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1.
Indian J Ophthalmol ; 70(4): 1381-1383, 2022 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-35326059

RESUMO

The emergence of smartphone-based imaging devices has been a boon in the field of ophthalmology, especially in obtaining high-quality ocular images. They can be specialized and utilized for imaging-specific regions of the eye. Among the multitude of applications of smartphone-based imaging, one of the upcoming major use is to image the microbiological world. Previous few reports have described attaching magnifying lenses of various types to the smartphone camera and transforming it into a microscope for imaging fungal hyphae and ocular surface parasites. We describe a novel technique of attaching the smartphone-based intraocular lens microscope (IOLSCOPE) to the slit lamp, thereby utilizing the slit lamp joystick for moving the smartphone over the concerned slide specimen to make it steady and obtain images of high resolution. This innovative do-it-yourself novel modification is especially useful in peripheral centers, vision centers, and local clinics for immediate screening and identification of microbial pathogens such as fungi and ocular surface parasites.


Assuntos
Lentes Intraoculares , Lâmpada de Fenda , Humanos , Microscopia , Microscopia com Lâmpada de Fenda , Smartphone
2.
Cornea ; 41(4): 450-455, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35244625

RESUMO

PURPOSE: The purpose of this study was to investigate 3-year changes in keratoconus (KC) indices to determine the indicators of KC progression compared with age-related changes in children aged 6 to 12 years. METHODS: In this report of the Shahroud Schoolchildren Eye Cohort Study, KC was diagnosed based on vision, refraction, tomography, and slitlamp examination findings. KC progression was defined as changes in refractive astigmatism or zonal maximum keratometry (Zonal Kmax-3 mm). Then, 3-year changes (Δ) in vision, refraction, and tomographic indices were compared between progressive KC and normal eyes. The best set of ∆parameters for distinguishing KC progression from age-related changes were determined using the area under curve (AUC). RESULTS: Eighteen KC eyes and 10,422 normal eyes were analyzed. All KC cases showed progression after 3 years. Δindices were statistically different between the 2 groups except corrected distance visual acuity, anterior radius of curvature, irregularity index, and KC percentage index. The best Δindices, in descending order of AUC value, were index of height decentration, Zonal Kmax-3 mm, refractive astigmatism, single point Kmax, and index of vertical asymmetry (all AUC > 0.9), followed by inferior-superior asymmetry, index of surface variance, minimum corneal thickness, index of height asymmetry, KC index, posterior radius of curvature, and Belin/Ambrósio total Deviation (AUC = 0.8-0.9). CONCLUSIONS: According to our findings, changes in index of height decentration, Zonal Kmax-3 mm, refractive astigmatism, single point Kmax, and index of vertical asymmetry are the best indices for detecting KC progression in children younger than 12 years.


Assuntos
Ceratocone/diagnóstico , Envelhecimento/fisiologia , Fenômenos Biomecânicos , Criança , Córnea/fisiopatologia , Paquimetria Corneana , Topografia da Córnea , Progressão da Doença , Feminino , Humanos , Ceratocone/epidemiologia , Ceratocone/fisiopatologia , Masculino , Prevalência , Curva ROC , Refração Ocular/fisiologia , Microscopia com Lâmpada de Fenda , Acuidade Visual/fisiologia
3.
Eye Contact Lens ; 48(7): 306-307, 2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-35333809

RESUMO

ABSTRACT: Demodex is an important pathogen causing eyelid and eyelash diseases. This article describes a quick, efficient, cost-effective office-based imaging of demodex with the help of an intraocular lens (IOL) and smartphone-aided innovated tool. Eyelid photography of a 56-year-old man with suspected demodex infestation was obtained using a 20-diopter (D) IOL over the smartphone camera called as Anterior Segment Photography using IOL (ASPI). A video or photograph of the epilated eyelash was taken using four 30-D IOLs attached to the smartphone camera to form an optical system called IOLSCOPE, which clearly detected the demodex parasite. The importance of ASPI and IOLSCOPE for the rapid office-based diagnosis of demodex pathogen in peripheral health centers devoid of slitlamp and microscopes has been emphasized here.


Assuntos
Pestanas , Lentes Intraoculares , Pestanas/parasitologia , Humanos , Masculino , Pessoa de Meia-Idade , Fotografação , Microscopia com Lâmpada de Fenda , Smartphone
4.
Invest Ophthalmol Vis Sci ; 63(2): 23, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-35147659

RESUMO

Purpose: The purpose of this study was to investigate whether the lamina cribrosa (LC) curve changes in response to intraocular pressure (IOP) reduction following administration of topical ocular hypotensive eye drops in eyes with normal tension glaucoma (NTG). Methods: Ninety-three eyes of 93 patients with treatment naïve NTG at initial examination and with ≥20% reduction from baseline IOP following administration of topical ocular hypotensive eye drops were included. Serial horizontal B-scan images of the optic nerve head (ONH) were obtained from each eye using enhanced depth imaging spectral domain optical coherence tomography (OCT) before and 1 year after IOP-lowering treatment. The LC curvature in each eye was assessed by measuring the LC curvature index (LCCI) in horizontal OCT B-scan images obtained at three (superior, central, and inferior) locations spaced equidistantly across the vertical optic disc diameter before and after IOP-lowering treatment. We evaluated the OCT detectible change in the LC curvature based on the interval change of LCCI to exceed the intersession standard deviation of 1.96 times and factors associated with the magnitude of the LCCI change in the eyes showing significant LC change. Results: IOP decreased from 15.7 ± 2.5 mm Hg at baseline to 11.2 ± 1.7 mm Hg after topical glaucoma medication. Among the 93 subjects, 62 (66.7%) eyes showed the significant reduction of the LCCI (interssetional change over 1.5) after the treatment; greater interssessional change of the LCCI after IOP reduction was associated with younger age (P = 0.020) and larger baseline LCCI (P < 0.001). Conclusions: The OCT detectible changes in LC curvature occurred in response to a modest decrease in the IOP in the naïve NTG eyes. The therapeutic benefit of these changes need to be assessed in longitudinal studies.


Assuntos
Pressão Intraocular/fisiologia , Glaucoma de Baixa Tensão/fisiopatologia , Hipotensão Ocular/fisiopatologia , Disco Óptico/patologia , Administração Oftálmica , Idoso , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/fisiologia , Feminino , Gonioscopia , Humanos , Glaucoma de Baixa Tensão/tratamento farmacológico , Masculino , Pessoa de Meia-Idade , Soluções Oftálmicas , Disco Óptico/diagnóstico por imagem , Estudos Prospectivos , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica , Tonometria Ocular , Acuidade Visual/fisiologia , Testes de Campo Visual , Campos Visuais/fisiologia
5.
Sci Rep ; 12(1): 1961, 2022 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-35121766

RESUMO

Glaucoma causes irreversible neuropathy, which, untreated, may lead to blindness. In this case-control study, we measured two-photon infrared (IR) light sensitivity in glaucomatous eyes to propose a new method to quantify the visual loss. In total, 64 patients were recruited with an equal distribution between glaucoma and control groups. Retinal sensitivity to IR light was assessed using a two-photon excitation device. A fundus-driven microperimeter was used to measure retinal sensitivity to visible light. The retinal nerve fiber layer (RNFL) thickness was quantified automatically with optical coherence tomography. The IR sensitivity of glaucoma and control eyes differed significantly (P = .003): 9.8 (6.5 to 13.1) dB vs. 10.9 (8.2 to 13.0) dB. Although in the visible-light microperimetry, retinal sensitivity was decreased in glaucoma (17.0, range: 6.9 to 20.0 dB) compared to the controls (17.7, range: 11.6 to 20.0 dB), this difference did not reach the significance level. A significant thinning of the RNFL in the glaucoma group was observed (P < .001). IR sensitivity significantly correlated with the RNFL in three of the four assessed quadrants instead of only one in visible-light microperimetry. Although further research is needed, this proof-of-concept study suggests that IR-light sensitivity can be used to support the detection of glaucomatous neuropathy.


Assuntos
Glaucoma de Ângulo Aberto/diagnóstico , Luz , Nervo Óptico/diagnóstico por imagem , Fotofobia/diagnóstico , Retina/fisiopatologia , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica , Testes de Campo Visual , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Glaucoma de Ângulo Aberto/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Nervo Óptico/fisiopatologia , Estimulação Luminosa , Fotofobia/fisiopatologia , Valor Preditivo dos Testes , Estudo de Prova de Conceito , Campos Visuais
6.
Invest Ophthalmol Vis Sci ; 63(1): 1, 2022 01 03.
Artigo em Inglês | MEDLINE | ID: mdl-34978560

RESUMO

Purpose: The purpose of this study was to investigate trabecular meshwork (TM) and Schlemm's canal (SC) morphology in Posner-Schlossman syndrome (PSS). Methods: Forty-five patients with PSS were recruited. TM thickness and length as well as SC area and diameter of both affected and fellow eyes were assessed using swept-source optical coherence tomography. Results: TM thickness (108.24 ± 28.29 µm vs. 89.36 ± 25.82 µm, P = 0.014), SC area (6010.90 ± 1287.54 µm2 vs. 5445.69 ± 1368.89 µm2, P = 0.003), and SC diameter (239.38 ± 60.17 µm vs. 217.76 ± 60.79 µm, P = 0.010) were significantly greater in the affected eyes. Furthermore, TM thickness (113.32 ± 30.03 µm vs. 89.00 ± 26.99 µm, P = 0.046), SC area (6216.32 ± 1267.87 µm2 vs. 5476.40 ± 1390.15 µm2, P = 0.001), and SC diameter (246.82 ± 64.12 vs. 212.53 ± 64.29 µm, P = 0.001) were significantly greater in the affected eyes than in the fellow eyes in the ocular hypertension (OHT) subgroup (affected eye with intraocular pressure [IOP] > 21 mm Hg). However, those differences were not noted in the ocular normal tension (ONT) subgroup (affected eye with IOP ≤ 21 mm Hg, all P > 0.05). Conclusions: TM edema might play a role in the IOP elevation in PSS. The edematous TM could make controlling IOP of the affected eyes difficult. When TM edema is relieved, IOP of the affected eyes can reduce to normal spontaneously or with IOP-lowing medications.


Assuntos
Limbo da Córnea/patologia , Malha Trabecular/patologia , Uveíte Anterior/patologia , Adulto , Estudos Transversais , Feminino , Glaucoma de Ângulo Aberto/patologia , Gonioscopia , Humanos , Pressão Intraocular , Masculino , Pessoa de Meia-Idade , Hipertensão Ocular/patologia , Tamanho do Órgão , Microscopia com Lâmpada de Fenda , Síndrome , Tomografia de Coerência Óptica , Adulto Jovem
8.
Exp Eye Res ; 216: 108933, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35031282

RESUMO

A characteristic rigid spatial arrangement of collagen fibrils in the stroma is critical for corneal transparency. This unique organization of collagen fibrils in corneal stroma can be impacted by the presence and interactions of proteoglycans and extracellular matrix (ECM) proteins in a corneal microenvironment. Earlier studies revealed that decorin, a leucine-rich proteoglycan in stroma, regulates keratocyte-collagen matrix assembly and wound healing in the cornea. This study investigated the role of decorin in the regulation of stromal fibrillogenesis and corneal transparency in vivo employing a loss-of-function genetic approach using decorin null (dcn-/-) and wild type (dcn+/+) mice and a standard alkali-injury model. A time-dependent ocular examinations with Slit lamp microscope in live animals assessed corneal clarity, haze, and neovascularization levels in normal and injured eyes. Morphometric changes in normal and injured dcn+/+ and dcn-/- corneas, post-euthanasia, were analyzed with Masson's Trichrome and Periodic Acid-Schiff (PAS) histology evaluations. The ultrastructure changes in all corneas were investigated with transmission electron microscopy (TEM). Injury to eye produced clinically relevant corneal haze and neovascularization in dcn-/- and dcn+/+ mice while corneas of uninjured eyes remained clear and avascular. A clinically significant haze and neovascularization appeared in injured dcn-/- corneas compared to the dcn+/+ corneas at day 21 post-injury and not at early tested times. Histological examinations revealed noticeably abnormal morphology and compromised collagen levels in injured dcn-/- corneas compared to the injured/normal dcn+/+ and uninjured dcn-/- corneas. TEM analysis exhibited remarkably uneven collagen fibrils size and distribution in the stroma with asymmetrical organization and loose packing in injured dcn-/- corneas than injured/normal dcn+/+ and uninjured dcn-/- corneas. The minimum and maximum inter-fibril distances were markedly irregular in injured dcn-/- corneas compared to all other corneas. Together, results of clinical, histological, and ultrastructural investigations in a genetic knockout model suggested that decorin influenced stromal fibrillogenesis and transparency in healing cornea.


Assuntos
Lesões da Córnea/metabolismo , Decorina/fisiologia , Colágenos Fibrilares/metabolismo , Organogênese/fisiologia , Cicatrização/fisiologia , Animais , Queimaduras Químicas/metabolismo , Lesões da Córnea/patologia , Proteínas da Matriz Extracelular/metabolismo , Queimaduras Oculares/induzido quimicamente , Colágenos Fibrilares/ultraestrutura , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Camundongos Transgênicos , Microscopia Eletrônica de Transmissão , Microscopia com Lâmpada de Fenda , Hidróxido de Sódio
9.
Exp Eye Res ; 216: 108940, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35074340

RESUMO

The purpose of this study was to examine the effect of topical and/or oral angiotensin converting enzyme II inhibitor and TGF-beta signaling blocker losartan on corneal stromal fibrosis that developed in rabbit corneas after Descemetorhexis removal of central Descemet's membrane and corneal endothelium. Twenty-eight New Zealand white rabbits were included and either had 8 mm central Descemetorhexis or sham control surgery without Descemetorhexis in one eye. Groups of 4 eyes without Descemetorhexis were treated for one month with no medications, topical losartan or oral losartan. Groups of 4 eyes with Descemetorhexis were treated with topical and oral vehicle, topical losartan, oral losartan, or both topical losartan and oral losartan for one month. Standardized slit lamp photos were obtained with central opacity intensity measured with ImageJ. The posterior fibrotic zone of corneas was measured on immunohistochemistry for alpha-smooth muscle actin (SMA) and keratocan using QuPath analysis. Collagen type IV expression in the posterior cornea was quantitated with ImageJ and duplex immunohistochemistry for collagen type IV and TGF beta-1. After Descemetorhexis, topical, but not oral, losartan decreased the intensity of central stromal opacity, reduced peripheral corneal scarring, and decreased alpha-smooth muscle actin myofibroblast fibrosis area compared to corneas that had Descemetorhexis and treatment with vehicles alone. Topical losartan decreased posterior stromal cellular, non-Descemet's membrane, collagen type IV production, that is likely stimulated by TGF beta as part of a negative regulatory feedback mechanism, compared to vehicle treatment at one month after Descemetorhexis. Topical losartan is likely to be effective in reducing corneal scarring fibrosis produced by traumatic injury, microbial infection, and some corneal diseases and surgeries.


Assuntos
Bloqueadores do Receptor Tipo 1 de Angiotensina II/administração & dosagem , Cicatriz/tratamento farmacológico , Colágeno Tipo IV/metabolismo , Doenças da Córnea/tratamento farmacológico , Substância Própria/patologia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior , Losartan/administração & dosagem , Actinas/metabolismo , Administração Oftálmica , Animais , Cicatriz/metabolismo , Doenças da Córnea/metabolismo , Substância Própria/metabolismo , Feminino , Fibrose/prevenção & controle , Imuno-Histoquímica , Soluções Oftálmicas , Proteoglicanas/metabolismo , Coelhos , Microscopia com Lâmpada de Fenda
10.
Optom Vis Sci ; 99(4): 389-393, 2022 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-35001064

RESUMO

SIGNIFICANCE: Severe acute respiratory syndrome coronavirus 2 has indirectly created challenges to the ophthalmic retinal examinations because of lens fogging related to patients wearing masks. To date, there are no objective data on the degree of diagnostic ophthalmic lens fogging associated with mask wearing or on the effectiveness of proposed solutions to ophthalmologic lens fogging. PURPOSE: The purposes of this study were to investigate the degree of ophthalmologic lens fogging in patients wearing masks and to assess the efficacy lens warming in reducing lens fogging and facilitating ophthalmologic retinal examinations. METHODS: This study quantified the degree of lens fogging in mask-wearing subjects using ImageJ to measure lens surface area fogged in slit-lamp photographs of 90 D lenses before and after the use of a lens warmer. We investigated the clinical relevance of diagnostic lens fogging via a survey study of eye care providers. Subjects rated on a Likert scale their experience with diagnostic lens fogging during retinal examination in mask-wearing patients with and without the use of a lens warming device. RESULTS: For mask-wearing subjects, the percentage of fogged lens area in a 90 D lens averaged 32.5% using an unheated lens and 1.1% using a heated lens. Survey responders noted significantly less fogging of the 78 and 90 D lenses on retinal examination when using the lens warmer (P < .001) and found that using the lens warmer facilitated their retinal examination (P < .001). CONCLUSIONS: This study shows that there is significant fogging of ophthalmic slit-lamp lenses associated with patients wearing masks and that using a lens warmer significantly reduces fogging and facilitates retinal examinations. Eye care providers would benefit from the use of a lens warmer to reduce diagnostic lens fogging during retinal examination.


Assuntos
COVID-19 , Cristalino , Lentes , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Microscopia com Lâmpada de Fenda , Testes Visuais
11.
Exp Eye Res ; 214: 108862, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34826417

RESUMO

Macular corneal dystrophy (MCD) is a rare form of hereditary corneal dystrophy caused by CHST6 mutations. Owing to the genetic heterogeneity and population differences among patients with MCD, the genetic cause of MCD has not been fully elucidated, and the pathogenesis underlying the genetic mutation is still unclear. In this study, Chinese families and sporadic patients were included as subjects, and clinical and genetic analyses were performed to detect novel CHST6 mutations. In addition, the underlying pathogenic mechanisms of MCD were investigated by in vitro cell experiments. Two consanguineously married families and 10 sporadic patients with MCD were enrolled. Direct sequencing of the CHST6 gene was performed in all the patients to identify novel mutations. Wild-type and mutant overexpression cell lines were constructed to study the effects of the mutation in vitro. The expressions of endoplasmic reticulum (ER) stress markers and apoptotic factors, cell senescence, and migration levels tests were performed in different overexpression cell lines. As a result, four novel mutations (R155Afs*66, S84Cfs*17, E71G, and E71Q) and 10 previously reported mutations in the CHST6 gene were identified. Among the reported mutations, the most frequent mutations detected in the patients were L21Rfs*88 (4/14) and L21H (4/14). All the novel mutations were absent in the 50 healthy controls and were predicted to alter highly conserved amino acids across the different species and considered to be "disease causing" by function prediction. The results of the in vitro cell experiment further demonstrated that the novel homozygous frameshift mutations (S84Cfs*17 and R155Afs*66) of CHST6 detected in the consanguineously married families could lead to truncated proteins with defect functions, higher ER stress and apoptotic levels, decreased cell migration, and excessive cell senescence in corneal stromal cells, thereby affecting the normal functions of corneal stromal cells. These changes might play important roles in corneal opacity, which is characteristic of corneas with MCD. Our study extended the existing spectrum of disease-causing mutations and further elucidated the underlying pathogenic mechanisms of MCD.


Assuntos
Apoptose/genética , Senescência Celular/genética , Distrofias Hereditárias da Córnea/genética , Mutação da Fase de Leitura/genética , Sulfotransferases/genética , Adulto , China/epidemiologia , Consanguinidade , Distrofias Hereditárias da Córnea/diagnóstico por imagem , Ceratócitos da Córnea/metabolismo , Análise Mutacional de DNA , Estresse do Retículo Endoplasmático/genética , Feminino , Humanos , Masculino , Linhagem , Reação em Cadeia da Polimerase , Microscopia com Lâmpada de Fenda , Tomografia de Coerência Óptica
12.
Cornea ; 41(3): 353-358, 2022 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-34839329

RESUMO

PURPOSE: The aim of this study was to describe a new type of medical device that allows for internet-enabled patient self-screening, without the aid of an ophthalmic professional, through biomicroscopy self-imaging and self-measurement of the best-corrected visual acuity (BCVA). METHODS: In this prospective nonrandomized comparative study, 56 patients were instructed to screen their own eyes using a custom-built e-Device containing miniaturized slitlamp optics and a visual acuity Snellen chart virtually projected at 20 ft. BCVA measurements were recorded, and biomicroscopic videos were scored for image quality of the anterior segment status on a scale from 1 to 5 (1 = poor and 5 = excellent) by a blinded observer. RESULTS: After a short instruction, all patients were able to self-image their eyes and perform a self-BCVA measurement using the e-Device. Patient self-image quality with the e-Device scored on average 3.3 (±0.8) for videos (n = 76) and 3.6 (±0.6) for photographs (n = 49). Self-BCVA measurement was within 1 Snellen line from routine BCVA levels in 66 of 72 eyes (92%). When compared with conventional biomicroscopy, patient self-biomicroscopy allowed for recognition of the relevant pathology (or absence thereof) in 26 of 35 eyes (74%); 9 cases showed insufficient image quality attributed to device operating error (n = 6) and mild corneal edema and/or scarring (n = 3). Patient satisfaction with the device was 4.4 (±0.9). CONCLUSIONS: An e-Device for combined BCVA self-measurement and biomicroscopy self-imaging may have potential as an aid in remote ophthalmic examination in the absence of an ophthalmic professional and may be considered for patients who are unable to visit an ophthalmic clinic for routine follow-up.


Assuntos
COVID-19/prevenção & controle , Quarentena , SARS-CoV-2 , Autoexame/métodos , Telemedicina/métodos , Seleção Visual/instrumentação , Acuidade Visual/fisiologia , Adulto , Idoso , COVID-19/epidemiologia , Controle de Doenças Transmissíveis/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Microscopia com Lâmpada de Fenda
13.
Cornea ; 41(2): 252-253, 2022 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-34743101

RESUMO

PURPOSE: The purpose of this study was to report a case of acute corneal epithelial rejection of living-related conjunctival limbal allograft (LR-CLAL) after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination. OBSERVATIONS: A 27-year-old woman developed acute epithelial rejection of LR-CLAL 2 weeks after receiving the SARS-CoV-2 vaccine. She received the LR-CLAL transplant 4 years and 7 months previously and had a stable clinical course with no history of rejection. She had an ABO blood group and human leukocyte antigen compatible donor, no systemic comorbidities, and no rejection risk factors. CONCLUSIONS: The novel SARS-CoV-2 vaccine upregulates the immune system to produce an adaptive immune response. The SARS-CoV-2 vaccine may potentially be associated with increased risk of rejection in those with ocular surface transplants.


Assuntos
/efeitos adversos , Epitélio Corneano/patologia , Rejeição de Enxerto/etiologia , Limbo da Córnea/citologia , Doadores Vivos , Transplante de Células-Tronco , Vacinação/efeitos adversos , Doença Aguda , Administração Oftálmica , Administração Oral , Adulto , Aloenxertos , COVID-19/prevenção & controle , Túnica Conjuntiva/citologia , Feminino , Glucocorticoides/uso terapêutico , Rejeição de Enxerto/diagnóstico , Rejeição de Enxerto/tratamento farmacológico , Humanos , Imunossupressores/uso terapêutico , Ácido Micofenólico/uso terapêutico , Soluções Oftálmicas , Microscopia com Lâmpada de Fenda , Tacrolimo/uso terapêutico , Acuidade Visual/fisiologia
14.
Exp Eye Res ; 214: 108880, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34871566

RESUMO

Pseudoexfoliation syndrome (PEX) represents an age-related systemic disease that is characterized by the accumulation of extracellular matrix material in ocular tissues and visceral organs. Abnormal matrix remodeling is thought to be one of the important factors in the etiopathogenesis of the disease. Prolidase represents an enzyme, which takes a significant part in collagen biosynthesis and remodeling of the extracellular matrix. The purpose of the current research was to assess the prolidase enzyme activity in the aqueous and serum samples of subjects with PEX. The study population consisted of 66 subjects, involving 33 subjects with age-related cataract among patients with PEX and 33 subjects with age-related cataract without PEX. The prolidase activity measurement was performed using the modified Chinard's method. Significantly increased aqueous prolidase activity was detected in the group with PEX (p < 0.01). Despite about a three times higher increase in the serum prolidase activity of the group with PEX in comparison with the control group, the two groups did not differ statistically significantly (p > 0.05). The high prolidase enzyme activity in the aqueous samples of subjects with PEX suggests that the collagen cycle and the remodeling of the extracellular matrix are accelerated. These results can be a guide for understanding the formation mechanisms of PEX.


Assuntos
Humor Aquoso/enzimologia , Catarata/sangue , Dipeptidases/sangue , Síndrome de Exfoliação/sangue , Idoso , Feminino , Humanos , Pressão Intraocular/fisiologia , Masculino , Pessoa de Meia-Idade , Microscopia com Lâmpada de Fenda , Espectrofotometria , Acuidade Visual/fisiologia
15.
Ophthalmology ; 129(2): 139-146, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34352302

RESUMO

PURPOSE: To develop and evaluate an automated, portable algorithm to differentiate active corneal ulcers from healed scars using only external photographs. DESIGN: A convolutional neural network was trained and tested using photographs of corneal ulcers and scars. PARTICIPANTS: De-identified photographs of corneal ulcers were obtained from the Steroids for Corneal Ulcers Trial (SCUT), Mycotic Ulcer Treatment Trial (MUTT), and Byers Eye Institute at Stanford University. METHODS: Photographs of corneal ulcers (n = 1313) and scars (n = 1132) from the SCUT and MUTT were used to train a convolutional neural network (CNN). The CNN was tested on 2 different patient populations from eye clinics in India (n = 200) and the Byers Eye Institute at Stanford University (n = 101). Accuracy was evaluated against gold standard clinical classifications. Feature importances for the trained model were visualized using gradient-weighted class activation mapping. MAIN OUTCOME MEASURES: Accuracy of the CNN was assessed via F1 score. The area under the receiver operating characteristic (ROC) curve (AUC) was used to measure the precision-recall trade-off. RESULTS: The CNN correctly classified 115 of 123 active ulcers and 65 of 77 scars in patients with corneal ulcer from India (F1 score, 92.0% [95% confidence interval (CI), 88.2%-95.8%]; sensitivity, 93.5% [95% CI, 89.1%-97.9%]; specificity, 84.42% [95% CI, 79.42%-89.42%]; ROC: AUC, 0.9731). The CNN correctly classified 43 of 55 active ulcers and 42 of 46 scars in patients with corneal ulcers from Northern California (F1 score, 84.3% [95% CI, 77.2%-91.4%]; sensitivity, 78.2% [95% CI, 67.3%-89.1%]; specificity, 91.3% [95% CI, 85.8%-96.8%]; ROC: AUC, 0.9474). The CNN visualizations correlated with clinically relevant features such as corneal infiltrate, hypopyon, and conjunctival injection. CONCLUSIONS: The CNN classified corneal ulcers and scars with high accuracy and generalized to patient populations outside of its training data. The CNN focused on clinically relevant features when it made a diagnosis. The CNN demonstrated potential as an inexpensive diagnostic approach that may aid triage in communities with limited access to eye care.


Assuntos
Cicatriz/diagnóstico por imagem , Úlcera da Córnea/diagnóstico por imagem , Aprendizado Profundo , Infecções Oculares Bacterianas/diagnóstico por imagem , Infecções Oculares Fúngicas/diagnóstico por imagem , Fotografação , Cicatrização/fisiologia , Algoritmos , Área Sob a Curva , Cicatriz/fisiopatologia , Úlcera da Córnea/classificação , Úlcera da Córnea/microbiologia , Infecções Oculares Bacterianas/classificação , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Fúngicas/classificação , Infecções Oculares Fúngicas/microbiologia , Reações Falso-Positivas , Humanos , Valor Preditivo dos Testes , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade , Microscopia com Lâmpada de Fenda
16.
Cornea ; 41(4): 499-501, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-34074890

RESUMO

PURPOSE: The purpose of this study was to evaluate the corneal toxicity of intravitreal methotrexate used for the prevention of proliferative vitreoretinopathy (PVR). METHODS: In this retrospective case series, eyes with recurrent retinal detachment secondary to PVR were treated with intravitreal injections of 400 µg methotrexate at an average frequency of every 7 days after vitrectomy with silicone oil tamponade. Corneas were examined for corneal epitheliopathy by slit-lamp biomicroscopy before each injection. RESULTS: Thirteen eyes of 12 patients were reviewed. All had a history of recurrent retinal detachment secondary to PVR treated with vitrectomy and silicone oil. The median age was 35 years (range: 9-83). Four patients (33%) were female. The median follow-up duration was 8 weeks (range: 5-10). The median BCVA (logMAR notation) was 2.00 preoperatively, 2.00 at 1 month postoperatively, and 2.00 at the most recent follow-up (P = 0.969). Ten eyes (77%) were pseudophakic. Nine eyes (69%) had a preexisting ocular comorbidity. The median number of injections was 8 (range: 5-10). The median interval time between each injection was 7.0 days (range: 5.8-10.5), and the median follow-up period beyond last injection was 16 weeks (range: 8-28). Two eyes (15.4%) developed mild corneal epitheliopathy during the course of the treatment. CONCLUSIONS: Most eyes in this small series tolerated methotrexate injections without corneal toxicity. In eyes that developed epitheliopathy, the findings were mild and not treatment-limiting.


Assuntos
Doenças da Córnea/induzido quimicamente , Tamponamento Interno , Epitélio Corneano/efeitos dos fármacos , Imunossupressores/toxicidade , Metotrexato/toxicidade , Óleos de Silicone/administração & dosagem , Vitreorretinopatia Proliferativa/tratamento farmacológico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Doenças da Córnea/diagnóstico , Epitélio Corneano/patologia , Feminino , Humanos , Injeções Intravítreas , Masculino , Pessoa de Meia-Idade , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Microscopia com Lâmpada de Fenda , Acuidade Visual , Vitrectomia
17.
Eur J Ophthalmol ; 32(1): 165-169, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33283534

RESUMO

PURPOSE: The aim of the present study was to evaluate the topographic status of the welders' corneas. METHODS: In this historical cohort, a group of welders (with at least 5 years' experience in welding) and a control group were assessed and compared. Lack of exposure to welding for 3 months or more was considered an exclusion criterion. In all participants, after taking a complete history of visual and ocular problems, both eyes underwent Pentacam imaging. Then, all subjects received slit lamp biomicroscopy for evaluation of ocular surface diseases. RESULTS: The data of 140 welders (mean age: 46.66 ± 13.01 years) and 172 controls (mean age: 45.05 ± 12.61 years) were analyzed. The welders' corneas had significantly higher eccentricity (p < 0.0001), keratometry readings (p < 0.0001), and cylinder power (p < 0.0001). The central, inferior, and nasal cornea were significantly thinner in the welders than in controls (p < 0.0001) while the difference was not significant in the superior and temporal cornea. All indices of corneal irregularity except for the central keratoconus index (CKI) and index of height asymmetry (IHA) were higher in welders compared to the control group (p < 0.0001). CONCLUSION: According to the results of this study, the welders' corneas are topographically irregular. Welders exhibit characteristics like steeper keratometry readings; higher eccentricity indexes; thinner central, inferior, and nasal corneas; and higher indices of corneal irregularity, especially the CK index. Long-term ultraviolet exposure may be a possible reason for these corneal changes.


Assuntos
Ceratocone , Ferreiros , Adulto , Córnea/diagnóstico por imagem , Topografia da Córnea , Humanos , Ceratocone/diagnóstico , Pessoa de Meia-Idade , Microscopia com Lâmpada de Fenda
18.
Acta Ophthalmol ; 100(1): e204-e212, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33829654

RESUMO

PURPOSE: To determine the association between plasma free fatty acid (FFA) levels and primary angle-closure glaucoma (PACG). METHODS: Free fatty acid (FFA) levels in patients with PACG (n = 181) and people without glaucoma (n = 340) were compared. Twenty-two FFAs and six lipid classes were measured using metabolomics analysis. Odds ratio (OR) of these metabolites and their 95% confidence intervals (95%CI) for PACG were obtained by logistic regression. Stepwise forward selection was performed to identify FFAs that influenced PACG risk. Areas under the curve (AUC) were applied to assess the predictive performance. Spearman's rank correlation was used to assess the relationship between ocular parameters and FFAs. RESULTS: Most FFAs in the PACG group were lower than those in the non-glaucoma group. Docosahexaenoic acid (DHA; OR for fourth quartile (Q4) vs. first quartile (Q1): 0.32 (0.16-0.66); per standard deviation (SD) increase: 0.64 (0.49-0.83); p for trend: 0.0007) and total saturated fatty acids (SFAs; OR for Q4 versus Q1: 0.27 (0.13-0.56); per SD increase: 0.65 (0.50-0.87); p for trend: 0.0004) were associated with decreased PACG risk. The AUC of the model that included DHA, total SFAs, demographic and ophthalmic factors increased from 0.8230 (0.7811-0.8649) to 0.8512 (0.8133-0.8891) (increased AUC: 0.0282 (0.0112-0.0453); p for increased AUC: 0.0012). Additionally, the cup-disc ratio had a weak negative correlation with DHA and total SFAs (DHA: r = -0.12085, p = 0.0065; total SFAs: r = -0.13318, p = 0.0024). CONCLUSIONS: Decrease in FFA levels may be related to lipid peroxidation. Docosahexaenoic acid (DHA) and total SFAs may be screening indices for PACG patients.


Assuntos
Ácidos Graxos não Esterificados/sangue , Glaucoma de Ângulo Fechado/sangue , Pressão Intraocular/fisiologia , Espectrometria de Massas/métodos , Metabolômica/métodos , Campos Visuais/fisiologia , Idoso , Biomarcadores/sangue , Feminino , Seguimentos , Glaucoma de Ângulo Fechado/diagnóstico , Glaucoma de Ângulo Fechado/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Microscopia com Lâmpada de Fenda/métodos
19.
Cornea ; 41(4): 505-511, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-34620764

RESUMO

PURPOSE: The purpose of this study was to evaluate the safety, efficacy, and efficiency of a Descemet membrane endothelial keratoplasty (DMEK) graft preparation device, DescePrep, through measurement of graft viability, yield, and preparation time in both healthy and diabetic (high-risk) donor eyes. METHODS: Twenty nondiabetic and 10 diabetic donor corneas were processed using DescePrep, which standardizes the liquid bubble technique. Corneas were stained with trypan blue and then processed. Cell counts through specular microscopy, optical coherence tomography imaging, and slit-lamp analysis were used for the evaluation of graft separation and viability in 5 nondiabetic corneas. The remaining 25 corneas (15 nondiabetic and 10 diabetic) were evaluated for preparation success rate and processing time. Ten corneas (5 nondiabetic and 5 diabetic) were randomly selected for further evaluation of global cell loss through staining. RESULTS: Ninety-seven percent of corneas (29 of 30) were prepared successfully with DescePrep. The average preparation time was 2.83 ± 1.8 minutes. There was no significant difference in the time of preparation between the nondiabetic and diabetic groups (P = 0.077). The overall average cell death after processing was 7.9% ± 3.7% for all corneas. There was no significant difference in cell viability between diabetic and nondiabetic tissues after DescePrep processing (P = 0.769). CONCLUSIONS: DescePrep is a new DMEK preparation technique that can process both nondiabetic and diabetic donor corneas at high yields in minutes. High-yield preparation of diabetic corneas may offer eye banks access to a larger donor pool, which is important because the demand for DMEK grafts continues to rise worldwide.


Assuntos
Doenças da Córnea/cirurgia , Ceratoplastia Endotelial com Remoção da Lâmina Limitante Posterior/instrumentação , Complicações do Diabetes/cirurgia , Eficiência , Coleta de Tecidos e Órgãos/métodos , Idoso , Contagem de Células , Sobrevivência Celular/fisiologia , Bancos de Olhos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Microscopia com Lâmpada de Fenda , Fatores de Tempo , Doadores de Tecidos , Resultado do Tratamento
20.
Ophthalmology ; 129(3): 285-294, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-34592243

RESUMO

PURPOSE: We hypothesized that the effect of blood lipid-related metabolites on primary open-angle glaucoma (POAG) would differ according to specific lipoprotein particles and lipid sub-fractions. We investigated the associations of blood levels of lipoprotein particles and lipid sub-fractions with POAG. DESIGN: Cross-sectional study. PARTICIPANTS: Individuals recruited for the baseline visit of the population-based Singapore Epidemiology of Eye Disease study (n = 8503). METHODS: All participants underwent detailed standardized ocular and systemic examinations. A total of 130 blood lipid-related metabolites were quantified using a nuclear magnetic resonance metabolomics platform. The analyses were conducted in 2 stages. First, we investigated whether and which lipid-related metabolites were directly associated with POAG using regression analyses followed by Bayesian network modeling. Second, we investigated if any causal relationship exists between the identified lipid-related metabolites, if any, and POAG using 2-sample Mendelian randomization (MR) analysis. We performed genome-wide association studies (GWAS) on high-density lipoprotein (HDL) 3 cholesterol (after inverse normal transformation) and used the top variants associated with HLD3 cholesterol as instrumental variables (IVs) in the MR analysis. MAIN OUTCOME MEASURE: Primary open-angle glaucoma. RESULTS: Of the participants, 175 (2.1%) had POAG. First, a logistic regression model showed that total HDL3 cholesterol (negatively) and phospholipids in very large HDL (positively) were associated with POAG. Further analyses using a Bayesian network analysis showed that only total HDL3 cholesterol was directly associated with POAG (odds ratio [OR], 0.72 per 1 standard deviation increase in HDL3 cholesterol; 95% confidence interval [CI], 0.61-0.84), independently of age, gender, intraocular pressure (IOP), body mass index (BMI), education level, systolic blood pressure, axial length, and statin medication. Using 5 IVs identified from the GWAS and with the inverse variance weighted MR method, we found that higher levels of HDL3 cholesterol were associated with a decreased odds of POAG (OR, 0.91; 95% CI, 0.84-0.99, P = 0.021). Other MR methods, including weighted median, mode-based estimator, and contamination mixture methods, derived consistent OR estimates. None of the routine lipids (blood total, HDL, or low-density lipoprotein [LDL] cholesterol) were associated with POAG. CONCLUSIONS: Overall, these results suggest that the relationship between HDL3 cholesterol and POAG might be causal and specific, and that dysregulation of cholesterol transport may play a role in the pathogenesis of POAG.


Assuntos
HDL-Colesterol/sangue , Glaucoma de Ângulo Aberto/sangue , Análise da Randomização Mendeliana , Metabolômica , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Estudo de Associação Genômica Ampla , Glaucoma de Ângulo Aberto/diagnóstico , Gonioscopia , Humanos , Espectroscopia de Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Razão de Chances , Polimorfismo de Nucleotídeo Único , Microscopia com Lâmpada de Fenda , Tonometria Ocular
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