Showing papers in "Cornea in 2012"
TL;DR: The proportion of subjects exhibiting signs of evaporative dry eye resulting from MGD far outweighs that of subjects with pure ADDE in a general clinic-based patient cohort.
Abstract: Purpose:To evaluate in a general clinic-based cohort of patients with dry eye disease (DED) the distribution of patients with aqueous-deficient or evaporative subtype of DED.Methods:Schirmer tests and meibomian gland dysfunction (MGD) (Foulks–Bron scoring) were evaluated in both eyes of 299 normal s
396 citations
TL;DR: The LipiFlow System was significantly more effective than the iHeat Warm Compress for adults with meibomian gland dysfunction and dry eye symptoms and these results support its safety and effectiveness in the treatment of MGD and Dry eye symptoms.
Abstract: PurposeTo evaluate the safety and effectiveness of the LipiFlow System compared to the iHeat Warm Compress (WC) for adults with meibomian gland dysfunction (MGD).MethodsThis was a non-significant risk, prospective, open-label, randomized, crossover multicenter clinical trial. One hundred thirty-nine
212 citations
TL;DR: Over a 3-month period, tear film osmolarity was found to have the lowest variability among commonly used signs of dry eye disease, followed by a downward trend in symptoms that preceded changes in symptoms during therapy.
Abstract: PURPOSE To evaluate the efficacy of commonly used biomarkers in dry eye disease management in a longitudinal observational case series study followed by an interventional study in a subset of subjects treated with cyclosporine A (0.05%). METHODS Bilateral tear osmolarity, Schirmer, tear film breakup time (TBUT), staining, meibomian grading, and Ocular Surface Disease Index were measured for a period of 3 consecutive months in participants recruited from a clinic-based population at 2 study sites. Fifty-two subjects completed the study (n = 16 mild/moderate, n = 36 severe; age, 47.1 ± 16.1 years). After the 3-month observation period, severe dry eye patients were prescribed topical cyclosporine A and evaluated for an additional 3 months. RESULTS Tear osmolarity (8.7 ± 6.3%) exhibited significantly less variability over a 3-month period than corneal staining (12.2 ± 8.8%, P = 0.040), conjunctival staining (14.8 ± 8.9%, P = 0.002), and meibomian grading (14.3 ± 8.8%, P < 0.0001) across the entire patient population. Osmolarity also demonstrated less variation than TBUT (11.7 ± 9.0%, P = 0.059), Schirmer tests (10.7 ± 9.2%, P = 0.67), and Ocular Surface Disease Index (9.3 ± 7.8%, P = 0.94), although the differences were not significant. Variation in osmolarity was less for mild dry eye patients (5.9 ± 3.1%) than severe dry eye patients (10.0 ± 6.9%, P = 0.038). After treatment, average osmolarity and variability were lowered from 341 ± 18 mOsm/L to 307 ± 8 mOsm/L (P < 0.0001, n = 10). A downward trend in symptoms followed changes in osmolarity, declining from 44 ± 17 mOsm/L to 38 ± 18 mOsm/L (P = 0.35). None of the other signs demonstrated a change after treatment. CONCLUSIONS Over a 3-month period, tear film osmolarity was found to have the lowest variability among commonly used signs of dry eye disease. Reductions in osmolarity preceded changes in symptoms during therapy.
182 citations
TL;DR: In pediatric age, a good functional response and keratoconus stability was obtained after corneal cross-linking in a 36-month follow-up and topographic results showed statistically significant improvement in K readings and asymmetry index values.
Abstract: PURPOSE Evaluation of stability and functional response after riboflavin-UVA–induced cross-linking in a population of patients younger than 18 years with progressive keratoconus after 36 months of follow-up. METHODS Prospective nonrandomized phase II open trial conducted at the Department of Ophthalmology, Siena University, Italy. The "Siena CXL Pediatrics" trial involved 152 patients aged 18 years or younger (10–18 years) with clinical and instrumental evidence of keratoconus progression. The population was divided into 2 groups according to corneal thickness (>450 and 450 μm) and +0.14 and +0.15 Snellen lines, respectively, in the thinner group (corneal thickness <450 μm). Patients in the latter group already showed a better and faster functional recovery than the thicker group at 3-month follow-up. Topographic results showed statistically significant improvement in K readings and asymmetry index values. Coma reduction was also statistically significant. CONCLUSIONS The study demonstrated significant and rapid functional improvement in pediatric patients younger than 18 years with progressive keratoconus, undergoing riboflavin-UVA–induced cross-linking. In pediatric age, a good functional response and keratoconus stability was obtained after corneal cross-linking in a 36-month follow-up.
171 citations
TL;DR: The hypothesis that there is a genetic predisposition that requires a “second hit” or environmental event to elicit progressive disease in keratoconus is agreed.
Abstract: Purpose:The etiology of keratoconus has been the subject of numerous studies. Here, we review the body of literature that attempts to determine what causes keratoconus.Methods:A review of the published literature was performed to evaluate the possible causes of keratoconus and how the different etio
146 citations
TL;DR: Two years after CXL, the observation of stable UCVA, improved BCVA, and reduced keratometry suggests stabilization in progression of keratoconus, and Unchanged corneal thickness, endothelial cell density, and foveal thickness suggest the long-term safety of this procedure.
Abstract: Purpose To assess the biomechanical and keratometric effects and the safety of treatment of progressive keratoconus with UV-riboflavin collagen cross-linking (CXL). Methods This is a prospective clinical controlled study. Fourteen eyes of 14 patients with progressive keratoconus were treated with CXL after corneal deepithelization. Patients were assessed preoperatively, at week 1 and at months 1, 3, 6, 9, 12, and 24 after treatment. We measured uncorrected visual acuity (UCVA) and best spectacle-corrected visual acuity (BSCVA) (logarithm of the minimum angle of resolution), refraction, biomicroscopy and fundus examination, intraocular pressure, axial length, endothelial cell density, corneal topography, minimal corneal thickness, macular optical coherence tomography, and corneal biomechanics with the ocular response analyzer. Results Comparing the preoperative results with 24-month postoperative results, we observed significant improvement in BCVA (0.21 ± 0.1 to 0.14 ± 0.1, P = 0.002) and stability in UCVA (0.62 ± 0.5 and 0.81 ± 0.49, P = 0.475). We observed a significant decrease in steepest-meridian keratometry (diopters) (53.9 ± 5.9 to 51.5 ± 5.4, P = 0.001) and in mean cylinder (diopters) (10.2 ± 4.1 to 8.1 ± 3.4, P = 0.001). Significant elongation of the eyes was observed, from 24.39 ± 1.7 mm to 24.71 ± 1.9 mm (P = 0.007). No significant change was observed in mean simulated keratometry, minimal corneal thickness, endothelial cell density, corneal hysteresis, and corneal resistance factor or foveal thickness. Conclusions Two years after CXL, the observation of stable UCVA, improved BCVA, and reduced keratometry suggests stabilization in progression of keratoconus. Unchanged corneal thickness, endothelial cell density, and foveal thickness suggest the long-term safety of this procedure. The observed increase in axial length and stability in corneal biomechanical parameters measured with the ocular response analyzer require further study for verification and explanation.
131 citations
University of Regensburg1, University of Erlangen-Nuremberg2, University of Duisburg-Essen3, University of Freiburg4, Medical University of Vienna5, Saarland University6, Ludwig Maximilian University of Munich7, University of Würzburg8, Leipzig University9, National Institutes of Health10, Fred Hutchinson Cancer Research Center11
TL;DR: The evidence levels for diagnosis and treatment of ocular cGVHD are low, and most of the treatment options are based on empirical knowledge, but topical immunosuppression, for example, with cyclosporine, represents a promising strategy to reduce inflammation and dryness in ocularcGVHD.
Abstract: Purpose:Ocular chronic graft-versus-host disease (cGVHD) is one of the most frequent long-term complications after hematopoietic stem cell transplantation and is often associated with significant morbidity and reduced quality of life.Methods:The German/Austrian/Swiss Consensus Conference on Clinical
117 citations
TL;DR: A large prospective series of deep lamellar endothelial keratoplasty (DLEK) yielded visual rehabilitation that was far faster than that of PK, with a predictable normal topography rarely seen with PK.
Abstract: Why do surgeons do what they do? When presented with various options for surgical therapy to a given ocular pathology, why do some surgeons choose one approach, whereas others choose an entirely different approach? Is superior visual outcome for the patient the deciding factor, or are there other more compelling reasons for choosing a particular operation? Are all of these reasons patient oriented? For the therapy of patients with vision loss because of endothelial dysfunction, the only visual rehabilitation that was available for nearly 100 years was penetrating keratoplasty (PK). This made the primary decision for the corneal transplant easy for the surgeon, with decisions of trephination size, suturing style, and other techniquespecific decisions to be made secondarily. Over the past decade, however, the field of endothelial keratoplasty (EK) has evolved and made the process of deciding what to do for the specific patient more complicated. Volumes of data over the past 10 years have demonstrated that all the posterior lamellar techniques of endothelial replacement yield far superior visual, topographic, and tectonic strength results compared with PK, and surgeons have now universally embraced the concept of selective endothelial replacement. The dominant form of EK throughout the world is now Descemet stripping automated endothelial keratoplasty (DSAEK), but this is not the first nor the most recent iteration of EK. The rich lexicon of EK subtypes not only represents the legacy of this exciting field but also can offer insight into why one form of EK becomes popular, whereas another form is relegated to a few true believers. Although the first human EK procedure to successfully clear the overlying cornea was reported by Charles Tillett in 1956, most would agree that the modern era of EK began with the posterior lamellar keratoplasty (PLK) described by Melles et al in their landmark cadaver eye and experimental animal PLK article of 1998. Melles’ subsequent cases reinforced the validity of this new approach to endothelial replacement. The specific method of PLK described by Melles did not take hold in the United States, however, primarily because the surgery involved the use of whole globes (not readily available in the United States) for the donor tissue preparation and because the manual resection of the posterior recipient cornea was performed with only air filling the anterior chamber, a step of the procedure that was difficult to the extreme. In March 2000, I performed the first modern EK procedure in the United States by modifying the PLK procedure with new instruments, introducing an artificial anterior chamber device so as to use standard corneal– scleral donor tissue, and advocating the use of cohesive viscoelastic to stabilize the recipient anterior chamber for easier recipient tissue resection. Similar to the Melles small series results with PLK, our large prospective series of deep lamellar endothelial keratoplasty (DLEK) yielded visual rehabilitation that was far faster than that of PK, with a predictable normal topography rarely seen with PK. The complication rate of DLEK was low, with less than a 5% dislocation rate and less than a 1% primary graft failure rate. But despite dozens of training courses taken by hundreds of surgeons from instructors, such as Gerrit Melles, Frank Price and myself, this surgery of PLK/DLEK, with clearly superior patient results compared with PK, was not embraced. Very few surgeons who took the PLK/DLEK courses went on to actually perform this new procedure. Why?
111 citations
TL;DR: Studies showed that keratoconus may be more prevalent, have earlier onset, and have greater disease progression in certain Asian and non-Asian ethnicities, particularly Indians, Pakistanis, Middle Easterners, and Polynesians, compared with white populations.
Abstract: Keratoconus is an ectatic corneal disorder for which exciting therapeutic and diagnostic technologies are emerging. However, its pathogenesis is still heterogeneous and elusive. We researched overlooked Asian keratoconus data by literature review of databases (PubMed, MEDLINE, Ovid, Google Scholar, Cornea, and Cochrane) using key words "keratoconus, Asia, epidemiology, treatment, risk factors, genes" and names of Asian countries. Articles and their references were analyzed. Studies showed that keratoconus may be more prevalent, have earlier onset, and have greater disease progression in certain Asian and non-Asian ethnicities, particularly Indians, Pakistanis, Middle Easterners, and Polynesians, compared with white populations. Epidemiological risk factors include ethnicity, age (younger than 30 years), gender (male), positive family history, and eye rubbing. Genetic and disease risk factors include atopy, vernal keratoconjunctivitis, Down syndrome, pellucid marginal corneal degeneration, VSX1 (visual system homeobox 1) gene, and Leber congenital amaurosis. Differentiation of heterogeneous keratoconus subsets with detailed genotype-phenotype characterization may advance understanding. Comprehensive multiethnic population studies with valid large-scale data are needed. New effective treatments (deep anterior lamellar keratoplasty, intrastromal corneal ring segments, and corneal collagen cross-linking with riboflavin) are succeeding previous treatments.
108 citations
TL;DR: The Boston type I KPro is an effective option for management of eyes with poor prognosis for primary or repeat penetrating keratoplasty, but visual potential is limited by preoperative comorbidities; however, glaucoma development or progression of preexisting glAUcoma is a significant cause of postoperative visual loss.
Abstract: The Boston Type I keratoprosthesis (KPro), approved for use by the FDA in 1992, was developed for patients who are poor candidates for traditional full-thickness corneal transplantation because of a high risk for graft failure or rejection. The indications for KPro implantation include recurrent corneal graft failure, herpetic disease and limbal stem cell deficiency secondary to chemical burns and aniridia.
Initial KPro implantation was associated with poor outcomes related to implant extrusion, corneal necrosis and endophthalmitis.1 As modifications in the implant design and postoperative management have evolved, the retention rates of the Boston Type I KPro have dramatically improved, making the procedure an increasingly accepted alternative to standard keratoplasty in eyes with an unacceptably high risk of corneal graft failure.2 With a reduction in acute complications, the long term visual outcomes after KPro surgery are still limited by chronic diseases, such as glaucoma.
The purpose of this study was to review the clinical experience at one institution using the Boston Type I KPro and to evaluate the development and progression of glaucoma following KPro surgery in these patients.
108 citations
TL;DR: There were no statistically significant changes in CH and CRF measurements 1 year after CXL and development of other in vivo biomechanical metrics would aid in evaluating the corneal response to CXL.
Abstract: Purpose: To investigate the invivo, corneal, biomechanical changes after corneal collagen cross-linking (CXL) using the Ocular Response Analyzer (ORA) in patients with keratoconus and postlaser in situ keratomileusis (LASIK) ectasia. Methods: Single-center, prospective, randomized, controlled, clinical trial. After CXL (69 eyes, 46 keratoconus and 23 postLASIK), corneal hysteresis (CH) and corneal resistance factor (CRF) were measured using the ORA and analyzed in a treatment, sham control, and fellow eye control group at baseline and 1, 3, 6, and 12 months. Results: There were no significant changes in CH (change = 0.05 61.5; P= 0.78) or CRF (change = 0.29 61.4; P= 0.1) at 1 year compared with preoperative values. Changes in CH and CRF were not correlated with changes in clinical outcomes of uncorrected visual acuity, best spectaclecorrected visual acuity, and maximum keratometry. There were no significant changes in CH in the sham or fellow eye control groups (Psham =0 .7;PFE = 0.3) or CRF (Psham =0 .6;PFE = 0.72). Conclusions: Despite an increase in CRF at one month, there were no statistically significant changes in CH and CRF measurements 1 year after CXL. Development of other in vivo biomechanical metrics would aid in evaluating the corneal response to CXL. (Cornea 2012;31:21‐25)
TL;DR: Tear hyperosmolarity is considered a key factor that leads to dry eye symptoms and to the progression of clinical signs and the TearLab device should not be used alone but in combination with classical dry eye tests.
Abstract: Purpose:To evaluate tear osmolarity with the recently introduced TearLab system (TearLab Corporation, San Diego, CA) in patients with non-Sjogren syndrome dry eye (NSSDE) and Sjogren syndrome dry eye (SSDE), and in healthy subjects, and to compare the results with those from classical dry eye tests.
TL;DR: Meibomian gland dysfunction was highly prevalent in this Asian population and associated with various systemic and ocular conditions in an urban Malay population in Singapore.
Abstract: Purpose:To describe the prevalence and associations of meibomian gland dysfunction (MGD) in an urban Malay population in Singapore.Methods:Population-based cross-sectional study of 3280 (78.7% response rate) Malay persons aged 40 to 80 years, living in Singapore. MGD was defined by a slit-lamp clini
TL;DR: After more than 10 years of use, MMC has been found to be effective when used for prevention and treatment of corneal haze, and questions remain regarding optimal treatment parameters and long-term safety.
Abstract: The purpose of the present study was to compare the physiological responses of oxygen uptake (VO(2)) and energy expenditure (EE) in two different aquatic resistance training protocols performed with three sets of 20 seconds (3 × 20) and six sets of 10 seconds (6 × 10) and with and without Speedo Resistance Equipment. Ten young healthy women volunteers, familiar with exercises in an aquatic environment, participated in this study. The four separate protocols were randomly selected and performed at a 48-hour interval by the same instructor. The total time of the 3 × 20 protocol was 34 minutes and that of the 6 × 10 protocol was 43 minutes, and all exercises were performed at maximal speed and amplitude. Although the protocols had different total times, they included one minute of stimulus per muscle group and the same time intervals. EE(gross) and EE(net) values were higher in the 6 × 10 protocol than in the 3 × 20 one. The variables VO(2) and EE(min) did not present significant difference between the protocols. VO(2), EE(gross), EE(net) and EE(min) values were higher when the equipment was used (W situation) than when it was not (WO situation). In the postexercise analysis, the W situation also showed higher VO(2) and EE(gross) values than the WO situation. Therefore, this study suggests the use of Speedo Resistance Equipment to increase VO(2) and EE, and it also suggests lengthier aquatic resistance training to obtain greater EE values per session.
TL;DR: Treatment of fungal keratitis with CXL seems to be effective in decreasing the intensity and severity of infectious ker atitis by F. solani, and may be useful as a coadjuvant in the medical treatment of resistant infections.
Abstract: Purpose To evaluate the efficacy of corneal cross-linking (CXL) (riboflavin-UV-A) as a simple therapy in Fusarium keratitis. Methods Twenty-four rabbits were systemically anesthetized, and the stromata of their right corneas were inoculated with Fusarium solani [10(5) colony-forming units (CFU) per milliliter]. Rabbits were divided into 2 groups: one was treated with CXL 72 hours after infection and the other did not receive any treatment (control). All eyes in both the groups were examined before (days 0 and 3) and after (day 7) CXL treatment. The eyes were enucleated, and corneal buttons were sent for microbiological and histological examinations. Results All animals developed Fusarium keratitis; there was no statistically significant difference between groups before treatment (day 0, P = 0.397 and day 3, P = 0.702). After CXL treatment, the difference in clinical scores on day 7 between groups was statistically significant (P = 0.00); the CXL group showed significant lower clinical score. The CXL group had 22.45 ± 5.09 CFU/g compared with 42.5 ± 3.12 CFU/g in the control group; this difference was statistically significant (P = 0.01). In the 3 buttons of the control group, similar amounts of Fusarium hyphae and inflammatory cells were observed. In 2 of the 3 buttons analyzed from the CXL group, fewer Fusarium hyphae, inflammatory cells, and nonspecific stromal changes were observed compared with the control group. Conclusions Treatment of fungal keratitis with CXL seems to be effective in decreasing the intensity and severity of infectious keratitis by F. solani. This therapy may be useful as a coadjuvant in the medical treatment of resistant infections.
TL;DR: The results of this study support the earlier theories of lower endothelial cell counts among subjects with type 2 diabetes mellitus in comparison with nondiabetic controls.
Abstract: Purpose: To study the corneal endothelial cell density and morphological features in type 2 diabetic patients (cases) and compare it with nondiabetic subjects (controls) in a populationbased cross-sectional study. Methods: Patients were recruited from the Sankara Nethralaya— Diabetic Retinopathy Epidemiology and Molecular Genetic Study, a population-based study to estimate the prevalence of type 2 diabetes and diabetic retinopathy in urban Chennai, South India. Corneal endothelial morphological features were recorded in all subjects using noncontact specular microscopy and central corneal thickness was measured using ultrasound pachymeter. Results: A total of 1191 cases and 121 controls were enrolled into the study. The mean corneal endothelial cell density (cells/mm 2 ) was lower in cases than in controls (2550 ± 326 vs. 2634 ± 256; P = 0.001). No difference was observed in the mean pachymetry values, hexagonality %, and coefficient of variation of cell size between cases and controls. Multivariate regression analysis, after adjusting for age, showed the mean cell density to be lesser by 66 cells/mm2 (95% confidence interval, 6.3–125.9) among diabetic patients compared with nondiabetic subjects. Conclusions: The results of this study, from a large populationbased sample, support the earlier theories of lower endothelial cell counts among subjects with type 2 diabetes mellitus in comparison with nondiabetic controls.
TL;DR: RvE1, delivered as its methyl ester prodrug, improved the outcome measures of corneal staining and goblet cell density in this murine model of dry eye, indicating the potential utility of endogenous resolvins and resolvin analogues in the treatment of dryEye.
Abstract: Purpose:Resolvin E1 (RvE1; RX-10001) belongs to a new class of endogenous immunoregulating mediators, originally identified as a metabolite of the omega-3 polyunsaturated fatty acid, eicosapentaenoic acid. Based on its proven efficacy in models of chronic inflammation, this study investigated the ef
TL;DR: Characteristics of the air pressure–corneal deformation profile are more affected by keratoconus than the traditionally extracted corneal hysteresis and corNEal resistance factors.
Abstract: PURPOSE: To perform advanced analysis of the corneal deformation response to air pressure in keratoconics compared with age- and sex-matched controls. METHODS: The ocular response analyzer was used to measure the air pressure-corneal deformation relationship of 37 patients with keratoconus and 37 age (mean 36 ± 10 years)- and sex-matched controls with healthy corneas. Four repeat air pressure-corneal deformation profiles were averaged, and 42 separate parameters relating to each element of the profiles were extracted. Corneal topography and pachymetry were performed with the Orbscan II. The severity of the keratoconus was graded based on a single metric derived from anterior corneal curvatures, difference in astigmatism in each meridian, anterior best-fit sphere, and posterior best-fit sphere. RESULTS: Most of the biomechanical characteristics of keratoconic eyes were significantly different from normal eyes (P <0.001), especially during the initial corneal applanation. With increasing keratoconus severity, the cornea was thinner (r = -0.407, P <0.001), the speed of corneal concave deformation past applanation was quicker (dive; r = -0.314, P = 0.01), and the tear film index was lower (r = -0.319, P = 0.01). The variance in keratoconus severity could be accounted for by the corneal curvature and central corneal thickness (r = 0.80) with biomechanical characteristics contributing an additional 4% (total r = 0.84). The area under the receiver operating characteristic curve was 0.919 ± 0.025 for keratometry alone, 0.965 ± 0.014 with the addition of pachymetry, and 0.972 ± 0.012 combined with ocular response analyzer biomechanical parameters. CONCLUSIONS: Characteristics of the air pressure-corneal deformation profile are more affected by keratoconus than the traditionally extracted corneal hysteresis and corneal resistance factors. These biomechanical metrics slightly improved the detection and severity prediction of keratoconus above traditional keratometric and pachymetric assessment of corneal shape.
TL;DR: With appropriate long-term monitoring by the cornea specialist and transplant physician, the risk of irreversible toxicity at current dosages of systemic immunosuppression in patients undergoing ocular surface stem cell transplantation in this population is minimal.
Abstract: Purpose To describe the systemic immunosuppression protocol used at the Cincinnati Eye Institute and University of Cincinnati, and to evaluate the success, tolerability, and side effects of systemic immunosuppression in patients undergoing ocular surface stem cell transplantation (OSST). Methods Retrospective study of all patients who had OSST from 1997 to 2007 and received follow-up for systemic immunosuppression at the Cincinnati Eye Institute. Patients were analyzed for demographics, systemic immunosuppression exposure, ocular surface stability, efficacy, and toxicity variables. Results A total of 225 eyes from 136 patients with a mean age of 43.6 years (range, 8.9-80.6 years) underwent OSST with systemic immunosuppression. The most common systemic immunosuppression regimen consisted of tacrolimus, mycophenolate mofetil, and a short course (1-3 months) of prednisone (102/136 patients, 75%). Prophylactic valganciclovir and trimethoprim/sulfamethoxazole (dapsone if sulfa allergy was present) were also used. Mean duration of immunosuppression was 42.1 months (range, 3.6-128 months) and mean follow-up time after OSST was 53.9 months (range, 3.6-147.3 months). At the patients' final follow-up visit, 105/136 patients (77.2%) had a stable ocular surface. There were 3 severe adverse events in 2 patients (1.5%) and 21 minor adverse events in 19 patients (14.0%). Of the 21 patients with adverse events, 10 (47.6%) had systemic comorbidities at initial presentation. Conclusions The prevention of graft rejection with the use of systemic immunosuppression after OSST is crucial and should be approached with the same rigor as in solid organ transplantation. With appropriate long-term monitoring by the cornea specialist and transplant physician, the risk of irreversible toxicity at current dosages of systemic immunosuppression in this population is minimal.
TL;DR: Genetic risk factors have a strong role in the severity of the FECD phenotype and corneal thickness and genotyping this cohort with high-density genetic markers followed by appropriate statistical analyses should lead to novel loci for disease susceptibility.
Abstract: Purpose:To describe the methods for family and case–control recruitment for a multicenter genetic and associated heritability analyses of Fuchs endothelial corneal dystrophy (FECD).Methods:Twenty-nine enrolling sites with 62 trained investigators and coordinators gathered individual and family infor
TL;DR: A higher incidence of fungal keratitis occurs during the months corresponding to the windy and harvest seasons, during which time infection from vegetative corneal injury may be more likely.
Abstract: PURPOSE Previous studies suggest that fungal keratitis is more common in hot humid climates and that bacterial keratitis is independent of seasonal variation. This study analyzes seasonal trends in the incidence of fungal and bacterial keratitis at the Aravind Eye Hospital in southeast India. METHODS Using microbiology records from August 2006 to July 2009, retrospective analyses of infectious keratitis were performed. Bacterial and fungal keratitis incidence data were analyzed for seasonal patterns. RESULTS Among the 6967 infectious keratitis cases, cultures were performed in 5221 (74.9%) cases; among them, 3028 (58%) were positive. Of the culture-positive cases, 1908 (63%) and 1081 (35.7%) were of fungal and bacterial etiology, respectively. The predominant fungal organism was Fusarium spp (42.3%) and the predominant bacterial organisms were Streptococcus pneumoniae (35.1%), Pseudomonas aeruginosa (24.3%), and Nocardia spp (8.1%). Analyses revealed an uneven distribution of fungal keratitis throughout the year (P < 0.001) with peaks in July and January. No significant seasonal trend was observed for the combined bacterial keratitis group. CONCLUSIONS A higher incidence of fungal keratitis occurs during the months corresponding to the windy and harvest seasons, during which time infection from vegetative corneal injury may be more likely. Robust screening efforts during these periods may mitigate visually debilitating sequelae from infectious keratitis.
TL;DR: The results suggest that KC exerts a significant impact on KC patients' QOL, even in its early stages with normal best-spectacle-corrected visual acuity, and both CXL and CXL combined with t-PRK seem to exert a beneficial impact on self-reported QOL.
Abstract: PURPOSE To assess the effect of stage 1 keratoconus (KC) and of the 2 prevalent KC therapeutic options: (1) corneal collagen cross-linking (CXL) and (2) CXL combined with topography-guided photorefractive keratectomy (t-PRK) on self-reported quality of life (QOL) by means of the 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ 25). METHODS Thirty-two patients with bilateral KC stage 1 (KC group) and best-corrected visual acuity of 20/20 in both eyes were prospectively recruited. Of them, 19 KC patients underwent typical CXL treatment (CXL group), whereas 13 underwent CXL combined with t-PRK treatment (tCXL group). Only the eye with the most advanced condition received the treatment. Subjects responded to the NEI-VFQ 25 1 day before the treatment and 1 year postoperatively. Thirty-nine age-matched contact lens users formed the control group. NEI-VFQ 25 subscale and total scores were associated with spherical equivalent, mean keratometry, and a series of Scheimpflug imaging-derived corneal variance indexes by means of the Spearman correlation coefficient and multivariate linear regression analysis. RESULTS Preoperatively, significant differences were detected between the KC group and the control group in VFQ 25 total and all subscale scores (P < 0.05), except "general health," "color vision," and "peripheral vision" domains. According to the multivariate linear regression analysis, the index of height decentration was the most significant predictor of VFQ 25 total score (b = 0.943; P = 0.016). Postoperatively, significant differences were detected in "mental health" and "dependency" VFQ 25 domains for both the CXL and tCXL groups (P = 0.05). Furthermore, the tCXL group demonstrated significant differences in the "near activities" (P = 0.04), "role limitations" (P = 0.02), and "driving" (P < 0.01) subscale scores. CONCLUSIONS Our results suggest that KC exerts a significant impact on KC patients' QOL, even in its early stages with normal best-spectacle-corrected visual acuity. Moreover, both CXL and CXL combined with t-PRK seem to exert a beneficial impact on self-reported QOL, suggesting that they should be applied as soon as possible.
TL;DR: Topical CsA 0.05% twice daily may be helpful in the treatment of MGD mainly by improving tear film stability.
Abstract: Purpose:To compare the efficacy of topical cyclosporine [0.05% cyclosporine A (CsA)] and preservative-free artificial tears in the treatment of meibomian gland dysfunction (MGD).Methods:A 3-month prospective, randomized, double-masked, parallel-group controlled trial enrolled 70 patients with sympto
TL;DR: The Boston keratoprosthesis is a good alternative as a primary penetrating corneal procedure in a select group of patients with very poor prognosis for penetrating keratoplasty, and visual acuity significantly improved in the majority of patients.
Abstract: PURPOSE To report the short-term visual outcomes and complications of keratoprosthesis surgery as the primary penetrating corneal procedure for patients at high risk for conventional corneal transplantation. METHODS A retrospective chart review was conducted of 21 eyes of 19 patients who underwent either Boston keratoprosthesis type I or type II as the primary penetrating corneal procedure from February 2007 to March 2011. RESULTS Nineteen type I (90.5%) and 2 type II (9.5%) Boston keratoprosthesis procedures were performed in 19 patients. Mean follow-up was 14.6 months (range, 6-36.3 mo). Primary indications for surgery included chemical or thermal injury, aniridia, and Stevens-Johnson syndrome. Preoperative best-corrected visual acuity (BCVA) ranged from 20/100 to light perception and was count fingers or worse in 20 eyes (95.2%). At last follow-up for all eyes, 15 eyes (71.4%) achieved BCVA≥20/200 and 4 eyes (19%) improved to BCVA≥20/50. No intraoperative complications occurred. Postoperative complications include retroprosthetic membrane formation (47.6%), cystoid macular edema (33.3%), elevated intraocular pressure (23.8%), glaucoma progression (14.3%), and endophthalmitis (4.8%). The initial keratoprosthesis was retained in 19 eyes (90.5%). CONCLUSION The Boston keratoprosthesis, based on early follow-up, is a good alternative as a primary penetrating corneal procedure in a select group of patients with very poor prognosis for penetrating keratoplasty. Although complications can occur and require close monitoring, visual acuity significantly improved in the majority of patients.
TL;DR: Early use of AMT prevents severe vision loss in SJS/TEN patients with initial moderate or severe ocular surface inflammation, and is presented as the first case–control study of the use of amniotic membrane in the management of acute SJS or TEN.
Abstract: PURPOSE To evaluate the indications and outcomes of amniotic membrane transplantation (AMT) performed within the first 2 weeks of presentation in the management of patients with acute Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). METHODS A retrospective chart review from January 1998 to May 2011 identified 128 SJS/TEN patients admitted to Loyola University Medical Center Burn intensive care unit. The degree of initial ocular surface inflammation was graded as mild, moderate, or severe within the first 2 weeks of admission. Patients were managed either medically or with amniotic membrane (AM). Outcomes were graded as good [best-corrected visual acuity (BCVA)>20/40], fair (BCVA 20/40 to 20/200 or with ocular surface discomfort, requiring contact lens or reconstructive surgeries), or poor (BCVA<20/200). RESULTS Of the 182 eyes (91 patients) with documented inpatient eye examinations, 108 eyes (59.4%) had mild or no initial ocular involvement, 37 eyes (20.3%) had moderate, and 37 eyes (20.3%) had severe inflammation. Of the 29 patients (58 eyes) with greater than 1 month of follow-up, 17 patients (33 eyes) were treated with medical management and 13 patients (25 eyes) were treated with early AM. One of the 23 eyes with moderate or severe presentation treated with early AMT (4.3%) resulted in a poor outcome within 3 months compared with 8 of 23 eyes (34.8%) that were medically managed (P=0.022). CONCLUSIONS We present the first case-control study of the use of AM in the management of acute SJS/TEN. Early use of AMT prevents severe vision loss in SJS/TEN patients with initial moderate or severe ocular surface inflammation.
TL;DR: Topical 0.03% tacrolimus eye drops successfully improved tear stability and ocular surface status in patients with dry eyes.
Abstract: Purpose:To report the clinical outcome of the treatment of dry eyes using 0.03% tacrolimus eye drops (olive oil + tacrolimus 0.03%) (Ophthalmos, Sao Paulo, Brazil).Methods:Sixteen eyes of 8 patients with Sjogren syndrome dry eyes (age, 51.13 ± 9.45 years) were enrolled in this study (prospective non
TL;DR: There is a strong correlation between ocular itching and Demodex infestation and between symptomatic resolution and reduction ofDemodex counts by daily lid massage with 5% TTOO.
Abstract: Purpose:To determine whether ocular itching associated with ocular demodicosis can be treated by lid massage with 5% tea tree oil ointment (TTOO).Methods:Twenty-four patients with ocular itching and ocular Demodex were treated with chlortetracycline hydrochloride eye ointment lid massage for 4 weeks
TL;DR: Infectious keratitis after Kpro can occur even when patients are on vancomycin and a fourth-generation fluoroquinolone for prophylaxis, and the details of the first reported case of ocular D. constricta are presented.
Abstract: Purpose To determine the incidence, clinical features, and outcomes of infectious keratitis after Boston type 1 keratoprosthesis (Kpro) implantation. Methods Ten cases of infectious keratitis were identified in a retrospective chart review of 105 patients (126 eyes) who received Kpro between November 2004 and November 2010 at the Cincinnati Eye Institute and were followed for at least 1 month (range, 1-66 months; mean, 25 months). Results The incidence was 7.9%. Patient diagnoses included 4 chemical injuries, 3 Stevens-Johnson syndrome, 2 ocular cicatricial pemphigoid, and 1 congenital aniridia. Kpro implantation was indicated in 2 eyes for a failed ocular surface and in 8 for penetrating keratoplasty failure. Four patients were contact lens intolerant or noncompliant. All were on topical vancomycin and moxifloxacin for prophylaxis and 2 were on topical amphotericin for prophylaxis. Three infiltrates were culture negative, 5 were fungal (3 Candida, 1 Fusarium, 1 Dactylaria constricta), and 2 were bacterial (Rhodococcus equi and Gram-negative cocci). All patients were managed with topical agents and 4 were given an oral antifungal agent. Four patients had Kpro removal with therapeutic penetrating keratoplasty and 1 had Kpro replacement. At final follow-up, only 2 patients retained their preinfection best vision. Risk factors for infectious keratitis included a diagnosis of cicatrizing conjunctivitis (Stevens-Johnson syndrome, ocular cicatricial pemphigoid, or chemical injury) and a history of persistent epithelial defect (P = 0.0003 and 0.0142, respectively). Contact lens wear, vancomycin use, and a history of systemic immunosuppression (or use at the time of infection) were not statistically significant risk factors. Conclusions Infectious keratitis after Kpro can occur even when patients are on vancomycin and a fourth-generation fluoroquinolone for prophylaxis. Fungal organisms are a growing cause for concern, and we present the details of the first reported case of ocular D. constricta. The evolution of our management and prophylaxis strategy for fungal keratitis after Kpro implantation is also described.
TL;DR: DED is frequent in patients with depressive and anxiety disorders, especially patients who are older, have longer duration of psychiatric disorder, and use an SSRI, which should be considered in the differential diagnosis of DED.
Abstract: Purpose:To investigate dry eye disease (DED) and risk factors in patients with depressive or anxiety disorders at a psychiatric clinic in China.Methods:Cross-sectional study. Subjects (≥16 years) who had depressive or anxiety disorders were evaluated with history, questionnaires (Self-rating Anxiety
TL;DR: The emulsion drops were shown to perform best, improving tear stability, and decreasing osmolarity and corneal staining, consistent with improvements in the lipid layer of the tear film as a result of prolonged use of emulsion Drops.
Abstract: Purpose To compare the efficacies of sodium hyaluronate, hydroxypropyl methylcellulose (HPMC), and a new oil-in-water emulsion (Emustil unidose; SIFI) in the management of lipid-deficient dry eye. Methods Seventy-five subjects with dry eye were randomly divided into 3 groups. Each was allocated sodium hyaluronate, HPMC, or emulsion eyedrops to be used four times daily for 90 days. Parameters were measured at baseline, 30 days, and 90 days. A compliance visit was performed at days 7 and 60. Results Significant reduction (P 0.05). There was a significant decrease in osmolarity and corneal staining in the emulsion group (P 0.05). Conclusions A significant reduction in evaporation and improvement in symptoms in all therapy groups were found from baseline to 90 days. However, no significant effect was seen on TTR for any group. The emulsion drops were shown to perform best, improving tear stability, and decreasing osmolarity and corneal staining. These results are consistent with improvements in the lipid layer of the tear film as a result of prolonged use of emulsion drops.