Impact of Keratoconus Stage on Outcome After Corneal Crosslinking

Abstract Background: This study aimed to analyze if the outcome after corneal crosslinking (CXL) in progressive keratoconus patients depends on the stage in which the procedure is performed. This knowledge would help to improve success of CXL and facilitate defining surgery indications in those patients.Methods: In this retrospective study, 124 consecutive eyes of 100 patients with progressive keratoconus undergoing corneal CXL at the University Eye Hospital Tübingen were included. The eyes were graded according to modified Krumeich stages depending on induced myopia or astigmatism, corneal radii, minimum corneal thickness, and morphological changes. The observation period took place from November 2008 to September 2018. Preoperatively, 12 and 24 months after CXL, the best corrected visual acuity (BCVA) was determined and astigmatism as well as keratometric parameters (Kmax, Kmin, central corneal thickness (CCT), minimum corneal thickness (MCT)) were measured by means of a Scheimpflug camera system.Results: BCVA results showed significant differences between the modified Krumeich stages 12 months (p=0.014) and 24 months postoperatively (p=0.032). Also, astigmatism differed significantly among the stages 24 months after CXL (p=0.023); however, after 12 months, no significant differences between the groups were detectable. In terms of Kmax, Kmin, CCT, and MCT, no significant differences between the Krumeich stages were observed.Conclusions: BCVA showed a significantly higher improvement after CXL in the early stage of keratoconus compared to a higher stage. However, the postinterventional keratometric values did not differ significantly between the different modified Krumeich stages. The significantly higher improvement in BCVA after CXL in the early stage might indicate that earlier intervention provides a higher subjective benefit to the individual. Further studies with larger sample sizes are needed to confirm these findings.

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Morphological Changes in Lamellar Macular Holes According to SD-OCT Examination over a Long Observation Period

Diagnostics ◽

10.3390/diagnostics11071145 ◽

2021 ◽

Vol 11 (7) ◽

pp. 1145

Author(s):

Magdalena Kal ◽

Izabela Chojnowska-Ćwiąkała ◽

Mateusz Winiarczyk ◽

Monika Jasielska ◽

Jerzy Mackiewicz

Keyword(s):

Retinal Thickness ◽

Morphological Changes ◽

Outer Diameter ◽

Corrected Visual Acuity ◽

Macular Holes ◽

Kolmogorov Smirnov ◽

Inner Diameter ◽

Observation Period ◽

Sd Oct

Background: The aim of this study was to evaluate the quantitative morphological changes in lamellar macular holes (LMHs) based on SD-OCT examinations and to assess the correlations among minimal retinal thickness (MRT), reading vision (RV), and best corrected visual acuity (BCVA) over a 36-month follow-up period. Methods: A group of 40 patients (44 eyes) with LMH was evaluated, with an average age of 69.87 (SD = 10.14). The quantitative parameters monitored in the follow-up period (at 0, 3, 6, 12, 18, 24, 30, and 36 months) were tested for normality of distribution by Shapiro–Wilk and Kolmogorov–Smirnov tests. Results: The RV and BCVA values were stable, and no significant changes were found at any of the check-ups during the 36-month follow-up period (BCVA p = 0.435 and RV p = 0.0999). The analysis of individual quantitative LMH parameters during the 36-month follow-up period did not demonstrate statistically significant differences: MRT (p = 0.461), Max RT temporal (p = 0.051), Max RT nasal (p = 0.364), inner diameter (ID) (p = 0.089), and outer diameter (OD) (p = 0.985). Conclusions: The observations at 0, 6, 12, 18, 24, 30, and 36 months revealed moderate and significant correlations between RV and MRT. No significant correlation between BCVA and MRT was observed.

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Whether Keratectasia Area Shown in Corneal Topography Is Appropriate for Evaluating the Effect of Corneal Cross-Linking for Keratoconus: A 12-Month Follow-Up Study

BioMed Research International ◽

10.1155/2019/1762537 ◽

2019 ◽

Vol 2019 ◽

pp. 1-5

Author(s):

Jia Wang ◽

Zhiwei Li ◽

Huankai Zhang ◽

Ning Gao ◽

Guoying Mu

Keyword(s):

Endothelial Cell ◽

Linear Regression ◽

Early Stage ◽

Morphological Changes ◽

Corneal Thickness ◽

Corneal Topography ◽

Cross Linking ◽

Follow Up Study ◽

Before And After

Purpose. To analyze the keratectasia area (KEA) shown in corneal topography before and after corneal cross-linking (CXL) in patients with progressive keratoconus (KC) and figure out whether KEA is appropriate for evaluating the effect of CXL. Methods. A retrospective analysis was conducted in 34 eyes from 24 progressive KC patients who have underwent CXL from 2015 to 2017. Area with K-value more than 47D shown in the corneal topography was marked and identified as KEA. Keratometry (K1, K2, and Kmax), KEA, thinnest corneal thickness (TCT), and endothelial cell density (ECD) were evaluated preoperatively or at months 3, 6, and 12 postoperatively. The changes of KEA before and after operation were evaluated. The relation of KEA and other parameters, including Kmax and TCT, was analyzed. Results. Linear regression model revealed the KEA, Kmax, K1, and K2 decreased after CXL in model y = 0.9622 -0.02408 x (P<0.05), y = 0.9982 -0.003469 x(P<0.05), y = 0.9977 + -0.001347 x(P<0.05), y = 0.9992 + -0.001779 x(P<0.05) (y represents KEA, Kmax, K1, or K2; x represents time (month)). The KEA is significantly decreased in early stage (before month 3) (P<0.05); however, the Kmax, K1, and K2 have no significant decrease in early stage (P= 0.09, 0.19, 0.32). Conclusions. The KEA is more sensitive than K-value in describing the morphological changes of cornea after CXL, especially in early stage after treatment.

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Accelerated Corneal Crosslinking for Treatment of Progressive Keratoconus in Pediatric Patients

European Journal of Ophthalmology ◽

10.5301/ejo.5000848 ◽

2016 ◽

Vol 27 (3) ◽

pp. 319-325 ◽

Cited By ~ 23

Author(s):

Döndü M. Ulusoy ◽

Emre Göktaş ◽

Necati Duru ◽

Ayşe Özköse ◽

Mustafa Ataş ◽

...

Keyword(s):

Visual Acuity ◽

Pediatric Patients ◽

Corneal Thickness ◽

Efficacy And Safety ◽

Ultraviolet A ◽

Corneal Crosslinking ◽

Corrected Visual Acuity ◽

Uncorrected Visual Acuity ◽

Group 2 ◽

Group 1

Purpose To evaluate the safety and efficacy of accelerated corneal crosslinking (CXL) in patients with progressive keratoconus aged 18 years or less. Methods A total of 28 eyes from 19 patients with progressive keratoconus aged 18 years or less were enrolled. We divided participants into 2 groups according to corneal thickness (CT). Group 1 included 13 eyes of 8 patients with CT ≥450 µm; group 2 included 15 eyes of 11 patients with CT <450 µm. Each participant underwent accelerated CXL using 10-minute ultraviolet A irradiance at 9 mW/cm2 for a total energy dose of 5.4 J/cm2. The efficacy and safety of the procedure were assessed postoperatively at 1, 3, 6, and 12 months with Pentacam and visual acuity. Results In uncorrected visual acuity, group 1 showed a statistically significant +0.12 logMAR improvement at 3 months postoperatively (p = 0.003), and in group 2, there was a statistically significant +0.3 logMAR improvement at 1 month postoperatively (p = 0.005). In best-corrected visual acuity, there was a +0.15 logMAR (p<0.001) and +0.22 logMAR (p = 0.005) improvement in group 1 and group 2, respectively, at 12 months postoperatively. All mean keratometric values including K1 and K2 dropped by at least 1 D or remained stable (< ± 1 D) in both groups after accelerated CXL treatment. Conclusions The findings showed that accelerated CXL treatment seems to be effective in slowing or halting the progression of keratoconus and that no permanent apparent complications are noted 6 months after accelerated CXL.

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Accelerated cross-linking technique using a protective corneal donor flap in the treatment of progressive keratoconus on «thin» corneas

Fyodorov journal of ophthalmic surgery ◽

10.25276/0235-4160-2021-2-26-31 ◽

2021 ◽

pp. 26-31

Author(s):

A.V. Tereshchenko ◽

◽

I.G. Trifanenkova ◽

S.K. Dem'yanchenko ◽

Y.Y. Golubeva ◽

...

Keyword(s):

Visual Acuity ◽

Corneal Thickness ◽

Cross Linking ◽

Donor Cornea ◽

Corrected Visual Acuity ◽

Uncorrected Visual Acuity ◽

The Difference ◽

Definition Of ◽

Thin Cornea ◽

Observation Period

Purpose. To develop a method of accelerated ultraviolet crosslinking with an initial corneal thickness equal to or less than 400 microns using a protective donor corneal flap. Definition of safety and effectiveness of this method in the treatment of progressive keratoconus. Material and methods. 20 patients (20 eyes) with a diagnosis of progressive keratoconus 2–3 stages were included in the study. The accelerated crosslinking was carried out with an IROC-VX-2000 device (Switzerland). A protective donor corneal flap was cut out by using a Femto LDV Z8 femtosecond laser (Ziemer, Switzerland). The thickness of the protective flap of the donor cornea was determined as the difference between 450 μm and the obtained value of the patient's pachymetry in 30 minutes of saturation with Dextralink in μm. Results. Indicators of uncorrected visual acuity and corrected visual acuity returned to the level of preoperative values and did not tend to decrease until the end of the observation period for 6 months. The average keratometry indices gradually decreased: after 3 months – 50.3 ± 1.5 μm, after 6 months – 48.9 ± 1.8 μm, by 12 months – 46.7 ± 2.1 μm. A decrease in elevation indicators of the anterior and posterior surfaces was marked on elevation maps throughout the observation period. Conclusion. The proposed ultraviolet crosslinking technique using a protective donor corneal flap in patients with corneal thickness 400 μm or less is reproducible. This technique proves its effectiveness and safety and allows to stabilize the condition in patients with progressive keratoconus with adequate visual function. This makes this technique necessary, taking into account the lack of adequate cross-linking technology with a thin cornea. Keywords: progressive keratoconus, thin cornea, ultraviolet crosslinking, protective donor corneal flap.

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‘A Routh O’ Auld Nick-Nackets’ – the antiquarian collection of John Rae

Scottish Archaeological Journal ◽

10.3366/saj.2014.0054 ◽

2015 ◽

Vol 36-37 (1) ◽

pp. 163-183

Author(s):

Paul Taylor

Keyword(s):

United States ◽

Nineteenth Century ◽

Social Context ◽

Moral Education ◽

The United States ◽

Representative Case ◽

National Museums ◽

The Individual ◽

The University

John Rae, a Scottish antiquarian collector and spirit merchant, played a highly prominent role in the local natural history societies and exhibitions of nineteenth-century Aberdeen. While he modestly described his collection of archaeological lithics and other artefacts, principally drawn from Aberdeenshire but including some items from as far afield as the United States, as a mere ‘routh o’ auld nick-nackets' (abundance of old knick-knacks), a contemporary singled it out as ‘the best known in private hands' (Daily Free Press 4/5/91). After Rae's death, Glasgow Museums, National Museums Scotland, the University of Aberdeen Museum and the Pitt Rivers Museum in Oxford, as well as numerous individual private collectors, purchased items from the collection. Making use of historical and archive materials to explore the individual biography of Rae and his collection, this article examines how Rae's collecting and other antiquarian activities represent and mirror wider developments in both the ‘amateur’ antiquarianism carried out by Rae and his fellow collectors for reasons of self-improvement and moral education, and the ‘professional’ antiquarianism of the museums which purchased his artefacts. Considered in its wider nineteenth-century context, this is a representative case study of the early development of archaeology in the wider intellectual, scientific and social context of the era.

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IMAGERY AND EMOTIONS IN THE PIANO PIECE „THE SICK DOLL“ FROM CHILDREN’S ALBUM OF P . I TCHAIKOVSKY

Education and Technologies Journal ◽

10.26883/2010.201.2223 ◽

2020 ◽

Vol 11 (1) ◽

pp. 110-113

Author(s):

Smilena Smilkova ◽

Keyword(s):

At Risk ◽

Social Work ◽

Short Story ◽

Special Educational Needs ◽

Social Pedagogy ◽

Sound Image ◽

The Individual ◽

The Right ◽

The University ◽

Art Pedagogy

The proposed material examines the creative task of students majoring in Social Pedagogy at the University „Prof. Dr. Assen Zlatarov“ in Burgas, and studying the discipline Art Pedagogy – Part 1 – Music. In the course of the lecture course students get acquainted with the elements of musical expression, as a means of figurative representations and impact of music, with different techniques concerning individual musical activities, with the endless and diverse opportunities that music provides in the use of art pedagogy for social work teachers.Verbal interpretation of music is a necessary component when working with children with special educational needs, at risk and in the norm. Looking at Tchaikovsky’s short and extremely figurative piano piece „The Sick Doll“ from his charming „Children’s Album“, in the form of a short story, tale or essay, students express their personal vision, feeling and transformation of the musical image. The aim of the task is to transcribe the sound image into a verbal one. This requires speed, flexibility and logic in thinking, through imagination and creativity in its manifestation. Children love to listen, especially when they are involved. In search of the right way to solve problems and situations, future social educators could successfully benefit from the conversion of sound into words, according to the needs and deficits of the individual or group.

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Connection of discontinuous segments in early functional recovery from thoracic ossification of the posterior longitudinal ligament treated with posterior instrumented surgery

Journal of Neurosurgery Spine ◽

10.3171/2019.8.spine19604 ◽

2020 ◽

Vol 32 (2) ◽

pp. 200-206

Author(s):

Kei Ando ◽

Kazuyoshi Kobayashi ◽

Masaaki Machino ◽

Kyotaro Ota ◽

Satoshi Tanaka ◽

...

Keyword(s):

Early Stage ◽

Morphological Changes ◽

Japanese Orthopaedic Association ◽

Multislice Ct ◽

Posterior Longitudinal Ligament ◽

Ct Images ◽

Rigid Fixation ◽

Disc Space ◽

Fusion Surgery ◽

Estimated Blood Loss

OBJECTIVEThe objective of this study was to investigate the relationship between morphological changes in thoracic ossification of the posterior longitudinal ligament (T-OPLL) and postoperative neurological recovery after thoracic posterior fusion surgery. Changes of OPLL morphology and postoperative recovery in cases with T-OPLL have not been examined.METHODSIn this prospective study, the authors evaluated data from 44 patients (23 male and 21 female) who underwent posterior decompression and fusion surgery with instrumentation for the treatment of T-OPLL at our hospital. The patients’ mean age at surgery was 50.7 years (range 38–68 years). The minimum duration of follow-up was 2 years. The location of thoracic ossification of the ligamentum flavum (T-OLF), T-OLF at the OPLL level, OPLL morphology, fusion range, estimated blood loss, operative time, pre- and postoperative Japanese Orthopaedic Association (JOA) scores, and JOA recovery rate were investigated. Reconstructed sagittal multislice CT images were obtained before and at 3 and 6 months and 1 and 2 years after surgery. The basic fusion area was 3 vertebrae above and below the OPLL lesion. All parameters were compared between patients with and without continuity across the disc space at the OPLL at 3 and 6 months after surgery.RESULTSThe preoperative morphology of OPLL was discontinuous across the disc space between the rostral and caudal ossification regions on sagittal CT images in all but one of the patients. Postoperatively, these segments became continuous in 42 patients (97.7%; occurring by 6.6 months on average) without progression of OPLL thickness. Patients with continuity at 3 months had significantly lower rates of diabetes mellitus (p < 0.05) and motor palsy in the lower extremities (p < 0.01). The group with continuity also had significantly higher mean postoperative JOA scores at 3 (p < 0.01) and 6 (p < 0.05) months and mean JOA recovery rates at 3 and 6 months (both p < 0.01) after surgery.CONCLUSIONSPreoperatively, discontinuity of rostral and caudal ossified lesions was found on CT in all patients but one of this group of 44 patients who needed surgery for T-OPLL. Rigid fixation with instrumentation may have allowed these segments to connect at the OPLL. Such OPLL continuity at an early stage after surgery may accelerate spinal cord recovery.

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Studies of rootstocks for stone fruit breeds (sweet cherry) in the condition of Hissar valley in Tajikistan

Agricultural Technologies ◽

10.35599/agritech/01.04.05 ◽

2019 ◽

Vol 1 (4) ◽

pp. 28-34

Author(s):

Rahima I. Ismoilova ◽

Sodzhida D. Umarova

Keyword(s):

Sweet Cherry ◽

Sour Cherry ◽

High Specificity ◽

Stone Fruit ◽

Wild Cherry ◽

Phenological Observation ◽

Entire Observation Period ◽

The Individual ◽

Leaf System ◽

Observation Period

This paper is about studying the rootstocks for stone fruit breeds (sweet cherry) in condition of Hissar valley in Tajikistan. Each type of rootstock has its own biological characteristics and imposes specific requirements for growing and development, both during reproduction in the mother plantation and during the growth of trees. For example, the root system in sour cherry is more superficial that of wild sweet cherry. Therefore, the care of trees grafted on sour cherry and wild cherry and of mother plantation bushes of these rootstocks cannot be same. Besides, there are very significant differences among the individual groups of rootstocks. Wild cherry, Mahaleb cherry and Lubskaya cherry are used as rootstocks in the conditions of the Hissar Valley in Tajikistan. High specificity of sweet cherry cultivar varieties depends on the rootstocks. Phenological observation were carried out in our experiments during years 2013-2018 in order to study their winter resistance, yield capacity and fruit quality. The same care for root and grafted plants was carried out during the entire observation period. At the same time a certain ratio between the leaf system of the rootstock and the graft was maintained by trimming the crown. As a result of the evolution and selection, we have identified the wild cherry forms which are distinguished by the highest yields. The most valuable cultivar varieties are Napoleon cherry and Bagration cherry. Compotes made of these varieties have received high evaluation in tasting.

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A University Education

10.1093/oso/9780198767268.001.0001 ◽

2017 ◽

Cited By ~ 7

Author(s):

David Willetts

Keyword(s):

Higher Education ◽

Modern Society ◽

University Education ◽

Modern World ◽

Controversial Issues ◽

The Us ◽

The Individual ◽

The University ◽

First Time ◽

The Relationship

Universities have a crucial role in the modern world. In England, entrance to universities is by nation-wide competition which means English universities have an exceptional influence on schools--a striking theme of the book. This important book first investigates the university as an institution and then tracks the individual on their journey to and through university. In A University Education, David Willetts presents a compelling case for the ongoing importance of the university, both as one of the great institutions of modern society and as a transformational experience for the individual. The book also makes illuminating comparisons with higher education in other countries, especially the US and Germany. Drawing on his experience as UK Minister for Universities and Science from 2010 to 2014, the author offers a powerful account of the value of higher education and the case for more expansion. He covers controversial issues in which he was involved from access for disadvantaged students to the introduction of L9,000 fees. The final section addresses some of the big questions for the future, such as the the relationship between universities and business, especially in promoting innovation.. He argues that the two great contemporary trends of globalisation and technological innovation will both change the university significantly. This is an authoritative account of English universities setting them for the first time in their new legal and regulatory framework.

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Ophthalmic Screening in Patients with Coronavirus Disease 2019: A Prospective Cohort Study

Journal of Clinical Medicine ◽

10.3390/jcm10050896 ◽

2021 ◽

Vol 10 (5) ◽

pp. 896

Author(s):

Anthia Papazoglou ◽

Anna Conen ◽

Sebastian Haubitz ◽

Markus Tschopp ◽

Viviane J. Guignard ◽

...

Keyword(s):

Animal Studies ◽

Clinical Course ◽

Intraocular Inflammation ◽

Ocular Motility ◽

Corrected Visual Acuity ◽

Published Evidence ◽

Laboratory Results ◽

Minimum Angle ◽

Observation Period

Postmortem pathological examinations, animal studies, and anecdotal reports suggest that coronavirus disease 2019 (COVID-19) could potentially affect intraocular tissue. However, published evidence is scarce and conflicting. In our study, we screened 100 eyes of 50 patients hospitalized for COVID-19. Relevant medical and ophthalmological history was assessed as well as symptoms, laboratory results, specific treatments, clinical course, and outcome. Ophthalmic exams including assessment of best corrected visual acuity (BCVA), intraocular pressure (IOP), color perception, ocular motility, ophthalmoscopy as well as optical coherence tomography (OCT) of the macula and the optic disc was performed at hospital admission and 29 to 192 days later. Of the 50 patients included, 14 (28%) were female. Median age was 64.5 (range 29–90) years. COVID-19 severity was mild in 15 (30%), severe in 30 (60%), and critical in five cases (10%). At baseline, median BCVA was 0.1 (0–1.8) Logarithm of the Minimum Angle of Resolution (LogMAR) and median IOP was 16 (8–22) mmHg. At follow-up, no relevant changes in BCVA and IOP were documented. No signs of active intraocular inflammation or optic nerve affection were found and OCT findings were widely stable during the observation period. Our findings suggest that COVID-19 does not regularly affect intraocular tissue.

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