Pathophysiology of Keratoconus

Dua, Harminder S.; Darren, S. J.; Al-Aqaba, Ting Mouhamed; Said, Dalia G.

doi:10.1016/b978-0-323-75978-6.00005-4

Cited by 3 publications

(4 citation statements)

References 93 publications

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“…Decreased Vitamin D serum levels have been associated with KC development and severity [35,36]. Similarly, elevated immunoglobulin E (IgE) levels are correlated to CE severity [37].…”

Section: Bloodmentioning

confidence: 99%

Ocular surface inflammation and ectatic corneal disorders

Erdinest

Wajnsztajn

London

et al. 2023

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review Inflammatory mediators are a focus of recent corneal ectasia (CE) research and are a profound, modifiable contributor to CE in general and keratoconus (KC) in particular, opening a path to explore new methods of control. As advanced imaging technology and expanded population screening allow for earlier detection, the possibility of early intervention can profoundly change the prognosis of CE. Recent findings Significant increases in the inflammatory mediators and immune components have been observed in the cornea, tear fluid, and blood of ectasia patients, while inflammation dampeners such as vitamin D and their receptors are reduced. Atopy and allergy have a strong association with KC, known to increase itch factors and stimulate eye rubbing, a risk factor in ectasia pathogenesis. Management of atopy or allergic conditions and topical anti-inflammatories has helped stabilize CE disease. Summary Strategies such as monitoring inflammatory factors and using immune or inflammatory modulators, including managing subclinical inflammation, may be clinically beneficial in stabilizing the disease and improving outcomes. The detected factors are biomarkers, but as yet unproven to be sensitive or specific enough to be considered biomarkers for early detection of CE. The establishment of such biomarkers could improve the therapeutic outcome.

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“…Decreased Vitamin D serum levels have been associated with KC development and severity [35,36]. Similarly, elevated immunoglobulin E (IgE) levels are correlated to CE severity [37].…”

Section: Bloodmentioning

confidence: 99%

Ocular surface inflammation and ectatic corneal disorders

Erdinest

Wajnsztajn

London

et al. 2023

Current Opinion in Allergy &Amp; Clinical Immunology

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“…Etiology of keratoconus is multifactorial, with environmental and genetic factors playing important roles ( 14 , 15 ). Atopy, eye rubbing, and exposure to ultraviolet rays are some of the recognized risk factors.…”

Section: Introductionmentioning

confidence: 99%

Management of keratoconus: an updated review

et al. 2023

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Keratoconus is the most common corneal ectatic disorder. It is characterized by progressive corneal thinning with resultant irregular astigmatism and myopia. Its prevalence has been estimated at 1:375 to 1:2,000 people globally, with a considerably higher rate in the younger populations. Over the past two decades, there was a paradigm shift in the management of keratoconus. The treatment has expanded significantly from conservative management (e.g., spectacles and contact lenses wear) and penetrating keratoplasty to many other therapeutic and refractive modalities, including corneal cross-linking (with various protocols/techniques), combined CXL-keratorefractive surgeries, intracorneal ring segments, anterior lamellar keratoplasty, and more recently, Bowman’s layer transplantation, stromal keratophakia, and stromal regeneration. Several recent large genome-wide association studies (GWAS) have identified important genetic mutations relevant to keratoconus, facilitating the development of potential gene therapy targeting keratoconus and halting the disease progression. In addition, attempts have been made to leverage the power of artificial intelligence-assisted algorithms in enabling earlier detection and progression prediction in keratoconus. In this review, we provide a comprehensive overview of the current and emerging treatment of keratoconus and propose a treatment algorithm for systematically guiding the management of this common clinical entity.

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“…Keratoconus (KC) is an uncommon bilateral ectatic disorder, with a worldwide prevalence of approximately 1/ 2,000. 9 It is characterized by central or paracentral progressive thinning and steepening of the cornea, leading to irregular astigmatism. The pathophysiology of KC likely involves genetic, environmental (e.g., chronic eye rubbing, atopy of the eye, and contact lens wear), and biochemical factors (e.g., upregulation of degradative enzymes).…”

Section: Introductionmentioning

confidence: 99%

“…The pathophysiology of KC likely involves genetic, environmental (e.g., chronic eye rubbing, atopy of the eye, and contact lens wear), and biochemical factors (e.g., upregulation of degradative enzymes). According to an extensive body of literature, [9][10][11] an initial event, which is yet to be determined and potentially regulated by genetic factors, initiates the failure of the "locking mechanism" established during early childhood, resulting in the destabilization of collagen fibrils in the corneal stroma. Subsequent biomechanical and biochemical processes contribute to the occurrence of lamellar or fibrillar slippage in the cornea, leading to the typical KC changes.…”

Section: Introductionmentioning

confidence: 99%

Association of torpedo maculopathy and keratoconus in a young patient: A multimodal imaging study

Cozzupoli,

Fasciani,

Fedeli

et al. 2023

European Journal of Ophthalmology

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Purpose To report and document a case of torpedo maculopathy found in a patient affected by keratoconus. Case report: An healthy 16-year-old male patient, affected by keratoconus in both eyes, was referred to the cornea service of our hospital for a follow-up visit. During the dilated fundus examination of the left eye, an oval, well-demarcated, hypopigmented lesion was observed in the juxtafoveal temporal region, pointing towards the center of the macula. Multimodal imaging of the lesion was performed, and the diagnosis of Torpedo Maculopathy was established based on the clinical picture. Conclusion This is the first case of torpedo maculopathy described in a patient affected by keratoconus. This association may be merely fortuitous or the result of developmental abnormalities affecting both corneal and retinal structures.

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Pathophysiology of Keratoconus

Cited by 3 publications

References 93 publications

Ocular surface inflammation and ectatic corneal disorders

Ocular surface inflammation and ectatic corneal disorders

Management of keratoconus: an updated review

Association of torpedo maculopathy and keratoconus in a young patient: A multimodal imaging study

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