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Paediatric cornea crosslinking current strategies:A review

Advances in Ophthalmology Practice and Research 2023年第2期3卷 55-62页

作者： Pawan Prasher Ashok Sharma Rajan Sharma Vipan K.Vig Verinder S.Nirankari Department of Ophthalmology Sri Guru Ram Das Institute of Medical Sciences and ResearchAmritsarPunjabIndia Cornea Centre SCO 2463-2464Sector 22 C160022ChandigarhIndia Amritsar Eye Hospital GNDU Shopping ComplexAmritsarPunjabIndia Department of Ophthalmology University of MarylandUSA

Background:In the general population,1 in 2000 people has keratoconus.Indians and other people from Southeast Asia have a higher incidence of keratoconus.Children with keratoconus typically present earlier in life and with a more severe disease.Rubbing the eyes has been identified as a risk factor.Children have a higher incidence and a faster rate of keratoconus progression.Visual rehabilitation in children with keratoconus is challenging.They have a low compliance with contact lens use.Many of these children require penetrating keratoplasty at an early age.Therefore,stopping the progression of keratoconus in children is of paramount importance.Main text:Compared to treatment,keratoconus progression prophylaxis is not only preferable,but also easier.corneal collagen cross-linking has been shown to be safe and effective in stopping its progression in children.The Dresden protocol,which involves central corneal deepithelization(7-9 mm),saturation of the stroma with riboflavin(0.25%),and 30 min UV-A exposure,has proven to be the most successful.Two significant disadvantages of the typical Dresden regimen are the prolonged operating time and the significant post-operative pain.Accelerated-CXL(9 mW/cm^(2) x 10 min)has been studied to reduce operative time and has been shown to be equally effective in some studies.Compared to accelerated CXL or traditional CXL,epi-off procedures,transepithelial treatment without the need for de-epithelialization and without postoperative discomfort,have been shown to be safer but less effective.corneal crosslinking should only be performed after treating children with active vernal keratoconjunctivitis.corneal opacity,chronic corneal edema,sterile infiltrates,and microbial keratitis have been reported after cross-linking of corneal collagen.Conclusions:The"Dresden protocol",also known as the conventional corneal cross-linking approach,should be used to halt the progression of keratoconus in young patients.However,if the procedure needs to be completed more rapidly,accelerated corneal c

关键词： Keratoconus corneal collagen cross-linking Corneal transplant Pediatric keratoconus

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Management of cytomegalovirus corneal endotheliitis

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Eye and Vision 2021年第1期8卷 18-30页

作者： Angela H.Y.Wong Wee Nie Kua Alvin L.Young Kelvin H.Wan Department of Ophthalmology Tuen Mun HospitalHong KongChina Department of Ophthalmology and Visual Sciences Prince of Wales HospitalHong KongChina Department of Ophthalmology and Visual Sciences The Chinese University of Hong KongHong KongChina

Background:Cytomegalovirus(CMV)can manifest as corneal endotheliitis in immunocompetent individuals.Early diagnosis is prudent to prevent endothelial cell loss,which could ultimately lead to corneal decompensation.CMV DNA was first detected in an eye with corneal endotheliitis in 2006;since then,clinical evidence from numerous case reports and case series have accumulated.Main text:In this narrative review,we identified several drugs,including ganciclovir,valganciclovir,and their combination in oral,intravenous,intravitreal,and topical forms in different concentrations,together with the judicious use of topical steroids,have reported variable success.There has yet to be any prospective comparative study evaluating the efficacy and safety of these assorted forms of treatment;clinical evidence is based on case reports and case series.CMV endotheliitis presenting with corneal edema can masquerade as other corneal diseases and thus poses a great challenge especially in post-keratoplasty eyes.Heightened awareness is needed before and after keratoplasty to start prompt prophylaxis and treatment.Conclusion:There is no consensus on the management of CMV endotheliitis.Further studies are much needed to elucidate the optimal treatment modality,regime,and duration in the treatment and prophylaxis of CMV endotheliitis.

关键词： Cytomegalovirus CMV Endotheliitis Keratoplasty Corneal transplant Cornea

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Cellular therapy of the corneal stroma: a new type of corneal surgery for keratoconus and corneal dystrophies

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Eye and Vision 2018年第1期5卷 250-259页

作者： Jorge L.Aliódel Barrio Jorge L.Alió Cornea Cataract and Refractive Surgery UnitVissum CorporaciónAlicanteSpain Division of Ophthalmology Universidad Miguel HernándezAlicanteSpain. Vissum Instituto Oftalmologico de AlicanteAvda de Denia s/n03016 AlicanteSpain

Cellular therapy of the corneal stroma,with either ocular or extraocular stem cells,has been gaining a lot of interest over the last decade.Multiple publications from different research groups are showing its potential benefits in relation to its capacity to improve or alleviate corneal scars,improve corneal transparency in metabolic diseases by enhancing the catabolism of the accumulated molecules,generate new organized collagen within the host stroma,and its immunosuppressive and immunomodulatory properties.Autologous extraocular stem cells do not require a healthy contralateral eye and they do not involve any ophthalmic procedures for their isolation.Mesenchymal stem cells have been the most widely assayed and have the best potential to differentiate into functional adult keratocytes in vivo and in vitro.While embryonic stem cells have been partially abandoned due to ethical implications,the discovery of the induced pluripotent stem cells(iPSC)has opened a new and very promising field for future research as they are pluripotent cells with the capacity to theoretically differentiate into any cell type,with the special advantage that they are obtained from adult differentiated cells.Cellular delivery into the corneal stroma has been experimentally assayed in vivo in multiple ways:systemic versus local injections with or without a carrier.Encouraging preliminary human clinical data is already available although still very limited,and further research is necessary in order to consolidate the clinical applications of this novel therapeutic line.

关键词： Stem cells Regenerative medicine Corneal transplant Decellularized cornea Cornea corneal stroma Cellular therapy MSC Mesenchymal stem cells

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corneal surgery in keratoconus: which type, which technique, which outcomes?

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Eye and Vision 2016年第1期3卷 8-21页

作者： Francisco Arnalich-Montiel Jorge L.Aliodel Barrio Jorge L.Alio IRYCIS.Ophthalmology Department Ramon y Cajal University HospitalMadridSpain Cornea Unit Hospital Vissum MadridMadridSpain Cornea and External Diseases Service Moorfields Eye HospitalLondonUK Cornea Cataract and Refractive Surgery UnitVissum CorporacionAlicanteSpain Division of Ophthalmology Universidad Miguel HernandezAlicanteSpain

Keratoconus is a disease characterized by progressive thinning,bulging,and distortion of the cornea.Advanced cases usually present with loss of vision due to high irregular astigmatism.A majority of these cases require surgical intervention.This review provides an update on the current treatment modalities of corneal surgery available for the management of advanced corneal ectasias.

关键词： Keratoconus Deep anterior lamellar keratoplasty Penetrating keratoplasty Corneal transplant Rejection

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Knowledge and attitudes toward corneal donation among Singaporean youth: a cross-sectional study

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Eye and Vision 2016年第1期3卷 131-140页

作者： Carisa Mariella Alvarez Paraz Ha Thi Thu Truong Darren Kyauk Sai Howard Yu Cajucom-Uy Cherry Lay Li Chan Selina Md Kassim Singapore Eye Bank Singapore National Eye Centre11 Third Hospital AvenueSingapore 168751Singapore SingHealth transplant Singapore Health Services Pte LtdTransplant Administrative and Resource OfficeSingapore General HospitalBlock 1Level 31 Hospital DriveSingapore 169608Singapore School of Applied Science Republic Polytechnic 9 Woodlands Avenue 9Singapore 738964Singapore

Background:To assess the knowledge of Singaporean youth regarding corneal donation and gauge their willingness to donate their corneas.Methods:We conducted a cross-sectional study among 500 students from five tertiary institutions in Singapore.All students answered self-administered questionnaires which included seven questions that tested knowledge and three questions that determined willingness to donate corneas.Results:Among 500 Singaporean youth aged 18 to 25,most students(73.2%)answered 3 or fewer of the 7 questions about corneal donation correctly.With regards to the willingness to donate,155(31%)were willing to donate their corneas,111(22.2%)were not willing to donate their corneas,and 234(46.8%)were undecided.Willingness to donate corneas was associated with an older age group(21 to 25 years old),those who are non-Muslims,and have good basic knowledge.Particularly,students with good basic knowledge were 1.71 times more likely to willingly donate their corneas.Conclusion:The knowledge of the Singaporean youth regarding corneal donation and transplantation is poor.Since insufficient information was cited as the most common reason for being undecided in regards to corneal donation,specific and tailored programs to increase knowledge and awareness are needed to convince the youth to support corneal donation.

关键词： corneal donation Donation knowledge Willingness Corneal transplant

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