Corneal neovascularisation following deep anterior lamellar keratoplasty for corneal ectasia: incidence, timing and risk factors.

BACKGROUND: The purpose of this study was to evaluate the incidence, timing and risk factors of corneal neovascularisation (NV) after deep anterior lamellar keratoplasty (DALK) for corneal ectasia. METHODS: This study included 616 eyes who underwent DALK between 2012 and 2020 in two tertiary referral centres. In one centre topical corticosteroids were discontinued after complete suture removal 1 year after surgery, whereas in the other they were discontinued 3-4 months after surgery. The presence and severity of corneal NV was ascertained based on slit lamp photographs. Potential risk factors for corneal NV were evaluated using the Cox proportional hazards model. RESULTS: The cumulative incidence of corneal NV was 8.7% at 1 year after surgery and 13.2% at 5 years. Mean time interval from surgery to development of corneal NV was 12.8±16.2 months, with 68.9% of cases occurring before complete suture removal. Early discontinuation of topical steroids, older age and ocular allergy were associated with an increased risk of developing corneal NV (respectively, HR=2.625, HR=1.019, HR=3.726, all p<0.05). CONCLUSIONS: The risk of corneal NV is higher in the first year following DALK. Early discontinuation of topical steroids, ocular allergy and older age are significant predictors of corneal NV.

The frequency of occurrence of certain corneal conditions by age and sex in Iranian adults.

PURPOSE: To determine the prevalence of posterior embryotoxon, corneal opacity, pigment on endothelium, corneal dystrophy, and corneal vascularization in a middle-aged Iranian population, and their association with age and sex. METHODS: In a cross-sectional study with multistage cluster sampling, subjects were chosen from 40 to 64-year-old residents of Shahroud in northern Iran. Participants had ophthalmic examinations before and after pupil dilation. Corneal abnormalities were diagnosed by an ophthalmologist using a slit lamp. RESULTS: Of the 6311 invitees, 5190 people (82.2%) participated; 58.6% (n=3040) were female. The prevalence of posterior embryotoxon, corneal opacity, and pigment on endothelium were 14.7% (95% CI: 13.4-16.0), 4.1% (95% CI: 3.4-4.7) and 1.2% (95% CI: 0.9-1.5), respectively, and corneal dystrophy and corneal vascularization were seen in 0.3% (95% CI: 0.2-0.5) and 3.7% (95% CI: 3.0-4.3), respectively. Unlike posterior embryotoxon, the prevalence of all studied abnormalities increased with age after adjusting for sex. The prevalence of posterior embryotoxon (p=0.023) and corneal dystrophy (p=0.038) was significantly higher in women, and the prevalence of corneal opacity (p<0.001) was significantly higher in men. After adjusting for age, sex, and cataract, cases with corneal opacity and corneal vascularization demonstrated significantly worse uncorrected and corrected visual acuity (p<0.001). CONCLUSION: This report is the first to explore the prevalence of a variety of corneal conditions in a Middle-Eastern population. The findings indicate that one out of five people may have some sort of corneal conditions, and some can impact corrected visual acuity.

[Ophthalmic manifestations after Lyell and Stevens-Johnson syndromes]. / Manifestations ophtalmiques au décours des syndromes de Lyell et de Stevens-Johnson.

PURPOSE: To describe the ocular complications at the end of serious drug eruptions such as Lyell syndrome or toxic epidemic necrolysis (TEN) syndrome, Stevens-Johnson syndrome (SJS), and SJS/TEN overlap syndrome; to analyze their relationship using disease severity scores. PATIENTS AND METHODS: A retrospective study carried out in the dermatology department in collaboration with the ophthalmopathy department in a series of 81 dossiers collated over a 10-year period. The severity of ophthalmological involvement was evaluated using the Foster score, and the drug eruption score was assessed using the Bastuji-Garin classification and the SCORTEN prognostic score. RESULTS: The average patient age was 36 years; the clinical forms seen were Lyell's syndrome in 57.8 % of cases, Stevens-Johnson syndrome in 32.8 % and overlap syndrome in 9.4 % of cases. According to the Foster classification, 34 % of patients were in stage I, 43 % in stage II, and 22 % in stage III. Stage I was seen in 50 % of cases presenting with overlap syndrome and in 42 % of patients with Stevens-Johnson, whereas stage III accompanied Lyell's syndrome in 27 % of cases, followed by SJS/TEN overlap syndrome in 16.6 % of cases. Photophobia persisted in 36 patients, and there were 17 cases of decreased visual acuity and 13 cases of eyelid malposition. Dry eye syndrome was noted in 39 cases and corneal perforation in 3 cases. DISCUSSION: The ocular manifestations of drug eruptions are daunting. It was suggested that ocular involvement is more serious when the peeled skin surface is extensive.

High-dose subconjunctival cyclosporine a implants do not affect corneal neovascularization after high-risk keratoplasty.

PURPOSE: To test whether subconjunctival cyclosporine A (CsA) implants affect the incidence and the degree of corneal neovascularization occurring after penetrating keratoplasty. DESIGN: Prospective, randomized, multicenter, controlled phase 2/3 clinical trial. The study comprised 43 trial sites in Germany, India, and the United States. PARTICIPANTS: Enrolled patients (n = 97) were randomized to 1 of 3 groups: treatment group A (n = 36), treatment group B (n = 40), and the control group (n = 21). METHODS: Patients from each group received either of 2 doses of subconjunctival CsA (group A, low-dose CsA; group B, high-dose CsA) or placebo (carrier only) implants at the time of high-risk penetrating keratoplasty. MAIN OUTCOME MEASURES: The incidence and degree of corneal neovascularization occurring after penetrating keratoplasty were evaluated in a substudy (LX201-01 study: NCT00447187). A web-based image upload system was developed. Standardized digital slit-lamp pictures were quantitatively and objectively evaluated using CellˆF morphometry software. RESULTS: No statistically significant difference in incidence and degree of corneal neovascularization developing after penetrating keratoplasty was found between treatment groups and placebo group. Mean corneal neovascularization area at week 52 (visit 12) was 2.32±1.79% in treatment group A versus placebo (2.79±2.11%; P = 0.45) and 2.74±2.22% in treatment group B versus placebo (2.79±2.11%; P = 0.94). CONCLUSIONS: High-dose subconjunctival CsA implants do not significantly affect corneal neovascularization after high-risk penetrating keratoplasty. This suggests that local CsA has negligible antiangiogenic effects in the human cornea, at least in the transplant setting.

[Corneal neovascularization: epidemiological, physiopathological, and clinical features]. / Néovascularisation cornéenne : aspects épidémiologiques, physiopathologiques et cliniques.

Corneal neovascularization is defined as the presence of vessels within the normally avascular corneal stroma. This physiopathological process is the consequence of local hyper-expression of pro-angiogenic factors in response to tissue damage. These new vessels (neovessels), initially immature and poorly developed, predispose the cornea to lipid exudation, inflammation, and scarring. Additionally, the influx of vascular cells into the stroma induces a loss of the cornea's immune privilege, resulting in a higher rate of graft rejection. In this literature review, we touch on epidemiological, physiopathological, and clinical aspects of corneal neovascularization, as well as secondary complications.

Nanoparticles in the treatment of angiogenesis-related blindness.

Nanoparticles can be used for the treatment of various retinal diseases. Due to small sizes, they can improve bioavailability of therapeutic agents and pass through biological barriers of the eye, such as the cornea, conjunctiva, sclera, and even more, blood-retinal barriers. Another important characteristic of nanoparticles is the ability to be fabricated based on the researchers' design through chemical processes. In this regard, they can act as a novel drug delivery system, enabling targeted therapies for angiogenesis-related blindness (ARB). With these possibilities, many researchers have utilized nanoparticles as novel therapeutic options for the treatment of exudative age-related macular degeneration and diabetic retinopathy, both of which are characterized by pathologic neovascularization. In this review, we summarize various attempts and rationales in using nanoparticles to treat ARB. After that, we discuss the toxicity of nanoparticles on the retina. We expect this review to be a stepping stone for novel therapeutics for ARB, resulting in improvement in visual outcomes.

Ocular complications of soft contact lens wearers in a tertiary eye care centre of Nepal.

AIM: To determine the prevalence and the major types of ocular complications related with soft contact lenses (CL) in a tertiary eye care centre of Nepal. METHODS: Medical files of 4064 soft CL wearers who started wearing CL between January 2003 and December 2010 in BP Koirala Lions Centre for Ophthalmic Studies (BPKLCOS) Kathmandu, Nepal, were retrospectively reviewed. Records of patients who visited the hospital with complications were analyzed. Patients with ocular complications non-related with CL wear were excluded. RESULTS: Complications were found in 4.9% of the total soft CL wearers. Contact lens induced papillary conjunctivitis (CLPC) was the most common complication, comprising 36.9% of the total patients with complications. The other commonly found complications were superior punctuate keratitis (SPK) in 16.2%, conjunctivitis in 18.2%, meibomian gland dysfunction (MGD) in 8.6%, contact lens induced peripheral ulcer (CLPU) in 4%, corneal vascularization in 3.5% and microbial keratitis in 3%. The average time of first occurrence of complications after starting of contact lens wear was 14.3±11.4 months. CONCLUSION: CLPC, conjunctivitis and SPK were the most common types of soft CL related complications found in Nepal. Vision threatening complications like microbial keratitis was also found in some patients. Patient education in CL hygiene, after care schedule and frequent follow up examinations may help to minimize CL related complications.

Prevalence of contact lens related complications in a tertiary eye centre in India.

AIM: To determine the prevalence of contact lens related complications in a tertiary eye care centre in India. METHODS: A retrospective review of the charts of 1255 patients who visited our contact lens clinic during 2001-2004 was conducted. The inclusion criteria included patients of at least 18 years of age, having refractive errors and keratoconus. Exclusion criteria included previous corneal surgeries and pediatric patients. 190 subjects with lens related complications were identified from among 923 patients who were using lenses. RESULTS: The prevalence of contact lens complications was 20.58%. Females with complications were more common (59.47%). The complications were more common in students. The most common complications were contact lens induced papillary conjunctivitis (CLPC) (6.39%), corneal vascularisation (4%), and superficial punctate keratitis (SPK) (3.5%). The total complications were less prevalent in patients wearing rigid gas permeable (RGP) lenses as compared to soft contact lenses. Infectious keratitis was noted in 8 eyes. Pseudomonas aeuroginosa was the most common organism isolated. The average daily wear with RGP lenses was 11.04±3.7h and 10.96±3h with soft contact lens. The highest number of complications was noted in 47.89% patients who were wearing lenses for excess of 11h. The number of patients with complications arising due to sleeping with the lenses was 74 (38.95%). CONCLUSION: Prevalence of contact lens complications was more in soft contact lens wearers compared to RGP wearers. CLPC was the most common complication followed by vascularisation and SPK.

Use of sealant (HFG) in corneal perforations.

PURPOSE: To repair corneal perforation using human fibrin glue and determine its efficacy. METHODS: A case series study was performed on corneal perforations up to 3 mm in diameter who were admitted in Farabi Eye Hospital. Age, visual acuity, presence and size of corneal thinning, corneal epithelial defect, size and depth of corneal infiltration, site and size of corneal perforation, corneal vascularization, anterior chamber depth, and reaction and the etiology of corneal perforation were recorded. Then, corneal perforation was sealed using FG and soft contact lens, and the patients were followed up for at least 3 months. Healing of the corneal perforation with adhesive was considered as a success (the primary outcome) and reported. RESULTS: Of 18 patients, 8 were women and 10 men. The mean age of the patients was 52 +/- 25.7 years. The size of corneal perforations was 0.6-3 mm (mean = 1.88 mm). The etiologies of corneal perforation were postinfectious in 11 and noninfectious in 7. Fifteen (83.3%) eyes had successful healing of corneal perforation after 3 months. All the patients who were failed had corneal perforation larger than 2 mm in diameter. The success rate was higher in corneal perforation

Ocular neovascularization: an epidemiologic review.

Neovascularization occurs in many eye diseases, and its epidemiologic impact is significant. However, data on the prevalence and incidence of ocular neovascularization have never been compiled to demonstrate its pervasiveness. This overview of ocular angiogenesis provides a review of the epidemiologic literature for neovascularization in various parts of the eye, including the cornea, iris, retina, and choroid. Relevant disease states are reviewed, as are their risk factors, so that their pathogenesis can be better understood. Data on the prevalence and incidence of the major diseases involving angiogenesis are synthesized to provide statistical evidence of the span and magnitude of ocular neovascularization. These prevalence and incidence data on ocular neovascularization are extrapolated to USA population data where possible, and "worst-case" estimates are calculated as well. Information was gathered with a search of the MEDLINE database, published monographs and volumes, and consultation with a number of primary authors. This study attempts to unify much of past and present epidemiologic research, and the information is presented in sections divided according to the anatomy of the eye.