keratopathy

角膜病变
  • 文章类型: Journal Article
    背景/目的:无虹膜相关角膜病变(AAK)是先天性无虹膜的潜在视力威胁病理,其潜在的病因和有效的治疗仍不清楚。方法:进行这项前瞻性研究,以评估和比较单独或联合羊膜移植(AMT)进行浅表角膜切除术(SK)后的短期结果。这里,在76例4级AAK患者中纳入76只眼。在所有的眼睛,为了在术前评估角膜缘上皮干细胞(LESC)的效率,建立了共聚焦显微镜中角膜上皮细胞的存在。分析包括:最佳矫正视力(BCVA),AAK分期和参与角膜新生血管(CNV)的角膜象限数量。结果:术后6个月,两组的平均BCVA为0.05,范围为0.002~0.1.当*单独使用SK*时,94.29%的患者出现BCVA改善,与AMT联合使用时,为92.68%。根据手术类型的不同,治疗效果没有统计学上的显着差异,关于BCVA,AAK的阶段和具有CNV的象限数。结论:对于与LESC部分效率相关的晚期AAK,仅SK是一种有效的短期结局,限于六个月。
    Background/Objectives: Aniridia-associated keratopathy (AAK) is a potentially vision-threatening pathology in congenital aniridia, for which both the underlying etiopathogenesis and effective treatment remain unclear. Methods:This prospective study was conducted to assess and compare the short-term outcome after superficial keratectomy (SK) alone or in a combination with an amniotic membrane transplantation (AMT). Here, 76 eyes were enrolled in 76 patients with grade 4 AAK. In all eyes, in order to assess preoperatively the efficiency of the limbal epithelial stem cells (LESC), the presence of corneal epithelial cells in confocal microscopy was established. The analyses included: best corrected visual acuity (BCVA), the stage of AAK and the number of corneal quadrants involved in corneal neovascularization (CNV). Results: Six months after surgery, the mean BCVA was 0.05 and ranged from 0.002 up to 0.1 in both groups. Improvement in BCVA occurred in 94.29% patients when *SK alone* was performed, and in 92.68% when in combination with AMT. There were no statistically significant differences in the effect of therapy depending on the type of surgery, regarding BCVA, stage of AAK and the number of quadrants with CNV. Conclusions: SK alone is an effective procedure in short outcomes limited to six months for advanced AAK in association with LESC partial efficiency.
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  • 文章类型: Journal Article
    目的:化脓性汗腺炎(HS)与免疫失调和全身性炎症有关。虽然以前的研究表明HS中眼部表现的患病率较高,角膜病变和角膜炎的具体风险尚不清楚.这项研究的主要目的是评估HS患者角膜炎和角膜病变的风险。
    方法:在这项使用TriNetX数据库数据进行的回顾性队列研究中,使用倾向评分匹配将53,716例HS患者与同等数量的非HS对照进行匹配。这项研究涵盖了从1月1日开始的时期,2005年12月31日,2017.危险比及其各自的95%置信区间(CI),计算以评估HS患者在5年内的角膜炎和角膜病变的发生情况,与非HS对照相比。
    结果:HS与5年期间的角膜炎风险高1.52倍(95CI=1.24-1.86)和角膜病变风险高1.47倍(95CI=1.18-1.84)相关。这些风险在敏感性分析中保持一致。在两种性别中都观察到角膜炎的风险升高。然而,HS患者(HR=1.61,95CI=1.24~2.10)和18~64岁患者(HR=1.32,95CI=1.04~1.68)的角膜病变风险显著增高.
    结论:HS与5年期间角膜炎和角膜病变的风险升高有关。建议在HS标准护理中考虑眼科表现。
    OBJECTIVE: Hidradenitis suppurativa (HS) is linked to immune dysregulation and systemic inflammation. While previous studies indicate a higher prevalence of ocular manifestations in HS, the specific risk of keratopathy and keratitis remains unclear. The primary aim of this study was to assess the risk of keratitis and keratopathy in individuals with HS.
    METHODS: In this retrospective cohort study conducted with data from the TriNetX database, 53,716 patients with HS were matched to an equivalent number of non-HS controls using propensity score matching. The study covered the period from January 1st, 2005, to December 31st, 2017. Hazard ratios and their respective 95% confidence intervals (CIs), were computed to evaluate the occurrences of keratitis and keratopathy over a 5-year duration in patients with HS, compared to non-HS controls.
    RESULTS: HS was associated with a 1.52 times higher risk of keratitis over a 5-year period (95%CI=1.24-1.86) and a 1.47 times higher risk of keratopathy (95%CI=1.18-1.84). These risks remained consistent in sensitivity analyses. The elevated risk of keratitis was observed across both sexes. However, the risk of keratopathy was significantly higher in women with HS (HR=1.61, 95%CI=1.24-2.10) and individuals aged 18-64 years (HR=1.32, 95%CI=1.04-1.68).
    CONCLUSIONS: HS was linked to an elevated risk of both keratitis and keratopathy over a 5-year period. Ophthalmologic manifestations are recommended to be considered in HS standard care.
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  • 文章类型: Journal Article
    糖尿病,最普遍的内分泌紊乱,不仅影响视网膜,而且显著涉及眼表。糖尿病有助于干眼病的发展,并引起形态学和功能性角膜改变,特别影响神经和上皮细胞。这些变化表现为上皮缺陷,灵敏度降低,和延迟的伤口愈合,共同封装在糖尿病性角膜病变的背景下。在这种情况的晚期,角膜溃疡和疤痕的进展进一步展开,最终导致角膜混浊.这种严重的并发症阻碍了视力,并有可能导致不可逆转的视力丧失。本文的主要目的是全面概述糖尿病性角膜病变的病理机制。重点放在探索负责糖尿病期间在角膜和泪膜中观察到的异常结构变化的氧化还原分子途径。此外,我们提供了有关针对氧化应激的潜在治疗方法的最新实验发现的见解。这项工作旨在加强我们对糖尿病和眼部并发症之间复杂相互作用的理解。为未来的治疗干预提供有价值的观点。
    Diabetes mellitus, the most prevalent endocrine disorder, not only impacts the retina but also significantly involves the ocular surface. Diabetes contributes to the development of dry eye disease and induces morphological and functional corneal alterations, particularly affecting nerves and epithelial cells. These changes manifest as epithelial defects, reduced sensitivity, and delayed wound healing, collectively encapsulated in the context of diabetic keratopathy. In advanced stages of this condition, the progression to corneal ulcers and scarring further unfolds, eventually leading to corneal opacities. This critical complication hampers vision and carries the potential for irreversible visual loss. The primary objective of this review article is to offer a comprehensive overview of the pathomechanisms underlying diabetic keratopathy. Emphasis is placed on exploring the redox molecular pathways responsible for the aberrant structural changes observed in the cornea and tear film during diabetes. Additionally, we provide insights into the latest experimental findings concerning potential treatments targeting oxidative stress. This endeavor aims to enhance our understanding of the intricate interplay between diabetes and ocular complications, offering valuable perspectives for future therapeutic interventions.
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  • 文章类型: Case Reports
    两只狗表现为双侧图案形成的角膜混浊。在完整的眼科检查后,开始使用局部免疫抑制剂进行治疗。通过使用裂隙灯生物显微镜和光谱域光学相干断层扫描(SD-OCT)分析系列图像来评估对治疗的反应。两只狗都对局部免疫抑制剂有反应;然而,一旦治疗减轻或停止,病变就会复发。两只狗中最有效的免疫抑制剂是0.03%他克莫司软膏。早期和连续治疗局部免疫抑制剂可能是必要的,以提高角膜透明度和防止疤痕。SD-OCT可以提供有关假定的免疫介导性角膜炎的有用结构信息,并有助于监测治疗反应。
    Two dogs presented with bilateral pattern-forming corneal opacity. Treatment with topical immunosuppressants was initiated after a complete ophthalmic examination. The response to treatment was assessed by analyzing serial images using slit-lamp biomicroscopy and spectral domain optical coherence tomography (SD-OCT). Both dogs responded to topical immunosuppressants; however, the lesions recurred once the treatment was abated or withdrawn. The most effective immunosuppressant in both dogs was 0.03% tacrolimus ointment. Early and continuous treatment with topical immunosuppressants may be necessary to improve corneal clarity and prevent scarring. SD-OCT could provide useful structural information regarding presumed immune-mediated keratitis and aid in monitoring treatment response.
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  • 文章类型: Journal Article
    Belantamabmafodotin(belamaf)已证明对严重预处理的多发性骨髓瘤患者具有临床意义的抗骨髓瘤活性。然而,它对分裂的细胞非常活跃,导致脱靶不良事件,特别是眼部毒性。常规监测最佳矫正视力(BCVA)和角膜检查结果的变化,以确定角膜病变视力(KVA)等级,以告知belamaf剂量修改。
    我们旨在开发一种半自动移动应用程序,以促进涉及belamaf的临床试验中眼部事件的分级。
    通过创建有限状态自动机(FSA)模型库来表示来自基线BCVA读数的KVA等级变化的所有排列,纸张过程是半自动的。FSA模型中的过渡状态独立于眼睛测量单元(例如,Snellen,logmar,十进制),并提供了确定KVA等级变化的统一方法。与FSA一起,将根据角膜检查结果确定等级变化的复杂决策树转换为逻辑语句,以进行准确有效的总体KVA等级计算.首先,基于Web的用户界面,符合临床实践设置,是为了简化关键KVA分级标准的输入而开发的。随后,我们开发了一个移动应用程序,其中包括额外的指导步骤,以协助临床决策.
    该应用经过了强有力的良好临床实践验证过程。主要利益攸关方审查了成果,我们的Belamaf医疗线索,和系统集成团队。使用Belamaf眼科检查(BEE)应用程序计算患者总体KVA等级的时间从20至30分钟减少到<1-2分钟。BEE应用程序很受欢迎,大多数调查人员选择“满意”或“高度满意”的准确性和时间效率。
    我们的半自动方法提供了准确的,简化的患者角膜状态评估方法,可减少错误并快速提供对潜在的belamaf剂量修改至关重要的信息。该应用程序目前可在AppleiOS和Android平台上使用,供DREAMM临床试验的研究人员使用,它的使用可以很容易地扩展到诊所,以支持需要做出知情的belamaf治疗决定的医疗保健提供者。
    UNASSIGNED: Belantamab mafodotin (belamaf) has demonstrated clinically meaningful antimyeloma activity in patients with heavily pretreated multiple myeloma. However, it is highly active against dividing cells, contributing to off-target adverse events, particularly ocular toxicity. Changes in best corrected visual acuity (BCVA) and corneal examination findings are routinely monitored to determine Keratopathy Visual Acuity (KVA) grade to inform belamaf dose modification.
    UNASSIGNED: We aimed to develop a semiautomated mobile app to facilitate the grading of ocular events in clinical trials involving belamaf.
    UNASSIGNED: The paper process was semiautomated by creating a library of finite-state automaton (FSA) models to represent all permutations of KVA grade changes from baseline BCVA readings. The transition states in the FSA models operated independently of eye measurement units (e.g., Snellen, logMAR, decimal) and provided a uniform approach to determining KVA grade changes. Together with the FSA, the complex decision tree for determining the grade change based on corneal examination findings was converted into logical statements for accurate and efficient overall KVA grade computation. First, a web-based user interface, conforming to clinical practice settings, was developed to simplify the input of key KVA grading criteria. Subsequently, a mobile app was developed that included additional guided steps to assist in clinical decision-making.
    UNASSIGNED: The app underwent a robust Good Clinical Practice validation process. Outcomes were reviewed by key stakeholders, our belamaf medical lead, and the systems integration team. The time to compute a patient\'s overall KVA grade using the Belamaf Eye Exam (BEE) app was reduced from a 20- to 30-min process to <1-2 min. The BEE app was well received, with most investigators surveyed selecting \"satisfied\" or \"highly satisfied\" for its accuracy and time efficiency.
    UNASSIGNED: Our semiautomated approach provides for an accurate, simplified method of assessment of patients\' corneal status that reduces errors and quickly delivers information critical for potential belamaf dose modifications. The app is currently available on the Apple iOS and Android platforms for use by investigators of the DREAMM clinical trials, and its use could easily be extended to the clinic to support healthcare providers who need to make informed belamaf treatment decisions.
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  • 文章类型: Case Reports
    一名36岁的患者在玻璃体腔中存在硅油12年后,右眼出现广泛的“白色疤痕”而没有疼痛。裂隙灯显微镜检查显示广泛的角膜白斑和轻度的角膜缘新生血管形成。前段光学相干断层扫描显示上皮下明显偏心增厚,基质厚度正常。我们首先进行硅油去除和眼内和前房灌洗,3个月后行上皮病变切除联合羊膜移植。患者对透明的角膜外观感到满意。
    A 36-year-old patient presented with a complaint of an extensive \"white scar\" in his right eye without pain after silicone oil presence in the vitreous cavity for 12 years. Slit-lamp microscopy revealed extensive corneal leukoplakia and mild limbus neovascularization. Anterior segment optical coherence tomography revealed marked eccentric thickening of the subepithelium and normal thickness of the stroma. We proceeded with silicone oil removal and intraocular and anterior chamber lavage at first, followed by epithelial lesion excision combined with amniotic membrane transplantation 3 months later. The patient was satisfied with the clear cornea appearance.
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  • 文章类型: Case Reports
    目的报告1例自行应用海水滴眼液继发的中毒性角膜病变。一位60岁的男性,出现无法解释的单侧视力下降和角膜变薄。最佳矫正视力为20/400OD,裂隙灯检查提示弥漫性角膜水肿伴中央变薄,完整的感觉,没有血管化.结合临床症状和发现的滴眼液的实验室分析与毒性角膜病变一致。毒性角膜病变可以伪装成其他形式的角膜病变,全面的病史记录和实验室分析可能有助于阐明诊断并避免明显的视觉发病率。
    To report a case of toxic keratopathy secondary to the self-application of seawater eye drops. A 60-year-old male who presented with unexplained unilateral decrease in vision and corneal thinning. Best-corrected visual acuity was 20/400 OD, slit-lamp examination indicated diffuse corneal edema with central thinning, intact sensation, and no vascularization. Laboratory analysis of the eye drops in conjunction with clinical symptoms and findings was consistent with toxic keratopathy. Toxic keratopathy can masquerade as the other forms of keratopathy, and a thorough history taking and laboratory analysis may help elucidate the diagnosis and avoid significant visual morbidity.
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  • 文章类型: Journal Article
    未经证实:迟发性芥子气角膜病变(DMGK)是眼化学性损伤患者的主要慢性结局。这项研究的目的是在30多年后对芥末暴露的角膜进行组织病理学评估。
    UNASSIGNED:在本研究中评估了板层角膜移植术后的十四个角膜。通过组织学方法制备角膜组织并用H&E染色。
    未经证实:这些病例的主要组织病理学发现是存在严重的基质水肿和角膜瘢痕。在可见浅表上皮的切片中,观察到上皮下大疱形成。还观察到Bowman膜的局灶性或弥漫性破坏和纤维化置换。在所有标本中都没有基质血管化和炎症的证据。
    未经评估:30多年后,在暴露于芥子气的患者中可以看到广泛的角膜疤痕。在硫芥子气暴露的角膜中,主要发现了无血管形成和成纤维细胞增殖的疤痕组织。这种病理结果与其他疤痕不同。在管理DMGK时,不应考虑炎症或免疫细胞浸润的证据。
    UNASSIGNED: Delayed mustard gas keratopathy (DMGK) is the main chronic outcome in eye-chemical injured patients. The aim of this study was the histopathological evaluation of mustard-exposed cornea after more than 30 years.
    UNASSIGNED: Fourteen corneas after Lamellar keratoplasty were evaluated in this study. Corneal tissues were prepared by histologic methods and stained by H&E.
    UNASSIGNED: The main histopathological findings in these cases were the presence of severe stromal edema and corneal scar. In the sections with visible superficial epithelium, subepithelial bullae formation was observed. Focal or diffuse disruption of Bowman\'s membrane and replacement with fibrosis were also seen. There was no evidence of stromal vascularization and inflammation in all specimens.
    UNASSIGNED: After more than 30 years, an extensive corneal scar is seen in sulfur mustard exposed patients. Scar tissue without vascularization and fibroblastic proliferation is the main finding in the sulfur mustard exposed cornea. This pathology result is different from other scars. No evidence of inflammation or immune cell infiltration should be considered in managing DMGK.
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  • 文章类型: Journal Article
    背景:全身麻醉期间和之后最常见的眼外伤是角膜擦伤,可在麻醉后的任何时间发生,甚至长达24小时。这项研究的目的是调查非眼科手术患者角膜损伤的发生率和相关因素。
    方法:这是一项描述性横断面研究。共有170名患者,进入手术室并符合纳入标准的人,是通过简单的非概率抽样选择的。使用数据收集表评估角膜损伤的发生率及其相关危险因素。使用荧光素纸和裂隙灯发出的钴蓝光的国家眼科研究所量表来检查暴露性角膜病变。
    结果:总体而言,结果显示,手术室中去除眼部护理后立即发生角膜病变的发生率为64.7%,65.9%在恢复室,术后24h为41.2%。吸烟者和药物滥用者在全身麻醉下接受气管内插管,术前接受了更多的阿片类药物,围手术期出血和液体摄入量较多。此外,在恢复室接受更多氧气流量的患者中,角膜病变的发生率更高。
    结论:吸烟,药物使用,气管插管是角膜病变的危险因素。因此,对于高风险患者和程序,为了防止眼睛受伤,必须获得术前信息和采取术中预防措施。需要未来的研究来证明这些发现。
    BACKGROUND: The most common eye injury during and after general anesthesia is corneal abrasion which can occur at any time after anesthesia and even up to 24 h after it. The aim of this study was to investigate the incidence and factors associated with corneal injury in patients undergoing nonocular surgery.
    METHODS: This was a descriptive cross-sectional study. A total of 170 patients, who were admitted to the operating room and met the inclusion criteria, were selected through simple nonprobability sampling. Data collection forms were used in order to assess the incidence of corneal injury and its related risk factors. The National Eye Institute scale with fluorescein paper and cobalt blue light by slit lamp were utilized to examine exposure keratopathy.
    RESULTS: Overall, the results showed that the incidence of keratopathy immediately after eye care removal was found to be 64.7% in the operating room, 65.9% in the recovery room, and 41.2% in 24 h after the surgery. Smokers\' patients and drug abusers under general anesthesia underwent endotracheal intubation, received more opioids preoperatively, and had more perioperative bleeding and fluid intake. Moreover, in patients who had received more oxygen flow in the recovery room; the rate of keratopathy was higher.
    CONCLUSIONS: Smoking, drug usage, and receiving endotracheal intubation are the risk factors of keratopathy. Therefore, for high-risk patients and procedures, it is indispensable to both obtain preoperative information and take intraoperative precautions in order to prevent eye injuries. Future studies are needed to demonstrate these finding.
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  • 文章类型: Case Reports
    我们报告了一例长期服用雷洛昔芬的患者的角膜斜视病。据我们所知,这是首例报道雷洛昔芬的眼部副作用。
    一位69岁的女性患者到我们的诊所进行例行的眼部检查。裂隙灯检查,在双侧角膜中观察到螺纹状的上皮下沉积物。她被诊断为雷洛昔芬引起的角膜旋涡(旋涡角膜病变)。停药后进行了后续评估;然而,角膜混浊没有改善.
    应询问角膜斜纹角膜患者是否摄入雷洛昔芬治疗骨质疏松症,因为它可能会导致角膜角膜炎。
    UNASSIGNED: We report a case of corneal verticillata in a patient who had been taking raloxifene for a prolonged period. To our knowledge, this is the first case report of an ocular side effect of raloxifene.
    UNASSIGNED: A 69-year-old female patient presented to our clinic for her routine eye check-up. On slit-lamp examination, whorl-like subepithelial deposits were observed in the bilateral corneas. She was diagnosed with corneal verticillata (vortex keratopathy) caused by raloxifene. A follow-up evaluation was conducted after discontinuation of the drug; however, the corneal opacity did not improve.
    UNASSIGNED: Patients with corneal verticillata should be asked regarding any intake of raloxifene for osteoporosis, as it may cause corneal verticillata.
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