Understanding corneal topography

Tissue protein and lipid alterations in response to metallic impaction

Tissue response to metallic contact and injury remains poorly understood at the level of proteins and lipid changes. We used corneas as a model system (bovine, porcine [n = 300 each], and human corneas [n = 6]) to characterize proteomic and lipidomic reactions to metallic exposure (impaction with iron). We also made a limited investigation into protein extractability and profile changes due to copper, and lead exposure as well. We identified selected proteins after trypsin digestion using an LCQ Deca XP and lipids using a TSQ Quantum Access Max mass spectrometer, respectively. Our findings indicate that iron impaction to corneal tissue results in cleavage of 1-phosphatidylinositol-4,5-bisphosphate phosphodiesterase beta-2 variant (PLCB2; 134 kDa) into a 36 kDa species and presence of the epithelial layer is necessary for this cleavage. Penetration of the cornea with other metals (copper and lead) resulted in lower protein extractability from corneal tissue compared with controls but not distinct changes in PLCB2. The changes in protein profiles were unique to the type of metal used for impaction. The depth of injury negatively affected protein extractability and profile compared with controls. These changes were also dependent on several other factors in a complex manner. Iron impaction of corneal tissue for 24 hours results in cleavage of PLCB2 commensurate with significant changes in phosphatidylinositols but not phosphatidylcholines or other phospholipids.

THz imaging system for in vivo human cornea

Terahertz (THz) imaging of corneal tissue water content (CTWC) is a proposed method for early, accurate detection and study of corneal diseases. Despite promising results from ex vivo and in vivo cornea studies, interpretation of the reflectivity data is confounded by the contact between corneal tissue and rigid dielectric window used to flatten the imaging field. This work develops a novel imaging system and image reconstruction methods specifically for nearly spherical targets such as human cornea. A prototype system was constructed using a 650 GHz multiplier source and Schottky diode detector. Resolution and imaging field strength measurement from characterization targets correlate well with those predicted by the quasioptical theory and physical optics analysis. Imaging experiments with corneal phantoms and ex vivo corneas demonstrate the hydration sensitivity of the imaging system and reliable measurement of CTWC. We present successful acquisition of non-contact THz images of in vivo human cornea, and discuss strategies for optimizing the imaging system design for clinical use.

Dynamic corneal imaging

PURPOSE

To determine the clinical practicability of in vivo dynamic corneal imaging (DCI) to assess the individual elastic properties of normal human eyes, eyes with abnormal findings, and eyes after refractive surgery.

SETTING

University Eye Clinic, Paracelsus Private Medical University, Salzburg, Austria.

METHODS

The DCI method uses sagittal, stepwise, central indentation of the cornea with electronically controlled microprecision motors and sequential registration of videotopography images. The indentation steps are preselected and range from 50 to 800 mum. The computerized analysis of the videotopography images captured during the process uses Zernike polynomials to establish a newly defined flexing curve for normal eyes and eyes with abnormal findings.

RESULTS

Dynamic corneal imaging was done in 187 eyes of 103 patients who had clinically healthy corneas, distinct keratoconus, or previous refractive surgery. The method rapidly evaluated artificially and reversibly induced changes in corneal topography in a clinical setting using a modified Placido disk-based computer-assisted videokeratography system with a small cone. In early analysis, the flexing curve showed a significant correlation with the applied indentation depth. Factors influencing the shape of the curve were central corneal thickness, intraocular pressure, and patient age. The DCI method also allowed easy examination of keratoconic corneas and corneas after refractive surgery.

CONCLUSIONS

Dynamic corneal imaging induced a reproducible and reversible change in corneal topography corresponding to the different indentation depths. The results indicate that several clinical parameters are correlated with corneal elastic behavior in vivo and that the technology could increase the predictability of refractive corneal surgery and help in the early diagnosis of corneal diseases and with newly developed therapies.

A new method for tear film stability analysis using videokeratography

PURPOSE

To report a new tear film stability analysis system using videokeratography.

DESIGN

Observational case series.

METHODS

New videokeratography software for TMS-2N (topographic modeling system; TOMEY Corporation, Nagoya, Japan) was developed that can automatically capture consecutive corneal surface images every second for 10 seconds. Forty-eight adult volunteers (80 eyes) were recruited for this study, and all subjects were examined with the new system. Corneal topographs were analyzed for tear breakup time (TMS-BUT) and the ratio of breakup area to entire color-code area (TMS-BUA) was calculated. Routine methods for tear film breakup time evaluation using slit-lamp microscope and fluorescence staining (SLE-BUT) were performed for comparison purposes. Regressive correlations of TMS-BUT or TMS-BUA with SLE-BUT were analyzed. Based on SLE results, subjects were separated into two groups with normal and short BUT, respectively. TMS-BUT and TMS-BUA were compared with SLE-BUT data with regard to the sensitivity and specificity of evaluation of dry eye symptoms.

RESULTS

Topographic modeling system-tear breakup time (TMS-BUT) had a positive correlation with SLE-BUT (R = 0.7219, P <.0001), whereas TMS-BUA showed a negative correlation (R = 0.6317, P <.0001). Among 34 eyes with normal SLE-BUT, 11 eyes (32.35%) displayed abnormal TMS-BUT, 9 (81.82%) of which were associated with dry eye symptoms. The sensitivities of TMS-BUT and TMS-BUA were 97.5% and 95%, respectively, significantly higher than that of SLE-BUT (75%), with P =.008 and 0.01, respectively. Topographic modeling system-BUT and TMS-BUA displayed a similar rate of specificity in comparison with SLE-BUT.

CONCLUSIONS

This new videokeratography system is a noninvasive and objective method with increased sensitivity for tear film stability analysis.