AIM：To evaluate the clinical and tomographic outcomes after implantation of a new intrastromal corneal ring segment（ICRS） with 140-degrees of arc in eyes with corneal ectasia.METHODS：We evaluated patients with cor...AIM：To evaluate the clinical and tomographic outcomes after implantation of a new intrastromal corneal ring segment（ICRS） with 140-degrees of arc in eyes with corneal ectasia.METHODS：We evaluated patients with corneal ectasia implanted with Ferrara 140° ICRS from April 2010 to February 2015.Outcome measures included preoperative and postoperative corrected distance visual acuity（CDVA）,keratometry simulated（K） reading,tomographic astigmatism and asphericity.All patients were evaluated using the Pentacam Scheimpflug system.RESULTS：The study evaluated 58 eyes.The mean followup was 16.81±10.8 mo.The CDVA（logM AR） improved from 0.5±0.20（20/60） to 0.3±0.21（20/40）（P〈0.01）.The average K reduced from 49.87±7.01 to 47.34±4.90 D（P〈0.01）.The asphericity changed from-0.60±0.86 to-0.23±0.67 D（P〈0.01）.The mean preoperative tomographic astigmatism decreased from-8.0±3.45 to-4.53±2.52 D（P〈0.01）.CONCLUSION：The new ICRS model with 140-degrees of arc effectively improve the visual acuity and reduce the high astigmatism usually found in patients with corneal ectasia.展开更多
AIM: To compare the clinical outcomes of the standard corneal cross linking(CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty.METHODS: Total...AIM: To compare the clinical outcomes of the standard corneal cross linking(CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty.METHODS: Totally 120 eyes of 83 patients scheduled to receive either standard CXL(3 m W/cm^2 for a period of 30 min) or accelerated CXL(18 m W/cm2 for a period of 5 min). The main outcomes for comparison were the change in: maximum-K reading(K-max), manifest refractive spherical equivalent(SE), central corneal thickness(CCT), and the best corrected distance visual acuity(CDVA).RESULTS: One hundred and eleven eyes completed the study. The main outcome measurement was the K-max reading. Both group showed significant improvement in the value postoperatively at 6 and 12 mo. The mean change in the standard group was 1.21±0.11 D and in the accelerated group was 0.90±0.05 D at the end of 12 mo postoperatively, with no statistically significant difference between the 2 groups. Similarly, CDVA improved significantly from their preoperative value in the standard group by 2.98±0.11 letters, and in the accelerated group by 2.20±0.06 letters, with no statistically significant difference between the two groups. Both of the SE, and CCT showed no statistically significant difference at the end of follow up period in each group.CONCLUSION: Both standard CXL and accelerated CXL are safe and effective treatment in halting ectasia after corneal refractive surgery. The accelerated CXL results are comparable to the standard CXL with short time exposure of the cornea to ultraviolet irradiation, leading to reduced operation time, reduced operative ocular discomfort, and corneal haze.展开更多
BACKGROUND Known ocular manifestations of Alport syndrome include features such as anterior lenticonus and fleck retinopathy. Reports of keratoconus in such patients are limited. We report tomographic findings consist...BACKGROUND Known ocular manifestations of Alport syndrome include features such as anterior lenticonus and fleck retinopathy. Reports of keratoconus in such patients are limited. We report tomographic findings consistent with keratoconus in a patient with Alport syndrome.CASE SUMMARY A 52-year-old female was referred to our ophthalmology clinic with decreased vision and increased tearing. She was diagnosed with stage Ⅲ Alport syndrome two years prior. Upon examination she was found to have average keratometries of 48D bilaterally with tomographic evidence of keratoconus.CONCLUSION Although a rare presentation, concurrent Alport syndrome and keratoconus should be considered when reviewing the ocular health of Alport syndrome patients and appropriate management steps should be taken upon the diagnosis.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
Background: Keratoglobus is a rare noninflammatory corneal disorder characterized by diffuse corneal thinning and globular protrusion of the cornea. Surgical management of keratoglobus is challenging and the standard ...Background: Keratoglobus is a rare noninflammatory corneal disorder characterized by diffuse corneal thinning and globular protrusion of the cornea. Surgical management of keratoglobus is challenging and the standard method has not yet been defined. Aim: To present the role of large penetrating keratoplasty (PK) in the management of keratoglobus. Case Presentation: A 29-year-old male patient with bilateral keratoglobus presented with acute corneal hydrops in his right eye following extensive Descemet’s membrane rupture, with a visual acuity in this eye limited to hand movement. Peripheral cornea was extremely thin and blue sclera was present. Acute hydrops was managed conservatively at this stage and two months later large PK was performed in the right eye using 9.5 mm diameter graft over a 9 mm patient’s cornea trephination. Minor aqueous leakage was seen on the first postoperative day, managed with 2 more interrupted 10.0 nylon sutures. No further complications were noticed and postoperative course was uneventful. Fifteen months postoperatively the graft was clear and best corrected visual acuity was 20/60. Conclusions: Large penetrating keratoplasty has an important role in the management of keratoglobus, in cases where peripheral tuck-in lamellar keratoplasty or epikeratoplasty present serious intraoperative difficulties in host lamellar dissection and in stabilizing the graft due to extensive peripheral corneal and scleral thinning.展开更多
This study evaluated the clinical outcomes in keratoconus corneas following accelerated transepithelial corneal collagen cross-linking（CXL）（Avedro KXL system,Waltham,MA,USA） over one year of follow-up.The mean de...This study evaluated the clinical outcomes in keratoconus corneas following accelerated transepithelial corneal collagen cross-linking（CXL）（Avedro KXL system,Waltham,MA,USA） over one year of follow-up.The mean depth of the demarcation line measured by optical coherence tomography（OCT） was 205.19 μm.One month after surgery,a non-statistically significant change was noted in sphere（P= 0.18） and in spherical equivalent（P= 0.17）,whereas a significant improvement was observed in corrected distance visual acuity（P=0.04）.A significant change was observed in topographic astigmatism（P= 0.03） and posterior corneal a sphericity（P= 0.04）.Accelerated transepithelial CXL may be a useful technique for the management of progressive keratoconus.展开更多
<strong>Purpose:</strong> To determine the diagnostic value of the anterior segment optical coherence tomography (AS-OCT) indices in differentiating normal from ectatic corneas. <strong>Material and ...<strong>Purpose:</strong> To determine the diagnostic value of the anterior segment optical coherence tomography (AS-OCT) indices in differentiating normal from ectatic corneas. <strong>Material and Methods:</strong> Two groups of patients—with corneal ectasia and normal controls were compared. Each group consists of 80 eyes of 43 age and sex-matched patients. All of them underwent corneal topography with OCULUS Keratograph 5M and corneal pachymetry with AS-OCT with RTVue-100. The indices generated by the AS-OCT pachymetric scans were analyzed. <strong>Results:</strong> There was a statistically significant difference for all the examined indices between the two groups with p values <0.001 and a confidence interval of 95%. The minimal corneal thickness (Min) was the best performing index according to the ROC analysis with an area under the curve of 0.976 and a combination of sensitivity and specificity of 0.925 and 0.911 respectively, and a “cut-off” value of 484 microns, followed by the indices of focal thinning—Min-Med and Min-Max with an area under the curve of 0.973 and 0.971 and sensitivity/specificity of 0.938/0.962 and 0.938/0.937 respectively. The rest of the examined parameters had an area under the curve in the range between 0.950 for the central corneal thickness and 0.814 for the outer superior segment. <strong>Conclusion:</strong> The anterior segment OCT indices showed excellent capability in differentiating ectatic from normal corneas.展开更多
文摘AIM：To evaluate the clinical and tomographic outcomes after implantation of a new intrastromal corneal ring segment（ICRS） with 140-degrees of arc in eyes with corneal ectasia.METHODS：We evaluated patients with corneal ectasia implanted with Ferrara 140° ICRS from April 2010 to February 2015.Outcome measures included preoperative and postoperative corrected distance visual acuity（CDVA）,keratometry simulated（K） reading,tomographic astigmatism and asphericity.All patients were evaluated using the Pentacam Scheimpflug system.RESULTS：The study evaluated 58 eyes.The mean followup was 16.81±10.8 mo.The CDVA（logM AR） improved from 0.5±0.20（20/60） to 0.3±0.21（20/40）（P〈0.01）.The average K reduced from 49.87±7.01 to 47.34±4.90 D（P〈0.01）.The asphericity changed from-0.60±0.86 to-0.23±0.67 D（P〈0.01）.The mean preoperative tomographic astigmatism decreased from-8.0±3.45 to-4.53±2.52 D（P〈0.01）.CONCLUSION：The new ICRS model with 140-degrees of arc effectively improve the visual acuity and reduce the high astigmatism usually found in patients with corneal ectasia.
文摘AIM: To compare the clinical outcomes of the standard corneal cross linking(CXL) and the accelerated CXL in patients with progressive corneal ectasia post refractive surgery and penetrating keratoplasty.METHODS: Totally 120 eyes of 83 patients scheduled to receive either standard CXL(3 m W/cm^2 for a period of 30 min) or accelerated CXL(18 m W/cm2 for a period of 5 min). The main outcomes for comparison were the change in: maximum-K reading(K-max), manifest refractive spherical equivalent(SE), central corneal thickness(CCT), and the best corrected distance visual acuity(CDVA).RESULTS: One hundred and eleven eyes completed the study. The main outcome measurement was the K-max reading. Both group showed significant improvement in the value postoperatively at 6 and 12 mo. The mean change in the standard group was 1.21±0.11 D and in the accelerated group was 0.90±0.05 D at the end of 12 mo postoperatively, with no statistically significant difference between the 2 groups. Similarly, CDVA improved significantly from their preoperative value in the standard group by 2.98±0.11 letters, and in the accelerated group by 2.20±0.06 letters, with no statistically significant difference between the two groups. Both of the SE, and CCT showed no statistically significant difference at the end of follow up period in each group.CONCLUSION: Both standard CXL and accelerated CXL are safe and effective treatment in halting ectasia after corneal refractive surgery. The accelerated CXL results are comparable to the standard CXL with short time exposure of the cornea to ultraviolet irradiation, leading to reduced operation time, reduced operative ocular discomfort, and corneal haze.
文摘BACKGROUND Known ocular manifestations of Alport syndrome include features such as anterior lenticonus and fleck retinopathy. Reports of keratoconus in such patients are limited. We report tomographic findings consistent with keratoconus in a patient with Alport syndrome.CASE SUMMARY A 52-year-old female was referred to our ophthalmology clinic with decreased vision and increased tearing. She was diagnosed with stage Ⅲ Alport syndrome two years prior. Upon examination she was found to have average keratometries of 48D bilaterally with tomographic evidence of keratoconus.CONCLUSION Although a rare presentation, concurrent Alport syndrome and keratoconus should be considered when reviewing the ocular health of Alport syndrome patients and appropriate management steps should be taken upon the diagnosis.
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Background: Keratoglobus is a rare noninflammatory corneal disorder characterized by diffuse corneal thinning and globular protrusion of the cornea. Surgical management of keratoglobus is challenging and the standard method has not yet been defined. Aim: To present the role of large penetrating keratoplasty (PK) in the management of keratoglobus. Case Presentation: A 29-year-old male patient with bilateral keratoglobus presented with acute corneal hydrops in his right eye following extensive Descemet’s membrane rupture, with a visual acuity in this eye limited to hand movement. Peripheral cornea was extremely thin and blue sclera was present. Acute hydrops was managed conservatively at this stage and two months later large PK was performed in the right eye using 9.5 mm diameter graft over a 9 mm patient’s cornea trephination. Minor aqueous leakage was seen on the first postoperative day, managed with 2 more interrupted 10.0 nylon sutures. No further complications were noticed and postoperative course was uneventful. Fifteen months postoperatively the graft was clear and best corrected visual acuity was 20/60. Conclusions: Large penetrating keratoplasty has an important role in the management of keratoglobus, in cases where peripheral tuck-in lamellar keratoplasty or epikeratoplasty present serious intraoperative difficulties in host lamellar dissection and in stabilizing the graft due to extensive peripheral corneal and scleral thinning.
文摘This study evaluated the clinical outcomes in keratoconus corneas following accelerated transepithelial corneal collagen cross-linking（CXL）（Avedro KXL system,Waltham,MA,USA） over one year of follow-up.The mean depth of the demarcation line measured by optical coherence tomography（OCT） was 205.19 μm.One month after surgery,a non-statistically significant change was noted in sphere（P= 0.18） and in spherical equivalent（P= 0.17）,whereas a significant improvement was observed in corrected distance visual acuity（P=0.04）.A significant change was observed in topographic astigmatism（P= 0.03） and posterior corneal a sphericity（P= 0.04）.Accelerated transepithelial CXL may be a useful technique for the management of progressive keratoconus.
文摘<strong>Purpose:</strong> To determine the diagnostic value of the anterior segment optical coherence tomography (AS-OCT) indices in differentiating normal from ectatic corneas. <strong>Material and Methods:</strong> Two groups of patients—with corneal ectasia and normal controls were compared. Each group consists of 80 eyes of 43 age and sex-matched patients. All of them underwent corneal topography with OCULUS Keratograph 5M and corneal pachymetry with AS-OCT with RTVue-100. The indices generated by the AS-OCT pachymetric scans were analyzed. <strong>Results:</strong> There was a statistically significant difference for all the examined indices between the two groups with p values <0.001 and a confidence interval of 95%. The minimal corneal thickness (Min) was the best performing index according to the ROC analysis with an area under the curve of 0.976 and a combination of sensitivity and specificity of 0.925 and 0.911 respectively, and a “cut-off” value of 484 microns, followed by the indices of focal thinning—Min-Med and Min-Max with an area under the curve of 0.973 and 0.971 and sensitivity/specificity of 0.938/0.962 and 0.938/0.937 respectively. The rest of the examined parameters had an area under the curve in the range between 0.950 for the central corneal thickness and 0.814 for the outer superior segment. <strong>Conclusion:</strong> The anterior segment OCT indices showed excellent capability in differentiating ectatic from normal corneas.
