Evaluation of Long-Term Corneal Morphology After Photorefractive Keratectomy by In Vivo Confocal Microscopy and Specular Microscopy; 20-Year Follow-Up

Purpose: The effect of long-term glycemic variability upon corneal sub-basal nerve plexus (CSNP) morphology analyzed by in vivo confocal microscopy (IVCM) has been poorly investigated in the setting of type 1 diabetes mellitus (T1DM). Our purpose was to analyze the association between morphometric parameters of CSNP and new markers of glycemic variability in a population of patients with T1DM. Methods: Forty patients with T1DM underwent: assessment of diabetic neuropathy (DN); analysis of subcutaneous advanced glycated end-products; IVCM scans of CSNP. The fully automated software ACCMetrics was employed to analyze IVCM images and calculate seven corneal nerve parameters. Data of diabetes duration, mean and standard deviation (SD) of either last-year and all-time glycated hemoglobin (HbA1C) were retrieved. Results: Diabetes duration and all-time SD of HbA1C were independently associated with CNFD (R = –0.26, p = 0.01; R = –0.27, p = 0.047 respectively), CNFL (R = –0.12; p = 0.01; R = –0.17, p = 0.01 respectively) and CNFrD (R = –0.001, p = 0.009; R = –0.002, p = 0.007 respectively). The analysis of the association among IVCM parameters and specific subtypes of DN showed that altered cold sensitivity was independently associated with CNFD (B = –0.24, p = 0.01), CNFL (B = –0.46, p = 0.01) and CNFrD (B = –28.65, p = 0.03). Conclusions: All-time SD of HbA1C and disease duration were found to be independent predictors of damage to CSNP in patients with T1DM.

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Lamellar Keratoplasty Combined with Amniotic Membrane Transplantation for the Treatment of Corneal Perforations: A Clinical and In Vivo Confocal Microscopy Study

BioMed Research International ◽

10.1155/2020/7403842 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Lan Ke ◽

Dan Shen ◽

Haoyu Wang ◽

Chen Qiao ◽

Qingyan Zeng

Keyword(s):

Confocal Microscopy ◽

Amniotic Membrane ◽

Corneal Stroma ◽

Lamellar Keratoplasty ◽

Amniotic Membrane Transplantation ◽

Corneal Perforation ◽

In Vivo Confocal Microscopy ◽

The Mean

Purpose. To evaluate the clinical and in vivo confocal microscopy outcome of lamellar keratoplasty combined with amniotic membrane transplantation for the treatment of corneal perforations. Methods. In this retrospective, noncomparative, and interventional case series, 13 eyes of 13 patients with corneal perforation were included. All eyes were treated with lamellar keratoplasty combined with amniotic membrane transplantation for corneal reconstruction. Age, underlying etiology, location, size of corneal ulcer, size of corneal perforation, hospitalization days and follow-up time, and corneal confocal microscopy were investigated. Aqueous leakage, anterior chamber formation, epithelial healing time, and visual acuity (VA) were monitored after operation. Results. The cause of corneal perforation (n = 13) was classified as infectious (n = 1) and noninfectious (n = 12). Most of the locations of corneal perforation were paracentral, and 2 of them were center. The anterior chambers were formed without aqueous leakage and other complications at postoperative day. The mean time of regained a smooth corneal surface was 7.5 ± 2.9 (ranging from 4 to 14) days. The mean hospitalization day was 13.1 ± 4.5 (ranging from 7 to 22) days. The mean follow-up time is 22.5 ± 14.5 (ranging from 4 to 43) months. The AM appeared as a high-reflective reflection in the corneal stroma after surgery about half a year and is almost transparent at about one year. Corneal stroma-derived cells were populated in the AM at about 1 month, increased at 2 months, and almost not obviously at 20 months postoperatively. The size and density of endothelial cells were stable after 1 year near the perforation site. The VA improved to varying degrees in 9 eyes, remained unchanged in 2 eyes, and decreased in 2 eyes. One eye recurrence and no side effects occurred during the follow-up time. Conclusion. Lamellar keratoplasty combined with amniotic membrane transplantation may be an alternative, safe, and effective surgical therapy in the treatment of corneal perforations in the absence of a fresh donor cornea. We recommend this surgery to treat with the size of corneal perforation of <4 mm in diameter no matter peripheral or central corneal perforation, especially who had immune-related diseases.

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Epithelial basement membrane dystrophy after femtosecond laser-assisted LASIK successfully treated with in vivo confocal microscopy-assisted photorefractive keratectomy

Journal of Cataract & Refractive Surgery ◽

10.1097/j.jcrs.0000000000000354 ◽

2020 ◽

Vol Publish Ahead of Print ◽

Author(s):

Po-Ying Wu ◽

Mei-Chi Tsui ◽

Chao-Kai Chang ◽

Huai-Wen Chang ◽

Wei-Li Chen

Keyword(s):

Confocal Microscopy ◽

Basement Membrane ◽

Femtosecond Laser ◽

Photorefractive Keratectomy ◽

In Vivo Confocal Microscopy ◽

Epithelial Basement Membrane ◽

Epithelial Basement

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Quantification of Stromal Thinning, Epithelial Thickness, and Corneal Haze after Photorefractive Keratectomy Using In Vivo Confocal Microscopy

Ophthalmology ◽

10.1016/s0161-6420(97)30307-8 ◽

1997 ◽

Vol 104 (3) ◽

pp. 360-368 ◽

Cited By ~ 116

Author(s):

Torben Møller-Pedersen ◽

Mitchell Vogel ◽

Hong Fang Li ◽

W. Matthew Petroll ◽

H. Dwight Cavanagh ◽

...

Keyword(s):

Confocal Microscopy ◽

Photorefractive Keratectomy ◽

In Vivo Confocal Microscopy ◽

Corneal Haze ◽

Epithelial Thickness

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Corneal in vivo confocal microscopy to detect belantamab mafodotin-induced ocular toxicity early and adjust the dose accordingly: a case report

Journal of Hematology & Oncology ◽

10.1186/s13045-021-01172-5 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Kevin Marquant ◽

Anne Quinquenel ◽

Carl Arndt ◽

Alexandre Denoyer

Keyword(s):

Multiple Myeloma ◽

Confocal Microscopy ◽

Adverse Effects ◽

Ultrastructural Changes ◽

In Vivo Confocal Microscopy ◽

Drug Conjugates ◽

Eye Health ◽

First Time

Abstract Background New targeted antibody–drug conjugates (ADCs) against multiple myeloma are known to induce adverse effects that may lead to treatment discontinuation. Preclinical studies reported early severe ocular damage related to the use of belantamab mafodotin (belamaf), including ocular surface inflammation, severe dry eye, and a specific toxicity to the cornea, namely microcystic keratopathy. While belamaf-induced ocular changes have not been prospectively studied, a better understanding of mechanisms involved as well as kinetics may aid in anticipating dose adjustment rather than stopping the treatment once clinical ocular damage is too severe. Case presentation A 61-year-old woman scheduled for belamaf as a fifth-line treatment against multiple myeloma was prospectively included. Clinical examinations were performed before and every 3 weeks afterward, together with in vivo confocal microscopy (IVCM) of the cornea. Visual acuity, symptoms, slit-lamp examination, and ultrastructural changes of the cornea were recorded according to the received dose of belamaf. More precisely, kinetics, shape, density, and location of the toxic corneal lesions have been followed and analyzed using IVCM. Also, specific lesions at the sub-basal nerve plexus layer were detected and characterized for the first time. This advanced approach allowed a better understanding of the belamaf-induced toxicity, further balancing the dose to maintain good vision and eye health while continuing the treatment. Conclusions Systematic ultrastructural analysis and follow-up of the corneal state during ADCs treatment for multiple myeloma may open new avenues in the therapeutic approach. Early preclinical detection of ocular damage may accurately contribute to finding the correct dose for each patient and not stopping the treatment due to severe ocular adverse effects.

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