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Corneal Disorders
Published in Ching-Yu Cheng, Tien Yin Wong, Ophthalmic Epidemiology, 2022
Darren S. J. Ting, Rashmi Deshmukh, Daniel S. W. Ting, Marcus Ang
Amongst all, keratoconus and FECD are two of the most commonly investigated corneal diseases. This is primarily attributed to the high disease prevalence and the need for corneal transplantation for the severe form of these diseases, which places substantial burden on the limited pool of donor corneas.95 Over the years, GWLS have successfully identified a number of genetic mutations implicated in keratoconus, including COL8A1, CAST, LOX, TCEB1, and TGFBI genes, amongst others.124 GWAS has increasingly been used to identify genetic susceptibility regions in keratoconus and FECD.124,125 For instance, McComish et al.115 recently identified a novel genetic locus in PNPLA2 at chromosome 11 for keratoconus based on over 6 million genetic variants. Several novel genetic loci for FECD, including TCF4, KANK4 rs79742895, LAMC1 rs3768617, and LINC00970/ATP1B1 rs1200114, have also been discovered through GWAS.119 Next-generation sequencing (NGS), which represents the most comprehensive tool in identifying genomic variants,126 has recently been utilized to unravel novel mutations associated with other types of corneal dystrophy.127
Red Eyes after Cataract Surgery and Other Operations
Published in Amy-lee Shirodkar, Gwyn Samuel Williams, Bushra Thajudeen, Practical Emergency Ophthalmology Handbook, 2019
Examination: Visual acuity must be checked and documented at each post-operative review. On the slit-lamp, examine the patient for any risk factors of ocular surface disease such as blepharitis, mucocoele, entropion or ectropion. Lid swelling and inflammation are also signs associated with endophthalmitis. Is there any yellow discharge from the eye? Perform a conjunctival swab of any discharge prior to examining the ocular surface specifically looking at wound and injection sites. If the patient complains of discomfort with blinking or eye movement this is more likely to be due to an ocular surface problem. Use fluorescein 2% to check for a wound leak from corneal incisions, sutures, trabeculectomy and vitrectomy port sites. In post-filtration surgery in glaucoma cases, look for any signs of pus-discharge, a milky bleb and wound leak suggestive of blebitis. In post-corneal graft patients, look for loose sutures that may be a source of irritation or infection and signs of graft failure or rejection. Look for signs of recurrent corneal disease in those with previous herpetic disease.
Epidemiology of Mycotic Keratitis
Published in Mahendra Rai, Marcelo Luís Occhiutto, Mycotic Keratitis, 2019
Ana Luiza Mylla Boso, Rosane Silvestre Castro, Denise Oliveira Fornazari, Monica Alves
A review of the literature was conducted to analyze the proportion of mycotic keratitis in different continents, the most common causative organisms, and when possible, risk factors associated with fungal infection of the cornea. The search was performed in February and March 2018, and included the terms “fungal corneal ulcer” OR “mycotic corneal ulcer” OR “infectious keratitis” OR “microbial keratitis” AND “epidemiology”. Only human studies and abstracts written in English were considered. Studies regarding the outbreak of Fusarium keratitis related to a specific contact lens solution (Saw 2007, Gaujoux et al. 2008 and 2011) were not included. One hundred and eleven studies were identified as potentially eligible through their abstracts and had their full-text assessed and data collected. Studies involving noninfectious corneal disease or only bacterial keratitis and systematic reviews were excluded as listed in the flowchart (Fig. 10.1). Additional studies were included when considered appropriate, resulting in 94 studies for analysis; the main features of each are displayed in Table 10.1.
Disparities in Access to Corneal Tissue in the Developing World
Published in Seminars in Ophthalmology, 2023
Catherine Liu, Hajirah N. Saeed
Corneal disease is a major cause of blindness worldwide, currently ranking fourth after cataract, glaucoma, and age-related macular degeneration.1 In 2020, 43.3 million people were estimated to be blind using the World Health Organization’s (WHO) definition of blindness as best corrected vision worse than 3/60 (20/400) in the better seeing eye.1,2 Of these, 4.2 million cases of blindness were attributable to corneal opacity and an additional 2 million cases are secondary to trachoma.1 In developing countries, corneal disease may represent the second leading cause of blindness,3 which is disproportionately higher than in other countries. In certain regions of Africa, as much as 90% of all blindness is attributable to corneal pathology4; however, availability and access to cornea tissue, which can often cure corneal blindness, in these parts of the world is dismal compared to industrialized countries. In contrast, the US has the highest rate of corneal transplantation, with the greatest amount of corneal procurement and transplantation per capita worldwide.5 There exists a significant disparity between countries when it comes to access to cornea tissue, with supply often inversely proportional to burden of disease.6 There are many variables and challenges that perpetuate this disparity. This review will discuss those factors as well as highlight how reduction in corneal blindness and access to sight saving cornea tissue may be attainable.
A prospective randomized clinical trial of active-fluidics versus gravity-fluidics system in phacoemulsification for age-related cataract (AGSPC)
Published in Annals of Medicine, 2022
Yu Luo, Hongyu Li, Wenqian Chen, Yi Gao, Tianju Ma, Zi Ye, Zhaohui Li
Similar to the study results of Oh and colleagues [17], there was no significant difference in BCVA between the two groups at one month and three months postoperatively. However, the recovery of BCVA in the early postoperative period (one day and one week) was significantly better in the AFS group. This variation might be strongly related to the higher incidence of corneal adverse events in the GFS group [30,31]. The corneal injuries, which influence the BCVA, like corneal edema and endothelial loss after phacoemulsification have been reported [32,33]. The injuries were attributed to the ultrasound energy and fluid turbulence. Damaged endothelial cells could not regenerate, and the “pump-leak” function, which maintains stromal hydration, is possessed only by healthy endothelium [32,34]. Therefore, it is essential to reduce intraoperative harms, particularly in patients combined with corneal diseases. When the corneal indicators at different time points were analysed, we found that the recovery time for CCT was longer in the GFS group, where a significantly higher CV at one day postoperatively was also recorded. These results suggested that even in cases of comparable CDE and EFU, the application of the AFS could reduce cornea injuries, with shorter postoperative recovery time and better early postoperative BCVA. The phenomenon might be related to the stable fluidics of the AFS, which is able to reduce turbulent flushing of the perfusate from damaging the corneal endothelium [19].
Assessment of patient-reported outcome measures used in corneal transplantation: a systematic review
Published in Clinical and Experimental Optometry, 2022
Mallika Prem Senthil, Ranjay Chakraborty, Jeremiah Lim
Corneal diseases are one of the leading causes of blindness.39 A successful corneal transplant might be able to restore vision partially or completely. Corneal transplantation is the most frequent type of transplant done worldwide and there has been a considerable evolution in the past two decades, such that instead of removing the entire cornea, the diseased layer can now be selectively replaced. In this systematic review, it was found that PROMs employed in corneal transplantation were used to: (1) assess QoL after surgery, (2) determine the relationship between QoL and objective measures and (3) compare the QoL scores between different corneal transplant techniques. Most of the studies showed an improvement in the QoL scores at three, six and 12 months after corneal transplantation.20,21,32,35,40 Improvement in the QoL scores were demonstrated after PKP,20 DALK,32 and DSAEK.35 However, the QoL scores did not significantly differ between different age groups, gender, and laterality of the transplant.25,41