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African swine fever (ASF), caused by the African swine fever virus (ASFV), is a highly infectious disease afflicting domestic pigs and wild boars. It exhibits an alarming acute infection fatality rate of up to 100%. Regrettably, no commercial vaccines or specific drugs for combating this disease are currently available. This study evaluated the anti-ASFV activities in porcine alveolar macrophages, 3D4/21 cells, and PK-15 cells of four bis-benzylisoquinoline alkaloids (BBAs): cepharanthine (CEP), tetrandrine, fangchinoline, and iso-tetrandrine. Furthermore, we demonstrated that CEP, which exhibited the highest selectivity index (SI = 81.31), alkalized late endosomes/lysosomes, hindered ASFV endosomal transport, disrupted virus uncoating signals, and thereby inhibited ASFV internalization. Additionally, CEP disrupted ASFV DNA synthesis, leading to the inhibition of viral replication. Moreover, berbamine was labeled with NBD to synthesize a fluorescent probe to study the cellular location of these BBAs. By co-staining with Lyso-Tracker and lysosome-associated membrane protein 1, we demonstrated that BBAs target the endolysosomal compartments for the first time. Our data together indicated that BBAs are a class of natural products with significant inhibitory effects against ASFV infection. These findings suggest their potential efficacy as agents for the prevention and control of ASF, offering valuable references for the identification of potential drug targets.IMPORTANCEThe urgency and severity of African swine fever (ASF) underscore the critical need for effective interventions against this highly infectious disease, which poses a grave threat to domestic pigs and wild boars. Our study reveals the potent anti-African swine fever virus (ASFV) efficacy of bis-benzylisoquinoline alkaloids (BBAs), particularly evident in the absence of progeny virus production under a 5 µM concentration treatment. The structural similarity among cepharanthine, tetrandrine, fangchinoline, and iso-tetrandrine, coupled with their analogous inhibitory stages and comparable selectivity indexes, strongly suggests a shared antiviral mechanism within this drug category. Further investigation revealed that BBAs localize to lysosomes and inhibit the internalization and replication of ASFV by disrupting the endosomal/lysosomal function. These collective results have profound implications for ASF prevention and control, suggesting the potential of the investigated agents as prophylactic and therapeutic measures. Furthermore, our study offers crucial insights into identifying drug targets and laying the groundwork for innovative interventions.

Asunto(s)

Virus de la Fiebre Porcina Africana , Antivirales , Bencilisoquinolinas , Endosomas , Lisosomas , Internalización del Virus , Replicación Viral , Animales , Virus de la Fiebre Porcina Africana/efectos de los fármacos , Virus de la Fiebre Porcina Africana/fisiología , Internalización del Virus/efectos de los fármacos , Bencilisoquinolinas/farmacología , Replicación Viral/efectos de los fármacos , Lisosomas/efectos de los fármacos , Lisosomas/metabolismo , Lisosomas/virología , Porcinos , Endosomas/metabolismo , Endosomas/efectos de los fármacos , Endosomas/virología , Antivirales/farmacología , Línea Celular , Fiebre Porcina Africana/virología , Fiebre Porcina Africana/tratamiento farmacológico , Fiebre Porcina Africana/metabolismo , Guanina/análogos & derivados , Guanina/farmacología , Alcaloides/farmacología , Macrófagos Alveolares/virología , Macrófagos Alveolares/efectos de los fármacos , Benzodioxoles

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African swine fever (ASF) is an acute, febrile, and highly lethal infectious disease in pigs caused by the African swine fever virus (ASFV). Effective detection methods and strict biosecurity measures are crucial for preventing and controlling ASF, especially since there are currently no commercially available vaccines or antiviral drugs to combat ASFV infection effectively. However, the emergence of low-virulence strains of ASFV in recent years has led to false-positive results, highlighting the importance of early-produced antibody detection methods. Therefore, detecting antibodies against ASFV produced early in the infection can facilitate the prompt identification of infected pigs. This study focused on the p30 protein, an early expressed protein during ASFV infection, to develop an indirect ELISA. This method was established using the HEK293F suspension cell expression system, which has the ability to produce large quantities of correctly folded proteins with normal functionality. In this study, we developed an indirect ELISA test utilizing the p30 recombinant protein produced by the HEK293F suspension cell expression system as the antigen coating. The concentration of the p30 protein obtained from the HEK293F suspension cell expression system was measured at 4.668 mg/mL, serving as the foundation for establishing the indirect ELISA. Our findings indicate that the indirect ELISA method exhibits a sensitivity of 1:12800. Furthermore, it demonstrates high specificity and excellent reproducibility. Comparing our results to those obtained from the commercial kit, we found a coincidence rate of 98.148 % for the indirect ELISA. In summary, we have developed a sensitive method for detecting ASFV, providing a valuable tool for monitoring ASFV infection in pig herds.

Asunto(s)

Virus de la Fiebre Porcina Africana , Fiebre Porcina Africana , Anticuerpos Antivirales , Ensayo de Inmunoadsorción Enzimática , Animales , Ensayo de Inmunoadsorción Enzimática/veterinaria , Ensayo de Inmunoadsorción Enzimática/métodos , Fiebre Porcina Africana/diagnóstico , Fiebre Porcina Africana/virología , Fiebre Porcina Africana/inmunología , Porcinos , Células HEK293 , Virus de la Fiebre Porcina Africana/inmunología , Humanos , Proteínas Recombinantes/inmunología , Fosfoproteínas , Proteínas Virales

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BACKGROUND: Global myopia prevalence poses a substantial public health burden with vision-threatening complications, necessitating effective prevention and control strategies. Precise prediction of spherical equivalent (SE), myopia, and high myopia onset is vital for proactive clinical interventions. METHODS: We reviewed electronic medical records of pediatric and adolescent patients who underwent cycloplegic refraction measurements at the Eye & Ear, Nose, and Throat Hospital of Fudan University between January 2005 and December 2019. Patients aged 3-18 years who met the inclusion criteria were enrolled in this study. To predict the SE and onset of myopia and high myopia in a specific year, two distinct models, random forest (RF) and the gradient boosted tree algorithm (XGBoost), were trained and validated based on variables such as age at baseline, and SE at various intervals. Outputs included SE, the onset of myopia, and high myopia up to 15 years post-initial examination. Age-stratified analyses and feature importance assessments were conducted to augment the clinical significance of the models. RESULTS: The study enrolled 88,250 individuals with 408,255 refraction records. The XGBoost-based SE prediction model consistently demonstrated robust and better performance than RF over 15 years, maintaining an R2 exceeding 0.729, and a Mean Absolute Error ranging from 0.078 to 1.802 in the test set. Myopia onset prediction exhibited strong area under the curve (AUC) values between 0.845 and 0.953 over 15 years, and high myopia onset prediction showed robust AUC values (0.807-0.997 over 13 years, with the 14th year at 0.765), emphasizing the models' effectiveness across age groups and temporal dimensions on the test set. Additionally, our classification models exhibited excellent calibration, as evidenced by consistently low brier score values, all falling below 0.25. Moreover, our findings underscore the importance of commencing regular examinations at an early age to predict high myopia. CONCLUSIONS: The XGBoost predictive models exhibited high accuracy in predicting SE, onset of myopia, and high myopia among children and adolescents aged 3-18 years. Our findings emphasize the importance of early and regular examinations at a young age for predicting high myopia, thereby providing valuable insights for clinical practice.

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Miopía , Refracción Ocular , Adolescente , Niño , Preescolar , Humanos , Miopía/diagnóstico , Miopía/epidemiología

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PURPOSE: To investigate the long-term clinical outcomes and changes in crystalline lens transparency after accelerated (45 mW/cm2) transepithelial corneal cross-linking (ATE-CXL) using the Pentacam imaging system in patients with progressive keratoconus. METHODS: The study prospectively included 44 keratoconus eyes of 40 patients (mean age: 24.39 ± 5.61 years) who underwent ATE-CXL. The examinations, including assessment of uncorrected distance visual acuity, corrected distance visual acuity, corneal topography, and corneal endothelial cell density count, were conducted preoperatively and 1 month, 3 months, 6 months, 1 year, and 5 years postoperatively. Measurement of crystalline lens density using Pentacam images was also performed pre- and postoperatively. RESULTS: All surgeries were uneventful with no postoperative complications. All keratometry values and corneal thickness remained stable during the 5-year follow-up period (all p > 0.05). There were no significant differences in corneal endothelial cell density count, visual acuity, and anterior average lens density in the 0.5-, 1.0-, and 1.5-mm depth zones during the 5-year follow-up period compared with the preoperative values (all p > 0.05). CONCLUSION: The results of this study suggest that ATE-CXL at 45 mW/cm2 is safe and effective for the treatment of progressive keratoconus in terms of both crystalline lens density and endothelial cell density.

Asunto(s)

Queratocono , Cristalino , Fotoquimioterapia , Humanos , Adolescente , Adulto Joven , Adulto , Queratocono/diagnóstico , Queratocono/tratamiento farmacológico , Fotoquimioterapia/métodos , Fármacos Fotosensibilizantes/uso terapéutico , Reticulación Corneal , Riboflavina/uso terapéutico , Rayos Ultravioleta , Colágeno/uso terapéutico , Topografía de la Córnea , Reactivos de Enlaces Cruzados/uso terapéutico

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AIMS: To predict the vault and the EVO-implantable collamer lens (ICL) size by artificial intelligence (AI) and big data analytics. METHODS: Six thousand two hundred and ninety-seven eyes implanted with an ICL from 3536 patients were included. The vault values were measured by the anterior segment analyzer (Pentacam HR). Permutation importance and Impurity-based feature importance are used to investigate the importance between the vault and input parameters. Regression models and classification models are applied to predict the vault. The ICL size is set as the target of the prediction, and the vault and the other input features are set as the new inputs for the ICL size prediction. Data were collected from 2015 to 2020. Random Forest, Gradient Boosting and XGBoost were demonstrated satisfying accuracy and mean area under the curve (AUC) scores in vault predicting and ICL sizing. RESULTS: In the prediction of the vault, the Random Forest has the best results in the regression model (R2=0.315), then follows the Gradient Boosting (R2=0.291) and XGBoost (R2=0.285). The maximum classification accuracy is 0.828 in Random Forest, and the mean AUC is 0.765. The Random Forest predicts the ICL size with an accuracy of 82.2% and the Gradient Boosting and XGBoost, which are also compatible with 81.5% and 81.8% accuracy, respectively. CONCLUSIONS: Random Forest, Gradient Boosting and XGBoost models are applicable for vault predicting and ICL sizing. AI may assist ophthalmologists in improving ICL surgery safety, designing surgical strategies, and predicting clinical outcomes.

Asunto(s)

Miopía , Lentes Intraoculares Fáquicas , Humanos , Implantación de Lentes Intraoculares/métodos , Inteligencia Artificial , Miopía/diagnóstico , Miopía/cirugía , Inteligencia , Estudios Retrospectivos

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AIMS: To investigate the association between the myopic severity and retinal microvascular density, choroidal vascularity and retrobulbar blood flow in adult anisomyopes. METHODS: This study comprised 90 eyes of 45 myopic anisomyopes who were recruited for Colour Doppler imaging (CDI) and optical coherence tomography angiography (OCTA). The superficial vessel density (SVD), deep vessel density (DVD), choroidal thickness (ChT) and choroidal vascularity, including total choroidal area (TCA), luminal area (LA), stromal area (SA) and Choroidal Vascularity Index (CVI), were measured using OCTA. Moreover, the Pulsatile Index, peak systolic velocity (PSV) and end diastolic velocity (EDV) of posterior ciliary artery (PCA), central retinal artery (CRA) and ophthalmic artery (OA) were quantified by CDI, and all parameters were compared between two eyes and the correlations among parameters were analysed. RESULTS: The mean difference of spherical equivalent (SE) and axial lengths (AL) between eyes were -6.00±2.94 D and 2.48±1.31 mm, respectively. The SVD, DVD, ChT, TCA, LA, SA and CVI were significantly lower in more myopic eyes compared with the contralateral eyes. In more myopic eyes, CDI parameters of CRA and PSV and EDV of PCA were also significantly lower. After adjusting for age and sex, the binocular asymmetry in LA and ChT was independent risk factor affecting interocular difference in both AL and SE. CONCLUSION: Retinal microvascular density, choroidal vascularity and retrobulbar blood flow were simultaneously lower in adult myopic anisomyopes with more myopic eyes and disturbed choroid circulation was related to the severity of myopia. Further longitudinal study was helped to identify the effect of choroidal parameters for myopic progression.

Asunto(s)

Anisometropía , Miopía , Adulto , Humanos , Tomografía de Coherencia Óptica/métodos , Estudios Longitudinales , Retina , Angiografía , Coroides/irrigación sanguínea

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African swine fever (ASF) is a highly fatal porcine disease caused by the African swine fever virus (ASFV), and resulting in huge economic losses across the globe. ASF has been raging in China for 3 years, and recently EP402R-deleted ASFV strains emerged, showing sub-acute or chronic symptoms in pigs and providing novel difficulties to monitor and control the disease as EP402R-deleted strains possess no hemadsorption (HAD) ability. In addition, the gene deletion virus with low viral load is prone to results retest or false negative due to the high cycle threshold (Ct) value under the current real-time polymerase chain reaction (PCR) detection method. Thus, a new method is needed to detect and distinguish wild strains and gene-deleted viruses. In this study, a duplex droplet digital polymerase chain reaction (ddPCR) assay based on the ASFV B646L and EP402R genes was established and showed good linearity (R2 > 0.99). The limit of detection for duplex ddPCR was 52 copies per reaction and 8.6 copies per reaction for B646L and EP402R, respectively. No cross-reaction with other porcine viruses [classical swine fever virus (CSFV), porcine reproductive and respiratory syndrome virus (PRRSV), porcine epidemic diarrhea virus (PEDV), porcine parvovirus (PPV), Japanese encephalitis virus (JEV), and porcine circovirus type 2 (PCV2)] was identified by this assay. In addition, 44 ASFV-suspicious clinical samples as well as EP402R-deleted ASFV were tested in parallel by duplex real-time PCR and ddPCR, indicative of a higher sensitivity which belonged to the duplex ddPCR assay. In summary, this is the first time that duplex ddPCR assay has been successfully developed to provide an efficient method to detect and differentiate ASFV wild-type and gene-deleted strains.

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BACKGROUND: This study aimed to evaluate the clinical outcomes and assess preoperative characteristics that may predict outcomes in keratoconus 1 year after accelerated transepithelial corneal cross-linking (ATE-CXL). METHODS: This prospective study included 93 eyes of 84 consecutive keratoconus patients with 1-year follow-up after ATE-CXL. Preoperative characteristics included corneal astigmatism, anterior chamber depth, anterior chamber volume, radius of curvature, posterior elevation, central corneal thickness (CCT), thinnest corneal thickness, steepest meridian keratometry, flattest meridian keratometry, and the maximum keratometry (Kmax). Data were obtained preoperatively and at 1, 3, 6, and 12 months postoperatively. The patient eyes were grouped into 3 subgroups according to CCT and Kmax values to observe the changes of keratoconus progression. RESULTS: All patients were successfully operated without complications at any follow-up time point. Mean changes of Kmax from baseline at 6 and 12 months were - 0.60 ± 2.21 D (P = 0.011) and - 0.36 ± 1.58 D (P = 0.030), respectively. Eyes with a thinner CCT and higher Kmax values exhibited a tendency for topographic flattening of ≥1.0 D (P = 0.003; P = 0.003). In the subgroup comparison, the Kmax values decreased significantly at 6 and 12 months after ATE-CXL in the group with CCT ≤ 450 µm (P = 0.018 and P = 0.045); the Kmax values of the group with Kmax > 65.0 D decreased significantly at 6 months postoperatively (P = 0.025). CONCLUSION: ATE-CXL is a safe and effective treatment for keratoconus patients. Patients with thinner CCT and higher Kmax values are more likely to benefit from ATE-CXL.

Asunto(s)

Queratocono , Fotoquimioterapia , Colágeno/uso terapéutico , Topografía de la Córnea , Reactivos de Enlaces Cruzados/uso terapéutico , Estudios de Seguimiento , Humanos , Queratocono/tratamiento farmacológico , Fármacos Fotosensibilizantes/uso terapéutico , Estudios Prospectivos , Riboflavina/uso terapéutico , Rayos Ultravioleta , Agudeza Visual

RESUMEN

African swine fever virus (ASFV) causes a viral disease in swine with a mortality rate of approximately 100%, threatening the global pig industry's economic development. However, vaccines are not yet commercially available, and other antiviral therapeutics, such as antiviral drugs, are urgently needed. In this study, berbamine hydrochloride, a natural bis-benzylisoquinoline alkaloid isolated from the traditional Chinese herb Berberis amurensis, showed significant antiviral activity against ASFV. The 50% cytotoxic concentration (CC50) of berbamine hydrochloride in porcine alveolar macrophages (PAMs) was 27.89 µM. The antiviral activity assay demonstrated that berbamine hydrochloride inhibits ASFV in a dose-dependent manner. In addition, a 4.14 log TCID50 decrease in the viral titre resulting from non-cytotoxic berbamine hydrochloride was found. Moreover, the antiviral activity of berbamine hydrochloride was maintained for 48h and took effect at multiplicities of infection (MOI) of 0.01, 0.1, and 1. The time-of-addition analysis revealed an inhibitory effect throughout the entire virus life-cycle. A subsequent viral entry assay verified that berbamine hydrochloride blocks the early stage of ASFV infection. Moreover, similar anti-ASFV activity of berbamine hydrochloride was also found in PK-15 and 3D4/21 cells. In summary, these results indicate that berbamine hydrochloride is an effective anti-ASFV natural product and may be considered a novel antiviral drug.

Asunto(s)

Virus de la Fiebre Porcina Africana , Fiebre Porcina Africana , Bencilisoquinolinas , Porcinos , Animales , Bencilisoquinolinas/farmacología , Antivirales/farmacología

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INTRODUCTION: This study investigated the long-term visual and optical quality changes after small incision lenticule extraction (SMILE) for the correction of moderate to high myopia. METHODS: Forty-one eyes of 41 patients with a mean spherical equivalent (SE) of - 6.74 ± 1.45 D undergoing SMILE were enrolled. Preoperative and 1-month, 3-month, 1-year and 5-year postoperative follow-up examinations were performed including visual acuity, manifest refraction, corneal aberrations and contrast sensitivity. An optical quality analysis system was used to measure objective scatter index (OSI), Strehl ratio (SR) and modulation transfer function cutoff frequency (MTFcutoff). RESULTS: The safety and efficacy indices were 1.09 ± 0.12 and 1.03 ± 0.17, respectively, at the 5-year follow-up. No significant changes in SE from 1 month to 5 years postoperatively were found. The OSI significantly increased at 1 and 3 months postoperatively (p < 0.01 and p < 0.01) and declined at 1 and 5 years (p = 0.81 and p = 0.87). MTFcutoff and SR showed similar trends. Coma, spherical aberration and total higher-order aberration significantly increased after SMILE (p < 0.01) and remained stable from 1 month to 5 years after surgery (p > 0.05). Contrast sensitivity in the photopic and mesopic condition showed no significant changes during 5-year follow-up (p > 0.05). CONCLUSION: The SMILE procedure is satisfactory in terms of optical quality for correcting moderate and high myopia in the long-term period. TRIAL REGISTRATION: ChiCTR-ONRC-13003114.

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Aims: This study aimed to investigate the corneal biomechanical changes and topographic outcomes of accelerated transepithelial corneal cross-linking (ATE-CXL) in pediatric progressive keratoconus. Methods: In this prospective longitudinal study, 31 eyes of 28 pediatric patients with keratoconus (21 boys and 7 girls; mean age, 14.35 ± 2.68 years) undergoing ATE-CXL (epithelium-on procedure with 45 mW/cm2 for 320 s) were included. Corvis ST was used to measure dynamic corneal response parameters at baseline and at 12 month after ATE-CXL. Corneal keratometry and corneal thickness were measured using Pentacam pre-operatively and 1, 6, and 12 month post-operatively. Results: No serious complications occurred during or after ATE-CXL. The maximum keratometry values were 60.10 ± 7.51 D pre-operatively and 61.42 ± 8.92, 61.17 ± 7.96, and 60.02 ± 7.58 D at 1, 6, and 12 month after ATE-CXL (P > 0.05), respectively. Corneal thickness remained stable during the 12-month follow-up (P > 0.05). At post-operative 12 month, first applanation time (P < 0.001), first applanation length (P = 0.004), second applanation velocity (P = 0.014), highest concavity time (P = 0.022), and radius of curvature at highest concavity (P = 0.031) increased significantly. The value of stiffness parameter at first applanation was significantly increased from 57.70 ± 27.57 pre-operatively to 63.36 ± 27.09 at 12 months after ATE-CXL (P = 0.018). Conclusions: ATE-CXL is safe and effective in stabilizing the progression of pediatric keratoconus. Changes in corneal biomechanical response consistent with stiffening following ATE-CXL were observed in pediatric patients with keratoconus.

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Background: Keratectasia after corneal refractive surgery is a rare but serious postoperative complication, and reports on accelerated transepithelial corneal crosslinking (ATE-CXL)-based treatment of patients with post-laser-assisted in situ keratomileusis (LASIK) ectasia are limited. Therefore, this study evaluated the long-term efficacy and safety of ATE-CXL for progressive post-LASIK ectasia. Methods: This prospective observational study was conducted at the Eye and ENT Hospital, Fudan University, Shanghai, China, and 25 eyes from 25 patients with post-LASIK ectasia undergoing ATE-CXL were examined. Clinical examinations were conducted preoperatively and postoperatively to assess parameters such as manifest refraction, corrected distance visual acuity (CDVA), endothelial cell density; keratometry, corneal thickness, posterior elevation and topometric indices were measured using Pentacam; sectoral pachymetry and epithelial thickness were evaluated using optical coherence tomography. A paired t-test, Wilcoxon rank-sum test, Kruskal-Wallis test, and repeated measures analysis of variance were used for statistical analysis. Results: Participants were examined for an average of 46 months. No severe complications occurred during or after ATE-CXL. CDVA improved from 0.25 ± 0.31 preoperatively to 0.15 ± 0.17 postoperatively (p = 0.011). Maximum keratometry decreased from 55.20 ± 8.33 D to 54.40 ± 7.98 D, with no statistical significance (p = 0.074), and the central corneal thickness increased from 414.92 ± 40.96 µm to 420.28 ± 44.78 µm (p = 0.047) at the final follow-up. Posterior elevation, pachymetry, and epithelial thickness remained stable (p > 0.05) throughout the follow-up. No significant differences were noted in topometric indices, except the central keratoconus index, which decreased significantly (p < 0.001) at the final follow-up. Conclusion: Improvements in CDVA and stabilization in corneal keratometry and posterior elevation after ATE-CXL were noted at the 46-months follow-up, demonstrating that ATE-CXL is a safe and effective treatment for progressive post-LASIK ectasia.

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PURPOSE: To compare the corneal biomechanical properties between post-LASIK ectasia and primary keratoconus. METHODS: A total of 42 eyes of 42 patients with matching age and central corneal thickness (CCT) were divided into two groups according to diagnosis of post-LASIK ectasia (PLE group; n = 21; age range: 22-47 years) and primary keratoconus (KC group; n = 21; age range: 21-47 years). The corneal biomechanical properties were assessed using Scheimpflug-based technology (Corvis ST; Oculus Optikgeräte, Wetzlar, Germany). The paired t-test and linear regression analysis were performed. RESULTS: The PLE group had significantly higher mean stiffness parameter at the first applanation (SP-A1; 76.65 ± 21.66 vs 52.72 ± 13.65, p ≤ 0.001) and mean stress-strain index (SSI) (SSI: 0.78 ± 0.16 versus 0.64 ± 0.12, p=0.001) than the KC group. SP-A1 was positively correlated with CCT in the PLE group (Pearson's r = 0.816, p ≤ 0.001), but not in the KC group (Pearson's r = -0.014, p=0.952). No statistical correlation was observed between SSI and CCT in either group (Pearson's r = 0.292, p=0.199, and Pearson's r = 0.004, p=0.985, respectively). CONCLUSIONS: In our case series, KC manifested more severe than PLE in biomechanical properties. Since SSI measurements were independent of corneal thickness, it can be used for corneal biomechanical assessment.

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PURPOSE: To investigate the long-term safety and efficacy of accelerated transepithelial cornealcross-linking (ATE-CXL) in children with progressive keratoconus. METHODS: Fifty-three eyes of 41 paediatric patients (34 boys, 7 girls; mean age 14.81±1.96 years) undergoing ATE-CXL were enrolled in the study. Corrected distance visual acuity (CDVA) and manifest refraction were assessed preoperatively and 36 months postoperatively. Corneal keratometry, corneal thickness and posterior elevation were measured using Pentacam preoperatively and 1, 6, 12 and 36 months postoperatively. Pachymetry and epithelial thicknesses were measured using optical coherence tomography preoperatively and 6, 12, and 36 months postoperatively. RESULTS: Thirty-six months postoperatively, CDVA improved from 0.32±0.28 to 0.26±0.25 in logarithm of the minimum angle resolution (p=0.025). Maximum keratometry was 58.73±9.70 D preoperatively and 59.20±10.24, 58.28±9.33, 57.88±9.99 and 58.98±10.79 D at 1, 6, 12 and 36 months postoperatively throughout the 36-month follow-up period (p>0.05). Similarly, corneal central thickness, which was 492.42±33.83 µm postoperatively, also remained stable during the 36-month follow-up (p>0.05). Both posterior central elevation and posterior highest elevation were stable at 12 months after ATE-CXL (p>0.05), but increased at 36 months postprocedure (p<0.05). Corneal pachymetry and epithelial thicknesses remained stable throughout the follow-up period (p>0.05). CONCLUSIONS: ATE-CXL is a safe and effective treatment in paediatric progressive keratoconus patients, leading to stable keratometry and corneal thickness throughout the 36-month follow-up.

Asunto(s)

Colágeno/metabolismo , Sustancia Propia/metabolismo , Reactivos de Enlaces Cruzados , Queratocono/tratamiento farmacológico , Fármacos Fotosensibilizantes/uso terapéutico , Riboflavina/uso terapéutico , Adolescente , Paquimetría Corneal , Topografía de la Córnea , Femenino , Estudios de Seguimiento , Humanos , Queratocono/metabolismo , Queratocono/fisiopatología , Masculino , Fotoquimioterapia/métodos , Estudios Prospectivos , Factores de Tiempo , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Rayos Ultravioleta , Agudeza Visual/fisiología

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BACKGROUND: Conventional corneal cross-linking is effective for retarding the progression of keratoconus. However the long-term efficacy and safety of accelerated (45 mW/cm2) transepithelial corneal cross-linking (ATE-CXL) on progressive keratoconus (KC) treatment is not fully understood. The purpose of this study is to evaluate the 2-year changes in corneal topographic parameters and densitometry values after ATE-CXL for KC. METHODS: Twenty-five progressive eyes of 25 KC patients (KC group) and 25 eyes of 25 myopes without KC (control group) were enrolled. Corneal topography and densitometry values were evaluated pre-operatively and at 6, 12 and 24 months post-operatively in the KC group. RESULTS: The mean values of flat keratometry (K1), steep keratometry (K2), mean keratometry (Km), corneal astigmatism (CA), maximum keratometry (Kmax), central corneal thickness (CCT), thinnest corneal thickness (TCT), anterior corneal elevation (ACE) and posterior corneal elevation (PCE) all remained unchanged over time (all P values > 0.05). The densitometry values of the anterior, central, posterior and total layers over the annular diameters 0 mm to 2 mm (Φ0-2 mm) and Φ2-6 mm all decreased significantly (all P values < 0.05). At post-operative month 24, except for the densitometry value of the posterior layer (Φ0-2 mm), which was significantly lower than that of the control group (post hoc P = 0.010), all densitometry values obtained from the remaining locations of the KC eyes were equal to those of the control group (All post hoc P values > 0.05). Subgroups with Km ≥ 50.30D or ACE ≥35.3 µm progressed significantly when compared with those with Km < 50.30D (F = 8.167, P = 0.004) or ACE< 35.3 µm (F = 5.207, P = 0.022). CONCLUSIONS: K1, K2, Km, CA, Kmax, CCT, TCT, ACE, and PCE values may remain stable but severer KC patients tend to have poorer long-term outcomes. The densitometry values of the full corneal thickness (total layer over Φ0-2 mm and Φ2-6 mm) may decrease to normal levels at 2 years after ATE-CXL for KC.

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Reactivos de Enlaces Cruzados/uso terapéutico , Queratocono/tratamiento farmacológico , Queratocono/patología , Fotoquimioterapia/métodos , Adulto , Estudios de Casos y Controles , Colágeno/metabolismo , Topografía de la Córnea , Densitometría , Femenino , Estudios de Seguimiento , Humanos , Queratocono/fisiopatología , Masculino , Fotoquimioterapia/efectos adversos , Fármacos Fotosensibilizantes/uso terapéutico , Estudios Prospectivos , Riboflavina/uso terapéutico , Rayos Ultravioleta , Agudeza Visual , Adulto Joven

RESUMEN

BACKGROUND: Keratoconus typically presents in the teenage years and is more advanced in younger patients when compared with adults. In the present study, we aimed to assess the safety and efficacy of accelerated transepithelial corneal collagen cross-linking (ATE-CXL) in children with progressive keratoconus. METHODS: In this retrospective consecutive study, 18 eyes were enrolled from 17 pediatric patients (15 boys and 2 girls) with a mean age of 14.44 ± 1.98 years. Manifest refraction, best-corrected visual acuity (BCVA), steepest meridian keratometry (K1), flattest meridian keratometry (K2), maximum keratometry (Kmax), thinnest corneal thickness (TCT), posterior central elevation (PCE), and posterior mean elevation (PME) were measured before and after ATE-CXL. The patients were followed-up at 1, 6, and 12 months. Repeated measures analysis of variance was used for statistical analysis. P < 0.05 was considered statistically significant. RESULTS: There were no complications in any case during or after ATE-CXL. BCVA improved from 0.64 ± 0.32 preoperatively to 0.69 ± 0.32 at 1-year postoperatively. The Kmax value was 56.67 ± 9.60 D before the treatment and 56.19 ± 8.55 D, 56.08 ± 8.85 D, and 55.94 ± 8.46 D at 1, 6, and 12 months postoperatively, respectively. No statistically significant differences were present in K1, K2, Kmax, PCE, and TCT before and after ATE-CXL during the 12-month follow-up (P > 0.05). CONCLUSIONS: ATE-CXL is a safe and effective treatment in pediatric progressive keratoconus patients. The long-term effects need further observation. TRIAL REGISTRATION: Retrospectively registered. Registration number: ChiCTR-OIC-16008181 . Registered 29 March 2016.

Asunto(s)

Colágeno/metabolismo , Reactivos de Enlaces Cruzados/uso terapéutico , Queratocono/tratamiento farmacológico , Fotoquimioterapia/métodos , Adolescente , Análisis de Varianza , Niño , Topografía de la Córnea , Femenino , Estudios de Seguimiento , Humanos , Masculino , Fármacos Fotosensibilizantes/uso terapéutico , Estudios Retrospectivos , Riboflavina/uso terapéutico , Rayos Ultravioleta , Agudeza Visual

RESUMEN

BACKGROUND: Adolescent KC is a special segment of the general KC population because an adolescents's eyes are still susceptible to blurred vision and optical defocus during the sensitive period of ocular and visual development. In the present study, we evaluated the ocular dimensions of 53 KC adolescents. METHODS: One hundred and six KC eyes of 53 (42 boys and 11 girls) KC adolescents (age 15.5 ± 1.7 years, range 11 to 18) were involved in this retrospective study. The eye with more severe KC (Severe Group) of each patient was compared with their less affected eye (Mild Group). Optical axial length (OAL) was measured by optical coherence biometry (IOL-master). Central corneal thickness, anterior chamber depth (ACD), flat keratometry value, steep keratometry value, and maximum keratometry value were assessed with an anterior segment analyzer (Pentacam HR). Anterior segment length (ASL) was manually measured from the 25 scheimpflug images captured by the Pentacam HR with the mean value recorded. The posterior segment length (PSL) was calculated with the formula "PSL = OAL-ASL". RESULTS: The mean ACD, OAL, ASL, and PSL values of the Severe Group were 3.51 ± 0.32 mm, 24.76 ± 1.24 mm, 4.01 ± 0.30 mm and 20.76 ± 1.15 mm.While those of the Mild Group were 3.36 ± 0.29 mm, 24.97 ± 1.40 mm, 3.94 ± 0.35 mm and 21.03 ± 1.31 mm. The Severe Group has significantly higher ACD (t = 4.539, P < 0.001) value but lower OAL (t = - 3.120, P = 0.003) and PSL (t = - 4.537, P < 0.001) values when compared with those of the Mild Group. For the Severe Group, the Kmax values were significantly correlated with the SE values (R = - 0.385, P = 0.004), the ACD values (R = 0.375, P = 0.006), the ASL values (R = 0.308, P = 0.025) and the PSL values (R = - 0.317, P = 0.021), but not with the OAL values (R = - 0.220, P = 0.114). In the Mild Group, the Kmax values were negatively correlated with the SE (R = - 0.577, P < 0.001), OAL(R = - 0.533, P < 0.001), and PSL (R = - 0.523, P < 0.001) values, but not with ACD (R = - 0.110, P = 0.434) or ASL (R = - 0.182, P = 0.192) values. CONCLUSIONS: For adolescent KC, the more keratoconic eyes may be characterized by deeper ACD but shorter OAL and PSL, when compared with the less affected ones.

Asunto(s)

Cámara Anterior/patología , Longitud Axial del Ojo/patología , Queratocono/diagnóstico , Adolescente , Pueblo Asiatico/etnología , Biometría , Niño , China/epidemiología , Topografía de la Córnea , Femenino , Humanos , Queratocono/epidemiología , Masculino , Refracción Ocular , Estudios Retrospectivos , Tomografía de Coherencia Óptica

RESUMEN

BACKGROUND: To evaluate the feasibility and efficacy of small incision lenticule extraction (SMILE) in the treatment of myopia with corneal opacity. METHODS: To evaluate the treatment of myopia with corneal opacity, 9 patients (4 males, 5 females) who underwent SMILE were enrolled in this prospective clinical study. One eye of each patient was treated. The results of laser scanning and lenticule extraction were observed during the surgery, and the surgical videos were again reviewed after surgery. Uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and spherical equivalence (SE) were noted at 1 month after surgery. The depth and density of the corneal opacities were measured by anterior segment optical coherence tomography (AS-OCT) and the Pentacam anterior eye segment analyzer. RESULTS: All procedures were uneventful and no intraoperative complications were observed. At 1 month after surgery, the UDVA of all patients was 20/25 or better and no patients lost Snellen lines. The mean safety and efficacy indexes were 1.10 ± 0.24 and 1.08 ± 0.16, respectively, at 1 month postoperatively. The mean postoperative spherical equivalent was 0.27 ± 0.23 diopter (D). All eyes were within ±0.75 D and 8 eyes (88.9%) were within ±0.50 D. There was no eccentric corneal topography or abnormal morphology in the corneal caps. The corneal opacities of all patients were within the optical zone. The mean preoperative depths in the deepest areas of corneal opacity were 152 ± 38 µm (range: 86-217 µm); at 1 month after surgery (P < .01), they were 117 ± 28 µm (range: 86-189 µm). The preoperative maximum density of corneal opacity was 48.5 ± 20.7 (range: 20.4 to 85.8); at 1 month after surgery (P > .05), it was 49.8 ± 26.7 (range: 19.8 to 82.5) at 1 month after surgery. CONCLUSION: Patients with corneal opacity can be successfully treated with the SMILE operation. The short-term outcome was good, however the long-term results need further study. TRIAL REGISTRATION: The trial registration number: ChiCTR-ONRC-13003114 , Date of Last Refreshed on: 2016-01-27, Date of registration on 2013-03-17(retrospectively registered).

Asunto(s)

Opacidad de la Córnea/cirugía , Sustancia Propia/cirugía , Cirugía Laser de Córnea/métodos , Microcirugia/métodos , Miopía/cirugía , Refracción Ocular , Adulto , Opacidad de la Córnea/complicaciones , Opacidad de la Córnea/diagnóstico , Sustancia Propia/patología , Topografía de la Córnea , Femenino , Estudios de Seguimiento , Humanos , Masculino , Miopía/complicaciones , Miopía/diagnóstico , Estudios Prospectivos , Factores de Tiempo , Tomografía de Coherencia Óptica , Resultado del Tratamiento , Adulto Joven

RESUMEN

PURPOSE: To investigate long-term changes in posterior corneal elevation after small incision lenticule extraction (SMILE). METHODS: Thirty-six eyes of 20 patients (7 male, 13 female) who underwent SMILE were recruited for this prospective consecutive study. The mean preoperative manifest spherical equivalent was -6.24 ± 1.47 diopters (D) (range: -3.88 to -8.75 D). Posterior corneal surfaces were measured by a Scheimpflug camera (Pentacam; Oculus Optikgeräte GmbH, Wetzlar, Germany) preoperatively and at 1 month, 6 months, 12 months, 2 years, and 3 years after surgery. Posterior central elevation (PCE), posterior maximal elevation (PME), and posterior elevation at the thinnest corneal point (PTE) in the central 4-mm area above the best-fit sphere (BFS) were analyzed. The BFS was the same across all follow-up periods and determined by the preoperative data. A P value of less than .05 was considered statistically significant. RESULTS: All surgeries were executed without complications and no case of keratectasia was observed during the follow-up. An uncorrected distance visual acuity of 20/20 or better was achieved in 100% of eyes at the last visit. The mean change of PCE, PME, and PTE at 3 years after the operation was -2.39 ± 2.85, 0.50 ± 3.33, and -2.33 ± 2.90 µm, respectively. There were significant differences in the measurements of PCE and PTE before surgery and 3 years after surgery (P ≤ .009); however, there was no significant difference in PME before surgery and 3 years after surgery (P = 1.000). No correlation was found between changes in posterior corneal elevation and residual bed thickness, ablation depth, and preoperative thinnest corneal thickness. CONCLUSIONS: The posterior corneal surface, measured using the Pentacam, was stable after SMILE in the long-term follow-up. The cause of the slight backward change of PCE and PTE needs further study. [J Refract Surg. 2017;33(2):84-88.].

Asunto(s)

Sustancia Propia/cirugía , Cirugía Laser de Córnea/métodos , Endotelio Corneal/patología , Miopía Degenerativa/cirugía , Adolescente , Adulto , Topografía de la Córnea , Dilatación Patológica/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Miopía Degenerativa/fisiopatología , Fotograbar , Estudios Prospectivos , Agudeza Visual/fisiología , Adulto Joven

RESUMEN

PURPOSE: The objective of this study is to investigate changes in corneal densitometry after accelerated transepithelial corneal collagen cross-linking (ATE-CXL) for patients with progressive keratoconus (KC). METHODS: Seventeen progressive KC patients who underwent ATE-CXL (KC group) were examined and compared against 17 non-KC myopes (control group). For the KC group, corneal topography and densitometry were evaluated preoperatively and at 1, 6, and 12 months postoperatively. Manifest refraction spherical equivalent and best spectacle-corrected distant visual acuity were assessed preoperatively and at 12 months postoperatively. These parameters were also evaluated in the control group. RESULTS: Preoperatively, in the KC group, the densitometry values of the total layer over the annular diameters (Φ) 0 to 2 and Φ 2 to 6 mm were 18.47 ± 1.81 and 16.62 ± 1.60, respectively. In the control group, the values were 14.98 ± 1.18 and 13.39 ± 1.33, respectively, significantly lower than those of the KC group (both post hoc P values < 0.001). At postoperative month 12, the densitometry values of Φ 0 to 2 and Φ 2 to 6 mm of the total layer in the KC group were 16.88 ± 1.57 and 15.28 ± 1.40, which were significantly lower than the preoperative values (post hoc P = 0.012 and 0.030, respectively). However, they were still higher than those of the myopes (post hoc P = 0.002 and 0.001, respectively). CONCLUSIONS: KC patients have much higher corneal densitometry values than myopes without KC. The KC patients' corneal densitometry values decreased significantly when measured at 12 months after ATE-CXL. However, they remain higher than those of the myopes.

Asunto(s)

Colágeno/metabolismo , Sustancia Propia/metabolismo , Reactivos de Enlaces Cruzados , Queratocono/tratamiento farmacológico , Fotoquimioterapia , Riboflavina/uso terapéutico , Adulto , Topografía de la Córnea , Densitometría , Epitelio Corneal , Femenino , Estudios de Seguimiento , Humanos , Queratocono/metabolismo , Queratocono/fisiopatología , Masculino , Fármacos Fotosensibilizantes , Refracción Ocular/fisiología , Estudios Retrospectivos , Rayos Ultravioleta , Agudeza Visual/fisiología , Adulto Joven