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PURPOSE: To identify weather variables associated with pathogens contributing to infectious conjunctivitis globally. METHODS: Sample collection and pathogen identification from patients with acute infectious conjunctivitis was performed from 2017 to 2023. We linked pathogens identified from 13 sites across 8 countries with publicly available weather data by geographic coordinates. Mixed effects logistic regression analysis was performed to estimate the associations between temperature, precipitation, and relative humidity exposures, and the prevalence of infection types (RNA virus, DNA virus, bacteria, and fungus). RESULTS: 498 cases from the United States, India, Nepal, Thailand, Burkina Faso, Niger, Vietnam, and Israel were included in the analysis. 8-day average precipitation (mm) was associated with increased odds of RNA virus infection (odds ratio (OR)=1.47, 95% confidence interval (CI): 1.12 to 1.93, P=0.01) and decreased odds of DNA infection (OR=0.62, 95% CI: 0.46 to 0.82, P<0.001). Relative humidity (%) was associated with increased odds of RNA virus infections (OR=2.64, 95% CI: 1.51 to 4.61, P<0.001), and fungal infections (OR=2.35, 95% CI: 1.19 to 4.66, P=0.01), but decreased odds of DNA virus (OR=0.58, 95%CI: 0.37 to 0.90, P=0.02) and bacterial infections (OR=0.42, 95% CI: 0.25 to 0.71, P<0.001). Temperature (°C) was not associated with ocular infections for any pathogen type. CONCLUSIONS: This study suggests that weather factors affect pathogens differently. Particularly, humidity and precipitation were predictors for pathogens contributing to conjunctivitis worldwide. Additional work is needed to clarify the effects of shifts in weather and environmental factors on ocular infectious diseases.
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Corneal transplantation is the most prevalent form of tissue transplantation. The success of corneal transplantation mainly relies on the integrity of corneal endothelial cells (CEnCs), which maintain graft transparency. CEnC density decreases significantly after corneal transplantation even in the absence of graft rejection. To date, different strategies have been used to enhance CEnC survival. The neuropeptide vasoactive intestinal peptide (VIP) improves CEnC integrity during donor cornea tissue storage and protects CEnCs against oxidative stress-induced apoptosis. However, little is known about the effect of exogenous administration of VIP on corneal transplant outcomes. We found that VIP significantly accelerates endothelial wound closure and suppresses interferon-γ- and tumor necrosis factor-α-induced CEnC apoptosis in vitro in a dose-dependent manner. In addition, we found that intracameral administration of VIP to mice undergoing syngeneic corneal transplantation with endothelial injury increases CEnC density and decreases graft opacity scores. Finally, using a mouse model of allogeneic corneal transplantation, we found for the first time that treatment with VIP significantly suppresses posttransplantation CEnC loss and improves corneal allograft survival.
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Transplante de Córnea , Endotélio Corneano/efeitos dos fármacos , Fármacos Gastrointestinais/farmacologia , Rejeição de Enxerto/prevenção & controle , Sobrevivência de Enxerto/efeitos dos fármacos , Peptídeo Intestinal Vasoativo/farmacologia , Cicatrização/efeitos dos fármacos , Aloenxertos , Animais , Células Cultivadas , Endotélio Corneano/lesões , Humanos , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Camundongos Endogâmicos C57BLRESUMO
PURPOSE: To determine the efficacy of azithromycin 1.5% eyedrops compared with oral doxycycline in patients with moderate to severe meibomian gland dysfunction (MGD). METHODS: This prospective randomized trial included 169 participants with newly diagnosed moderate to severe MGD. Participants were randomly assigned to treatment with azithromycin 1.5% eyedrops (n = 85) twice daily for 2 days then once daily until 4 weeks or oral doxycycline (n = 84) 100 mg twice daily for 4 weeks. Signs and symptoms of MGD were evaluated at baseline and 4 weeks later. The percentages of participants with improvement in meibum quality were assessed as a primary outcome. Secondary outcomes were MGD-related symptoms, meibum expressibility, Oxford ocular surface staining score, tear film break up time (TBUT), and drug side effects. RESULTS: Although there were significant improvements in all outcomes in both groups, there was no between-group differences in the percentages of participants with improved meibum quality (P = 0.80), MGD-related symptoms (P > 0.05), meibum expressibility (P = 0.92), Oxford ocular surface staining score (P = 0.59), and TBUT (P = 0.99). Five (5.88%) participants in azithromycin group and four (4.76%) participants in doxycycline group discontinued medications due to drug side effects (P = 0.75). CONCLUSIONS: Both azithromycin 1.5% eyedrops and oral doxycycline significantly improved signs and symptoms in patients with moderate to severe MGD. Both azithromycin 1.5% eyedrops and oral doxycycline showed no difference in term of improved signs and symptoms of MGD as well as drug side effects that lead to discontinuation of medication.
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Azitromicina/administração & dosagem , Doxiciclina/administração & dosagem , Doenças Palpebrais/tratamento farmacológico , Glândulas Tarsais/efeitos dos fármacos , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Relação Dose-Resposta a Droga , Doenças Palpebrais/diagnóstico , Doenças Palpebrais/metabolismo , Feminino , Humanos , Masculino , Glândulas Tarsais/metabolismo , Pessoa de Meia-Idade , Soluções Oftálmicas , Estudos Prospectivos , Método Simples-Cego , Lágrimas/metabolismo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To compare the clinical outcomes of femtosecond laser (FS) and microkeratome (MK) for thin-flap in situ keratomileusis (LASIK). MATERIALS AND METHODS: Data from patients with moderate to high myopia (spherical equivalent, >-4 diopters [D]) who underwent thin-flap LASIK using FS (199 eyes/110 patients) and MK (157 eyes/86 patients) were analyzed in this retrospective study. Preoperative and postoperative data were recorded from day 1 and months 1 and 3, postoperatively. Visual and refractive outcomes were compared for efficacy, safety, predictability, stability, and the efficacy and safety indices. RESULTS: Three months postoperatively, more eyes in the FS group had an uncorrected distance visual acuity (UCVA) of 20/40 or better compared to MK group (relative risk [RR] 1.01, 95% confidence interval [CI], 0.97-1.05, P = 0.58); significantly more eyes in FS group had an UCVA of 20/20 or better (RR, 1.26, 95%CI, 1.08-1.48, P = 0.003). Intraoperative bleeding occurred in 5% and 36.7%, respectively, of FS and MK groups. There were no significant differences in the refractive predictability within spherical equivalents of 0.5 D (FS, 72%; MK, 63%) and 1.0 D (FS, 90%; MK, 86%). Both groups showed good stability 3 months, postoperatively. The efficacy index in FS group was 113.4%; that in MK group was 102.5% at 3 months postoperatively (P < 0.05). The safety indices for FS and MK groups at 3 months postoperatively were 116.4% and 108.2%, respectively (P < 0.05). CONCLUSIONS: Both methods of thin-flap created LASIK were effective, safe, predicable, and stable. FS group had significant improvements in efficacy and safety, confirmed by the efficacy and safety indices, compared to MK group. Lasers Surg. Med. 48:596-601, 2016. © 2016 Wiley Periodicals, Inc.
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Ceratomileuse Assistida por Excimer Laser In Situ/instrumentação , Miopia/cirurgia , Adulto , Feminino , Seguimentos , Humanos , Ceratomileuse Assistida por Excimer Laser In Situ/métodos , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVES: To identify predictive factors and to construct predictive models using epidemiological and clinical preoperative factors for the visual acuity change after intracorneal ring segment (ICRS) implantation in patients with keratoconus. METHODS: The medical records of 287 keratoconic eyes of 230 patients implanted with ICRS at Chula Refractive Surgery Center of a tertiary university hospital (Bangkok, Thailand) between January 2012 and March 2022 were retrospectively reviewed for epidemiological and clinical preoperative variables, including those derived from Scheimpflug tomography. After randomly excluding one eye for each bilateral case, the remaining 230 eyes were randomized into two groups: a training group (184 eyes) and a validation group (46 eyes). In the training group, the correlation between the interesting variables and postoperative uncorrected and corrected distance visual acuity change (ΔUDVA and ΔCDVA; logMAR scale) at 6 months was explored, and then the multiple linear regression analysis was used to develop the predictive models. The obtained models were tested using the validation group. RESULTS: There were 5 and 14 preoperative variables that statistically correlated with ΔUDVA and ΔCDVA respectively. Only the preoperative corrected distance visual acuity (CDVAp) strongly correlated with ΔCDVA (Beta = -0.746). Using multiple regression, the preoperative uncorrected distance visual acuity (UDVAp) and front mean keratometry were selected in the proposed model for ΔUDVA (adjusted R2 = 38.8%), while the CDVAp and index of surface variance (ISV) were selected in the model [Formula: see text] (adjusted R2 = 48.9%). The ΔUDVA and ΔCDVA models were correct in 47.83% and 63.4% of the validation group within 0.20 logMAR, respectively. CONCLUSIONS: Potential predictive factors and models for ICRS-induced changes in visual acuity are proposed as adjunctive tools for clinicians. Such tools could be used for case selection and during counselling before ICRS implantation to maximize surgical outcomes.
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Ceratocone , Humanos , Substância Própria/cirurgia , Topografia da Córnea , Olho Artificial , Ceratocone/cirurgia , Próteses e Implantes , Implantação de Prótese/métodos , Refração Ocular , Estudos Retrospectivos , TailândiaRESUMO
Importance: Infectious conjunctivitis can lead to corneal involvement and result in ocular morbidity. The identification of biomarkers associated with corneal involvement has the potential to improve patient care. Objective: To identify biomarkers in patients with acute infectious conjunctivitis. Design, Setting, and Participants: This cross-sectional study took place from December 2016 to March 2024. Analyses were performed in 3 phases. First, logistic regression and machine learning algorithms were used to predict the probability of demonstrating corneal involvement in patients with presumed infectious conjunctivitis. Second, quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to confirm the most important biomarker gene identified by the algorithm. Third, the biomarker gene was validated in prospectively collected conjunctival samples of adult patients from 3 outpatient centers in Thailand and 1 in India. Patients with signs and symptoms of infectious conjunctivitis and onset within less than 14 days were eligible. Exclusion criteria were the inability to consent, presumed toxicity, or allergic conjunctivitis. Exposures: Acute infectious conjunctivitis. Main Outcomes and Measures: The identification and validation of ocular surface gene expression associated with corneal findings on slitlamp examination. Results: Thirteen genes exhibited a 1.5-log2 fold change in expression in patients with corneal involvement compared to patients without corneal involvement. Using the 13 genes to train and cross validate, logistic regression produced the highest mean area under the receiver operating characteristic curve (AUROC; 0.85; 95% CI, 0.84-0.86) for corneal involvement. The removal of apolipoprotein E (APOE) from the gene ensemble led to a decline in predictive performance of the logistic regression classifier (from mean AUROC 0.85 [95% CI, 0.84-0.86] to 0.74 [95% CI, 0.73-0.75]; adjusted P = .001 [Tukey test]). Orthogonal testing of APOE expression level with RT-qPCR showed that APOE expression was higher in patients with corneal involvement compared to patients without (median [IQR], 0.23 [0.04-0.47] vs 0.04 [0.02-0.06]; P = .004 [Mann-Whitney U test]). Using a Youden index of 0.23 Δ threshold cycle, APOE had a sensitivity of 56% (95% CI, 33-77) and a specificity of 88% (95% CI, 79-93) in 106 samples with conjunctivitis at Aravind, India (P < .001 [Fisher exact test]). When applied to a different patient population in Thailand, the same criteria could discriminate between disease states (58 samples; sensitivity, 47%; 95% CI, 30-64 and specificity, 93%; 95% CI, 77-99; P = .001 [Fisher exact test]). Conclusions and Relevance: The results from this study suggest that the host conjunctival immune response can be meaningfully interrogated to identify biomarkers for ocular surface diseases.
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Purpose: To evaluate diacerein (interleukin-1ß inhibitor) efficacy on ocular surface disease (OSD). Patients and Methods: This prospective observational study included patients who received diacerein for osteoarthritis and had dry eye (DE). The primary outcome was corneal staining score. Secondary outcomes were ocular surface disease index (OSDI) score, tear breakup time (TBUT), tear osmolarity (Osm), Schirmer's test results, interleukin-1α (IL-1α), interleukin-1ß (IL-1ß), and interleukin-1 receptor antagonist (IL-1Ra) levels in tears. All measurements were done at baseline and 2-month follow-up visits. Linear mixed models were used to examine the effect of all parameters, and log-transformed models were used for IL-1α, IL-1ß, and IL-1Ra analyses. Results: Thirty-four patients (31 females and 3 males) were enrolled. The corneal staining score improved by 1.29 points (P=0.022, 95% confidence interval [95% CI] 0.19 to 2.40) after 2 months, and the OSDI score improved by 17.2 points (P<0.001, 95% CI 10.82 to 23.58) but TUBT decreased by 0.66 seconds (P=0.021, 95% CI 0.10 to 1.22). No significant differences were observed in the tear Osm and Schirmer's test. IL-1Ra demonstrated no statistical difference, IL-1α was significantly increased by 80% (P=0.260), and IL-1ß was significantly decreased by 99.21% (P<0.001). Conclusion: Diacerein can improve corneal staining and decrease IL-1ß levels in tears, which reflects better DE symptoms. Diacerein may be a promising alternative treatment for patients with OSD and osteoarthritis.
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PURPOSE: To evaluate agreement of total corneal power (TCP) measured by swept-source anterior segment optical coherence tomography (CASIA 2), Scheimpflug tomography (Pentacam AXL), and swept-source optical biometer (IOLMaster 700) in normal and keratoconic patients. METHODS: This is a prospective observational study conducted at King Chulalongkorn Memorial Hospital, Bangkok, Thailand. Biometric values were measured by each device for three times by two operators to evaluate repeatability and reproducibility of TCP. The agreement of TCP and other parameters including total corneal astigmatism, anterior keratometry, anterior corneal astigmatism, posterior keratometry, posterior corneal astigmatism, anterior chamber depth, white-to-white corneal diameter (WTW), central corneal thickness, and intraocular power were also evaluated. RESULTS: This study enrolled 100 healthy participants and 34 patients with keratoconus. The repeatability and reproducibility of TCP were high in all devices (ICC > 0.9). The agreement of TCP was excellent among three devices in both groups (ICC > 0.9). However, the agreement of TCP between CASIA 2 and IOLMaster 700 was slightly lower in healthy participants (ICC = 0.867) and keratoconic patients (ICC = 0.852) with mean differences of more than 1.0 diopter is clinically significant. Wider 95% limit of agreement were found in keratoconic eyes. Most of other parameters showed good to excellent agreement except WTW which showed poor to moderate agreement in both groups. IOL power showed clinically significant differences in patients with keratoconus. CONCLUSIONS: The agreement of TCP measured by three devices was excellent in normal and keratoconic patients. However, TCP cannot be used interchangeably between devices.
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Astigmatismo , Ceratocone , Biometria , Córnea/diagnóstico por imagem , Topografia da Córnea/métodos , Humanos , Reprodutibilidade dos Testes , Tailândia , Tomografia de Coerência Óptica/métodosRESUMO
Background: Studies in the epidemiology of keratoconus are limited in Southeast Asia. A study on the prevalence and characteristics of keratoconus in the Thai population could give a general idea of its impact. Objectives: To study keratoconus prevalence in patients seeking refractive surgery and analyze the characteristics of keratoconus. Methods: Medical records from April 2015 to August 2018 were retrospectively reviewed. Keratoconus and keratoconus suspect prevalence in patients seeking laser vision correction were calculated. The characteristics of keratoconus patients were reviewed. The Amsler-Krumeich classification was used to determine the stages. Topographically, the types of cones were categorized into oval, nipple, pellucid marginal degeneration (PMD)-like, and astigmatic types. Results: Keratoconus and keratoconus suspect prevalence were 1.66% and 0.68%, respectively. Out of the affected patients, 73.8% were male. The mean age at diagnosis was 25.25 ± 8.35 years. The presenting symptoms were blurred vision (87%) and itching (47%). Stage 1 was predominant, found in 39% of patients (followed by stages 2, 4, and 3, respectively). Ocular findings comprised the Munson sign (14.63%), the Rizutti sign (6.94%), Fleischer ring (28.14%), Vogt striae (24.95%), corneal scar (8.63%), prominent corneal nerve (2.81%), and corneal staining (7.69%). Mean uncorrected visual acuity (logarithm of the minimum angle of resolution [logMAR]) was 0.88 ± 0.64. Mean corrected visual acuity (logMAR) was 0.40 ± 0.49. Mean Q-value was -0.92 ± 0.63. The thinnest pachymetry was 459.39 ± 56.96 microns. The mean keratometry was 49.7 ± 6.64 diopters. Topographically, the types of cones were oval (57%), astigmatic (33%), PMD-like (5%), and nipple type (4%). Conclusions: Keratoconus prevalence among Thai patients seeking refractive surgery was 1.66%. Most patients were male and presented with the disease at a mild bilateral stage in their second decade of life.
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PURPOSE: To evaluate the structure and function of meibomian glands in patients with thyroid related orbitopathy (TRO) compared with age- and sex-matched controls without TRO. METHODS: This cross-sectional study included 106 eyes of 53 patients with TRO and 106 eyes of 53 age- and sex-matched controls without TRO. Patients with TRO were assessed for thyroid hormone status, activity and severity of TRO. All participants completed OSDI questionnaires. Their meibomian glands' structure and function were assessed, including the area of meibomian gland dropout, lipid layer thickness (LLT), meibum expressibility and quality scores, tear break-up time (TBUT), corneal and conjunctival staining scores. A generalized estimating equation (GEE) was used to compare between the two groups. The correlations between the area of meibomian gland dropout with symptoms and signs of TRO were evaluated using GEE and Spearman correlation. RESULTS: All patients with TRO had inactive status. The mean area of meibomian gland dropout was higher in the TRO group (34.5±11.2%) compared with that of controls (30.1±10.7%, P = 0.03). Both mean meibum quality (TRO, 1.6±0.7; Controls, 2.0 ±0.5) and expressibility (TRO, 1.5 ±0.7; Controls, 1.7 ±0.6) scores were slightly better in the TRO group compared with those of controls (P = 0.01). There was no significant difference in OSDI, corneal and conjunctival staining, TBUT and LLT. The area of meibomian gland dropout in patients with TRO was correlated with euthyroid status (P<0.05) and lagophthalmos (P = 0.03). CONCLUSIONS: Patients with inactive TRO showed significantly higher meibomian gland dropout compared with that of age- and sex-matched controls without TRO.
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Oftalmopatia de Graves/diagnóstico , Glândulas Tarsais/fisiopatologia , Glândula Tireoide/fisiopatologia , Adulto , Idoso , Estudos de Casos e Controles , Estudos Transversais , Doenças Palpebrais/fisiopatologia , Feminino , Oftalmopatia de Graves/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Lágrimas/química , Adulto JovemRESUMO
Acanthamoeba keratitis is predominantly caused by genotype T4. We report a case of severe keratitis caused by Acanthamoeba in a 39-year-old man who had prior accidental exposure to a corrosive chemical. The patient developed central full thickness ring infiltration and epithelial defect with hypopyon that required keratoplasty. The acanthamoebae isolated from the patient exhibited thermotolerance phenotype with the capability to grow well at ambient temperature and at 42°C. Analysis of a near complete 18S rRNA gene of this isolate revealed a distinct sequence that can be unequivocally assigned to genotype T12, a rare genotype incriminated in corneal infections.
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Ceratite por Acanthamoeba/diagnóstico , Acanthamoeba/genética , Genótipo , Acanthamoeba/classificação , Acanthamoeba/efeitos dos fármacos , Acanthamoeba/patogenicidade , Ceratite por Acanthamoeba/tratamento farmacológico , Adulto , Antiprotozoários/uso terapêutico , Infecções Oculares Parasitárias/diagnóstico , Infecções Oculares Parasitárias/tratamento farmacológico , Humanos , Masculino , Filogenia , RNA Ribossômico 18S/genética , Análise de Sequência de DNA , Índice de Gravidade de Doença , TailândiaRESUMO
PURPOSE: To determine the percentage of eyes with corneal astigmatic power stability and mean corneal keratometric power at 6-month post-pterygium excision, and to identify the time, and the associated factors, required to achieve stability. METHODS: This prospective observational study enrolled patients undergoing pterygium excision. Patients were evaluated for baseline characteristics and keratometric data before and every month after pterygium excision for six months using IOL Master 500® (Carl Zeiss, Meditec). Clinically stable corneal astigmatic power and keratometric power were, respectively, defined as changes in these parameters of less than 0.25 and 0.27 diopters after two consecutive visits. Time to corneal astigmatic and keratometric power stability, as well as factors associated with the stability, were analyzed. RESULTS: Forty percent and 73.3% of eyes, respectively, demonstrated corneal astigmatic and corneal keratometric stability at six months post-operation. Within three months of reaching initial stability, the corneal astigmatic power and the mean keratometric power showed instability in 46.7% and 27.3% of patients, respectively. No patients with keratometric stability for more than three months became unstable during the study period. The extension of pterygium exceeding 3.0 mm was associated with a delay in time to corneal astigmatic stability (HRadjusted 0.41; 95% CI 0.19-0.89; P= 0.02). CONCLUSION: According to the clinical relevance, 40% and 73% of patients, respectively, presented corneal astigmatic and keratometric stability within six months post-operation. Patients with a pterygium extension of more than 3 mm required a longer time for corneal astigmatic stability. It is recommended that keratometric stability be achieved for at least three months before commencing with additional procedures.
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PURPOSE: To evaluate the association between symptoms and signs of dry eye diseases (DED) with corneal biomechanical parameters. METHODS: This cross-sectional study enrolled 81 participants without history of ocular hypertension, glaucoma, keratoconus, corneal edema, contact lens use, diabetes, and ocular surgery. All participants were evaluated for symptoms and signs of DED using OSDI questionnaire, tear film break-up time (TBUT), conjunctival and corneal staining (NEI grading) and Schirmer test. Corneal biomechanical parameters were obtained using Corvis ST. Mixed-effects linear regression analysis was used to determine the association between symptoms and signs of DED with corneal biomechanical parameters. Difference in corneal biomechanical parameter between participants with low (Schirmer value ≤10 mm; LT group) and normal (Schirmer value >10mm; NT group) tear production was analyzed using ANCOVA test. RESULTS: The median OSDI scores, TBUT, conjunctival and corneal staining scores as well as Schirmer test were 13±16.5 (range; 0-77), 5.3±4.2 seconds (range; 1.3-11), 0±1 (range; 0-4), 0±2 (ranges; 0-9) and 16±14 mm (range; 0-45) respectively. Regression analysis adjusted with participants' refraction, intraocular pressure, and central corneal thickness showed that OSDI had a negative association with highest concavity radius (P = 0.02). The association between DED signs and corneal biomechanical parameters were found between conjunctival staining scores with second applanation velocity (A2V, P = 0.04), corneal staining scores with second applanation length (A2L, P = 0.01), Schirmer test with first applanation time (A1T, P = 0.04) and first applanation velocity (P = 0.01). In subgroup analysis, there was no difference in corneal biomechanical parameters between participants with low and normal tear production (P>0.05). The associations were found between OSDI with time to highest concavity (P<0.01) and highest displacement of corneal apex (HC-DA, P = 0.04), conjunctival staining scores with A2L (P = 0.01) and A2V (P<0.01) in LT group, and Schirmer test with A1T (P = 0.02) and HC-DA (P = 0.03), corneal staining scores with A2L (P<0.01) in NT group. CONCLUSIONS: According to in vivo observation with Corvis ST, patients with DED showed more compliant corneas. The increase in dry eye severity was associated with the worsening of corneal biomechanics in both patients with low and normal tear production.
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Córnea/metabolismo , Córnea/fisiologia , Síndromes do Olho Seco/metabolismo , Adolescente , Adulto , Idoso , Fenômenos Biomecânicos , Criança , Pré-Escolar , Estudos Transversais , Síndromes do Olho Seco/fisiopatologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Tonometria Ocular , Adulto JovemRESUMO
PURPOSE: To evaluate long-term survival outcomes and determine the prognostic factors of corneal transplantation performed at a tertiary referral hospital in Thailand. DESIGN: A 15-year retrospective cohort study. MATERIALS AND METHODS: One corneal graft per patient was selected; graft failure was defined as graft opacity due to recurrent disease or endothelial cell dysfunction. Kaplan-Meier survival analysis was performed. Median time to failure was compared using the Log rank test. Prognostic factors were identified using the Cox proportional hazards model. RESULTS: We enrolled 704 transplanted grafts. Surgical indications were optical (88.5%), therapeutic (10.2%), and tectonic (1.3%). The most common diagnoses were corneal opacity (25.3%), bullous keratopathy (15.8%), and regraft (14.8%). The overall survival rates at 1, 3, 5, and 10 years were 87.5%, 72.0%, 59.2%, and 41.7%, respectively. Univariate analysis identified age, primary diagnosis, graft size, pre-existing glaucoma, prior lens status, prior intraocular surgery, indication for surgery, donor endothelial cell density, and previous graft rejection as prognostic factors for graft failure. Multivariate analysis revealed three prognostic factors: primary diagnosis of perforation/peripheral ulceration/Mooren's ulcer (hazard ratio [HR]=28.57; 95% confidence interval [CI], 6.32-129.16; P<0.001), active keratitis (HR=24.30; 95% CI, 5.88-100.43; P<0.001), regraft (HR=9.37; 95% CI, 2.27-38.66; P=0.002), and pseudophakic/aphakic bullous keratopathy (HR=7.97; 95% CI, 1.93-32.87; P=0.004); pre-existing glaucoma (HR=1.52; 95% CI, 1.13-2.04; P=0.006); and previous graft rejection (HR=1.95; 95% CI, 1.54-2.48; P<0.001). CONCLUSION: Overall corneal graft survival rate was high in the first postoperative year and decreased after that. Primary diagnosis, pre-existing glaucoma, and previous graft rejection negatively influenced graft survival.
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PURPOSE: To identify factors associated with the prognosis in Pythium keratitis. PATIENTS AND METHODS: The medical records of 25 patients (26 eyes) diagnosed with Pythium keratitis at a referral institution were reviewed. The demographic and clinical characteristics, treatment, microbiological diagnosis, histopathological features, and outcomes were recorded. The histopathological specimens were reviewed. The patients were divided into a globe removal group and a globe salvage group. Univariate analysis was used to identify factors associated with poor outcomes. RESULTS: Fifteen eyes (57.7%) were removed. Patients in the globe removal group were on average 16.4 years older (95% CI 6.98 to 25.88) than those in the globe salvage group, received the first medication (either topical antifungals or antibiotics) later than one day after the onset of symptoms (RR = 2.75, 95% CI 1.18 to 6.42), and had a maximal diameter of the infiltration area ≥6 mm (RR = 3.14, 95% CI 1.17 to 8.45). The globe removal group showed satellite, multifocal, or total corneal infiltration patterns (RR = 2.82, 95% CI 1.03 to 7.74) and a hypopyon (RR = 3.43, 95% CI 1.26 to 9.35) as risk factors. The histopathological examination showed a higher density of Pythium in the globe removal group than the globe salvage group (median 376 (interquartile range 323, 620) versus 107 (interquartile range 16, 260) hyphae per high power field; P = 0.035). CONCLUSION: The risk of globe removal in patients with Pythium keratitis increased with age, delayed initial topical antifungal or antibiotic treatment, advanced disease at presentation, and dense Pythium hyphae infiltration of the cornea. Early recognition and treatment are critical to successfully eradicate the infection.
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PURPOSE: To study the efficacy and safety of intense pulsed light (IPL) in patients with meibomian gland dysfunction (MGD). METHODS: This prospective randomized double-masked sham-controlled trial included 114 patients with MGD. Patients were randomized into the IPL or sham group. Either the IPL or sham procedure was performed on days 0, 15, and 45. Ocular Surface Disease Index (OSDI), visual analog scale, visual acuity, tear breakup time, meibum quality and expressibility, meibography grade, ocular surface staining, tear film lipid layer thickness, tear osmolarity, Schirmer test, tear interleukin-1 receptor agonist, and interleukin-6 levels were examined on days 0, 15, and 45 and at months 3 and 6. Subgroup analysis according to stage and the patient's compliance to conventional treatment were also analyzed. Any adverse events during the study were recorded. A multilevel mixed-effect linear regression model was used. P value less than 0.05 was considered statistically significant. RESULTS: At 6 months, tear breakup time, meibum quality grades, expressibility grades, and OSDI were better in the IPL group (5.23 ± 2.91 vs. 3.11 ± 0.99 seconds, P < 0.001; 8.74 ± 4.74 vs. 13.19 ± 5.01, P < 0.001; 0.50 ± 0.67 vs. 1.12 ± 0.70, P < 0.001; 24.29 ± 16.92 vs. 32.71 ± 20.07, P < 0.05). OSDI, meibum quality, and expressibility in the IPL group began to improve at day 15 (P < 0.001), whereas the results in the sham group began to improve at day 45 (P < 0001). No adverse event occurred after IPL. CONCLUSIONS: IPL is effective and safe for MGD treatment in all stages regardless of compliance.
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Terapia de Luz Pulsada Intensa/métodos , Disfunção da Glândula Tarsal/terapia , Glândulas Tarsais/metabolismo , Lágrimas/metabolismo , Adulto , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Disfunção da Glândula Tarsal/metabolismo , Pessoa de Meia-Idade , Concentração Osmolar , Estudos ProspectivosRESUMO
PURPOSE: To identify factors predicting corneal astigmatic change following suture removal in post-penetrating keratoplasty patients. PATIENTS AND METHODS: This cross-sectional study included the data of 33 events of corneal suture removal from 27 post-penetrating keratoplasty patients. Sutures were removed from the steep axis of transplanted cornea with 16 interrupted corneal sutures. Corneal astigmatism was measured before and after suture removal using ORBSCAN II. Patients' demographic data and corneal biomechanics parameters obtaining from the Corvis ST were recorded. The changes in corneal astigmatism were calculated using vector analysis. The correlation between changes in corneal astigmatism and the potential factors was evaluated using Spearman's correlation coefficient and linear regression model. RESULTS: The mean corneal astigmatism before and after suture removal was 7.1±3.7 diopters (D) and 5.5±3.2D, respectively. The mean astigmatic change was 7.0±6.3D (range, 0.3-30.8D) by vector analysis at 9.7±5.5 weeks after suture removal. Change in corneal astigmatism was significantly correlated with pre-suture removal astigmatism (Rs=0.47, P=0.01). There was no correlation between the donor-recipient trephine diameter difference, the duration from corneal transplantation to suture removal, the number of removed sutures with the change in corneal astigmatism, and corneal biomechanics parameters (P>0.05). Linear regression is given by the following equation: astigmatic change (D)=1.05x pre-suture removal astigmatism (D) - 0.43. CONCLUSION: The astigmatic change after corneal suture removal in post-keratoplasty patients was significantly correlated with pre-suture removal astigmatism. These findings will permit a validated approach for reducing corneal astigmatism in post-keratoplasty patients.
RESUMO
PURPOSE: To show the alteration of tomography, topometric indices and corneal densitometry after corneal refractive surgery combined with collagen crosslinking. PATIENTS AND METHODS: All medical records of patients undergoing corneal refractive surgery with simultaneous collagen crosslinking during April 2015 and August 2018 were retrospectively reviewed. Corneal tomography, higher-order aberrations (HOA), topographic indices and corneal densitometry were evaluated. All the data at 1 month, 3 months and 6 months were compared to baseline value. All complications were noted. P value less than 0.05 was considered statistically significant. RESULTS: Medical records of fourteen patients (twenty-five eyes) were reviewed. HOA increased at all time points (p < 0.05). Keratoconus index and central keratoconus index decreased, whereas index of surface variance, index of vertical asymmetry, index of height decentration and the minimum of radius of curvature increased at all time points (p < 0.05). Index of height asymmetry increased at 3 and 6 months (p < 0.05). Corneal densitometry at anterior layer of 0-10 mm zone and center layer of 0-6 mm zone increased at 1 and 3 months (p < 0.05). At 6 months, the densitometry at 0-6 mm zone returned to baseline level. However, at 6 months, at anterior and center layer of 6-10 mm zone, the densitometry values were still more than preoperative values (p < 0.05). There was one case of bacterial keratitis. CONCLUSION: After the corneal refractive surgery combined with collagen crosslinking, the HOA and corneal densitometry increased. Topographic indices showed conflicting results.
RESUMO
Purpose: To describe a case of microsporidial stromal keratitis with endophthalmitis in an immunocompetent patient.Methods: Case reportResults: A 58-year-old HIV-negative man presented with stromal keratitis in his right eye. The patient demonstrated subsequent vitritis, multifocal retinitis and arteritis, and macular edema with recurrent vitreous hemorrhage after therapeutic keratoplasty. Numerous microsporidial spores were detected in corneal tissues by modified trichrome stain. Both corneal tissues and vitreous sample of the affected eye showed positive results by polymerase chain reaction targeting the microsporidial small subunit rRNA gene whose sequences belonged to Vittaforma corneae. Post-keratoplasty and vitrectomy, his best-corrected visual acuity was hand motion due to pale optic disc.Conclusion: Endophthalmitis can be a consequence of microsporidial stromal keratitis in an immunocompetent host. Early recognition and prompt treatment should be considered in patients diagnosed with microsporidial keratitis presenting with mild vitritis, retinitis, and recurrent vitreous hemorrhage.
Assuntos
Endoftalmite/microbiologia , Infecções Oculares Fúngicas/microbiologia , Ceratite/microbiologia , Microsporidiose/diagnóstico , Vittaforma/isolamento & purificação , Substância Própria/patologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE: To compare the thickness of the limbal epithelium (LE) and the bulbar conjunctival epithelium (BCE) between patients with dry eye disease (DED) with and without ocular graft-versus-host disease (GVHD). METHODS: This cross-sectional study enrolled 40 patients with moderate to severe DED including 20 with and 20 without chronic ocular GVHD. All patients had a comprehensive clinical ophthalmic assessment. Moreover, the thickness of the LE and BCE in both nasal and temporal regions of both eyes was measured using spectral domain optical coherence tomography. RESULTS: The average LE thickness in all patients with dry eye (GVHD and non-GVHD) was 65.8 ± 11.9 µm temporally and 69.7 ± 11.1 µm nasally (P = 0.02). The average BCE thickness was 55.8 ± 11.4 µm temporally and 60.1 ± 11.0 µm nasally (P = 0.03). There were no statistically significant differences between GVHD and non-GVHD groups in LE thickness (69.6 ± 11.7 vs. 66.1 ± 6.2 µm, respectively, P = 0.31) or BCE thickness (58.9 ± 9.6 vs. 57.3 ± 9.8 µm, respectively, P = 0.82). There was a significant correlation between LE thickness and BCE thickness (P = 0.01, Rs = 0.41). A statistically significant negative correlation was also observed between LE thickness and age (P = 0.002, Rs = -0.35). There were no significant correlations between the thickness of the LE or BCE and other clinical parameters. CONCLUSIONS: No difference exists in the thickness of the ocular surface epithelia between dry eyes with and without ocular GVHD, which would suggest that these epithelial changes may be independent of the underlying etiology and possibly only reflect the disease severity. Furthermore, there are regional variations in the thickness of the ocular surface epithelia in patients with DED.