Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retin...Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature.However,growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit,which includes both the retinal vascular structures and neural tissues.Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening.However,diabetic corneal neuropathy is commonly overlooked and underdiagnosed,leading to severe ocular surface impairment.Several studies have found that these two conditions tend to occur together,and they share similarities in their pathogenesis pathways,being triggered by a status of chronic hyperglycemia.This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy,whether diabetic corneal neuropathy precedes diabetic retinopathy,as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy.We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.展开更多
AIM:To evaluate the clinical outcomes after subsequent implantation of a new intrastromal corneal ring segment(ICRS)model followed by an additional short-arc ICRS implant in keratoconus patients.METHODS:This retrospec...AIM:To evaluate the clinical outcomes after subsequent implantation of a new intrastromal corneal ring segment(ICRS)model followed by an additional short-arc ICRS implant in keratoconus patients.METHODS:This retrospective single-arm cohort study evaluated 25 eyes of 21 keratoconus patients implanted with the new ICRS followed by 140-arch length ICRS(140-ICRS)implantation.Uncorrected distance visual acuity(UDVA,logMAR),corrected distance visual acuity(CDVA,logMAR),sphere,astigmatism,keratometry,spherical equivalent(SE),and asphericity were compared preoperatively and postoperatively after both ICRS implantation.RESULTS:The average follow-up time after 140-ICRS implantation was 6.40±2.20mo.The mean preoperative UDVA improved from 1.27±0.14 preoperative to 0.52±0.26 after both ICRS implantation(P=0.03).The mean sphere value reduced from-5.34±2.74 preoperatively to-2.06±1.84 postoperatively(P<0.001)after the first ICRS implantation and decreased to-0.59±1.54 postoperatively(P<0.001)after 140-ICRS implantation.The mean preoperative astigmatism was-3.72±1.56 and improved to-2.82±1.08 after the first ICRS implantation,and following the 140-ICRS implantation,the mean astigmatism was-1.37±0.67(P=0.001).The SE and asphericity changes were statistically significant(P<0.001).The researchers did not find intraoperative or postoperative complications for both procedures.CONCLUSION:The combination of 2 different ICRSs can efficiently regularize the cornea,reduce the SE,and improve visual acuity in selected keratoconus patients.展开更多
Among refractive errors,astigmatism is the most common optical aberration,where refraction changes in different meridians of the eye.It causes blurred vision at any distance and includes corneal,lenticular,and retinal...Among refractive errors,astigmatism is the most common optical aberration,where refraction changes in different meridians of the eye.It causes blurred vision at any distance and includes corneal,lenticular,and retinal astigmatism.Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism,for example,a large size surgery incision.The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery.Nowadays,three surgical approaches can be used.By placing a sutureless clear corneal incision on the steep meridian of the cornea,a preoperative corneal astigmatism less than 1.0 D can be corrected.Single or paired peripheral corneal relaxing incisions(PCRIs)provide 1.0-3.0 D corneal astigmatism correction.PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism,if more than 2.0 D,the risk of overcorrection and irregular astigmatism is increased.When toric intraocular lenses(IOLs)are unavailable in markets,PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism.Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism.Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D.These approaches can be used alone or in combination.展开更多
Background: This case report presents a case of bilateral Thiel-Behnke corneal dystrophy in Denmark. Thiel-Behnke is an autosomal dominant inherited epithelial-stromal TGFBI dystrophy causing visual impairment. Method...Background: This case report presents a case of bilateral Thiel-Behnke corneal dystrophy in Denmark. Thiel-Behnke is an autosomal dominant inherited epithelial-stromal TGFBI dystrophy causing visual impairment. Methods and Results: This case study presents a 24-year-old Lithuanian man, with no previous ocular history, who had experienced slowly progressive visual impairment since his childhood. He was examined at the Department of Ophthalmology at Vejle Hospital and Aarhus University Hospital, where he was diagnosed with bilateral Thiel-Behnke corneal dystrophy. Histology confirmed the diagnosis. A lamellar corneal transplantation was performed in the right eye;however, due to epithelial growth under the corneal graft, it was later decided to redo the operation. Following the operations, the patient experienced a visual improvement in best corrected visual acuity (BCVA) from 0.1 (20/25 Snellen equivalent) to 0.3 (20/40 Snellen equivalent) in his right eye. Conclusions: This case of Thiel-Behnke corneal dystrophy is to our knowledge the first reported case in Denmark.展开更多
Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from dam...Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.展开更多
AIM:To investigate the role of transmembrane protein 206(TMEM206)in corneal edema in mice by knockout the TMEM206 gene using CRISPR/Cas9 editing technology.METHODS:TMEM206-knockout mice were generated using the CRISPR...AIM:To investigate the role of transmembrane protein 206(TMEM206)in corneal edema in mice by knockout the TMEM206 gene using CRISPR/Cas9 editing technology.METHODS:TMEM206-knockout mice were generated using the CRISPR-Cas9 system.Variations in ophthalmic pathology were observed using slit lamp microscope and optical coherence tomography(OCT),intraocular pressure(IOP)was measured using a TonoLab Rebound Tonometer,and the ultrastructure of the corneal was observed using a transmission electron microscope.RESULTS:Corneal opacity was observed in 4/18 homozygous TMEM206^(-/-)mice whereas a similar change was not observed in heterozygous TMEM206^(+/-)mice and wild-type littermates.OCT examination showed that the mean central cornea thickness was 125±5.4μm in 4 homozygous TMEM206^(-/-)mice developed corneal edema and 115±1.2μm in wild-type mice(t=3.468,P<0.05)at 43wk.The mean IOP was 12.08±0.07 mm Hg in four right eyes with corneal edema and 12.03±0.03 mm Hg in three normal left eyes(P>0.05).Transmission electron microscopy revealed a disruption in the organization of the collagen fibrils in the central part of the cornea in homozygous TMEM206^(-/-)mice.CONCLUSION:TMEM206 is associated with corneal edema which caused organizational disruption of collagen fibrils in corneas of mice.展开更多
AIM:To assess the corneal high-order aberration(HOA)and its correlation with corneal morphological parameters in patients with bilateral keratoconus(KCN)and unilateral Vogt’s striae.METHODS:A total of 168 eyes of 84 ...AIM:To assess the corneal high-order aberration(HOA)and its correlation with corneal morphological parameters in patients with bilateral keratoconus(KCN)and unilateral Vogt’s striae.METHODS:A total of 168 eyes of 84 patients with KCN,whose corneas had definite signs of unilateral Vogt’s striae,were enrolled.Corneal HOA and morphological parameters were measured using Pentacam HR.RESULTS:The corneal morphological parameters between KCN eyes with and without Vogt’s striae were evidently different(P<0.001).The 3rd coma 90°,4th spherical aberration,5th coma 90°,root-mean-square(RMS)(total),and RMS(HOA)in the front,back surfaces and total cornea in KCN eyes with Vogt’s striae were significantly higher than those in KCN eyes without Vogt’s striae(P<0.001).In KCN eyes with Vogt’s striae,the 3rd coma 90°and 4th spherical aberration in the front surface and total cornea were negatively correlated with flat keratometry value(K1),steep keratometry value(K2),mean keratometry value(Km),maximum keratometry value(Kmax),anterior corneal elevation(ACE),and posterior corneal elevation(PCE;P<0.05).The 3rd coma 90°,4th spherical aberration in back surface and RMS(total),RMS(HOA)in the front,back surfaces,total cornea were positively correlated with K1,K2,Km,Kmax,ACE,and PCE(P<0.05).CONCLUSION:Corneal HOA especially vertical coma and spherical aberration may increase when Vogt’s striae appeared in KCN eyes.The scale of increase is significantly related with changes in corneal shapes.展开更多
In recent years, stem cells have been a focal point in research designed to evaluate the efficacy of ophthalmologic therapies, specifically those for corneal conditions. The corneal epithelium is one of the few region...In recent years, stem cells have been a focal point in research designed to evaluate the efficacy of ophthalmologic therapies, specifically those for corneal conditions. The corneal epithelium is one of the few regions of the body that maintains itself using a residual stem cell population within the adjacent limbus. Stem cell movement has additionally captivated the minds of researchers due to its potential application in different body regions. The cornea is a viable model for varying methods to track stem cell migratory patterns, such as lineage tracing and live imaging from the limbus. These developments have the potential to pave the way for future therapies designed to ensure the continuous regeneration of the corneal epithelium following injury via the limbal stem cell niche. This literature review aims to analyze the various methods of imaging used to understand the limbal stem cell niche and possible future directions that might be useful to consider for the better treatment and prevention of disorders of the cornea and corneal epithelium. .展开更多
AIM:To construct a competent corneal lamellar substitute in order to alleviate the shortage of human corneal donor.METHODS:Rabbit mesenchymal stem cells(MSCs)were isolated from bone marrow and identified by flow cytom...AIM:To construct a competent corneal lamellar substitute in order to alleviate the shortage of human corneal donor.METHODS:Rabbit mesenchymal stem cells(MSCs)were isolated from bone marrow and identified by flow cytometric,osteogenic and adipogenic induction.Xenogenic decellularized corneal matrix(XDCM)was generated from dog corneas.MSCs were seeded and cultured on XDCM to construct the tissueengineered cornea.Post-transplantation biocompatibility of engineered corneal graft were tested by animal experiment.Rabbits were divided into two groups then underwent lamellar keratoplasty(LK)with different corneal grafts:1)XDCM group(n=5):XDCM;2)XDCM-MSCs groups(n=4):tissue-engineered cornea made up with XDCM and MSCs.The ocular surface recovery procedure was observed while corneal transparency,neovascularization and epithelium defection were measured and compared.In vivo on focal exam was performed 3 mo postoperatively.RESULTS:Rabbit MSCs were isolated and identified.Flow cytometry demonstrated isolated cells were CD90 positive and CD34,CD45 negative.Osteogenic and adipogenic induction verified their multipotent abilities.MSC-XDCM grafts were constructed and observed.In vivo transplantation showed the neovascularization in XDCMMSC group was much less than that in XDCM group postoperatively.Post-transplant 3-month confocal test showed less nerve regeneration and bigger cell-absent area in XDCM-MSC group.CONCLUSION:This study present a novel corneal tissue-engineered graft that could reduce post-operatively neovascularization and remain transparency,meanwhile shows that co-transplantation of MSCs may help increase corneal transplantation successful rate and enlarge the source range of corneal substitute to overcome cornea donor shortage.展开更多
Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropath...Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,respectively.Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin biopsies.However,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic neuropathy.More recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy.In this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and management.We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.展开更多
Background:Our goal is to build a multi-unit ocular biometric system based on the fusion of left and right corneal shapes for identity authentication.Methods:Ocular biometrics such as iris,periocular,retina,sclera and...Background:Our goal is to build a multi-unit ocular biometric system based on the fusion of left and right corneal shapes for identity authentication.Methods:Ocular biometrics such as iris,periocular,retina,sclera and eye movement have become established biometric traits,primarily due to extensive efforts made by the biometrics community in the field of iris recognition.In this work,we propose an ocular biometric trait based on the 3D shape of the cornea to improve biometric authentication.We show how the fusion of the left and right corneas can be used as a biometric trait for person recognition.First,we started by realizing our own cornea database by using a Pentacam Topographer(Oculus)which contains 288 corneal topographies of both eyes captured from 36 different people of different ages.For each eye,data acquisition was done during two different sessionsto establish the repeatability of the measurements over time.The time interval between the two sessions was equal or greater than one month.In each session;8 acquisitions(4 left eyes end 4 right eyes)were taken.Then,features were extracted by modeling the shape of the left and right corneas with a Zernike polynomial expansion.The fusion of the left and right shapes of cornea was performed at the matching score level using the weighted-sum rule.Results:For each individual,we had eight feature vectors(eight measures in two sessions)of size 36(Zernike polynomial coefficients)from their corneal topographies.The experimental results on our cornea database constructed for this study showed encouraging performance of the proposed ocular biometric system with Equal Error Rate decreasing to 1.38%with the weighted-sum rule compared to the analysis of the left(4.5%)or right(3.7%)cornea alone.Conclusions:The objective of this work was to investigate corneal topographyas an accurate biometric modality using shape discriminating features.Our idea was to propose an ocular multi-unit system based on the fusion of the left and right corneal shapes.The corneal feature extraction was done by Zernike polynomial decomposition.Multi-unit cornea fusion was performed at the matching score level to generate a unique score.This allowed a significative decrease of the EER to 1.38%.展开更多
AIM： To assess acellular ostrich corneal matrix used as a scaffold to reconstruct a damaged cornea. METHODS： A hypertonic saline solution combined with a digestion method was used to decellularize the ostrich cornea...AIM： To assess acellular ostrich corneal matrix used as a scaffold to reconstruct a damaged cornea. METHODS： A hypertonic saline solution combined with a digestion method was used to decellularize the ostrich cornea. The microstructure of the acellular corneal matrix was observed by transmission electron microscopy （TEM） and hematoxylin and eosin （H＆E） staining. The mechanical properties were detected by a rheometer and a tension machine. The acellular corneal matrix was also transplanted into a rabbit cornea and cytokeratin 3 was used to check the immune phenotype, RESULTS： The microstructure and mechanical properties of the ostrich cornea were well preserved after the decellularization process, in vitro, the methyl thiazolyl tetrazoUum results revealed that extracts of the acellular ostrich corneas （AOCs） had no inhibitory effects on the proliferation of the corneal epithelial or endothelial cells or on the keratocytes, The rabbit lamellar keratoplasty showed that the transplanted AOCs were transparent and completely incorporated into the host cornea while corneal turbidity and graft dissolution occurred in the acellular porcine cornea （APC） transplantation, The phenotype of the reconstructed cornea was similar to a normal rabbit cornea with a high expression of cytokeratin 3 in the superficial epithelial cell layer, CONCLUSION： We first used AOCs as scaffolds to reconstruct damaged corneas. Compared with porcine corneas, the anatomical structures of ostrich corneas are closer to those of human corneas. In accordance with the principle that structure determines function, a xenograft lamellar keratoplasty also confirmed that the AOC transplantation generated a superior outcome compared to that of the APC graft.展开更多
The keratoprosthesis(KPro;artificial cornea)is a special refractive device to replace human cornea by using heterogeneous forming materials for the implantation into the damaged eyes in order to obtain a certain visio...The keratoprosthesis(KPro;artificial cornea)is a special refractive device to replace human cornea by using heterogeneous forming materials for the implantation into the damaged eyes in order to obtain a certain vision.The main problems of artificial cornea are the biocompatibility and stability of the tissue particularly in penetrating keratoplasty.The current studies of tissue-engineered scaffold materials through comprising composites of natural and synthetic biopolymers together have developed a new way to artificial cornea.Although a wide agreement that the long-term stability of these devices would be greatly improved by the presence of cornea cells,modification of keratoprosthesis to support cornea cells remains elusive.Most of the studies on corneal substrate materials and surface modification of composites have tried to improve the growth and biocompatibility of cornea cells which can not only reduce the stimulus of heterogeneous materials,but also more importantly continuous and stable cornea cells can prevent the destruction of collagenase.The necrosis of stroma and spontaneous extrusion of the device,allow for maintenance of a precorneal tear layer,and play the role of ensuring a good optical surface and resisting bacterial infection.As a result,improvement in corneal cells has been the main aim of several recent investigations;some effort has focused on biomaterial for its well biological properties such as promoting the growth of cornea cells.The purpose of this review is to summary the growth status of the corneal cells after the implantation of several artificial corneas.展开更多
AIM：To investigate the feasibility of corneal anterior lamellar reconstruction with human corneal epithelial cells and fibroblasts,and an acellular porcine cornea matrix（APCM） in vitro.·METHODS：The scaffold w...AIM：To investigate the feasibility of corneal anterior lamellar reconstruction with human corneal epithelial cells and fibroblasts,and an acellular porcine cornea matrix（APCM） in vitro.·METHODS：The scaffold was prepared from fresh porcine corneas which were treated with 0.5%sodium dodecyl sulfate（SDS）solution and the complete removal of corneal cells was confirmed by hematoxylin-eosin（HE）staining and 4’,6-diamidino-2-phenylindole（DAPI）staining.Human corneal fibroblasts and epithelial cells were cultured with leaching liquid extracted from APCM,and then cell proliferative ability was evaluated by MTT assay.To construct a human corneal anterior lamellar replacement,corneal fibroblasts were injected into the APCM and cultured for 3d,followed by culturing corneal epithelial cells on the stroma construction surface for another 10d.The corneal replacement was analyzed by HE staining,and immunofluorescence staining.·R ESULTS：Histological examination indicated that there were no cells in the APCM by HE staining,and DAPI staining did not detect any residual DNA.The leaching liquid from APCM had little influence on the proliferation ability of human corneal fibroblasts and epithelial cells.At 10d,a continuous 3 to 5 layers of human corneal epithelial cells covering the surface of the APCM was observed,and the injected corneal fibroblasts distributed within the scaffold.The phenotype of the construction was similar to normal human corneas,with high expression of cytokeratin 12 in the epithelial cell layer and high expression of Vimentin in the stroma.·CONCLUSION：Corneal anterior lamellar replacement can be reconstructed in vitro by cultivating human corneal epithelial cells and fibroblasts with an acellular porcine cornea matrix.This laid the foundation for the further transplantation in vitro.展开更多
AIM: To report the 3mo outcomes of collagen crosslinking(CXL) with a hypo-osmolar riboflavin in thin corneas with the thinnest thickness less than 400 μm without epithelium.METHODS: Eight eyes in 6 patients with age ...AIM: To report the 3mo outcomes of collagen crosslinking(CXL) with a hypo-osmolar riboflavin in thin corneas with the thinnest thickness less than 400 μm without epithelium.METHODS: Eight eyes in 6 patients with age 26.2±4.8y were included in the study. All patients underwent CXL using a hypo-osmolar riboflavin solution after its de-epithelization. Best corrected visual acuity, manifest refraction, the thinnest corneal thickness, and endothelial cell density were evaluated before and 3mo after the procedure.RESULTS: The mean thinnest thickness of the cornea was 408.5 ±29.0 μm before treatment and reduced to369.8 ±24.8 μm after the removal of epithelium. With the application of the hypo-osmolar riboflavin solution, the thickness increased to 445.0 ±26.5 μm before CXL and recover to 412.5 ±22.7 μm at 3mo after treatment, P =0.659). Before surgery, the mean K-value of the apex of the keratoconus corneas was 57.6 ±4.0 diopters, and slightly decreased(54.7±4.9 diopters) after surgery(P =0.085). Mean best-corrected visual acuity was 0.55 ±0.23 logarithm of the minimal angle of resolution, and increased to 0.53±0.26 logarithm after surgery(P =0.879).The endothelial cell density was 2706.4 ±201.6 cells/mm2 before treatment, and slightly decreased( 2641. 2 ±218.2 cells/mm2) at last fellow up(P =0.002).CONCLUSION: Corneal collagen cross-linking with a hypo-osmolar riboflavin in thin corneas seems to be a promising treatment. Further study should be done to evaluate the safety and efficiency of CXL in thin corneas for the long-term.展开更多
AIM： To investigate the long term（≥5 y） efficacy, predictability, and safety of laser in situ keratomileusis（LASIK） in eyes with thin corneas [central corneal thickness（CCT） 〈500 μm]. METHODS： A total of 33...AIM： To investigate the long term（≥5 y） efficacy, predictability, and safety of laser in situ keratomileusis（LASIK） in eyes with thin corneas [central corneal thickness（CCT） 〈500 μm]. METHODS： A total of 339 patients met the criteria of this study. Finally, 175 eyes of 89 patients who had thin corneas and underwent LASIK≥5 y ago returned to our clinic and included in this study. Preoperative parameters recorded included uncorrected visual acuity（UCVA）, corrected distance visual acuity（CDVA）, manifest refraction, CCT and corneal topography. At returning visits, in addition to visual acuity and manifest refraction, ultrasound CCT and corneal topography were performed. Optical coherence tomography was used to measure the CCT, LASIK flap thickness, and residual stromal bed thickness（RSBT）. Safety index, efficacy index, percentage of eyes within ±0.5 D and ±1.0 D of refraction, percent tissue altered（PTA）, and percentage stromal bed thickness（PSBT） were calculated. RESULTS： The safety index was 1.09 and efficacy index was 0.99. The percentages of eyes within ±0.5 D and ±1.0 D were 71.2% and 87.7%, respectively. The mean PTA was 40%±6%（range 20% to 55%）; 76 eyes（43.4%） had PTA 〈40% and 99 eyes（56.6%） had PTA≥40%. The mean RSBT was 303±27 μm（range 240 to 390 μm）, and 2 eyes had RSBT〈250 μm. The mean PSBT was 61%±9%（range 51% to 85%）. No eyes developed ectasia. CONCLUSION： In this cohort with the PSBT of 50% or more, LASIK is safe with follow-up for at least 5 y.展开更多
AIM： To choose appropriate concentration of sodium hydroxide（Na OH） solution to establish a stable and consistent corneal alkali burn mouse model in grade II.·METHODS： The mice（n =60） were randomly divided ...AIM： To choose appropriate concentration of sodium hydroxide（Na OH） solution to establish a stable and consistent corneal alkali burn mouse model in grade II.·METHODS： The mice（n =60） were randomly divided into four groups and 15 mice each group. Corneal alkali burns were induced by placing circle filter paper soaked with Na OH solutions on the right central cornea for 30 s.The concentrations of Na OH solutions of groups A, B, C,and D were 0.1 mol/L, 0.15 mol/L, 0.2 mol/L, and 1.0 mol/L respectively. Then these corneas were irrigated with 20 m L physiological saline（0.9% Na Cl）. On day 7 postburn, slit lamp microscope was used to observe corneal opacity,corneal epithelial sodium fluorescein staining positive rate, incidence of corneal ulcer and corneal neovascularization, meanwhile pictures of the anterior eyes were taken. Cirrus spectral domain optical coherence tomography was used to scan cornea to observe corneal epithelial defect and corneal ulcer.·RESULTS： Corneal opacity scores（ x ±s） were not significantly different between the group A and group B（P =0.097）. Incidence of corneal ulcer in group B was significantly higher than that in group A（P =0.035）.Incidence of corneal ulcer and perforation rate in group B was lower than that in group C. Groups C and D had corneal neovascularization, and incidence of corneal neovascularization in group D was significantly higher than that in group C（P =0.000）.·CONCLUSION： Using 0.15 mol/L Na OH can establish grade II mouse model of corneal alkali burns.展开更多
A rare case of bilateral scleromalacia perforans, bilateral peripheral corneal thinning (contact lens cornea) and unilateral orbital inflammatory disease in a 50 year old female patient with an indolent form Wegener&#...A rare case of bilateral scleromalacia perforans, bilateral peripheral corneal thinning (contact lens cornea) and unilateral orbital inflammatory disease in a 50 year old female patient with an indolent form Wegener's granulomatosis(WG) involving lungs and sinuses is reported. The patient survived for 12 years after the initial diagnosis of systemic disease. There was perforation of left globe following trauma and no perforation of the right globe till the last follow up of the patient.展开更多
AIM： To demonstrate the changes in ultrastructure and histopathology of the cornea in acute corneal alkaline burns after femtosecond laser-assisted deep lamellar keratoplasty.·METHODS： The New Zealand white rab...AIM： To demonstrate the changes in ultrastructure and histopathology of the cornea in acute corneal alkaline burns after femtosecond laser-assisted deep lamellar keratoplasty.·METHODS： The New Zealand white rabbits treated with alkaline corneal burn were randomized into two groups,Group A（16 eyes） with femtosecond laser-assisted deep lamellar keratoplasty 24 h after burn and Group B（16 eyes）without keratoplasty as controls. All eyes were evaluated with transmission electron microscopy（TEM） at 1, 2, 3,and 4wk follow-up, then all corneas were tested by hematoxylin and eosin staining histology.· RESULTS： The corneal grafts in Group A were transparent, while those in Group B showed corneal stromal edema and loosely arranged collagen fibers. One week after treatment, TEM revealed the intercellular desmosomes in the epithelial layers and intact non-dissolving nuclei in Group A. At week 4, the center of the corneas in Group A was transparent with regularly arranged collagen fibers and fibroblasts in the stroma. In Group B, squamous cells were observed on the corneal surface and some epithelial cells were detached.· CONCLUSION： Femtosecond laser-assisted deep lamellar keratoplasty can suppress inflammatory responses, prevent toxic substance-induced injury to the corneal endothelium and inner tissues with quicker recovery and better visual outcomes.展开更多
AIM： To evaluate the efficacy of modified corneal ulcer debridement in superficial fungal keratitis unresponsive to medications.METHODS： A total of 209 patients（209 eyes） with fungal keratitis, involving no more t...AIM： To evaluate the efficacy of modified corneal ulcer debridement in superficial fungal keratitis unresponsive to medications.METHODS： A total of 209 patients（209 eyes） with fungal keratitis, involving no more than 50% of the stromal depth and not responding to antifungal agents for 2 wk, were recruited in this retrospective, noncomparative study. The patients were treated with modified corneal ulcer debridement. All visible corneal infiltrates were removed under an operating microscope to obtain a clean stromal bed and smooth incised edges. Antifungal drugs were used immediately after surgery. Healing time of the ulcers was recorded. Fungal recurrence, visual acuity, corneal thickness and risk factors for treatment failure were monitored.RESULTS： The follow-up was 13.6±5.8m o. The corneal ulcers healed in 195 of 209 eyes（93.3%）, with a mean healing time of 8.4±6.8 d. The other 14 eyes were further treated by penetrating keratoplasty（PK）（1 eye）, anterior lamellar keratoplasty（LK）（7 eyes）, conjunctival flap covering（4 eyes） or amniotic membrane transplantation（2 eyes）. The best corrected visual acuity（BCVA） was ≥20/70 in 80.3% of the eyes, ≥20/40 in 56.9% of the eyes, and ≥20/25 in 27.3% of the eyes. The corneas at the lesions became thinner, but all in the safe range. No fungal recurrence or corneal ectasis developed during the follow-up. The risk of treatment failure was higher in patients with preoperative hypopyon（P=0.036） and ever using steroid（P=0.025）.CONCLUSION： Modified surgical debridement is a simple and effective method for the treatment of superficial fungal infection of the cornea, with improved visual acuity and no recurrence. Such an intervention in time can rapidly control fungal infection and largely shorten corneal ulcer healing time.展开更多
文摘Diabetic corneal neuropathy and diabetic retinopathy are ocular complications occurring in the context of diabetes mellitus.Diabetic corneal neuropathy refers to the progressive damage of corneal nerves.Diabetic retinopathy has traditionally been considered as damage to the retinal microvasculature.However,growing evidence suggests that diabetic retinopathy is a complex neurovascular disorder resulting from dysfunction of the neurovascular unit,which includes both the retinal vascular structures and neural tissues.Diabetic retinopathy is one of the leading causes of blindness and is frequently screened for as part of diabetic ocular screening.However,diabetic corneal neuropathy is commonly overlooked and underdiagnosed,leading to severe ocular surface impairment.Several studies have found that these two conditions tend to occur together,and they share similarities in their pathogenesis pathways,being triggered by a status of chronic hyperglycemia.This review aims to discuss the interconnection between diabetic corneal neuropathy and diabetic retinopathy,whether diabetic corneal neuropathy precedes diabetic retinopathy,as well as the relation between the stage of diabetic retinopathy and the severity of corneal neuropathy.We also endeavor to explore the relevance of a corneal screening in diabetic eyes and the possibility of using corneal nerve measurements to monitor the progression of diabetic retinopathy.
文摘AIM:To evaluate the clinical outcomes after subsequent implantation of a new intrastromal corneal ring segment(ICRS)model followed by an additional short-arc ICRS implant in keratoconus patients.METHODS:This retrospective single-arm cohort study evaluated 25 eyes of 21 keratoconus patients implanted with the new ICRS followed by 140-arch length ICRS(140-ICRS)implantation.Uncorrected distance visual acuity(UDVA,logMAR),corrected distance visual acuity(CDVA,logMAR),sphere,astigmatism,keratometry,spherical equivalent(SE),and asphericity were compared preoperatively and postoperatively after both ICRS implantation.RESULTS:The average follow-up time after 140-ICRS implantation was 6.40±2.20mo.The mean preoperative UDVA improved from 1.27±0.14 preoperative to 0.52±0.26 after both ICRS implantation(P=0.03).The mean sphere value reduced from-5.34±2.74 preoperatively to-2.06±1.84 postoperatively(P<0.001)after the first ICRS implantation and decreased to-0.59±1.54 postoperatively(P<0.001)after 140-ICRS implantation.The mean preoperative astigmatism was-3.72±1.56 and improved to-2.82±1.08 after the first ICRS implantation,and following the 140-ICRS implantation,the mean astigmatism was-1.37±0.67(P=0.001).The SE and asphericity changes were statistically significant(P<0.001).The researchers did not find intraoperative or postoperative complications for both procedures.CONCLUSION:The combination of 2 different ICRSs can efficiently regularize the cornea,reduce the SE,and improve visual acuity in selected keratoconus patients.
基金Supported by Independent Research Foundation of the 305 Hospital of PLA(No.24ZZJJLW-010).
文摘Among refractive errors,astigmatism is the most common optical aberration,where refraction changes in different meridians of the eye.It causes blurred vision at any distance and includes corneal,lenticular,and retinal astigmatism.Cataract surgery used to cause a progressive increase in the pre-exisiting corneal astigmatism because of creating a surgically induced astigmatism,for example,a large size surgery incision.The development of surgical techniques during last decades has made cataract surgery interchange to treat preoperative corneal astigmatism at time of surgery.Nowadays,three surgical approaches can be used.By placing a sutureless clear corneal incision on the steep meridian of the cornea,a preoperative corneal astigmatism less than 1.0 D can be corrected.Single or paired peripheral corneal relaxing incisions(PCRIs)provide 1.0-3.0 D corneal astigmatism correction.PCRIs are typically used for treating 1.0-1.5 D of regular corneal astigmatism,if more than 2.0 D,the risk of overcorrection and irregular astigmatism is increased.When toric intraocular lenses(IOLs)are unavailable in markets,PCRIs are still a reasonable option for patients with up to 3.0 D of pre-existing corneal astigmatism.Toric IOLs implantation can correct 1.0-4.5 D of corneal astigmatism.Several IOLs are approved to correct a high degree of corneal astigmatism with cylinder power up to 12.0 D.These approaches can be used alone or in combination.
文摘Background: This case report presents a case of bilateral Thiel-Behnke corneal dystrophy in Denmark. Thiel-Behnke is an autosomal dominant inherited epithelial-stromal TGFBI dystrophy causing visual impairment. Methods and Results: This case study presents a 24-year-old Lithuanian man, with no previous ocular history, who had experienced slowly progressive visual impairment since his childhood. He was examined at the Department of Ophthalmology at Vejle Hospital and Aarhus University Hospital, where he was diagnosed with bilateral Thiel-Behnke corneal dystrophy. Histology confirmed the diagnosis. A lamellar corneal transplantation was performed in the right eye;however, due to epithelial growth under the corneal graft, it was later decided to redo the operation. Following the operations, the patient experienced a visual improvement in best corrected visual acuity (BCVA) from 0.1 (20/25 Snellen equivalent) to 0.3 (20/40 Snellen equivalent) in his right eye. Conclusions: This case of Thiel-Behnke corneal dystrophy is to our knowledge the first reported case in Denmark.
文摘Corneal neuromas,also termed microneuromas,refer to microscopic,irregula rly-shaped enlargements of terminal subbasal nerve endings at sites of nerve damage or injury.The formation of corneal neuromas results from damage to corneal nerves,such as following corneal pathology or corneal or intraocular surge ries.Initially,denervated areas of sensory nerve fibers become invaded by sprouts of intact sensory nerve fibers,and later injured axons regenerate and new sprouts called neuromas develop.In recent years,analysis of corneal nerve abnormalities including corneal neuromas which can be identified using in vivo confocal microscopy,a non-invasive imaging technique with microscopic resolution,has been used to evaluate corneal neuropathy and ocular surface dysfunction.Corneal neuromas have been shown to be associated with clinical symptoms of discomfort and dryness of eyes,and are a promising surrogate biomarker for ocular surface diseases,such as neuropathic corneal pain,dry eye disease,diabetic corneal neuropathy,neurotrophic keratopathy,Sjogren's syndrome,bullous keratopathy,post-refra ctive surgery,and others.In this review,we have summarized the current literature on the association between these ocular surface diseases and the presentation of corneal microneuromas,as well as elaborated on their pathogenesis,visualization via in vivo confocal microscopy,and utility in monitoring treatment efficacy.As current quantitative analysis on neuromas mainly relies on manual annotation and quantification,which is user-dependent and labor-intensive,future direction includes the development of artificial intelligence software to identify and quantify these potential imaging biomarkers in a more automated and sensitive manner,allowing it to be applied in clinical settings more efficiently.Combining imaging and molecular biomarkers may also help elucidate the associations between corneal neuromas and ocular surface diseases.
基金Supported by National Natural Science Foundation of China(No.31571294).
文摘AIM:To investigate the role of transmembrane protein 206(TMEM206)in corneal edema in mice by knockout the TMEM206 gene using CRISPR/Cas9 editing technology.METHODS:TMEM206-knockout mice were generated using the CRISPR-Cas9 system.Variations in ophthalmic pathology were observed using slit lamp microscope and optical coherence tomography(OCT),intraocular pressure(IOP)was measured using a TonoLab Rebound Tonometer,and the ultrastructure of the corneal was observed using a transmission electron microscope.RESULTS:Corneal opacity was observed in 4/18 homozygous TMEM206^(-/-)mice whereas a similar change was not observed in heterozygous TMEM206^(+/-)mice and wild-type littermates.OCT examination showed that the mean central cornea thickness was 125±5.4μm in 4 homozygous TMEM206^(-/-)mice developed corneal edema and 115±1.2μm in wild-type mice(t=3.468,P<0.05)at 43wk.The mean IOP was 12.08±0.07 mm Hg in four right eyes with corneal edema and 12.03±0.03 mm Hg in three normal left eyes(P>0.05).Transmission electron microscopy revealed a disruption in the organization of the collagen fibrils in the central part of the cornea in homozygous TMEM206^(-/-)mice.CONCLUSION:TMEM206 is associated with corneal edema which caused organizational disruption of collagen fibrils in corneas of mice.
基金Supported by Xi’an Health Committee Research Projects(No.2023yb14)Shaanxi Province Natural Science Basic Research Project(No.2024JC-YBMS-623)Shaanxi Province Science and Technology Plan Project(No.2024SFYBXM-331).
文摘AIM:To assess the corneal high-order aberration(HOA)and its correlation with corneal morphological parameters in patients with bilateral keratoconus(KCN)and unilateral Vogt’s striae.METHODS:A total of 168 eyes of 84 patients with KCN,whose corneas had definite signs of unilateral Vogt’s striae,were enrolled.Corneal HOA and morphological parameters were measured using Pentacam HR.RESULTS:The corneal morphological parameters between KCN eyes with and without Vogt’s striae were evidently different(P<0.001).The 3rd coma 90°,4th spherical aberration,5th coma 90°,root-mean-square(RMS)(total),and RMS(HOA)in the front,back surfaces and total cornea in KCN eyes with Vogt’s striae were significantly higher than those in KCN eyes without Vogt’s striae(P<0.001).In KCN eyes with Vogt’s striae,the 3rd coma 90°and 4th spherical aberration in the front surface and total cornea were negatively correlated with flat keratometry value(K1),steep keratometry value(K2),mean keratometry value(Km),maximum keratometry value(Kmax),anterior corneal elevation(ACE),and posterior corneal elevation(PCE;P<0.05).The 3rd coma 90°,4th spherical aberration in back surface and RMS(total),RMS(HOA)in the front,back surfaces,total cornea were positively correlated with K1,K2,Km,Kmax,ACE,and PCE(P<0.05).CONCLUSION:Corneal HOA especially vertical coma and spherical aberration may increase when Vogt’s striae appeared in KCN eyes.The scale of increase is significantly related with changes in corneal shapes.
文摘In recent years, stem cells have been a focal point in research designed to evaluate the efficacy of ophthalmologic therapies, specifically those for corneal conditions. The corneal epithelium is one of the few regions of the body that maintains itself using a residual stem cell population within the adjacent limbus. Stem cell movement has additionally captivated the minds of researchers due to its potential application in different body regions. The cornea is a viable model for varying methods to track stem cell migratory patterns, such as lineage tracing and live imaging from the limbus. These developments have the potential to pave the way for future therapies designed to ensure the continuous regeneration of the corneal epithelium following injury via the limbal stem cell niche. This literature review aims to analyze the various methods of imaging used to understand the limbal stem cell niche and possible future directions that might be useful to consider for the better treatment and prevention of disorders of the cornea and corneal epithelium. .
基金Supported by National Natural Science Foundation of China(No.81700799)Clinical Medicine Plus X-Young Scholar Project,Peking University。
文摘AIM:To construct a competent corneal lamellar substitute in order to alleviate the shortage of human corneal donor.METHODS:Rabbit mesenchymal stem cells(MSCs)were isolated from bone marrow and identified by flow cytometric,osteogenic and adipogenic induction.Xenogenic decellularized corneal matrix(XDCM)was generated from dog corneas.MSCs were seeded and cultured on XDCM to construct the tissueengineered cornea.Post-transplantation biocompatibility of engineered corneal graft were tested by animal experiment.Rabbits were divided into two groups then underwent lamellar keratoplasty(LK)with different corneal grafts:1)XDCM group(n=5):XDCM;2)XDCM-MSCs groups(n=4):tissue-engineered cornea made up with XDCM and MSCs.The ocular surface recovery procedure was observed while corneal transparency,neovascularization and epithelium defection were measured and compared.In vivo on focal exam was performed 3 mo postoperatively.RESULTS:Rabbit MSCs were isolated and identified.Flow cytometry demonstrated isolated cells were CD90 positive and CD34,CD45 negative.Osteogenic and adipogenic induction verified their multipotent abilities.MSC-XDCM grafts were constructed and observed.In vivo transplantation showed the neovascularization in XDCMMSC group was much less than that in XDCM group postoperatively.Post-transplant 3-month confocal test showed less nerve regeneration and bigger cell-absent area in XDCM-MSC group.CONCLUSION:This study present a novel corneal tissue-engineered graft that could reduce post-operatively neovascularization and remain transparency,meanwhile shows that co-transplantation of MSCs may help increase corneal transplantation successful rate and enlarge the source range of corneal substitute to overcome cornea donor shortage.
文摘Diabetic neuropathy is a prevalent microvascular complication of diabetes mellitus,affecting nerves in all parts of the body including corneal nerves and peripheral nervous system,leading to diabetic corneal neuropathy and diabetic peripheral neuropathy,respectively.Diabetic peripheral neuropathy is diagnosed in clinical practice using electrophysiological nerve conduction studies,clinical scoring,and skin biopsies.However,these diagnostic methods have limited sensitivity in detecting small-fiber disease,hence they do not accurately reflect the status of diabetic neuropathy.More recently,analysis of alterations in the corneal nerves has emerged as a promising surrogate marker for diabetic peripheral neuropathy.In this review,we will discuss the relationship between diabetic corneal neuropathy and diabetic peripheral neuropathy,elaborating on the foundational aspects of each:pathogenesis,clinical presentation,evaluation,and management.We will further discuss the relevance of diabetic corneal neuropathy in detecting the presence of diabetic peripheral neuropathy,particularly early diabetic peripheral neuropathy;the correlation between the severity of diabetic corneal neuropathy and that of diabetic peripheral neuropathy;and the role of diabetic corneal neuropathy in the stratification of complications of diabetic peripheral neuropathy.
文摘Background:Our goal is to build a multi-unit ocular biometric system based on the fusion of left and right corneal shapes for identity authentication.Methods:Ocular biometrics such as iris,periocular,retina,sclera and eye movement have become established biometric traits,primarily due to extensive efforts made by the biometrics community in the field of iris recognition.In this work,we propose an ocular biometric trait based on the 3D shape of the cornea to improve biometric authentication.We show how the fusion of the left and right corneas can be used as a biometric trait for person recognition.First,we started by realizing our own cornea database by using a Pentacam Topographer(Oculus)which contains 288 corneal topographies of both eyes captured from 36 different people of different ages.For each eye,data acquisition was done during two different sessionsto establish the repeatability of the measurements over time.The time interval between the two sessions was equal or greater than one month.In each session;8 acquisitions(4 left eyes end 4 right eyes)were taken.Then,features were extracted by modeling the shape of the left and right corneas with a Zernike polynomial expansion.The fusion of the left and right shapes of cornea was performed at the matching score level using the weighted-sum rule.Results:For each individual,we had eight feature vectors(eight measures in two sessions)of size 36(Zernike polynomial coefficients)from their corneal topographies.The experimental results on our cornea database constructed for this study showed encouraging performance of the proposed ocular biometric system with Equal Error Rate decreasing to 1.38%with the weighted-sum rule compared to the analysis of the left(4.5%)or right(3.7%)cornea alone.Conclusions:The objective of this work was to investigate corneal topographyas an accurate biometric modality using shape discriminating features.Our idea was to propose an ocular multi-unit system based on the fusion of the left and right corneal shapes.The corneal feature extraction was done by Zernike polynomial decomposition.Multi-unit cornea fusion was performed at the matching score level to generate a unique score.This allowed a significative decrease of the EER to 1.38%.
基金Supported by National Natural Science Foundation of China(No.31200724)Key Innovation Project of Shaanxi Science and Technology Plan(No. 2012KTCQ03-11)+1 种基金Shenzhen Peacock Plan(No. KQCX20130628155525051)Projects of Basic Research of Shenzhen(No.JCYJ20120614193611639,No.JCYJ 20140509172959988)
文摘AIM： To assess acellular ostrich corneal matrix used as a scaffold to reconstruct a damaged cornea. METHODS： A hypertonic saline solution combined with a digestion method was used to decellularize the ostrich cornea. The microstructure of the acellular corneal matrix was observed by transmission electron microscopy （TEM） and hematoxylin and eosin （H＆E） staining. The mechanical properties were detected by a rheometer and a tension machine. The acellular corneal matrix was also transplanted into a rabbit cornea and cytokeratin 3 was used to check the immune phenotype, RESULTS： The microstructure and mechanical properties of the ostrich cornea were well preserved after the decellularization process, in vitro, the methyl thiazolyl tetrazoUum results revealed that extracts of the acellular ostrich corneas （AOCs） had no inhibitory effects on the proliferation of the corneal epithelial or endothelial cells or on the keratocytes, The rabbit lamellar keratoplasty showed that the transplanted AOCs were transparent and completely incorporated into the host cornea while corneal turbidity and graft dissolution occurred in the acellular porcine cornea （APC） transplantation, The phenotype of the reconstructed cornea was similar to a normal rabbit cornea with a high expression of cytokeratin 3 in the superficial epithelial cell layer, CONCLUSION： We first used AOCs as scaffolds to reconstruct damaged corneas. Compared with porcine corneas, the anatomical structures of ostrich corneas are closer to those of human corneas. In accordance with the principle that structure determines function, a xenograft lamellar keratoplasty also confirmed that the AOC transplantation generated a superior outcome compared to that of the APC graft.
基金National Natural Science Foundation of China(No.50973082)
文摘The keratoprosthesis(KPro;artificial cornea)is a special refractive device to replace human cornea by using heterogeneous forming materials for the implantation into the damaged eyes in order to obtain a certain vision.The main problems of artificial cornea are the biocompatibility and stability of the tissue particularly in penetrating keratoplasty.The current studies of tissue-engineered scaffold materials through comprising composites of natural and synthetic biopolymers together have developed a new way to artificial cornea.Although a wide agreement that the long-term stability of these devices would be greatly improved by the presence of cornea cells,modification of keratoprosthesis to support cornea cells remains elusive.Most of the studies on corneal substrate materials and surface modification of composites have tried to improve the growth and biocompatibility of cornea cells which can not only reduce the stimulus of heterogeneous materials,but also more importantly continuous and stable cornea cells can prevent the destruction of collagenase.The necrosis of stroma and spontaneous extrusion of the device,allow for maintenance of a precorneal tear layer,and play the role of ensuring a good optical surface and resisting bacterial infection.As a result,improvement in corneal cells has been the main aim of several recent investigations;some effort has focused on biomaterial for its well biological properties such as promoting the growth of cornea cells.The purpose of this review is to summary the growth status of the corneal cells after the implantation of several artificial corneas.
基金Supported by the National Natural Science Foundation of China(No.81271716)
文摘AIM：To investigate the feasibility of corneal anterior lamellar reconstruction with human corneal epithelial cells and fibroblasts,and an acellular porcine cornea matrix（APCM） in vitro.·METHODS：The scaffold was prepared from fresh porcine corneas which were treated with 0.5%sodium dodecyl sulfate（SDS）solution and the complete removal of corneal cells was confirmed by hematoxylin-eosin（HE）staining and 4’,6-diamidino-2-phenylindole（DAPI）staining.Human corneal fibroblasts and epithelial cells were cultured with leaching liquid extracted from APCM,and then cell proliferative ability was evaluated by MTT assay.To construct a human corneal anterior lamellar replacement,corneal fibroblasts were injected into the APCM and cultured for 3d,followed by culturing corneal epithelial cells on the stroma construction surface for another 10d.The corneal replacement was analyzed by HE staining,and immunofluorescence staining.·R ESULTS：Histological examination indicated that there were no cells in the APCM by HE staining,and DAPI staining did not detect any residual DNA.The leaching liquid from APCM had little influence on the proliferation ability of human corneal fibroblasts and epithelial cells.At 10d,a continuous 3 to 5 layers of human corneal epithelial cells covering the surface of the APCM was observed,and the injected corneal fibroblasts distributed within the scaffold.The phenotype of the construction was similar to normal human corneas,with high expression of cytokeratin 12 in the epithelial cell layer and high expression of Vimentin in the stroma.·CONCLUSION：Corneal anterior lamellar replacement can be reconstructed in vitro by cultivating human corneal epithelial cells and fibroblasts with an acellular porcine cornea matrix.This laid the foundation for the further transplantation in vitro.
文摘AIM: To report the 3mo outcomes of collagen crosslinking(CXL) with a hypo-osmolar riboflavin in thin corneas with the thinnest thickness less than 400 μm without epithelium.METHODS: Eight eyes in 6 patients with age 26.2±4.8y were included in the study. All patients underwent CXL using a hypo-osmolar riboflavin solution after its de-epithelization. Best corrected visual acuity, manifest refraction, the thinnest corneal thickness, and endothelial cell density were evaluated before and 3mo after the procedure.RESULTS: The mean thinnest thickness of the cornea was 408.5 ±29.0 μm before treatment and reduced to369.8 ±24.8 μm after the removal of epithelium. With the application of the hypo-osmolar riboflavin solution, the thickness increased to 445.0 ±26.5 μm before CXL and recover to 412.5 ±22.7 μm at 3mo after treatment, P =0.659). Before surgery, the mean K-value of the apex of the keratoconus corneas was 57.6 ±4.0 diopters, and slightly decreased(54.7±4.9 diopters) after surgery(P =0.085). Mean best-corrected visual acuity was 0.55 ±0.23 logarithm of the minimal angle of resolution, and increased to 0.53±0.26 logarithm after surgery(P =0.879).The endothelial cell density was 2706.4 ±201.6 cells/mm2 before treatment, and slightly decreased( 2641. 2 ±218.2 cells/mm2) at last fellow up(P =0.002).CONCLUSION: Corneal collagen cross-linking with a hypo-osmolar riboflavin in thin corneas seems to be a promising treatment. Further study should be done to evaluate the safety and efficiency of CXL in thin corneas for the long-term.
基金Supported in part by the National Natural Science Foundation of China(No.11402161)the Programs for Science and Technique Development of Shanxi Province,China(No.20120313025-3)+1 种基金the Science and Technology Research Projects of the Shanxi Provincial Health Department,China(No.201201018)an unrestricted grant from Research to Prevent Blindness,New York,NY,USA
文摘AIM： To investigate the long term（≥5 y） efficacy, predictability, and safety of laser in situ keratomileusis（LASIK） in eyes with thin corneas [central corneal thickness（CCT） 〈500 μm]. METHODS： A total of 339 patients met the criteria of this study. Finally, 175 eyes of 89 patients who had thin corneas and underwent LASIK≥5 y ago returned to our clinic and included in this study. Preoperative parameters recorded included uncorrected visual acuity（UCVA）, corrected distance visual acuity（CDVA）, manifest refraction, CCT and corneal topography. At returning visits, in addition to visual acuity and manifest refraction, ultrasound CCT and corneal topography were performed. Optical coherence tomography was used to measure the CCT, LASIK flap thickness, and residual stromal bed thickness（RSBT）. Safety index, efficacy index, percentage of eyes within ±0.5 D and ±1.0 D of refraction, percent tissue altered（PTA）, and percentage stromal bed thickness（PSBT） were calculated. RESULTS： The safety index was 1.09 and efficacy index was 0.99. The percentages of eyes within ±0.5 D and ±1.0 D were 71.2% and 87.7%, respectively. The mean PTA was 40%±6%（range 20% to 55%）; 76 eyes（43.4%） had PTA 〈40% and 99 eyes（56.6%） had PTA≥40%. The mean RSBT was 303±27 μm（range 240 to 390 μm）, and 2 eyes had RSBT〈250 μm. The mean PSBT was 61%±9%（range 51% to 85%）. No eyes developed ectasia. CONCLUSION： In this cohort with the PSBT of 50% or more, LASIK is safe with follow-up for at least 5 y.
基金Supported by National Science and Technology Major Project of China(No.2011ZXJ09104-10C)
文摘AIM： To choose appropriate concentration of sodium hydroxide（Na OH） solution to establish a stable and consistent corneal alkali burn mouse model in grade II.·METHODS： The mice（n =60） were randomly divided into four groups and 15 mice each group. Corneal alkali burns were induced by placing circle filter paper soaked with Na OH solutions on the right central cornea for 30 s.The concentrations of Na OH solutions of groups A, B, C,and D were 0.1 mol/L, 0.15 mol/L, 0.2 mol/L, and 1.0 mol/L respectively. Then these corneas were irrigated with 20 m L physiological saline（0.9% Na Cl）. On day 7 postburn, slit lamp microscope was used to observe corneal opacity,corneal epithelial sodium fluorescein staining positive rate, incidence of corneal ulcer and corneal neovascularization, meanwhile pictures of the anterior eyes were taken. Cirrus spectral domain optical coherence tomography was used to scan cornea to observe corneal epithelial defect and corneal ulcer.·RESULTS： Corneal opacity scores（ x ±s） were not significantly different between the group A and group B（P =0.097）. Incidence of corneal ulcer in group B was significantly higher than that in group A（P =0.035）.Incidence of corneal ulcer and perforation rate in group B was lower than that in group C. Groups C and D had corneal neovascularization, and incidence of corneal neovascularization in group D was significantly higher than that in group C（P =0.000）.·CONCLUSION： Using 0.15 mol/L Na OH can establish grade II mouse model of corneal alkali burns.
文摘A rare case of bilateral scleromalacia perforans, bilateral peripheral corneal thinning (contact lens cornea) and unilateral orbital inflammatory disease in a 50 year old female patient with an indolent form Wegener's granulomatosis(WG) involving lungs and sinuses is reported. The patient survived for 12 years after the initial diagnosis of systemic disease. There was perforation of left globe following trauma and no perforation of the right globe till the last follow up of the patient.
基金Supported by the Military Medical Science and Technology General Project During the 12thFive-Year Plan Period(No.CWS11J239)Autonomous Region of Xinjiang the Mandatory Project of Science and Technology(No.201491171)
文摘AIM： To demonstrate the changes in ultrastructure and histopathology of the cornea in acute corneal alkaline burns after femtosecond laser-assisted deep lamellar keratoplasty.·METHODS： The New Zealand white rabbits treated with alkaline corneal burn were randomized into two groups,Group A（16 eyes） with femtosecond laser-assisted deep lamellar keratoplasty 24 h after burn and Group B（16 eyes）without keratoplasty as controls. All eyes were evaluated with transmission electron microscopy（TEM） at 1, 2, 3,and 4wk follow-up, then all corneas were tested by hematoxylin and eosin staining histology.· RESULTS： The corneal grafts in Group A were transparent, while those in Group B showed corneal stromal edema and loosely arranged collagen fibers. One week after treatment, TEM revealed the intercellular desmosomes in the epithelial layers and intact non-dissolving nuclei in Group A. At week 4, the center of the corneas in Group A was transparent with regularly arranged collagen fibers and fibroblasts in the stroma. In Group B, squamous cells were observed on the corneal surface and some epithelial cells were detached.· CONCLUSION： Femtosecond laser-assisted deep lamellar keratoplasty can suppress inflammatory responses, prevent toxic substance-induced injury to the corneal endothelium and inner tissues with quicker recovery and better visual outcomes.
基金Supported by the Natural Science Foundation of Shandong Province(No.ZR2014HQ059)
文摘AIM： To evaluate the efficacy of modified corneal ulcer debridement in superficial fungal keratitis unresponsive to medications.METHODS： A total of 209 patients（209 eyes） with fungal keratitis, involving no more than 50% of the stromal depth and not responding to antifungal agents for 2 wk, were recruited in this retrospective, noncomparative study. The patients were treated with modified corneal ulcer debridement. All visible corneal infiltrates were removed under an operating microscope to obtain a clean stromal bed and smooth incised edges. Antifungal drugs were used immediately after surgery. Healing time of the ulcers was recorded. Fungal recurrence, visual acuity, corneal thickness and risk factors for treatment failure were monitored.RESULTS： The follow-up was 13.6±5.8m o. The corneal ulcers healed in 195 of 209 eyes（93.3%）, with a mean healing time of 8.4±6.8 d. The other 14 eyes were further treated by penetrating keratoplasty（PK）（1 eye）, anterior lamellar keratoplasty（LK）（7 eyes）, conjunctival flap covering（4 eyes） or amniotic membrane transplantation（2 eyes）. The best corrected visual acuity（BCVA） was ≥20/70 in 80.3% of the eyes, ≥20/40 in 56.9% of the eyes, and ≥20/25 in 27.3% of the eyes. The corneas at the lesions became thinner, but all in the safe range. No fungal recurrence or corneal ectasis developed during the follow-up. The risk of treatment failure was higher in patients with preoperative hypopyon（P=0.036） and ever using steroid（P=0.025）.CONCLUSION： Modified surgical debridement is a simple and effective method for the treatment of superficial fungal infection of the cornea, with improved visual acuity and no recurrence. Such an intervention in time can rapidly control fungal infection and largely shorten corneal ulcer healing time.
