Cornea : The Journal of Cornea and External Diseases

ICYMI: Cornea Update: Investigating Risk Factors for Meibomian Gland Dysfunction and Loss Among Young Medical Trainees: Purpose: To determine risk factors for meibomian gland disease and associated structural abnormalities in meibography among young medical trainees. Methods: This study included 84 medical students and residents younger than 45 years. All participants completed an ocular history and lifestyle questionnaire and the standardized patient evaluation of eye dryness (SPEED) II questionnaire. Meibomian gland (MG) dropout and structural changes were evaluated using meibography and scored by 2 graders using meiboscores. Statistical analysis aimed to identify MG loss risk factors. Results: Eighty-four individuals participated, and 168 meibography images were reviewed. Previous contact lens (CL) use (n = 88) demonstrated increased MG loss (P = 0.007). Correlation analysis revealed positive associations between MG loss and both frequency (Spearman r = 0.212, P = 0.003) and duration (Spearman r = 0.271, P 0.05). Conclusions: In a young trainee population, where age-related factors are reduced, previous CL use and eye makeup use are significant risk factors for MG loss. Frequency and length of CL wear affect MG dropout severity. Eye makeup usage also affected MG loss. Highlighting the incongruence of symptoms to signs, SPEED II scores showed no relationship with MG structural integrity. http://dlvr.it/TGwT9M #Cornea #Ophthalmology #Ophthotwitter

ICYMI: Cornea Update: Delphi-Based Global Consensus on Adopting Endothelial Keratoplasty: An Endothelial Keratoplasty Learners Group Initiative: Purpose: To identify areas of consensus among experts on the performance of endothelial keratoplasty by using a modified Delphi approach, to help create a framework for novice surgeons to adopt these procedures. Methods: Thirty-one international experts in endothelial keratoplasty participated. Two rounds of electronic survey were followed by a hybrid, virtual meeting. Consensus was set at 75%, and results with agreement between 70% and 75% were deemed as achieving near consensus. Results: A consensus was reached for 98 statements covering the preoperative, intraoperative, and postoperative aspects of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty. Four statements achieved near consensus, and consensus could not be achieved for 11 statements. For DMEK, the panel supported a peel technique to prepare tissue for endothelium out DMEK, implanted via an injector and supported by a near full air/gas fill as a baseline procedure onto which more advanced techniques can be built. DMEK tissue should be marked to ensure correct orientation. An inferior peripheral iridotomy should be used to prevent pupil block when a near full air/gas fill in used in endothelial keratoplasty (EK). Descemet stripping automated endothelial keratoplasty was considered preferable to Descemet stripping endothelial keratoplasty where access to microkeratome preparation was available. Conclusions: The Delphi process allowed areas of consensus on the performance of EK to be established by a group of international experts. The statements generated are a helpful framework for novice surgeons learning EK. Further research is needed to help determine what specific tomographic features indicate EK, when guttae are considered visually significant and how to approach combined aphakia and endothelial dysfunction. http://dlvr.it/TGwT8p #Cornea #Ophthalmology #Ophthotwitter

Cornea Update: Delphi-Based Global Consensus on Adopting Endothelial Keratoplasty: An Endothelial Keratoplasty Learners Group Initiative: Purpose: To identify areas of consensus among experts on the performance of endothelial keratoplasty by using a modified Delphi approach, to help create a framework for novice surgeons to adopt these procedures. Methods: Thirty-one international experts in endothelial keratoplasty participated. Two rounds of electronic survey were followed by a hybrid, virtual meeting. Consensus was set at 75%, and results with agreement between 70% and 75% were deemed as achieving near consensus. Results: A consensus was reached for 98 statements covering the preoperative, intraoperative, and postoperative aspects of Descemet membrane endothelial keratoplasty (DMEK) and Descemet stripping endothelial keratoplasty/Descemet stripping automated endothelial keratoplasty. Four statements achieved near consensus, and consensus could not be achieved for 11 statements. For DMEK, the panel supported a peel technique to prepare tissue for endothelium out DMEK, implanted via an injector and supported by a near full air/gas fill as a baseline procedure onto which more advanced techniques can be built. DMEK tissue should be marked to ensure correct orientation. An inferior peripheral iridotomy should be used to prevent pupil block when a near full air/gas fill in used in endothelial keratoplasty (EK). Descemet stripping automated endothelial keratoplasty was considered preferable to Descemet stripping endothelial keratoplasty where access to microkeratome preparation was available. Conclusions: The Delphi process allowed areas of consensus on the performance of EK to be established by a group of international experts. The statements generated are a helpful framework for novice surgeons learning EK. Further research is needed to help determine what specific tomographic features indicate EK, when guttae are considered visually significant and how to approach combined aphakia and endothelial dysfunction. http://dlvr.it/TGt81R #Cornea #Ophthalmology #Ophthotwitter

Cornea Update: Investigating Risk Factors for Meibomian Gland Dysfunction and Loss Among Young Medical Trainees: Purpose: To determine risk factors for meibomian gland disease and associated structural abnormalities in meibography among young medical trainees. Methods: This study included 84 medical students and residents younger than 45 years. All participants completed an ocular history and lifestyle questionnaire and the standardized patient evaluation of eye dryness (SPEED) II questionnaire. Meibomian gland (MG) dropout and structural changes were evaluated using meibography and scored by 2 graders using meiboscores. Statistical analysis aimed to identify MG loss risk factors. Results: Eighty-four individuals participated, and 168 meibography images were reviewed. Previous contact lens (CL) use (n = 88) demonstrated increased MG loss (P = 0.007). Correlation analysis revealed positive associations between MG loss and both frequency (Spearman r = 0.212, P = 0.003) and duration (Spearman r = 0.271, P 0.05). Conclusions: In a young trainee population, where age-related factors are reduced, previous CL use and eye makeup use are significant risk factors for MG loss. Frequency and length of CL wear affect MG dropout severity. Eye makeup usage also affected MG loss. Highlighting the incongruence of symptoms to signs, SPEED II scores showed no relationship with MG structural integrity. http://dlvr.it/TGt81M #Cornea #Ophthalmology #Ophthotwitter

ICYMI: Cornea Update: Prevalence and Severity of Corneal Guttata After Descemet Membrane Endothelial Keratoplasty: Purpose: The postoperative occurrence of corneal guttae (CG) in patients after Descemet membrane endothelial keratoplasty (DMEK) can lead to a significant reduction in visual acuity (VA) with the subsequent need for repeat DMEK. Therefore, the aim of this study was to analyze the prevalence and clinical significance of CG in transplanted corneas after DMEK. Methods: The prevalence and progression of CG after DMEK of 1657 patients were examined using endothelial specular microscopy images. The severity grade of CG was classified into 3 grades (G1 80%). Central corneal thickness, VA, and endothelial cell density (ECD) were examined during a postoperative follow-up time of 19.5 ± 17.6 months (range 6–84 months). Results: The prevalence of CG postoperatively was 1.3% (22/1657 eyes) after 4-6 weeks. We could classify 15/22 (68%) as G1, 5/22 (23%) as G2, and 2/22 (9%) as G3. In 12/22 (55%), either preparation and/or implantation was conspicuously difficult. None of the eyes showed an increase in CG during follow-up. 21/22 were stable in VA, central corneal thickness, and ECD during the entire follow-up. One patient with G3 required a repeat DMEK after 12 months (secondary graft failure). Conclusions: The prevalence of CG in our study population was notably lower than previously described and was mainly characterized by mild, low-grade findings without clinical significance and were stable during the follow-up. Preoperative overlook of CG in the tissue bank cannot be completely excluded, but the remarkable proportion of intraoperative complications in this group may have led to the occurrence of these CG. http://dlvr.it/TGrNyd #Cornea #Ophthalmology #Ophthotwitter

ICYMI: Cornea Update: Topical Losartan for Corneal Fibrosis: A Case Series With Densitometry Analysis: Purpose: To present the clinical, topographic, and densitometry outcomes of patients with corneal fibrosis treated with topical losartan. Methods: In this case series, patients with corneal scars treated with topical losartan 0.8 mg/mL 4 times a day for 6 months were included. Age, sex, cause of corneal opacity, months with corneal opacity, and previous topical treatment were recorded. Patients were examined at baseline and 1, 3, and 6 months after starting treatment. At each visit, uncorrected and best-corrected visual acuity, subjective refraction, intraocular pressure, slit-lamp examination, corneal tomography, and densitometry were performed. Patients were asked about drop comfort and possible side effects on a 0 to 10 self-reported scale. Results: Eight eyes of 7 patients (4 males, 3 females, mean age 45.1 ± 12.0 years) were included. Best-corrected visual acuity logMAR was 0.28 ± 0.17 pretreatment and 0.17 ± 0.11 after 6 months of topical losartan (P = 0.358). The visual acuity of 5 eyes improved, 1 eye remained unchanged, and the vision of 2 eyes declined. No changes in topographic and densitometry parameters were noted within the cohort analyzed as a group (all P > 0.05). No systemic side effects were reported, and tolerance was from very good to excellent (all 2/10 or better). Conclusions: No significant improvements in visual acuity and densitometry values were noted with topical losartan in this series analyzed as a group. Further research to assess the full scope of clinical applications in corneal fibrosis is needed, particularly randomized clinical trials to address the effect of time and unequivocally prove its beneficial effects. http://dlvr.it/TGpCpL #Cornea #Ophthalmology #Ophthotwitter

ICYMI: Cornea Update: Examination of the Corneal Endothelium in Patients With Congenital Aniridia With a PAX6 Mutation Using In Vivo Confocal Laser Scanning Microscopy: Purpose: In PAX6 syndrome, it is still not clear, whether prenatally, parallel to the iris tissue developmental anomaly, there is neural ectodermal, neural crest, or mesodermal cell deposition at the corneal endothelium, affecting endothelial structure and function. In addition, because of the postnatal corneal inflammation and commonly appearing secondary glaucoma, progressive endothelial changes are expected. Our purpose was to study the corneal endothelium in subjects with PAX6 aniridia, using in vivo confocal laser scanning microscopy. Methods: Twenty-seven eyes of 16 subjects with congenital aniridia (age 28.25 ± 16.32 [11–59] years, 8 [50%] female) and 40 eyes of 26 healthy subjects (age 33.8 ± 15.2 [14–67] years, 17 [58.6%] females) were examined. Aniridia-associated keratopathy and iris malformation were graded, and means of endothelial cell density, cell area, cell diameter, spatial pattern of cell centroids (Clark–Evans index), polygonality, neighbor count, percentage of hexagonal cells, and endothelial deposit number were determined by in vivo confocal laser scanning microscopy. Results: Mean cell diameter and mean Clark–Evans index were significantly lower (P = 0.049; P = 0.008) in congenital aniridia eyes than in controls. There were hyperreflective endothelial deposits in congenital aniridia eyes but not in controls (P < 0.001). Only aniridia-associated keratopathy grade correlated positively with mean endothelial deposit number (P = 0.017). Conclusions: In congenital aniridia, the corneal endothelium might possess a slightly better quality and greater reserves than in healthy subjects. Corneal endothelial deposition seems to be independent from developmental abnormalities but may be related to up to date undescribed endothelial inflammatory or metabolic changes. http://dlvr.it/TGpCpJ #Cornea #Ophthalmology #Ophthotwitter

ICYMI: Cornea Update: Letter Regarding: Clinical Outcomes and Indications of In-Office Sutureless Dried Gamma Ray–Sterilized Human Amniotic Membrane Transplantation With Bandage Contact Lenses in Various Ocular Surface Disorders: No abstract available http://dlvr.it/TGpCpH #Cornea #Ophthalmology #Ophthotwitter

ICYMI: Cornea Update: Definition of Progressive Keratoconus: A Systematic Review: Purpose: To identify the definitions used for progressive keratoconus in the literature. Methods: A systematic literature review aimed to identify the definitions used for “progressive keratoconus” in the published articles. A comprehensive search from January 2018 to May 2023 was conducted across Cochrane Library, PubMed, Taylor & Francis, Web of Science, and other bibliographic databases at Oftalmosalud, Lima, Peru. The inclusion criteria were articles including patients with keratoconus without any previous surgical procedure and containing the definition of “progressive keratoconus” or “keratoconus progression” and a sample size greater than 10 eyes. Results: A total of 221 articles were included for analysis. The 3 most frequent parameters to define progression included data from anterior curvature, pachymetry, and refraction used in 97.8% (216/221), 37.6% (83/221), and 32.1% (71/221) of the articles, respectively. Specifically, the most frequent criterion used was maximum keratometry (Kmax), used in 85.5% (189/221) of the articles. Progression was assessed between 6- and 12-month follow-up in 64.7% (143/221) of the articles. Data from posterior cornea were used in only 8.1% (18/221) of the studies. None of the studies included data from the corneal epithelium. Conclusions: The present study demonstrates the lack of unified criteria to define progression of keratoconus and an underutilization of the technology described. It also shows that the single point Kmax measurement is the most commonly used criterion, followed by a change in refractive astigmatism and thinning at the thinnest pachymetric point. http://dlvr.it/TGpCpF #Cornea #Ophthalmology #Ophthotwitter

ICYMI: Cornea Update: Prospective Study of Corneal Sensitivity in Patients Treated With Proton Therapy for Extraocular Tumors: Introduction: Several cases of radio-induced neurotrophic keratitis had been observed after proton therapy delivering a mean corneal dose of ≥50 GyRBE. We conducted a prospective exploratory study to assess corneal sensitivity in subsequent patients undergoing proton therapy for cephalic extraocular tumors. Material and Methods: Forty-three patients (85 eyes) treated with high-energy proton therapy were included in this prospective, single-center, observational cohort study. All patients had their corneal sensitivity measured using Cochet–Bonnet esthesiometer, before and average 6 months after irradiation. Ocular surface was clinically assessed for stromal opacity, corneal thinning, corneal perforation, superficial punctate keratitis graded according to Oxford classification, and tear break-up time. Cornea and extraocular sensitive innervation structures of cornea were contoured and their dose metrics assessed. Results: No severe corneal damage was detected. Corneal sensitivity, superficial punctate keratitis according to Oxford classification, and tear break-up time did not vary significantly after irradiation. The mean value of maximal dose to cornea and extraocular sensory innervation of cornea were 10.7 GyRBE and 42.0 GyRBE, respectively. Doses to cornea and its innervation structures were not associated with significant changes in corneal sensitivity (P = 0.423 and P = 0.614). A dose per fraction greater than 2 GyRBE was significantly associated (P = 0.033) with a decrease of corneal sensitivity after proton therapy. Conclusions: This pilot study showed no excess risk of damage to corneal sensitivity 6 months after proton therapy, as doses to the cornea could be minimized. However, based on prior neurotrophic keratitis cases for corneal doses above 50 GyRBE, further investigation is needed to establish the impact of high-dose proton therapy on corneal sensitivity. http://dlvr.it/TGpCpC #Cornea #Ophthalmology #Ophthotwitter