Management of advanced corneal ectasias

Maharana, Prafulla K.; Dubey, Aditi; Jhanji, Vishal; Sharma, Namrata; Das, Sujata; Vajpayee, Rasik B

doi:10.1136/bjophthalmol-2015-307059

Cited by 46 publications

(41 citation statements)

References 64 publications

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“…Intracorneal ring segment implantation is widely used in KC, but may not be applicable in true PMD [ 13 ]. In advanced cases, both ectasias can be treated with penetrating or deep anterior lamellar keratoplasty, but the technical disposal is different (graft size, position) [ 18 , 19 ]. Furthermore, crescentic wedge resection in PMD can also be a treatment [ 8 , 19 ].…”

Section: Introductionmentioning

confidence: 99%

Tear Mediators in Corneal Ectatic Disorders

et al. 2016

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PurposeTo compare the concentrations of 11 tear mediators in order to reveal the biochemical difference between pellucid marginal degeneration (PMD) and keratoconus (KC).MethodsWe have designed a cross-sectional study in which patients with corneal ectasia based on slit-lamp biomicroscopy and Pentacam HR (keratometry values (K1, K2, Kmax), astigmatism, minimal radius of curvature (Rmin), corneal thickness (Apex and Min), indices (surface variation, vertical asymmetry, keratoconus, central keratoconus, height asymmetry and decentration)) were enrolled. Eyes of keratoconic patients were similar to the PMD patients in age and severity (K2, Kmax and Rmin). Non-stimulated tear samples were collected from nine eyes of seven PMD patients, 55 eyes of 55 KC patients and 24 eyes of 24 healthy controls. The mediators’ (interleukin -6, -10, chemokine ligand 5, -8, -10, matrix metalloproteinase (MMP) -9, -13, tissue inhibitor of metalloproteinases (TIMP)-1, tissue plasminogen activator, plasminogen activator inhibitor, nerve growth factor) concentrations were measured using Cytometric Bead Array.ResultsMMP-9 was the only mediator which presented relevant variances between the two patient groups (p = 0.005). The ratios of MMP-9 and TIMP-1 were 2.45, 0.40 and 0.23 in PMD, KC and the controls, respectively.ConclusionAs far as we are aware, this is the first study that aims to reveal the biochemical differences between PMD and KC. Further studies of biomarkers to investigate the precise role of these mediators need to be defined, and it is important to confirm the observed changes in a larger study to gain further insights into the molecular alterations in PMD.

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Section: Introductionmentioning

confidence: 99%

Tear Mediators in Corneal Ectatic Disorders

et al. 2016

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“…Advanced cases with severe corneal thinning generally require corneal surgery for visual rehabilitation as well as for improving corneal strength. 16 Many cases of keratoconus are unable to tolerate contact lens due to associated VKC or an unsatisfactory fit in advanced cones. Such patients may be suitable candidates for Implantable Collamer Lens (ICL) for the correction of their myopic astigmatism.…”

Section: Discussionmentioning

confidence: 99%

Implantable Collamer Lens (ICL) Sizing in Advanced Keratoconus

Arora¹

2016

DJO

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“…A detailed and uniform ophthalmologic examination was performed in all cases, according to the clinical standards [3]. Testing sessions consisted of a minimum of three corneal topographies for each cornea made with Sirius Tomographer (CSO, Florence, Italy), which was always carried out by the same experienced examiner.…”

Section: Ophthalmological Examinationmentioning

confidence: 99%

“…However, the cornea is not a perfect biological structure because its surfaces do not present symmetry of revolution in a healthy scenario, which entails the existence of deformations, misalignments, and decentralizations between its anterior and posterior surfaces and between its singular points (apex, vertex, and minimum thickness point) [2]. However, in a pathological scenario, the progression of the asymmetry in the corneal architecture contributes to a decrease in its optical capacity, which causes a loss of the patients' visual quality [3]. This decrease in optical functionality may have its origin in a physio-pathological mechanism derived from a pathology called keratoconus.…”

Section: Introductionmentioning

confidence: 99%

Study of Morpho-Geometric Variables to Improve the Diagnosis in Keratoconus with Mild Visual Limitation

et al. 2018

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The validation of new methods for the diagnosis of incipient cases of Keratoconus (KC) with mild visual limitation is of great interest in the field of ophthalmology. During the asymmetric progression of the disease, the current diagnostic indexes do not record the geometric decompensation of the corneal curvature nor the variation of the spatial profile that occurs in singular points of the cornea. The purpose of this work is to determine the structural characterization of the asymmetry of the disease by using morpho-geometric parameters in KC eyes with mild visual limitation including using an analysis of a patient-specific virtual model with the aid of computer-aided design (CAD) tools. This comparative study included 80 eyes of patients classified as mild KC according to the degree of visual limitation and a control group of 122 eyes of normal patients. The metric with the highest area under the receiver operating characteristic (ROC) curve was the posterior apex deviation. The most prominent correlation was found between the anterior and posterior deviations of the thinnest point for the mild keratoconic cases. This new custom computational approach provides the clinician with a three-dimensional view of the corneal architecture when the visual loss starts to impair.

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Management of advanced corneal ectasias

Cited by 46 publications

References 64 publications

Tear Mediators in Corneal Ectatic Disorders

Tear Mediators in Corneal Ectatic Disorders

Implantable Collamer Lens (ICL) Sizing in Advanced Keratoconus

Study of Morpho-Geometric Variables to Improve the Diagnosis in Keratoconus with Mild Visual Limitation

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