grossman School of Medicine, New York, NY 10016, USA
| | - Colin E Willoughby
- Department of Ophthalmology, Belfast Health and Social Care Trust, Belfast BT12 6BA UK.,Genomic Medicine, Biomedical Sciences Research Institute, Ulster University, Coleraine BT52 1SA, UK
| | - Shukti Chakravarti
- Department of Ophthalmology, NYU Grossman School of Medicine, New York, NY 10016, USA.,Department of Pathology, NYU Grossman School of Medicine, New York, NY 10016, USA
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45
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Veerappa AM. Cascade of interactions between candidate genes reveals convergent mechanisms in keratoconus disease pathogenesis. Ophthalmic Genet 2021; 42:114-131. [PMID: 33554698 DOI: 10.1080/13816810.2020.1868013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Keratoconus is a progressive thinning, steepening and distortion of the cornea which can lead to loss of vision if left untreated. Keratoconus has a complex multifactorial etiology, with genetic and environmental components contributing to the disease pathophysiology. Studies have observed high concordance between monozygotic twins, discordance between dizygotic twins, and high familial segregation indicating the presence of a very strong genetic component in the pathogenesis of keratoconus. The use of genome-wide linkage studies on families and twins, genome-wide association studies (GWAS) on case-controls, next-generation sequencing (NGS)-based genomic screens on both familial and non-familial cohorts have led to the identification of keratoconus candidate genes with much greater success and increased resproducibility of genetic findings. This review focuses on candidate genes identified till date and attempts to understand their role in biological processes underlying keratoconus pathogenesis. In addition, using these genes I propose molecular pathways that could contribute to keratoconus pathogenesis. The pathways identified the presence of direct cross-talk between known candidate genes of keratoconus and remarkably, 28 known candidate genes have a direct relationship among themselves that involves direct protein-protein binding, regulatory activities such as activation and inhibition, chaperone, transcriptional activation/co-activation, and enzyme catalysis. This review attempts to describe these relationships and cross-talks in the context of keratoconus pathogenesis.
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Affiliation(s)
- Avinash M Veerappa
- Department of Ophthalmology, NYU Langone Medical Center, New York, New York, USA
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46
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Tanriverdi B, Sarac O, Cubukcu HC, Caglayan M, Durak ZE, Durak I, Cagil N. Xanthine oxidase enzyme activity in keratoconic corneal epithelium. Int Ophthalmol 2021; 41:1063-1069. [PMID: 33389422 DOI: 10.1007/s10792-020-01665-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/27/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE To assess the activity of xanthine oxidase (XO) enzyme in keratoconic corneal epithelium and to evaluate its relationship with the keratoconus (KC) severity. METHODS This prospective and randomized study included 66 eyes of 54 KC patients who received corneal collagen cross-linking treatment and 43 eyes of 32 patients who underwent photorefractive keratectomy due to their refractive error. During surgical procedures, the corneal epithelium was mechanically scraped and gathered to analyze the XO enzyme activity spectrophotometrically. The KC group was subdivided into three groups (stages 1, 2, and 3) according to the Amsler-Krumeich classification. The results were compared between the KC and the control group and in between KC subgroups. RESULTS No significant differences in age and gender were found between the KC and control groups (p = 0.064 and p = 0.296, respectively). The mean XO activity levels of the KC and control groups were 173.57 ± 87.61 and 223.70 ± 99.52 mIU/mg, respectively (p < 0.001). In KC group, 33 eyes were at stage 1, 19 were at stage 2, and 14 were at stage 3. No significant difference was observed between KC subgroups regarding XO activity levels (p = 0.681). CONCLUSION In this study, our findings revealed that ultraviolet-related pro-oxidant XO enzyme may have a role in the etiopathogenesis of KC. Further studies are needed to support our result. CLINICAL TRIALS REGISTRATION When we started this study in 2018, we did not have a "Clinical Trials Registration." However, we have ethics committee approval (date: 21. 02. 2018/No: 22).
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Affiliation(s)
| | - Ozge Sarac
- Department of Ophthalmology, Yildirim Beyazit University, Ankara, Turkey
| | - Hikmet Can Cubukcu
- Department of Medical Biochemistry, Maresal Cakmak State Hospital, Erzurum, Turkey
| | - Mehtap Caglayan
- Gazi Yasargil Training and Research Hospital, Diyarbakir, Turkey
| | | | - Ilker Durak
- Department of Medical Biochemistry, Faculty of Medicine, Ankara University, Morphology Building, Ankara, Turkey
| | - Nurullah Cagil
- Department of Ophthalmology, Yildirim Beyazit University, Ankara, Turkey
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47
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Crawford AZ, Zhang J, Gokul A, McGhee CNJ, Ormonde SE. The Enigma of Environmental Factors in Keratoconus. Asia Pac J Ophthalmol (Phila) 2020; 9:549-556. [PMID: 33284230 DOI: 10.1097/apo.0000000000000334] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Keratoconus is an ectatic disorder with highly complex and varied causes including genetic variations and environmental factors. Its prevalence varies widely between regions and countries. Many environmental factors have been proposed to be associated with keratoconus, but the interpretation of their individual contributions is difficult due to the presence of many confounding variables. The current literature was reviewed to evaluate the strength of the associations and the causative effects of environmental factors on keratoconus. Ethnicity and consanguinity have been revealed as important determinants for geographical variations in keratoconus prevalence. Eye rubbing, atopy, floppy eyelid syndrome, contact lens wear, pregnancy, and thyroid hormone disturbances are likely associated with keratoconus. The first 4 factors can induce ocular surface inflammation, matrix metalloproteinase release, and keratocyte apoptosis, consistent with the postulated etiology of keratoconus. The associations of keratoconus with UV exposure, cigarette smoking, personality, and sex were less convincing once confounding factors were considered. Future studies powered for multivariate analysis of factors discussed will hopefully shed light on what is truly important in the development and progression of keratoconus.
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Affiliation(s)
- Alexandra Z Crawford
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Jie Zhang
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Akilesh Gokul
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Charles N J McGhee
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
| | - Sue E Ormonde
- Department of Ophthalmology, New Zealand National Eye Centre, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Ophthalmology, Greenlane Clinical Centre, Auckland District Health Board, Auckland, New Zealand
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48
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Németh O, Langenbucher A, Eppig T, Lepper S, Milioti G, Abdin A, Nagy ZZ, Seitz B, Szentmáry N. Correlation between Corneal Endothelial Cell Density and Central Ocular Surface Temperature in Normal and Keratoconus Eyes. Curr Eye Res 2020; 46:445-451. [PMID: 32847408 DOI: 10.1080/02713683.2020.1812087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE In keratoconus (KC), an increase of the corneal back surface area may result in endothelial cell density (ECD) decrease and an increase of the corneal front surface area in ocular surface temperature (OST) decrease due to increased heat dissipation. Along with these hypotheses, we aimed to analyse the correlation between ECD and central corneal OST in patients with KC and healthy controls. PATIENTS AND METHODS A total of 154 eyes with KC (mean age 36.1 ± 12.5 years) and 92 healthy eyes (mean age 36.4 ± 12.8 years) were examined. Corneal front and back surface area at the central 5 mm corneal diameter (FSA and BSA) were calculated based on Pentacam measurement data:FSA or BSA = 2×3.14×R(R-√R2-D/2)2,where R referred to corneal front or back surface radius of curvature and D to the corneal front or back surface diameter (5 mm for the present study), respectively.ECD was determined by specular microscopy (EM-3000) and central corneal OST by thermography (TG-1000). RESULTS ECD was significantly lower in KC (2498 ± 356/mm2) patients than in controls (2638 ± 294/mm2; p < .001). FSA (20.35 ± 0.26 mm2 vs. 20.17 ± 0.03 mm2) and BSA (20.84 ± 0.58 mm2 vs. 20.45 ± 0.08 mm2) were significantly higher in KC patients than in controls (p = .001; p < .001), but the average central corneal OST did not differ significantly between both groups (34.2 ± 0.6°C vs.34.3 ± 0.7°C; p = .62). OST at the corneal centre correlated weakly, positively with ECD (r = 0.2; p < .05), but OST did not correlate with FSA (r = 0.045) or BSA (r = 0.064). CONCLUSIONS Endothelial cell density seems to have a mild impact on central ocular surface temperature in keratoconus and normal subjects. This effect is not correlated to the corneal front or back surface area.
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Affiliation(s)
- Orsolya Németh
- Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Homburg/Saar, Germany.,Department of Ophthalmology, Markusovszky University Teaching Hospital, Szombathely, Hungary.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | | | - Timo Eppig
- Experimental Ophthalmology, Saarland University, Homburg/Saar, Germany
| | - Sabine Lepper
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Georgia Milioti
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Aladin Abdin
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Zoltán Zsolt Nagy
- Department of Ophthalmology, Semmelweis University, Budapest, Hungary
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Medical Center, Homburg/Saar, Germany
| | - Nóra Szentmáry
- Rolf M. Schwiete Center for Limbal Stem Cell and Congenital Aniridia Research, Homburg/Saar, Germany.,Department of Ophthalmology, Semmelweis University, Budapest, Hungary
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49
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Abdul-Maksoud RS, Fouad RA, Elsayed TG, Ibrahem RA, Badawi AE. The impact of catalase and glutathione peroxidase-1 genetic polymorphisms on their enzyme activities among Egyptian patients with keratoconus. J Gene Med 2020; 22:e3192. [PMID: 32203639 DOI: 10.1002/jgm.3192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 02/12/2020] [Accepted: 03/15/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Elevated oxidative stress plays a significant role in pathophysiology of keratoconus (KC). Polymorphisms of the antioxidant enzymes as CAT and GPX-1 might alter their antioxidant enzyme capacities leading to increase in the oxidative damage induced KC. AIM To analyze the impact of CAT rs7943316 A/T and GPX-1 rs1050450 C/T single nucleotide polymorphisms (SNPs) on the risk and severity of KC among a group of Egyptian population. SUBJECT & METHODS CAT rs7943316 and GPX-1 rs1050450 SNPs were examined using polymerase chain reaction-restriction fragment length polymorphism in 100 control subjects and 150 KC patients [50 patients (KC stages 1&2), 50 patients (KC stage 3) and 50 patients (KC stage 4)]. RESULTS Patients with TT genotype of CAT rs7943316 were at high risk of developing KC. T allele of GPX-1 rs1050450 was significantly associated with KC risk (P ˂0.001). The frequency of CAT TT genotype and T allele was significantly higher among severe stages of KC compared to mild and moderate stages. GPX-1 T allele frequency was significantly higher among severe stages of KC compared to mild and moderate stages. A very significant decrease in the antioxidant enzyme activities was observed in association with these SNPs. Age of the patients, CAT and GPX-1 SNPs as well as their enzyme activities were independent predictors of KC severity. CONCLUSION Our study suggests that CAT (rs7943316) and GPX-1 (rs1050450) SNPs act as independent predictors for different grades of KC and that these SNPs might have a role in the pathogenesis of the disease.
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Affiliation(s)
- Rehab S Abdul-Maksoud
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rania A Fouad
- Medical Biochemistry Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Tamer G Elsayed
- Ophthalmology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Reda A Ibrahem
- Public Health and Community Medicine Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Amani E Badawi
- Ophthalmology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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50
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Wojakowska A, Pietrowska M, Widlak P, Dobrowolski D, Wylęgała E, Tarnawska D. Metabolomic Signature Discriminates Normal Human Cornea from Keratoconus-A Pilot GC/MS Study. Molecules 2020; 25:molecules25122933. [PMID: 32630577 PMCID: PMC7356237 DOI: 10.3390/molecules25122933] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
The molecular etiology of keratoconus (KC), a pathological condition of the human cornea, remains unclear. The aim of this work was to perform profiling of metabolites and identification of features discriminating this pathology from the normal cornea. The combination of gas chromatography and mass spectrometry (GC/MS) techniques has been applied for profiling and identification of metabolites in corneal buttons from 6 healthy controls and 7 KC patients. An untargeted GC/MS-based approach allowed the detection of 377 compounds, including 46 identified unique metabolites, whose levels enabled the separation of compared groups of samples in unsupervised hierarchical cluster analysis. There were 13 identified metabolites whose levels differentiated between groups of samples. Downregulation of several carboxylic acids, fatty acids, and steroids was observed in KC when compared to the normal cornea. Metabolic pathways associated with compounds that discriminated both groups were involved in energy production, lipid metabolism, and amino acid metabolism. An observed signature may reflect cellular processes involved in the development of KC pathology, including oxidative stress and inflammation.
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Affiliation(s)
- Anna Wojakowska
- European Centre for Bioinformatics and Genomics, Institute of Bioorganic Chemistry Polish Academy of Sciences, Noskowskiego12/14, 61-704 Poznan, Poland;
| | - Monika Pietrowska
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-102 Gliwice, Poland; (M.P.); (P.W.)
| | - Piotr Widlak
- Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Wybrzeze Armii Krajowej 15, 44-102 Gliwice, Poland; (M.P.); (P.W.)
| | - Dariusz Dobrowolski
- Department of Ophthalmology & Tissue and Cells Bank, St. Barbara Hospital, Trauma Center, Plac Medyków 1, 41-200 Sosnowiec, Poland;
- Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, Medical University of Silesia, Panewnicka 65, 40-760 Katowice, Poland;
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, Division of Medical Science in Zabrze, Medical University of Silesia, Panewnicka 65, 40-760 Katowice, Poland;
- Department of Ophthalmology, District Railway Hospital, Panewnicka 65, 40-760 Katowice, Poland
| | - Dorota Tarnawska
- Department of Ophthalmology, District Railway Hospital, Panewnicka 65, 40-760 Katowice, Poland
- Faculty of Science and Technology, Silesian Center for Education and Interdisciplinary Research, University of Silesia, 75 Pułku Piechoty 1A, 41-500 Chorzów, Poland
- Correspondence:
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