Laser refractive surgery is one of the most commonly performed procedures worldwide.In laser refractive surgery,Femtosecond Laser in Situ Keratomileusis and Refractive Lenticule Extraction have emerged as promising al...Laser refractive surgery is one of the most commonly performed procedures worldwide.In laser refractive surgery,Femtosecond Laser in Situ Keratomileusis and Refractive Lenticule Extraction have emerged as promising alternatives to microkeratome Laser in Situ Keratomileusis and Photorefractive Keratectomy.Following laser refractive surgery,the corneal nerves,epithelial and stromal cells release neuromediators,including neurotrophins,neuropeptides and neurotransmitters.Notably,nerve growth factor,substance P,calcitonin gene-related peptide and various cytokines are important mediators of neurogenic inflammation and corneal nerve regeneration.Alterations in neuromediator profiles and ocular surface parameters following laser refractive surgery are attributed to the surgical techniques and the severity of tissue insult induced.In this review,we will discuss the(1)Functions of neuromediators and their physiological and clinical significance;(2)Changes in the neuromediators following various laser refractive surgeries;(3)Correlation between neuromediators,ocular surface health and corneal nerve status;and(4)Future directions,including the use of neuromediators as potential biomarkers for ocular surface health following laser refractive surgery,and as adjuncts to aid in corneal regeneration after laser refractive surgery.展开更多
Small Aδand C nerve fibers of the sensory and autonomic nervous systems constitute 70–90%of peripheral nerve fibers including corneal nerves(Muller et al.,2003).Corneal nerves originate from the ophthalmic branch of...Small Aδand C nerve fibers of the sensory and autonomic nervous systems constitute 70–90%of peripheral nerve fibers including corneal nerves(Muller et al.,2003).Corneal nerves originate from the ophthalmic branch of the trigeminal nerve and enter the cornea at the limbus radially from all directions toward the central cornea at the level of anterior and middle stroma.The subepithelial nerve plexus lies at the interface between the Bowman layer and anterior stroma.They then divide into smaller branches and turn 90°toward Bowman’s layer(Muller et al.,2003),travelling between Bowman’s layer and the basal epithelial layer and forming the sub-basal nerve plexus(Muller et al.,2003).展开更多
Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from dam...Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.展开更多
Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retin...Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature.However,growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit,which includes both the retinal vascular structures and neural tissues.Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening.However,diabetic corneal neuropathy is commonly overlooked and underdiagnosed,leading to severe ocular surface impairment.Several studies have found that these two conditions tend to occur together,and they share similarities in their pathogenesis pathways,being triggered by a status of chronic hyperglycemia.This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy,whether diabetic corneal neuropathy precedes diabetic retinopathy,as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy.We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.展开更多
Dear Sir,I am Dr. Nilufer Yesilirmak, from the Department of Cornea, Bascom Palmer Eye Institute, Miami, Florida,USA. We wrote to report a reduction of graft rejection with dexamethasone intravitreal implant （Ozurde...Dear Sir,I am Dr. Nilufer Yesilirmak, from the Department of Cornea, Bascom Palmer Eye Institute, Miami, Florida,USA. We wrote to report a reduction of graft rejection with dexamethasone intravitreal implant （Ozurdex ） in a case with aphakia.展开更多
Corneal diseases are a major cause of blindness in the world. Although great progress has been achieved in the treatment of corneal diseases, wound healing after severe corneal damage and immunosuppressive therapy aft...Corneal diseases are a major cause of blindness in the world. Although great progress has been achieved in the treatment of corneal diseases, wound healing after severe corneal damage and immunosuppressive therapy after corneal transplantation remain prob-lematic. Mesenchymal stem cells(MSCs) derived from bone marrow or other adult tissues can differentiate into various types of mesenchymal lineages, such as osteocytes, adipocytes, and chondrocytes, both in vivo and in vitro. These cells can further differentiate into specific cell types under specific conditions. MSCs migrate to injury sites and promote wound healing by secreting anti-inflammatory and growth factors. In ad-dition, MSCs interact with innate and acquired immune cells and modulate the immune response through their powerful paracrine function. Over the last decade, MSCs have drawn considerable attention because of their beneficial properties and promising therapeutic prospective. Furthermore, MSCs have been applied to various studies related to wound healing, autoim-mune diseases, and organ transplantation. This review discusses the potential functions of MSCs in protecting corneal tissue and their possible mechanisms in corneal wound healing and corneal transplantation.展开更多
Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropath...Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,respectively.Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin biopsies.However,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic neuropathy.More recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy.In this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and management.We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.展开更多
AIM：To evaluate the clinical outcomes of V4 c implantable collamer lens（Hole ICL） implantation with regard to the optical quality assessed according to different degrees of decentering.METHODS：This included 49 eye...AIM：To evaluate the clinical outcomes of V4 c implantable collamer lens（Hole ICL） implantation with regard to the optical quality assessed according to different degrees of decentering.METHODS：This included 49 eyes that received conventional ICL and 94 eyes that received Hole ICL.The eyes that received Hole ICL were divided into three groups according to the degree of decentering：group 1,central hole within 1 hole diameter（HD） from the pupil center;group 2,central hole within 1 HD to 2 HD;and group 3,central hole within 2 HD to 3 HD.Visual acuity（VA）,intraocular pressure（IOP）,and spherical equivalent（SE） values were assessed at 1wk,1 and 3mo after surgery.The ocular modulation transfer function,Strehl ratio,objective scattering index,and higher order aberrations（HOAs） were measured for 4-mm pupils at 3mo after surgery.RESULTS：There were no significant differences in VA,IOP,and SE among the conventional and Hole ICL groups.With regard to HOAs,values for coma and spherical aberrations showed no differences.The total HOA and trefoil values were significantly higher in group 2 than in group 1（P=0.02,0.03,respectively）.There were no significant differences among groups with regard to other optical quality parameter at 3mo after surgery.CONCLUSION：Our results suggest that Hole ICL implantation provides satisfactory visual quality that is equivalent to that provided by conventional ICL,regardless of the presence of central hole and degree of decentering.展开更多
Dear Editor,Iam Dr.Erick Hemandez-Bogantes from the Department of Cornea and Refractive Surgery,Conde of Valenciana Foundation Institute of Ophthalmology,Mexico City,Mexico. The purpose of this letter is to present 3 ...Dear Editor,Iam Dr.Erick Hemandez-Bogantes from the Department of Cornea and Refractive Surgery,Conde of Valenciana Foundation Institute of Ophthalmology,Mexico City,Mexico. The purpose of this letter is to present 3 cases (6 eyes)of toxic anterior segment syndrome (TASS)after same day implantation of a posterior phakic implantable collamer lens (ICL;V4c Visian ICL;STAAR Surgical,Monrovia,CA,USA).展开更多
AIM: To do a randomized prospective interventional study for comparing the effects of a single subconjunctival triamcinolone acetonide(SCTA) injection to tapering topical loteprednol in patients undergoing phacoemulsi...AIM: To do a randomized prospective interventional study for comparing the effects of a single subconjunctival triamcinolone acetonide(SCTA) injection to tapering topical loteprednol in patients undergoing phacoemulsification surgery under topical anesthesia. METHODS: A total of 400 patients were randomized into 2 groups; Group A(200 patients) received 5 mg SCTA at the end of surgery and topical ketorolac tromethamine(0.5%) with ofloxacin(0.3%) combination for 3 wk. Group B(200 patients) received tapering topical loteprednol etabonate(0.5%) along with ofloxacin(0.3%) and ketorolac tromethamine(0.5%) for 3 wk. Outcomes evaluated were intraocular pressure(IOP), anterior chamber cells/flare and macular oedema postoperatively at 1, 6 and 12 wk.RESULTS: Baseline parameters were almost similar in both the groups. No statistical difference was seen between the preoperative and postoperative IOP values for Group A(P=0.82) and Group B(P=0.61) and postoperative IOP values in between both groups(P=0.14) at 1 wk. Incidence of cells/flare postoperative was statistically not significant(P=0.82) in both groups at all follow up visits. Postoperative macular oedema was not observed at any follow up visit. CONCLUSION: SCTA appears to be an effective alternative to prolong postoperative topical steroid use.展开更多
The aim of the study is to evaluate the safety and effi cacy of trans-epithelial accelerated corneal cross-linking（TE-ACXL） in children with progressive keratoconus.Retrospective,case-series of 23 eyes of 14 childre...The aim of the study is to evaluate the safety and effi cacy of trans-epithelial accelerated corneal cross-linking（TE-ACXL） in children with progressive keratoconus.Retrospective,case-series of 23 eyes of 14 children who underwent TE-ACXL.Evaluations were performed at baseline and 1,3,6,12 and 18 mo postoperatively.Mean follow-up time of 23.82±3.15 mo and mean age was 13.7±1.4 y（range 11 to 16 y）.Mean preoperative uncorrected distance visual acuity changed from 0.92±0.45 log MAR（20/160） to 0.71±0.40 log MAR（20/100）（P=0.001）.Mean keratometry（Km） changed from 53.87± 6.03 to 53.00±5.81（P=0.001）.Pachymetry did not have significant changes at last follow-up（P=0.30）.The mean preoperative sphere was-5.58±2.48 and-4.89±4.66 D（P=0.11） at last follow-up;refractive cylinder from-5.58±2.48 to-5.02±2.23（P=0.046）.In conclusion,tomographic and refractive stability are shown in over 91% of eyes with pediatric progressive keratoconus who underwent TE-ACXL.展开更多
Background: Standard precautions (SPs) are the minimum infection prevention practices that aim to protect Health care workers (HCWs) including physicians and prevent them from transmitting the infections to their pati...Background: Standard precautions (SPs) are the minimum infection prevention practices that aim to protect Health care workers (HCWs) including physicians and prevent them from transmitting the infections to their patients. Purpose: To assess the level of compliance of physicians with standard precautions of handling patients with infectious respiratory disease. Method: A cross sectional questionnaire-based study was conducted in two tertiary level hospitals named M Abdur Rahim Medical College and Hospital, Dinajpur, Bangladesh and Rajshahi Medical College and Hospital, Rajshahi, Bangladesh to assess the level of compliance of physicians with standard precautions. Purposive sampling technique was applied as per inclusion criteria and data was collected by face to face interview from 285 physicians. Statistical analysis of the results was done by SPSS and a p value less than 0.05 was considered as significant. Result: The study revealed that maximum physicians (76.5%) handling patients with infectious respiratory disease had a moderate level of compliance with standard precautions. 78.6% of the physicians had moderate level of awareness about standard precautions. Only 20.35% of the physicians had training on infection control. 94.4% of the respondents didn’t know the component of standard precaution and most of the physicians were not aware of the sequence of wearing and removing the different components of PPEs. Conclusion: The study result implies that with increased awareness, the compliance of the physicians with standard precautions increased. The main reasons of non-compliance with standard precautions were found to be lack of resources, lack of regular training and excess workload.展开更多
Endothelial keratoplasty(EK)is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue,which retains healthy portions of a patient's cor...Endothelial keratoplasty(EK)is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue,which retains healthy portions of a patient's cornea while replacing diseased innermost corneal layer(s)with healthy donor tissue,to achieve corneal dehydration and transparency before the onset of irreversible stromal edema and permanent loss of corneal clarity.Recently,the pathophysiology of corneal decompensation is increasingly being researched upon.Consequent improvement in pharmacotherapy is progressively leading to reduction in the indications of EK.In addition,EK techniques have progressed towards using thinner tissue,optimizing visual outcomes.Improvements have enabled better donor tissue formulation,usage,and attachment,and surgical modifications have enhanced the tissue utilization in difficult clinical scenarios lowering failure and rejection.However,challenges are encountered in various complex clinical scenarios in-cluding eyes with prior intraocular surgery,complex anterior chamber anatomy,glaucoma,ocular surface disease etc.These complexities demand tailored surgical strategies,including modifications in graft handling,instru-mentation,and postoperative management to ensure success.Attention to these details and addressing patient-specific factors can help improve outcomes in these difficult cases.The choice of procedure depends on multiple factors,including the surgeon's experience,patient's ocular anatomy,and the specific clinical scenario.This review article encompasses the recent developments in this field presenting a comprehensive picture of our modern understanding of the indications,contraindications,surgical techniques,clinical situations,community aspects and future directions pertaining to EK.展开更多
Keratoconus is a progressive, usually bilateral disease of the cornea that significantly diminishes visual acuity, secondary to a progressive corneal deformity which is characterized by corneal thinning, variable degr...Keratoconus is a progressive, usually bilateral disease of the cornea that significantly diminishes visual acuity, secondary to a progressive corneal deformity which is characterized by corneal thinning, variable degrees of irregular astigmatism and specific abnormal topographic patterns. Normally it initiates during puberty and is progressive until the third or fourth decade of life, when normally the progression rate is diminished or waned. There are multiple scales to clinically classify keratoconus. One of the most commonly used is Amsler-Krumeich and recently with the development of morphometric and aberrometric techniques, additional scales have been created that allow keratoconus to be classified according to its severity. Despite certain etiology of keratoconus remains unknown, current treatment options are available in patients with ectatic corneas and they vary depending on the severity of the disease and they include spectacles, contact lenses, intrastromal rings, keratoplasty both penetrant or lamellar, cross-linking, refractive lens exchange withintraocular lens implant, phakic intraocular lenses and the combination of these alternatives. Some authors have been using excimer laser in patients with keratoconus but the safety of the procedure is controversial. Currently, the techniques for the management of keratoconus can be classified in 3 types: corneal strengthening techniques, optical optimization techniques and combined techniques.展开更多
Objective To investigate the effects of fresh and preserved amniotic membrane on polymorphonuclear neutrophils (PMNs) so as to understand the anti-inflammatory mechanism of amniotic membrane transplantation.Methods ...Objective To investigate the effects of fresh and preserved amniotic membrane on polymorphonuclear neutrophils (PMNs) so as to understand the anti-inflammatory mechanism of amniotic membrane transplantation.Methods Conditioned medium was collected 48 hours after fresh or preserved amnions were cultured in DMEM and 5% CO 2 at 37℃. Then, polymorphonuclear cells were cultured in conditioned culture or DMEM. Fluorescent microscopy with 4’,6-diamidino-2-phenylindole (DAPI) staining and cytometry were performed 6, 9, 12, and 15 hours later. Results Apoptotic neutrophils were found in each group at different time points. The percentage of apoptotic cells at 6, 9, 12, and 15 hours after culture in the fresh and preserved amnion groups and the control group was 17.3%, 24.4%, 29.8%, 37.1%, and 16.2%, 20.1%, 23.7%, 27.7%, and 10.2%, 13.7%, 21.1%, 26.4%, respectively (t test, P 1<0.01, P 2<0.01 and P 3<0.01).Conclusion Amniotic membrane can accelerate apoptosis of polymorphonuclear neutrophils, reduce inflammation, and prevent ocular surface collagen from resolution, indicating that fresh amnion might have a stronger effect than preserved amnion.展开更多
Background:The aim of the study was to evaluate the outcomes of dissatisfed patients reporting poor visual quality following implantation of multifocal intraocular lenses(MF-IOLs),managed by IOL exchange with another ...Background:The aim of the study was to evaluate the outcomes of dissatisfed patients reporting poor visual quality following implantation of multifocal intraocular lenses(MF-IOLs),managed by IOL exchange with another multifocal optical profle.Methods:This is a retrospective series of cases.MF-IOL exchange was done in 15 dissatisfed patients(30 eyes)with the perception of poor visual quality for far distance afected by neuroadaptation failure.Patients underwent a bilateral exchange of a MF-IOL with another MF-IOL of a diferent optical profle.Visual outcomes and complications were analyzed.Questionnaires including Quality of Vision(QoV),Visual Function Index-14(VF-14)and its Rasch-revised version(VF-8R)and a satisfaction questionnaire were also used for outcome evaluation.Results:The mean elapsed time from implantation to explantation-reimplantation was 11.8 months.The QoV scores improved signifcantly across all the three subscales.Visual function improved with a change in VF-14 score from 60.41±24.81 to 90.16±10.91(P<0.001).The VF-8R score improved as well.The uncorrected distance visual acuity improved from 0.24 to 0.12 logMAR after exchange(P<0.001)and corrected distance visual acuity improved from 0.15 to 0.04 logMAR(P<0.001).Safety and efcacy indexes reached 1.46 and 1.16,respectively.Concerning patients’satisfaction following MF-IOL exchange,80%of the patients reported they would have the MF-IOL reimplantation procedure again.Conclusions:Patient dissatisfaction with neuroadaptation failure following MF-IOL implantation can be managed in 80%of our cases by MF-IOL exchange with a diferent MF-IOL optical profle.展开更多
Background:To examine the retinal structure–vascular-function relationship using optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)in myopia.Methods:This was a prospective cross-secti...Background:To examine the retinal structure–vascular-function relationship using optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)in myopia.Methods:This was a prospective cross-sectional study comprising 86 eyes of 45 individuals with varying axial lengths and spherical equivalents and no posterior segment abnormalities.All eyes underwent optical coherence tomography with the Spectralis SD-OCT and OCTA with RTVue-XR Avanti;Optovue.Individual macular retinal layer thicknesses and flow areas and vessel densities were measured on OCT and OCTA,respectively.Linear correlations were made between the macular layer thicknesses,flow areas and vessel densities with axial length,spherical equivalent and visual acuity.Results:The participants’mean ages were 33.34±14.45 years,mean spherical equivalent refractions were−7.17±5.71 D and axial lengths were 25.95±2.41 mm.There were significant positive correlations of foveal angle(r=0.757,p=0.001),inner retinal(r=0.764,p=0.001)and outer plexiform layer(r=0.771,p=0.001)thickness on OCT and vessel densities in deep capillary plexus(r=0.313,p=0.003)on OCTA with axial length and negative correlations with spherical equivalents and visual acuity.Significant negative correlations of outer nuclear layer(r=−0.560,p=0.03)and photoreceptor outer segment layer thickness(r=−0.856,p<0.001)were noted on OCT with axial length and positive correlations with spherical equivalents and visual acuity.Conclusion:The lateral retinal stretching in myopia could possibly explain the correlation between retinal layer thickness,vascular density and visual acuity in these eyes.Further research is required to investigate this.展开更多
Microbial keratitis caused by more than one microorganism is rare. It may occur as a coinfection or as a secondary infection superimposed with an existent microorganism. Both infectious and immune mechanisms are impli...Microbial keratitis caused by more than one microorganism is rare. It may occur as a coinfection or as a secondary infection superimposed with an existent microorganism. Both infectious and immune mechanisms are implicated in microbial keratitis. Herein, we report an unusual clinical case of viral and fungal mixed infection. Written informed consent was obtained from the patient.展开更多
Background:The aim of this study is to review the outcomes of canaloplasty versus canaloplasty combined with phacoemulsification in a retrospective cohort study and to evaluate the efficacy of these methods in terms o...Background:The aim of this study is to review the outcomes of canaloplasty versus canaloplasty combined with phacoemulsification in a retrospective cohort study and to evaluate the efficacy of these methods in terms of intraocular pressure(IOP)lowering effect,postoperative complications and additional glaucoma surgery or reintroduction of medical therapy over a 12-month follow-up.Methods:In a retrospective cohort study,602 eyes with primary open angle glaucoma(POAG)were treated with canaloplasty or canaloplasty combined with phacoemulsification.The results were evaluated separately in two main groups;group A canaloplasty(262 eyes)and group B canaloplasty combined with phaco(322 eyes).Each group was then subdivided into three additional groups according to the severity of glaucoma.The criteria for successful treatment were evaluated between three IOP ranges;IOP≤16 mmHg,18 mmHg and 21 mmHg.Complete success was considered the percentage of eyes reaching target IOP with no medication and partial success with medication.Groups A and B subgroups were compared using the Kaplan Meier test.Mean IOP,reduction of antiglaucoma agents and additional IOP lowering methods were also evaluated.The follow-up time was 12 months.Statistical significance was set at p<0.05.Results:An incomplete intraoperative cannulation of Schlemm’s canal resulting in conversion to other glaucoma surgery occurred in 18 eyes(2.99%).In both of the main groups,postoperative hyphema,descemet membrane detachment and transient IOP rise were the most common postoperative complications.The mean IOP in group A and subgroups at 12 months was 13.26±4.5 mmHg,15.19±3.97 mmHg and 18.09±3.75 mmHg.Respectively in group B mean IOP was 14.51±4.69 mmHg,14.40±4.11 mmHg and 14.25±2.76 mmHg.Complete success was achieved in group A in 69.19,74.51 and 74.31%of eyes.In group B complete success was achieved in 81.60,77.33 and 83.33%of eyes respectively.Kaplan Meier between groups A and B was statistically significant for IOP≤16 mmHg and IOP≤21 mmHg(p=0.0041 and p=0.0312),but not for IOP≤18 mmHg(p=0.6935).Partial success for IOP≤16 mmHg was 95.23 and 92.26%,for IOP≤18 mmHg was 91.66 and 90.47%and for IOP≤21 mmHg,90.00 and 93.10%,in groups A and B respectively.Twenty-three eyes received additional surgery(3.93%),10 trabeculectomies and 2 cyclophotocoagulation in group A,and 9 trabeculectomies and 2 cyclophotocoagulation in group B.Conclusion:Canaloplasty and canaloplasty combined with phacoemulsification significantly lower the IOP and have a lower postoperative complication rate.Additional glaucoma surgery or medication following both procedures is necessary if target IOP is unsatisfactory.In this study,canaloplasty combined with phacoemulsification demonstrated superior success rate compared to canaloplasty alone.展开更多
文摘Laser refractive surgery is one of the most commonly performed procedures worldwide.In laser refractive surgery,Femtosecond Laser in Situ Keratomileusis and Refractive Lenticule Extraction have emerged as promising alternatives to microkeratome Laser in Situ Keratomileusis and Photorefractive Keratectomy.Following laser refractive surgery,the corneal nerves,epithelial and stromal cells release neuromediators,including neurotrophins,neuropeptides and neurotransmitters.Notably,nerve growth factor,substance P,calcitonin gene-related peptide and various cytokines are important mediators of neurogenic inflammation and corneal nerve regeneration.Alterations in neuromediator profiles and ocular surface parameters following laser refractive surgery are attributed to the surgical techniques and the severity of tissue insult induced.In this review,we will discuss the(1)Functions of neuromediators and their physiological and clinical significance;(2)Changes in the neuromediators following various laser refractive surgeries;(3)Correlation between neuromediators,ocular surface health and corneal nerve status;and(4)Future directions,including the use of neuromediators as potential biomarkers for ocular surface health following laser refractive surgery,and as adjuncts to aid in corneal regeneration after laser refractive surgery.
文摘Small Aδand C nerve fibers of the sensory and autonomic nervous systems constitute 70–90%of peripheral nerve fibers including corneal nerves(Muller et al.,2003).Corneal nerves originate from the ophthalmic branch of the trigeminal nerve and enter the cornea at the limbus radially from all directions toward the central cornea at the level of anterior and middle stroma.The subepithelial nerve plexus lies at the interface between the Bowman layer and anterior stroma.They then divide into smaller branches and turn 90°toward Bowman’s layer(Muller et al.,2003),travelling between Bowman’s layer and the basal epithelial layer and forming the sub-basal nerve plexus(Muller et al.,2003).
文摘Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.
文摘Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature.However,growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit,which includes both the retinal vascular structures and neural tissues.Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening.However,diabetic corneal neuropathy is commonly overlooked and underdiagnosed,leading to severe ocular surface impairment.Several studies have found that these two conditions tend to occur together,and they share similarities in their pathogenesis pathways,being triggered by a status of chronic hyperglycemia.This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy,whether diabetic corneal neuropathy precedes diabetic retinopathy,as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy.We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.
文摘Dear Sir,I am Dr. Nilufer Yesilirmak, from the Department of Cornea, Bascom Palmer Eye Institute, Miami, Florida,USA. We wrote to report a reduction of graft rejection with dexamethasone intravitreal implant （Ozurdex ） in a case with aphakia.
文摘Corneal diseases are a major cause of blindness in the world. Although great progress has been achieved in the treatment of corneal diseases, wound healing after severe corneal damage and immunosuppressive therapy after corneal transplantation remain prob-lematic. Mesenchymal stem cells(MSCs) derived from bone marrow or other adult tissues can differentiate into various types of mesenchymal lineages, such as osteocytes, adipocytes, and chondrocytes, both in vivo and in vitro. These cells can further differentiate into specific cell types under specific conditions. MSCs migrate to injury sites and promote wound healing by secreting anti-inflammatory and growth factors. In ad-dition, MSCs interact with innate and acquired immune cells and modulate the immune response through their powerful paracrine function. Over the last decade, MSCs have drawn considerable attention because of their beneficial properties and promising therapeutic prospective. Furthermore, MSCs have been applied to various studies related to wound healing, autoim-mune diseases, and organ transplantation. This review discusses the potential functions of MSCs in protecting corneal tissue and their possible mechanisms in corneal wound healing and corneal transplantation.
文摘Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,respectively.Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin biopsies.However,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic neuropathy.More recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy.In this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and management.We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.
文摘AIM：To evaluate the clinical outcomes of V4 c implantable collamer lens（Hole ICL） implantation with regard to the optical quality assessed according to different degrees of decentering.METHODS：This included 49 eyes that received conventional ICL and 94 eyes that received Hole ICL.The eyes that received Hole ICL were divided into three groups according to the degree of decentering：group 1,central hole within 1 hole diameter（HD） from the pupil center;group 2,central hole within 1 HD to 2 HD;and group 3,central hole within 2 HD to 3 HD.Visual acuity（VA）,intraocular pressure（IOP）,and spherical equivalent（SE） values were assessed at 1wk,1 and 3mo after surgery.The ocular modulation transfer function,Strehl ratio,objective scattering index,and higher order aberrations（HOAs） were measured for 4-mm pupils at 3mo after surgery.RESULTS：There were no significant differences in VA,IOP,and SE among the conventional and Hole ICL groups.With regard to HOAs,values for coma and spherical aberrations showed no differences.The total HOA and trefoil values were significantly higher in group 2 than in group 1（P=0.02,0.03,respectively）.There were no significant differences among groups with regard to other optical quality parameter at 3mo after surgery.CONCLUSION：Our results suggest that Hole ICL implantation provides satisfactory visual quality that is equivalent to that provided by conventional ICL,regardless of the presence of central hole and degree of decentering.
文摘Dear Editor,Iam Dr.Erick Hemandez-Bogantes from the Department of Cornea and Refractive Surgery,Conde of Valenciana Foundation Institute of Ophthalmology,Mexico City,Mexico. The purpose of this letter is to present 3 cases (6 eyes)of toxic anterior segment syndrome (TASS)after same day implantation of a posterior phakic implantable collamer lens (ICL;V4c Visian ICL;STAAR Surgical,Monrovia,CA,USA).
文摘AIM: To do a randomized prospective interventional study for comparing the effects of a single subconjunctival triamcinolone acetonide(SCTA) injection to tapering topical loteprednol in patients undergoing phacoemulsification surgery under topical anesthesia. METHODS: A total of 400 patients were randomized into 2 groups; Group A(200 patients) received 5 mg SCTA at the end of surgery and topical ketorolac tromethamine(0.5%) with ofloxacin(0.3%) combination for 3 wk. Group B(200 patients) received tapering topical loteprednol etabonate(0.5%) along with ofloxacin(0.3%) and ketorolac tromethamine(0.5%) for 3 wk. Outcomes evaluated were intraocular pressure(IOP), anterior chamber cells/flare and macular oedema postoperatively at 1, 6 and 12 wk.RESULTS: Baseline parameters were almost similar in both the groups. No statistical difference was seen between the preoperative and postoperative IOP values for Group A(P=0.82) and Group B(P=0.61) and postoperative IOP values in between both groups(P=0.14) at 1 wk. Incidence of cells/flare postoperative was statistically not significant(P=0.82) in both groups at all follow up visits. Postoperative macular oedema was not observed at any follow up visit. CONCLUSION: SCTA appears to be an effective alternative to prolong postoperative topical steroid use.
文摘The aim of the study is to evaluate the safety and effi cacy of trans-epithelial accelerated corneal cross-linking（TE-ACXL） in children with progressive keratoconus.Retrospective,case-series of 23 eyes of 14 children who underwent TE-ACXL.Evaluations were performed at baseline and 1,3,6,12 and 18 mo postoperatively.Mean follow-up time of 23.82±3.15 mo and mean age was 13.7±1.4 y（range 11 to 16 y）.Mean preoperative uncorrected distance visual acuity changed from 0.92±0.45 log MAR（20/160） to 0.71±0.40 log MAR（20/100）（P=0.001）.Mean keratometry（Km） changed from 53.87± 6.03 to 53.00±5.81（P=0.001）.Pachymetry did not have significant changes at last follow-up（P=0.30）.The mean preoperative sphere was-5.58±2.48 and-4.89±4.66 D（P=0.11） at last follow-up;refractive cylinder from-5.58±2.48 to-5.02±2.23（P=0.046）.In conclusion,tomographic and refractive stability are shown in over 91% of eyes with pediatric progressive keratoconus who underwent TE-ACXL.
文摘Background: Standard precautions (SPs) are the minimum infection prevention practices that aim to protect Health care workers (HCWs) including physicians and prevent them from transmitting the infections to their patients. Purpose: To assess the level of compliance of physicians with standard precautions of handling patients with infectious respiratory disease. Method: A cross sectional questionnaire-based study was conducted in two tertiary level hospitals named M Abdur Rahim Medical College and Hospital, Dinajpur, Bangladesh and Rajshahi Medical College and Hospital, Rajshahi, Bangladesh to assess the level of compliance of physicians with standard precautions. Purposive sampling technique was applied as per inclusion criteria and data was collected by face to face interview from 285 physicians. Statistical analysis of the results was done by SPSS and a p value less than 0.05 was considered as significant. Result: The study revealed that maximum physicians (76.5%) handling patients with infectious respiratory disease had a moderate level of compliance with standard precautions. 78.6% of the physicians had moderate level of awareness about standard precautions. Only 20.35% of the physicians had training on infection control. 94.4% of the respondents didn’t know the component of standard precaution and most of the physicians were not aware of the sequence of wearing and removing the different components of PPEs. Conclusion: The study result implies that with increased awareness, the compliance of the physicians with standard precautions increased. The main reasons of non-compliance with standard precautions were found to be lack of resources, lack of regular training and excess workload.
文摘Endothelial keratoplasty(EK)is defined as an umbrella term comprising methods for selective surgical replacement of corneal endothelium and adjacent corneal tissue,which retains healthy portions of a patient's cornea while replacing diseased innermost corneal layer(s)with healthy donor tissue,to achieve corneal dehydration and transparency before the onset of irreversible stromal edema and permanent loss of corneal clarity.Recently,the pathophysiology of corneal decompensation is increasingly being researched upon.Consequent improvement in pharmacotherapy is progressively leading to reduction in the indications of EK.In addition,EK techniques have progressed towards using thinner tissue,optimizing visual outcomes.Improvements have enabled better donor tissue formulation,usage,and attachment,and surgical modifications have enhanced the tissue utilization in difficult clinical scenarios lowering failure and rejection.However,challenges are encountered in various complex clinical scenarios in-cluding eyes with prior intraocular surgery,complex anterior chamber anatomy,glaucoma,ocular surface disease etc.These complexities demand tailored surgical strategies,including modifications in graft handling,instru-mentation,and postoperative management to ensure success.Attention to these details and addressing patient-specific factors can help improve outcomes in these difficult cases.The choice of procedure depends on multiple factors,including the surgeon's experience,patient's ocular anatomy,and the specific clinical scenario.This review article encompasses the recent developments in this field presenting a comprehensive picture of our modern understanding of the indications,contraindications,surgical techniques,clinical situations,community aspects and future directions pertaining to EK.
文摘Keratoconus is a progressive, usually bilateral disease of the cornea that significantly diminishes visual acuity, secondary to a progressive corneal deformity which is characterized by corneal thinning, variable degrees of irregular astigmatism and specific abnormal topographic patterns. Normally it initiates during puberty and is progressive until the third or fourth decade of life, when normally the progression rate is diminished or waned. There are multiple scales to clinically classify keratoconus. One of the most commonly used is Amsler-Krumeich and recently with the development of morphometric and aberrometric techniques, additional scales have been created that allow keratoconus to be classified according to its severity. Despite certain etiology of keratoconus remains unknown, current treatment options are available in patients with ectatic corneas and they vary depending on the severity of the disease and they include spectacles, contact lenses, intrastromal rings, keratoplasty both penetrant or lamellar, cross-linking, refractive lens exchange withintraocular lens implant, phakic intraocular lenses and the combination of these alternatives. Some authors have been using excimer laser in patients with keratoconus but the safety of the procedure is controversial. Currently, the techniques for the management of keratoconus can be classified in 3 types: corneal strengthening techniques, optical optimization techniques and combined techniques.
文摘Objective To investigate the effects of fresh and preserved amniotic membrane on polymorphonuclear neutrophils (PMNs) so as to understand the anti-inflammatory mechanism of amniotic membrane transplantation.Methods Conditioned medium was collected 48 hours after fresh or preserved amnions were cultured in DMEM and 5% CO 2 at 37℃. Then, polymorphonuclear cells were cultured in conditioned culture or DMEM. Fluorescent microscopy with 4’,6-diamidino-2-phenylindole (DAPI) staining and cytometry were performed 6, 9, 12, and 15 hours later. Results Apoptotic neutrophils were found in each group at different time points. The percentage of apoptotic cells at 6, 9, 12, and 15 hours after culture in the fresh and preserved amnion groups and the control group was 17.3%, 24.4%, 29.8%, 37.1%, and 16.2%, 20.1%, 23.7%, 27.7%, and 10.2%, 13.7%, 21.1%, 26.4%, respectively (t test, P 1<0.01, P 2<0.01 and P 3<0.01).Conclusion Amniotic membrane can accelerate apoptosis of polymorphonuclear neutrophils, reduce inflammation, and prevent ocular surface collagen from resolution, indicating that fresh amnion might have a stronger effect than preserved amnion.
基金the Network for Cooperative Research in Health“OFTARED”,Nodo Dioptrio Ocular,Biobanco Iberia(Reference:RD16/0008/0012)funded by Instituto de Salud Carlos III and co-funded by European Regional Development Fund(ERDF)Project"A way to make Europe"。
文摘Background:The aim of the study was to evaluate the outcomes of dissatisfed patients reporting poor visual quality following implantation of multifocal intraocular lenses(MF-IOLs),managed by IOL exchange with another multifocal optical profle.Methods:This is a retrospective series of cases.MF-IOL exchange was done in 15 dissatisfed patients(30 eyes)with the perception of poor visual quality for far distance afected by neuroadaptation failure.Patients underwent a bilateral exchange of a MF-IOL with another MF-IOL of a diferent optical profle.Visual outcomes and complications were analyzed.Questionnaires including Quality of Vision(QoV),Visual Function Index-14(VF-14)and its Rasch-revised version(VF-8R)and a satisfaction questionnaire were also used for outcome evaluation.Results:The mean elapsed time from implantation to explantation-reimplantation was 11.8 months.The QoV scores improved signifcantly across all the three subscales.Visual function improved with a change in VF-14 score from 60.41±24.81 to 90.16±10.91(P<0.001).The VF-8R score improved as well.The uncorrected distance visual acuity improved from 0.24 to 0.12 logMAR after exchange(P<0.001)and corrected distance visual acuity improved from 0.15 to 0.04 logMAR(P<0.001).Safety and efcacy indexes reached 1.46 and 1.16,respectively.Concerning patients’satisfaction following MF-IOL exchange,80%of the patients reported they would have the MF-IOL reimplantation procedure again.Conclusions:Patient dissatisfaction with neuroadaptation failure following MF-IOL implantation can be managed in 80%of our cases by MF-IOL exchange with a diferent MF-IOL optical profle.
文摘Background:To examine the retinal structure–vascular-function relationship using optical coherence tomography(OCT)and optical coherence tomography angiography(OCTA)in myopia.Methods:This was a prospective cross-sectional study comprising 86 eyes of 45 individuals with varying axial lengths and spherical equivalents and no posterior segment abnormalities.All eyes underwent optical coherence tomography with the Spectralis SD-OCT and OCTA with RTVue-XR Avanti;Optovue.Individual macular retinal layer thicknesses and flow areas and vessel densities were measured on OCT and OCTA,respectively.Linear correlations were made between the macular layer thicknesses,flow areas and vessel densities with axial length,spherical equivalent and visual acuity.Results:The participants’mean ages were 33.34±14.45 years,mean spherical equivalent refractions were−7.17±5.71 D and axial lengths were 25.95±2.41 mm.There were significant positive correlations of foveal angle(r=0.757,p=0.001),inner retinal(r=0.764,p=0.001)and outer plexiform layer(r=0.771,p=0.001)thickness on OCT and vessel densities in deep capillary plexus(r=0.313,p=0.003)on OCTA with axial length and negative correlations with spherical equivalents and visual acuity.Significant negative correlations of outer nuclear layer(r=−0.560,p=0.03)and photoreceptor outer segment layer thickness(r=−0.856,p<0.001)were noted on OCT with axial length and positive correlations with spherical equivalents and visual acuity.Conclusion:The lateral retinal stretching in myopia could possibly explain the correlation between retinal layer thickness,vascular density and visual acuity in these eyes.Further research is required to investigate this.
基金This study was supported by a grant from Tianjin Medical University Eye Institute science foundation （No. 15YKYJS003）.
文摘Microbial keratitis caused by more than one microorganism is rare. It may occur as a coinfection or as a secondary infection superimposed with an existent microorganism. Both infectious and immune mechanisms are implicated in microbial keratitis. Herein, we report an unusual clinical case of viral and fungal mixed infection. Written informed consent was obtained from the patient.
文摘Background:The aim of this study is to review the outcomes of canaloplasty versus canaloplasty combined with phacoemulsification in a retrospective cohort study and to evaluate the efficacy of these methods in terms of intraocular pressure(IOP)lowering effect,postoperative complications and additional glaucoma surgery or reintroduction of medical therapy over a 12-month follow-up.Methods:In a retrospective cohort study,602 eyes with primary open angle glaucoma(POAG)were treated with canaloplasty or canaloplasty combined with phacoemulsification.The results were evaluated separately in two main groups;group A canaloplasty(262 eyes)and group B canaloplasty combined with phaco(322 eyes).Each group was then subdivided into three additional groups according to the severity of glaucoma.The criteria for successful treatment were evaluated between three IOP ranges;IOP≤16 mmHg,18 mmHg and 21 mmHg.Complete success was considered the percentage of eyes reaching target IOP with no medication and partial success with medication.Groups A and B subgroups were compared using the Kaplan Meier test.Mean IOP,reduction of antiglaucoma agents and additional IOP lowering methods were also evaluated.The follow-up time was 12 months.Statistical significance was set at p<0.05.Results:An incomplete intraoperative cannulation of Schlemm’s canal resulting in conversion to other glaucoma surgery occurred in 18 eyes(2.99%).In both of the main groups,postoperative hyphema,descemet membrane detachment and transient IOP rise were the most common postoperative complications.The mean IOP in group A and subgroups at 12 months was 13.26±4.5 mmHg,15.19±3.97 mmHg and 18.09±3.75 mmHg.Respectively in group B mean IOP was 14.51±4.69 mmHg,14.40±4.11 mmHg and 14.25±2.76 mmHg.Complete success was achieved in group A in 69.19,74.51 and 74.31%of eyes.In group B complete success was achieved in 81.60,77.33 and 83.33%of eyes respectively.Kaplan Meier between groups A and B was statistically significant for IOP≤16 mmHg and IOP≤21 mmHg(p=0.0041 and p=0.0312),but not for IOP≤18 mmHg(p=0.6935).Partial success for IOP≤16 mmHg was 95.23 and 92.26%,for IOP≤18 mmHg was 91.66 and 90.47%and for IOP≤21 mmHg,90.00 and 93.10%,in groups A and B respectively.Twenty-three eyes received additional surgery(3.93%),10 trabeculectomies and 2 cyclophotocoagulation in group A,and 9 trabeculectomies and 2 cyclophotocoagulation in group B.Conclusion:Canaloplasty and canaloplasty combined with phacoemulsification significantly lower the IOP and have a lower postoperative complication rate.Additional glaucoma surgery or medication following both procedures is necessary if target IOP is unsatisfactory.In this study,canaloplasty combined with phacoemulsification demonstrated superior success rate compared to canaloplasty alone.
