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AIM: To evaluate the clinical efficacy of corneal stromal lenticule-combined accelerated transepithelial corneal collagen cross-linking(SC-A-TE-CXL)in the treatment of severe keratoconus.METHODS: Prospective before-after self-control study. A total of 10 cases(14 eyes)of severe keratoconus with the thinnest corneal thickness(including epithelium)less than 400 μm were collected from March 2019 to July 2022 at the ophthalmology department of Affiliated Eye Hospital of Nanjing Medical University. Among them, 8 males(12 eyes)and 2 females(2 eyes)were treated with SC-A-TE-CXL. Corneal curvature, uncorrected visual acuity(UCVA), best corrected visual acuity(BCVA), the thinnest corneal thickness(TCT), central corneal thickness(CCT), non-contact intraocular pressure, endothelial cell density(ECD)and anterior or posterior elevations at the thinnest point before surgery and at 1, 3, 6 and 12 mo postoperatively were observed and recorded, as well as corneal cross-linking depth at 1 mo postoperatively.RESULTS: UCVA and BCVA at 1, 3, 6, and 12 mo after SC-A-TE-CXL were higher than those preoperatively, but there were no differences(F=0.793, P=0.535; F=0.783, P=0.542). K1, K2, Km and Kmax decreased at each time point postoperatively compared with those preoperatively, but there were no differences(F=0.627, P=0.574; F=1.264, P=0.296; F=0.727, P=0.520; F=1.115, P=0.359). Anterior and posterior elevations at the thinnest point both decreased compared with those preoperatively, but the differences were not statistically significant(F=1.046, P=0.359; F=1.164, P=0.337). The non-contact intraocular pressure at each time point postoperatively was higher than that preoperatively, but the differences were not statistically significant(F=0.814, P=0.522). There were no differences in CCT and TCT at any time points of the follow-ups compared with those preoperatively(F=0.931, P=0.453; F=0.782, P=0.542). There was no difference in ECD at 12 mo postoperatively versus preoperative value(t=1.266, P=0.228). At 1 mo postoperatively, anterior segment optical coherence tomography(AS-OCT)exhibited an increase of density in the anterior stroma, and there was a demarcation line with an average depth of 124.07±25.13 μm.CONCLUSION: SC-A-TE-CXL can be considered as a surgical treatment for severe keratoconus, which can delay the progression of severe keratoconus with high safety. However, the long-term efficacy of this treatment requires further observation.
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AIM: To investigate the diagnostic value of the difference of binocular biological parameters of the anterior segment in early keratoconus.METHODS: Retrospective case-control study. A total of 183 patients(366 eyes)who visited our hospital from March 2022 to November 2023 were included, including 107 cases(214 eyes)in the control group(patients with simple refractive error), 40 cases(80 eyes)in the subclinical keratoconus group, and 36 cases(72 eyes)in the clinical keratoconus group. All of the patients were examined by the Pentacam anterior segment analyzer to determine the inferior-superior 3 mm of the posterior corneal surface(I-S), corneal posterior elevation of the thinnest point(P.E.), maximum posterior elevation of the best fit sphere(MPE from BFS), the maximum posterior elevation of the best fit toric ellipsoid(MPE from BFTE), posterior aspherical asymmetry index(AAI), central corneal thickness(CCT), thinnest corneal thickness(TCT), pachymetric progression index average(PPIavg), Ambrósio relational thickness maximum(ARTmax), Belin/ Ambrósio enhanced ectasia display(BAD-D), and the binocular difference of each test was calculated separately for each patient. The control group was further divided according to corneal diameter: 21 cases(42 eyes)with corneal diameter <11.2 mm in group A, 54 cases(108 eyes)with 11.2 mm≤ corneal diameter ≤11.8 mm in group B, and 32 cases(64 eyes)with corneal diameter >11.8 mm in group C.RESULTS: There was significant differences in the binocular I-S, P.E., MPE from BFS, MPE from BFTE, AAI, CCT, TCT, PPIavg, ARTmax and BAD-D between the clinical keratoconus group and the control group(P<0.05). The difference of binocular I-S, P.E., MPE from BFS, MPE from BFTE, AAI, CCT, TCT, PPIavg, and BAD-D were of high diagnostic value(AUC≥0.900), with the best diagnostic ability for P.E. and BAD-D, and an AUC as high as 0.999 and 0.995, respectively. The difference of binocular P.E. and ARTmax between the subclinical keratoconus group and the control group were statistically significant(P<0.05). The difference of binocular I-S, P.E. and BAD-D had high diagnostic value for subclinical keratoconus(AUC≥0.900). In the control group A, B and C, there were no significant difference in binocular I-S, CCT, TCT, MPE from BFS, MPE from BFTE, AAI, PPIavg and ARTmax(all P>0.05), and none of them had correlation with corneal diameter(P>0.05); however, there were statistical significant differences in binocular P.E. and BAD-D in the control group A, B and C(P=0.007, 0.003), while the P.E. differences had no correlation with corneal diameter(P=0.270), and binocular BAD-D differences were negatively correlated with corneal diameter(r=-0.230, P=0.017).CONCLUSION: Pentacam anterior segment analyzer can accurately measure a variety of corneal biological parameters. Difference of binocular corneal I-S, P.E. and BAD-D are sensitive indexes for the early diagnosis of keratoconus. Among them, difference of binocular I-S and P.E. are less affected by corneal diameter, thus being significant for the early diagnosis of keratoconus with different cornea diameters.
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Objective:To investigate clinical treatment regimens for ocular lesions in patients with severe ocular rosacea.Methods:A total of 28 patients (34 eyes) with severe rosacea complicated by blepharokeratoconjunctivitis were collected from outpatient department of the Affiliated Eye Hospital of Nanjing Medical University from December 1, 2019 to May 30, 2021. They were randomly divided into two groups: group A (13 cases, 16 eyes) topically treated with sodium hyaluronate 0.3% eye drops and levofloxacin 0.5% eye drops, and group B (15 cases, 18 eyes) topically treated with sodium hyaluronate 0.3% eye drops alone. Patients in both groups also received oral minocycline hydrochloride 100 mg every day for the first 2 weeks, and then 50 mg every day for the next 6 weeks. Meanwhile, all patients received same physical therapies such as meibomian gland massage, eyelid hot compresses and eyelid margin cleaning. LogMAR visual acuity, tear break-up time (BUT) , ocular surface disease index (OSDI) score, and meibomian gland function grading examination results in the two groups were recorded before and 8 weeks after treatment. Paired t test was used to compare within-group differences in the parameters before and after treatment, and two-independent-sample t test to compare intergroup differences after treatment. Results:After 8-week treatment, both group A and group B showed significantly increased LogMAR visual acuity ( t = 3.10, 2.15, P = 0.007, 0.046, respectively) , improved BUT ( t = 3.44, 2.85, P = 0.003, 0.011, respectively) , but significantly decreased OSDI scores ( t = 7.12, 9.33, respectively, both P < 0.001) and meibomian gland function scores ( t = 13.73, 16.82, respectively, both P < 0.001) compared with those before treatment. After treatment, no significant differences were observed in the LogMAR visual acuity ( P = 0.721) , BUT ( P = 0.189) , OSDI scores ( P = 0.808) and meibomian gland function scores ( P = 0.191) between the two groups. No adverse drug reactions occurred during the treatment. During the follow-up period (8 months or shorter) , no recurrence of ocular lesions was observed. Conclusion:Without topical antibiotics, oral minocycline hydrochloride combined with topical sodium hyaluronate eye drops is still effective for the treatment and prevention of recurrence of ocular lesions in patients with severe ocular rosacea.