Publications by authors named "Jesper Hjortdal"

162 Publications

Practice patterns of corneal transplantation in Europe: First report by the European Cornea and Cell Transplantation Registry (ECCTR).

J Cataract Refract Surg 2021 Jan 11. Epub 2021 Jan 11.

1 University Eye Clinic, Maastricht University Medical Center+, The Netherlands. 2 Translational Health Sciences, University of Bristol, UK. 3 Tissue and Eye Services, NHS Blood and Transplant, Bristol, UK. 4 European Eye Bank Association (EEBA), Venice, Italy. 5 Department of Ophthalmology, Sahlgrenska University Hospital, Gothenburg, Sweden. 6 European Society of Cataract and Refractive Surgeons (ESCRS), Dublin, Ireland. 7 Department of Ophthalmology, Royal Victoria Infirmary and Newcastle University, Newcastle upon Tyne, UK. 8 Dutch Transplant Foundation, Leiden, The Netherlands. 9 Department of Ophthalmology, Aarhus University Hospital, Denmark. 10 European Society of Cornea and Ocular Surface Disease Specialists (EuCornea), Dublin, Ireland. 11 The Veneto Eye Bank Foundation, Venice, Italy. 12 Department of Clinical Sciences, Ophthalmology, Faculty of Medicine, Lund University, Lund, Sweden.

Purpose: To report practice patterns of corneal transplantation in Europe.

Setting: Corneal clinics in ten European member states, the United Kingdom, and Switzerland.

Design: Multinational registry study.

Methods: Corneal transplant procedures registered in the European Cornea and Cell Transplantation Registry (ECCTR) were identified. We analyzed preoperative donor and recipient characteristics, indication and reason for transplantation, and surgical techniques.

Results: 12,913 corneal transplants were identified from ten European Union member states, the United Kingdom (UK) and Switzerland. Most countries were self-sufficient with regard to donor tissue. Fuchs' endothelial corneal dystrophy (FED) was the most common indication (41%, n=5,325), followed by regraft (16%, n=2,108), Pseudophakic bullous keratopathy (PBK, 12%, n=1,594), and keratoconus (12%, n=1,506). Descemet stripping (automated) endothelial keratoplasty (DS[A]EK, 46%, n=5,918) was the most commonly performed technique, followed by Penetrating keratoplasty (PK, 30%, n=3,886), and Descemet membrane endothelial keratoplasty (DMEK, 9%, n=1,838). Vision improvement was the main reason for corneal transplantation (90%, n=11,591). Surgical technique and reason for transplantation differed between indications.

Conclusions: This report provides the most comprehensive overview of corneal transplantation practice patterns in Europe to date. Fuchs endothelial dystrophy is the most common indication, vision improvement the leading reason, and DS(A)EK the predominant technique for corneal transplantation.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000574DOI Listing
January 2021

The Interday Repeatability of Parameters for the Assessment of Progressive Disease in Subjects With Less Advanced Keratoconus.

Am J Ophthalmol 2021 Jan 7;225:38-46. Epub 2021 Jan 7.

Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.

Purpose: To evaluate the interday repeatability in the measurement of parameters used for the detection of progression of keratoconus by prediction limits (PL) for single measurements, and the repeatability coefficient (RC) for the mean of replicate measurements.

Design: Prospective reliability analysis for cases and control eyes.

Methods: Twenty-five eyes in 25 subjects with KC and 25 eyes in 25 healthy controls were included. Four consecutive measurements were made, 3 days apart, with a Pentacam HR tomographic instrument (denoted the Pentacam) and a Nidek ARK 560-A auto-keratometer (denoted the keratometer). Main outcome measures were the intra- and interday RC of parameters used in the detection of progression of keratoconus.

Results: The most repeatable parameter obtained with the Pentacam was the curvature power of the central flat meridian (K1, 0.44 D [RC], -0.55 to 0.60 diopter [D] [PL]), followed by the central steep meridian (K2, 0.72 D [RC], -0.90 to 0.94 D [PL]). The interday repeatability of K1 and K2 was similar when using the keratometer (K1, 0.32 D [RC], -0.66 to 0.57 D [PL], K2, 0.93 D [RC], -1.36 to 1.08 D [PL]). The interday repeatability of the curvature power of the steepest point (Kmax, 0.84 D [RC], -0.90 to 1.11 D [PL]) would benefit from being stratified: RC = 0.44 D and PL = -0.49 to 0.67 D for Kmax < 49.0 D, and RC = 1.08 D and PL = -1.19 to 1.42 D for Kmax ≥ 49.0 D.

Conclusions: The interday repeatability of measurements, single or replicate, in subjects with keratoconus should be considered when diagnosing progressive disease. K1 exhibited the best intraday repeatability. Kmax benefits from being stratified according to disease severity.
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http://dx.doi.org/10.1016/j.ajo.2020.12.028DOI Listing
January 2021

Changes in accommodative function following small-incision lenticule extraction for high myopia.

PLoS One 2020 30;15(12):e0244602. Epub 2020 Dec 30.

Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.

Purpose: To examine whether the amplitude of accommodation, the accommodative response, and the accommodative facility is affected and correlated with changes in higher-order aberrations for patients with high myopia surgically treated with small-incision lenticule extraction (SMILE).

Methods: 35 highly myopic eyes (myopic spherical equivalent of at least 6 diopters) of 35 patients treated with SMILE were included. Assessments were made before and 3 months after surgery. Donders push-up-method was used to measure the amplitude of accommodation. The accommodative response was assessed using an open-field autorefractor"Grand Seiko WAM-5500" (Grand Seiko Co. Ltd., Hiroshima, Japan) in combination with a Badal optometer and stimuli of accommodation at 0.0, 0.5, 1.25, 2.0, 3.0, and 4.0 D, respectively. Accommodative facility was measured at 40 cm with ±2,00D flipper lenses. All measurements of accommodation were performed monocularly with the refractive error corrected with soft contact lenses.

Results: The amplitude of accommodation did not change statistically significantly (mean difference -0.24 D (SD 0.98), 95% CI of mean difference -0.58 D to 0.11 D, paired-sample t(34) = -1.39; P = 0.17). The accommodative responses at 0.0, 0.5, 1.25, 2.0, 3.0, and 4.0 D did not statistically significantly change either (F(6,29) = 1.15; P = .36). Finally, the accommodative facility was also unchanged with a mean difference of 1.11 cycles per minute (SD 5.11, 95% CI of mean difference -0.64 to 2.87, paired-sample t(34) = 1.29; P = 0.21). No clinically significant associations between changes in accommodation and higher-order aberrations were found.

Conclusions: SMILE does not alter the amplitude of accommodation, the accommodative response, nor the accommodative facility for highly myopic patients, and the surgically induced corneal higher-order aberrations do not affect the accommodative function.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0244602PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773189PMC
March 2021

Outcomes of corneal transplantation in Europe: Report by the European Cornea and Cell Transplantation Registry (ECCTR).

J Cataract Refract Surg 2020 Nov 30. Epub 2020 Nov 30.

University Eye Clinic, Maastricht University Medical Center+, The Netherlands.

Purpose: To analyze real-world graft survival and visual acuity outcomes of corneal transplantation in Europe.

Setting: Corneal clinics in ten European Union member states, the United Kingdom, and Switzerland.

Design: Multinational registry study.

Methods: All corneal transplant procedures registered in the European Cornea and Cell Transplantation Registry (ECCTR) were identified. Graft survival of primary corneal transplants were analyzed using Kaplan-Meier survival curves with log-rank test and Cox regression. Corrected distance visual acuities (CDVA) are reported at baseline and two-years postoperatively using the Lundström distribution matrix.

Results: 12,913 corneal transplants were identified. Overall two-year graft survival of corneal transplants is high (89%) but differed between indications, ranging from 98% in keratoconus and 80% for trauma. Overall, CDVA improved after surgery, but the risk of losing vision ranged from 7% (baseline vision ≤0.1 Snellen) to 58% (baseline vision ≥1.0 Snellen).

Conclusions: This report provides a comprehensive overview of graft survival and visual outcomes of corneal transplantation in Europe. We provide real-world estimates of outcomes for a variety of indications and surgical techniques to support benchmarking, and demonstrate the relationship between baseline and postoperative vision.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000520DOI Listing
November 2020

One threat, different answers: the impact of COVID-19 pandemic on cornea donation and donor selection across Europe.

Br J Ophthalmol 2020 Nov 26. Epub 2020 Nov 26.

University Eye Clinic Maastricht, Maastricht University Medical Centre+, Maastricht, The Netherlands.

Objectives: To assess to which extent the COVID-19 pandemic affected corneal transplantation by virtue of donor selection algorithms in different European countries.

Design: Survey.

Setting: 110 eye banks in 26 European countries.

Participants: 64 eye banks covering 95% of European corneal transplantation activity.

Interventions: A questionnaire listing the number of corneas procured and distributed from February to May 2018-2020 was circulated to eye banks.

Main Outcome Measures: The primary outcome was the number of corneal procurements. Additional outcomes were national algorithms for donor selection, classified according to their stringency (donors with COVID-19 history, suspected for COVID-19, asymptomatic, PCR testing) and the pandemic severity in each country. We calculated Spearman's correlation coefficient to determine, two by two, the relationship between the 3-month decline in eye banking activity (procurement), the stringency of donor selection algorithm and the grading of pandemic severity (cases and deaths). A partial correlation was run to determine the relationship between decline and stringency while controlling for pandemic severity.

Results: Procurements decreased by 38%, 68% and 41%, respectively, in March, April and May 2020 compared with the mean of the previous 2 years, while grafts decreased, respectively, by 28%, 68% and 56% corresponding to 3866 untreated patients in 3 months. Significant disparities between countries and the decrease in activity correlated with stringency in donor selection independent of pandemic severity.

Conclusions: Our data demonstrate significant differences between countries regarding donor screening algorithms based on precautionary principles and, consequently, a decrease in the donor pool, already constrained by a long list of contraindications. Fundamental studies are needed to determine the risk of SARS-CoV-2 transmission by corneal transplantation and guide evidence-based recommendations for donor selection to justify their substantial medical and economic impact.
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http://dx.doi.org/10.1136/bjophthalmol-2020-317938DOI Listing
November 2020

The visual image quality after small-incision lenticule extraction (SMILE) compared to spectacles and contact lenses.

J Cataract Refract Surg 2020 Nov 19. Epub 2020 Nov 19.

Department of Ophthalmology, Aarhus University Hospital, Denmark.

Purpose: To assess the influence of small-incision lenticule extraction (SMILE) for high myopia on the visual image quality assessed by the logarithm of the Visual Strehl Ratio (logVSX), and put this into a clinical context by pairwise comparing the logVSX of postoperative eyes with those of myopic controls wearing spectacles and/or contact lenses.

Setting: University Hospital DESIGN:: Prospective & cross-sectional clinical study METHODS:: Patients with a myopic spherical equivalent of at least 6 diopters treated with SMILE aimed at emmetropia and correspondingly myopic controls corrected with spectacles and/or contact lenses were included. The logVSX calculation was divided into habitual logVSX based on the wavefront aberration measurement directly, and optimal logVSX calculated in a theoretical through-focus experiment to obtain the best-achievable logVSX.

Results: 117 eyes of 61 patients and 64 eyes of 34 myopic controls were included. SMILE did not affect the habitual logVSX, but worsened the optimal logVSX (P<0.001). The postoperative habitual logVSX was significantly worse compared to contact lenses (P=0.002). The postoperative optimal logVSX was significantly worse compared to both spectacles (P<0.01) and contact lenses (P=0.003). There was no difference in habitual or optimal logVSX between spectacles and contact lenses.

Conclusions: SMILE for high myopia does not affect the habitual logVSX but decreases the optimal logVSX slightly. The postoperative habitual logVSX is worse than for contact lenses but not spectacles, and the postoperative optimal logVSX is worse than for both contact lenses and spectacles. There is no difference in either habitual or optimal logVSX between spectacles and contact lenses.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000501DOI Listing
November 2020

Impact on binocular visual function of small-incision lenticule extraction for high myopia.

J Cataract Refract Surg 2020 Nov 19. Epub 2020 Nov 19.

Department of Ophthalmology, Aarhus University Hospital, Denmark (Gyldenkerne, Ivarsen, Nisted, Hjortdal).

Purpose: To assess if small-incision lenticule extraction (SMILE) for high myopia reduces the binocular visual function assessed by stereoacuity, binocular visual acuity, binocular contrast sensitivity, and binocular summation.

Setting: University hospital DESIGN:: Prospective case series METHODS:: Patients with a myopic spherical equivalent of at least 6 diopters (D) scheduled for SMILE aimed at emmetropia were included. Psychophysical testing was done with correction before surgery but no correction after surgery. Stereoacuity was assessed with the Randot Circles test and the near Frisby test, visual acuity (monocular and binocular) was assessed with high-contrast Early Treatment Diabetic Retinopathy Study charts, and contrast sensitivity (monocular and binocular) was assessed with the Pelli-Robson chart and the Freiburg Acuity and Contrast Test. Binocular summation was calculated by comparing the binocular score against the best monocular score.

Results: 138 eyes of 69 patients were included. Mean spherical equivalent changed from -7.46 D±1.06 (SD) to -0.23 D±0.40 after surgery. Stereoacuity did not change significantly following surgery; median change (IQR) was -0.32 (-6.21 to 1.55) seconds of arc with the Frisby test and 0.00 (-7.5 to 5.0) seconds of arc with the Randot test (P≥0.06). Binocular postoperative uncorrected distance visual acuity was not different from the preoperative corrected distance visual acuity (P=0.40). Contrast sensitivity declined slightly monocularly with both tests of contrast sensitivity, but was unaltered binocularly (P≥0.08). Binocular summation for visual acuity and contrast sensitivity was unaltered following surgery (P≥0.09).

Conclusions: SMILE for high myopia did not reduce the binocular function assessed by stereoacuity, binocular visual acuity, binocular contrast sensitivity, and binocular summation.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000480DOI Listing
November 2020

Diagnostic Criteria for Terrien Marginal Degeneration: Nordic Terrien Degeneration Study.

Cornea 2021 Feb;40(2):133-141

Department of Ophthalmology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Purpose: To refine the diagnostic criteria for Terrien marginal degeneration (TMD) based on experience in 3 Nordic countries.

Methods: This is a retrospective, multicenter, hospital-based cross-sectional study of 49 eyes of 29 white patients in tertiary referral centers in Finland, Sweden, and Denmark from 1998 to January 2018. The median follow-up was 3 years. Symptoms, best corrected visual acuity, astigmatism, corneal thickness, curvature and cavities, stage, and progression were analyzed.

Results: TMD was diagnosed equally likely between 15 and 86 years of age (median, 47 years). Twenty patients (69%) had bilateral disease, and 62% were men. Seventeen patients (59%) had symptoms including blurred vision and ocular surface disease symptoms without inflammatory signs. Eight patients (28%) had slightly reduced corneal sensitivity. Median best corrected visual acuity was 20/25 (range, 20/16-20/200) and astigmatism was 2.6 diopters (D) (range, 0-10) with a mean progression of 0.41 D per year (range, 0-5.4). Age and astigmatism were not correlated. All eyes had peripheral vascularization, lipid deposits, and hyperreflectivity throughout thinned peripheral stroma and its anterior edge. The thinning progressed in 15 patients (52%). Of 26 patients, 8 (31%) had single or confluent paralimbal intrastromal cavities, most commonly superiorly. By Süveges classification, the stage was 2 (92%) or 3 (8%). Minimum corneal thickness and corneal curvature were loosely associated, leading to different stages in Wang classification in 34 eyes (69%).

Conclusions: TMD is defined by peripheral corneal thinning, superficial neovascularization, lipid deposition at the leading edge, absence of ulceration and inflammation, and frequently cavitation. The most sensitive way to follow its progression is anterior segment optical coherence tomography.
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http://dx.doi.org/10.1097/ICO.0000000000002427DOI Listing
February 2021

Distribution of Stromal Cell Subsets in Cultures from Distinct Ocular Surface Compartments.

J Ophthalmic Vis Res 2020 Oct-Dec;15(4):493-501. Epub 2020 Oct 25.

Regenerative Medicine Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.

Purpose: To reveal the phenotypic differences between human ocular surface stromal cells (hOSSCs) cultured from the corneal, limbal, and scleral compartments.

Methods: A comparative analysis of cultured hOSSCs derived from four unrelated donors was conducted by multichromatic flow cytometry for six distinct CD antigens, including the CD73, CD90, CD105, CD166, CD146, and CD34.

Results: The hOSSCs, as well as the reference cells, displayed phenotypical profiles that were similar in high expression of the hallmark mesenchymal stem cell markers CD73, CD90, and CD105, and also the cancer stem cell marker CD166. Notably, there was considerable variation regarding the expression of CD34, where the highest levels were found in the corneal and scleral compartments. The multi-differentiation potential marker CD146 was also expressed highly variably, ranging from 9% to 89%, but the limbal stromal and endometrial mesenchymal stem cells significantly surpassed their counterparts within the ocular and reference groups, respectively. The use of six markers enabled investigation of 64 possible variants, however, just four variants accounted for almost 90% of all hOSSCs, with the co-expression of CD73, CD90, CD105, and CD166 and a combination of CD146 and CD34. The limbal compartment appeared unique in that it displayed greatest immunophenotype diversity and harbored the highest proportion of the CD146+CD34- pericyte-like forms, but, interestingly, the pericyte-like cells were also found in the avascular cornea.

Conclusion: Our findings confirm that the hOSSCs exhibit an immunophenotype consistent with that of MSCs, further highlight the phenotypical heterogeneity in stroma from distinct ocular surface compartments, and finally underscore the uniqueness of the limbal region.
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http://dx.doi.org/10.18502/jovr.v15i4.7780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7591840PMC
October 2020

Characterization of Tear Immunoglobulins in a Small-Cohort of Keratoconus Patients.

Sci Rep 2020 06 10;10(1):9426. Epub 2020 Jun 10.

North Texas Eye Research Institute, University of North Texas Health Science Center, Fort Worth, TX, 76107, USA.

Keratoconus (KC) is classically considered a non-inflammatory condition caused by central corneal thinning that leads to astigmatism and reduced visual acuity. Previous studies have identified increased systemic levels of pro-inflammatory factors, including interleukin-6, tumor necrosis factor-α, and matrix metalloproteinase-9, suggesting that KC may have an inflammatory component in at least a subset of patients. In this study, we evaluated the levels of different immunoglobulins (light and heavy chains) based on Ig α, Ig λ, Ig κ, Ig µ, and Ig heavy chain subunits in non-KC tears (n = 7 control individuals) and KC tears (n = 7 KC patients) using tandem-liquid chromatography mass spectrometry. The most abundant Ig heavy chains detected in both control individuals and KC patients were Ig α-1 and Ig α-2 likely correlating to the higher IgA levels reported in human tears. We identified significant differences in immunoglobulin κ-chain V-II levels in KC patients compared to control individuals with no significant difference in Ig κ/Ig λ ratios or heavy chain levels. Our study supports previous findings suggesting that KC possesses a systemic component that may contribute to the KC pathology. Further studies are required to define causality and establish a role for systemic immune system-dependent factors and pro-inflammatory processes in KC development or progression.
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http://dx.doi.org/10.1038/s41598-020-66442-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287105PMC
June 2020

Intrastromal Lenticule Rotation for the Treatment of High Astigmatism.

J Refract Surg 2020 Jun;36(6):415-418

Purpose: To describe the first clinical case using intrastromal lenticule rotation to surgically correct high astigmatism in an amblyopic eye.

Methods: A 31-year-old woman with mixed astigmatism of +2.00 -5.00 × 10° (spherical equivalent -0.50 diopters [D]) in her left eye, uncorrected distance visual acuity (UDVA) of 0.8 logMAR, and corrected distance visual acuity (CDVA) of 0.7 logMAR underwent refractive lenticule rotation surgery.

Results: Postoperative refractive astigmatism changed to 0.00 D cylinder. There was a postoperative myopic shift and her spherical equivalent refraction was -4.00 D at 1 week, -3.75 D at 1 month, and -3.25 D at 3 and 6 months. The patient noted a slight improvement in UDVA and a significant improvement in her uncorrected near visual acuity from Jaeger 13 (> 1.0 logMAR) to Jaeger 5 (0.3 logMAR) at 1 and 3 months and subsequently to Jaeger 2 (0.1 logMAR).

Conclusions: To the best of the authors' knowledge, this is the first clinical case of astigmatism correction using small incision lenticule extraction lenticule rotation. This case of an amblyopic eye demonstrates that the procedure is capable of correcting both corneal and refractive astigmatism, and the short-term result seems stable. [J Refract Surg. 2020;36(6):415-418.].
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http://dx.doi.org/10.3928/1081597X-20200506-02DOI Listing
June 2020

The Keratoconus Outcome Research Questionnaire: A Cross-Cultural Validation Study of the Danish Version.

Cornea 2020 Aug;39(8):998-1005

Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark; and.

Purpose: To evaluate the psychometric properties of the Danish Keratoconus Outcome Research Questionnaire (KORQ).

Methods: Phase 1: Rasch analysis assessed the original Danish KORQ. Phase 2: Reengineering of the Danish KORQ to optimize the psychometric properties and functioning of the KORQ.

Results: The KORQ was self-administered by 195 patients. Phase 1 displayed trouble with local dependency and poor item fit. In phase 2, local dependency was addressed, and acceptable item fit was obtained for both subscales by collapsing item pairs into superitems (A6+A7, A9+A17, and S6+S9) and deleting 2 items (S4 and S2). After these corrections, the inter-item range was 0.28 to 0.72 for activity limitation scale (AL-S) and 0.14 to 0.54 for symptoms scale (S-S). Ordered thresholds were present, except in items A11, S5, and S10. No differential item functioning was present. Person separation reliability was 0.93 for AL-S and 0.81 for S-S. The person-item maps showed that the target was slightly above the study population. The maximal corneal curvature was the clinical measure of keratoconus with the highest correlation of 0.33 for AL-S and 0.24 for S-S. Evaluating individual questions showed that patients had the most trouble seeing at distance, driving at night, and wearing rigid gas-permeable lenses, whereas the least troublesome areas were walking up/downstairs, doing household tasks, avoiding objects on their path, and doing their job.

Conclusions: The revised Danish KORQ largely fulfilled the assumptions of the Rasch model and displayed satisfactory psychometric properties. The need to revise the Danish KORQ highlights that cross-cultural validation is of key importance when working with patient-reported outcomes.
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http://dx.doi.org/10.1097/ICO.0000000000002354DOI Listing
August 2020

Astigmatism prediction in small-incision lenticule extraction.

J Cataract Refract Surg 2020 04;46(4):524-533

From the Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.

Purpose: To investigate whether postoperative-induced refractive astigmatism after small-incision lenticule extraction (SMILE) could be predicted by preoperative objective astigmatism measured with autorefraction, keratometry, and Scheimpflug tomography.

Setting: University eye clinic.

Design: Retrospective case series.

Methods: Only eyes without preoperative subjective astigmatism treated with SMILE for myopia were included. Postoperative subjective astigmatism was compared with preoperative objective astigmatism. Examinations were performed before SMILE and 3 months postoperatively and included subjective refraction, keratometry, autorefraction, and Scheimpflug tomographer measurements. Astigmatism was analyzed using double-angle plots and multivariate statistics.

Results: A total of 358 eyes of 358 patients were included. The mean preoperative sphere was -7.33 diopter (D) ± 1.46 (SD). The postoperative spherical equivalent was -0.30 ± 0.49 D. Postoperatively, 79.6% and 98.9% of patients had a subjective cylinder ≤0.50 D and ≤1.00 D, respectively. Preoperative objective astigmatism measured with keratometry, autorefraction, and Scheimpflug tomography was significantly different (P < .05) from postoperative subjective refraction when all patients were analyzed; for patients with postoperative refractive astigmatism ≥0.50 D, preoperative astigmatism with keratometry and Scheimpflug tomography was not significantly different from postoperative refractive astigmatism. Preoperative objective astigmatism ≥0.50 D increased the risk ratio of postoperative subjective astigmatism ≥0.50 D by 2.2 (P < .001).

Conclusions: Preoperative objective astigmatism could not be directly interchanged with postoperative subjective astigmatism, but the presence of preoperative astigmatism ≥0.50 D doubled the risk of inducing a postoperative subjective astigmatism ≥0.50 D. Extra care when performing subjective refraction should be taken in the presence of high objective astigmatism.
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http://dx.doi.org/10.1097/j.jcrs.0000000000000083DOI Listing
April 2020

Association between keratoconus disease severity and repeatability in measurements of parameters for the assessment of progressive disease.

PLoS One 2020 14;15(2):e0228992. Epub 2020 Feb 14.

Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.

Background: Progressive keratoconus can lead to severely impaired vision, but there is currently no consensus on the definition of progressive disease. Errors in the measurement of the parameters commonly used to establish progressive disease were evaluated in an attempt to determine the limits at which a true change in the values can be detected. The possible association between measurement error and disease severity was also investigated to evaluate the need for limits based on disease severity.

Methods: Sixty-one eyes were studied in 61 patients with keratoconus. Four replicate measurements were made in each patient using a Scheimpflug-based tomographic system (denoted the PC) and an auto-keratometer (denoted the AK). The repeatability coefficient, i.e., the level below which differences between two measurements are found in 95% of paired observations, was calculated. Patients were further divided into three groups based on disease severity (parameter magnitude).

Results: Increasing magnitude of all the keratometric parameters investigated was significantly associated with increasing measurement errors, and thus worse repeatability. The maximum keratometry value (Kmax) was the least repeatable parameter (1.23 D, 95% CI 1.11-1.35 D) and showed the strongest association between parameter magnitude and measurement error. The repeatability coefficient ranged between 0.32 and 1.62 D, depending on disease severity. The most repeatable parameter was the flattest central keratometry value (K1), measured with the PC (0.51 D, 95% CI 0.46-0.56 D) and the AK (0.54 D, 95% CI 0.48-0.59 D). K1 showed the weakest association between parameter magnitude and measurement error. The repeatability coefficient for K1 ranged between 0.40 and 0.54 D when using the PC, and between 0.34 and 0.70 D when using the AK in the three groups.

Conclusions: The association between the magnitude of the keratometric parameters and their measurement errors suggests that limits should be based on disease severity to ensure reliable detection of progressive keratoconus. Further studies are, however, required.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228992PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021304PMC
May 2020

Biochemical mechanisms of aggregation in TGFBI-linked corneal dystrophies.

Prog Retin Eye Res 2020 07 29;77:100843. Epub 2020 Jan 29.

Department of Molecular Biology and Genetics, Aarhus University, Aarhus, Denmark. Electronic address:

Transforming growth factor-β-induced protein (TGFBIp), an extracellular matrix protein, is the second most abundant protein in the corneal stroma. In this review, we summarize the current knowledge concerning the expression, molecular structure, binding partners, and functions of human TGFBIp. To date, 74 mutations in the transforming growth factor-β-induced gene (TGFBI) are associated with amyloid and amorphous protein deposition in TGFBI-linked corneal dystrophies. We discuss the current understanding of the biochemical mechanisms of TGFBI-linked corneal dystrophies and propose that mutations leading to granular corneal dystrophy (GCD) decrease the solubility of TGFBIp and affect the interactions between TGFBIp and components of the corneal stroma, whereas mutations associated with lattice corneal dystrophy (LCD) lead to a destabilization of the protein that disrupts proteolytic turnover, especially by the serine protease HtrA1. Future research should focus on TGFBIp function in the cornea, confirmation of the biochemical mechanisms in vivo, and the development of disease models. Future therapies for TGFBI-linked corneal dystrophies might include topical agents that regulate protein aggregation or gene therapy that targets the mutant allele by CRISPR/Cas9 technology.
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http://dx.doi.org/10.1016/j.preteyeres.2020.100843DOI Listing
July 2020

Increasing incidence of Acanthamoeba keratitis in a large tertiary ophthalmology department from year 1994 to 2018.

Acta Ophthalmol 2019 Dec 29. Epub 2019 Dec 29.

Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.

Purpose: Acanthamoeba (AA) keratitis is a rare and severe infection with poor prognosis. The aim was to investigate the incidence and risk factors of AA keratitis in a large tertiary ophthalmology department in Denmark.

Methods: A search was performed in our electronic patient records by the keywords: 'PHMB/polyhexanid', 'Brolene' or 'amoeba and chlorhexidine' from year 1994 to 2018, and afterwards medical records were reviewed. A total of 65 cases of AA keratitis were hereby identified.

Results: Patients were relatively young, median (range) age of 38 (15-70) years. A significant increase of diagnosing AA keratitis occurred from 0.13 cases per million per year in the first 5 years to 2.7 cases per million per year the last 5 years. Eighty-nine per cent of patients were contact lens users, and 49% had received corticosteroids before the diagnosis was established. Severe pain was present in 34% of patients. Prognosis was poor with final visual acuity of logMAR (mean, 95% CI) 0.30 (0.18-0.41), 18% had transplantation à chaud, and 2% were enucleated.

Conclusion: The study indicates that the incidence of AA keratitis is increasing, also in Denmark. Most patients were young contact lens users. The course of the disease is long and often painful, and the prognosis is poor despite relevant treatment.
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http://dx.doi.org/10.1111/aos.14337DOI Listing
December 2019

Göttingen Minipig is not a Suitable Animal Model for Testing of Tissue-Engineered Corneal Endothelial Cell-Carrier Sheets and for Endothelial Keratoplasty.

Curr Eye Res 2020 08 6;45(8):945-949. Epub 2020 Jan 6.

Department of Ophthalmology, Aarhus University Hospital , Aarhus, Denmark.

Aim: To test the feasibility of implanting human anterior lens capsules (HALCs) with porcine corneal endothelial cells (pCEC) in Göttingen minipigs and at the same time test the suitability of Göttingen minipig as model for endothelial keratoplasty.

Materials And Methods: Cell-carrier constructs of decellularized HALC with cultured (pCEC) were created for implementation . Eight Göttingen minipigs (6 months old) underwent surgery with descemetorhexis or removal of endothelium by scraping and implementation of HALC without (animal 1-4) and with (animal 5-8) pCEC. Follow-up examinations included optical coherence tomography (OCT) imaging (1,2 and 3 months) and slit-lamp examination (<1 week as well as 1,2 and 3 months).

Results: Intraoperative challenges included difficulties in maintaining an anterior chamber due to soft tissue and vitreous pressure, development of corneal edema and difficulties removing Descemet's membrane because of strong adhesion to stroma. Therefore, descemetorhexis was replaced by mechanical scraping of the endothelium in animal 4-8. HALCs without pCEC were implanted in animal 1-4. Apposition to the back surface was not achieved in animal 1 and 3 because of corneal edema and poor visibility. Animal 5 was sacrificed because of a lens capsule tear. HALCs with pCEC were implanted in animal 6-8. Slit-lamp examination the first week revealed corneal edema in all animals, although mild in animals 4. One-month examination showed retrocorneal membranes with overlying corneal edema in all animals. Histology showed fibrosis in the AC and on the back surface of the cornea, compatible with the clinical diagnosis of retrocorneal membrane.

Conclusions: In conclusion, the minipig is not suitable for corneal transplantation studies because of intraoperative challenges and development of retrocorneal membrane postoperatively. For testing of the surgical handling and the therapeutic potential of tissue-engineered endothelial cell-carrier constructs other animal models are required.
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http://dx.doi.org/10.1080/02713683.2019.1706747DOI Listing
August 2020

Gonadotropins in Keratoconus: The Unexpected Suspects.

Cells 2019 11 22;8(12). Epub 2019 Nov 22.

Department of Ophthalmology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 167, 8200 Aarhus N, Denmark.

Keratoconus (KC) is the most common ectatic corneal disease with a significant visual acuity burden. The actual burden is intangible given that KC can disrupt daily activities (reading, driving, and various career paths). Despite decades of research and clinical studies, the etiology, onset, and pathobiology of KC remain a mystery. The purpose of this study was to investigate the role of gonadotropins in KC. We recruited 86 KC patients (63 males, 23 female), and 45 healthy controls (22 male, 23 female). Plasma samples were collected and analyzed using an enzyme-linked immunosorbent assay. Corneal stromal cells from KC and healthy controls, and human epithelial corneal cells, were also investigated for gonadotropin-related markers. Our results show significant alterations of LH/FSH in KCs, compared to healthy controls. Our data also reveals, for the first time, the existence of gonadotropins and their receptors in KC. Our study is the first to demonstrate the role of LH/FSH in KCs, and expand the list of organs known to express gonadotropins, or their receptors, to include the human cornea. Our findings suggest that the human cornea is capable of responding to gonadotropins, and propose an intriguing mechanism for the onset and/or progression of KC.
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http://dx.doi.org/10.3390/cells8121494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6953013PMC
November 2019

High-risk Corneal Transplantation: Recent Developments and Future Possibilities.

Transplantation 2019 12;103(12):2468-2478

Department of Ophthalmology, CHU de Nantes, France.

Human corneal transplantation (keratoplasty) is typically considered to have superior short- and long-term outcomes and lower requirement for immunosuppression compared to solid organ transplants because of the inherent immune privilege and tolerogenic mechanisms associated with the anterior segment of the eye. However, in a substantial proportion of corneal transplants, the rates of acute rejection and/or graft failure are comparable to or greater than those of the commonly transplanted solid organs. Critically, while registry data and observational studies have helped to identify factors that are associated with increased risk of corneal transplant failure, the extent to which these risk factors operate through enhancing immune-mediated rejection is less clear. In this overview, we summarize a range of important recent clinical and basic insights related to high-risk corneal transplantation, the factors associated with graft failure, and the immunological basis of corneal allograft rejection. We highlight critical research areas from which continued progress is likely to drive improvements in the long-term survival of high-risk corneal transplants. These include further development and clinical testing of predictive risk scores and assays; greater use of multicenter clinical trials to optimize immunosuppressive therapy in high-risk recipients and robust clinical translation of novel, mechanistically-targeted immunomodulatory and regenerative therapies that are emerging from basic science laboratories. We also emphasize the relative lack of knowledge regarding transplant outcomes for infection-related corneal diseases that are common in the developing world and the potential for greater cross-pollination and synergy between corneal and solid organ transplant research communities.
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http://dx.doi.org/10.1097/TP.0000000000002938DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6867666PMC
December 2019

Intrastromal Lenticule Rotation for Treatment of Astigmatism Up to 10.00 Diopters Ex Vivo in Human Corneas.

J Refract Surg 2019 Jul;35(7):451-458

Purpose: To evaluate the feasibility of intrastromal lenticule rotation (ISLR) as a novel technique for management of astigmatism up to 10.00 diopters (D).

Methods: Eighteen human donor corneas were mounted on an artificial anterior chamber. After laser application and dissection, the lenticule was rotated 90° in the intrastromal pocket. Scheimpflug tomography (Pentacam HR; Oculus Optikgeräte GmbH, Wetzlar, Germany) was acquired preoperatively and following ISLR. The attempted astigmatic correction was twice the cylindrical magnitude of the lenticule referenced to the corneal plane: 4.80 D (5.00 D group, n = 9) and 9.32 D (10.00 D group, n = 9), respectively. The change in keratometric astigmatism was evaluated by vector analysis.

Results: In the 5.00 D group, ISLR caused a mean absolute surgical induced astigmatism (SIA) of 5.30 ± 1.14 D with a correction index (CI) of 1.14 ± 0.25 and an angle of error (AoE) of -0.80° ± 4.61°. In the 10.00 D group, the SIA averaged 9.57 ± 1.10 D with a CI of 1.03 ± 0.12 and an AoE of 2.75° ± 3.60°. The average total corneal refractive power (TCRP) increased 1.36 ± 0.67 and 1.95 ± 1.57 D in the 5.00 D and 10.00 D groups, respectively. Postoperative optical coherence tomography revealed stromal redistribution in the periphery of the optical zone with tissue addition in the preoperative steep meridian and tissue reduction in the preoperative flat meridian.

Conclusions: ISLR seemed feasible and precise for management of regular astigmatism up to 10.00 D ex vivo in human donor corneas. A myopic shift was observed in TCRP. The in vivo corneal remodeling after ISLR warrants investigation. [J Refract Surg. 2019;35(7):451-458.].
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http://dx.doi.org/10.3928/1081597X-20190618-02DOI Listing
July 2019

Scheimpflug Imaging of the Danish Cohort of Patients With Wilson Disease.

Cornea 2019 Aug;38(8):998-1002

Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.

Purpose: The purpose of this study was to investigate the use of anterior segment imaging in diagnosing Kayser-Fleischer rings in patients with Wilson disease.

Methods: In a tertiary center for Wilson disease, patients were examined with a Pentacam HR Scheimpflug-based tomography device in addition to conventional slit-lamp examination. The inferior part of the cornea was analyzed using both a built-in densitometry module and ImageJ.

Results: Thirty-one patients with Wilson disease (78% of all Danish patients) were included, resulting in 83 examinations over a 5-year period. Ten had a manifest Kayser-Fleischer ring in the inferior part of the cornea on at least 1 examination, 5 had other causes of peripheral corneal scatter, and 16 had normal examinations. The built-in densitometry module performed poorly in discriminating between the presence and absence of a Kayser-Fleischer ring. However, analysis of the images in ImageJ and calculation of a normalized signal (peak posterior value/peak anterior value) with a cutoff value set to 1 detected 28 of 31 Kayser-Fleischer rings and resulted in 96% sensitivity and 95% specificity. In 12 patients who underwent 3 or more examinations during the period, changes in the normalized signal seemed to reflect the efficiency of the treatment, although more studies are needed for this conclusion.

Conclusions: ImageJ-based analysis of Pentacam images has a high sensitivity in detecting Kayser-Fleischer rings and can be used as a diagnostic procedure for Wilson disease and may be a tool to monitor the disease in an objective manner.
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http://dx.doi.org/10.1097/ICO.0000000000001959DOI Listing
August 2019

Corneal injury: Clinical and molecular aspects.

Exp Eye Res 2019 09 22;186:107709. Epub 2019 Jun 22.

Department of Ophthalmology, Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA; Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA. Electronic address:

Currently, over 10 million people worldwide are affected by corneal blindness. Corneal trauma and disease can cause irreversible distortions to the normal structure and physiology of the cornea often leading to corneal transplantation. However, donors are in short supply and risk of rejection is an ever-present concern. Although significant progress has been made in recent years, the wound healing cascade remains complex and not fully understood. Tissue engineering and regenerative medicine are currently at the apex of investigation in the pursuit of novel corneal therapeutics. This review uniquely integrates the clinical and cellular aspects of both corneal trauma and disease and provides a comprehensive view of the most recent findings and potential therapeutics aimed at restoring corneal homeostasis.
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http://dx.doi.org/10.1016/j.exer.2019.107709DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6703935PMC
September 2019

Incidence and prevalence of keratoconus in Denmark - an update.

Acta Ophthalmol 2019 Dec 9;97(8):752-755. Epub 2019 Apr 9.

Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.

Purpose: To describe the annual incidence rate of keratoconus in Denmark 1995-2015 and prevalence of keratoconus in the National Danish Patient Register 1977-2015.

Methods: All patients diagnosed with keratoconus in the National Danish Patient Register 1977-2015 were included in the study. The annual incidence rates and the overall prevalence of diagnosed keratoconus in the register were calculated using life tables from the general Danish population. A sub-analysis excluding immigrants and descendants was performed.

Results: An increase in the annual incidence rate was seen from 1.24 per 100 000 person-years in 2003 to 3.83 per 100 000 in 2011. The average incidence rate 2011-2015 was 3.60 per 100 000 person-years. A survey of primary-sector ophthalmologists supported that the register data could be considered complete from 2011. The prevalence of diagnosed keratoconus in the National Patient Register 1977-2015 was 44 per 100 000 persons. Excluding immigrants and descendants yielded an average incidence rate 2011-2015 of 2.89 per 100 000 person-years and a prevalence of diagnosed keratoconus in the National Patient Register 1977-2015 of 40 per 100 000 persons.

Conclusion: The present incidence rate (based on 2011-2015 data) has increased 2-3-fold during the last 10-15 years. The increase is possibly largely a consequence of more complete data due to the availability of corneal cross-linking, which has changed the referral pattern from the primary sector. Other factors such as better diagnostic tools and immigration may also play a role.
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http://dx.doi.org/10.1111/aos.14082DOI Listing
December 2019

A nationwide population-based study of social demographic factors, associated diseases and mortality of keratoconus patients in Denmark from 1977 to 2015.

Acta Ophthalmol 2019 Aug 13;97(5):497-504. Epub 2018 Nov 13.

Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.

Purpose: To study sociodemographic factors, associated diseases and survival of Danish keratoconus patients.

Methods: All patients diagnosed with keratoconus 1977-2015 (n = 2679) were matched to 10 persons who had not been diagnosed with keratoconus (n = 26 790). Conditional logistic regression assessed whether sociodemographic factors and specific systemic diseases were associated with the odds of keratoconus. Mortality was assessed with time-to-event analysis.

Results: After adjustment, non-Europeans had more than threefold higher odds of keratoconus compared to Europeans (OR, 3.34; 96% CI 2.94-3.80). Single persons had 27% higher odds (OR, 1.27; 95% CI 1.13-1.43), and divorced persons had 18% lower odds (OR 0.82; 95% CI 0.68-0.97) of keratoconus compared with persons in a relationship. Persons living in cities with <500 and 500-4999 inhabitants had 40% (OR, 0.60; 95% CI 0.51-0.71) and 30% (OR, 0.70; 95% CI 0.61-0.81) lower odds of keratoconus, respectively, compared with those living in the capital (>1 000 000 inhabitants). Persons receiving government substitution had 68% higher odds of keratoconus (OR, 1.68; 95% CI 1.30-2.17) compared to self-employed. Keratoconus patients had more than twofold higher odds of asthma (OR, 2.21; 95% CI 1.91-2.55), more than threefold higher odds of allergic rhinitis (OR, 3.44; 95% CI 2.75-4.30), more than sevenfold higher odds of atopic dermatitis (OR, 7.97; 95% CI, 6.21-10.21) and 69% higher odds of depression (OR, 1.69; 95% CI 1.18-2.43). Mortality rates were similar among keratoconus patients and controls (HR, 1.02; 95% CI 0.90-1.16).

Conclusion: Danish keratoconus patients differ from controls on several sociodemographic factors and have higher risk of allergic rhinitis, asthma, atopic dermatitis and depression. They do not have excess mortality compared to controls.
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http://dx.doi.org/10.1111/aos.13961DOI Listing
August 2019

Prolactin-Induced Protein is a novel biomarker for Keratoconus.

Exp Eye Res 2019 02 26;179:55-63. Epub 2018 Oct 26.

Department of Cell Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA; Department of Ophthalmology/Dean McGee Eye Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA. Electronic address:

Purpose: The purpose of the study was to investigate the role of Prolactin-Induced Protein (PIP) as a predictive biomarker for Keratoconus (KC).

Participants: This study included one hundred and forty-seven patients with KC (105 male, 42 female), and sixty healthy controls (27 male, 33 female).

Methods: Tears, plasma and saliva samples were collected from all participants. In both KC and healthy groups all collected samples were divided into four age subgroups (15-24y), (25-34y), (35-44y) and (45y and up). Samples were analyzed using western blot (WB) and enzyme-linked immunosorbent assay (ELISA). Areas under the receiver operating characteristic curves (AUROCs) were used to evaluate diagnostic accuracy for distinguishing between KC and healthy eyes.

Main Outcome Measures: Difference in PIP protein levels between patients with KC and healthy controls.

Results: Results showed significant downregulation of PIP expression in all three biological fluids on KC patients when compared to healthy controls, independent of age, sex and severity. Since PIP is a hormonal-regulated protein, we also investigated the expression of major sex hormones. We detected significant upregulation in salivary and plasma Dehydroepiandrosterone sulfate (DHEA-S) levels and significant downregulation of estrone and estriol levels, in KC patients compared to healthy controls, independent of sex, age, and KC severity stage. ROC was used to determine the overall predictive accuracy of this protein in KC. Data showed an area under the curve (AUC) for PIP in tears of 0.937 (95%CI: 0.902-0.971), in plasma of 0.928 (95%CI: 0.890-0.968) and in saliva of 0.929 (95%CI: 0.890-0.968).

Conclusions: Conclusively, our results show that PIP levels are reduced in all three human biological fluids tested, and may independently or in combination with current imaging techniques aid in screening and diagnosis of KC. Our data revealed that PIP levels can potentially differentiate between disease and healthy cases, and PIP levels are stable in relation to KC severity, sex and age. Moreover, alterations in sex hormone levels in correlation with reduced PIP levels in KC provide an intriguing insight in the underlying KC pathophysiology and highlights the role of PIP as a KC biomarker.
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http://dx.doi.org/10.1016/j.exer.2018.10.015DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360109PMC
February 2019

Optical and visual quality after small-incision lenticule extraction.

J Cataract Refract Surg 2019 01 1;45(1):54-61. Epub 2018 Nov 1.

Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.

Purpose: To examine the relationship between corneal higher-order aberrations (HOAs), scatter, and residual refraction with visual symptoms and visual acuity after small-incision lenticule extraction (SMILE) for myopia and astigmatism.

Setting: University Eye Clinic, Aarhus, Denmark.

Design: Prospective case series.

Methods: Eyes had small-incision lenticule extraction for myopia or myopic astigmatism. Examinations were performed preoperatively and 1 day, 7 days, 1 month, and 3 months postoperatively and included subjective refraction, Pentacam HR measurements, scatter measurements (objective scatter index [OSI]), and questionnaires on visual quality and symptoms.

Results: The mean preoperative spherical equivalent (SE) was -7.08 diopters (D) ± 1.17 (SD). At 3 months, the mean uncorrected distance visual acuity (UDVA) was -0.03 ± 0.11 logarithm of the minimum angle of resolution and the mean SE, -0.17 ± 0.33 D; the OSI increased by a mean of 0.22 ± 0.53 (P = .06) and coma by 0.1 ± 0.1 μm (P < .001); spherical aberration did not change significantly. The severity of self-reported visual symptoms decreased postoperatively. Scatter, corneal HOAs, and residual refraction were not correlated with the degree of visual symptoms. On linear regression analysis, residual refraction was a significant predictor of UDVA (1 day: adjusted R = 0.16, P = .02; 3 months: adjusted R = 0.55, P < .001). Scatter and corneal HOAs were not associated with postoperative UDVA.

Conclusions: Despite statistically significant changes in scatter and corneal HOAs, the severity of self-reported visual symptoms decreased postoperatively. Residual refraction was a good predictor of postoperative UDVA. Scatter and corneal HOAs had no effect on the postoperative UDVA.
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http://dx.doi.org/10.1016/j.jcrs.2018.08.026DOI Listing
January 2019

Retrospective Single-Center Registry Study on Graft Thickness 1 Year After Descemet Stripping Automated Endothelial Keratoplasty.

Cornea 2019 Feb;38(2):183-188

Department of Ophthalmology, Aarhus University Hospital, Aarhus, Denmark.

Purpose: To compare the graft thickness of eye bank precut grafts with graft thickness measured 1 year after Descemet stripping automated endothelial keratoplasty (DSAEK) and to correlate the graft thickness of eye bank precut grafts with best spectacle-corrected visual acuity (BSCVA) and endothelial cell density (ECD) 1 year after DSAEK.

Methods: This was a retrospective registry study of 183 eyes of 179 DSAEK patients. Grafts were cut in the eye bank after 1 day in dextran-containing medium, and thickness was measured by optical coherence tomography immediately after precutting. Examinations 1 year after DSAEK included optical coherence tomography for graft thickness, BSCVA, and specular microscopy. Patients were divided into 2 groups based on the median graft thickness. The correlations between original graft thickness and graft thickness measured 1 year later, BSCVA, and ECD were analyzed by linear regression analyses.

Results: Graft thickness decreased from 116 ± 36.8 μm before to 100 ± 36.8 μm 1 year after DSAEK (R =0.901, P <0.0001). Mean BSCVA 1 year after DSAEK was 0.24 logMAR in eyes without ocular comorbidity. BSCVA was 0.25 ± 0.16 (0.21-0.28) and 0.20 ± 0.11 (0.18-0.23) in eyes with a graft thickness above or below 111 μm, respectively (P = 0.04). ECD loss 1 year after surgery did not correlate with graft thickness (R = 0.0006, P <0.875).

Conclusions: Graft thickness measured immediately after precutting correlates strongly with graft thickness measured 1 year after DSAEK. This study suggests that ultrathin grafts provide better visual acuity 1 year after DSAEK than regular grafts.
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http://dx.doi.org/10.1097/ICO.0000000000001793DOI Listing
February 2019