bluuebunny/crossref_metadata_2025_split huggingface dataset:
Comparison of waveform‐derived ORA parameters in clinical keratoconus, subclinical keratoconus and healthy subjects
Authors: Atay Kubra , Özalp Onur , Atalay Eray 
Published: January 2024

Aims/Purpose: The aim of this study was to comparison of waveform‐derived Ocular Response Analyser (ORA) parameters in clinical keratoconus (KC), subclinical keratoconus (SKC) and healthy subjects.Methods: This retrospective comparative case series study included 24 eyes with SKC, 24 eyes with KC and 48 eyes of age‐ and sex‐matched healthy subjects. Keratoconus diagnosis was based on clinical examinations, and Scheimpflug corneal tomography. SKC was defined as the presence of the following: (1) normal biomicroscopic findings and topography; (2) anterior (≤7 μm) and posterior (≤16 μm) elevation difference map marked green or yellow; (3) mean keratometry <47D; (4) BAD‐D value <3 SD and (5) keratoconus in the fellow eye. Thirty‐seven parameters derived from the waveform signal obtained with ORA were analysed. The Kruskal‐Wallis H test with Bonferroni correction was used for comparisons. p < 0.05 was considered statistically significant.Results: While the rate of females in all groups was 33.3%, the mean age was 25.6 ± 0.9, 25.8 ± 1.3 and 25.7 ± 0.8 years in KC, SKC and healthy subjects, respectively. Statistically significant differences between KC and healthy eyes were found in p1area (p = 0.005), p2area (p < 0.001), w1 (p = 0.001), w2 (p = 0.002), path1 (p = 0.032), path2 (p < 0.001), aplhf (p = 0.018), p1area1 (p = 0.021), p2area1 (p < 0.001), w11 (p = 0.028), w21 (p = 0.001), and path21 (p < 0.001). While there were significant differences in w2 (p = 0.016), w21 (p = 0.042), and path21 (p = 0.033) parameters between SKC and healthy eyes, no significant difference was found between SKC and KC eyes.Conclusions: Approximately one‐third of the waveform‐derived ORA parameters can be used to differentiate between KC and healthy subjects. Parameters derived from the second applanation signal of ORA were superior in distinguishing SKC from healthy subjects.
Diagnostic errors and delay of keratitis fugax hereditaria
Authors: Immonen Annamari , Kawan Sabita , Backlund Michael , Saaren‐Seppälä Heikki , Kivelä Tero , Turunen Joni 
Published: January 2024

Aims/Purpose: To chart misdiagnoses associated with keratitis fugax hereditaria (KFH), an autosomal dominant periodic corneal autoinflammatory disease, and the frequency of misdiagnosed KFH in patients diagnosed with unspecified anterior uveitis, herpes keratitis, or unspecified keratitis.Methods: Charts of patients with genetically confirmed KFH (n = 94) were reviewed. Two Finnish biobanks provided 2037 DNA samples meeting the inclusion criterion of a diagnosis KFH can be misdiagnosed with and the exclusion criterion of having a common underlying cause of anterior uveitis, such as rheumatoid arthritis. The NLRP3 c.61G>C variant was detected using restriction fragment length polymorphism analysis, and Sanger sequencing for confirmation. Age, sex, ocular and other diagnoses, and laboratory results were collected from patients carrying the variant.Results: The time between first symptoms and the diagnosis of KFH ranged from 0 to 62 years (median, 21; interquartile range [IQR], 8–45). Analysis of patient charts revealed that the most common misdiagnoses were acute anterior uveitis (51% of all misdiagnoses/26% of all patients), conjunctivitis (26%/13%), or recurrent erosion (21%/11%). A mild anterior chamber inflammation was observed in 30% of patients, 0.5+ or 1+ by Standardization of Uveitis Nomenclature (SUN) criteria. Of the biobank samples, 12/2037 (0.59%; 95% confidence interval [CI] 0.56%–0.61%) carried the c.61G>C variant: 11 diagnosed with anterior uveitis, and one with unspecified keratitis. Three had previously been diagnosed with KFH. The age range of the 12 variant carriers varied from 38 to 79 (median, 63; IQR, 48–76) with nine females and three males.Conclusions: KFH is most frequently misdiagnosed as anterior uveitis. In Finland, it might be beneficial to add testing for the NLRP3 c.61G>C variant in existing laboratory test packages for anterior uveitis.
Mechanotransduction and corneal endothelium homeostasis: Application in tissue engineering
Authors: Hussain Noor Ahmed , Figueiredo Francisco , Connon Che 
Published: January 2024

Aim: Globally, there is a significant shortage of corneas available in the eye banks. This high demand has triggered a new platform for addressing the issue by using biomaterials. Mechanical cues play a key role in regulating fundamental cellular functions, as demonstrated by numerous studies conducted on many types of cells. This project's goal is to engineer an effective Descemet's membrane (DM) by changing the stiffness of compressed collagen scaffolds so that it maximizes the functional properties of Descemet's membrane to fully support endothelial cells.Methods: This study entails creation of collagen substrates of varying stiffness which enabled to scrutinize the effect of different biomechanical signals on human corneal endothelial cells (HCECs) behaviour. Thereafter, the viability, function, and responses of HCECs were compared to determine the best scaffold to support corneal endothelial cells. Collagen scaffolds were characterized: light transmittance, scaffold stiffness values, and surface topography by Atomic Force Microscope. Studying HCECs' responses and behaviour on scaffolds of different stiffness has been done by assessing the cell viability and immunofluorescence labelling for Yes‐associated protein (YAP), ZO‐1, and Na/K ATPase.Results: The study found higher growth rate of stiff scaffolds and a confluent monolayer of HCECs in comparison to soft scaffolds. This was accompanied by an increase in nuclear YAP. Typical functional markers were expressed by HCECs on a stiff collagen scaffold compared to a softer scaffold. Collagen scaffolds with a different stiffness do affect nuclear YAP, therefore demonstrating mechanosensitivity of corneal endothelial cells.Conclusion: In conclusion, these results convey that tissue engineering of the human corneal endothelium can determine the scaffold which mimics the best DM biomechanical properties. Hence, very soon scaffold improvements is viable if the role of mechanotransduction is explained for endothelial cell homeostasis.
Peripheral sterile corneal infiltrate after cross linking in keratoconus: A case report
Authors: Ayad Rima , Ghizlane Daghouj , Chahir Roukaya , Ajdour Lamiaa 
Published: January 2024

Aims/Purpose: The aim of our work is to describe the clinical aspect of sterile corneal infiltrates after cross linking and to evaluate the risk factors involved in their occurrence.Methods: We report the case of a young girl, followed for bilateral keratoconus having made a cross linking which was complicated by sterile catarrhal infiltrates.Results: This is a 15 years old girl, followed for allergic conjunctivitis with notion of self‐medication. The ophthalmological examination on admission found a visual acuity with correction counting fingers at 1 metre in oculus uterque (OU), some conjunctival papillae, minimal blepharitis, clear cornea, cortico‐nuclear cataract ocular tone was 10 mmHg in OU, normal fundus in OU. A corneal topography was performed showing signs of bilateral keratoconus classified as stage III according to the Krumeich classification. An emergency cross linking was indicated in OU starting with the OL, the patient was put on a topical antibiotic treatment, artificial tears with a daily control. At 4 days post‐op, the cornea had completely re‐epithelialized with the presence of a slight central haze and the appearance of 2 inferior stromal opacities of 1 mm/1 mm associated with a crescent infiltrate and 2 similar superior stromal opacities taking the fluorescent in front of the free edge. A corneal swab was taken for bacteriological, mycological and parasitological study and came back negative. The patient was initially put on ceftazidime and vancomycin based eye drops with a blepharitis treatment based on azyter collyrium lavage and artificial tear. The examination 48 h later showed persistence of stromal opacities without taking fluo. A local corticosteroid therapy was started with strict monitoring. The evolution was marked by an almost total regression of the stromal opacities and a disappearance of the central haze. The diagnosis of sterile infiltrate was made in view of the marked clinical improvement under local corticosteroid therapy and the absence of germs in the corneal sample.Conclusions: Evaluation of risk factors showed that epithelial injury may be the common pathway in pathogenesis, as no sterile infiltrate in Epi‐on CXL occurred, and postoperative NSAIDs use increased the risk of developing sterile infiltrates approximately fourfold.
Herpetic keratouveitis: A three year follow‐up case
Authors: Arun Kirupakaran , Georgoudis Panagiotis 
Published: January 2024

Aims/Purpose: Herpetic keratouveitis1 is a common presentation to Eye Casualty but due to the broad spectrum of manifestations that it can present with, it is an easy diagnosis to miss. The aim of this report is to create awareness among ophthalmologists of how this disease can present, appropriate clues to the diagnosis as well as how it should be managed.Methods: A 76 year old male presented to the eye emergency department with a 1 week history of significant visual deterioration (6/90 pinhole), redness and photophobia in his left eye. He was initially treated 6 weeks prior with a course of tapering steroid drops for presumed acute anterior uveitis which led to an initial improvement in symptoms, followed by a sudden worsening of symptoms. Ocular examination revealed a 9 mm × 8 mm central corneal ulcer with a satellite lesion superonasally, Descemet folds, reduced corneal sensation with mild anterior chamber inflammation and no posterior segment pathology. Corneal scrapes as well as PCR was sent for culture and sensitivity.Results: PCR revealed a positive result for herpes simplex virus and the patient showed significant improvement with oral acyclovir, topical gancyclovir ointment and topical steroid drops. In the 3 years following the initial presentation, the patient has had 3 further episodes of left herpetic keratouveitis and has now been put on lifelong maintenance dose oral acyclovir and FML drops.Conclusions: We report this case to highlight the key clinical features compatible with herpetic keratouveitis. This disease can be chronic and should be considered in any patient presenting with chronic anterior uveitis not improving with steroid drops. PCR remains the gold‐standard for diagnosis however this is not always positive and clinical diagnosis remains key.Reference1. Cunningham E.T. Diagnosing and treating herpetic anterior uveitis. Ophthalmology 2000; 107(12: 2129–30. doi:10.1016/s0161‐6420(00)00287‐6.
In‐vivo evaluation of corneal collagen fibrils pattern to detect Keratoconus
Authors: Ancona Chiara , Passaro Maria Laura , Airaldi Matteo , Lipari Eugenio , Semeraro Francesco , Kaye Stephen B. , Romano Vito 
Published: January 2024

Aims/Purpose: The corneal stroma, is formed by fibrous connective tissue containing collagen fibrils that are super‐organized in lamellae. In keratoconus (KC), intra‐lamellar and inter‐lamellar disrupted organization causes a progressive thinning and corneal ectasia. The LUMAXIS is a new medical device specifically designed to evaluate the effects of the interaction between polarized light and corneal stroma. It identifies the orientation of collagen fibrils in the cornea, highlighting ultrastructural changes of the tissue. The purpose of this study was to employ the LUMAXIS to discriminate changes in the pattern of corneal collagen fibrils to detect keratoconus.Methods: Patients with KC and controls were included in this prospective study. Corneal tomography (Pentacam) was acquired as well as polarimetric interferometry (LUMAXIS, Phronema S.r.l., Bari, Italy). Custom software was developed to improve the visualization of the representative cross by extracting the histogram equalized luminance to provide a numerical outcome. We then fit a set of ellipses to the image in a semi‐automatic approach, aiming to capture the boundaries of the iris, pupil, each four quadrants of the cross, and eyelids. Combining this information, we are able to obtain a cross parameter. A correlation between cross outcome and Kmax was calculated.Results: A total of sixty eyes of sixty patients were included: 30 healthy subjects (including 60 eyes, mean age of 38.0 ± 13.2 years) and 30 patients with KC (60 eyes, mean age of 39.2 ± 12.9 years). Maximum keratometry value were 59.4 ± 11.2 D in the KC group and 45.3 ± 0.8 D in the healthy group. The cross parameter was 0.41 ± 0.028 in the KC group and 0.24 ± 0.055 in the healthy group. Using only measures taken from the cross resulting from the Lumaxis scan, we were able to distinguish between KC and healthy eyes.Conclusions: The interferometric analysis of diffractive and polarizing effects related to the birefringent properties provides new morphological information at corneal fibrils level. A different corneal pattern of corneal collagen fibrils can be recognized in keratoconus patients compared to healthy patients.
Flap amputation for the diagnosis and treatment of acanthamoeba keratitis: A case report
Authors: Usuga Juan Cadavid , Velez Mauricio , Usuga Maria Ortiz , Perdomo Camilo Restrepo , Izquierdo Luis 
Published: January 2024

Aims/Purpose: To report a laser assisted in situ keratomileusis (LASIK) flap amputation as both diagnostic and therapeutic tool in a case of Acanthamoeba keratitis, in a scleral contact lens patient.Methods: Case report and literature review.Results: Acanthamoeba keratitis is a serious sight‐threatening infection, which imposes a considerable diagnostic and therapeutic challenge to the ophthalmologist. We report a case of a 38 years old male with post‐LASIK ectasia who was using scleral fitted contact lenses; as he developed keratitis, who had unspecific symptoms such as tearing, photophobia, burning sensation, foreign body sensation and decreased vision. His LASIK flap was surgically amputated as both diagnostic and therapeutic procedure. Histopathology analysis revealed abundant acanthamoeba cysts (Figure 1: Intact intrastromal Acanthamoeba cysts (arrow). Right (R): HE x 400 and left (L): Gomori Methenamine‐Silver Stain ×400). After diagnosis, treatment initiated with 0.2% Chlorhexidine, Propamidine Isothionate and systemic Voriconazole, observing resolution of the infiltrate and complete epithelization within 1 week. At 1 month postoperative, the patient developed symptoms secondary to medications without changes in his visual acuity; Fluorometholone drops were added to the anti‐amoebic treatment, which was continued for six more months.Conclusions: Corneal Flap amputation is a reasonable option as a diagnostic and therapeutic aid in the management of Acanthamoeba keratitis in patients with past history of LASIK.Figure 1imageFigure 1
Prevalence and associations of keratokonus among children, adults and elderly in the population‐based ural eye studies
Authors: Panda‐Jonas Songhomitra , Mukharram Bikbov , Gyulli M. , Gilmanshin Timur , Jonas Jost , Iakupova Ellina , Fakhretdinova Albina , Tuliakova Azaliia , Iulia A. , Leisan Gilemzyanova , Khakimov Dinar Dinar A. , Miniazeva Liana 
Published: January 2024

Aims/Purpose: To estimate prevalence and associations of keratoconus in populations in Russia with an age from childhood to seniority.Methods: The study population consisted of the cohorts of three population‐based studies performed in urban and rural areas within the same geographical region in Bashkortostan/Russia: The Ural Children Eye Study (UCES; age: 6–18 years; n = 4890), Ural Eye and Medical Study (UEMS; age: 40+ years; n = 5314) and Ural Very Old Study (UVOS; age: 85+ years; n = 651). Based upon Scheimflug imaging, keratoconus was defined by a keratometric reading of ≥48 D in any eye.Results: The mean maximal and minimal corneal refractive power increased from the UCES (43.58 ± 1.50 dioptres (D) and 42.70 ± 1.42D, respectively) to the UEMS (44.26 ± 1.70 D and 43.61 ± 1.76D, resp.) and to the UVOS (45.1 ± 1.72D and 43.98 ± 1.68D, resp.). Correspondingly, keratoconus prevalence increased from the UCES (42/4890; 0.086%; 95% CI: 0.060, 0.112) to the UEMS (112/5314; 2.11%; 95% CI: 1.72, 2.49) and to the UVOS (42/651; 6.45%; 95% CI: 4.56, 8.34). In the UCES, higher keratoconus prevalence was associated (multivariable analysis) with higher birth order (OR: 2.34; 95% CI: 1.32, 4.15; p = 0.004), lower birthweight (OR: 0.99; 95% CI: 0.99, 0.99; p < 0.001), and shorter axial length (OR: 0.15;9 5% CI: 0.08, 0.30; p < 0.001). In the UEMS, keratoconus prevalence correlated with shorter axial length (OR: 0.15; 95% CI: 0.10, 0.23; p < 0.001), larger corneal volume (OR: 1.17; 95% CI: 1.09, 1.25; p = 0.001), thicker lens (OR: 2.27; 95% CI:1.06, 5.28; p = 0.04), cortical cataract degree (OR: 1.02; 95% CI:1.01, 1.04; p = 0.01), and higher stage of age‐related macular degeneration (OR: 1.65; 95% CI: 1.09, 2.51; p = 0.02). In the UVOS, keratoconus prevalence correlated with lower educational level (OR: 0.84; 95% CI:0.71, 0.99; p = 0 0.04) and lower dynamometric hand grip force (OR: 0.92; 95% CI: 0.88, 0.97; p = 0.003).Conclusions: In this study on multiethnic groups from Russia, keratokonus prevalence increased from the paediatric group (0.09%) to the adult group (2.11%) and seniority group (6.45%), correlated mostly with biometric ocular parameters, and was in all age groups statistically independent of most systemic parameters.
Conjunctival vessel density as inflammatory ocular surface marker in systemic autoimmune disease
Authors: Aragona Emanuela , Arrigo Alessandro , Perra Cristian , Miserocchi E. , Modorati Giulio , Bandello Francesco 
Published: January 2024

Aims/Purpose: Autoimmune diseases are characterized by a pro‐inflammatory environment, with over‐release of chemokines, as IL‐6, IL‐1β and TNFα. These might have a pro‐vasodilation effect at a conjunctival level, with the clinical result of hyperaemia. Hyperaemia is hardly evaluable from a research point of view. The aim of this study is to investigate the use of conjunctival vessel density (CVD) as a marker of vessel dilation and, indirectly, of ocular surface inflammation, in a cohort of patients affected by autoimmune diseases.Methods: Study design: cross‐sectional, observational. CVD score was obtained analysing vessel‐enhanced images obtained by R‐scan module of Keratograph 5M (OCULUS Optikgeräte GmbH, Wetzlar, Germany). Images were loaded in ImageJ software package and in‐house scripts were used to analyse CVD at baseline and at follow‐up visit. CVD was obtained through the same methodology widely used in retinal research to study macular vessel density. Clinical data were collected and the correlations were reported.Results: We collected data from a cohort of patients suffering from autoimmune diseases. All the eyes were categorized considering both systemic and topic treatments, co‐existence of more autoimmune disorders, clinical signs and severity of dry eye. CVD values resulted significantly correlated with dry eye severity, in particular the higher was dry eye severity score, the higher was CVD (p < 0.05).Conclusions: CVD is a new quantitative metric to objectively measure conjunctival hyperaemia; this diagnostic methodology resulted highly feasible to be performed in clinical practice, without inducing patients' distress, and resulted a parameter highly correlated with the pro‐inflammatory status of the patients.Reference1.Singh RB, Liu L, Anchouche S, Yung A, Mittal SK, Blanco T et al. Ocular redness ‐ I: Aetiology, pathogenesis, and assessment of conjunctival hyperemia. Ocul Surf 2021.2. Wu S, Hong J, Tian L, Cui X, Sun X, Xu J. Assessment of Bulbar Redness with a Newly Developed Keratograph. Optom Vis Sci 2015.3. Arrigo A, Aragona E, Saladino A, Amato A, Bandello F, Battaglia Parodi M. The impact of different thresholds on optical coherence tomography angiography images binarization and quantitative metrics. Sci Rep 2021.
Our experience in managing patients with dry eye syndrome
Authors: Boieva Yuliia , Bezditko Pavel , Ivzhenko Liudmyla , Shelenkova Anastasiia 
Published: January 2024

Aims: To confirm the effectiveness of a comprehensive approach to the treatment of patients(PT) with moderate and moderate severity of dry eye syndrome (DES).Methods: 53 PT (106 eyes) with 2 and 3 stages of DES aged from 25 to 52 years were included in the examination. The control group (I gr) included 19 PT, in the studied group (II gr)–29 PT. In addition to the standard ophthalmological examination, the PT underwent a Schirmer's test (SCH), Symptomatic Break –Up Time (SBUT), compression test to assess the secretory capacity (Korb, 2005) of the meibomian glands(MG) (using a glass rod) and Ocular Surface Disease Index Questionnaire (OSDI). The TFOS DEWS II report was used to classify the stage of DES. The inclusion criteria: PT with the SCH‐values ≥3 mm, without systemic diseases, the degree of violation of the excretory ability of the MG corresponded to stages 1 and 2. PT of the II gr were offered complex treatment:1‐instillation of drops with hyaluronic acid 5 times a day; 2‐in 2–3 min use of drops with the LIPITECH system; 3– a carbomer‐gel once at night;4‐systematic massages of the eyelids a course of 5–10 sessions over 1.5 months. PT of the I gr continued to use artificial tears min 3 times a day. Control was at 2, 4 and 6 weeks.Results: Positive dynamics are noted in the II gr for all 4 control indicators. The average indicative of SCH increased by 54.7% (7.5 ± 0.04 mm), SBUT improved by 35.6% (3.6 ± 0.01 s), the duration (time from the beginning) of meibum evacuation decreased by 37.7% (2.3 ± 0.08 s); the OSDI decreased by 54.8% (38.0 ± 0.1) (p < 0.05). The I gr: SCH increased by 20.8% (1.5 ± 0.01 mm), SBUT improved by 12.6% (0.9 ± 0.09 s), the duration of meibum evacuation decreased by 5.7% (0.4 ± 0.04 s); the OSDI‐36.2% (24.9 ± 0.7) (p < 0.05).Conclusions: With a comprehensive approach to the problem and the patient's understanding of the need to comply with all recommendations, it is possible to achieve a prolonged positive result of treatment, and to preserve this effect in the future.