Advancements in diagnostic methods and surgical techniques for keratoconus (KC) have increased non-invasive treatment options. Successful surgical planning for KC involves a combination of clinical science, empirical evidence, and surgical expertise. Assessment of disease progression is crucial, and halting the progression should be the focus if it is progressive. While surgeons used to rely on experience alone to decide the surgical method, comparing the network of primary factors, such as visual acuity, across studies can help them choose the most appropriate treatments for each patient and achieve optimal outcomes. Meticulous tabulation methods facilitate interpretation, highlighting the importance of selecting the correct surgical and rehabilitation approach based on each patient's condition and stage of the disease. We detail the outcomes of a comprehensive network meta-analysis comparing the effectiveness of various combined therapeutic refractive treatments for KC at identical stages of the disease, spanning 4 distinct follow-up intervals. Additionally, the comprehensive analysis suggests that for corneas with optimal best corrected visual acuity (BCVA) preoperatively (classified as regular), combining phakic intraocular lenses with intracorneal ring segments (ICRS) and corneal cross-linking (CXL) could offer the best therapeutic approach provided the disease stage does not exceed stage 3. For irregular corneas, although initial follow-ups show a significant difference in BCVA with surface ablation, longer-term follow-ups recommend combining surface ablation with ICRS and CXL, especially at higher stages.
This review explores contemporary challenges in penetrating keratoplasty (PK), focusing on technical intricacies, technological advancements, and strategies for preventing graft rejection. A systematic literature search from January 2018 to July 2023 was conducted across PubMed, Cochrane, Web of Science, Scopus, and EMBASE. The inclusion criteria comprised studies on PK and its comparison with other corneal pathologies, with emphasis on keratoconus (KC). Two independent reviewers screened studies, extracting relevant data. The review covers PK evolution, highlighting infra-red femtosecond lasers' impact on graft shapes, minimizing astigmatism, and enhancing wound healing. Graft rejection, a primary complication, is examined, detailing risk factors and preventive measures. Preoperative considerations, diagnostic techniques for rejection, and PK in KC are discussed. Postoperative care's significance, including intraocular pressure monitoring and steroid administration, is emphasized. The paper concludes with a comprehensive approach to prevent graft rejection, involving topical and systemic medications. An outlook on evolving monoclonal antibody research is presented. As the field progresses, personalized approaches and ongoing therapeutic exploration are expected to refine strategies, enhancing PK outcomes.
Deep anterior lamellar keratoplasty (DALK) has emerged as a transformative approach in managing corneal pathologies, notably keratoconus (KC), providing a viable alternative to penetrating keratoplasty (PK). This systematic review explores the intricacies of DALK, comparing its preoperative, intraoperative, and postoperative considerations with PK. Extensive literature searches revealed a wealth of data regarding DALK's advantages and challenges, with an emphasis on graft survival, visual outcomes, and complications. In the preoperative phase, DALK showcases its versatility, catering to a wide spectrum of patients, including those with KC and ocular surface disorders. Intraoperatively, it offers innovative techniques to address emphysema, bubble formation, and Descemet's membrane perforation, all while maintaining a strong focus on patient-centered outcomes. Postoperatively, DALK's lower rejection rates and decreased complications underscore its potential superiority over PK, although unique challenges such as graft failure from nonimmunologic factors demand vigilant management. This comprehensive review not only serves as a valuable resource for ophthalmic surgeons but also sheds light on the evolving landscape of corneal transplantation, highlighting DALK's role as a transformative force in the field.
PURPOSE: To verify corneal biomechanical changes, poststromal augmentation using myopic small-incision lenticule extraction's (SMILEs) lenticules in advanced keratoconus (KCN) through Corvis ST (Oculus, Wetzlar, Germany). MATERIALS AND METHODS: A clinical trial enrolled 22 advanced KCN patients. We implanted lenticules exceeding 100 µ according to a nomogram and evaluated biomechanical factors through Corvis ST at 3-, 6-, and 24-month postimplantation. We examined parameters during the first applanation (A1), second applanation (A2), highest concavity (HC)/max concavity events, and Vinciguerra screening parameters, as recently established criteria derived from the ideal blend of diverse biomechanical and ocular factors and formulated through the application of logistic regression. Regression analyses explored relationships with age, mean keratometry value, thickness, sphere, cylinder, and best-corrected visual acuity. RESULTS: Patients were well matched for age, intraocular pressure, and central corneal thickness (CCT). The mean spherical equivalent decreased from -13.48 ± 2.86 Diopters (D) to -8.59 ± 2.17 D (P < 0.007), and mean keratometry decreased from 54.68 ± 2.77 D to 51.95 ± 2.21 D (P < 0.006). Significant increases were observed in HC time (HCT), Radius-central curvature radius at the HC state-, peak distance (PD) during HC state, CCT, first applanation time, and stiffness parameter (A1T and SP-A1), whereas HC deformation amplitude, maximum deformation amplitude ratio at 2 mm, Corvis Biomechanical Index (CBI), integrated radius (IR), second applanation deformation amplitude (A2DA), first applanation velocity and deflection amplitude (A1V and A1DeflA) significantly decreased postlenticule implantation. Multivariable regression revealed age positively correlated with SP-A1 (P = 0.003) and negatively with HC delta Arc length (P = 0.007). Mean K positively correlated with CCT (P = 0.05) and negatively with CBI (P = 0.032). Best-corrected visual acuity positively correlated with HCT (P = 0.044), and the cylinder positively correlated with PD (P = 0.05) and CCT (P = 0.05) whereas negatively with IR (P = 0.025). CONCLUSIONS: Stromal augmentation using myopic SMILE lenticules induces significant corneal biomechanical changes in KCN.
Background: New developments in artificial intelligence, particularly with promising results in early detection and management of keratoconus, have favorably altered the natural history of the disease over the last few decades. Features of artificial intelligence in different machine such as anterior segment optical coherence tomography, and femtosecond laser technique have improved safety, precision, effectiveness, and predictability of treatment modalities of keratoconus (from contact lenses to keratoplasty techniques). These options ingrained in artificial intelligence are already underway and allow ophthalmologist to approach disease in the most non-invasive way. Objectives: This study comprehensively describes all of the treatment modalities of keratoconus considering machine learning strategies. Design: A multidimensional comprehensive systematic narrative review. Data sources and methods: A comprehensive search was done in the five main electronic databases (PubMed, Scopus, Web of Science, Embase, and Cochrane), without language and time or type of study restrictions. Afterward, eligible articles were selected by screening the titles and abstracts based on main mesh keywords. For potentially eligible articles, the full text was also reviewed. Results: Artificial intelligence demonstrates promise in keratoconus diagnosis and clinical management, spanning early detection (especially in subclinical cases), preoperative screening, postoperative ectasia prediction after keratorefractive surgery, and guiding surgical decisions. The majority of studies employed a solitary machine learning algorithm, whereas minor studies assessed multiple algorithms that evaluated the association of various keratoconus staging and management strategies. Last but not least, AI has proven effective in guiding the implantation of intracorneal ring segments in keratoconus corneas and predicting surgical outcomes. Conclusion: The efficient and widespread clinical translation of machine learning models in keratoconus management is a crucial goal of potential future approaches to better visual performance in keratoconus patients. Trial registration: The article has been registered through PROSPERO, an international database of prospectively registered systematic reviews, with the ID: CRD42022319338.
Keratoconus: from fundamentals to future Artificial intelligence has changed how we treat the eye disease keratoconus in recent years. This study examines the many keratoconus therapies available, including surgery and contact lens wear, and how artificial intelligence can improve the safety and accuracy of these procedures. We combed through numerous papers to locate this data. To achieve the best outcomes, several parameters and methods should be evaluated. According to the study, some elements from eye scans are more useful than others. The idea behind using artificial intelligence is to help patients see better and treat keratoconus more effectively.
This narrative review aimed to have an algorithmic approach to microphthalmos by a systematic search. The definition can be related to a number of special phenotypes. In the more challenging cases of complex microphthalmos, relative anterior microphthalmos, and nanophthalmos, the surgeon can approach these cases more safely if they have a deep understanding of the anatomical variations and ideal formulae for intraocular lens computation and knows how to avoid intra- and post-operative complications. In this article, we review the criteria by which we recognize and describe pre-, intra-, and post-operative considerations, as well as discuss the ideal intraocular lenses for microphthalmos, given the intricate varieties of small eye phenotypes.
PURPOSE: This review was designed to compare different corneal imaging modalities using artificial intelligence (AI) for the diagnosis of keratoconus (KCN), subclinical KCN (SKCN), and forme fruste KCN (FFKCN). METHODS: A comprehensive systematic search was conducted in scientific databases, including Web of Science, PubMed, Scopus, and Google Scholar based on the PRISMA statement. Two independent reviewers assessed all potential publications on AI and KCN up to March 2022. The Critical Appraisal Skills Program (CASP) 11-item checklist was used to evaluate the validity of the studies. Eligible articles were categorized into three groups (KCN, SKCN, and FFKCN) and included in the meta-analysis. The pooled estimate of accuracy (PEA) was calculated for all selected articles. RESULTS: The initial search yielded 575 relevant publications, of which 36 met the CASP quality criteria and were included in the analysis. Qualitative assessment showed that Scheimpflug and Placido combined with biomechanical and wavefront evaluations improved KCN detection (PEA, 99.2, and 99.0, respectively). The Scheimpflug system (92.25 PEA, 95% CI, 94.76-97.51) and a combination of Scheimpflug and Placido (96.44 PEA, 95% CI, 93.13-98.19) had the highest diagnostic accuracy for the detection of SKCN and FFKCN, respectively. The meta-analysis outcomes showed no significant difference between the CASP score and accuracy of the publications (all P > 0.05). CONCLUSIONS: Simultaneous Scheimpflug and Placido corneal imaging methods provide high diagnostic accuracy for early detection of keratoconus. The use of AI models improves the discrimination of keratoconic eyes from normal corneas.
Keratoconus , Humans , Keratoconus/diagnosis , Corneal Topography/methods , Artificial Intelligence , Cornea , Corneal Pachymetry , ROC Curve
INTRODUCTION: This study investigated patient satisfaction levels in five premium intraocular lenses (IOLs). A secondary aim was to determine whether patient satisfaction was associated with the cataract grade before lens surgery. METHODS: In this multicenter prospective comparative study, 164 patients from diverse backgrounds underwent cataract surgery and were assigned for identical bilateral implantation of multifocal IOLs. In addition to visual performance, quality of life was measured using the National Eye Institute Refractive Error Quality Of Life Instrument (NEI-RQL 42) scoring questionnaire. The Sirius Scheimpflug Analyzer was used to evaluate the posterior cornea and aberrations. Finally, the association of patient satisfaction reports with the Pentacam Cataract Grading Scale (PCGS) and Lens Opacities Classification System (LOCS III) was evaluated. RESULTS: A considerable subjective improvement was observed in uncorrected far, near (40 cm), and intermediate (60 cm) visual acuity in the five groups (P values < 0.001). A significant difference was observed in mesopic and photopic contrast sensitivity between Symfony, Trinova, and AT LISA at the spatial frequency of 12 cycles per degree, favoring Symfony (P < 0.001). PanOptix users had considerably lower mean coma values (P < 0.001), while AT LISA users had lower mean spherical aberrations (P = 0.009) compared to the other groups. No additional safety concerns relating to IOLs were recorded. Mean satisfaction had a high correlation with LOCS and Pentacam Nuclear Staging (PNS) in each lens group, e.g., correlation coefficient and P value for AT LISA were respectively r = 0.99, P < 0.001 and r = 0.97, P = 0.004. CONCLUSION: Despite discrepancies between groups of lenses, most patients who received multifocal IOLs reported satisfaction at more than 3 years after the initial operation. A growing number of patients with cataracts are seeking spectacle-free vision with presbyopia-correcting IOLs. Hence, the high satisfaction rate among patients with cataract could indicate the value of offering a wider range of available lenses.
Cataract , Lenses, Intraocular , Multifocal Intraocular Lenses , Humans , Cataract/complications , Lens Implantation, Intraocular , Patient Satisfaction , Prospective Studies , Prosthesis Design , Quality of Life
ABSTRACT: The ectatic disease of the cornea poses a significant challenge for ophthalmologists because commonly used treatments to improve visual acuity, such as spectacles and contact lenses, may not be effective, especially in advanced stages. In addition, the preferred surgical management, corneal transplantation, has various issues related to tissue availability, the steep learning curve, and postoperative complications such as tissue stability and half-life. Ongoing research for an alternative to keratoplasty has suggested various methods, such as corneal crosslinking, which can improve visual function when combined with other techniques. Early reports have become available on the feasibility and safety of different strategies for corneal stromal augmentation, both with and without corneal crosslinking, and their favorable clinical outcomes, including visual and keratometry improvements. Here, we explore the cutting-edge advancements in stromal lenticule implantation, encompassing different facets of the procedure.
Corneal Stroma , Corneal Transplantation , Humans , Corneal Topography , Corneal Stroma/surgery , Cornea , Visual Acuity , Corneal Transplantation/methods
The remarkable recent advances in managing keratoconus, the most common corneal ectasia, encouraged researchers to conduct further studies on the disease. Despite the abundance of information about keratoconus, debates persist regarding the detection of mild cases. Early detection plays a crucial role in facilitating less invasive treatments. This review encompasses corneal data ranging from the basic sciences to the application of artificial intelligence in keratoconus patients. Diagnostic systems utilize automated decision trees, support vector machines, and various types of neural networks, incorporating input from various corneal imaging equipment. Although the integration of artificial intelligence techniques into corneal imaging devices may take time, their popularity in clinical practice is increasing. Most of the studies reviewed herein demonstrate a high discriminatory power between normal and keratoconus cases, with a relatively lower discriminatory power for subclinical keratoconus.
Age-related changes in the lower eyelid are noticed by patients as bags or circles under the eye, a tired look, and a flattened face. Lower eyelid blepharoplasty, in which the excess skin and/or orbital fat is excised and repositioned, is mainly performed for aesthetic reasons rather than the correction of functional abnormalities. Favorable outcomes for the combination of these approaches have been reported, but the most suitable surgical technique is still debated. This systematic narrative review deals with the indications, preoperative considerations, operative techniques, and complications of several different surgical approaches to lower eyelid blepharoplasty.
Blepharoplasty , Humans , Blepharoplasty/methods , Eyelids/surgery , Skin Transplantation , Orbit , Adipose Tissue/surgery
Purpose: Keratoconus (KC) is the most common primary ectatic corneal disease, characterized by progressive thinning of the cornea, affecting its shape and structure and leading to visual loss. Lysyl oxidase is an important component of the extracellular matrix and contributes to the homeostasis of corneal stromal extracellular matrix via enzymatic reaction. This nationwide registration study aims to examine the association of KC with 2 known single nucleotide polymorphisms, rs2956540 and rs10519694, in a population of Iranian descent. Design: Case-control. Participants: One hundred seventy-eight subjects with KC and 180 clinically healthy subjects participated in the study. Methods: Genomic DNA was extracted from peripheral blood samples, and their genotypes were determined using tetra-primer amplification refractory mutation system-polymerase chain reaction. Main Outcome Measures: Allele frequency for rs2956540 and rs10519694. Results: Genotype frequency was significantly different between cases and controls for rs2956540 (P value = 0.019). The rs2956540 C allele carriers were significantly more frequent among KC cases than healthy controls (P valuechi-square = 0.015, P valueFisher exact = 0.017). There was a significant difference in genotype frequency between groups for rs10519694 (P value = 0.001). T allele carriers were significantly more frequent among KC patients (P valuechi-square = 0.002, P valueFisher exact = 0.001). Sex stratification revealed no significant differences in genotype frequency between males and females in cases and controls. Fitting the general linear model showed that rs10519694 could be considered a predictor for the development of KC (P value = 0.001); however, this was not observed for rs2956540 (P value = 0.323). Conclusions: rs2956540 and rs10519694 are associated with KC in a population of Iranian descent. rs10519694 could potentially be used for KC risk prediction.
BACKGROUND: In this study, we seek to answer the question: Does blepharoplasty for dermatochalasis alter visual performance? OBJECTIVES: We seek to determine the impact of blepharoplasty on visual performance (refraction, contrast sensitivity, and visual field) in patients with dermatochalasis. METHODS: A total of 146 eyelids of 74 patients, 48 (64.9%) females and 26 (35.1%) males ranging from 40 to 68 years old, with dermatochalasis were analyzed prospectively. Refraction, contrast sensitivity, visual acuity, higher-order aberrations (HOAs), and mean deviation index (MDI) in the Humphrey visual field were evaluated and recorded before and at 2, 4, and 6 months after upper eyelid blepharoplasty. RESULTS: At the latest follow-up, uncorrected and corrected distance visual acuity showed no significant differences (P > .05). Patients' contrast sensitivity increased significantly at all spatial frequencies under both conditions (P < .05) except at 12 cycles per degree in the photopic condition (P = .947). Mean astigmatism significantly decreased from -1.17 ± 0.83 to -0.89 ± 0.66 postoperatively (P ≤ .001). Total HOAs decreased significantly from 0.59 ± 0.13 µm to 0.51 ± 0.09 µm (P < .01) after surgery. The root mean square of the spherical aberration (P < .01), vertical trefoil (P = .018), horizontal trefoil (P < .01), horizontal coma (P < .001), and vertical coma (P < .01) decreased significantly. The MDI of the Humphrey visual field increased significantly postoperatively at all times compared with preoperatively (P < .05). The Blepharoplasty Outcomes Evaluation questionnaire showed significant favorable satisfaction with visual quality indexes (P < .001). CONCLUSIONS: Upper lid blepharoplasty, in addition to its aesthetic effect, is an effective intervention to promote visual function and quality of life.
Coma , Quality of Life , Male , Female , Humans , Adult , Middle Aged , Aged , Patient Satisfaction , Prospective Studies , Visual Acuity
Objective: There are inconsistent findings on the association between obesity and age-related cataract (ARC). This systematic review was done to summarize available findings on the association between obesity [defined by body mass index (BMI)] and ARC by performing a dose-response meta-analysis on eligible prospective cohort studies. Methods: We performed a systematic search in PubMed, Scopus, ISI Web of Knowledge, and Google Scholar until June 2022 to identify eligible publications. Results: In total, 16 studies with a total sample size of 1,607,125 participants were included. Among all of these studies, there were 103,897 cases of ARC. In the follow-up periods ranging between 4 and 28 years, 4,870 cases of nuclear cataract, 1,611 cases of cortical cataract, and 1,603 cases of posterior subcapsular cataracts (PSC) were detected. By comparing the highest and lowest categories of BMI, we found that higher BMI was associated with an increased risk of ARC (RR: 1.18, 95% CI: 1.09-1.28) and PSC (RR: 1.44, 95% CI: 1.08-1.90). In the dose-response analysis, each 5 kg/m2 increase in BMI was associated with a 6 and 27% increased risk of ARC (RR: 1.06, 95% CI: 1.01-1.12) and PSC (RR: 1.27, 95% CI: 1.14-1.41), respectively. In addition, we found a positive association for cortical cataract among high-quality studies, in which higher BMI was associated with a 20% increased risk of cortical cataract (RR: 1.20, 95% CI: 1.02-1.42). In terms of nuclear cataract, we found no significant association either in the comparison between the highest and lowest categories of BMI or in the dose-response meta-analysis. Conclusion: Obesity (defined by BMI) was associated with an increased risk of ARC, PSC, and cortical cataract in adults. However, such a positive association was not seen for nuclear cataract. PROSPERO registration: CRD42022357132.
Melasma is a chronic and acquired pigmentary condition that primarily affects women and undermines patient satisfaction and confidence. Melasma mostly affects females, accounting for 90% of all cases. It affects people of all races, particularly those with skin types IV and V who live in areas with lots of UV radiation. According to the studies, Melasma lesions are seen throughout the face in centrofacial, malar, and mandibular patterns. Melasma lesions on the forehead, cheeks, nose, upper lip, and/or chin are the most prevalent centrofacial pattern. Melasma lesions can also be detected along the periorbital area, especially in Asian people. Melasma is notably resistant to treatment, with many patients experiencing only temporary relief and relapses. Combining therapies that target numerous pathologic components, including photodamage, inflammation, aberrant vascularity, and abnormal pigmentation, generally results in the most dramatic therapeutic improvements. Treatments for dark circles include topical depigmenting medicines like hydroquinone, kojic acid, azelaic acid, and topical retinoic acid, and physical treatments such as chemical peels, surgical adjustments, and laser therapy. The objective of therapy should be to figure out what is causing the hyperpigmentation and what is contributing to it. This article provides an overview of melasma therapies and the efficacy of methimazole and cysteamine for melasma therapy.
Hydroquinones , Melanosis , Cysteamine/therapeutic use , Female , Humans , Melanosis/drug therapy , Melanosis/etiology , Methimazole , Treatment Outcome , Tretinoin/therapeutic use
AIM: To compare the visual results of non-topography-guided and topography-guided photorefractive keratectomy (PRK) applying sequential and simultaneous corneal cross-linking (CXL) treatment for keratoconus. METHODS: Interventional and comparative prospective study. Sixty-nine eyes (36 patients) suffering from keratoconus (stages 1 Amsler-Krumeich classification) were divided into four groups: sequential topography-guided photorefractive keratectomy with CXL, simultaneous topography-guided photorefractive keratectomy with CXL, simultaneous non-topography guided photorefractive keratectomy with CXL, and sequential non-topography guided photorefractive keratectomy with CXL. The main outcome measures were pre- and postoperative uncorrected distance visual acuity (UDVA), best corrected distance visual acuity (CDVA), manifest refraction, contrast sensitivity, and keratometry. RESULTS: All analyzed visual, contrast sensitivity, and refractive parameters showed a significant improvement in the four groups (all P<0.05). A noticeable improvement was seen in keratometry in all the groups, and a remarkable difference was observed between topography-guided groups in comparison to non-topography-guided groups (P<0.05). Interestingly, the improvement in all parameters showed a degree of stability to the end of the follow-up. CONCLUSION: The treatment priorities in all four groups are safety, efficacy, and predictability in the correction of the sphero-cylindrical errors in mild and moderate keratoconus. No significant differences among groups in the recorded objective outcomes were found.
Cardiovascular wellbeing has been dramatically affected by severe acute respiratory syndrome coronavirus (SARS-CoV-2), the reason for the coronavirus disease pandemic 2019 (COVID-19) pandemic. There is a greater risk of morbidity and death in individuals with preexisting heart diseases. Clinical syndromes of the acute coronary syndrome, acute myocardial injury, myocarditis, arrhythmias, heart failure, and venous thromboembolism can, directly and indirectly, affect the heart. There may also be adverse heart effects of specific therapeutics under review for COVID-19. The renin-angiotensin-aldosterone system (RAAS) mechanism in virus replication makes it essential to understand the consequences of the system-modulating medications. For optimum patient care, detailed knowledge of specific cardiovascular symptoms of COVID-19 and the role of RAAS in the prognosis of COVID-19 disease is necessary.
COVID-19 , Cardiovascular Diseases , Myocarditis , Humans , Pandemics , Renin-Angiotensin System , SARS-CoV-2
AIM: To compare the clinical outcomes of a variety of multifocal intraocular lenses (MIOLs) in patients diagnosed with presbyopia or cataracts. METHODS: This clinical trial study included 141 patients (282 eyes) with different MIOLs implantation. The Symfony (60 eyes), the ReSTOR (100 eyes), the AT LISAtri (60 eyes), and the PanOptix (62 eyes) intraocular lenses were evaluated in this prospective interventional study. The near, intermediate, and distant visual acuities, contrast sensitivity, and defocus curve were measured as valid criteria. To statistically analyze the results, we used the Statistical Package for Social Science software, the non-parametric Wilcoxon signed-rank t, the one-way analysis of variance and the Tukey's post-hoc test in our analysis. Moreover, we conducted a detailed literature search on the PubMed database in English about MIOLs, in total 59 studies were included in this review article. RESULTS: The four approaches did not show any significant difference in the best-corrected distance visual acuity (P>0.05). The defocus curves at the contrast of 100% showed that trifocal IOLs had better intermediate performance than the bifocal IOL (P<0.05). There were no statistically significant differences between AT LISAtri and PanOptix lenses for visual acuity at all distances. The eyes with PanOptix, Symfony, and AT LISAtri IOL showed better contrast sensitivity than those ReSTOR at spatial frequencies of 1, 3, and 6 cpd in photopic and mesopic conditions (P<0.001). CONCLUSION: All four groups of the multifocal lenses were satisfying in terms of distance and near vision. Also, the group of trifocal lenses led to satisfactory outcomes in intermediate vision, without degradation in quality of vision.
