Journal of Cornea

Pterygium Is Related to Short Axial Length

Zhang, Li Mei; Lu, Yang; Gong, Lan

Cornea. ۳۹(۲):۱۴۰-۱۴۵, February 2020.

Purpose:

To test the hypothesis that pterygium presents with both refractive and anatomical changes, especially short axial length.

Methods:

A retrospective, hospital-based cross-sectional study included 521 eyes from 521 patients who were enrolled through a community survey by Shanghai Heping Eye Hospital was conducted. Patients with primary pterygium in at least 1 eye were considered the pterygium group, and those with normal eyes were considered the nonpterygium group. The prevalence and length of pterygium, refractive characteristics including spherical power, astigmatism, corneal curvature, and anatomical parameters including axial length, anterior chamber depth, endothelial cell density, and corneal thickness were compared between groups.

Results:

Five hundred twenty-one eyes of 521 patients (214 men and 307 women) with a mean age of 70.5 ± ۷.۶ years were included in the study. The prevalence of hyperopia (81.6%, 65.1%, P = ۰.۰۰۱), axial length (23.1 ± ۱.۲ mm, 24.2 ± ۲.۴ mm, P < 0.001), anterior chamber depth (2.9 ± ۰.۳ cm, 3.1 ± ۰.۴ cm, P = ۰.۰۰۱), flat K value (42.94 ± ۲.۱۶ diopters, 43.73 ± ۱.۴۸ diopters, P = ۰.۰۰۲), Kmax (51.13 ± ۷.۷۴ diopters, 47.49 ± ۵.۶۲ diopters, P < 0.001), and spherical power (0.97 ± ۲.۴۰ diopters, −۰.۸۲ ± ۴.۴۰ diopters, P < 0.001) were statistically different between the pterygium and nonpterygium groups. Age (r = −۰.۲۱, P = ۰.۰۲۵), corneal astigmatism (r = −۰.۴۱, P < 0.001), flat K value (r = −۰.۳۹, P < 0.001), and endothelial cell density (r = −۰.۳۳, P = ۰.۰۰۱) were all negatively correlated with the length of pterygium. The prevalence of pterygium and severe pterygium over 3 mm were statistically different according to the severity of hyperopia ( P < 0.001) and axial length ( P < 0.001). Stratified χ ۲ analysis showed that axial length, rather than hyperopia, was a related factor to pterygium (odds ratio = 5.23, 95% confidence interval: 2.50–۱۰.۹۳).

Conclusions:

We conclude from our study that the prevalence of pterygium is related to small eye size. SDF-1/CXCR4 signaling may play a vital role in pterygium and shorter axial length. Further study focused on SDF-1/CXCR4 signaling will be needed.

Subclinical Inflammation of the Ocular Surface in Soft Contact Lens Wear

Saliman, Noor Haziq; Morgan, Philip B.; MacDonald, Andrew S.; More

Cornea. ۳۹(۲):۱۴۶-۱۵۴, February 2020.

Purpose:

To investigate the inflammatory response of the ocular surface with different soft contact lens (CL) replacement frequencies and materials.

Methods:

Twenty soft CL wearers were required to wear 3 lens types: reusable Acuvue 2 (A2), reusable Acuvue Oasys (AO), and daily disposable Acuvue Oasys (AODD), for 1 week in random sequence in 1 eye with the nonlens-wearing eye acting as a control. Three methods were used to assess the subclinical response: tear cytokine evaluation, in vivo confocal microscopy (IVCM), and impression cytology.

Results:

Of 13 cytokines investigated, differences were observed only for IL-12p70, which was present in greater concentrations for A2 (interocular difference 8.8 pg/mL, 95% confidence interval 5.5–۱۲.۱) and AO (8.9 [5.7–۱۲.۱]) compared with AODD (3.7 [0.6–۶.۸]). For IVCM, corneal presumed dendritic cell density was lower for AODD (interocular difference 1.9 [−۰.۱ to 3.9] cells/mm ۲ ) than for both A2 (9.3 [7.2–۱۱.۴]) and AO (10.6 [8.6–۱۲.۶]). This trend was the same for the other 5 IVCM measures evaluated. The proportion of CD45 + cells in the bulbar conjunctiva was lower for AODD (0.6 [−۰.۳ to 1.5]%) compared with A2 (4.6 [3.7–۵.۶]) and AO (4.8 [3.9–۵.۸]). Similar findings were observed for cells in the upper lid margin.

Conclusions:

This work has demonstrated for the first time that daily disposable CL wear produces a minimal subclinical inflammatory response compared with no lens wear over 1 week. By contrast, this inflammatory response is upregulated with reusable lenses but appears to be similar between hydrogel and silicone hydrogel materials over this short time frame.

Accelerated Versus Standard Corneal Cross-Linking for Progressive Keratoconus: A Meta-Analysis of Randomized Controlled Trials

Kobashi, Hidenaga; Tsubota, Kazuo

Cornea. ۳۹(۲):۱۷۲-۱۸۰, February 2020.

Purpose:

To compare the clinical results of accelerated corneal collagen cross-linking (ACXL) to standard corneal collagen cross-linking (SCXL) in progressive keratoconus by summarizing randomized controlled trials using a meta-analysis.

Methods:

Trials meeting the selection criteria were quality appraised, and data were extracted by 2 independent authors. A comprehensive search was performed using the Cochrane methodology to evaluate the clinical outcomes of ACXL and SCXL for treating progressive keratoconus. Estimates were evaluated by weighted mean difference (WMD) and 95% confidence interval (CI) for absolute changes of the outcomes during 12-month observation periods. Postoperative demarcation line depth was also compared.

Results:

We identified 6 randomized controlled trials that met the eligibility criteria for this meta-analysis. SCXL resulted in a significantly better outcome in postoperative changes in best spectacle-corrected visual acuity (WMD = −۰.۰۲; ۹۵% CI, −۰.۰۳ to −۰.۰۱; P < 0.0001); however, the small differences may not be clinically significant. ACXL provided a significantly better improvement of cylindrical refraction after the 1-year follow-up (WMD = 0.15; 95% CI, 0.05–۰.۲۶; P = ۰.۰۰۵). Demarcation line depth at 1 month after SCXL was deeper than that after ACXL (WMD = −۱۰۲.۲۵; ۹۵% CI, −۱۵۷.۱۶ to −۴۷.۳۵; P = ۰.۰۰۰۳). No differences in the changes in maximum keratometry, central corneal thickness, uncorrected visual acuity, spherical equivalent refraction, corneal biomechanical properties, and corneal endothelial cell density were found among both groups.

Conclusions:

An ACXL shows a comparable efficacy and safety profile at the 1-year follow-up, but it has less impact on improving best spectacle-corrected visual acuity when compared with the Dresden protocol. Overall, both methods similarly stop the disease progression.

Successful Descemet Membrane Endothelial Keratoplasty in Proven Herpetic Endothelial Decompensation Requires Intensive Antiviral Therapy

Friehmann, Asaf; Myerscough, James; Giannaccare, Giuseppe; More

Cornea. ۳۹(۲):۱۹۶-۱۹۹, February 2020.

Purpose:

To report the outcomes of Descemet membrane endothelial keratoplasty (DMEK) with intensive antiviral therapy for corneal edema secondary to herpes simplex virus type 1 (HSV-1)-mediated endotheliitis.

Methods:

All eyes with polymerase chain reaction positive for HSV-1 undergoing DMEK for endothelial decompensation between January 2014 and January 2018 were followed up prospectively at our tertiary referral center. All eyes had been free of active inflammation for a minimum of 9 months and were treated prophylactically with high-dose systemic and topical antivirals, which were continued for a prolonged period of time. Primary outcomes were the occurrence of immunological rejection and/or recurrence of endotheliitis, eventually resulting in graft failure. Secondary outcomes were best spectacle-corrected visual acuity and endothelial cell loss.

Results:

Four consecutive eyes of 4 patients were included with a mean (±SD) patient age of 68.5 ± ۱۵.۱ years. The postoperative follow-up averaged 22 months. No eyes exhibited any signs of immunologic rejection, recurrence of endotheliitis, or graft failure. Mean (±SD) decimal best spectacle-corrected visual acuity improved from 0.2 ± ۰.۱ to 0.7 ± ۰.۲ ( P = ۰.۰۰۷), whereas mean (±SD) endothelial cell loss was 56% ± ۱۰.۲% at the final postoperative follow-up.

Conclusions:

DMEK is an effective option to treat corneal edema secondary to HSV-1-related endotheliitis. Intensive antiviral prophylaxis may reduce the risk of recurrence and subsequent graft failure.