Correction of postkeratoplastic astigmatism by intrastromal corneal segments implantation using a femtosecond laser

Background. After penetrating keratoplasty, mild to high induced corneal astigmatism was observed in each case. The existing choice of correction of postkeratoplastic astigmatism is aimed at fi nding an individual approach in order to compensate for it and not weaken the biomechanical properties of the corneal graft.The aim: to analyze the clinical, functional, and morphological results of postkeratoplastic astigmatism correction by implantation of intrastromal corneal segments using a femtosecond laser.Methods. 22 patients were examined before and 1 year after surgery. The operation was performed under local anesthesia: stage I – an intrastromal tunnel was formed using a femtosecond laser “Femto Visum” 1 MHz (Optosystems, Russia); stage II – the intrastromal corneal segments were implanted. The results were assessed using standard and special research methods using optical coherence tomography Visante OCT (Zeiss, Germany), keratotopography (Tomey-5, Japan), optical corneal analyzer ORA (Reichert, USA), laser tindalemetry FC-2000 (Kowa, Japan) and confocal microscope Confoscan-4 (Nidek, Japan).Results. Before the operation, uncorrected visual acuity averaged 0.09 ± 0.05, after a year – 0.50 ± 0.16; best corrected visual acuity – 0.30 ± 0.12 and 0.60 ± 0.05 respectively; cylindrical component of refraction – –10.29 ± 3.12 and –2.20 ± 0.64 D respectively; mean keratometry value – 43.59 ± 2.14 and 38.56 ± 1.75 D respectively; corneal hysteresis – 7.92 ± 1.22 and 8.95 ± 1.05 mm Hg respectively; corneal resistance factor – 7.01 ± 1.81 and 8.44 ± 1.44 mm Hg respectively; protein fl ux in the moisture of the anterior chamber – 2.97 ± 0.28 and 3.04 ± 0.24 f/ms respectively; endothelial cell density – 1521 ± 327 and 1475 ± 419 cells/mm2 respectively.Conclusion. Intrastromal corneal segments implantation into a corneal graft using a femtosecond laser has efficiency and safety method in correcting postkeratoplastic astigmatism.

Impact of Hypothyroidism on Tomography and Biomechanics in Keratoconus – Cross-Sectional and Longitudinal Assessment within the Homburg Keratoconus Center at the Time of Inclusion and after 1 Year

Background and Purpose The etiology of keratoconus (KC) is probably multifactorial but remains essentially unknown. Previous scientific observations have suggested that hypothyroidism might play a role in the development and progression of KC. The purpose of this study was to analyze the tomographic and biomechanical parameters in KC patients with or without hypothyroidism. Methods Twenty-eight patients with KC and hypothyroidism (HT group) and fifty-six KC patients without thyroid dysfunction (WHT group) with matching gender and age were analyzed. Mean age was 40.3 years (range 14 – 57) in the HT group and 40.3 years (range 14 – 57) in the WHT group. Routine ophthalmic examinations consisted of corneal tomography and biomechanical parameters. We extracted the following KC parameters from the Pentacam (Pentacam HR, Oculus, Wetzlar, Germany): Keratoconus Index (KI), maximum keratometry (Kmax), astigmatism, and thinnest pachymetry (TP). From the ocular response analyzer (ORA, Reichert Ophthalmic Instruments, Depew, NY, USA), we extracted corneal hysteresis (CH), corneal resistance factor (CRF), and KC match index (KMI). Results The comparison of the tomographic and biomechanical values from cross-sectional and longitudinal analyses showed no significant differences between the HT and WHT groups. Conclusion The severity of KC based on tomographical and biomechanical parameters does not seem to depend on the presence of hypothyroidism.

Corneal Biomechanical Changes in Third Trimester of Pregnancy

Background and Objectives: There is a clear evidence that pregnancy is associated with high production of sex hormones. During the first, second and third trimester of pregnancy, blood hormones levels increase gradually. Cells with affinity for sex hormones have been identified in different ocular tissues, such as: lid, lacrimal gland, meibomian gland, bulbar and palpebral conjunctivae, cornea, iris, ciliary body, lens, retina (retinal pigment epithelium) and choroid. This is why pregnancy is associated with changes at ocular level, involving anterior and posterior segments. Several clinical trials have been made trying to highlight changes in corneal biomechanics during pregnancy. By conducting this review, we want to evaluate both the changes in parameters that define corneal biomechanics and intraocular pressure values in pregnant. Materials and Methods: Following a systematic search in the literature related mainly to changes in corneal biomechanics during pregnancy, focusing on the paper published in the last decade, we included in a meta-analysis the cumulative results of three prospective comparative studies. Results: Important changes in corneal biomechanics (corneal hysteresis and corneal resistance factor) parameters were observed in women in the third trimester of pregnancy, but these variations were not statistically significant. Also, a decrease in intraocular pressure was mentioned in these women, but only the corneal compensation intraocular pressure showed a decrease with statistical significance. Conclusions: A decrease in corneal compensatory intraocular pressure was observed in pregnant women in the third trimester of pregnancy, but without other statistically significant changes resulting from the analysis of the other three parameters (corneal hysteresis, corneal resistance factor and Goldmann-correlated intraocular pressure).

Use of Corneal hysteresis and Corneal Resistance Factor in Target Intraocular Pressure Estimation in Patients with Early Primary Open Angle Glaucoma

Purpose: To introduce a new method for estimation of the target intraocular pressure (TIOP) in naïve eyes with early primary open angle glaucoma (POAG) using Corneal hysteresis (CH) and corneal resistance factor (CRF).Methods: A prospective quasi-experimental study was conducted on naïve 90 eyes of 45 patients who were newly diagnosed with early primary open angle glaucoma (POAG). They were compared to 72 eyes of 36 normal subjects. The TIOP was determined for each eye. The IOP Goldmann (IOPg), IOP corneal-compensated (IOPcc), CH and CRF were estimated by Ocular Response Analyzer (ORA, Reichert) device. Measurements were taken for each patient prior to treatment and after 1, 3, 6, 9 and 12 months of receiving medications; either monotherapy or combination therapy.Results: For all patients, there was a significant negative correlation (p < 0.05) between IOP, either IOPg or IOPcc, and CH while a significant positive relationship (p < 0.05) existed between IOP and CRF. For patients with early POAG, The CH was significantly increased (p ≤ 0.001) while CRF was significantly decreased (p ≤ 0.001) when TIOP was achieved. At IOP levels higher than TIOP, CH value was lower than CRF with a significant negative correlation between them in contrast to controls. This correlation was reversed on reaching TIOP and CH values became higher than CRF similar to controls.Conclusion: CH, CRF and IOP measured by ORA can be used for TIOP estimation. This provides us with a guide for assessing the effectiveness of medications introduced to patients with POAG.

Biomechanical Properties in Different Types of Thin Corneas in Menoufia Population

Background. To evaluate and compare corneal hysteresis (CH) and corneal resistance factor (CRF) in normal thin (NT) healthy corneas with central corneal thickness (CCT) of 470–500 μm with matched thickness in keratoconus suspect (KCS) and keratoconus (KC) eyes. Methods. A total of 103 eyes in three groups were included prospectively: NT, KCS, and KC groups based on clinical examination and Pentacam findings. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured using the ocular response analyzer (ORA). CCT, CH, and CRF were compared between the three groups and statistically analyzed by variance tests. Results. The three groups consisted of 44 NT, 26 KCS, and 33 KC. The mean CH measured was 8.689 ± 1.775, 9.051 ± 1.1190, and 8.129 ± 0.8539 mmHg in NT, KCS, and KC eyes, respectively. The mean CRF was 8.441 ± 1.663, 8.337 ± 1.114, and 7.2422 ± 1.3110 mmHg in NT, KCS, and KC eyes, respectively. Within the range of central corneal thickness (470–500 μm), only mean CRF was statistically significantly different between the NT and KC ( P < 0.05 ); there was no statistically significant difference between NT and KCS, nor was the mean CH between each group ( P > 0.05 ). Conclusions. CRF only can be helpful in differentiating KC from NT eyes; KCS could not be predicted with either corneal biomechanical metrics. There was no benefit from CH in differentiating between the three study groups.

Induced Astigmatism and Concomitant High Myopia Correction with Femtosecond Laser-assisted Intrastromal MyoRing Implantation

Purpose. Analysis of the results of astigmatism correction after penetrating keratoplasty and concomitant high myopia using the MyoRing ring implantation, clinical case as an example. Material and methods. Patient G., 51 years old, underwent surgery to correct astigmatism and concomitant high myopia. MyoRing was implanted in the right eye within corneal transplant limits using femtosecond laser-assisted intrastromal MyoRing implantation. Before the surgery uncorrected visual acuity at the operated eye was 0.01; corrected visual acuity 0.06; spherical component of refraction was (–)6.0 D, cylindrical component was (–)8.0 D. Mean keratometry in the right eye was 43.96 D. Corneal hysteresis was 6.5 mm Hg, corneal resistance factor was 5.5 mm Hg, cornea thickness in center was 529 mkm. The patient was followed up for one year. Results. In 12 months after the surgery visual acuity of the right eye without correction was 0.7 and 0.8 with correction. Spherical component was (–)1.0 D, cylindrical component was (–)2.0 D. Mean keratometry in the right eye was 35.10 D. Corneal hysteresis was 7.2 mm Hg, corneal resistance factor was 6.3 mm Hg, cornea thickness in center was 533 mkm. The patient was satisfied with the result of operation. Conclusion. Femtosecond laser-assisted intrastromal MyoRing implantation for correction induced astigmatism after penetrating keratoplasty and concomitant high myopia is efficient, safe and provides strengthening of biomechanical properties of the cornea besides refractive and visual effect. Key words: postkeratoplastic astigmatism, high myopia, MyoRing, femtosecond laser

Analysis of Corneal Distortion after Myopic PRK

The purpose of the study is to evaluate the corneal biomechanical properties (CBP) and their behaviors after myopic refractive surgery both with Ocular Response Analyzer (ORA) and Corvis ST (CST). This retrospective study included 145 eyes of 145 patients with a mean age of 33.13 ± 9.24 years, who underwent myopic photorefractive keratectomy (PRK) for a refractive defect, measured as spherical equivalent, of mean −4.69 ± 2.04 D and have been evaluated before surgery and at 1, 3 and 6 months follow-up. Corneal hysteresis (CH) and corneal resistance factor (CRF) values significantly decreased after 1 month and remained statistically stable during further follow-ups. CST parameters had a different evolution: only second applanation time (AT2) differences showed a significant variation after 1 month that did not statistically change over time. Highest concavity deformation amplitude (HCDA), highest concavity peak distance (HCPD), first applanation time (AT1) and velocity (AV1) showed continuous significant differences both after 3 and after 6 months. This study suggests that after central surface ablation surgery, such as myopic PRK, corneal shape is remodeling, and its deformation parameters are going to change even at 6 months follow-up. This indicates that it should be important to evaluate refractive surgery patients during a longer follow-up because this could allow earlier diagnosis and better management of late-onset complications.

Biomechanical Properties in Different Types of Thin Corneas in Menoufia Population

Background:To evaluate and compare corneal hysteresis (CH) and corneal resistance factor (CRF) in normal thin (NT) healthy corneas with central corneal thickness (CCT) 470-500 µm with matched thickness in keratoconus suspect (KCS) and keratoconus (KC) and eyes.Methods: A total of 103 eyes in three groups were included prospectively: NT, KCS and KC groups based on clinical examination and pentacam findings. Corneal hysteresis (CH) and corneal resistance factor (CRF) were measured by the ocular response analyzer (ORA). CCT ,CH and CRF were compared between the three groups and statistically analyzed by variance tests.Results:The three groups consisted of 44 NT, 26 KCS, and 33 KC. The mean CH measured was 8.689 ± 1.775, 9.051 ± 1.1190 and 8.129 ± 0.8539 mmHg in NT, KCS and KC eyes, respectively. The mean CRF was 8.441 ± 1.663, 8.337 ± 1.114 and 7.2422 ± 1.3110 mmHg in NT, KCS and KC eyes, respectively. Within range of central corneal thickness (470 – 500 µm), only mean CRF was statistically significantly different between the NT and KC (P < 0.05); there was no statistically significant difference between NT and KCS, nor the mean CH between each group (P > 0.05).Conclusions: CRF only can be helpful in differentiating KC from NT eyes; KCS could not be predicted with either corneal biomechanical metrics. No benefit from CH in differentiating between the three study groups.

Fine-mapping and cell-specific enrichment at corneal resistance factor loci prioritize candidate causal regulatory variants

Corneal resistance factor (CRF) is altered during corneal diseases progression. Genome-wide-association studies (GWAS) indicated potential CRF and disease genetics overlap. Here, we characterise 135 CRF loci following GWAS in 76029 UK Biobank participants. Enrichment of extra-cellular matrix gene-sets, genetic correlation with corneal thickness (70% (SE = 5%)), reported keratoconus risk variants at 13 loci, all support relevance to corneal stroma biology. Fine-mapping identifies a subset of 55 highly likely causal variants, 91% of which are non-coding. Genomic features enrichments, using all associated variants, also indicate prominent regulatory causal role. We newly established open chromatin landscapes in two widely-used human cornea immortalised cell lines using ATAC-seq. Variants associated with CRF were significantly enriched in regulatory regions from the corneal stroma-derived cell line and enrichment increases to over 5 fold for variants prioritised by fine-mapping-including at GAS7, SMAD3 and COL6A1 loci. Our analysis generates many hypotheses for future functional validation of aetiological mechanisms.