BACKGROUND The current case report describes successful phacoemulsification with the aid of perioperative topical ascorbic acid(AA) in two patients with corneal endothelial disorders to prevent postoperative corneal e...BACKGROUND The current case report describes successful phacoemulsification with the aid of perioperative topical ascorbic acid(AA) in two patients with corneal endothelial disorders to prevent postoperative corneal endothelial decompensation.CASE SUMMARY Two eyes of two patients underwent phacoemulsification with pre-existing corneal endothelial disorders including Fuchs corneal endothelial dystrophy(Patient 1) and endotheliitis(Patient 2). Topical AA was applied to both patients at least one month before and after with a frequency of four times per day. After the surgery, both eyes improved best-corrected visual acuity(BCVA) and there was limited human corneal endothelial cell loss without signs of corneal endothelial decompensation, such as deteriorated BCVA or persistent corneal edema during the follow-up of at least two years.CONCLUSION Perioperative administration of topical AA may be an alternative therapy to the triple procedure in patients expecting to undergo cataract surgery.展开更多
Background:To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs'endothelial corneal dystrophy(FECD)without clinically evident corneal edema from healthy and late-...Background:To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs'endothelial corneal dystrophy(FECD)without clinically evident corneal edema from healthy and late-stage FECD eyes using high-definition optical coherence tomography(HD-OCT).Methods:In this observational case-control study,104 eyes(53 FECD eyes and 51 healthy controls)received HDOCT imaging(Envisu R2210,Bioptigen,Buffalo Grove,IL,USA)using a 6 mm radial scan pattern centered on the corneal vertex.FECD was clinically categorized into early(without corneal edema)and late stage(with corneal edema).A total of 18,720 anterior segment optical coherence tomography(AS-OCT)images(9180 healthy;5400 early-stage FECD;4140 late-stage FECD)of 104 eyes(81 patients)were used to develop and validate a deep learning classification network to differentiate early-stage FECD eyes from healthy eyes and those with clinical edema.Using 5-fold cross-validation on the dataset containing 11,340 OCT images(63 eyes),the network was trained with 80%of these images(3420 healthy;3060 early-stage FECD;2700 late-stage FECD),then tested with 20%(720 healthy;720 early-stage FECD;720 late-stage FECD).Thereafter,a final model was trained with the entire dataset consisting the 11,340 images and validated with a remaining 7380 images of unseen AS-0CT scans of 41 eyes(5040 healthy;1620 early-stage FECD 720 late-stage FECD).Visualization of learned features was done,and area under curve(AUC),specificity,and sensitivity of the prediction outputs for healthy,early and late-stage FECD were computed.Results:The final model achieved an AUC of 0.997±0.005 with 91%sensitivity and 97%specificity in detecting early-stage FECD;an AUC of 0.974±0.005 with a specificity of 92%and a sensitivity up to 100%in detecting late-stage FECD;and an AUC of 0.998±0.001 with a specificity 98%and a sensitivity of 99%in discriminating healthycorneas fromall FECD.Conclusion:Deep learning algorithm is an accurate autonomous novel diagnostic tool of FECD with very high 展开更多
Abstract This paper is devoted to the study of the period function for a class of reversible quadratic system x=-2xy,y=k-1-2kx＋（k＋1）x^2-1/2y^2.We determine the monotonicity of the period function for each k ∈ R....Abstract This paper is devoted to the study of the period function for a class of reversible quadratic system x=-2xy,y=k-1-2kx＋（k＋1）x^2-1/2y^2.We determine the monotonicity of the period function for each k ∈ R. It is proved that the period function has at most one critical point.展开更多
It is a common belief that Fuchs' endothelial dystrophy predominantly affectsCaucasians but rarely Asians. However, in one Japanese study, primary corneal guttae (first stageof Fuchs ' dystrophy) were found in...It is a common belief that Fuchs' endothelial dystrophy predominantly affectsCaucasians but rarely Asians. However, in one Japanese study, primary corneal guttae (first stageof Fuchs ' dystrophy) were found in four of 107 cataract patients. With the growing popularity ofphacoemulsification in China in the past decade, the increased incidence of endothelialdecompensation may be due to learning curves among surgeons as well as that the prevalence of Fuchs'dystrophy among Chinese is higher than we thought. Low index of suspicion for Fuchs' dystrophy mayresult in missing of diagnosis and occurrence of endothelial decompensation, particularly when noextra protection is provided for endothelial cells during phacoemulsification. This study was aimedat improving our knowledge about Fuchs' dystrophy among Chinese population and reminding surgeons ofextra endothelial protection during cataract surgery for patients with Fuchs' dystrophy.展开更多
PURPOSE: To assess the diagnosis-based spontaneous lon-gterm changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). D...PURPOSE: To assess the diagnosis-based spontaneous lon-gterm changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). DESIGN: Retrospective non-randomized clinical trial. METHODS: setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after suture removal in this retrospective longitudinal study. MAIN OUTCOME MEASURES: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)]were assessed in at least three up to 16 ophthalmologic examinations in the all-sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval < 12 months) separately for each patient with a linear regression model. RESULTS: Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 ± 0.50/- 0.63± 0.46 diopters, P=.02) and an increase/a decrease in TEQ (0.37 ± 0.54/- 0.69 ± 0.49 diopters, P=.04) corresponding to a decrease/an increase in SEQ (- 0.31 ± 0.47/0.63 ± 0.43 diopters, P=.02). KAST/TAST/RAST showed a minimal annual decrease (- 0.06 ± 0.41/- 0.05 ± 0.45/- 0.06 ± 0.41 diopters) in FD but an increase in KC(0.46± 0.41/0.51± 0.43/0.46± 0.38 diopters) (P=.05/0.06/0.12). CONCLUSIONS: In the followup after post- keratoplasty suture removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after suture removal.展开更多
Background:Fuchs endothelial corneal dystrophy is a hereditary disease and the most frequent cause of corneal transplantation in the worldwide.Its main clinical signs are an accelerated decrease in the number of endot...Background:Fuchs endothelial corneal dystrophy is a hereditary disease and the most frequent cause of corneal transplantation in the worldwide.Its main clinical signs are an accelerated decrease in the number of endothelial cells,thickening of Descemet’s membrane and formation of guttae in the extracellular matrix.The cornea’s ability to maintain stromal dehydration is impaired,causing painful epithelial bullae and loss of vision at the point when the amount of corneal endothelial cells cannot be compensated.At present,apart from corneal transplantation,there is no other effective treatment that prevents blindness.Main text:In this review,we first summarized the mutations of COL8A2,TCF4,TCF8,SLC4A11 and AGBL1 genes in Fuchs endothelial corneal dystrophy.The molecular mechanisms associated with Fuchs endothelial corneal dystrophy,such as endoplasmic reticulum stress and unfolded protein response pathway,oxidative stress,mitochondrial dysregulation pathway,apoptosis pathway,mitophagy,epithelial-mesenchymal transition pathway,RNA toxicity and repeat-associated non-ATG translation,and other pathogenesis,were then explored.Finally,we discussed several potential treatments related to the pathogenesis of Fuchs endothelial corneal dystrophy,which may be the focus of future research.Conclusions:The pathogenesis of Fuchs endothelial corneal dystrophy is very complicated.Currently,corneal transplantation is an important method in the treatment of Fuchs endothelial corneal dystrophy.It is necessary to continuously explore the pathogenesis of Fuchs endothelial corneal dystrophy and establish the scientific foundations for the development of next-generation corneal therapeutics.展开更多
BACKGROUND Hammered silver appearance of the corneal endothelium is considered a characteristic change in iridocorneal-endothelial syndrome.Herein we report an interesting case of hammered silver appearance of the cor...BACKGROUND Hammered silver appearance of the corneal endothelium is considered a characteristic change in iridocorneal-endothelial syndrome.Herein we report an interesting case of hammered silver appearance of the corneal endothelium in Fuchs uveitis syndrome(FUS).CASE SUMMARY A 49-year-old man with progressive vision loss in the right eye for one year was admitted to our hospital.The clinical manifestations of the patient’s right eye were mild conjunctival hyperemia,scattered stellate keratic precipitates on the corneal endothelium,normal depth anterior chamber,2+cellular reaction in the aqueous humor,diffuse iris depigmentation,absence of synechia,Koeppe nodules,opalescent lens,and vitreous opacity.FUS and a complicated cataract were diagnosed based on the typical clinical manifestations.The corneal endothelial changes were recorded in detail by slit-lamp examination,specular microscopy,and in vivo confocal microscopy before cataract extraction,revealing a hammered silver appearance of the corneal endothelium in the affected eye,a wide-band dark area,as well as irregular corneal endothelial protuberances and dark bodies of various sizes.Subsequently,the patient underwent phacoemulsification combined with intraocular lens implantation,and his postoperative visual acuity recovered to 1.0.CONCLUSION Hammered silver appearance of the corneal endothelium in FUS,which is considered a more serious manifestation of endothelial damage,is rare and may be caused by many irregular protrusions in the corneal endothelium.展开更多
Background:To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs’endothelial corneal dystrophy(FECD)without clinically evident corneal edema from healthy and late-sta...Background:To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs’endothelial corneal dystrophy(FECD)without clinically evident corneal edema from healthy and late-stage FECD eyes using high-definition optical coherence tomography(HD-OCT).Methods:In this observational case-control study,104 eyes(53 FECD eyes and 51 healthy controls)received HDOCT imaging(Envisu R2210,Bioptigen,Buffalo Grove,IL,USA)using a 6 mm radial scan pattern centered on the corneal vertex.FECD was clinically categorized into early(without corneal edema)and late-stage(with corneal edema).A total of 18,720 anterior segment optical coherence tomography(AS-OCT)images(9180 healthy;5400 early-stage FECD;4140 late-stage FECD)of 104 eyes(81 patients)were used to develop and validate a deep learning classification network to differentiate early-stage FECD eyes from healthy eyes and those with clinical edema.Using 5-fold cross-validation on the dataset containing 11,340 OCT images(63 eyes),the network was trained with 80%of these images(3420 healthy;3060 early-stage FECD;2700 late-stage FECD),then tested with 20%(720 healthy;720 early-stage FECD;720 late-stage FECD).Thereafter,a final model was trained with the entire dataset consisting the 11,340 images and validated with a remaining 7380 images of unseen AS-OCT scans of 41 eyes(5040 healthy;1620 early-stage FECD 720 late-stage FECD).Visualization of learned features was done,and area under curve(AUC),specificity,and sensitivity of the prediction outputs for healthy,early and late-stage FECD were computed.Results:The final model achieved an AUC of 0.997±0.005 with 91%sensitivity and 97%specificity in detecting early-FECD;an AUC of 0.974±0.005 with a specificity of 92%and a sensitivity up to 100%in detecting late-stage FECD;and an AUC of 0.998±0.001 with a specificity 98%and a sensitivity of 99%in discriminating healthy corneas from all FECD.Conclusion:Deep learning algorithm is an accurate autonomous novel diagnostic tool of FECD with very high se展开更多
基金Supported by the Chang Gung Memorial Hospital,No.CMRPG3F1471~2 and No.CMRPG3G0031~3the Ministry of Science and Technology No.MOST106-2314-B-182A-042-34 and No.MOST 107-2314-B-182A-088-MY3
文摘BACKGROUND The current case report describes successful phacoemulsification with the aid of perioperative topical ascorbic acid(AA) in two patients with corneal endothelial disorders to prevent postoperative corneal endothelial decompensation.CASE SUMMARY Two eyes of two patients underwent phacoemulsification with pre-existing corneal endothelial disorders including Fuchs corneal endothelial dystrophy(Patient 1) and endotheliitis(Patient 2). Topical AA was applied to both patients at least one month before and after with a frequency of four times per day. After the surgery, both eyes improved best-corrected visual acuity(BCVA) and there was limited human corneal endothelial cell loss without signs of corneal endothelial decompensation, such as deteriorated BCVA or persistent corneal edema during the follow-up of at least two years.CONCLUSION Perioperative administration of topical AA may be an alternative therapy to the triple procedure in patients expecting to undergo cataract surgery.
基金supported by a NEI K23 award(K23EY026118)NEI core center grant to the University of Miami(Grant No.P30 EY014801)Research to Prevent Blindness(RPB)。
文摘Background:To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs'endothelial corneal dystrophy(FECD)without clinically evident corneal edema from healthy and late-stage FECD eyes using high-definition optical coherence tomography(HD-OCT).Methods:In this observational case-control study,104 eyes(53 FECD eyes and 51 healthy controls)received HDOCT imaging(Envisu R2210,Bioptigen,Buffalo Grove,IL,USA)using a 6 mm radial scan pattern centered on the corneal vertex.FECD was clinically categorized into early(without corneal edema)and late stage(with corneal edema).A total of 18,720 anterior segment optical coherence tomography(AS-OCT)images(9180 healthy;5400 early-stage FECD;4140 late-stage FECD)of 104 eyes(81 patients)were used to develop and validate a deep learning classification network to differentiate early-stage FECD eyes from healthy eyes and those with clinical edema.Using 5-fold cross-validation on the dataset containing 11,340 OCT images(63 eyes),the network was trained with 80%of these images(3420 healthy;3060 early-stage FECD;2700 late-stage FECD),then tested with 20%(720 healthy;720 early-stage FECD;720 late-stage FECD).Thereafter,a final model was trained with the entire dataset consisting the 11,340 images and validated with a remaining 7380 images of unseen AS-0CT scans of 41 eyes(5040 healthy;1620 early-stage FECD 720 late-stage FECD).Visualization of learned features was done,and area under curve(AUC),specificity,and sensitivity of the prediction outputs for healthy,early and late-stage FECD were computed.Results:The final model achieved an AUC of 0.997±0.005 with 91%sensitivity and 97%specificity in detecting early-stage FECD;an AUC of 0.974±0.005 with a specificity of 92%and a sensitivity up to 100%in detecting late-stage FECD;and an AUC of 0.998±0.001 with a specificity 98%and a sensitivity of 99%in discriminating healthycorneas fromall FECD.Conclusion:Deep learning algorithm is an accurate autonomous novel diagnostic tool of FECD with very high
文摘Abstract This paper is devoted to the study of the period function for a class of reversible quadratic system x=-2xy,y=k-1-2kx＋（k＋1）x^2-1/2y^2.We determine the monotonicity of the period function for each k ∈ R. It is proved that the period function has at most one critical point.
文摘It is a common belief that Fuchs' endothelial dystrophy predominantly affectsCaucasians but rarely Asians. However, in one Japanese study, primary corneal guttae (first stageof Fuchs ' dystrophy) were found in four of 107 cataract patients. With the growing popularity ofphacoemulsification in China in the past decade, the increased incidence of endothelialdecompensation may be due to learning curves among surgeons as well as that the prevalence of Fuchs'dystrophy among Chinese is higher than we thought. Low index of suspicion for Fuchs' dystrophy mayresult in missing of diagnosis and occurrence of endothelial decompensation, particularly when noextra protection is provided for endothelial cells during phacoemulsification. This study was aimedat improving our knowledge about Fuchs' dystrophy among Chinese population and reminding surgeons ofextra endothelial protection during cataract surgery for patients with Fuchs' dystrophy.
文摘PURPOSE: To assess the diagnosis-based spontaneous lon-gterm changes in corneal power and refraction with a regression model in the all-sutures-out time period following non-mechanical penetrating keratoplasty (PK). DESIGN: Retrospective non-randomized clinical trial. METHODS: setting: Clinical practice. study population: 147 eyes [47 Fuchs dystrophy (FD); 100 keratoconus (KC)] were studied after suture removal in this retrospective longitudinal study. MAIN OUTCOME MEASURES: Zeiss keratometry [equivalent power (KEQ) and astigmatism (KAST)], corneal topography analysis [equivalent power (TEQ) and astigmatism (TAST)], and subjective refractometry [spherical equivalent (SEQ) and refractive cylinder (RAST)]were assessed in at least three up to 16 ophthalmologic examinations in the all-sutures-out time period. observation procedure: The time course of each target variable was analyzed in a longitudinal manner (time interval < 12 months) separately for each patient with a linear regression model. RESULTS: Post-keratoplasty follow-up ranged from 31 months to 10.3 years. In the linear regression model, the annual change in FD/KC showed an increase/a decrease in KEQ (0.29 ± 0.50/- 0.63± 0.46 diopters, P=.02) and an increase/a decrease in TEQ (0.37 ± 0.54/- 0.69 ± 0.49 diopters, P=.04) corresponding to a decrease/an increase in SEQ (- 0.31 ± 0.47/0.63 ± 0.43 diopters, P=.02). KAST/TAST/RAST showed a minimal annual decrease (- 0.06 ± 0.41/- 0.05 ± 0.45/- 0.06 ± 0.41 diopters) in FD but an increase in KC(0.46± 0.41/0.51± 0.43/0.46± 0.38 diopters) (P=.05/0.06/0.12). CONCLUSIONS: In the followup after post- keratoplasty suture removal, patients with FD/KC tend to develop a spontaneous myopic shift (steepening of the cornea)/hyperopic shift (flattening of the cornea). In contrast with those with FD, patients with KC should be counseled on the fact that astigmatism may increase again over time after suture removal.
基金supported by the Heilongjiang Postdoctoral Fund(Grant No.LBH-Z18185)the Heilongjiang Provincial Colleges and Universities Basic Scientific Research Fund(Grant No.2018-KYYWF-0484).
文摘Background:Fuchs endothelial corneal dystrophy is a hereditary disease and the most frequent cause of corneal transplantation in the worldwide.Its main clinical signs are an accelerated decrease in the number of endothelial cells,thickening of Descemet’s membrane and formation of guttae in the extracellular matrix.The cornea’s ability to maintain stromal dehydration is impaired,causing painful epithelial bullae and loss of vision at the point when the amount of corneal endothelial cells cannot be compensated.At present,apart from corneal transplantation,there is no other effective treatment that prevents blindness.Main text:In this review,we first summarized the mutations of COL8A2,TCF4,TCF8,SLC4A11 and AGBL1 genes in Fuchs endothelial corneal dystrophy.The molecular mechanisms associated with Fuchs endothelial corneal dystrophy,such as endoplasmic reticulum stress and unfolded protein response pathway,oxidative stress,mitochondrial dysregulation pathway,apoptosis pathway,mitophagy,epithelial-mesenchymal transition pathway,RNA toxicity and repeat-associated non-ATG translation,and other pathogenesis,were then explored.Finally,we discussed several potential treatments related to the pathogenesis of Fuchs endothelial corneal dystrophy,which may be the focus of future research.Conclusions:The pathogenesis of Fuchs endothelial corneal dystrophy is very complicated.Currently,corneal transplantation is an important method in the treatment of Fuchs endothelial corneal dystrophy.It is necessary to continuously explore the pathogenesis of Fuchs endothelial corneal dystrophy and establish the scientific foundations for the development of next-generation corneal therapeutics.
文摘BACKGROUND Hammered silver appearance of the corneal endothelium is considered a characteristic change in iridocorneal-endothelial syndrome.Herein we report an interesting case of hammered silver appearance of the corneal endothelium in Fuchs uveitis syndrome(FUS).CASE SUMMARY A 49-year-old man with progressive vision loss in the right eye for one year was admitted to our hospital.The clinical manifestations of the patient’s right eye were mild conjunctival hyperemia,scattered stellate keratic precipitates on the corneal endothelium,normal depth anterior chamber,2+cellular reaction in the aqueous humor,diffuse iris depigmentation,absence of synechia,Koeppe nodules,opalescent lens,and vitreous opacity.FUS and a complicated cataract were diagnosed based on the typical clinical manifestations.The corneal endothelial changes were recorded in detail by slit-lamp examination,specular microscopy,and in vivo confocal microscopy before cataract extraction,revealing a hammered silver appearance of the corneal endothelium in the affected eye,a wide-band dark area,as well as irregular corneal endothelial protuberances and dark bodies of various sizes.Subsequently,the patient underwent phacoemulsification combined with intraocular lens implantation,and his postoperative visual acuity recovered to 1.0.CONCLUSION Hammered silver appearance of the corneal endothelium in FUS,which is considered a more serious manifestation of endothelial damage,is rare and may be caused by many irregular protrusions in the corneal endothelium.
基金This study was supported by a NEI K23 award(K23EY026118)NEI core center grant to the University of Miami(P30 EY014801)Research to Prevent Blindness(RPB).The funding organization had no role in the design or conduct of this research.
文摘Background:To describe the diagnostic performance of a deep learning algorithm in discriminating early-stage Fuchs’endothelial corneal dystrophy(FECD)without clinically evident corneal edema from healthy and late-stage FECD eyes using high-definition optical coherence tomography(HD-OCT).Methods:In this observational case-control study,104 eyes(53 FECD eyes and 51 healthy controls)received HDOCT imaging(Envisu R2210,Bioptigen,Buffalo Grove,IL,USA)using a 6 mm radial scan pattern centered on the corneal vertex.FECD was clinically categorized into early(without corneal edema)and late-stage(with corneal edema).A total of 18,720 anterior segment optical coherence tomography(AS-OCT)images(9180 healthy;5400 early-stage FECD;4140 late-stage FECD)of 104 eyes(81 patients)were used to develop and validate a deep learning classification network to differentiate early-stage FECD eyes from healthy eyes and those with clinical edema.Using 5-fold cross-validation on the dataset containing 11,340 OCT images(63 eyes),the network was trained with 80%of these images(3420 healthy;3060 early-stage FECD;2700 late-stage FECD),then tested with 20%(720 healthy;720 early-stage FECD;720 late-stage FECD).Thereafter,a final model was trained with the entire dataset consisting the 11,340 images and validated with a remaining 7380 images of unseen AS-OCT scans of 41 eyes(5040 healthy;1620 early-stage FECD 720 late-stage FECD).Visualization of learned features was done,and area under curve(AUC),specificity,and sensitivity of the prediction outputs for healthy,early and late-stage FECD were computed.Results:The final model achieved an AUC of 0.997±0.005 with 91%sensitivity and 97%specificity in detecting early-FECD;an AUC of 0.974±0.005 with a specificity of 92%and a sensitivity up to 100%in detecting late-stage FECD;and an AUC of 0.998±0.001 with a specificity 98%and a sensitivity of 99%in discriminating healthy corneas from all FECD.Conclusion:Deep learning algorithm is an accurate autonomous novel diagnostic tool of FECD with very high se
