In vivo confocal microscopy and tear cytokine analysis in post-LASIK ectasia

Pahuja, Natasha; Shetty, Rohit; Deshmukh, Rashmi; Sharma, Anupam; Nuijts, Rudy M.M.A.; Jhanji, Vishal; Sethu, Swaminathan; Ghosh, Arkasubhra

doi:10.1136/bjophthalmol-2016-309142

Cited by 19 publications

(16 citation statements)

References 30 publications

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“…2,3 However, it can also occur following the treatment of low to moderate myopia due to corneal biomechanical instability and inflammation. 4,5 The primary corneal ectasia conditions of keratoconus and pellucid marginal degeneration (PMD) also result in significant increases in higher order aberrations, predominantly spherical aberration and coma. [6][7][8] Scleral lenses are large diameter rigid gas-permeable lenses, which vault the corneal apex and rest on the conjunctival tissue overlying the sclera.…”

Section: Introductionmentioning

confidence: 99%

The effect of scleral lenses on vision, refraction and aberrations in post‐LASIK ectasia, keratoconus and pellucid marginal degeneration

Kumar

Shetty

Lalgudi

et al. 2021

Ophthalmic Physiologic Optic

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Purpose: To quantify the effect of a single scleral lens design on visual acuity and ocular higher-order aberrations in eyes with post-LASIK ectasia, keratoconus and pellucid marginal degeneration (PMD) that could not achieve satisfactory vision with spectacles or soft contact lenses. Methods: Forty-six eyes of 28 participants fitted with diagnostic scleral lenses (KeraCare) were analysed, including 19, 15 and 12 eyes with post-LASIK ectasia, keratoconus and PMD, respectively. Corrected distance visual acuity (CDVA) and ocular aberrations were measured prior to lens wear and during lens wear after 60 min of settling. An i-Trace aberrometer was used to determine aberrations over a 4.5 mm diameter pupil. Results: Before lens wear, the median (95% confidence interval) values across all groups were: CDVA 0.30 (0.30, 0.40) logMAR, spherical equivalent refraction -2.75 (-5.25, -2.12) D, cylindrical refraction 3.75 (2.50, 5.00) D, higher-orderroot-mean-square error (HO-RMS) 0.90 (0.64, 1.03) lm and vertical coma coefficient C(3,-1) -0.32 (-0.42, -0.12) lm. RMS coma of 0.52 (0.40, 0.74) lm was higher for the keratoconus group than for the other groups (p < 0.05). During lens wear, values improved considerably across all groups: CDVA 0.0 (0.0, 0.00) logMAR, spherical equivalent refraction -0.50 (-0.75, +0.50) D, cylindrical refraction 0.50 (0.00, 0.50) D, HO-RMS 0.32 (0.26, 0.42) lm and C(3,-1) +0.12 (+0.02, +0.19) lm (all p < 0.001 compared to pre-lens wear). While reduced significantly, RMS coma remained higher in the keratoconus group at 0.35 (0.31, 0.52) lm than in the post-LASIK ectasia and PMD groups at 0.17 (0.12, 0.21) lm and 0.07 (0.02, 0.46) lm, respectively (p < 0.05). Conclusions: The KeraCare scleral contact lens reduced ocular aberrations and improved visual acuity in patients with post-LASIK ectasia, keratoconus and PMD. The sign of vertical coma changed in keratoconus and PMD.

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Section: Introductionmentioning

confidence: 99%

The effect of scleral lenses on vision, refraction and aberrations in post‐LASIK ectasia, keratoconus and pellucid marginal degeneration

Kumar

Shetty

Lalgudi

et al. 2021

Ophthalmic Physiologic Optic

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“…While corneal ectasias have traditionally been thought to be non-inflammatory, recent reports suggest this is incorrect. 10 , 11 , 12 , 13 A variety of inflammatory pathways appear to be involved in the ectatic process. In keratoconus, elevated levels of pro-inflammatory cytokines (such as IL-1 α and TNF- α ), activation of proteases including matrix metalloproteinases, and decreased activity of protease inhibitors have been demonstrated.…”

Section: Discussionmentioning

confidence: 99%

Cogan syndrome masquerading as corneal ectasia

Little

Randleman

2021

American Journal of Ophthalmology Case Reports

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Purpose To report a case of Cogan syndrome that presented with the appearance of bilateral asymmetric corneal ectasia on Scheimpflug tomography. Methods Case Report and Literature Review. Results A 43-year-old woman previously diagnosed with keratoconjunctivitis sicca and presumed keratoconus presented with seven months of episodic eye pain and progressive bilateral blurry vision with new onset bilateral monocular diplopia. Review of symptoms were significant for tinnitus, vertigo, and sensorineural hearing loss that began many months after her initial presentation for visual symptoms. Scheimpflug tomography showed asymmetric focal steepening on anterior curvature with corresponding focal total corneal thinning, focal posterior elevation, and abnormal ARTMax (205 OD, 103 OS) and BAD-D (2.75 OD, 5.6 OS) values. Clinical examination was notable only for faint anterior corneal stromal inflammation without neovascularization, but there was significant corresponding focal hyperreflectivity on anterior segment optical coherence tomography (OCT) examination with focal epithelial hypertrophy rather than thinning. Given the combined findings of interstitial keratitis and sensorineural hearing loss the patient was diagnosed with Cogan syndrome. She responded well to topical steroids and systemic immunosuppressive therapy, with near resolution of her abnormal topographic and tomographic findings and resolution of monocular diplopia in both eyes. Conclusions Cogan syndrome should be suspected for any patient with corneal stromal findings and associated with vertigo and/or hearing loss. Anterior segment optical coherence tomography (OCT) can distinguish between ectatic and inflammatory diseases and may help make the appropriate diagnosis in subtle cases.

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“…A retrospective study conducted by Pahuja et al 24 suggests an ongoing inflammatory response in PLE corneas. Their study included 12 eyes of PLE subjects (based on corneal topography) and 14 post-LASIK control eyes.…”

Section: Pathogenesismentioning

confidence: 99%

“…Immunohistochemical evaluation of PLE revealed abnormal epithelial basement membrane (EBM) structure similar to KC and bullous keratopathy and increase in certain proteinases indicating lysis and remodeling of EBM. 24 In a prospective comparative case series, Kymionis et al 25 investigated corneal tissue alterations after corneal collagen cross-linking in patients with post-LASIK keratectasia (five eyes) and KC (five eyes). Three normal/ healthy and three post-LASIK without ectasia corneas were also examined as controls.…”

Section: Histopathology and Immunohistochemistrymentioning

confidence: 99%

Post Laser-assisted in situ Keratomileusis Ectasia: A Systematic Review

Barbara¹,

Busool²

2017

International Journal of Keratoconus and Ectatic Corneal Diseases

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Purpose: To provide a comprehensive overview of ectasia development following laser-assisted in situ keratomileusis (LASIK). Materials and methods:Literature review of relevant studies dealing with corneal ectasia associated with refractive surgery, keratoconus (KC), and cross-linking.Results: Post Laser-assisted (PLE) involves histopathologic, clinical, and topographic characteristics similar to KC. Several risk screening indices were developed to enhance the detection of KC suspect and mild KC cases prior to the laser procedure. A grading system of PLE was developed, based on risk factors for the severity of ectasia, primarily measured by visual loss. The aims of the treatment are halting ectasia progression and restoring visual acuity. Conclusion:Familiarity with the highly sensitive and specific indices for ectasia screening, in addition to procedure parameters that increase the likelihood of ectasia development following the refractive procedure, is essential for minimizing the risk of PLE. However, when ectasia develops, early recognition and proper management are essential to prevent progression and improve visual rehabilitation.

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In vivo confocal microscopy and tear cytokine analysis in post-LASIK ectasia

Abstract: The current study found a significant difference in the tear film cytokine profile between normal and PLE eyes. Presence of increased corneal dendritic cells and altered tear cytokines suggests an ongoing inflammatory response in PLE.

Cited by 19 publications

References 30 publications

The effect of scleral lenses on vision, refraction and aberrations in post‐LASIK ectasia, keratoconus and pellucid marginal degeneration

The effect of scleral lenses on vision, refraction and aberrations in post‐LASIK ectasia, keratoconus and pellucid marginal degeneration

Cogan syndrome masquerading as corneal ectasia

Post Laser-assisted in situ Keratomileusis Ectasia: A Systematic Review

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