Cornea and Anterior Eye Diseases

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (10 January 2024) | Viewed by 9711

Special Issue Editors


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Guest Editor
Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Paseo de Belén, 17—Campus Miguel Delibes, 47011 Valladolid, Spain
Interests: cornea; anterior eye; ocular surface; contact lens; myopia control with contact lenses; tomography; keratoconus
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Lecturer in Contact Lenses and Scientific Director of CeRCA Lab, University of Salento, Via per Arnesano, 73100 Lecce, Italy
Interests: cornea; contact lenses; tear film; corneal topography; anterior segment OCT; aberrometry; quality of vision
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Anterior eye health is necessary to guarantee good vision and quality of life; a huge number of anterior eye conditions are leading causes of ocular morbidity with different impacts on subject vision, such as dry eye disease, conjunctival issues (such as infections, immune diseases, systemic diseases complications, etc.), different types of trauma, microbial keratitis, corneal dystrophies, degenerations and ectasias (as keratoconus, etc.), cataracts, eye inflammation (uveitis) or complications of contact lens wear or other related eye treatments (for example, the impact of eyedrops on the ocular surface in glaucoma management or other chronic eye diseases, corneal iatrogenic issues after corneal refractive surgery, etc.).

This Special Issue invites original articles and reviews focusing on the broad topic of cornea, anterior eye diseases and eye diseases from in vitro/in vivo models, the evaluation of technology for corneal and anterior eye clinical assessment (topography, tomography, specular microscopy, biometry, etc.), and improvements in eye condition diagnosis and patient management with experimental and/or clinical evidence across a wide range of patients (pediatric, adults and ancient), with particular attention paid to primary eye care practice (early diagnosis), interdisciplinary collaboration and the management of patients' quality of live.

Dr. Raúl Martín
Dr. Giancarlo Montani
Guest Editors

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Keywords

  • cornea
  • anterior eye
  • corneal dystrophy
  • dry eye
  • ocular surface
  • ocular imaging
  • contact lenses
  • contact lens complications
  • primary eye care

Published Papers (9 papers)

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Research

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12 pages, 1334 KiB  
Article
The Repeatability and Agreement of Ocular Parameters Measured with the MYAH and Myopia Master Devices between Expert and Non-Expert Practitioners
by Sara Ortiz-Toquero, Irene Sanchez, Carmen Gurrea, Alba Recio, David Balsa and Raul Martin
Life 2024, 14(3), 407; https://doi.org/10.3390/life14030407 - 19 Mar 2024
Viewed by 634
Abstract
In myopia control, it is essential to measure the axial length (AL) and corneal parameters, and to monitor whether changes in these parameters have occurred over time. The aim of this study was to analyse the repeatability and agreement between expert and non-expert [...] Read more.
In myopia control, it is essential to measure the axial length (AL) and corneal parameters, and to monitor whether changes in these parameters have occurred over time. The aim of this study was to analyse the repeatability and agreement between expert and non-expert practitioners in ocular parameters measured by the MYAH and Myopia Master. Three repeated measurements (n = 42) were recorded with the MYAH and Myopia Master by two (an expert and a non-expert) observers in a randomized order. The AL, K1, K2, and white-to-white (WTW) distance were collected. The intraobserver repeatability was excellent in all parameters measured with both devices in both observers. The AL outcome presented the best repeatability with the MYAH and Myopia Master (intraclass correlation coefficient, ICC = 1.0; coefficient of variation, CV ≤ 0.06% for both observers), while the WTW presented poorer results (ICC ≤ 0.991; CV ≤ 0.52%). The Myopia Master provides a significantly (p ≤ 0.01) flatter K1 and K2 as well as a lower WTW (p ≤ 0.01) than the MYAH. No statistically significant difference in AL measurements was found with either device (p ≥ 0.10; ICC = 1.0). None of the parameters showed differences (p ≥ 0.12) between the expert and non-expert observer. The MYAH and Myopia Master provide consistent measurements in a healthy adult population regardless of the previous clinical experience of the observer. AL measurements should be used interchangeably but K1, K2, and WTW should be used interchangeably with caution. Full article
(This article belongs to the Special Issue Cornea and Anterior Eye Diseases)
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13 pages, 1509 KiB  
Article
Effectiveness of a Standardized Combination of Intracameral Mydriatics and Anaesthetic on Mydriasis during Cataract Surgery with Coexisting Diseases
by Joanna Katarzyna Dereń-Szumełda, Mariola Dorecka, Łukasz Zandecki and Ewa Mrukwa-Kominek
Life 2024, 14(1), 14; https://doi.org/10.3390/life14010014 (registering DOI) - 21 Dec 2023
Viewed by 798
Abstract
Purpose: To examine the effectiveness of a standardized combination of intracameral mydriatics and anesthetic (SCIMA) on mydriasis in patients with coexisting diseases such as diabetes mellitus (DM) and pseudoexfoliation syndrome (PXF) during phacoemulsification. Methods: Patients with cataract were included in the study if [...] Read more.
Purpose: To examine the effectiveness of a standardized combination of intracameral mydriatics and anesthetic (SCIMA) on mydriasis in patients with coexisting diseases such as diabetes mellitus (DM) and pseudoexfoliation syndrome (PXF) during phacoemulsification. Methods: Patients with cataract were included in the study if they achieved pupil dilation diameter ≥ 6.0 mm after the administration of mydriatic eyedrops (ME) during the first visit (V1). During the second visit (V2), pupil size measurements were obtained for phacoemulsification surgery with SCIMA. Effective mydriasis was defined as a pupil diameter ≥ 6.0 mm just prior to capsulorhexis without the use of additional pupil dilating agents. The measurements after ME administration during V1 and after SCIMA use during V2 were compared. Results: 103 patients (103 eyes) were divided into 3 groups: cataract and DM (n = 35), cataract and PXF (n = 32), and cataract without DM or PXF (n = 36). SCIMA administration allowed the achievement of effective mydriasis (≥6.0 mm) in all groups (n = 103; 100%). Mydriasis was significantly larger (p ≤ 0.001) after ME (7.3 mm) than after SCIMA (6.8 mm) administration. Conclusions: Patients with cataract and such comorbidities as DM or PXF are likely to achieve effective pharmacological mydriasis during cataract phacoemulsification after SCIMA application. Mydriasis after ME is slower and larger, while SCIMA is faster. Full article
(This article belongs to the Special Issue Cornea and Anterior Eye Diseases)
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15 pages, 2042 KiB  
Article
Anterior Scleral Thickness Profile in Keratoconus
by Neus Burguera-Giménez, María Amparo Díez-Ajenjo, Noemí Burguera and Cristina Peris-Martínez
Life 2023, 13(11), 2223; https://doi.org/10.3390/life13112223 - 19 Nov 2023
Viewed by 857
Abstract
Purpose: Considering that peripheral corneal thinning occurs in keratoconus (KC), the anterior scleral thickness (AST) profile was measured to compare thickness variations in healthy and KC eyes across several meridians. Methods: This cross-sectional case–control study comprised 111 eyes of 111 patients: 61 KC [...] Read more.
Purpose: Considering that peripheral corneal thinning occurs in keratoconus (KC), the anterior scleral thickness (AST) profile was measured to compare thickness variations in healthy and KC eyes across several meridians. Methods: This cross-sectional case–control study comprised 111 eyes of 111 patients: 61 KC eyes and 50 age- and axial-length-matched healthy eyes. The AST was explored at three scleral eccentricities (1, 2, and 3 mm from the scleral spur) across four scleral zones (nasal, temporal, superior, and inferior) by using swept-source optical coherence tomography. The AST variations among eccentricities and scleral regions within and between groups were investigated. Results: The AST significantly varied with scleral eccentricity in healthy eyes over the temporal meridian (p = 0.009), whereas in KC eyes, this variation was observed over the nasal (p = 0.001), temporal (p = 0.029) and inferior (p = 0.006) meridians. The thinnest point in both groups was 2 mm posterior to the scleral spur (p < 0.001). The sclera was thickest over the inferior region (control 581 ± 52 μm, KC 577 ± 67 μm) and thinnest over the superior region (control 448 ± 48 μm, KC 468 ± 58 μm) in both populations (p < 0.001 for all eccentricities). The AST profiles were not significantly different between groups (p > 0.05). The inferior–superior thickness asymmetry was statistically different 2 mm posterior to the scleral spur between groups (p = 0.009), specifically with subclinical KC (p = 0.03). There is a trend where the asymmetry increases, although not significantly, with the KC degree (p > 0.05). Conclusions: KC eyes presented significant thickness variations among eccentricities over the paracentral sclera. Although AST profiles did not differ between groups, the inferior–superior asymmetry differences demonstrated scleral changes over the vertical meridian in KC that need further investigation. Full article
(This article belongs to the Special Issue Cornea and Anterior Eye Diseases)
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13 pages, 6651 KiB  
Article
Comparison of the Ocular Surface Disease Index and the Symptom Assessment in Dry Eye Questionnaires for Dry Eye Symptom Assessment
by Raul Martin and EMO Research Group
Life 2023, 13(9), 1941; https://doi.org/10.3390/life13091941 - 21 Sep 2023
Viewed by 807
Abstract
Background: Patient-reported dry eye symptoms (DESs), assessed using the Ocular Surface Disease Index (OSDI) and the Symptom Assessment iN Dry Eye (SANDE) questionnaires, were compared in a large sample of patients. Methods: The correlation (Spearman coefficient) and agreement (Bland-Altman analysis) between the OSDI [...] Read more.
Background: Patient-reported dry eye symptoms (DESs), assessed using the Ocular Surface Disease Index (OSDI) and the Symptom Assessment iN Dry Eye (SANDE) questionnaires, were compared in a large sample of patients. Methods: The correlation (Spearman coefficient) and agreement (Bland-Altman analysis) between the OSDI and SANDE questionnaire scores (with and without score normalization) were assessed in 1033 patients and classified according to the OSDI score as non-DES and DES in a cross-sectional analysis. Results: The normalized and non-normalized SANDE results were higher than the OSDI results in all samples (2.83 ± 12.40 (p = 0.063) and 2.85 ± 15.95 (p = 0.016), respectively) and in non-DES (p > 0.063) and DES (p < 0.001) with both OSDI cutoff values. Weak correlations were found (Spearman coefficient <0.53; p < 0.001) in all cases except DES (0.12, p = 0.126). Weak agreement was found with a Bland-Altman analysis of the normalized and non-normalized scores of both questionnaires (mean difference from −7.67 ± 29.17 (DES patients) to −1.33 ± 8.99 (non-DES patients) without score normalization, and from −9.21 ± 26.37 (DES patients) to −0.85 ± 4.01 (non-DES) with data normalization), with a statistically significant linear relationship (R2 > 0.32, p < 0.001). The SANDE questionnaire did not yield the same patient classification as OSDI. The same operative curves (ROC) of the SANDE normalized and non-normalized scores were used to differentiate among patients with DES using OSDI < 12 (0.836 ± 0.015) or OSDI < 22 (0.880 ± 0.015) cutoff values. Conclusions: Normalized and non-normalized data collected from the SANDE questionnaire showed relevant differences from those of the OSDI, which suggests that the results of the SANDE visual analog scale-based questionnaire provide different patient classifications than the OSDI score. Full article
(This article belongs to the Special Issue Cornea and Anterior Eye Diseases)
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12 pages, 1555 KiB  
Article
Comparing Tear Film Viscosity between Sjögren and Non-Sjögren Dry Eye Disease
by Hung-Yin Lai, Alexander Chen, Po-Chiung Fang, Hun-Ju Yu and Ming-Tse Kuo
Life 2023, 13(7), 1484; https://doi.org/10.3390/life13071484 - 30 Jun 2023
Cited by 1 | Viewed by 1110
Abstract
This study aimed to compare tear film viscosity (TFV) in Sjögren and non-Sjögren dry eye diseases (DEDs). This was a cross-sectional observational study. A total of 68 DED patients were enrolled, including 32 patients with Sjögren syndrome (SS) and 36 without SS. TFV [...] Read more.
This study aimed to compare tear film viscosity (TFV) in Sjögren and non-Sjögren dry eye diseases (DEDs). This was a cross-sectional observational study. A total of 68 DED patients were enrolled, including 32 patients with Sjögren syndrome (SS) and 36 without SS. TFV was assessed by a tear film analyzer and determined by the momentary moving speed (MMS; MMS (t) = α × t−β, t = time (s)) with its power-law fitting-derived parameters (α and β). Among the four indices of TFV (MMS (0.1 s), MMS (2.0 s), α, and β), the SS-DED patients had significantly lower MMS (0.1 s) (p = 2.01 × 10−5), α (p = 0.0375), and β (p = 0.0076). The SS-DED group also had significantly higher OSDI, lower central and nasal tear meniscus height (TMH), and higher OSS. MMS (0.1 s) was significantly correlated with nasal TMH and OSS (ρ = 0.2520, p = 0.0381 in nasal TMH; ρ = −0.3487, p = 0.0036 in OSS). Index β was not correlated with any non-TFV tests. In conclusion, MMS (0.1 s), α, and β are promising TFV indices in distinguishing SS-DED from non-SS-DED patients early. Among these TFV indices, lower MMS is the best alternative clue for detecting SS-DED. Full article
(This article belongs to the Special Issue Cornea and Anterior Eye Diseases)
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11 pages, 260 KiB  
Article
Influence of Keratoconus Severity on Detecting True Progression with Scheimpflug Imaging and Anterior Segment Optical Coherence Tomography
by Sara Ortiz-Toquero, Carlota Fuente, Clara Auladell and Francisco Arnalich-Montiel
Life 2023, 13(7), 1474; https://doi.org/10.3390/life13071474 - 29 Jun 2023
Viewed by 843
Abstract
To determine consistent change over time in keratoconus disease, it is necessary to establish progression cut-off values based on intersession variability of the device used to monitor the cornea. The aim of this study was to analyze the accuracy of corneal parameters using [...] Read more.
To determine consistent change over time in keratoconus disease, it is necessary to establish progression cut-off values based on intersession variability of the device used to monitor the cornea. The aim of this study was to analyze the accuracy of corneal parameters using Scheimpflug tomography and anterior segment optical coherence tomography in healthy and keratoconic eyes of varying severity to determine the cut-off values that indicate real progression. Three repeated measurements of each cornea of healthy (20 eyes) and keratoconic eyes (mild = 16, moderate = 25 and severe = 20) were recorded using Pentacam and Casia SS-1000 devices, which were repeated 2–3 weeks later. K1, K2, maximal anterior and posterior keratometry, and corneal thickness at the thinnest location (TCT) were collected. The accuracy was excellent with both devices; however, the Casia device presented better repeatability and reproducibility in all parameters in all groups compared to the Pentacam. The cut-off of the Pentacam and Casia in the mild stage were lower (K1 = 0.50 and 0.37 D; K2 = 0.51 and 0.37 D; Kmax-A = 1.24 and 0.65 D; Kmax-P = 0.38 and 0.17 D; TCT = 19.64 and 11.19 µm) than that of the severe stage (K1 = 1.09 and 0.88 D; K2 = 1.41 and 0.87 D; Kmax-A = 2.74 and 2.15 D; Kmax-P = 0.82 and 0.22 D; TCT = 28.68 and 14.83 µm). These results show that the greater the keratoconus severity, the greater the change that must occur for it to be considered real. Full article
(This article belongs to the Special Issue Cornea and Anterior Eye Diseases)
8 pages, 3448 KiB  
Communication
ByLimb: Development of a New Technique to Implant Intracorneal Ring-Segments from the Perilimbal Region
by Roberto Albertazzi, Roger Zaldivar and Carlos Rocha-de-Lossada
Life 2023, 13(6), 1283; https://doi.org/10.3390/life13061283 - 30 May 2023
Viewed by 942
Abstract
A new technique that allows implanting intracorneal ring-segments (ICRS) from the limbal zone is described. Using a femtosecond laser (FSL), a 360° corneal tunnel is created with an internal diameter of 5.4 mm and an external diameter of 7.0 mm, with a wider [...] Read more.
A new technique that allows implanting intracorneal ring-segments (ICRS) from the limbal zone is described. Using a femtosecond laser (FSL), a 360° corneal tunnel is created with an internal diameter of 5.4 mm and an external diameter of 7.0 mm, with a wider area (0.2 mm inner and 0.2 mm outer) in the upper 60° of the tunnel (called landing zone). Next, a 4.36 mm-long corneal-limbal incision was created with the FSL, which connects to the bubbles created in the landing zone. The entire procedure was performed using intraoperative optical coherence tomography (OCT). Once the two incisions were connected using blunt-edged Mac Pherson forceps, the bubbles were released from the surgical plane. The programmed ICRS(s), 6 mm in diameter, are then placed in the corneal tunnel from the limbal incision with the aid of Sinskey forceps. Finally, when the ICRS is in place, the surgery is complete. Full article
(This article belongs to the Special Issue Cornea and Anterior Eye Diseases)
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10 pages, 252 KiB  
Article
Detecting True Change in Keratoconus after Intracorneal Ring Segment Implantation
by Francisco Arnalich-Montiel, Carlota Fuente, Clara Auladell and Sara Ortiz-Toquero
Life 2023, 13(4), 978; https://doi.org/10.3390/life13040978 - 10 Apr 2023
Viewed by 853
Abstract
Confirming the progression of keratoconus is of paramount relevance to providing the appropriate treatment. Real change should be considered consistent over time. It must be greater than the variability of the measurement of the device used to monitor the cornea. The present study [...] Read more.
Confirming the progression of keratoconus is of paramount relevance to providing the appropriate treatment. Real change should be considered consistent over time. It must be greater than the variability of the measurement of the device used to monitor the cornea. The present study aimed to assess the intraobserver repeatability and intersession reproducibility of a Scheimpflug camera in measuring corneal parameters in virgin keratoconus and intrastromal corneal ring segments (ICRS) implantation eyes to discriminate real change from measurement noise. Sixty keratoconus and 30 ICRS eyes were included. Corneal parameters were determined in three consecutive measurements and were repeated 2 weeks later. The precision within the same session for all parameters was better in the keratoconic eyes, with mean repeatability limits 33% narrower (range 13% to 55%) compared with ICRS eyes. Mean reproducibility limits were 16% narrower (range +48% to −45%) compared with ICRS eyes. The cutoff values to consider a real corneal shape change were lower for virgin keratoconic than for ICRS, except for the thinnest corneal thickness and Stage C (ABCD system), which were the opposite. Corneal tomography measurements in ICRS eyes showed worse accuracy than in virgin keratoconus, which should be taken into account by practitioners in patients’ follow up. Full article
(This article belongs to the Special Issue Cornea and Anterior Eye Diseases)

Review

Jump to: Research

12 pages, 1494 KiB  
Review
Artificial Intelligence and Infectious Keratitis: Where Are We Now?
by Mohammad Soleimani, Kasra Cheraqpour, Reza Sadeghi, Saharnaz Pezeshgi, Raghuram Koganti and Ali R. Djalilian
Life 2023, 13(11), 2117; https://doi.org/10.3390/life13112117 - 26 Oct 2023
Cited by 2 | Viewed by 2023
Abstract
Infectious keratitis (IK), which is one of the most common and catastrophic ophthalmic emergencies, accounts for the leading cause of corneal blindness worldwide. Different pathogens, including bacteria, viruses, fungi, and parasites, can cause IK. The diagnosis and etiology detection of IK pose specific [...] Read more.
Infectious keratitis (IK), which is one of the most common and catastrophic ophthalmic emergencies, accounts for the leading cause of corneal blindness worldwide. Different pathogens, including bacteria, viruses, fungi, and parasites, can cause IK. The diagnosis and etiology detection of IK pose specific challenges, and delayed or incorrect diagnosis can significantly worsen the outcome. Currently, this process is mainly performed based on slit–lamp findings, corneal smear and culture, tissue biopsy, PCR, and confocal microscopy. However, these diagnostic methods have their drawbacks, including experience dependency, tissue damage, cost, and time consumption. Diagnosis and etiology detection of IK can be especially challenging in rural areas or in countries with limited resources. In recent years, artificial intelligence (AI) has opened new windows in medical fields such as ophthalmology. An increasing number of studies have utilized AI in the diagnosis of anterior segment diseases such as IK. Several studies have demonstrated that AI algorithms can diagnose and detect the etiology of IK accurately and fast, which can be valuable, especially in remote areas and in countries with limited resources. Herein, we provided a comprehensive update on the utility of AI in IK. Full article
(This article belongs to the Special Issue Cornea and Anterior Eye Diseases)
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