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Vasanthananthan K, Bourgonje VJA, Lie JT, Mulders-Al-Saady R, Groeneveld-van Beek EA, de Leeuw J, Miron A, Wijdh RHJ, Stoutenbeek R, Melles GRJ, Oellerich S, Kocaba V. Corneal Guttae After Descemet Membrane Endothelial Keratoplasty. Cornea 2024; 43:146-153. [PMID: 37088908 DOI: 10.1097/ico.0000000000003287] [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: 12/19/2022] [Accepted: 03/09/2023] [Indexed: 04/25/2023]
Abstract
PURPOSE The aim of this study was to report on the occurrence of corneal guttae after Descemet membrane endothelial keratoplasty (DMEK). METHODS In this retrospective case series, 13 eyes of 13 patients who underwent DMEK at 2 tertiary referral centers between 2007 and 2021 (average available follow-up 73 ± 52 months, range 18-174 months) and showed corneal guttae during postoperative examinations were included. Eye bank images were retrospectively reviewed. RESULTS Occurrence of guttae was observed by specular microscopy in 13 eyes. In 11 cases, presence of guttae was confirmed by confocal microscopy and in 1 case by histology. Five eyes showed an increase in guttae density during the postoperative course. Surgery indications were Fuchs endothelial corneal dystrophy (n = 11), pseudophakic bullous keratopathy (n = 1), and DMEK graft failure after allograft rejection (n = 1); the latter eye had shown no signs of guttae after primary DMEK. Two eyes with guttae required a repeat DMEK due to graft failure. At the last available follow-up, all 11 remaining eyes had clear corneas and 10 eyes had a best-corrected visual acuity of ≥0.9 (decimal). During donor cornea processing in the eye bank, no guttae were observed on the donor tissue. CONCLUSIONS Corneal guttae can occur after DMEK including in eyes operated for indications other than Fuchs endothelial corneal dystrophy and most likely guttae were present on the donor graft but were not detectable by routine slit-lamp and light microscopy evaluation in the eye bank. Postoperative guttae density varies among patients and especially small isolated guttae do not seem to affect clinical outcomes.
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Affiliation(s)
- Keamela Vasanthananthan
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Vincent J A Bourgonje
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Jessica T Lie
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands
| | - Rana Mulders-Al-Saady
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
| | - Esther A Groeneveld-van Beek
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands
| | - Jacky de Leeuw
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Alina Miron
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Robert H J Wijdh
- Universitair Medisch Centrum Groningen, Groningen, the Netherlands; and
| | - Remco Stoutenbeek
- Universitair Medisch Centrum Groningen, Groningen, the Netherlands; and
| | - Gerrit R J Melles
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
- Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands
| | - Silke Oellerich
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
| | - Viridiana Kocaba
- Netherlands Institute for Innovative Ocular Surgery, Rotterdam, the Netherlands
- Melles Cornea Clinic Rotterdam, Rotterdam, the Netherlands
- Amnitrans EyeBank Rotterdam, Rotterdam, the Netherlands
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore
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Singh RB, Parmar UPS, Kahale F, Jeng BH, Jhanji V. Prevalence and Economic Burden of Fuchs Endothelial Corneal Dystrophy in the Medicare Population in the United States. Cornea 2023:00003226-990000000-00402. [PMID: 37906001 DOI: 10.1097/ico.0000000000003416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/23/2023] [Indexed: 11/02/2023]
Abstract
PURPOSE The aim of this study was to assess the prevalence and economic burden of Fuchs endothelial corneal dystrophy (FECD) in patients older than 65 years in the United States. METHODS A retrospective analysis of the Medicare data reported to the Vision and Eye Health Surveillance System including patients diagnosed with FECD between 2014 and 2019 was performed. The crude prevalence rate of FECD was assessed and extrapolated to estimate the total case burden in the United States. The prevalence data were further compared between men and women and different racial groups. In addition, the economic burden was computed using inflation-adjusted direct costs of treatment to patients. RESULTS The Medicare database included 25,432,700 patients older than 65 years. The national prevalence of FECD in this population cohort was calculated to be 1.12% in 2019. In 2019, FECD case burden in Medicare patients older than 65 years was 284,846 and total estimated FECD case count in the country in this age group was 591,226. FECD prevalence was significantly higher in women as compared to men during the 6-year period evaluated in this study. The intergroup comparison revealed that FECD prevalence in the White population was significantly higher than all other racial groups (P < 0.0001). The total inflation-adjusted economic burden of FECD in the United States in 2019 was USD 291.648 million and has increased from USD 243.998 million over the 6-year study period. CONCLUSIONS The estimated prevalence of FECD in the individuals older than 65 years is 1.12% in the United States. FECD prevalence is significantly higher in women and White population compared with other ethnicities.
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Affiliation(s)
- Rohan Bir Singh
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
- Department of Population, Policy and Practice Research, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
- Discipline of Ophthalmology and Visual Sciences, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | | | - Francesca Kahale
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | - Bennie H Jeng
- Scheie Eye Institute, Perelman School of Medicine, University of Pennslyvania, Philadelphia, PA; and
| | - Vishal Jhanji
- Vision Institute, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, PA
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3
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Han S, Mueller C, Wuebbolt C, Kilcullen S, Nayyar V, Calle Gonzalez B, Mahdavi Fard A, Floss JC, Morales MJ, Patel SP. Selective effects of estradiol on human corneal endothelial cells. Sci Rep 2023; 13:15279. [PMID: 37714879 PMCID: PMC10504266 DOI: 10.1038/s41598-023-42290-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023] Open
Abstract
In Fuchs endothelial corneal dystrophy (FECD), mitochondrial and oxidative stresses in corneal endothelial cells (HCEnCs) contribute to cell demise and disease progression. FECD is more common in women than men, but the basis for this observation is poorly understood. To understand the sex disparity in FECD prevalence, we studied the effects of the sex hormone 17-β estradiol (E2) on growth, oxidative stress, and metabolism in primary cultures of HCEnCs grown under physiologic ([O2]2.5) and hyperoxic ([O2]A) conditions. We hypothesized that E2 would counter the damage of oxidative stress generated at [O2]A. HCEnCs were treated with or without E2 (10 nM) for 7-10 days under both conditions. Treatment with E2 did not significantly alter HCEnC density, viability, ROS levels, oxidative DNA damage, oxygen consumption rates, or extracellular acidification rates in either condition. E2 disrupted mitochondrial morphology in HCEnCs solely from female donors in the [O2]A condition. ATP levels were significantly higher at [O2]2.5 than at [O2]A in HCEnCs from female donors only, but were not affected by E2. Our findings demonstrate the resilience of HCEnCs against hyperoxic stress. The effects of hyperoxia and E2 on HCEnCs from female donors suggest cell sex-specific mechanisms of toxicity and hormonal influences.
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Affiliation(s)
- Seoyoung Han
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Christian Mueller
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Caitlin Wuebbolt
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Sean Kilcullen
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Varinda Nayyar
- Research Service, Veterans Administration Western New York Healthcare System, Buffalo, NY, USA
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Brayan Calle Gonzalez
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Ali Mahdavi Fard
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Jamie C Floss
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Michael J Morales
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Sangita P Patel
- Research Service, Veterans Administration Western New York Healthcare System, Buffalo, NY, USA.
- Department of Ophthalmology, Ross Eye Institute, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.
- Ophthalmology Service, Veterans Administration Western New York Healthcare System, Buffalo, NY, USA.
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4
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Han S, Mueller C, Wuebbolt C, Kilcullen S, Nayyar V, Gonzalez BC, Fard AM, Floss JC, Morales MJ, Patel SP. Selective effects of estradiol on human corneal endothelial cells. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.04.27.538629. [PMID: 37162976 PMCID: PMC10168450 DOI: 10.1101/2023.04.27.538629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Fuchs endothelial corneal dystrophy (FECD) results from genetic and environmental factors triggering mitochondrial and oxidative stress in corneal endothelial cells (CEnCs) leading to CEnC death and corneal opacification. FECD is more common in women than men, but the basis for this observation is unknown. Because FECD is commonly diagnosed around the time of the menopausal transition in women when estrogen levels decrease precipitously, we studied the effects of the potent estrogen,17-β estradiol (E2) on growth, oxidative stress, and metabolism in primary cultures of human CEnCs (HCEnCs) under conditions of physiologic 2.5% O 2 ([O 2 ] 2.5 ) and under hyperoxic stress ([O 2 ] A : room air + 5% CO 2 ). We hypothesized that E2 would counter the stresses of the hyperoxic environment in HCEnCs. HCEnCs were treated ± 10 nM E2 for 7-10 days at [O 2 ] 2.5 and [O 2 ] A followed by measurements of cell density, viability, reactive oxygen species (ROS), mitochondrial morphology, oxidative DNA damage, ATP levels, mitochondrial respiration (O 2 consumption rate [OCR]), and glycolysis (extracellular acidification rate [ECAR]). There were no significant changes in HCEnC density, viability, ROS levels, oxidative DNA damage, OCR, and ECAR in response to E2 under either O 2 condition. We found that E2 disrupted mitochondrial morphology in HCEnCs from female donors but not male donors at the [O 2 ] A condition. ATP levels were significantly higher at [O 2 ] 2.5 compared to [O 2 ] A in HCEnCs from female donors only, but were not affected by E2. Our findings demonstrate the overall resilience of primary HCEnCs against hyperoxic stress. The selective detrimental effects of hyperoxia and estradiol on HCEnCs from female but not male donors suggests mechanisms of toxicity based upon cell-sex in addition to hormonal environment.
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Affiliation(s)
- Seoyoung Han
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Christian Mueller
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Caitlin Wuebbolt
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Sean Kilcullen
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Varinda Nayyar
- Research Service, Veterans Administration of Western New York Healthcare System, Buffalo, New York, USA
- Ross Eye Institute, Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Brayan Calle Gonzalez
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Ali Mahdavi Fard
- Ross Eye Institute, Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Jamie C. Floss
- Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Michael J. Morales
- Department of Physiology and Biophysics, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Sangita P. Patel
- Research Service, Veterans Administration of Western New York Healthcare System, Buffalo, New York, USA
- Ross Eye Institute, Department of Ophthalmology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
- Ophthalmology Service, Veterans Administration of Western New York Healthcare System, Buffalo, New York, USA
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Liu S, Sadan AN, Muthusamy K, Zarouchlioti C, Jedlickova J, Pontikos N, Thaung C, Hardcastle AJ, Netukova M, Skalicka P, Dudakova L, Bunce C, Tuft SJ, Davidson AE, Liskova P. Phenotype and genotype of concurrent keratoconus and Fuchs endothelial corneal dystrophy. Acta Ophthalmol 2023. [PMID: 36883248 DOI: 10.1111/aos.15654] [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: 08/15/2022] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 03/09/2023]
Abstract
PURPOSE To characterise the phenotype and genotype of concurrent keratoconus and Fuchs endothelial corneal dystrophy (KC + FECD). METHODS We recruited 20 patients with concurrent KC + FECD for a retrospective observational case series from the United Kingdom and the Czech Republic. We compared eight parameters of corneal shape (Pentacam, Oculus) with two groups of age-matched controls who had either isolated keratoconus (KC) or isolated FECD. We genotyped probands for an intronic triplet TCF4 repeat expansion (CTG18.1) and the ZEB1 variant c.1920G >T p.(Gln640His). RESULTS The median age at diagnosis of patients with KC + FECD was 54 (interquartile range 46 to 66) years, with no evidence of KC progression (median follow-up 84 months, range 12 to 120 months). The mean (standard deviation (SD)) of the minimum corneal thickness, 493 (62.7) μm, was greater than eyes with KC, 458 (51.1) μm, but less than eyes with FECD, 590 (55.6) μm. Seven other parameters of corneal shape were more like KC than FECD. Seven (35%) probands with KC + FECD had a TCF4 repeat expansion of ≥50 compared to five controls with isolated FECD. The average of the largest TCF4 expansion in cases with KC + FECD (46 repeats, SD 36 repeats) was similar to the age-matched controls with isolated FECD (36 repeats, SD 28 repeats; p = 0.299). No patient with KC + FECD harboured the ZEB1 variant. CONCLUSIONS The KC + FECD phenotype is consistent with KC but with superimposed stromal swelling from endothelial disease. The proportion of cases with a TCF4 expansion is similar in concurrent KC + FECD and age-matched controls with isolated FECD.
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Affiliation(s)
- Siyin Liu
- Manchester Royal Eye Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,UCL Institute of Ophthalmology, London, UK
| | | | - Kirithika Muthusamy
- UCL Institute of Ophthalmology, London, UK.,Moorfields Eye Hospital, London, UK
| | | | - Jana Jedlickova
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | | | - Caroline Thaung
- UCL Institute of Ophthalmology, London, UK.,Moorfields Eye Hospital, London, UK
| | | | - Magdalena Netukova
- Eye Clinic, Medical Faculty Charles University, Teaching Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Pavlina Skalicka
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Lubica Dudakova
- Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Catey Bunce
- UCL Institute of Ophthalmology, London, UK.,Moorfields Eye Hospital, London, UK
| | - Stephen J Tuft
- UCL Institute of Ophthalmology, London, UK.,Moorfields Eye Hospital, London, UK
| | | | - Petra Liskova
- UCL Institute of Ophthalmology, London, UK.,Department of Paediatrics and Inherited Metabolic Disorders, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic.,Department of Ophthalmology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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6
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Schmitz L, Safi T, Munteanu C, Seitz B, Daas L. Prevalence and severity of cornea guttata in the graft following Descemet Membrane Endothelial Keratoplasty (DMEK). Acta Ophthalmol 2022; 100:e1737-e1745. [PMID: 35652475 DOI: 10.1111/aos.15195] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 05/14/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this study was to determine the prevalence and severity of cornea guttata (CG) in grafts after Descemet membrane endothelial keratoplasty (DMEK) and to investigate its impact on various clinical parameters during follow-up. METHODS This retrospective study included 664 operations (DMEK and triple-DMEK) on 466 patients. The prevalence and progression of CG after the operation were examined using endothelial specular microscopy images. The severity grade of CG was classified into four grades: G0 without CG, G1 - G3 with increasing severity of CG. Clinical parameters such as central corneal thickness (CCT), visual acuity (VA), endothelial cell density (ECD), pleomorphism and polymegalism were examined during a postoperative follow-up time of 19.6 ± 15.8 months. RESULTS Cornea guttata (CG) appeared postoperatively in 124 (18.7%) eyes. 112 (16.9%) could be classified as G1, 9 (1.4%) as G2 and only 3 (0.5%) as G3. The examination of clinical parameters showed significant differences between healthy and low-grade CG (G0/G1) and high-grade CG (G2/G3). A significant deterioration was found in the corrected distance visual acuity (CDVA) (p = 0.02). CCT showed an increase between G0 (534 ± 58 μm) and G2 (549 ± 71 μm)/G3 (558 ± 56 μm) with a p-value of 0.02. Additionally, a significant increase in pleomorphism (p = 0.003) and polymegalism (p = 0.04) was detected. CONCLUSION Cornea guttata (CG) prevalence after DMEK and triple-DMEK was found to be 18.7%, although most of these cases were classified as low-grade CG and showed no clinical significance. Around 1.9% were classified as high-grade CG and significantly affected several clinical parameters during the follow-up.
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Affiliation(s)
- Lena‐Marie Schmitz
- Department of Ophthalmology Saarland University Medical Center (UKS) Homburg/Saar Germany
| | - Tarek Safi
- Department of Ophthalmology Saarland University Medical Center (UKS) Homburg/Saar Germany
| | - Cristian Munteanu
- Department of Ophthalmology Saarland University Medical Center (UKS) Homburg/Saar Germany
| | - Berthold Seitz
- Department of Ophthalmology Saarland University Medical Center (UKS) Homburg/Saar Germany
| | - Loay Daas
- Department of Ophthalmology Saarland University Medical Center (UKS) Homburg/Saar Germany
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Menzel-Severing J, Geerling G. Descemet Stripping without Transplantation in Fuchs Endothelial Corneal Dystrophy. Klin Monbl Augenheilkd 2022; 239:760-766. [PMID: 35580623 DOI: 10.1055/a-1751-3411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Traditionally, corneal endothelium is considered post-mitotic, which means that spontaneous regeneration after loss of endothelial cells (e.g., in the context of Fuchs endothelial corneal dystrophy) is not expected. Nevertheless, it has been observed in several cases that an edematous cornea can clear after removal of a smaller area of Descemet's membrane. The posterior aspect of this area becomes covered again by corneal endothelial cells. This has resulted in a new surgical approach that does not involve a posterior lamellar graft: "Descemet stripping only". At the same time, data from in vitro experiments suggest that Rho kinase inhibitors (ROCK inhibitors) are pharmacological agents that promote proliferation and migration of corneal endothelium, and thus have a positive influence on healing.
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Affiliation(s)
| | - Gerd Geerling
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Deutschland
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8
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Viberg A, Westin IM, Golovleva I, Byström B. TCF4 trinucleotide repeat expansion in Swedish cases with Fuchs' endothelial corneal dystrophy. Acta Ophthalmol 2021; 100:541-548. [PMID: 34644448 DOI: 10.1111/aos.15032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/22/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Fuchs' endothelial corneal dystrophy (FECD) has been considered a genetically heterogeneous disease but is increasingly associated with the transcription factor 4 (TCF4) gene. This study investigates the prevalence of the cytosine-thymine-guanine (CTG)n repeat expansion in TCF4 among FECD patients in northern Sweden coupled to the phenotype. METHODS Blood samples were collected from 85 FECD cases at different stages. Short tandem repeat PCR and triplet repeat-primed PCR were applied in order to determine TCF4 (CTG)n genotype. RESULTS A (CTG)n repeat expansion (n > 50) in TCF4 was identified in 76 of 85 FECD cases (89.4%) and in four of 102 controls (3.9%). The median (CTG)n repeat length was 81 (IQR 39.3) in mild FECD and 87 (IQR 13.0) in severe FECD (p = 0.01). A higher number of (CTG)n repeats in an expanded TCF4 allele increased the probability of severe FECD. Other ocular surgery was overrepresented in FECD cases without a (CTG)n repeat expansion (44.4%, n = 4) compared with 3.9% (n = 3) in FECD cases with an (CTG)n repeat expansion (p < 0.001). CONCLUSION In northern Sweden, the FECD phenotype is associated with (CTG)n expansion in the TCF4 gene, with nearly 90% of patients being hetero- or homozygous for (CTG)n expansion over 50 repeats. Furthermore, the severity of FECD was associated with the repeat length in the TCF4 gene. Ocular surgery might act as an environmental factor explaining the clinical disease in FECD without a repeat expansion in TCF4.
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Affiliation(s)
- Andreas Viberg
- Department of Clinical Sciences/Ophthalmology Umeå University Umeå Sweden
| | - Ida Maria Westin
- Department of Medical Biosciences/Medical and Clinical Genetics Umeå University Umeå Sweden
| | - Irina Golovleva
- Department of Medical Biosciences/Medical and Clinical Genetics Umeå University Umeå Sweden
| | - Berit Byström
- Department of Clinical Sciences/Ophthalmology Umeå University Umeå Sweden
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9
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Safi T, Daas L, Kiefer GL, Sharma M, Ndiaye A, Deru M, Alexandersson J, Seitz B. Semiquantitative Criteria in the Eye Bank That Correlate with Cornea Guttata in Donor Corneas. Klin Monbl Augenheilkd 2021; 238:680-687. [PMID: 34157770 DOI: 10.1055/a-1498-1846] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cornea guttata may not be recognized in the eye bank and recent studies have displayed that guttae are transplanted in about 15% of cases in varying severities. The purpose of this study was to establish semiquantitative criteria for the detection of cornea guttata in donor corneas in the eye bank. METHODS In this retrospective cohort study, preoperative endothelial pictures of donor corneas were collected and classified according to the post-penetrating keratoplasty cornea guttata grade into three distinct groups: group 1 consists of healthy corneas with no guttae (guttata grade 0); group 2 constitutes corneas with mild asymptomatic cornea guttata (guttata grade +); and group 3 comprises corneas with advanced widespread cornea guttata (guttata grade ++/+++/++++). The preoperative pictures of each group were then individually analyzed using the following five semiquantitative criteria: The number and the area of the cell-depleted surfaces, the presence of less than 50% of the cells having a hexagonal or a circular shape, the presence of cell membrane defects and interruptions, the presence of blebs in the cell membrane, and the presence of groups of cells with a distinct whitish color. RESULTS In total, 262 patients were included in this study, with a total number of 1582 preoperative donor corneal endothelial pictures. Out of those pictures, groups 1, 2, and 3 encompassed 995 (62.9%), 411 (26.0%), and 176 (11.1%) pictures, respectively. Three out of the five eye bank criteria were found to correlate with postoperative cornea guttata with a highly significant p value of < 0.001. These three criteria are the presence of less than 50% of the cells having a hexagonal or a circular shape, the presence of cell membrane defects and interruptions and, the presence of blebs. The presence of groups of cells with a distinct whitish color was only a weak predictive factor for cornea guttata (p = 0.069). There was no statistically significant correlation between the number and the area of cell-depleted surfaces and postoperative cornea guttata with a p = 0.181. CONCLUSION Three semiquantitative criteria that can be detected in the eye bank using inverted light microscopy seem to correlate with postoperative cornea guttata: The presence of blebs, the presence of cell membrane defects and interruptions, as well as endothelial pictures with less than 50% of the cells having a hexagonal of circular shape. The presence of groups of cells with a distinct whitish color appears to be a weak predictor of cornea guttata.
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Affiliation(s)
- Tarek Safi
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Loay Daas
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
| | - Gian-Luca Kiefer
- Department of Cognitive Assistants, German Research Centre for Artificial Intelligence Saarbrucken Branch, Saarbrucken, Germany
| | - Mansi Sharma
- Department of Cognitive Assistants, German Research Centre for Artificial Intelligence Saarbrucken Branch, Saarbrucken, Germany
| | - Alassane Ndiaye
- Department of Cognitive Assistants, German Research Centre for Artificial Intelligence Saarbrucken Branch, Saarbrucken, Germany
| | - Matthieu Deru
- Department of Cognitive Assistants, German Research Centre for Artificial Intelligence Saarbrucken Branch, Saarbrucken, Germany
| | - Jan Alexandersson
- Department of Cognitive Assistants, German Research Centre for Artificial Intelligence Saarbrucken Branch, Saarbrucken, Germany
| | - Berthold Seitz
- Department of Ophthalmology, Saarland University Hospital and Saarland University Faculty of Medicine, Homburg, Germany
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10
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Guo SP, Chang HC, Lu LS, Liu DZ, Wang TJ. Activation of kelch-like ECH-associated protein 1/nuclear factor erythroid 2-related factor 2/antioxidant response element pathway by curcumin enhances the anti-oxidative capacity of corneal endothelial cells. Biomed Pharmacother 2021; 141:111834. [PMID: 34153850 DOI: 10.1016/j.biopha.2021.111834] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/04/2021] [Accepted: 06/14/2021] [Indexed: 01/24/2023] Open
Abstract
Fuchs endothelial corneal dystrophy is one of the most common indications for corneal transplantation, and impaired anti-oxidative function is observed in corneal endothelial cells (CECs). Curcumin is well-known for its anti-oxidative property; but, no study has examined the effect of curcumin on anti-oxidative therapeutic roles in corneal endothelial disease. In our experiments, oxidative stress 0.25 mM tert-butyl hydroperoxide for 2 h was induced in immortalized human CECs pretreated with curcumin. Cell behavior and viability, reactive oxygen species production, and the protein expression of the kelch-like ECH-associated protein 1 (Keap1)/nuclear factor erythroid 2-related factor 2(Nrf2)/antioxidant response element (ARE) pathway were examined; the Keap1/Nrf2/ARE pathway is crucial anti-oxidative pathway of curcumin. The results showed that pretreatment with 12.5 μM curcumin significantly reduced the ROS production and improved the survival of CECs under oxidative stress. In addition, curcumin pretreatment significantly increased the expression of nuclear Nrf2, and the productions of superoxide dismutase 1 and heme oxygenase-1, which were the target anti-oxidative enzymes of the Keap1/Nrf2/ARE pathway. Our findings showed that curcumin enhanced the growth and differentiation of CECs under oxidative stress. The activation of Keap1/Nrf2/ARE pathway by curcumin was crucial for CECs to improve their anti-oxidative capacity.
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Affiliation(s)
- Siao-Pei Guo
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei 110301, Taiwan; Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110301, Taiwan
| | - Hua-Ching Chang
- Department of Dermatology, Taipei Medical University Hospital, Taipei 110301, Taiwan
| | - Long-Sheng Lu
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 110301, Taiwan; Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110301, Taiwan
| | - Der-Zen Liu
- Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 110301, Taiwan; Medical and Pharmaceutical Industry Technology and Development Center, New Taipei City 248, Taiwan
| | - Tsung-Jen Wang
- Department of Ophthalmology, Taipei Medical University Hospital, Taipei 110301, Taiwan; Department of Ophthalmology, School of Medicine, College of Medicine, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei 110301, Taiwan.
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11
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Aketa N, Uchino M, Kawashima M, Uchino Y, Yuki K, Ozawa Y, Sasaki M, Yamagishi K, Sawada N, Tsugane S, Tsubota K, Iso H. Myopia, corneal endothelial cell density and morphology in a Japanese population-based cross-sectional study: the JPHC-NEXT Eye Study. Sci Rep 2021; 11:6366. [PMID: 33737603 PMCID: PMC7973534 DOI: 10.1038/s41598-021-85617-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 03/03/2021] [Indexed: 01/27/2023] Open
Abstract
This population-based cross-sectional study was performed to determine the mean corneal endothelial cell density (ECD), coefficient of variation (CV), and hexagonality (HEX), and their associations with myopia in Japanese adults living in Chikusei city. Of 7109 participants with available data, 5713 (2331 male and 3382 female) participants were eligible for analysis. After assessing the relationship between participant characteristics and spherical equivalent refraction (SER), the association of SER with the abnormal value of ECD (< 2000 cells/mm), CV (≥ 0.40), and HEX (≤ 50%) were determined using the logistic regression models adjusting for potential confounders (age, intraocular pressure, keratometric power, height, and antihypertensive drug use). In male participants, there was no statistically significant relationships between SER and endothelial parameters. In female participants, compared to emmetropia, SER ≤ − 6 D had significantly higher odds ratio (OR) of having the abnormal value of CV (OR = 2.07, 95% confidence interval [CI] 1.39–3.10) and HEX (OR = 2.04, 95% CI 1.29–3.23), adjusted for potential confounders, indicating that the high myopia was associated with the abnormal values of CV and HEX. Further adjustment for contact lenses wear partly attenuated these associations. Association between the SER and ECD was not detected.
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Affiliation(s)
- Naohiko Aketa
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Miki Uchino
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Motoko Kawashima
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yuichi Uchino
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kenya Yuki
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Yoko Ozawa
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mariko Sasaki
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Faculty of Medicine, and Health Services Research and Development Center, University of Tsukuba, Tsukuba, Japan. .,Ibaraki Western Medical Center, Chikusei, Japan.
| | - Norie Sawada
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Shoichiro Tsugane
- Epidemiology and Prevention Group, Center for Public Health Sciences, National Cancer Center, Tokyo, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.,Tsubota Laboratory, Inc., Tokyo, Japan
| | - Hiroyasu Iso
- Department of Public Health, Graduate School of Medicine, Osaka University, Suita, Japan
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12
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Diseases of the corneal endothelium. Exp Eye Res 2021; 205:108495. [PMID: 33596440 DOI: 10.1016/j.exer.2021.108495] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 02/05/2021] [Accepted: 02/08/2021] [Indexed: 12/17/2022]
Abstract
The corneal endothelial monolayer and associated Descemet's membrane (DM) complex is a unique structure that plays an essential role in corneal function. Endothelial cells are neural crest derived cells that rest on a special extracellular matrix and play a major role in maintaining stromal hydration within a narrow physiologic range necessary for clear vision. A number of diseases affect the endothelial cells and DM complex and can impair corneal function and vision. This review addresses different human corneal endothelial diseases characterized by loss of endothelial function including: Fuchs endothelial corneal dystrophy (FECD), posterior polymorphous corneal dystrophy (PPCD), congenital hereditary endothelial dystrophy (CHED), bullous keratopathy, iridocorneal endothelial (ICE) syndrome, post-traumatic fibrous downgrowth, glaucoma and diabetes mellitus.
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13
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Nowińska A, Chlasta-Twardzik E, Dembski M, Ulfik-Dembska K, Wylęgała E. Corneal Analysis with Swept Source Optical Coherence Tomography in Patients with Coexisting Cataract and Fuchs Endothelial Corneal Dystrophy. Diagnostics (Basel) 2021; 11:diagnostics11020223. [PMID: 33540847 DOI: 10.3390/diagnostics11020223] [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: 01/09/2021] [Revised: 01/28/2021] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
This study focused on defining the characteristic features of keratometry and pachymetry elevation maps based on swept source optical coherence tomography (SS OCT) in Fuchs endothelial corneal dystrophy (FECD) eyes with a coexisting cataract. 70 eyes of 35 patients diagnosed with FECD and a coexisting cataract and 70 control eyes were included in this prospective, controlled, observational, cross-sectional study. Features characteristic of intermediately affected eyes included an increased corneal thinnest thickness (CTT) (p = 0.01), 3 and 6 mm asymmetry (p < 0.0001), higher order Fourier indices (p < 0.05 and p ≤ 0.0001, respectively), chord µ, and a posterior Ectasia Screening Index (pESI) (p < 0.01). The lack of agreement between the anterior and posterior elevation map and a significant area of negative values in the posterior map were detected. In advanced FECD eyes, our study additionally revealed decreased posterior keratometry steep (Ks), keratometry flat (Kf), keratometry average (AvgK), eccentricity (Ecc), an increased corneal apex thickness (CAT), and decreased 3 and 6 mm posterior spherical indices (p < 0.0001 for all of the above). Characteristic features of subclinical FECD, independent of the corneal thickness, can be detected by SS OCT and should be considered during the preoperative assessment of patients with a coexisting cataract.
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Affiliation(s)
- Anna Nowińska
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
| | - Edyta Chlasta-Twardzik
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
| | - Michał Dembski
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
| | - Klaudia Ulfik-Dembska
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
| | - Edward Wylęgała
- Chair and Clinical Department of Ophthalmology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
- Ophthalmology Department, Railway Hospital, 40-760 Katowice, Poland
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14
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Gazit I, Dubinsky‐Pertzov B, Or L, Pras E, Belkin A, Einan‐Lifshitz A. Eye patching after cataract surgery is associated with an increased risk of short-term corneal oedema. Acta Ophthalmol 2021; 99:e81-e85. [PMID: 32567237 DOI: 10.1111/aos.14510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate the effect of postoperative eye patching after routine cataract surgery on corneal oedema and visual acuity on the first postoperative day. SETTING One public healthcare centre. DESIGN AND METHODS This randomized controlled trial included patients undergoing uneventful cataract surgery in one medical centre. Patients were randomized into two groups: the surgical eye was patched with a single dose of a local steroid and antibiotic for 24 hr in the first group, and a plastic shield was used in the second with local steroid and antibiotic drops. The eyes were examined preoperatively and on the first postoperative day. Examination included the following: best-corrected visual acuity (BCVA), full slit lamp examination, intraocular pressure (IOP), anterior chamber depth (ACD) and central corneal thickness (CCT) using the IOL Master 700 (Zeiss, Germany). Cumulative dissipated energy (CDE) and operation time were recorded for all cases. RESULTS One hundred eyes of 100 patients were included in the study. The postoperative increase in CCT 24 hr after surgery was 138 and 70 µm in the patched group as compared to the non-patched group, respectively (p = 0.001). Best-corrected visual acuity (BCVA) on the first postoperative day was 0.5 ± 0.45 LogMAR and 0.3 ± 0.3 LogMAR in the patched and non-patched group, respectively (p = 0.01). There was no difference in CDE (11.33 ± 9.2 and 10.22 ± 7.3; p = 0.94) between the two groups. CONCLUSIONS Eye patching after routine cataract surgery is associated with an increase in corneal oedema and slower visual recovery on the first postoperative day.
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Affiliation(s)
- Inbal Gazit
- Department of Ophthalmology Shamir Medical Center Beer Ya'acov Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Biana Dubinsky‐Pertzov
- Department of Ophthalmology Shamir Medical Center Beer Ya'acov Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Lior Or
- Department of Ophthalmology Shamir Medical Center Beer Ya'acov Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Eran Pras
- Department of Ophthalmology Shamir Medical Center Beer Ya'acov Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Avner Belkin
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
- Department of Ophthalmology Meir Medical Center Kfar Saba Israel
| | - Adi Einan‐Lifshitz
- Department of Ophthalmology Shamir Medical Center Beer Ya'acov Israel
- Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
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15
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Ong Tone S, Kocaba V, Böhm M, Wylegala A, White TL, Jurkunas UV. Fuchs endothelial corneal dystrophy: The vicious cycle of Fuchs pathogenesis. Prog Retin Eye Res 2021; 80:100863. [PMID: 32438095 PMCID: PMC7648733 DOI: 10.1016/j.preteyeres.2020.100863] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/05/2020] [Accepted: 04/10/2020] [Indexed: 12/13/2022]
Abstract
Fuchs endothelial corneal dystrophy (FECD) is the most common primary corneal endothelial dystrophy and the leading indication for corneal transplantation worldwide. FECD is characterized by the progressive decline of corneal endothelial cells (CECs) and the formation of extracellular matrix (ECM) excrescences in Descemet's membrane (DM), called guttae, that lead to corneal edema and loss of vision. FECD typically manifests in the fifth decades of life and has a greater incidence in women. FECD is a complex and heterogeneous genetic disease where interaction between genetic and environmental factors results in cellular apoptosis and aberrant ECM deposition. In this review, we will discuss a complex interplay of genetic, epigenetic, and exogenous factors in inciting oxidative stress, auto(mito)phagy, unfolded protein response, and mitochondrial dysfunction during CEC degeneration. Specifically, we explore the factors that influence cellular fate to undergo apoptosis, senescence, and endothelial-to-mesenchymal transition. These findings will highlight the importance of abnormal CEC-DM interactions in triggering the vicious cycle of FECD pathogenesis. We will also review clinical characteristics, diagnostic tools, and current medical and surgical management options for FECD patients. These new paradigms in FECD pathogenesis present an opportunity to develop novel therapeutics for the treatment of FECD.
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Affiliation(s)
- Stephan Ong Tone
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Viridiana Kocaba
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Myriam Böhm
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Adam Wylegala
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Tomas L White
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States
| | - Ula V Jurkunas
- Cornea Center of Excellence, Schepens Eye Research Institute, Harvard Medical School, Boston, MA, United States; Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA, United States; Department of Ophthalmology, Harvard Medical School, Boston, MA, United States.
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16
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Price MO, Mehta JS, Jurkunas UV, Price FW. Corneal endothelial dysfunction: Evolving understanding and treatment options. Prog Retin Eye Res 2020; 82:100904. [PMID: 32977001 DOI: 10.1016/j.preteyeres.2020.100904] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/14/2020] [Accepted: 09/19/2020] [Indexed: 12/13/2022]
Abstract
The cornea is exquisitely designed to protect the eye while transmitting and focusing incoming light. Precise control of corneal hydration by the endothelial cell layer that lines the inner surface of the cornea is required for optimal transparency, and endothelial dysfunction or damage can result in corneal edema and visual impairment. Advances in corneal transplantation now allow selective replacement of dysfunctional corneal endothelium, providing rapid visual rehabilitation. A series of technique improvements have minimized complications and various adaptations allow use even in eyes with complicated anatomy. While selective endothelial keratoplasty sets a very high standard for safety and efficacy, a shortage of donor corneas in many parts of the world restricts access, prompting a search for alternatives. Clinical trials are underway to evaluate the potential for self-recovery after removal of dysfunctional central endothelium in patients with healthy peripheral endothelium. Various approaches to using cultured human corneal endothelial cells are also in clinical trials; these aim to multiply cells from a single donor cornea for use in potentially hundreds of patients. Pre-clinical studies are underway with induced pluripotent stem cells, endothelial stem cell regeneration, gene therapy, anti-sense oligonucleotides, and various biologic/pharmacologic approaches designed to treat, prevent, or retard corneal endothelial dysfunction. The availability of more therapeutic options will hopefully expand access around the world while also allowing treatment to be more precisely tailored to each individual patient.
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Affiliation(s)
- Marianne O Price
- Cornea Research Foundation of America, 9002 N. Meridian St., Suite 212, Indianapolis, IN, USA.
| | - Jodhbir S Mehta
- Singapore National Eye Centre, 11 Third Hospital Ave #08-00, 168751, Singapore
| | - Ula V Jurkunas
- Massachusetts Eye and Ear Infirmary, 243 Charles St., Boston, MA, USA
| | - Francis W Price
- Price Vision Group, 9002 N. Meridian St., Suite 100, Indianapolis, IN, USA
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17
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The impact of corneal guttata on the results of cataract surgery. J Cataract Refract Surg 2019; 45:803-809. [DOI: 10.1016/j.jcrs.2018.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/20/2018] [Accepted: 12/28/2018] [Indexed: 11/19/2022]
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18
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Ahmed Mohamed ET, Perone JM, Brand S, Koegel M, Declercq NF. Scanning Acoustic Microscopy Comparison of Descemet's Membrane Normal Tissue and Tissue With Fuchs' Endothelial Dystrophy. Invest Ophthalmol Vis Sci 2018; 59:5627-5632. [PMID: 30481279 DOI: 10.1167/iovs.18-25516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To describe the application of scanning acoustic microscopy in the GHz-range (GHz-SAM) for qualitative imaging and quantitative characterization of the micromechanical properties of the Descemet's membrane and endothelial cells of cornea tissue. Methods Investigated were samples of a normal tissue and a tissue with Fuchs' endothelial dystrophy (FECD, cornea Guttata). Descemet's membranes were fixed on glass substrates and imaged utilizing a focused acoustic lens operating at a center frequency of 1 GHz. Results GHz-SAM data, based on the well-established V(z) technique, revealed discrepancies in the velocity of the propagation of Rayleigh surface acoustic waves (RSAW). RSAW were found to be slower in glass substrates with FECD samples than in the same glass substrates (soda-lime) with normal Descemet membrane, which indicates lower shear and bulk moduli of elasticity in tissues affected by FECD. Conclusions Noninvasive/nondestructive GHz-SAM, is utilized in this study for the imaging and characterization of Descemet membranes, fixated on glass substrates. V(z) signatures containing sufficient oscillations were obtained for the system of Descemet membranes on glass substrates. The observed variation in the microelastic properties indicates potential for further investigations with GHz-SAM based on the V(z) technique.
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Affiliation(s)
- Esam T Ahmed Mohamed
- Laboratory for Ultrasonic Nondestructive Evaluation "LUNE", UMI Georgia Tech-CNRS 2958, Metz, France
| | - Jean-Marc Perone
- Ophthalmology Department of the Regional Hospital Center of Metz-Thionville, Mercy Hospital, Metz, France
| | - Sebastian Brand
- Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Center for Applied Microstructure Diagnostics CAM, Halle, Germany
| | - Michael Koegel
- Fraunhofer Institute for Microstructure of Materials and Systems IMWS, Center for Applied Microstructure Diagnostics CAM, Halle, Germany
| | - Nico F Declercq
- Laboratory for Ultrasonic Nondestructive Evaluation "LUNE", UMI Georgia Tech-CNRS 2958, Metz, France
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19
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Comparison of the Center and Flex-Center Methods of Corneal Endothelial Cell Analysis in the Presence of Guttae. Cornea 2017; 36:1514-1520. [DOI: 10.1097/ico.0000000000001334] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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20
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Rizwan M, Peh GS, Adnan K, Naso SL, Mendez AR, Mehta JS, Yim EKF. In Vitro Topographical Model of Fuchs Dystrophy for Evaluation of Corneal Endothelial Cell Monolayer Formation. Adv Healthc Mater 2016; 5:2896-2910. [PMID: 27701826 DOI: 10.1002/adhm.201600848] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2016] [Indexed: 12/13/2022]
Abstract
A common indication for corneal transplantation, which is the most transplanted tissue, is a dysfunctional corneal endothelium due to Fuchs' endothelial dystrophy (FED). FED is diagnosed by the presence of in vivo pathological microtopography on the Descemet membrane, which is called corneal guttata. Minimally invasive corneal endothelial cell regenerative procedures such as endothelial cell injection therapy and Rho kinase inhibitor pharmacotherapy have been proposed as alternatives to conventional corneal transplantation for FED patients. However, the effect of guttata on monolayer reformation following such therapies is unknown and there is no equivalent in vitro or animal model to study monolayer reformation. Using a synthetic guttata FED disease model, the formation of the monolayer is investigated to evaluate the efficacy of both therapies. Results obtained suggest that guttata dimensions, density, and spacing greatly affect the fate of corneal endothelial cells in terms of migratory behavior and monolayer reformation. Densely packed synthetic guttata mimicking late-stage FED hinders monolayer reformation, while synthetic guttata of lower height and density show improved monolayer formation. These results suggest that severity of the FED, as determined by height and density of existing guttata, can potentially attenuate corneal endothelial monolayer formation of corneal cell injection therapy and pharmacotherapy.
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Affiliation(s)
- Muhammad Rizwan
- Department of Biomedical Engineering; National University of Singapore; Singapore 117583
- Institute of Materials Research and Engineering; Agency for Science; Technology and Research (A*STAR); Singapore 138634
| | - Gary S. Peh
- Tissue Engineering and Stem Cell Group; Singapore Eye Research Institute; Singapore 169856
- Duke-NUS Graduate Medical School; Singapore 169857
| | - Khadijah Adnan
- Tissue Engineering and Stem Cell Group; Singapore Eye Research Institute; Singapore 169856
| | - Sacha L. Naso
- Tissue Engineering and Stem Cell Group; Singapore Eye Research Institute; Singapore 169856
| | - Alon R. Mendez
- Department of Biomedical Engineering; National University of Singapore; Singapore 117583
| | - Jodhbir S. Mehta
- Duke-NUS Graduate Medical School; Singapore 169857
- Singapore National Eye Centre; Singapore 168751
| | - Evelyn K. F. Yim
- Department of Biomedical Engineering; National University of Singapore; Singapore 117583
- Department of Surgery; National University of Singapore, Singapore; Mechanobiology Institute; National University of Singapore; Singapore 117411
- Department of Chemical Engineering; University of Waterloo; Waterloo Ontario Canada N2L 3G1
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21
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Zhang X, Igo RP, Fondran J, Mootha VV, Oliva M, Hammersmith K, Sugar A, Lass JH, Iyengar SK. Association of smoking and other risk factors with Fuchs' endothelial corneal dystrophy severity and corneal thickness. Invest Ophthalmol Vis Sci 2013; 54:5829-35. [PMID: 23882692 DOI: 10.1167/iovs.13-11918] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE We investigated effects of smoking and other risk factors on the development of advanced Fuchs' endothelial corneal dystrophy (FECD) and on central corneal thickness (CCT). METHODS Eyes from Caucasian probands, affected and unaffected family members, and unrelated controls matched for age from the FECD Genetics Multi-Center Study (n = 2044 subjects) were examined. Univariate and multivariate models, adjusted for family correlations, were used to determine the effect of smoking, sex, diabetes, and age on FECD case/control status and CCT. RESULTS In a multivariate model, sex and smoking were associated significantly with advanced FECD (grades 4-6) development (P = 0.016 and P = 0.047, respectively). Female sex increased odds by 34%. Smoking increased odds by 30%. In a multivariate model, diabetes was associated with an increase of 9.1 μm in average CCT (P = 0.021). Female sex was associated significantly with a decrease in average CCT by 6.9 μm (P = 0.015). Smoking had no significant effect on CCT in any model. As shown previously, advanced FECD was associated with large increases in CCT (31.4-94.2 μm). CONCLUSIONS Smoking was associated with an increased risk of advanced FECD and self-reported diabetes was associated with increased CCT. Further study of the impact of smoking and diabetes on FECD development and changes in corneal thickness is warranted.
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Affiliation(s)
- Xiaolin Zhang
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University and University Hospitals Eye Institute, Cleveland, Ohio, USA
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