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Esporcatte LPG, Salomão MQ, Lopes BT, Sena N, Machado AP, Vinciguerra P, Vinciguerra R, Ambrósio R. Keratoconus and Corneal Ectasia with Relatively Low Keratometry. Ophthalmol Ther 2024; 13:2023-2035. [PMID: 38824471 PMCID: PMC11178753 DOI: 10.1007/s40123-024-00964-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 05/01/2024] [Indexed: 06/03/2024] Open
Abstract
INTRODUCTION The study aims to demonstrate and estimate the prevalence of clinical corneal ectasia and keratoconus (KC) in patients with relatively low keratometry (low-K KC). METHODS In a retrospective, analytical, and non-interventionist study, one eye was randomly selected from 1054 patients from the original Tomographic Biomechanical Index (TBIv1) study and the external validation (from Rio de Janeiro, Brazil, and Milan, Italy clinics). Patients were stratified into three groups. Group 1 included 736 normal patients, and groups 2 and 3 included 318 patients with clinical KC in both eyes, divided into low-K KC (90 patients) and high-K KC (228 patients), respectively. All patients underwent a comprehensive ophthalmological evaluation along with Pentacam and Corvis ST (Oculus, Wetzlar, Germany) examinations. Cases with maximum mean zone 3 mm keratometry (Kmax zone mean 3 mm) lower than 47.6 diopters (D) were considered as low-keratometry keratoconus, and cases with Kmax zone mean 3 mm higher than 47.6 D were regarded as high-keratometry keratoconus. RESULTS Ninety (28.30%) of the 318 KC group presented ectasia with low-keratometric values (low-Kmax). The average age in the normal group was 39.28 years (range 6.99-90.12), in the low-Kmax KC group it was 37.49 (range 13.35-78.45), and in the high-Kmax KC group it was 34.22 years (range 12.7-80.34). Mean and SD values and median (range), respectively, of some corneal tomographic and biomechanical parameters evaluated from the low-Kmax KC group were as follows: Belin-Ambrósio enhanced ectasia display (BAD-D) 3.79 ± 1.62 and 3.66 (0.83-9.73); Pentacam random forest index (PRFI) 0.78 ± 0.25 and 0.91 (0.05-1); corneal biomechanical index (CBI) 0.58 ± 0.43 and 0.75 (0-1); TBI 0.93 ± 0.17 and 1 (0.35-1); and stiffness parameter at A1 (SP-A1) 86.16 ± 19.62 and 86.05 (42.94-141.66). CONCLUSION Relatively low keratometry, with a Kmax lower than 47.6 D, can occur in up to 28.30% of clinical keratoconus. These cases have a less severe presentation of the disease. Future studies involving larger populations and prospective designs are necessary to confirm the prevalence of keratoconus with low keratometry and define prognostic factors in such cases.
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Affiliation(s)
- Louise Pellegrino G Esporcatte
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rua Conde de Bonfim 211/712, Rio de Janeiro, RJ, 20520-050, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | - Marcella Q Salomão
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rua Conde de Bonfim 211/712, Rio de Janeiro, RJ, 20520-050, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Instituto Benjamin Constant, Rio de Janeiro, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rua Conde de Bonfim 211/712, Rio de Janeiro, RJ, 20520-050, Brazil
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- School of Engineering, University of Liverpool, Liverpool, L69 3GH, UK
| | - Nelson Sena
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Aydano P Machado
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Brazilian Artificial Intelligence Networking in Medicine-BrAIN, Rio de Janeiro, Brazil
- Computing Institute, Federal University of Alagoas, Maceió, Brazil
- Brazilian Artificial Intelligence Networking in Medicine - BrAIN, Maceió, Brazil
| | - Paolo Vinciguerra
- Department of Biomedical Science, Humanitas University, Rozzano, Italy
- Eye Center, Humanitas Clinical and Research Center, Rozzano, Italy
| | - Riccardo Vinciguerra
- School of Engineering, University of Liverpool, Liverpool, L69 3GH, UK
- Department of Ophthalmology, Humanitas San Pio X Hospital, Milan, Italy
| | - Renato Ambrósio
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rua Conde de Bonfim 211/712, Rio de Janeiro, RJ, 20520-050, Brazil.
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil.
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
- Brazilian Artificial Intelligence Networking in Medicine-BrAIN, Rio de Janeiro, Brazil.
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
- Brazilian Artificial Intelligence Networking in Medicine - BrAIN, Maceió, Brazil.
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Chong YJ, Azzopardi M, Hussain G, Recchioni A, Gandhewar J, Loizou C, Giachos I, Barua A, Ting DSJ. Clinical Applications of Anterior Segment Optical Coherence Tomography: An Updated Review. Diagnostics (Basel) 2024; 14:122. [PMID: 38248000 PMCID: PMC10814678 DOI: 10.3390/diagnostics14020122] [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: 11/20/2023] [Revised: 12/28/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
Since its introduction, optical coherence tomography (OCT) has revolutionized the field of ophthalmology and has now become an indispensable, noninvasive tool in daily practice. Most ophthalmologists are familiar with its use in the assessment and monitoring of retinal and optic nerve diseases. However, it also has important applications in the assessment of anterior segment structures, including the cornea, conjunctiva, sclera, anterior chamber, and iris, and has the potential to transform the clinical examination of these structures. In this review, we aim to provide a comprehensive overview of the potential clinical utility of anterior segment OCT (AS-OCT) for a wide range of anterior segment pathologies, such as conjunctival neoplasia, pterygium, scleritis, keratoconus, corneal dystrophies, and infectious/noninfectious keratitis. In addition, the clinical applications of AS-OCT (including epithelial mapping) in preoperative planning and postoperative monitoring for corneal and refractive surgeries are discussed.
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Affiliation(s)
- Yu Jeat Chong
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
- Modality Ophthalmology, Modality Partnership, Birmingham B19 1BP, UK;
| | - Matthew Azzopardi
- Department of Ophthalmology, Royal Free Hospital, London NW3 2QG, UK;
| | - Gulmeena Hussain
- University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK;
| | - Alberto Recchioni
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
| | - Jaishree Gandhewar
- New Cross Hospital, Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK;
| | | | - Ioannis Giachos
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
| | - Ankur Barua
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
| | - Darren S. J. Ting
- Birmingham and Midland Eye Centre, Birmingham B18 7QH, UK; (A.R.); (I.G.); (A.B.)
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, University of Birmingham, Birmingham B15 2TT, UK
- Academic Ophthalmology, School of Medicine, University of Nottingham, Nottingham NG7 2RD, UK
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Wallace HB, Vellara HR, Gokul A, McGhee CNJ, Meyer JJ. Comparison of Ectasia Detection in Early Keratoconus Using Scheimpflug-Based Corneal Tomography and Biomechanical Assessments. Cornea 2023; 42:1528-1535. [PMID: 36973879 DOI: 10.1097/ico.0000000000003273] [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: 09/10/2022] [Accepted: 01/15/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE The aim of this study was to determine the detection of keratoconus using corneal biomechanical parameters only, a corneal tomographic parameter only, and a parameter that combines corneal biomechanical and tomographic indices. METHODS The discriminatory power of the Pentacam Random Forest Index (PRFI), Belin/Ambrósio Enhanced Ectasia Display (BAD-D) index, Corvis Biomechanical Index (CBI), and Tomographic and Biomechanical Index (TBI) to differentiate between normal eyes (n = 84), eyes with very asymmetric corneal ectasia (VAE-E, n = 21), and the fellow eyes without apparent ectasia based on normal tomography (VAE-NT, n = 21) was assessed. Statistical analyses were completed with R software using t -tests, Wilcoxon rank sum tests, and receiver operating characteristic (ROC) curves. The DeLong test was used to compare the area under the ROC curve (AUROC). RESULTS The TBI and PRFI had the highest AUROC when distinguishing between normal and VAE-E corneas (AUROC = 1.00, 95% CI = 1.00-1.00); however, they were not statistically superior to the CBI (AUROC = 0.97, P = 0.27) or BAD-D (AUROC = 1.00, P = 0.34). The TBI (AUROC = 0.92, 95% CI = 0.86-0.98) was superior to CBI (AUROC = 0.78, P = 0.02) and BAD-D (AUROC = 0.81, P = 0.02) when distinguishing between healthy and VAE-NT corneas. At a threshold of 0.72, the TBI had 99% sensitivity, 67% specificity, and 92% accuracy in distinguishing normal and VAE-NT corneas. CONCLUSIONS The TBI is a useful parameter for the screening of subclinical and frank keratoconus in tomographically normal eyes.
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Affiliation(s)
- Henry B Wallace
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand; and
| | - Hans R Vellara
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand; and
| | - Akilesh Gokul
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand; and
| | - Charles N J McGhee
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand; and
- Department of Ophthalmology, Auckland District Health Board, New Zealand
| | - Jay J Meyer
- Department of Ophthalmology, Faculty of Medical and Health Sciences, New Zealand National Eye Centre, University of Auckland, Auckland, New Zealand; and
- Department of Ophthalmology, Auckland District Health Board, New Zealand
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Ambrósio R, Salomão MQ, Barros L, da Fonseca Filho JBR, Guedes J, Neto A, Machado AP, Lopes BT, Sena N, Esporcatte LPG. Multimodal diagnostics for keratoconus and ectatic corneal diseases: a paradigm shift. EYE AND VISION (LONDON, ENGLAND) 2023; 10:45. [PMID: 37919821 PMCID: PMC10623885 DOI: 10.1186/s40662-023-00363-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023]
Abstract
Different diagnostic approaches for ectatic corneal diseases (ECD) include screening, diagnosis confirmation, classification of the ECD type, severity staging, prognostic evaluation, and clinical follow-up. The comprehensive assessment must start with a directed clinical history. However, multimodal imaging tools, including Placido-disk topography, Scheimpflug three-dimensional (3D) tomography, corneal biomechanical evaluations, and layered (or segmental) tomography with epithelial thickness by optical coherence tomography (OCT), or digital very high-frequency ultrasound (dVHF-US) serve as fundamental complementary exams for measuring different characteristics of the cornea. Also, ocular wavefront analysis, axial length measurements, corneal specular or confocal microscopy, and genetic or molecular biology tests are relevant for clinical decisions. Artificial intelligence enhances interpretation and enables combining such a plethora of data, boosting accuracy and facilitating clinical decisions. The applications of diagnostic information for individualized treatments became relevant concerning the therapeutic refractive procedures that emerged as alternatives to keratoplasty. The first paradigm shift concerns the surgical management of patients with ECD with different techniques, such as crosslinking and intrastromal corneal ring segments. A second paradigm shift involved the quest for identifying patients at higher risk of progressive iatrogenic ectasia after elective refractive corrections on the cornea. Beyond augmenting the sensitivity to detect very mild (subclinical or fruste) forms of ECD, ectasia risk assessment evolved to characterize the inherent susceptibility for ectasia development and progression. Furthermore, ectasia risk is also related to environmental factors, including eye rubbing and the relational impact of the surgical procedure on the cornea.
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Affiliation(s)
- Renato Ambrósio
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil.
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil.
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil.
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil.
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil.
| | - Marcella Q Salomão
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Benjamin Constant Institute, Rio de Janeiro, Brazil
| | - Lorena Barros
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - João Batista R da Fonseca Filho
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - Jaime Guedes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
| | - Alexandre Neto
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
| | - Aydano P Machado
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Computing Institute, Federal University of Alagoas, Maceió, Brazil
| | - Bernardo T Lopes
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
- Department of Ophthalmology, Alder Hey Children's Hospital, Liverpool, L12 2AP, UK
| | - Nelson Sena
- Department of Ophthalmology, Federal University the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
| | - Louise Pellegrino Gomes Esporcatte
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Rio Vision Hospital, Rua Prudente de Moraes, 1276, Rio de Janeiro, RJ, 22420-042, Brazil
- Brazilian Study Group of Artificial Intelligence and Corneal Analysis - BrAIN, Rio de Janeiro & Maceió, Brazil
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Erdinest N, Wajnsztajn D, London N, Solomon A. Ocular surface inflammation and ectatic corneal disorders. Curr Opin Allergy Clin Immunol 2023; 23:430-437. [PMID: 37490610 DOI: 10.1097/aci.0000000000000935] [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: 07/27/2023]
Abstract
PURPOSE OF REVIEW Inflammatory mediators are a focus of recent corneal ectasia (CE) research and are a profound, modifiable contributor to CE in general and keratoconus (KC) in particular, opening a path to explore new methods of control. As advanced imaging technology and expanded population screening allow for earlier detection, the possibility of early intervention can profoundly change the prognosis of CE. RECENT FINDINGS Significant increases in the inflammatory mediators and immune components have been observed in the cornea, tear fluid, and blood of ectasia patients, while inflammation dampeners such as vitamin D and their receptors are reduced. Atopy and allergy have a strong association with KC, known to increase itch factors and stimulate eye rubbing, a risk factor in ectasia pathogenesis. Management of atopy or allergic conditions and topical anti-inflammatories has helped stabilize CE disease. SUMMARY Strategies such as monitoring inflammatory factors and using immune or inflammatory modulators, including managing subclinical inflammation, may be clinically beneficial in stabilizing the disease and improving outcomes. The detected factors are biomarkers, but as yet unproven to be sensitive or specific enough to be considered biomarkers for early detection of CE. The establishment of such biomarkers could improve the therapeutic outcome.
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Affiliation(s)
- Nir Erdinest
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center
| | - Denise Wajnsztajn
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center
| | | | - Abraham Solomon
- Department of Ophthalmology, Hadassah-Hebrew University Medical Center
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Yang F, Dong Y, Bai C, Alzogool M, Wang Y. Bibliometric and visualized analysis of myopic corneal refractive surgery research: from 1979 to 2022. Front Med (Lausanne) 2023; 10:1141438. [PMID: 37575980 PMCID: PMC10416457 DOI: 10.3389/fmed.2023.1141438] [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: 01/10/2023] [Accepted: 07/14/2023] [Indexed: 08/15/2023] Open
Abstract
Background Myopic corneal refractive surgery is one of the most prevalent ophthalmic procedures for correcting ametropia. This study aimed to perform a bibliometric analysis of research in the field of corneal refractive surgery over the past 40 years in order to describe the current international status and to identify most influential factors, while highlighting research hotspots. Methods A bibliometric analysis based on the Web of Science Core Collection (WoSCC) was used to analyze the publication trends in research related to myopic corneal refractive surgery. VOSviewer v.1.6.10 was used to construct the knowledge map in order to visualize the publications, distribution of countries, international collaborations, author productivity, source journals, cited references, keywords, and research hotspots in this field. Results A total of 4,680 publications on myopic corneal refractive surgery published between 1979 and 2022 were retrieved. The United States has published the most papers, with Emory University contributing to the most citations. The Journal of Cataract and Refractive Surgery published the greatest number of articles, and the top 10 cited references mainly focused on outcomes and wound healing in refractive surgery. Previous research emphasized "radial keratotomy (RK)" and excimer laser-associated operation methods. The keywords containing femtosecond (FS) laser associated with "small incision lenticule extraction (SMILE)" and its "safety" had higher burst strength, indicating a shift of operation methods and coinciding with the global trends in refractive surgery. The document citation network was clustered into five groups: (1) outcomes of refractive surgery: (2) preoperative examinations for refractive surgery were as follows: (3) complications of myopic corneal refractive surgery; (4) corneal wound healing and cytobiology research related to photorefractive laser keratotomy; and (5) biomechanics of myopic corneal refractive surgery. Conclusion The bibliometric analysis in this study may provide scholars with valuable to information and help them better understand the global trends in myopic corneal refractive surgery research frontiers. Two stages of rapid development occurred around 1991 and 2013, shortly after the innovation of PRK and SMILE surgical techniques. The most cited articles mainly focused on corneal wound healing, clinical outcomes, ocular aberration, corneal ectasia, and corneal topography, representing the safety of the new techniques.
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Affiliation(s)
- Fang Yang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Department of Ophthalmology, Renmin Hospital, Hubei University of Medicine, Shiyan, China
| | - Yi Dong
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin, China
| | - Chen Bai
- Department of General Surgery, Taihe Hospital, Hubei University of Medicine, Shiyan, China
| | - Mohammad Alzogool
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin, China
- School of Medicine, Nankai University, Tianjin, China
| | - Yan Wang
- Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China
- Tianjin Eye Hospital, Tianjin Key Lab of Ophthalmology and Visual Science, Tianjin Eye Institute, Nankai University Affiliated Eye Hospital, Tianjin, China
- Nankai Eye Institute, Nankai University, Tianjin, China
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Loureiro T, Rodrigues-Barros S, Carreira AR, Gouveia-Moraes F, Carreira P, Vide Escada A, Campos P, Machado I, Campos N, Ambrosio R, Archer TJ, Reinstein DZ. Corneal Epithelial Thickness Changes After Topical Treatment of Dry Eye Disease in Primary Sjögren Syndrome. Clin Ophthalmol 2023; 17:993-1005. [PMID: 37035513 PMCID: PMC10075387 DOI: 10.2147/opth.s375505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/11/2022] [Indexed: 04/03/2023] Open
Abstract
Purpose To evaluate the changes on epithelial thickness before and after topical treatment in primary Sjögren syndrome-associated dry eye disease (SS-DED). Methods This was a prospective study that included referred women with SS-DED and healthy age-matched controls. Corneal epithelial thickness was evaluated using high-definition anterior segment optical coherence tomography (Cirrus 5000 HD-OCT) in the baseline first consultation, and four weeks after treatment with preservative free 1mg/1mL sodium hyaluronate. Schirmer test 1 (ST1), tear break-up time (TBUT), tear meniscus height (TMH), SICCA Ocular Surface Score (SICCA OSS) and Ocular Surface Disease Index (OSDI) were evaluated. Statistical significance was defined as p-value <0.05. Results The study included 40 eyes, 20 with SS-DED and 20 controls. At baseline, SS-DED patients had lower ST1 (11.1 ± 2.2mm vs 14.1 ± 3.1mm, p<0.01), faster TBUT (9.1 ± 1.8s vs 13.2 ± 1.1s, p<0.01) and lower TMH (211.2 ± 68.4 µm vs 217.2 ± 60.1µm; p<0.01) than the control group, whereas SICCA OSS and OSDI were higher (p<0.01). The superior epithelium was thinner in SS-DED group (41.1 ± 3.2 µm vs 43.1± 2.3 µm, p<0.01). After treatment, ST1, TBUT, TMH, SICCA OSS, and OSDI improved (p<0.01), and superior epithelium thickened (p<0.01) in the SS-DED group. Conclusion Treatment with sodium hyaluronate improved ST1, TBUT, TMH, SICCA-OSS, and OSDI score. Superior epithelium tends to be thinner in SS-DED but becomes thicker with treatment. Our results seem to illustrate the morphological changes in the corneal epithelium in DED, which could be further recognized as a clinical biomarker of SS-DED.
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Affiliation(s)
- Tomas Loureiro
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
- Correspondence: Tomas Loureiro, Ophthalmology Department, Hospital Garcia de Orta, Avenida Torrado da Silva, Almada, 2805-267, Portugal, Tel +351 913 513 175, Email
| | | | | | | | - Pedro Carreira
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Vide Escada
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Paul Campos
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ines Machado
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Nuno Campos
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | - Renato Ambrosio
- Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Margines JB, Rabinowitz YS, Li X, Gaster RN. Results of Corneal Collagen Cross-Linking in Patients with Corneal Ectasia after Laser Refractive Surgery - A Prospective Study. Photodiagnosis Photodyn Ther 2023; 42:103521. [PMID: 36931367 DOI: 10.1016/j.pdpdt.2023.103521] [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: 12/06/2022] [Revised: 02/24/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023]
Abstract
PURPOSE To evaluate the safety and efficacy of epithelium-off (epi-off) corneal cross-linking (CXL) in patients with post-LASIK corneal ectasia (PLE) SETTING: Private clinical practice DESIGN: Prospective clinical trial METHODS: 82 eyes of adult patients post-LASIK, ages 21-67, with a topography pattern consistent with corneal ectasia, corrected distance visual acuity (CDVA) worse than 20/20, and minimum corneal pachymetry > 400 µm underwent epi-off CXL. Exclusion criteria were patients with corneas that were thinner than 400 μm or demonstrated central corneal scarring, history of herpetic eye disease, pregnancy or nursing. Follow up examinations of spherical equivalent, uncorrected distance visual acuity (UDVA), CDVA, steep keratometry (KSteep) and minimum pachymetry occurred on different but highly overlapping subsets of the operated eyes yearly until 5 years post-CXL. RESULTS Over the 5 years of follow up, spherical equivalent did not significantly change while UCVA and CDVA stabilized or improved to a non-significant degree. KSteep and minimum pachymetry continued to be decreased to a statistically significant degree (p < 0.05 at 5 years). CONCLUSIONS CXL in PLE patients is safe and efficacious: it halts progression of PLE and may improve visual function. KSteep and minimum pachymetry decrease post-CXL. Patients with PLE should be encouraged to stop progression of the disease by undergoing epi-off CXL once progression is established.
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Affiliation(s)
| | | | - Xiaohui Li
- Institute for Translational Genomics and Population Sciences, The Lundquist Institute for Biomedical Innovation, and Department of Pediatrics at Harbor-UCLA Medical Center, Torrance, CA, USA
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Zhang J, Cai B, Ma L, Qin Y, Li S, Sun C, Liang J, Han Y, Zhuang W. Clinical and genetic analysis VSX1 variants among families with keratoconus in northwest China. Front Genet 2023; 14:1145426. [PMID: 36999054 PMCID: PMC10043922 DOI: 10.3389/fgene.2023.1145426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
Purpose: To screen VSX1 gene sequence variations and describe the clinical features of families with keratoconus (KC) from northwest China.Methods: We screened VSX1 sequence variations and clinical data of 37 families including 37 probands with diagnosed KC from Ningxia Eye Hospital (China). VSX1 was screened by targeted next-generation sequencing (NGS) and verified by Sanger sequencing. In silico analysis including Mutation Taster, MutationAssessor, PROVEAN, MetaLR, FATHMM, M-CAP, FATHMM-XF_coding and DANN was performed to identify the pathogenicity of the sequence variations as well as the conserved amino acid variations of VSX1 was implemented by Clustal X. All subjects were assessed in Pentacam Scheimpflug tomography and corneal biomechanical Corvis ST examinations.Results: Five VSX1 gene variants, were identified in six (16.2%) unrelated families with KC. In silico analysis predicted deleterious effects of the three missense variants (p.G342E, p.G160V, and p.L17V) in the encoded protein. Another previously reported synonymous variation (p.R27R) in the first exon and one heterozygous change in the first intron (c.425-73C>T) were identified in three KC families. Clinical examination of the asymptomatic first-degree parents from these six families who shared the gene with the proband had suspected KC changes in topographic and biomechanical markers. These variants co-segregated with the disease phenotype in all affected individuals but not in unaffected family members or healthy controls, though with variable expressivity.Conclusion: The variant p.G342E of VSX1 is implicated in the pathogenesis of KC, which expands the range of the spectrum of VSX1 mutations with an autosomal dominant inheritance pattern and variable expression in the clinical phenotype. Genetic screening combined with clinical phenotype may help in the genetic counseling of patients with KC and identification of individuals with subclinical KC.
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Affiliation(s)
- Jinjin Zhang
- Third Clinical Medical College of Ningxia Medical University, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Ningxia Eye Hospital, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Bo Cai
- Third Clinical Medical College of Ningxia Medical University, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Ningxia Eye Hospital, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Limei Ma
- College of Medical Technology, North Minzu University, Yinchuan, China
| | - Yixuan Qin
- Third Clinical Medical College of Ningxia Medical University, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Ningxia Eye Hospital, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Shuai Li
- College of Medical Technology, North Minzu University, Yinchuan, China
| | - Caihong Sun
- Third Clinical Medical College of Ningxia Medical University, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Ningxia Eye Hospital, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Jing Liang
- Third Clinical Medical College of Ningxia Medical University, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Ningxia Eye Hospital, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Yu Han
- Third Clinical Medical College of Ningxia Medical University, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
| | - Wenjuan Zhuang
- Third Clinical Medical College of Ningxia Medical University, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- Ningxia Eye Hospital, People’s Hospital of Ningxia Hui Autonomous Region, Yinchuan, China
- *Correspondence: Wenjuan Zhuang,
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Corneal ectasia detection by epithelial pattern standard deviation from OCT. J Cataract Refract Surg 2023; 49:190-194. [PMID: 36201664 DOI: 10.1097/j.jcrs.0000000000001066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/25/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE To test the ability of the corneal epithelial pattern standard deviation (PSD) to distinguish between normal and cases with corneal ectatic condition. SETTING Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil. DESIGN Cross-sectional retrospective study. METHODS Patients were stratified into 4 groups based on clinical data and corneal tomography. Groups 1 and 2 comprised 1 eye randomly selected from 105 patients with normal corneas (N) and 86 patients with bilateral keratoconus (KC). Groups 3 and 4, respectively, comprised 11 ectatic eyes with no surgical treatment for KC (very asymmetric ectasia [VAE]-E) from patients whose fellow eyes (61) presented with normal topographic patterns (VAE-NT). Corneas were scanned using an OCT system (RT Vue) and Scheimpflug corneal tomography (Pentacam) and also had biomechanical assessment through the Corvis ST. Corneal epithelial thickness maps were analyzed, and the PSD value was calculated. The area under the receiver operating characteristic curve analysis was used to evaluate the diagnostic accuracy of the indices. RESULTS A total of 105 normal eyes, 86 keratoconic eyes, and 11 ectatic eyes whose fellow eyes (61) presented normal topographic patterns were evaluated. Epithelial PSD was significantly different across the 4 groups ( P < .0001). The pairwise comparison revealed that the normal group presented significantly lower values than both ectasia groups (KC and VAE-E, P < .0001) and the VAE-NT group ( P = .0008). There was no statistical significant difference between KC and VAE-E ( P = .4284), while they were significantly higher than the VAE-NT group ( P < .0001 and P = .0004). CONCLUSIONS Epithelial PSD can be used to detect abnormal epithelial thickness patterns. Corneal epithelial thickness changes could be detected accurately in patients with KC, even in the form fruste of the disease.
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Özdoğan S, Gürelik G, Bilgihan K. Analysis of corneal biomechanical properties 25 years after myopic photorefractive keratectomy. Int Ophthalmol 2023; 43:325-331. [PMID: 35918497 DOI: 10.1007/s10792-022-02436-w] [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: 01/15/2022] [Accepted: 07/05/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate corneal biomechanical changes using Corvis ST in patients treated with photorefractive keratectomy (PRK) 25 years ago. METHODS In this study, 32 post-PRK and 38 normal eyes underwent Corvis ST (CST) assessments. The measured CST factors were: time of highest concavity (HC), time of applanation 1 (AT1), time of applanation 2 (AT2), length of applanation 1 (AL1), length of applanation 2 (AL2), velocity of applanation 1 (AV1), velocity of applanation 2 (AV2), deformation amplitude (DA), peak distance (PD), integrated radius (IR), Ambrosio relational thickness horizontal (ARTh), stiffness parameter at first applanation (SP-A1), DA ratio (2 mm), Belin/Ambrosio enhanced ectasia display (BAD) and corneal biomechanical index (CBI). RESULTS The mean [± standard deviation (SD)] age was 51.4 ± 7.36 years in PRK, 51.4 ± 3.62 in control group. PRK was performed 24.69 ± 1.78 years ago. ARTh, SP-A1, AT1, AL1, and AL2 were lower in PRK. PD, AT2, DA ratio (2 mm), and IR were statistically higher in PRK (P < 0.01). In PRK and control group the mean value of CBI was 0.91 ± 0.11 and 0.50 ± 0.27 (P < 0.001), and mean value of BAD was 3.34 ± 1.53 and 1.1 ± 0.70 (P < 0.001). In PRK 71.9% of eyes were classed "high risk CBI plus diseased BAD" and 25% remained in the "high risk CBI and normal BAD" group. CONCLUSIONS In this study, most of the post-PRK eyes which were clinically and topographically normal were classified as "high risk CBI plus diseased BAD" and had significantly worse CBI and BAD values than the control group. This leads to the conclusion that CBI and BAD alone are not appropriate to evaluate post-PRK ectasia.
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Affiliation(s)
- Sibel Özdoğan
- Dr. Abdurrahman Yurtarslan Oncology Training and Research Hospital, 06400, Ankara, Turkey.
| | - Gökhan Gürelik
- Departments of Ophthalmology, Gazi University Medical School, Ankara, Turkey
| | - Kamil Bilgihan
- Departments of Ophthalmology, Gazi University Medical School, Ankara, Turkey
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Enhanced Diagnostics for Corneal Ectatic Diseases: The Whats, the Whys, and the Hows. Diagnostics (Basel) 2022; 12:diagnostics12123027. [PMID: 36553038 PMCID: PMC9776904 DOI: 10.3390/diagnostics12123027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/07/2022] Open
Abstract
There are different fundamental diagnostic strategies for patients with ectatic corneal diseases (ECDs): screening, confirmation of the diagnosis, classification of the type of ECD, severity staging, prognostic assessment, and clinical follow-up. The conscious application of such strategies enables individualized treatments. The need for improved diagnostics of ECD is related to the advent of therapeutic refractive procedures that are considered prior to keratoplasty. Among such less invasive procedures, we include corneal crosslinking, customized ablations, and intracorneal ring segment implantation. Besides the paradigm shift in managing patients with ECD, enhancing the sensitivity to detect very mild forms of disease, and characterizing the inherent susceptibility for ectasia progression, became relevant for identifying patients at higher risk for progressive iatrogenic ectasia after laser vision correction (LVC). Moreover, the hypothesis that mild keratoconus is a risk factor for delivering a baby with Down's syndrome potentially augments the relevance of the diagnostics of ECD. Multimodal refractive imaging involves different technologies, including Placido-disk corneal topography, Scheimpflug 3-D tomography, segmental or layered tomography with layered epithelial thickness using OCT (optical coherence tomography), and digital very high-frequency ultrasound (VHF-US), and ocular wavefront. Corneal biomechanical assessments and genetic and molecular biology tests have translated to clinical measurements. Artificial intelligence allows for the integration of a plethora of clinical data and has proven its relevance in facilitating clinical decisions, allowing personalized or individualized treatments.
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Yücekul B, Dick HB, Taneri S. Systematic detection of keratoconus in OCT: corneal and epithelial thickness maps. J Cataract Refract Surg 2022; 48:1360-1365. [PMID: 35714335 DOI: 10.1097/j.jcrs.0000000000000990] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 06/08/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE To detect keratoconus (KC) only by analyzing the corneal and epithelial map parameters and patterns in optical coherence tomography (OCT). SETTING Tertiary care refractive surgery center. DESIGN Retrospective data collection. METHODS Corneal and epithelial thickness maps of normal, manifest, and subclinical keratoconic eyes (according to the Belin-Ambrosio display, Pentacam) were evaluated using spectral-domain OCT (Zeiss Cirrus 5000 HD). A new 2-step decision tree was developed based on previous studies with another OCT device. In the first step, if at least 1 of the 4 independent parameters (pachymetry minimum, pachymetry minimum-median, pachymetry superonasal-inferotemporal, and epithelial superonasal-inferotemporal) overruns the cutoff values, the eye was suspicious for KC. In the second step, if the epithelial map showed concentric thinning and the thinnest point of the cornea and epithelium is coincident, the eye was classified as keratoconic. RESULTS 172 manifest keratoconic eyes (108 patients), 21 subclinical keratoconic eyes (20 patients), and 172 normal eyes (90 age-matched participants) were included in this study. Step 1 captured 100% of manifest and subclinical keratoconic eyes. Step 2 ruled out all suspicious but normal cases and, falsely, 2 subclinical keratoconic eyes. Our 2-step decision tree reached 100% specificity, 100% sensitivity in manifest KC, and 90.4% sensitivity in subclinical KC. CONCLUSIONS Pachymetric and epithelial map parameters and patterns in OCT can be used in the diagnosis of KC, including subclinical cases, yielding a high level of agreement with the commonly used diagnostic reference, the Belin-Ambrosio display. Further improvements by refining our algorithm and including an automated evaluation in the software are desirable.
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Affiliation(s)
- Burcu Yücekul
- From the Department of Ophthalmology, Haseki Training and Research Hospital, Istanbul, Turkey (Yücekul); Ruhr University, Bochum, Germany (Dick, Taneri); Zentrum für Refraktive Chirurgie, Augenzentrum am St. Franziskus Hospital, Muenster, Germany (Taneri)
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Herber R, Hasanli A, Lenk J, Vinciguerra R, Terai N, Pillunat LE, Raiskup F. Evaluation of Corneal Biomechanical Indices in Distinguishing Between Normal, Very Asymmetric, and Bilateral Keratoconic Eyes. J Refract Surg 2022; 38:364-372. [PMID: 35686712 DOI: 10.3928/1081597x-20220601-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the ability of biomechanical indices provided by the Ocular Response Analyzer (ORA; Reichert Ophthalmic Instruments) and dynamic Scheimpflug analyzer (Corvis ST; Oculus Optikgeräte GmbH) to distinguish between normal eyes and eyes with very asymmetric ectasia (VAE) and mild and moderate keratoconus. METHODS This prospective, observational, and monocentric study included normal eyes (defined as keratoconus percentage index < 60, Belin/Ambrósio total deviation value [BAD-D] < 1.6, inferior-superior keratometry [I-S value] < 1.45 and maximum keratometry [Kmax] < 47) and eyes with clinical bilateral keratoconus (mild and moderate) and VAE (defined as unilateral keratoconus, where one eye showed a clinical keratoconus and the fellow eye was topographically normal [VAE-NT] or topographically and tomographically normal [VAE-NTT]). All eyes were measured by the Pentacam (Oculus Optikgeräte GmbH), ORA, and Corvis ST. Receiver operating characteristic curve analysis was performed to test the diagnostic ability. RESULTS Fifty-eight normal eyes and 238 ectatic eyes were included. The highest area under the curve (AUC) was provided by the Corvis Biomechanical Index (CBI) with an AUC of 0.979, followed by ORA corneal resistance factor (0.865), and corneal hysteresis (0.824) separating normal eyes from all ectatic subgroups. The AUC of the CBI was statistically significantly higher than all other parameters (DeLong test, P < .001). A sensitivity of 100% and 70.9%, respectively, and a specificity of 93.1% was found to distinguish normal eyes from VAE-NT and VAE-NTT using a cut-off value of 0.2. CONCLUSIONS The assessment of biomechanical properties is an additional important method to evaluate corneal ectasia independent of its stage. The CBI provides further information for ectasia screening in cases where corneal topography and tomography are clinically not suspicious by using a cutoff of 0.2. [J Refract Surg. 2022;38(6):364-372.].
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Nasef MH, El Emam SY, Haleem TI, Shalaby WS, Allam WA. Visual and Topographic Outcomes of Corneal Collagen Cross Linking for Post LASIK Ectasia. Clin Ophthalmol 2022; 16:2025-2032. [PMID: 35757019 PMCID: PMC9231688 DOI: 10.2147/opth.s370033] [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: 04/12/2022] [Accepted: 06/08/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To assess the topographic and visual outcomes of corneal cross-linking (CXL) for post-LASIK ectasia. Methods A retrospective case series of patients who had progressive post-LASIK ectasia, with at least 2 years of follow-up. They had epithelium-off CXL. Topographical and visual changes were recorded. Results The study included 21 eyes of 11 patients. At month 24, the final logMAR corrected distance visual acuity (CDVA) and spherical equivalent (SE) were stable compared to baseline (0.16, and −2.0 diopter (D), respectively). The final Kmean and Kmax were 42.5 and 47.4 D, respectively. Stability or improvement in CDVA, SE, and Kmax was seen in 17 eyes (81%). Significant corneal thinning was seen (438 vs 457 microns, p = 0.003). Thinning by 2% or more was seen in 12 eyes (57.1%). Failure of CXL was seen in 4 eyes (19%). No other ocular complications were seen. Conclusion CXL for post LASIK ectasia is a safe and effective modality. Despite corneal thinning, there was stability or improvement in topographic parameters and CDVA over the 2-year follow-up period.
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Affiliation(s)
- Mohamed H Nasef
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
- Correspondence: Mohamed H Nasef, Tanta University Ophthalmology Hospital, Tanta University Medical Campus, Al-Geish St, Tanta, Gharbia, 31527, Egypt, Tel +20 10 02826555, Email
| | - Sharif Y El Emam
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Tamer I Haleem
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Wesam S Shalaby
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
| | - Waleed A Allam
- Ophthalmology Department, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
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Asroui L, Dagher SA, Elsheikh A, Lopes BT, Roberts CJ, Assouad M, Awwad ST. Biomechanical Evaluation of Topographically and Tomographically Normal Fellow Eyes of Patients With Keratoconus. J Refract Surg 2022; 38:318-325. [PMID: 35536713 DOI: 10.3928/1081597x-20220225-01] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To determine the effectiveness of parameters and indices based on biomechanical measures at discriminating fellow eyes with topographically and tomographically normal corneas in patients with keratoconus from normal control corneas. METHODS The study included 47 keratoconus suspect eyes, defined as the topographically and tomographically normal fellow eyes of patients with frank keratoconus in the other eye. Eyes were imaged using the Pentacam HR and Corvis ST (both Oculus Optikgeräte GmbH). Fellow eyes were then categorized as topographically/tomographically normal fellow eyes (TNF) and topographically/tomographically borderline fellow eyes (TBF). The ability of each of the Corvis Biomechanical Index (CBI), Tomographic and Biomechanical Index (TBI), stiffness parameter at applanation 1 (SP-A1), and stress-strain index (SSI) at discriminating between normal controls and keratoconus suspects was assessed. RESULTS The TBI had the best discriminative ability with the greatest area under the receiver operating characteristic (AUROC) curve value of 0.946 for normal controls versus TBF eyes, and 0.824 for normal controls versus TNF eyes. Compared to the TBI AUROC curves, SP-A1 and CBI had AUROC curve values of 0.833 (P = .09) and 0.822 (P = .01) for normal controls versus TBF eyes, respectively, and AUROC curve values of 0.822 (P = .96) and 0.550 (P = .0002) for normal controls versus TNF eyes, respectively. The TBI had the best positive predictive value for TNF and TBF eyes, followed by CBI and SP-A1. CONCLUSIONS The TBI and the purely biomechanical parameter SP-A1 were of moderate utility in distinguishing between normal and keratoconus suspect eyes. In the absence of topographic/tomographic evidence of keratectasia, an independently abnormal biomechanical parameter may suggest an increased risk of ectasia. [J Refract Surg. 2022;38(5):318-325.].
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Changes in Corneal Morphology with Age in Asian Population: A Multicenter Study of 30,618 Cases. Adv Ther 2021; 38:5763-5776. [PMID: 34704192 PMCID: PMC8572190 DOI: 10.1007/s12325-021-01922-4] [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: 07/05/2021] [Accepted: 09/14/2021] [Indexed: 11/23/2022]
Abstract
Introduction To evaluate normal reference ranges for corneal morphological parameters and investigate age-related changes in these parameters in Asian subjects with healthy eyes in order to provide reference data for preoperative evaluation of corneal refractive surgery and the early differential diagnosis of subclinical and asymptomatic keratoconus. Methods This cross-sectional, multicenter, observational study was conducted in five provinces of China, from January 2014 through October 2019. It is a retrospective analysis. Examiner-blinded clinical measurements were performed after stratification of the subjects into the following age groups: < 18, 18–30, 31–40, 41–50. We evaluated 30,618 healthy eyes of Chinese subjects who exhibited a normal corneal morphology, had no history of eye surgery or trauma, stopped wearing soft contact lenses for at least 2 weeks (rigid contact lenses for at least 4 weeks), and underwent topographic studies for both eyes on the same day. Results While the anterior and posterior corneal curvatures (K1 and K2) increased with age, corneal astigmatism of the anterior and posterior surfaces (ΔK) and central, minimum, and overall corneal thicknesses decreased with age. Age-related decrease of the overall corneal thickness was more obvious toward the periphery. The anterior and posterior corneal surface heights exhibited a decrease and an increase, respectively. Both index of height asymmetry (IHA) and index of vertical asymmetry (IVA) exhibited an increase with age. Conclusions The cornea exhibits overall thinning with age and gradually changes from a flat ellipse to an elongated ellipse in Asian individuals with healthy eyes. However, the anterior and posterior surfaces become smoother with age. Owing to the very large number of cases, these small differences are statistically significant. The results obtained are consistent with the hypothesis that a normal cornea seems to withstand quite well the effect of IOP, external pressures, and the natural cross-linking.
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Moshirfar M, Tukan AN, Bundogji N, Liu HY, McCabe SE, Ronquillo YC, Hoopes PC. Ectasia After Corneal Refractive Surgery: A Systematic Review. Ophthalmol Ther 2021; 10:753-776. [PMID: 34417707 PMCID: PMC8589911 DOI: 10.1007/s40123-021-00383-w] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/02/2021] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION The incidence of ectasia following refractive surgery is unclear. This review sought to determine the worldwide rates of ectasia after photorefractive keratectomy (PRK), laser-assisted in situ keratomileusis (LASIK), and small incision lenticule extraction (SMILE) based on reports in the literature. METHODS A systematic review was conducted according to modified Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Publications were identified by a search of eight electronic databases for relevant terms between 1984 and 2021. Patient characteristics and preoperative values including manifest refractive spherical refractive equivalent (MRSE), central corneal thickness (CCT), anterior keratometry, postoperative residual stromal bed (RSB), and percent tissue altered (PTA) were summarized. In addition, annual rates of each refractive surgery were determined, and incidence of post-refractive ectasia for each type was calculated using the number of ectatic eyes identified in the literature. RESULTS In total, 57 eyes (70 eyes including those with preoperative risk factors for ectasia) were identified to have post-PRK ectasia, while 1453 eyes (1681 eyes including risk factors) had post-LASIK ectasia, and 11 eyes (19 eyes including risk factors) had post-SMILE ectasia. Cases of refractive surgery performed annually were estimated as 283,920 for PRK, 1,608,880 for LASIK, and 96,750 for SMILE. Reported post-refractive ectasia in eyes without preoperative identifiable risk factors occurred with the following incidences: 20 per 100,000 eyes in PRK, 90 per 100,000 eyes in LASIK, and 11 per 100,000 eyes in SMILE. The rate of ectasia in LASIK was found to be 4.5 times higher than that of PRK. CONCLUSION Post-refractive ectasia occurs at lower rates in eyes undergoing PRK than LASIK. Although SMILE appears to have the lowest rate of ectasia, the number of cases already reported since its recent approval suggests that post-SMILE ectasia may become a concern. Considering that keratoconus is a spectrum of disease, pre-existing keratoconus may play a larger role in postoperative ectasia than previously accounted for in the literature.
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Affiliation(s)
- Majid Moshirfar
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA.
- John A. Moran Eye Center, University of Utah School of Medicine, Salt Lake City, UT, USA.
- Utah Lions Eye Bank, Murray, UT, USA.
| | - Alyson N Tukan
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Nour Bundogji
- University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
| | - Harry Y Liu
- McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shannon E McCabe
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
- Mission Hills Eye Center, Pleasant Hill, CA, USA
| | - Yasmyne C Ronquillo
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
| | - Phillip C Hoopes
- Hoopes Vision Research Center, Hoopes Vision, 11820 S. State Street Suite #200, Draper, UT, 84020, USA
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Liu Y, Zhang Y, Chen Y. Application of a scheimpflug-based biomechanical analyser and tomography in the early detection of subclinical keratoconus in chinese patients. BMC Ophthalmol 2021; 21:339. [PMID: 34544392 PMCID: PMC8454178 DOI: 10.1186/s12886-021-02102-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
Background In vivo corneal biomechanics evaluation has been used to help screen early keratoconus in recent years. This study is to evaluate the value of a Scheimpflug-based biomechanical analyser combined with tomography in detecting subclinical keratoconus by distinguishing normal eyes from frank keratoconus (KC) and forme frusta keratoconus (FFKC) eyes in Chinese patients. Methods Study design: diagnostic test. This study included 31 bilateral frank keratoconus patients, 27 unilateral clinically manifesting keratoconus patients with very asymmetric eyes, and 79 control subjects with normal corneas. Corneal morphological and biomechanical parameters were measured using a Pentacam HR and a Corvis ST (OCULUS, Wetzlar, Germany). The diagnostic ability of computed parameters reflecting corneal biomechanical and morphological traits [including the Belin-Ambrósio deviation index (BAD_D), the Corvis biomechanical index (CBI) and the tomographic and biomechanical index (TBI)] was determined using receiver operating characteristic (ROC) curve analysis and compared by the DeLong test. Additionally, the area under the curve (AUC), the best cut-off values, and the Youden index for each parameter were reported. A novel corneal stiffness parameter, the stress-strain index (SSI), was also compared between KC, FFKC and normal eyes. Results Every morphological and biomechanical index analysed in this study was significantly different among KC, FFKC and normal eyes (P = 0.000). The TBI was most valuable in detecting subclinical keratoconus (FFKC eyes), with an AUC of 0.928 (P = 0.000), and both forms of corneal ectasia (FFKC and frank KC eyes), with an AUC of 0.966 (P = 0.000). The sensitivity and specificity of the TBI was 97.5 and 77.8 % in detecting FFKC and 97.5 and 89.7 % in detecting any KC, respectively, with a cut-off value of 0.375. The morphological index BAD_D and the biomechanical index CBI were also very useful in distinguishing eyes with any KC from normal eyes, with AUCs of 0.965 and 0.934, respectively. The SSI was significantly different between KC, FFKC and normal eyes (P = 0.000), indicating an independent decrease in corneal stiffness in KC eyes. Conclusions The combination of a Scheimpflug-based biomechanical analyser and tomography could increase the accuracy in detecting subclinical keratoconus in Chinese patients. The TBI was the most valuable index for detecting subclinical keratoconus, with a high sensitivity and specificity. Evaluation of corneal biomechanical properties in refractive surgery candidates could be helpful for recognizing potential keratoconic eyes and increasing surgical safety.
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Affiliation(s)
- Yan Liu
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Yu Zhang
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China
| | - Yueguo Chen
- Department of Ophthalmology, Peking University Third Hospital, Beijing, China. .,Beijing Key Laboratory of Restoration of Damaged Ocular Nerves, Peking University Third Hospital, 49 North Garden Road, Haidian District, 100191, Beijing, China.
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Surface ablation outcomes in high myopia with different epithelium removal techniques. J Cataract Refract Surg 2021; 47:1175-1182. [PMID: 34468455 DOI: 10.1097/j.jcrs.0000000000000611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/27/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To study the outcomes of alcohol-assisted photorefractive keratectomy (PRK) when compared with transepithelial PRK (TransPRK) using 2 software programs, with or without SmartPulse Technology (SmartSurfACE), in high myopia. SETTING Vissum Miranza, University Miguel Hernandez, Alicante, Spain. DESIGN Retrospective, consecutive, case series. METHODS High myopic eyes undergoing surface ablation were included. The main inclusion criteria were preoperative spherical equivalent (SE) above -5.50 diopters (D) and no other ocular surgeries. Mitomycin-C was used in all the surgeries. The outcomes were analyzed using the 6-month follow-up visit data. RESULTS 135 eyes were included. Alcohol-assisted PRK was performed in 65 eyes, transepithelial PRK (TransPRK1) in 32 eyes, and TransPRK2 in 38 eyes. The mean all groups preoperative sphere, cylinder, and SE were -6.00 ± 0.87 D, -1.13 ± 1.03 D, and -6.57 ± 0.69 D, respectively. The mean efficacy index in the alcohol-assisted PRK group was 0.91 ± 0.18 compared with 0.98 ± 0.1 and 0.98 ± 0.12 in the TransPRK1 and TransPRK2, respectively (P = .027). The mean safety index in alcohol-assisted PRK was 0.99 ± 0.05, whereas it was 1 ± 0.06 in the TransPRK1 and 0.99 ± 0.08 in the TransPRK2 (P = .780). A final SE of ± 0.50 D was achieved in 96.9% of eyes in the TransPRK1 group and in 100% eyes in the TransPRK2 group compared with 73.8% in the alcohol-assisted PRK group (P < .001). CONCLUSIONS Surface ablation with the Amaris 500 excimer laser with flying spot pattern and mitomycin C use showed adequate refractive outcomes in high myopia correction in the 3 groups. TransPRK with or without SmartPulse Technology achieved statistically significant better outcomes than alcohol-assisted PRK in refractive predictability and efficacy.
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Corneal Tomography Multivariate Index (CTMVI) effectively distinguishes healthy corneas from those susceptible to ectasia. Biomed Signal Process Control 2021. [DOI: 10.1016/j.bspc.2021.102995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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22
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Update and Review of Diagnosis and Management of Post-Refractive Surgery Ectasia. J Cataract Refract Surg 2021; 48:487-499. [PMID: 34486581 DOI: 10.1097/j.jcrs.0000000000000808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Post-Refractive Surgery Ectasia is a serious, sight-threatening, and highly - avoided complication seen after the following procedures: Laser in situ Keratomileusis, Photorefractive Keratectomy, Small Incision Lenticule Extraction, Radial and/or Arcuate Keratotomy. Specific risk factors may include age, corneal thickness, degree of refractive error, corneal topographic changes including irregular astigmatism, percent tissue ablation, and residual stromal bed. Biomarkers may be a new option to help indicate who is at greatest risk for ectasia. Visual aids including glasses or contacts lenses are often required to achieve optimal vision. Collagen crosslinking is the only treatment thought to stop progression of ectasia and prevent keratoplasty. Other surgical options may include topography-guided phototherapeutic keratectomy and intrastromal corneal ring segments. Ultimately an "ounce of prevention is a pound of cure" so careful preoperative screening and ultimately offering the safest and most effective treatments for patients is arguably the most important job of the refractive surgeon.
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Customized eye modeling for optical quality assessment in myopic femto-LASIK surgery. Sci Rep 2021; 11:16049. [PMID: 34362982 PMCID: PMC8346559 DOI: 10.1038/s41598-021-95730-z] [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: 04/04/2021] [Accepted: 07/27/2021] [Indexed: 02/07/2023] Open
Abstract
Refractive surgery is recognized as an effective method for myopia treatment, but it can induce night vision disturbances such as glare. We present an eye modeling method for the optical quality assessment in response to the structural changes in the eyes by femto-LASIK surgery. Customized eye models were built from the measurements of 134 right eyes pre- and post-operatively. Optical performance was evaluated using spot diagrams, point spread functions (PSFs), modulation transfer functions (MTFs), and chromatic aberrations at various fields (0°-30°), different pupil diameters (2-6 mm), and initial myopias (- 1.25 to - 10.5 D). Pupil size and initial myopia are the two major factors that affect visual performance of post-operative eyes. The results of spot diagrams, PSFs, and MTFs indicated that post-operative visual performance deteriorated as the visual field and pupil size increased, and it was significantly influenced by initial myopia. Post-operative chromatic aberrations were also affected by initial myopia. As pupil size increased, the post-operative longitudinal chromatic aberrations tended to decrease slightly, while the transverse chromatic aberrations remained similar. The use of eye modeling for refractive surgery assessment could possibly provide a more personalized surgical approach, could improve the prediction accuracy of refractive surgery outcomes, and promote the invention and development of better surgical methods.
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Agreement and repeatability of corneal tomography in healthy eyes using a novel Swept-Source optical coherence tomographer, a rotating Scheimpflug camera and a dual Scheimpflug-Placido system. J Cataract Refract Surg 2021; 48:190-198. [PMID: 34224476 DOI: 10.1097/j.jcrs.0000000000000734] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the accordance and repeatability of tomographic parameters measured by a novel Swept-Source optical coherence tomographer (SS-OCT, ANTERION), a rotating Scheimpflug camera (RSC, Pentacam) and a dual Scheimpflug-Placido system (DSP, Galilei G6). SETTING Department of Ophthalmology of Univ. Hospital Carl Gustav Carus, Dresden, Germany. DESIGN Prospective reliability analysis. METHODS Thirty randomly selected eyes of 30 healthy participants were enrolled in this study. Normal tomography were ensured by bilaterally evaluating appropriated parameters using RSC. All subjects received three consecutive measurements on each device by the same operator and in the uniform order RSC, SS-OCT and DSP. Anterior (ACP) and posterior (PCP) corneal parameters such as flat and steep keratometry and corneal thickness were analyzed. Repeatability was assessed by using a coefficient of repeatability (CR) and a coefficient of variation (CV). Agreement between RSC and SS-OCT as well as RSC and DSP were shown by Bland-Altman plots (BA). RESULTS CR of ACP did not exceed 0.5 D. There were no statistical differences in repeatability of ACP obtained from the three devices (P>0.05). For PCP and corneal thickness there was statistically significant higher repeatability mostly found for SS-OCT as opposed to RSC and DSP (P<0.05). For a wide range of analyzed parameters there were large limits of agreement (95%-LoA) found between the devices. CONCLUSION The SS-OCT showed highly repeatable measurements in healthy subjects regarding anterior, posterior and corneal thickness parameters. Repeatability of ACP did not differ between the devices. A mostly wide range of 95%-LoA prevents interchangeability between the devices.
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Chen S, Li XY, Jin JJ, Shen RJ, Mao JY, Cheng FF, Chen ZJ, Linardaki E, Voulgaraki S, Aslanides IM, Jin ZB. Genetic Screening Revealed Latent Keratoconus in Asymptomatic Individuals. Front Cell Dev Biol 2021; 9:650344. [PMID: 34136477 PMCID: PMC8202288 DOI: 10.3389/fcell.2021.650344] [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] [Received: 01/07/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose To adopt molecular screening in asymptomatic individuals at high risk of developing keratoconus as a combinative approach to prevent subclinical patients from post-refractive surgery progressive corneal ectasia. Methods In this study, 79 Chinese and nine Greek families with keratoconus were recruited, including 91 patients with clinically diagnosed keratoconus as well as their asymptomatic but assumptive high-risk first-degree relatives based on underlying genetic factor. Mutational screening of VSX1, TGFBI, and ZEB1 genes and full clinical assessment including Pentacam Scheimpflug tomography were carried out in these individuals. Results Five variants in VSX1 and TGFBI genes were identified in three Chinese families and one Greek family, and four of them were novel ones. Surprisingly, ultra-early corneal changes in Belin/Ambrosio Enhanced Ectasia Display of Pentacam corneal topography together with co-segregated variants were revealed in the relatives who had no self-reported symptoms. Conclusions Variants of VSX1 and TGFBI genes identified in both the clinically diagnosed and subclinical patients may cause the keratoconus through an autosomal dominant inheritance pattern, with different variable expressivity. Combining genetic with Belin/AmbrosioEnhanced Ectasia Display can be used to identify patients with latent keratoconus. This study indicates that genetic testing may play an important supplementary role in re-classifying the disease manifestation and evaluating the preoperative examination of refractive surgery.
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Affiliation(s)
- Shihao Chen
- Center for Refractive Surgery, The Eye Hospital, Wenzhou Medical University, Wenzhou, China
| | - Xing-Yong Li
- Center for Refractive Surgery, The Eye Hospital, Wenzhou Medical University, Wenzhou, China.,Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China
| | - Jia-Jia Jin
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China
| | - Ren-Juan Shen
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China.,Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
| | - Jian-Yang Mao
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China
| | - Fei-Fei Cheng
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China
| | - Zhen-Ji Chen
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China
| | | | | | - Ioannis M Aslanides
- Center for Refractive Surgery, The Eye Hospital, Wenzhou Medical University, Wenzhou, China.,Emmetropia Mediterranean Eye Institute, Heraklion, Greece
| | - Zi-Bing Jin
- Division of Ophthalmic Genetics, The Eye Hospital, Wenzhou Medical University, National Center for International Research in Regenerative Medicine and Neurogenetics, Wenzhou, China.,Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China.,Beijing Advanced Innovation Center for Big Data-Based Precision Medicine, Beihang University and Capital Medical University, Beijing Tongren Hospital, Beijing, China
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Khamar P, Rao K, Wadia K, Dalal R, Grover T, Versaci F, Gupta K. Advanced epithelial mapping for refractive surgery. Indian J Ophthalmol 2021; 68:2819-2830. [PMID: 33229657 PMCID: PMC7856960 DOI: 10.4103/ijo.ijo_2399_20] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
One of the leading challenges in refractive surgery today is the presence of underlying subclinical early-stage keratoconus (KC), which can lead to iatrogenic post laser in situ keratomileusis ectasia. Timely detection of this condition could aid the refractive surgeons in better decision-making. This includes being able to defer refractive surgery in subclinical cases as well as providing treatment for the same in the form of appropriate corneal collagen crosslinking treatments. Corneal topography is considered the gold standard for the diagnosis of corneal ectatic disorders. However, there is a likelihood that topographers are overlooking certain subclinical cases. The corneal epithelium is known to remodel, which may mask underlying stromal irregularities. Imaging and analyzing corneal epithelium and stroma independently will undoubtedly open newer avenues to supplement our understanding of postrefractive surgery outcomes and KC. This review encapsulates the various Optical coherence tomography-based epithelial mapping devices particularly RTVue (Optovue, Fremont, USA) and MS-39 (Costruzione Strumenti Oftalmici, Florence, Italy) in terms of their utility in these conditions. It will help guide the clinician on how including an epithelial mapping in clinical practice can aid in diagnosis, management, and interpretation of outcomes both for refractive surgery as well as KC.
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Affiliation(s)
- Pooja Khamar
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bengaluru, India
| | - Kavita Rao
- Director, Cornea, Cataract and Refractive Surgery Services, Aditya Jyot Eye Hospital, Mumbai, India
| | - Kareeshma Wadia
- Cornea, Cataract and Refractive Surgery Services, Jehan Eye Clinic, Vile Parle West, Mumbai, India
| | - Ritika Dalal
- Refractive Surgeon and Dry Eye Specialist, Dr Dalal's Clinic, Mumbai, India
| | - Tushar Grover
- Director, Vision Eye Centre & Associate Consultant, Sir Ganga Ram Hospital, New Delhi, India
| | | | - Krati Gupta
- Department of Cornea and Refractive Surgery,, Narayana Nethralaya, Bengaluru, India
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Chen D, Lam AK. Reliability and repeatability of the Pentacam on corneal curvatures. Clin Exp Optom 2021; 92:110-8. [DOI: 10.1111/j.1444-0938.2008.00336.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Davie Chen
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China E‐mail:
| | - Andrew Kc Lam
- School of Optometry, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR, China E‐mail:
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Lan G, Aglyamov S, Larin KV, Twa MD. In vivo human corneal natural frequency quantification using dynamic optical coherence elastography: Repeatability and reproducibility. J Biomech 2021; 121:110427. [PMID: 33873114 DOI: 10.1016/j.jbiomech.2021.110427] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/20/2021] [Accepted: 03/29/2021] [Indexed: 12/14/2022]
Abstract
Reliable and quantitative assessment of corneal biomechanics is important for the detection and treatment of corneal disease. The present study evaluates the repeatability and reproducibility of a novel optical coherence tomography (OCT)-based elastography (OCE) method for in vivo quantification of corneal natural frequency in 20 normal human eyes. Sub-micron corneal oscillations were induced by repeated low-force (13 Pa) microliter air pulses at the corneal apex and were observed by common-path phase-sensitive OCT imaging adjacent to a measurement region of 1-6.25 mm2. Corneal natural frequencies were quantified using a single degree of freedom model based on the corneal oscillations. Corneal natural frequencies ranged from 234 to 277 Hz (coefficient of variation: 3.2%; n = 286 for a 2.5 × 2.5 mm2 area; time: 28.6 s). The same natural frequencies can be acquired using a smaller sampling size (n = 9 for 1 mm2) and a shorter time (0.9 s). Spatial distribution and local changes in natural frequencies can be distinguished using denser sampling (e.g., 26 × 41 points for 2.5 × 5 mm2). This novel optical method demonstrates highly repeatable and reliable in vivo measurements of human corneal natural frequencies. While further studies are required to fully characterize anatomical and structural dependencies, this method may be complementary to the current OCE methods used to estimate Young's modulus from strain- or shear-wave-based measurements for the quantitative determination of corneal biomechanics.
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Affiliation(s)
- Gongpu Lan
- Foshan University, School of Physics and Optoelectronic Engineering, Foshan, Guangdong 528000, China
| | - Salavat Aglyamov
- University of Houston, Mechanical Engineering, Houston, TX 77204, United States
| | - Kirill V Larin
- University of Houston, Biomedical Engineering, Houston, TX 77204, United States
| | - Michael D Twa
- University of Houston, College of Optometry, Houston, TX 77204, United States.
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Loureiro TDO, Rodrigues-Barros S, Lopes D, Carreira AR, Gouveia-Moraes F, Vide-Escada A, Campos NP. Corneal Epithelial Thickness Profile in Healthy Portuguese Children by High-Definition Optical Coherence Tomography. Clin Ophthalmol 2021; 15:735-743. [PMID: 33658753 PMCID: PMC7917471 DOI: 10.2147/opth.s293695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 12/25/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction and Objective To evaluate corneal epithelial thickness (ET) and corneal thickness (CT) profiles in healthy eyes of Portuguese children and provide information to establish the first normative Caucasian database for these age group. Methods Sixty healthy eyes of 60 children aged between 8 and 18 were evaluated using the Cirrus high-definition optical coherence tomography device. The average ET and CT were assessed using Cirrus Review Software with predefined concentric corneal ring-shaped zones. Specific regions of ET (central, superior, inferior, temporal, nasal, superonasal, inferotemporal, superotemporal and inferonasal) were also assessed. The mean ET, the mean CT and the difference of ET in corresponding octants were compared by gender. Correlations between central epithelial thickness (CET), age and refractive error were evaluated. Results and Discussion The average ET was lower in the peripheric zones, whereas the average CT was higher. ET was thinner in the superior area than in the inferior (p<0.05). ET was thicker in boys than in girls (p<0.05), but CT did not differ. CET was not correlated with older age or refractive error. Conclusion Optical coherence tomography analysis of ET reveals that it is thinner in the periphery, where the CT is thicker. Unlike CT, ET seems to be influenced by gender. ET profile proved to be a useful tool in keratoconus diagnosis and subclinical keratoconus detection in adults. As epithelial changes occur early in the disease and keratoconus is more aggressive in pediatric population, a normative database of ET profile could contribute to enhance early recognition of the disease in this age group.
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Affiliation(s)
| | | | - Diogo Lopes
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
| | | | | | - Ana Vide-Escada
- Ophthalmology Department, Hospital Garcia de Orta, Almada, Portugal
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Biomechanical Properties in Different Types of Thin Corneas in Menoufia Population. J Ophthalmol 2021; 2021:6613143. [PMID: 33520298 PMCID: PMC7817240 DOI: 10.1155/2021/6613143] [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: 10/22/2020] [Revised: 11/20/2020] [Accepted: 12/10/2020] [Indexed: 12/03/2022] Open
Abstract
Background To evaluate and compare corneal hysteresis (CH) and corneal resistance factor (CRF) in normal thin (NT) healthy corneas with central corneal thickness (CCT) of 470–500 μm with matched thickness in keratoconus suspect (KCS) and keratoconus (KC) eyes. Methods A total of 103 eyes in three groups were included prospectively: NT, KCS, and KC groups based on clinical examination and Pentacam findings. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured using the ocular response analyzer (ORA). CCT, CH, and CRF were compared between the three groups and statistically analyzed by variance tests. Results The three groups consisted of 44 NT, 26 KCS, and 33 KC. The mean CH measured was 8.689 ± 1.775, 9.051 ± 1.1190, and 8.129 ± 0.8539 mmHg in NT, KCS, and KC eyes, respectively. The mean CRF was 8.441 ± 1.663, 8.337 ± 1.114, and 7.2422 ± 1.3110 mmHg in NT, KCS, and KC eyes, respectively. Within the range of central corneal thickness (470–500 μm), only mean CRF was statistically significantly different between the NT and KC (P < 0.05); there was no statistically significant difference between NT and KCS, nor was the mean CH between each group (P > 0.05). Conclusions CRF only can be helpful in differentiating KC from NT eyes; KCS could not be predicted with either corneal biomechanical metrics. There was no benefit from CH in differentiating between the three study groups.
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Mohammadpour M, Khorrami-Nejad M. Post-LASIK keratectasia in the context of a thicker than intended flap detected by anterior segment optical coherence tomography. SAGE Open Med Case Rep 2021; 9:2050313X211050462. [PMID: 34987816 PMCID: PMC8721368 DOI: 10.1177/2050313x211050462] [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: 08/09/2021] [Accepted: 09/14/2021] [Indexed: 12/02/2022] Open
Abstract
The corneal flap created in LASIK is responsible for most of its advantages in comparison with surface ablation. However, lamellar dissection of the corneal layers in LASIK can also result in serious complications such as corneal ectasia. A 23-year-old man underwent LASIK for correction of −4.75 −2.00@15 in the right eye and −4.50 −2.00@160 in the left eye with a preoperative thinnest corneal thickness of 518 µm/right eye and 513 µm/left eye in 2009. An intended flap thickness and ablation depth in both eyes were 160 µm and 94 µm, respectively, and subsequently, residual stromal bed thickness was 264 µm/right eye and 259 µm/left eye. Several years after surgery, he was referred for the decreased vision. His corrected-distance visual acuity was 0.50 in both eyes. A scissoring reflex was found in retinoscopy. Orbscan imaging was compatible with keratoconus. Anterior segment optical coherence tomography was performed to measure the LASIK flap. It was much thicker (200 µm) than intended (160 µm), and therefore, the residual stromal bed thickness was much thinner. In summary, keratectasia may develop in cases where thicker than expected flaps result in excessive thinning of the residual stromal bed. The obtained results from this case emphasize and remind the importance of intraoperative measurement of flap thickness and using femtosecond and new criteria for patient selection to avoid post-LASIK keratectasia.
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Affiliation(s)
- Mehrdad Mohammadpour
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Khorrami-Nejad
- Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
- School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Purpose. To examine the outcomes of keratorefractive surgeries in keratoconus suspect patients. Methods. This study included 192 keratoconus suspects (351 eyes), treated with photorefractive keratectomy (PRK) (211 eyes), Lasik (96 eyes), and Femto-Lasik (44 eyes) surgeries in an eye clinic. The best spectacle-corrected visual acuity (BSCVA) and subjective refraction were evaluated preoperatively and postoperatively (three months and five years after the procedure). The Orbscan II topography system was also used preoperatively and five years after the procedure. Results. The patients’ mean age was 31.6 ± 5.49 years (range: 21–47 years) in the last follow-up. There was no significant difference between the preoperative and postoperative mean values of BSCVA in any of the surgical methods (
= 0.49). The mean spherical equivalent, cylindrical power, corneal curvature, the thinnest corneal thickness, and the central corneal thickness decreased significantly in the last follow-up (
< 0.001). Four patients (3.50%) in the PRK group and one patient (1.85%) in the Lasik group needed glasses in the last follow-up. Eleven cases of corneal ectasia were detected in the last follow-up (six eyes of four patients [2.84%] and five eyes of four patients [5.20%] in the PRK and Lasik groups, respectively). Conclusion. In the present study, the high risk of postoperative ectasia was detected in keratoconus suspects following PRK and Lasik surgeries. According to the results, it can be concluded that Femto-Lasik surgery provides better outcomes than Lasik and PRK. Overall, the surgical criteria are suggested to be evaluated case by case, and the patients must be followed up over time to assess the corneal topography and refraction stability.
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Abstract
Ectatic corneal disease (ECD) comprises a group of disorders characterized by progressive thinning and subsequent bulging of the corneal structure. Different phenotypes have been recognized, including keratoglobus, pellucid marginal degeneration (PMD), and keratoconus (KC). Keratoconus has been widely investigated throughout the years, but the advent of laser refractive surgery boosted an immediate need for more knowledge and research about ectatic diseases. This article discusses nomenclature of ectatic disease, etiology and pathogenesis, along with treatment options, with special focus ok KC and forme fruste keratoconus.
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Pavlatos E, Chen S, Yang Y, Wang Q, Huang D, Li Y. A Coincident Thinning Index for Keratoconus Identification Using OCT Pachymetry and Epithelial Thickness Maps. J Refract Surg 2020; 36:757-765. [PMID: 33170283 DOI: 10.3928/1081597x-20200925-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 09/10/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To develop a coincident thinning (CTN) index to differentiate between keratoconic and healthy corneas using optical coherence tomography (OCT) measurements of pachymetry and epithelial thickness. METHODS Pattern deviation maps of pachymetry and epithelial thickness were generated using Fourier-domain OCT images of the cornea. The co-localized thinning of the two maps was quantified using a novel CTN index, which was calculated from Gaussian fits of the regions of maximum relative thinning. The CTN index was validated using k-fold cross-validation, and its classification performance was compared to minimum pachymetry and maximum keratometry. RESULTS A total of 82 normal eyes and 133 eyes within three groups of keratoconus severity were evaluated. The pattern deviation maps for the keratoconic eyes showed relative thinning that was larger in magnitude and more strongly correlated with the Gaussian function compared to normal eyes (all P < .01). The distance between the pachymetric and epithelial maximum relative thinning locations was significantly smaller for the keratoconic eyes than for the normal eyes (all P < .02). The CTN index was significantly larger for all three keratoconus groups compared to normal eyes (all P < .0001). The CTN index demonstrated a sensitivity of 100% in detecting manifest keratoconus, 100% for subclinical keratoconus, and 56% for forme fruste keratoconus. The overall classification accuracy was better for the CTN index (93%) than for minimum pachymetry (86%) and maximum keratometry (86%). CONCLUSIONS The CTN index is a highly sensitive measure of coincident pachymetric and epithelial thinning. It provides valuable information for detecting and monitoring early to moderate keratoconus. [J Refract Surg. 2020;36(11):757-765.].
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Shi C, Wang M, Zhu T, Zhang Y, Ye Y, Jiang J, Chen S, Lu F, Shen M. Machine learning helps improve diagnostic ability of subclinical keratoconus using Scheimpflug and OCT imaging modalities. EYE AND VISION 2020; 7:48. [PMID: 32974414 PMCID: PMC7507244 DOI: 10.1186/s40662-020-00213-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 08/19/2020] [Indexed: 12/26/2022]
Abstract
Purpose To develop an automated classification system using a machine learning classifier to distinguish clinically unaffected eyes in patients with keratoconus from a normal control population based on a combination of Scheimpflug camera images and ultra-high-resolution optical coherence tomography (UHR-OCT) imaging data. Methods A total of 121 eyes from 121 participants were classified by 2 cornea experts into 3 groups: normal (50 eyes), with keratoconus (38 eyes) or with subclinical keratoconus (33 eyes). All eyes were imaged with a Scheimpflug camera and UHR-OCT. Corneal morphological features were extracted from the imaging data. A neural network was used to train a model based on these features to distinguish the eyes with subclinical keratoconus from normal eyes. Fisher’s score was used to rank the differentiable power of each feature. The receiver operating characteristic (ROC) curves were calculated to obtain the area under the ROC curves (AUCs). Results The developed classification model used to combine all features from the Scheimpflug camera and UHR-OCT dramatically improved the differentiable power to discriminate between normal eyes and eyes with subclinical keratoconus (AUC = 0.93). The variation in the thickness profile within each individual in the corneal epithelium extracted from UHR-OCT imaging ranked the highest in differentiating eyes with subclinical keratoconus from normal eyes. Conclusion The automated classification system using machine learning based on the combination of Scheimpflug camera data and UHR-OCT imaging data showed excellent performance in discriminating eyes with subclinical keratoconus from normal eyes. The epithelial features extracted from the OCT images were the most valuable in the discrimination process. This classification system has the potential to improve the differentiable power of subclinical keratoconus and the efficiency of keratoconus screening.
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Affiliation(s)
- Ce Shi
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang, 325027 China
| | - Mengyi Wang
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang, 325027 China
| | - Tiantian Zhu
- College of Computer Science and Technology, Zhejiang University of Technology, Hangzhou, Zhejiang 12624 China
| | - Ying Zhang
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang, 325027 China
| | - Yufeng Ye
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang, 325027 China
| | - Jun Jiang
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang, 325027 China
| | - Sisi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang, 325027 China
| | - Fan Lu
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang, 325027 China
| | - Meixiao Shen
- School of Ophthalmology and Optometry, Wenzhou Medical University, 270 Xueyuan Road, Wenzhou, Zhejiang, 325027 China
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Yu AY, Shao H, Pan A, Wang Q, Huang Z, Song B, McAlinden C, Huang J, Chen S. Corneal biomechanical properties in myopic eyes evaluated via Scheimpflug imaging. BMC Ophthalmol 2020; 20:279. [PMID: 32652982 PMCID: PMC7353814 DOI: 10.1186/s12886-020-01530-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
Background To investigate the biomechanical properties of the cornea in myopic eyes using corneal visualization Scheimpflug technology (Corvis ST). The relationships between the biomechanical properties of the cornea and the degree of myopia were also investigated. Methods 265 eyes of 265 subjects were included. Based on spherical equivalent (SE) in diopters (D), participants were divided into four groups: low myopia/control (SE: − 0.50 to − 3.00D), moderate myopia (SE: − 3.00 to − 6.00D), high myopia (SE: − 6.00 to − 10.00D) and severe myopia (SE greater than − 10.00D). Axial length (AL), anterior segment parameters, and corneal biomechanical properties were obtained with the Lenstar LS900, Pentacam HR and Corvis ST, respectively. Results Mean (±SD) SE was − 7.29 ± 4.31D (range: − 0.63 to − 25.75D). Mean AL was 26.31 ± 1.82 mm (range: 21.87 to 31.94 mm). Significant differences were detected within the four groups in terms of six corneal biomechanical parameters: deformation amplitude (DA), time from start until second applanation (A2-time), length of flattened cornea at the second applanation (A2-length), corneal velocity during the first and second applanation (A2-velocity), time from start to highest concavity (HC-time), and central curvature at highest concavity (HC radius). AL was positively associated with DA whereas negatively associated with A1-velocity and A2-length. SE was positively associated with A2-time, HC-time and A2-velocity, whereas negatively associated with DA. IOP was positively associated with four corneal biomechanical parameters and negatively associated with three parameters. Conclusions Eyes with severe myopia showed greater DA, lesser A2 time, HC time, and faster A2-velocity compared to low to high myopia. This suggests the cornea becomes weaker and more deformable with elongation of axial length with corresponding increases in myopia. DA, A2-time and A2-velocity could be useful corneal biomechanical indicators in patients with myopia.
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Affiliation(s)
- A-Yong Yu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Key Laboratory of Vision Science, Ministry of Health Peoples Republic of China, Wenzhou, Zhejiang, China
| | - Hui Shao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Anpeng Pan
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Key Laboratory of Vision Science, Ministry of Health Peoples Republic of China, Wenzhou, Zhejiang, China
| | - Qinmei Wang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Key Laboratory of Vision Science, Ministry of Health Peoples Republic of China, Wenzhou, Zhejiang, China
| | - Zixu Huang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Benhao Song
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Colm McAlinden
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China.,Department of Ophthalmology, Singleton Hospital, Swansea Bay University Health Board, Swansea, UK
| | - Jinhai Huang
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China. .,Key Laboratory of Vision Science, Ministry of Health Peoples Republic of China, Wenzhou, Zhejiang, China. .,Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China.
| | - Sisi Chen
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang, China. .,Key Laboratory of Vision Science, Ministry of Health Peoples Republic of China, Wenzhou, Zhejiang, China. .,Eye Hospital of Wenzhou Medical University, 270 West Xueyuan Road, Wenzhou, Zhejiang, 325027, China.
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Mohammadpour M, Farhadi B, Mirshahi R, Masoumi A, Mirghorbani M. Simultaneous photorefractive keratectomy and accelerated collagen cross-linking in high-risk refractive surgery (Tehran protocol): 3-year outcomes. Int Ophthalmol 2020; 40:2659-2666. [PMID: 32607947 DOI: 10.1007/s10792-020-01447-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 05/23/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate safety and efficacy of performing simultaneous photorefractive keratectomy (PRK) and collagen cross-linking (CXL) in myopic patients with preoperative risk factors for developing keratectasia. METHODS Seventeen eyes of 15 patients with at least one of the following risk factors were recruited: central keratometry (Kmax) between 48 and 50, difference between inferior, superior corneal power (I-S value) between 1.4 and 1.9 and corneal thickness between 450 and 480 µm. Upon final stage of standard PRK, 0.02% mitomycin was applied for 30-50 s, and then, accelerated CXL was performed for 5 min. Pre- and postoperative Oculus Pentacam® imaging for keratometry values, measurement of uncorrected distance visual acuity (UDVA) and corrected distance visual acuity (CDVA) were done for all patients. RESULTS Mean follow-up time was 32.08 ± 7.79 months (range 25-49 months). Mean age of patients was 28.78 ± 3.80 years. Mean postoperative spherical equivalent was + 0.19 ± 0.42 (- 0.5 to + 1.0 [D]). Mean UDVA and CDVA improved from 0.9062 ± 0.485 log MAR and 0.0148 ± 0.043 log MAR to 0.0173 ± 0.040 log MAR and 0.0057 ± 0.023 log MAR, respectively (P = 0.011, P = 0.735). Mild degree of early postoperative stromal haze was seen which did not persist more than 6 months. There was no late stromal haze, corneal ectasia or other major postoperative complication in the follow-up period. CONCLUSION Combined PRK and accelerated CXL is an efficient and safe procedure for high-risk refractive surgery candidates, with no increased risk of persistent corneal haze.
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Affiliation(s)
- Mehrdad Mohammadpour
- Ophthalmology Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Behnaz Farhadi
- Ophthalmology Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
| | - Reza Mirshahi
- Ophthalmology Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran.,Eye Research Center, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Masoumi
- Ophthalmology Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran.
| | - Masoud Mirghorbani
- Ophthalmology Department, Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, 1336616351, Iran
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Anterior and posterior ratio of corneal surface areas: A novel index for detecting early stage keratoconus. PLoS One 2020; 15:e0231074. [PMID: 32240243 PMCID: PMC7117727 DOI: 10.1371/journal.pone.0231074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 03/15/2020] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate the diagnostic ability of the ratio of anterior and posterior corneal surface areas (As/Ps) comparing with other keratoconus screening indices in distinguishing forme fruste keratoconus (FFKC) from normal eyes. Methods In this comparative study, 13 eyes of 13 patients with FFKC, 29 eyes of 29 patients with keratoconus (KC) and 88 eyes of 88 patients with normal subjects were involved. The As/Ps measured by the anterior segment optical coherence tomography (AS-OCT) and other indices measured by AS-OCT and rotating Scheimpflug–based corneal tomography were evaluated. The area under receiver-operating-characteristics (AU-ROC) was calculated to assess the diagnostic ability in discriminating FFKC from normal eyes. Results The As/Ps, the Belin/Ambrosio display enhanced ectasia total derivation value (BAD-D) and posterior and anterior elevation values showed the AU-ROC 0.9 or more in differentiating FFKC from normal eyes (0.980, 0.951, 0.924 and 0.903, respectively). The sensitivity and specificity were 0.92 and 0.96 for the As/Ps, 1.00 and 0.90 for BAD-D, 0.85 and 0.86 for posterior elevation value, and 0.85 and 0.96 for anterior elevation value, respectively. Conclusions Among the several indices for keratoconus screening which we evaluated, the As/Ps obtained by AS-OCT had the large AU-ROC with high sensitivity and specificity in detecting FFKC, which was comparable with BAD-D obtained by rotating Scheimpflug–based corneal tomography. The As/Ps may provide information for improving the diagnostic accuracy of KC, even in the initial stage of the disease.
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Saad A, Binder PS, Gatinel D. Evaluation of the percentage tissue altered as a risk factor for developing post-laser in situ keratomileusis ectasia. J Cataract Refract Surg 2019; 43:946-951. [PMID: 28823442 DOI: 10.1016/j.jcrs.2017.04.040] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/12/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To assess the currently recommended percentage tissue altered (PTA) metric for its ability to screen for ectasia after laser in situ keratomileusis (LASIK). SETTING Gavin Herbert Eye Institute, University of California, Irvine, California, USA, and Rothschild Foundation, Paris, France. DESIGN Retrospective case series. METHODS The study used a LASIK database created by 1 surgeon for LASIK cases with normal preoperative topography that had a minimum follow-up of 24 months with complete preoperative and intraoperative data to permit the calculation of PTA values to detect eyes at risk for developing ectasia. RESULTS Of the eyes, 593 eyes had complete data and met the inclusion criteria. Based on measured flap thickness, 126 eyes (21%) had a PTA value of 40% or more (mean 44) and a percentage of that flap thickness accounted for the PTA (mean 66.7%; range 34% to 92%). The mean attempted laser ablation was 79.8 μm ± 29.2 (SD), and the mean residual bed thickness was 304.4 ± 29.2 μm (range 212 to 369 μm). No eye developed ectasia over a mean follow-up of 30 months. CONCLUSIONS The current PTA calculation when applied to a LASIK population with normal preoperative topography and flap thickness measured with ultrasound did not predict the risk for ectasia. Differences between study populations and assumptions might have accounted for the different outcomes obtained in the initially published PTA study.
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Affiliation(s)
- Alain Saad
- From the Rothschild Foundation (Saad, Gatinel) and the Center of Expertise and Research in Optics for Clinicians (Saad, Gatinel), Paris, France; American University of Beirut (Saad), Beirut, Lebanon; Gavin Herbert Eye Institute (Binder), Department of Ophthalmology, University of California Irvine, Irvine, California, USA.
| | - Perry S Binder
- From the Rothschild Foundation (Saad, Gatinel) and the Center of Expertise and Research in Optics for Clinicians (Saad, Gatinel), Paris, France; American University of Beirut (Saad), Beirut, Lebanon; Gavin Herbert Eye Institute (Binder), Department of Ophthalmology, University of California Irvine, Irvine, California, USA
| | - Damien Gatinel
- From the Rothschild Foundation (Saad, Gatinel) and the Center of Expertise and Research in Optics for Clinicians (Saad, Gatinel), Paris, France; American University of Beirut (Saad), Beirut, Lebanon; Gavin Herbert Eye Institute (Binder), Department of Ophthalmology, University of California Irvine, Irvine, California, USA
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Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Salvestrini P, Piñero DP. New parameters for evaluating corneal biomechanics and intraocular pressure after small-incision lenticule extraction by Scheimpflug-based dynamic tonometry. J Cataract Refract Surg 2019; 43:803-811. [PMID: 28732615 DOI: 10.1016/j.jcrs.2017.03.035] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 03/08/2017] [Accepted: 03/11/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To evaluate parameters and dynamic corneal densitometry with a new dynamic Scheimpflug analyzer (Corvis ST) in eyes having small-incision lenticule extraction (SMILE). SETTING Qvision, Vithas Virgen del Mar Hospital, Almería, Spain. DESIGN Retrospective case series. METHODS The study comprised eyes from the same institution having small-incision lenticule extraction surgery. Preoperative and 1-month postoperative measurements were taken. RESULTS Forty-three eyes were evaluated. The mean difference in intraocular pressure (IOP) and biomechanically corrected IOP before and after surgery was 2.24 mm Hg ± 1.26 mm (SD) (P = .001) and 0.57 ± 1.77 mm Hg (P = .04), respectively. All dynamic Scheimpflug analyzer parameters changed significantly after surgery (P < .05). The variation in each parameter was correlated with the removed corneal thickness (P < .05), except the stiffness parameter at the first applanation (P = .15). None of the 4 dynamic corneal densitometry parameters changed significantly as a result of surgery (P ≥ .29). A new sign, described as an inclined brightness fringe moving through the corneal periphery, appeared preoperatively in eyes with higher dynamic corneal densitometry. This sign was more prevalent postoperatively (48.8% versus 72.1%) (P = .04). CONCLUSIONS The biomechanically corrected IOP measured after surgery with the dynamic Scheimpflug analyzer showed better agreement with the preoperative values than IOP. The stiffness parameter was not dependent on the amount of removed corneal thickness. A new sign correlated with dynamic corneal densitometry was found and might be related to changes in corneal hydration and biomechanics.
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Affiliation(s)
- Joaquín Fernández
- From the Department of Ophthalmology (Fernández, Rodríguez-Vallejo, Martínez, Tauste, Salvestrini), Qvision, Vithas Virgen del Mar Hospital, and the Department of Ophthalmology (Fernández), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain
| | - Manuel Rodríguez-Vallejo
- From the Department of Ophthalmology (Fernández, Rodríguez-Vallejo, Martínez, Tauste, Salvestrini), Qvision, Vithas Virgen del Mar Hospital, and the Department of Ophthalmology (Fernández), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain.
| | - Javier Martínez
- From the Department of Ophthalmology (Fernández, Rodríguez-Vallejo, Martínez, Tauste, Salvestrini), Qvision, Vithas Virgen del Mar Hospital, and the Department of Ophthalmology (Fernández), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain
| | - Ana Tauste
- From the Department of Ophthalmology (Fernández, Rodríguez-Vallejo, Martínez, Tauste, Salvestrini), Qvision, Vithas Virgen del Mar Hospital, and the Department of Ophthalmology (Fernández), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain
| | - Patrizia Salvestrini
- From the Department of Ophthalmology (Fernández, Rodríguez-Vallejo, Martínez, Tauste, Salvestrini), Qvision, Vithas Virgen del Mar Hospital, and the Department of Ophthalmology (Fernández), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain
| | - David P Piñero
- From the Department of Ophthalmology (Fernández, Rodríguez-Vallejo, Martínez, Tauste, Salvestrini), Qvision, Vithas Virgen del Mar Hospital, and the Department of Ophthalmology (Fernández), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain
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Chan C, Saad A, Randleman JB, Harissi-Dagher M, Chua D, Qazi M, Saragoussi JJ, Shetty R, Ancel JM, Ang R, Reinstein DZ, Gatinel D. Analysis of cases and accuracy of 3 risk scoring systems in predicting ectasia after laser in situ keratomileusis. J Cataract Refract Surg 2019; 44:979-992. [PMID: 30115298 DOI: 10.1016/j.jcrs.2018.05.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 03/27/2018] [Accepted: 05/15/2018] [Indexed: 11/17/2022]
Abstract
PURPOSE To identify risk factors for ectasia after laser in situ keratomileusis (LASIK) by comparing the accuracy of the Ectasia Risk Score System (ERSS), Screening Corneal Objective Risk of Ectasia (SCORE) Analyzer, and percentage of tissue altered (PTA) in predicting the occurrence of ectasia. SETTING Multiple centers in 8 countries. DESIGN Retrospective case series. METHODS Previously unpublished post-LASIK ectasia cases were analyzed. Consecutive patients who had LASIK performed at least 5 years previously with no resultant ectasia were used as controls. Axial maps from preoperative Orbscan IIz topographies were analyzed in a masked fashion, and examination files tested with the SCORE Analyzer. The PTA values and ERSS scores were generated using available preoperative and perioperative data. Only eyes with subjectively identified normal preoperative topography were tested with the PTA. Threshold values for the SCORE, ERSS, and PTA were more than or equal to 0, 4, and 40, respectively. RESULTS Ectasia occurred in 31 eyes (22 patients); 79 eyes (44 patients) were used as controls. In all eyes, the sensitivity and specificity for predicting ectasia, respectively, were 67.7% and 79.7% for the ERSS and 64.5% and 100% for the SCORE. In eyes with normal topography (ectasia group, 12 eyes; controls, 64 eyes), the PTA yielded sensitivity of 33.3% and specificity of 85.9%. The area under the receiver operating characteristic curve was highest for SCORE (0.911) followed by the ERSS (0.844) and PTA (0.557). CONCLUSIONS The SCORE was most predictive of ectasia, achieving the best specificity; the ERSS had the best sensitivity. Further studies are required to validate the PTA as a screening metric for ectasia.
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Affiliation(s)
- Cordelia Chan
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - Alain Saad
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - J Bradley Randleman
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - Mona Harissi-Dagher
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - Daniel Chua
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - Mujtaba Qazi
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - Jean-Jacques Saragoussi
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - Rohit Shetty
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - Jean-Marc Ancel
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - Robert Ang
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - Dan Z Reinstein
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom
| | - Damien Gatinel
- From Singapore National Eye Center (Chan, Chua) and Eye Surgeons @ Novena (Chan), Singapore, Singapore; the Rothschild Foundation (Saad, Gatinel), Clinique Lamartine (Ancel), and the Centre D'Ophtalmologie (Saragoussi), Paris, France; the American University of Beirut (Saad), Beirut, Lebanon; Roski Eye Institute (Randleman), University of Southern California, Los Angeles, California, and Pepose Vision Institute (Qazi), Chesterfield, Missouri, USA; the Departement d'Ophtalmologie (Harissi-Dagher), Université de Montréal, Montreal, Quebec, Canada; Narayana Nethralaya Hospital (Shetty), Bangalore, India; Asian Eye Institute (Ang), Manila, Philippines; London Vision Clinic (Reinstein), London, United Kingdom.
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De Stefano VS, Seven I, Randleman JB, Dupps WJ. Custom air puff-derived biomechanical variables in a refractive surgery screening setting: Study from 2 centers. J Cataract Refract Surg 2019; 44:589-595. [PMID: 29773456 DOI: 10.1016/j.jcrs.2018.03.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 03/13/2018] [Accepted: 03/16/2018] [Indexed: 11/18/2022]
Abstract
PURPOSE To assess the ability of air puff-derived biomechanical variables to predict surgeon-perceived candidacy for laser in situ keratomileusis (LASIK). SETTING Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio, and Emory Eye Institute, Emory University, Atlanta, Georgia, USA. DESIGN Retrospective case series. METHODS Data were collected from refractive surgery screening examinations by 2 surgeons at 2 centers. Disqualified cases (19 eyes and 28 eyes from each surgeon) were judged not to be candidates based on available data including standard variables from the Ocular Response Analyzer. Controls consisted of LASIK candidates (n = 26 and 23). Three custom biomechanical variables not available during screening were calculated and compared by group and surgeon. RESULTS The hysteresis loop area was significantly different between disqualified cases and controls for both surgeons (Surgeon 1: controls, 121.50 ± 25.38 [SD], disqualified, 107.62 ± 18.50, P = .04; Surgeon 2: controls, 135.89 ± 22.47, disqualified, 106.11 ± 16.40, P < .001). The area under the curves of the receiver operating characteristics and the cutoff values were statistically significant for the concavity minimum and hysteresis loop area for Surgeon 1 and for all variables except concavity minimum for Surgeon 2. The hysteresis loop area had the highest odds ratio (Surgeon 1, 4.48, Surgeon 2, 20.00). Adjusted R2 in best-subsets regressions were 40.2% for Surgeon 1 and 62.9% for Surgeon 2. CONCLUSIONS The hysteresis loop area was predictive of which patients were disqualified for LASIK at different sites. Certain measures of the corneal dynamic response to an air puff might serve as correlates to clinically perceived ectasia risk.
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Affiliation(s)
- Vinicius S De Stefano
- From the Cole Eye Institute (De Stefano, Seven, Dupps) and the Department of Biomedical Engineering (Dupps), Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, and the Keck School of Medicine (Randleman) and the Roski Eye Institute (Randleman), University of Southern California Los Angeles, Los Angeles, California, USA; Ophthalmology (De Stefano), Federal University of São Paulo, São Paulo, Brazil
| | - Ibrahim Seven
- From the Cole Eye Institute (De Stefano, Seven, Dupps) and the Department of Biomedical Engineering (Dupps), Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, and the Keck School of Medicine (Randleman) and the Roski Eye Institute (Randleman), University of Southern California Los Angeles, Los Angeles, California, USA; Ophthalmology (De Stefano), Federal University of São Paulo, São Paulo, Brazil
| | - J Bradley Randleman
- From the Cole Eye Institute (De Stefano, Seven, Dupps) and the Department of Biomedical Engineering (Dupps), Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, and the Keck School of Medicine (Randleman) and the Roski Eye Institute (Randleman), University of Southern California Los Angeles, Los Angeles, California, USA; Ophthalmology (De Stefano), Federal University of São Paulo, São Paulo, Brazil
| | - William J Dupps
- From the Cole Eye Institute (De Stefano, Seven, Dupps) and the Department of Biomedical Engineering (Dupps), Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, and the Keck School of Medicine (Randleman) and the Roski Eye Institute (Randleman), University of Southern California Los Angeles, Los Angeles, California, USA; Ophthalmology (De Stefano), Federal University of São Paulo, São Paulo, Brazil.
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Ong HS, Farook M, Tan BBC, Williams GP, Santhiago MR, Mehta JS. Corneal Ectasia Risk And Percentage Tissue Altered In Myopic Patients Presenting For Refractive Surgery. Clin Ophthalmol 2019; 13:2003-2015. [PMID: 31686775 PMCID: PMC6798818 DOI: 10.2147/opth.s215144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 08/13/2019] [Indexed: 01/01/2023] Open
Abstract
Purpose A percentage tissue altered (PTA) score of ≥40% has been advocated as an independent indicator of post-operative ectasia risk following laser in-situ keratomileusis (LASIK). This study was performed to test the hypothesis that refractive procedures, such as laser-assisted sub-epithelial keratectomy (LASEK) or small incision lenticule extraction (SMILE), may alter the range of PTA, within which refractive corneal surgery can be safely performed. Setting Refractive department, tertiary ophthalmic hospital. Design Retrospective observational study. Methods Review of case notes was performed for patients who presented for refractive surgeries, other than LASIK. To determine the risk of corneal ectasia for each patient prior to refractive surgery, we estimated what each patient’s PTA would have been if they had undergone LASIK. The Randleman Ectasia Risk Score System (ERSS) was also calculated. Results 114 eyes (66 patients) were included. 94 eyes underwent SMILE. 20 eyes underwent LASEK. A significant proportion of eyes had PTA ≥40% – SMILE eyes: up to 31.9%, LASEK eyes: up to 60.0% (at presumed LASIK flap of 120 μm). The maximum calculated PTA was up to 47.9% in the SMILE group and up to 51.5% in the LASEK group. Using ERSS, 12.8–16% of SMILE eyes and 15.0–80.0% of LASEK eyes would have been considered to have moderate-to-high ectasia risk. No post-surgical ectasia was observed at 3 years. Conclusion SMILE and LASEK alter the range of PTA, within which corneal refractive surgery may be performed with a lower risk of developing post-operative corneal ectasia; a safe PTA threshold needs to be determined for these procedures before recommendations for clinical practice can be made.
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Affiliation(s)
- Hon Shing Ong
- Department of Corneal and External Diseases, Singapore National Eye Centre, Singapore, Singapore.,Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,SingHealth Duke-NUS Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Mohamed Farook
- Department of Corneal and External Diseases, Singapore National Eye Centre, Singapore, Singapore
| | - Benjamin Boon Chuan Tan
- Department of Corneal and External Diseases, Singapore National Eye Centre, Singapore, Singapore
| | - Geraint P Williams
- Department of Corneal and External Diseases, Singapore National Eye Centre, Singapore, Singapore.,Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore
| | - Marcony R Santhiago
- Department of Ophthalmology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Department of Ophthalmology, University of Sao Paulo, Sao Paulo, Brazil
| | - Jodhbir S Mehta
- Department of Corneal and External Diseases, Singapore National Eye Centre, Singapore, Singapore.,Tissue Engineering and Stem Cell Group, Singapore Eye Research Institute, Singapore, Singapore.,SingHealth Duke-NUS Ophthalmology and Visual Sciences Academic Clinical Programme, Duke-NUS Graduate Medical School, Singapore, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore, Singapore
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Ferreira-Mendes J, Lopes BT, Faria-Correia F, Salomão MQ, Rodrigues-Barros S, Ambrósio R. Enhanced Ectasia Detection Using Corneal Tomography and Biomechanics. Am J Ophthalmol 2019; 197:7-16. [PMID: 30201341 DOI: 10.1016/j.ajo.2018.08.054] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 08/30/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To test the accuracy of the Tomographic and Biomechanical Index (TBI) for ectasia detection in an independent population from the original study. DESIGN Retrospective case-control study. METHODS Subjects: Patients were grouped according to clinical diagnosis including corneal topography (front-surface curvature): Normal group, including 1 eye randomly selected from 312 patients with normal corneas; Keratoconus group, including 1 eye randomly selected from 118 patients with keratoconus; a nonoperated ectatic eye from 57 patients with very asymmetric ectasia (57 eyes, VAE-E group), and the nonoperated fellow eye with normal topography (57 eyes, VAE-NT group). MAIN OUTCOME MEASURES The ability of TBI to distinguish normal and ectatic corneas; and comparison with other indexes, including the Belin/Ambrósio Deviation Index (BAD-DI) and the Corvis Biomechanical Index (CBI), considering the areas under receiver operating characteristic curves (AUCs). RESULTS The AUC of the TBI was statistically higher than all other tested parameters (DeLong, P < .001). Considering all cases, the cut-off value of 0.335 for the TBI provided a sensitivity of 94.4% and a specificity of 94.9% (AUC = 0.988; 95% confidence interval [CI] 0.982-0.995). Considering the VAE-NT group, optimized TBI cut-off value of 0.295 provided a sensitivity of 89.5% and a specificity of 91.0% (AUC = 0.960; 95% CI 0.937-0.983). CONCLUSION The TBI was more accurate than all parameters tested for differentiating normal from ectatic corneas. The TBI may epitomize ectasia susceptibility and distinguish cases with fruste disease from true unilateral cases among the eyes with normal-topography VAE.
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Under-the-Flap Crosslinking and LASIK in Early Ectasia with Hyperopic Refractive Error. J Ophthalmol 2018; 2018:4342984. [PMID: 30581603 PMCID: PMC6276485 DOI: 10.1155/2018/4342984] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/15/2018] [Indexed: 11/25/2022] Open
Abstract
Purpose To present safety, efficacy, and early results of a new combinational treatment for early corneal ectasia with hyperopic refractive error aimed to reinstate emmetropia and stabilize cornea. Method This is a retrospective case series. All surgeries were performed at the Beirut Eye Specialist Hospital, Lebanon. Surgical procedure consisted of (1) lifting flap (post-LASIK ectasia)/creation of corneal flap (keratoconus), (2) application of excimer laser ablation to correct refractive error, (3) loose repositioning of flap, (4) under-the-flap irrigation with riboflavin 0.1% dextran solution, and (5) application of UVA light. Results A total of 7 eyes (4 patients; mean age 24.25 years; all male) were included. 2 patients had early keratoconus, and 2 patients had early post-LASIK ectasia. Pretreatment vs. last postoperative follow-up visit (mean 11.25 months; range 6–15 months) UDVA (logMAR), spherical equivalent (SE) (D), astigmatism (D), and central pachymetry (µm) were 0.35 ± 0.18 vs. 0.05 ± 0.07, p=0.017; −0.81 ± 0.67 vs. −0.46 ± 0.57, p=0.078; 2.46 ± 0.53 vs. 0.68 ± 0.28, p=0.018; and 547 ± 58 vs. 536 ± 49, p=0.07, respectively. In all eyes, BCVA was 0.1 logMAR or better before and after treatment. No eye showed a decrease in BCVA. Two eyes of one patient had an epithelial ingrowth, which was removed in one case. Follow-up results showed no major complications and no progression of corneal ectasia. Conclusion Early results showed that under-the-flap CXL with excimer laser correction is an effective treatment for early hyperopic keratectasia, with the advantage of rapid recovery, postoperative corneal stability, and no epithelial healing complications. The procedure seems to bear a risk for postoperative epithelial growth into the flap interface.
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Salomão M, Hoffling-Lima AL, Lopes B, Belin MW, Sena N, Dawson DG, Ambrósio R. Recent developments in keratoconus diagnosis. EXPERT REVIEW OF OPHTHALMOLOGY 2018. [DOI: 10.1080/17469899.2018.1555036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Marcella Salomão
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Instituto Benjamin Constant, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Bernardo Lopes
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Instituto Benjamin Constant, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Department of Biomaterial Mechanics, University of Liverpool, Liverpool, Tucson, UK
| | - Michael W. Belin
- Department of Ophthalmology and Visual Sciences, University of Arizona, USA
| | - Nelson Sena
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Daniel G. Dawson
- Department of Ophthalmology, University of Florida, Gainesville, FL, USA
| | - Renato Ambrósio
- Instituto de Olhos Renato Ambrósio, Rio de Janeiro, Brazil
- Rio de Janeiro Corneal Tomography and Biomechanics Study Group, Rio de Janeiro, Brazil
- Department of Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
- Department of Ophthalmology, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
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Enhanced Tomographic Assessment to Detect Corneal Ectasia Based on Artificial Intelligence. Am J Ophthalmol 2018; 195:223-232. [PMID: 30098348 DOI: 10.1016/j.ajo.2018.08.005] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 12/17/2022]
Abstract
PURPOSE To improve the detection of corneal ectasia susceptibility using tomographic data. DESIGN Multicenter case-control study. METHODS Data from patients from 5 different clinics from South America, the United States, and Europe were evaluated. Artificial intelligence (AI) models were generated using Pentacam HR (Oculus, Wetzlar, Germany) parameters to discriminate the preoperative data of 3 groups: stable laser-assisted in situ keratomileusis (LASIK) cases (2980 patients with minimum follow-up of 7 years), ectasia susceptibility (71 eyes of 45 patients that developed post-LASIK ectasia [PLE]), and clinical keratoconus (KC; 182 patients). Model accuracy was independently tested in a different set of stable LASIK cases (298 patients with minimum follow-up of 4 years) and in 188 unoperated patients with very asymmetric ectasia (VAE); these patients presented normal topography (VAE-NT) in 1 eye and clinically diagnosed ectasia in the other (VAE-E). Accuracy was evaluated with ROC curves. RESULTS The random forest (RF) provided highest accuracy among AI models in this sample with 100% sensitivity for clinical ectasia (KC+VAE-E; cutoff 0.52), being named Pentacam Random Forest Index (PRFI). Considering all cases, the PRFI had an area under the curve (AUC) of 0.992 (94.2% sensitivity, 98.8% specificity; cutoff 0.216), being statistically higher than the Belin/Ambrósio deviation (BAD-D; AUC = 0.960, 87.3% sensitivity, 97.5% specificity; P = .006, DeLong's test). The optimized cutoff of 0.125 provided sensitivity of 85.2% for VAE-NT and 80% for PLE, with 96.6% specificity. CONCLUSION The PRFI enhances ectasia diagnosis. Further integrations with corneal biomechanical parameters and with the corneal impact from laser vision correction are needed for assessing ectasia risk.
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Bohac M, Koncarevic M, Pasalic A, Biscevic A, Merlak M, Gabric N, Patel S. Incidence and Clinical Characteristics of Post LASIK Ectasia: A Review of over 30,000 LASIK Cases. Semin Ophthalmol 2018; 33:869-877. [PMID: 30359155 DOI: 10.1080/08820538.2018.1539183] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To report the incidence of postoperative ectasia after laser in situ keratomileusis (LASIK). METHODS A retrospective case review of 30,167 eyes (16,732 patients) was conducted following LASIK between August 2007 and August 2015. The follow-up was between 2 and 8 years. Tomography was performed after 2 years postop. After identifying cases of ectasia, the charts of these patients were examined to identify any common factors that may have predisposed them to develop ectasia. RESULTS Ten eyes of seven patients developed post-LASIK ectasia. Eight eyes had been treated for myopia and myopic astigmatism, two eyes for mixed astigmatism. There were no cases of ectasia after LASIK for hyperopia. All 10 cases of ectasia had a flap that was created using the Moria M2 mechanical microkeratome (average flap thickness 118.15 ± 12.88 µm) and refractive error corrected using the Wavelight Allegretto excimer laser. Retrospectively, most prevalent risk factors were thin cornea (≤ 500 µm, 50% of cases), anterior topographic map irregularities (e.g., asymmetric bow tie, 40% of cases), Ectasia Risk Score > 3 (40% of cases), percent tissue thickness alteration ≥ 40% (20% of cases) and low residual stromal bed (≤ 300 µm, 30% of cases). One eye had no identifiable risk factors. In the retrospective chart review 14.97% (4,506) of all the eyes had similar risk factors to the cases that went on to develop ectasia. CONCLUSION The incidence of ectasia was 0.033% over 8 years. The incidence could be higher as some cases may destabilize beyond this period and some patients were lost to follow-up asymptomatic of any clinical signs. Other intrinsic factors may trigger the development of post LASIK ectasia. The current widely accepted risk factors are not sufficiently rigorous for screening out potential ectasia from developing after LASIK. There is a need to augment accuracy with higher sensitivity and specificity.
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Affiliation(s)
- Maja Bohac
- a School of Medicine, University of Rijeka , Specialty Eye Hospital "Svjetlost" , Zagreb , Croatia
| | - Mateja Koncarevic
- a School of Medicine, University of Rijeka , Specialty Eye Hospital "Svjetlost" , Zagreb , Croatia
| | - Adi Pasalic
- a School of Medicine, University of Rijeka , Specialty Eye Hospital "Svjetlost" , Zagreb , Croatia
| | - Alma Biscevic
- a School of Medicine, University of Rijeka , Specialty Eye Hospital "Svjetlost" , Zagreb , Croatia
| | - Maja Merlak
- b Department of Ophthalmology , School of Medicine, University of Rijeka , Rijeka , Croatia
| | - Nikica Gabric
- a School of Medicine, University of Rijeka , Specialty Eye Hospital "Svjetlost" , Zagreb , Croatia
| | - Sudi Patel
- a School of Medicine, University of Rijeka , Specialty Eye Hospital "Svjetlost" , Zagreb , Croatia.,c NHS National Services Scotland , Edinburgh , UK
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Fernández J, Rodríguez-Vallejo M, Martínez J, Tauste A, Piñero DP. Corneal biomechanics after laser refractive surgery: Unmasking differences between techniques. J Cataract Refract Surg 2018; 44:390-398. [PMID: 29615281 DOI: 10.1016/j.jcrs.2017.10.054] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 10/17/2022]
Abstract
The hypothesis that small-incision lenticule extraction provides better preservation of corneal biomechanics than previous laser refractive techniques has led to a growth in the interest in clinical and experimental research in this field. This hypothesis is based on the fact that corneal layers with greater stiffness are preserved with this new technique. However, this hypothesis is controversial because clinical research has shown a great disparity in the outcomes. In this review, we performed an in-depth analysis of the factors that might affect corneal biomechanics in laser refractive surgery procedures from a macrostructural to a microstructural viewpoint. New advances in algorithms with current devices or the introduction of new devices might help unmask the possible advantages of small-incision lenticule extraction in corneal biomechanics.
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Affiliation(s)
- Joaquín Fernández
- From the Department of Ophthalmology (Qvision) (Fernández, Rodríguez-Vallejo, Martínez, Tauste), Vithas Virgen del Mar Hospital and the Department of Ophthalmology (Fernández, Piñero), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain
| | - Manuel Rodríguez-Vallejo
- From the Department of Ophthalmology (Qvision) (Fernández, Rodríguez-Vallejo, Martínez, Tauste), Vithas Virgen del Mar Hospital and the Department of Ophthalmology (Fernández, Piñero), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain.
| | - Javier Martínez
- From the Department of Ophthalmology (Qvision) (Fernández, Rodríguez-Vallejo, Martínez, Tauste), Vithas Virgen del Mar Hospital and the Department of Ophthalmology (Fernández, Piñero), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain
| | - Ana Tauste
- From the Department of Ophthalmology (Qvision) (Fernández, Rodríguez-Vallejo, Martínez, Tauste), Vithas Virgen del Mar Hospital and the Department of Ophthalmology (Fernández, Piñero), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain
| | - David P Piñero
- From the Department of Ophthalmology (Qvision) (Fernández, Rodríguez-Vallejo, Martínez, Tauste), Vithas Virgen del Mar Hospital and the Department of Ophthalmology (Fernández, Piñero), Torrecárdenas Hospital Complex, Almería, and the Department of Optics, Pharmacology and Anatomy (Piñero), University of Alicante, and the Department of Ophthalmology (Piñero), Vithas Medimar International Hospital, Alicante, Spain
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Validation of an Objective Keratoconus Detection System Implemented in a Scheimpflug Tomographer and Comparison With Other Methods. Cornea 2018; 36:689-695. [PMID: 28368992 DOI: 10.1097/ico.0000000000001194] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To validate a recently developed program for automatic and objective keratoconus detection (Keratoconus Assistant [KA]) by applying it to a new population and comparing it with other methods described in the literature. METHODS KA uses machine learning and 25 Pentacam-derived parameters to classify eyes into subgroups, such as keratoconus, keratoconus suspect, postrefractive surgery, and normal eyes. To validate this program, it was applied to 131 eyes diagnosed separately by experienced corneal specialists from 2 different centers (Fondation Rothschild, Paris, and Antwerp University Hospital [UZA]). The agreement of the KA classification with 7 other indices from the literature was assessed using interrater reliability and confusion matrices. The agreement of the 2 clinical classifications was also assessed. RESULTS For keratoconus, KA agreed in 92.6% of cases with the clinical diagnosis by UZA and in 98.0% of cases with the diagnosis by Rothschild. In keratoconus suspect and forme fruste detection, KA agreed in 65.2% (UZA) and 100% (Rothschild) of cases with the clinical assessments. This corresponds with a moderate agreement with a clinical assessment (κ = 0.594 and κ = 0.563 for Rothschild and UZA, respectively). The agreement with the other classification methods ranged from moderate (κ = 0.432; Score) to low (κ = 0.158; KISA%). Both clinical assessments agreed substantially (κ = 0.759) with each other. CONCLUSIONS KA is effective at detecting early keratoconus and agrees with trained clinical judgment. As keratoconus detection depends on the method used, we recommend using multiple methods side by side.
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