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International Journal of Keratoconus and Ectatic Corneal Diseases
Current Issue : Volume 5, Issue 1, January-April 2016
 
 
1.  Original Article
Corneal Deformation Response with Dynamic Ultra-high-speed Scheimpflug Imaging for Detecting Ectatic Corneas
Marcella Q Salomão, Fernando F Correia, Isaac Ramos, Allan Luz, Renato Ambrósio Jr
[Pages No:1-5]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1113 | FREE

ABSTRACT

Purpose: To test the ability of metrics derived from corneal response to noncontact tonometry (NCT) to distinguish between normal and ectatic cases.

Materials and methods: The prototype of CorVis ST (Oculus, Wetzlar, Germany) was used for assessing corneal biomechanical response using ultra-high-speed 8 mm horizontal Scheimpflug photography, taking 4,330 frames per second during NCT. Patients were stratified based on clinical data, including rotating Scheimpflug corneal tomography (Oculus Pentacam HR). Biomechanical data from one eye randomly selected of 177 patients with normal corneas (N) and from 79 patients with bilateral keratoconus (KC) were investigated. Group forme fruste keratoconus (FFKC) was composed of 20 eyes with normal topographic patterns from cases with ectasia detected in the fellow eye. Group keratoconus suspect (KCS) had 16 eyes from 16 patients with topographic patterns suspicious of KC but documented stability over 3 years and normal tomographic findings. A combination of deformation parameters using linear regression analysis (Prototype Factor 1, pF1) was created by the BrAIn (Brazilian Artificial Intelligence on Corneal Tomography and Biomechanics) study group in order to provide the best possible separation of KC and normals.

Results: Statistical significant differences were found for N × KC for several parameters, including first and second applanation times, deformation amplitude, and maximal concavity radius (Mann-Whitney, p < 0.001). However, the areas under the receiver operating characteristic curves (AUC) were lower than 0.90. The pF1 had AUC of 0.945 (IC 0.909-0.97; sensitivity = 87.3% and specificity = 89.3%). The pF1 had statistically significant differences between the ectatic (KC and FFKC) and nonectatic groups (N and KCS) (p < 0.05, Kruskall-Wallis Test with post hoc Dunn’s test).

Conclusion: Corneal deformation response analysis by ultrahigh- speed 8 mm horizontal Scheimpflug photography provides relevant data for distinguishing ectatic and nonectatic corneas but cannot be used independently to detect KC. This data may be integrated with corneal tomography data for enhancing sensitivity and specificity for screening ectasia.

Keywords: Corneal biomechanics, CorVis ST, Forme fruste keratoconus, Keratoconus.

How to cite this article: Salomão MQ, Correia FF, Ramos I, Luz A, Ambrósio R Jr. Corneal Deformation Response with Dynamic Ultra-high-speed Scheimpflug Imaging for Detecting Ectatic Corneas. Int J Kerat Ect Cor Dis 2016;5(1):1-5.

Source of support: Nil

Conflict of interest: None

 
2.  Review Article
Eye Rubbing, a Sine Qua Non for Keratoconus?
Damien Gatinel
[Pages No:6-12]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1114 | FREE

ABSTRACT

Keratoconus, a dystrophy of unknown origin, remains an ophthalmic enigma. The contrast between the presence of marked structural changes and deformation of the corneal wall and the relative absence of specific genetic and biomolecular findings continues to intrigue ophthalmologists. In Marfan syndrome, where genetic and molecular abnormalities are well identified, and similar changes in collagen observed, the cornea tends not to be steeper, irregular or ectatic, but are globally flatter. This suggests that an external mechanical force may be necessary to induce the apparition and progression of the ectatic process in keratoconus. Eye rubbing has long been acknowledged as a risk factor for keratoconus and its progression, but could it in fact be the root cause? Many clinical observations and reports support the hypothesis of eye rubbing as a first and necessary hit for inducing progressive ectatic deformation of the corneal wall. Validating or refuting this hypothesis on the basis of patient admission may be impossible. It is difficult to document the frequency, duration and intensity of eye rubbing in patients with keratoconus, and virtually impossible to prove that every patient who denies the habit truly does not rub his eyes. Both the increase in incidence of atopy and the time spent in front of the computer screen in the general population may account for an increased tendency for eye rubbing, and lead to the perceived increased prevalence of keratoconus in both urban and non-urban areas. This paper explores the possibility that the mechanical stress imposed on the cornea by rubbing may not be as much a second hit evoking the structural changes of a predisposed cornea exhibiting unknown collagen progressive alteration, but rather the necessary trigger and sine qua non of the keratoconic process. Even if this provocative hypothesis is impossible to prove, it is equally difficult to refute, and acknowledging eye rubbing as a possible root cause increases awareness within the general population and if true, could dramatically reduce the incidence of keratoconus, and halt its progression in eyes already affected.

Keywords: Computer vision syndrome, Corneal biomechanics, Crosslinking, Ectasia, Eye rubbing, Etiology of keratoconus, Keraotoconus, Marfan syndrome.

How to cite this article: Gatinel D. Eye Rubbing, a Sine Qua Non for Keratoconus? Int J Kerat Ect Cor Dis 2016;5(1):6-12.

Source of support: I thank Cordelia Chan, MD, for assisting the revision of the manuscript.

Conflict of interest: None

 
3.  Review Article
Corneal Collagen Cross-linking in Infective Keratitis
Shiji Ummar, Abdelsattar N Farrag
[Pages No:13-16]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1115 | FREE

ABSTRACT

Purpose of review: To summarize the current understanding of effects of cross-linking (CXL) in infective keratitis based on available evidence.

Method of literature search: A PubMed search was conducted with combinations not limited to the following search terms: corneal collagen CXL, riboflavin, ultraviolet A, keratoconus, microbial keratitis, fungal keratitis, bacterial keratitis, Acanthamoeba keratitis. A review of the search results was performed and relevant articles to the topic were included.

Summary: Most of the published literature showed promising results in treatment of infectious keratitis by corneal collagen CXL using photoactivated riboflavin as an adjuvant therapy but with questionable efficacy in deep keratitis due to slowgrowing organisms.

How to cite this article: Ummar S, Farrag AN. Corneal Collagen Cross-linking in Infective Keratitis. Int J Kerat Ect Cor Dis 2016;5(1):13-16.

Source of support: Nil

Conflict of interest: None

 
4.  Review Article
Implantable Contact Lenses in Keratoconus
Suruchi Gupta
[Pages No:17-20]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1116 | FREE

ABSTRACT

Keratoconus is a progressive inherited disorder with varying economic and social consequences. Varying modalities of visual rehabilitation such as spectacles, contact lenses, surgical treatment in the form of corneal collagen cross-linking to arrest progression, and surface refractive procedures such as photorefractive keratectomy, implantation of phakic intraocular lenses (IOLs), or Intacs have been undertaken with varying results. This review article focuses on the introduction of phakic IOLs/implantable contact lenses in keratoconus. Thorough research was made on PubMed, Google, HINARI, and related sites for all related material, and it was thoroughly studied to draft this article.

Keywords: Corneal collagen cross-linking, Implantable contact lens, Keratoconus, Toric.

How to cite this article: Gupta S. Implantable Contact Lenses in Keratoconus. Int J Kerat Ect Cor Dis 2016;5(1):17-20.

Source of support: Nil

Conflict of interest: None

 
5.  Review Article
Progression in Keratoconus
Paolo Vinciguerra, Raffaele Piscopo, Fabrizio Camesasca, Riccardo Vinciguerra
[Pages No:21-31]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1117 | FREE

ABSTRACT

The study of keratoconus progression was once based upon slitlamp study, keratometry, and placido disk image examination. Today we have a lot of new corneal devices and indexes wich can help the ophthalmologist to make earlier the diagnosis and also to recognize as much is possible a progressive keratoconus. Only a deep knowledge of the meaning of all these indexes and values, together with the ability to interlock one another, increases reliability in the evaluation of Corneal Ectasia. Some pratical instructions are provided to help the early diagnosis of progressive Keratoconus.

Keywords: Corneal tomography, Corneal topography, Ectasia, Keratoconus.

How to cite this article: Vinciguerra P, Piscopo R, Camesasca F, Vinciguerra R. Progression in Keratoconus. Int J Kerat Ect Cor Dis 2016;5(1):21-31.

Source of support: Nil

Conflict of interest: None

 
6.  Case Series
Pathogenesis of Fixed Dilated Pupil (Urrets-Zavalía Syndrome) after Deep Lamellar Keratoplasty in Keratoconus
José RC Reis, Alberto Diniz-Filho, Fábio M Rocha, Leonardo Torquetti
[Pages No:32-34]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1118 | FREE

ABSTRACT

Purpose: To present a case series of patients that developed Urrets-Zavalia syndrome (UZS) after deep anterior lamellar keratoplasty (DALK) for treating keratoconus and discuss the mechanisms for the syndrome.

Materials and methods: Retrospective chart analysis of patients who developed UZS after DALK at the Cornea Unit, Hospital São Geraldo, Federal University of Minas Gerais.

Results: We present a series of 3 patients with features consistent with UZS, after undergoing DALK. Elevated intraocular pressure (IOP) was noted in the early postoperative period in 2 cases, despite the fact that the other case reported eye pain, headache, and nausea at the night after the surgery with undocumented IOP. Although at different extents, the pupil remained atrophic and dilated in all 3 eyes, and 2 of them developed anterior subcapsular cataract.

Conclusion: Iris ischemia resulting from occlusion of iris root vessels due to elevated IOP higher than diastolic blood pressure causes UZS. Elevated IOP should be monitored, especially in young patients with low diastolic blood pressure, in order to avoid the occurrence of the syndrome.

Keywords: Cornea, Keratoconus, Keratoplasty, Pupil.

How to cite this article: Reis JRC, Diniz-Filho A, Rocha FM, Torquetti L. Pathogenesis of Fixed Dilated Pupil (Urrets-Zavalía Syndrome) after Deep Lamellar Keratoplasty in Keratoconus. Int J Kerat Ect Cor Dis 2016;5(1):32-34.

Source of support: Nil

Conflict of interest: None

 
7.  Case Report
Subclinical Keratoconus Detection in Identical Twins
Gustavo Guerra, Vitor Buchmuller de Oliveira, Ivan Ferreira, Isaac Ramos, Michael W Belin, Renato Ambrósio Jr
[Pages No:35-39]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1119 | FREE

ABSTRACT

Purpose: To report clinical keratoconus in only one eye of two identical female twins, along with subclinical disease in the fellow eyes, elaborating on the two-hit hypothesis of ectasia development, which relates to the combination of genetics and the impact of environment.

Methods: Case report and literature review.

Results: Two identical 48-year-old female twins were presented for clinical evaluation. Mild keratoconus was detected in the right eye of twin 1, characterized by classic slit-lamp findings (exacerbated corneal nerves and incomplete Fleisher’s ring) and front surface curvature abnormalities, including asymmetry of the inferior-superior curvature at 6 mm (I-S value) of 2.78 D and a grade 1 Topographic Keratoconus Classification pattern. Topographic Keratoconus Classification was possible in the fellow eye of twin 1 (I-S value = 1.22 D) and negative in both eyes of twin 2 (I-S value = -0.46 OD and -0.13 OS). Ambrósio’s Relational Thickness for the maximal progression meridian was 209 and 354 in twin 1 and 360 and 392 in twin 2 in the right and left eyes respectively. The final deviation value of the Belin-Ambrósio Enhanced Ectasia Display was 4.54 and 1.47 in twin 1 and 1.7 and 1.35 in twin 2.

Conclusion: Corneal tomography data provide a better representation of corneal genotype in detecting mild, subclinical, or forme fruste keratoconus in the fellow eyes with normal topography of these twins. These cases present high risk or susceptibility for ectasia progression if environmental factors are associated (second hit).

Keywords: Corneal tomography, Heritability, Subclinical or forme fruste keratoconus, Twin.

How to cite this article: Guerra G, de Oliveira VB, Ferreira I, Ramos I, Belin MW, Ambrósio R Jr. Subclinical Keratoconus Detection in Identical Twins. Int J Kerat Ect Cor Dis 2016;5(1):35-39.

Source of support: Nil

Conflict of interest: Dr. Ambrósio and Dr. Belin are consultants for OCULUS Optikgeräte GmbH.

 
8.  Case Report
Unilateral Ectasia characterized by Advanced Diagnostic Tests
Isaac C Ramos, Dan Z Reinstein, Timothy J Archer, Marine Gobbe, Marcella Q Salomão, Bernardo Lopes, Allan Luz, Fernando Faria-Correia, Damien Gatinel, Michael W Belin, Renato Ambrósio Jr
[Pages No:40-51]
Full Text PDF | Abstract | DOI : 10.5005/jp-journals-10025-1120 | FREE

ABSTRACT

To describe a case of very asymmetric ectasia successfully treated by femtosecond laser-assisted intracorneal ring segment implantation, in which the diagnosis of unilateral ectasia in the right eye was based on the clinical findings including history, follow-up, and advanced diagnostic data. The patient’s history was positive for ocular allergy with moderateto- intense eye rubbing only in the right eye. The uncorrected distance visual acuity was 20/63 in the right eye and 20/32 in the left eye. The corrected distance visual acuity (CDVA) was 20/40 in the right eye (-1.75-4.00 × 35°) and 20/16 in the left eye (-0.50-0.25 × 115°). After femtosecond laser-assisted intracorneal ring segment implantation, the right eye improved CDVA to 20/20-1. Concerning ectasia/keratoconus diagnosis, the left eye remained stable over 1 year of follow-up with unremarkable topometric, tomographic, and biomechanical findings. Epithelial thickness mapping by spectral domain optical coherence tomography and very-high-frequency digital ultrasound demonstrated epithelial thickness within normal limits in the left eye. Advanced diagnostic methods along with clinical data enable the distinction from unilateral ectasia cases and subclinical (fruste) keratoconus. Literature review is also performed along with case presentation and discussion.

Keywords: Corneal tomography, Keratoconus, Unilateral ectasia.

How to cite this article: Ramos IC, Reinstein DZ, Archer TJ, Gobbe M, Salomão MQ, Lopes B, Luz A, Faria-Correia F, Gatinel D, Belin MW, Ambrósio R Jr. Unilateral Ectasia characterized by Advanced Diagnostic Tests. Int J Kerat Ect Cor Dis 2016;5(1):40-51.

Source of support: Nil

Conflict of interest: Drs. Ambrósio and Belin are consultants for Oculus (Wetzlar, Germany); Dr. Reinstein is a consultant for Carl Zeiss Meditec (Carl Zeiss Meditec AG, Jena, Germany) and has proprietary interest in the Artemis technology (ArcScan Inc, Morrison, Colorado, USA) through patents administered by the Center for Technology Licensing at Cornell University (CTL), Ithaca, New York, USA. Dr. Gatinel is a consultant for TECHNOLAS Perfect Vision (Munich, Germany). The remaining authors have no proprietary or financial interest in the materials presented herein.

 
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