Update in the Management of Keratoconus

Oyeniran, Enny; Tauqeer, Zujaja

doi:10.1016/j.yaoo.2021.04.019

Cited by 3 publications

(5 citation statements)

References 45 publications

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“…In advanced keratoconus without any previous acute corneal hydrops, DALK with big bubble techniques is the most common type of lamellar keratoplasty performed, accounting for more than 50% of the corneal transplantations in some countries ( 43 , 266 , 278 ). There are many other ALK techniques, such as manual layer-by-layer pre-descemetic DALK (pdDALK), dDALK with viscodissection, pdDALK with the Melles technique, and FSL-assisted DALK.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…DALK has become the treatment of choice because it has several advantages over PK. With DALK, the host corneal endothelial cells are retained, eliminating the risk of corneal endothelial rejection and graft failure ( 253 , 254 , 265 , 266 , 282 ). Other benefits of DALK include lower risk of endophthalmitis, reduced dependence on long-term topical corticosteroids [hence lesser risk of ocular hypertension (OHT) and glaucoma], faster recovery, and stronger graft-host junction ( 282 , 283 ).…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…In view of the potential complications and the shortage of donor corneas, keratoplasty is usually reserved as the last resort for treating advanced keratoconus. In general, DALK is the technique of choice when Descemet's membrane remains free of scarring or opacity and corneal endothelium remains healthy (10,43,253,254,(265)(266)(267). On the other hand, PK is indicated when there is significant, full-thickness corneal scarring (e.g., following acute corneal hydrops or perforation), extremely thin cornea (<150-200 µm, though technically is still possible for DALK), or in cases with co-existing endothelial dysfunctions (43,265,266).…”

Section: Keratoplastymentioning

confidence: 99%

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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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Section: Surgical Treatmentmentioning

confidence: 99%

Section: Surgical Treatmentmentioning

confidence: 99%

Section: Keratoplastymentioning

confidence: 99%

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Management of keratoconus: an updated review

et al. 2023

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“…In advanced stages, a cornea transplant is the only feasible treatment option. If diagnosed early, however, less invasive treatments like Corneal Cross Linking (CXL) or Intracorneal Ring Segments (ICRS) can be used to reduce disease progression 4 .…”

Section: Introductionmentioning

confidence: 99%

Automated cornea diagnosis using deep convolutional neural networks based on cornea topography maps

Fassbind

Langenbucher

Streich

2023

Sci Rep

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Cornea topography maps allow ophthalmologists to screen and diagnose cornea pathologies. We aim to automatically identify any cornea abnormalities based on such cornea topography maps, with focus on diagnosing keratoconus. To do so, we represent the OCT scans as images and apply Convolutional Neural Networks (CNNs) for the automatic analysis. The model is based on a state-of-the-art ConvNeXt CNN architecture with weights fine-tuned for the given specific application using the cornea scans dataset. A set of 1940 consecutive screening scans from the Saarland University Hospital Clinic for Ophthalmology was annotated and used for model training and validation. All scans were recorded with a CASIA2 anterior segment Optical Coherence Tomography (OCT) scanner. The proposed model achieves a sensitivity of 98.46% and a specificity of 91.96% when distinguishing between healthy and pathological corneas. Our approach enables the screening of cornea pathologies and the classification of common pathologies like keratoconus. Furthermore, the approach is independent of the topography scanner and enables the visualization of those scan regions which drive the model’s decisions.

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“…In advanced stages, only a cornea transplantation is a feasible treatment option. If diagnosed early, however, less invasive treatments like Corneal Cross Linking (CXL) or Intracorneal Ring Segments (ICRS) can be used to reduce disease progression significantly 4 .…”

Section: Introductionmentioning

confidence: 99%

Automated Cornea Diagnosis using Deep Convolutional Neural Networks based on Cornea Topography Maps

Fassbind

Langenbucher

Streich

2022

Preprint

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Cornea topography maps allow ophthalmologists to screen and diagnose cornea pathologies. We aimto automatically identify any cornea abnormalitiesbased on such cornea topography maps, with focus on diagnosing keratoconus. A set of 1946 consecutive screening scans from the Saarland University Hospital Clinic for Ophthalmology was annotated and used for model training and validation. All scans were recorded witha CASIA2 anterior segment Optical Coherence Tomography (OCT) scanner.We propose to represent the OCT scans as images and apply Convolutional Neural Networks (CNNs) for the automatic analysis. The developed model is based on a state-of-the-art ConvNeXt CNN architecture with weights fine-tuned for the given specific application using the cornea scans dataset. On a new dataset, our model achieves a sensitivity of 97% and a specificity of 97% when distinguishing between Healthy and Pathological corneas. While a comparison to previous work is intricate due tosignificant variations in the experimental setup, our model outperforms other published studies, either in terms of detection performance, and/or in terms of number of potential cornea abnormalities the model can identify. Furthermore, the proposed approach is independent of the topography scanner and allows to visually represent scan regions that drive the models' decision.

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Update in the Management of Keratoconus

Cited by 3 publications

References 45 publications

Management of keratoconus: an updated review

Management of keratoconus: an updated review

Automated cornea diagnosis using deep convolutional neural networks based on cornea topography maps

Automated Cornea Diagnosis using Deep Convolutional Neural Networks based on Cornea Topography Maps

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