Journal of Clinical Medicine

Research

14 pages, 1683 KiB

Open AccessArticle

Interleukin 12 in the Acute Phase of the Immune Response after Excimer Laser Treatment

by Mirko Resan, Zeljka Cvejic, Igor Pancevski, Gabriele Thumann, Martina Kropp, Ivo Guber, Dragana Ristic, Danilo Vojvodic and Bojan Pajic

J. Clin. Med. 2023, 12(13), 4472; https://doi.org/10.3390/jcm12134472 - 4 Jul 2023

Cited by 1 | Viewed by 1181

Abstract

Background and objectives: The aim of the research was to investigate the differences in the concentrations of IL-12, IL-4, IL-10, and IFN-γ in tears after LASIK and PRK procedures. Materials and methods: The study included 68 myopic eyes up to −3.0 D refractive [...] Read more.

Background and objectives: The aim of the research was to investigate the differences in the concentrations of IL-12, IL-4, IL-10, and IFN-γ in tears after LASIK and PRK procedures. Materials and methods: The study included 68 myopic eyes up to −3.0 D refractive spherical equivalent, divided into two groups: Group 1 LASIK (n = 31) and Group 2 PRK (n = 37). Three tear samples were taken from each eye: immediately before the procedure (t₀), 1 h after the procedure (t₁), and 24 h after the procedure (t₂). The concentrations of IL-12p70, IL-4, IL-10, and IFN-γ in the tear samples were determined by flow cytometry. Participants were not taking anti-inflammatory therapy 24 h after the procedure. Results: IL-4 levels 1 h after treatment did not differ between LASIK and PRK (p = 0.990), while 24 h after PRK there was a significant decrease in IL-4 levels (p < 0.05), but not after LASIK (p = 0.476). In both the LASIK (p < 0.05) and PRK (p < 0.05) groups, there is an increase in IL-10 concentrations 1 h after treatment, which persists 24 h after LASIK (p < 0.05) but not after PRK (p = 0.081). There is an increase in IL-12p70 concentration 1 h after treatment in both the LASIK (p < 0.001) and PRK groups (p < 0.001). There is also an increase in IL-12p70 concentration 24 h after PRK (p < 0.005), but not after LASIK (p = 0.775). Conclusions: IL-4 concentration shows a significantly higher value in the LASIK group than in the PRK group after 24 h. IL-10 and IL-12p70 levels increase one hour after surgery in both groups. After 24 h, the IL-10 levels remain elevated in the LASIK group, and the IL-12p70 levels remain elevated in the PRK group. Thus, LASIK and PRK procedures show different inflammatory dynamics. Full article

(This article belongs to the Special Issue Corneal Surgery: From Innovation to Clinical Praxis)

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9 pages, 1274 KiB

Open AccessArticle

Characteristics of Grape Shelf Eye Injuries at Vineyards in Japan

by Wataru Kikushima, Yoichi Sakurada and Kenji Kashiwagi

J. Clin. Med. 2022, 11(23), 7079; https://doi.org/10.3390/jcm11237079 - 29 Nov 2022

Viewed by 1371

Abstract

We aimed to investigate the characteristics and visual outcomes of farm work-associated eye injuries at vineyards. We retrospectively reviewed medical charts of patients with farm work-associated eye injuries. The eyes were divided into two groups according to the type of farming that contributed [...] Read more.

We aimed to investigate the characteristics and visual outcomes of farm work-associated eye injuries at vineyards. We retrospectively reviewed medical charts of patients with farm work-associated eye injuries. The eyes were divided into two groups according to the type of farming that contributed to the eye injury: the vineyard and other farming groups. Injury types, surgical procedures, and changes in visual acuity were statistically evaluated. After initial treatment, patients were followed up at different periods. We examined 30 eyes, including 14 eye injuries in the vineyard group and 16 eye injuries in the other farming group. The mean age of the patients was 58.8 ± 16.7 years, and 83.3% were male. None of the patients wore any safety eyewear at the time of injury. After initial treatment, the mean best-corrected visual acuity significantly improved from 0.83 ± 0.94 at baseline to 0.30 ± 0.57 at the final follow-up (p = 5.8 × 10⁻⁴). Eye injuries in the vineyard group were mostly caused by the penetration of wires of grape shelves and were frequent from winter to spring. We concluded that farm work-associated eye injuries at vineyards have characteristic properties compared with those during other farm work. The use of safety eyewear is strongly recommended to prevent eye injuries during farm work. Full article

(This article belongs to the Special Issue Corneal Surgery: From Innovation to Clinical Praxis)

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11 pages, 2081 KiB

Open AccessArticle

Comparison of Corneal Higher-Order Aberrations Following Topography-Guided LASIK and SMILE for Myopic Correction: A Propensity Score Matching Analysis

by Eun Min Kang, Ik Hee Ryu, In Sik Lee, Jin Kuk Kim, Sun Woong Kim and Yong Woo Ji

J. Clin. Med. 2022, 11(20), 6171; https://doi.org/10.3390/jcm11206171 - 19 Oct 2022

Cited by 8 | Viewed by 2748

Abstract

Ocular aberrations, particularly corneal higher-order aberrations (HOAs), which impair visual quality, should be minimized or corrected during any laser vision correction. We compared changes in visual outcomes, including HOAs, in patients who underwent Topography-Guided laser-assisted in situ keratomileusis (TG-LASIK) or small-incision lenticule extraction [...] Read more.

Ocular aberrations, particularly corneal higher-order aberrations (HOAs), which impair visual quality, should be minimized or corrected during any laser vision correction. We compared changes in visual outcomes, including HOAs, in patients who underwent Topography-Guided laser-assisted in situ keratomileusis (TG-LASIK) or small-incision lenticule extraction (SMILE) after propensity score matching (PSM) to reduce selection bias. Of 2749 patients who underwent SMILE or TG-LASIK for myopia, 152 eyes underwent complete ophthalmic examination preoperatively and over six months postoperatively. Visual outcomes were comparatively analyzed after PSM. As a result, 45 eyes were included in each group after PSM. There was a comparable improvement in visual acuity (VA) and refractive parameters postoperatively, with no difference between the two PSM-groups. However, 6.6% in the SMILE PSM-group lost two or more lines of Snellen VA at the six-month follow-up, while none in the TG-LASIK PSM-group did. Specifically, the SMILE PSM-group showed a significant increase in corneal HOAs, including spherical aberration, coma, and total HOAs (0.0736 ± 0.162 μm; 0.181 ± 0.233 μm; and 0.151 ± 0.178 μm, respectively), whereas TG-LASIK PSM-group did not. Furthermore, SMILE PSM-group had greater postoperative corneal HOAs than those in TG-LASIK PSM-group. Collectively, TG-LASIK induces fewer corneal HOAs even after facilitating between-group comparability using PSM analysis. TG-LASIK provides better visual quality than SMILE for myopia. Full article

(This article belongs to the Special Issue Corneal Surgery: From Innovation to Clinical Praxis)

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11 pages, 2224 KiB

Open AccessArticle

Visual Outcomes of Small-Incision Lenticule Extraction (SMILE) in Thin Corneas

by Erika Eskina, Olga Klokova, Roman Damashauskas, Karine Davtyan, Bojan Pajic and Marina Movsesian

J. Clin. Med. 2022, 11(14), 4162; https://doi.org/10.3390/jcm11144162 - 18 Jul 2022

Cited by 3 | Viewed by 2824

Abstract

We aimed to find out whether thin (≤500 μm) or normal (>500 μm, control) corneal thickness would impact efficacy and safety outcomes of small-incision lenticule extraction (SMILE). We retrospectively analyzed medical records of adult patients who had undergone SMILE. A total of 57 [...] Read more.

We aimed to find out whether thin (≤500 μm) or normal (>500 μm, control) corneal thickness would impact efficacy and safety outcomes of small-incision lenticule extraction (SMILE). We retrospectively analyzed medical records of adult patients who had undergone SMILE. A total of 57 eyes were included in the “thin corneas” group and 180 eyes in the “control” group. At one month after surgery, rates of patients with uncorrected distance visual activity (UDVA) ≥ 0.8 were significantly higher in patients from the control group compared to the “thin corneas” group (87 vs. 71%, respectively p < 0.01), though rates were comparable at 3 months (87 vs. 76%, respectively, p > 0.05). SMILE had comparable safety in patients with thin and normal corneas. Procedure result predictability was comparable between groups. Regression analysis demonstrated that cap thickness impacted posterior corneal biomechanics, and the volume of removed tissue had a higher influence in patients with thin corneas. Moreover, an increase in cap thickness was associated with better final BCVA. Further study is needed for the evaluation of the impact of thin corneas on SMILE outcomes and planning. Our study also indicates that patients with thin corneas might require a different approach to nomogram calculation. Full article

(This article belongs to the Special Issue Corneal Surgery: From Innovation to Clinical Praxis)

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7 pages, 561 KiB

Open AccessArticle

A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface

by Farhad Hafezi, Mark Hillen, Leonard Kollros, Jerry Tan and Shady T. Awwad

J. Clin. Med. 2022, 11(14), 4109; https://doi.org/10.3390/jcm11144109 - 15 Jul 2022

Cited by 6 | Viewed by 2689

Abstract

Corneal epithelium removal during photorefractive keratotomy (PRK), TransPRK, or corneal cross-linking (CXL) means that patients experience pain and inflammation after the procedure, which need to be carefully managed with topical drug regimens. One highly effective class of topical analgesics is non-steroidal anti-inflammatory drugs [...] Read more.

Corneal epithelium removal during photorefractive keratotomy (PRK), TransPRK, or corneal cross-linking (CXL) means that patients experience pain and inflammation after the procedure, which need to be carefully managed with topical drug regimens. One highly effective class of topical analgesics is non-steroidal anti-inflammatory drugs (NSAIDs), but these must be used carefully, as their use has been associated with delayed re-epithelialization and, in rare cases, corneal melting. However, our clinical experience has been that the concomitant use of topical corticosteroids obviates this risk. Here, we present a mechanistic explanation for our observations, our TransPRK and epithelium-off CXL protocols, and the postoperative medication regimens where topical NSAIDs are used in combination with topical steroid therapy during the first two postoperative days (where pain and inflammation levels are the highest). We detail the results of a single-center retrospective case analysis that examined eyes that underwent TransPRK (n = 301) or epithelium-off CXL (n = 576). Topical NSAID use in the first two postoperative days to control pain and inflammation after PRK/TransPRK or epithelium-off CXL, when used in combination with topical steroid therapy, does not appear to be associated with corneal melting or delayed epithelial healing. This approach may represent an improvement over current methods of handling post-surgical pain in procedures that require corneal epithelial debridement. Full article

(This article belongs to the Special Issue Corneal Surgery: From Innovation to Clinical Praxis)

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Review

Jump to: Research, Other

7 pages, 240 KiB

Open AccessReview

Turner Syndrome: Ocular Manifestations and Considerations for Corneal Refractive Surgery

by Majid Moshirfar, Mark T. Parsons, Chap-Kay Lau, Nicholas A. Chartrand, Yasmyne C. Ronquillo and Phillip C. Hoopes

J. Clin. Med. 2022, 11(22), 6853; https://doi.org/10.3390/jcm11226853 - 20 Nov 2022

Cited by 2 | Viewed by 2157

Abstract

Turner Syndrome (TS) is the most common sex chromosome abnormality in females and is associated with physical changes, hormone deficiencies, increased risk of autoimmune disease, and ocular complications. In this article, we review the main ocular findings associated with TS and discuss their [...] Read more.

Turner Syndrome (TS) is the most common sex chromosome abnormality in females and is associated with physical changes, hormone deficiencies, increased risk of autoimmune disease, and ocular complications. In this article, we review the main ocular findings associated with TS and discuss their significance for the patient considering refractive surgery. We also present four cases of TS to highlight the clinical findings that may be present in these patients. The most common ocular manifestations include refractive errors, strabismus, and amblyopia. Less commonly, patients with TS may present with keratoconus, cataracts, glaucoma, uveitis, or other disorders of the posterior segment. When considering corneal refractive surgery in a TS patient, clinicians should perform a thorough ocular history, ask patients about hormone therapy and autoimmune conditions, and pay particular attention to any of the associated ocular symptoms of TS. Full article

(This article belongs to the Special Issue Corneal Surgery: From Innovation to Clinical Praxis)

6 pages, 700 KiB

Open AccessReview

Corneal Transplant Rejections in Patients Receiving Immune Checkpoint Inhibitors

by Majid Moshirfar, Noor F. Basharat, Tanner S. Seitz, Briana K. Ply, Yasmyne C. Ronquillo and Phillip C. Hoopes

J. Clin. Med. 2022, 11(19), 5647; https://doi.org/10.3390/jcm11195647 - 25 Sep 2022

Cited by 6 | Viewed by 2210

Abstract

Immune checkpoint inhibitors (ICIs) are antibodies that target and block immune checkpoints. These biologics were initially approved by the United States Food and Drug Administration (US FDA) in 2011 for the management of melanoma. Since then, the use of ICI therapy has increased, [...] Read more.

Immune checkpoint inhibitors (ICIs) are antibodies that target and block immune checkpoints. These biologics were initially approved by the United States Food and Drug Administration (US FDA) in 2011 for the management of melanoma. Since then, the use of ICI therapy has increased, with many new medications on the market that treat approximately 50 types of cancers. Patients receiving this therapy are at an increased risk for transplant rejection, including corneal rejection. Ophthalmologists must be aware of individuals receiving ICI therapy as it may be a relative contraindication for patients with a history of corneal transplantation. Patients on ICIs may also experience ocular side effects, including uveitis, dry eye, and inflammation, while on checkpoint inhibitor therapy. This commentary discusses the current understanding of immune checkpoint inhibitors, their mechanism of action, their ocular side effects, and their role in corneal transplant rejection. Full article

(This article belongs to the Special Issue Corneal Surgery: From Innovation to Clinical Praxis)

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Other

Jump to: Research, Review

12 pages, 2561 KiB

Open AccessCase Report

First Clinical Results of a New Generation of Ablative Solid-State Lasers

by Bojan Pajic, Brigitte Pajic-Eggspuehler, Zeljka Cvejic, Christian Rathjen and Viktor Ruff

J. Clin. Med. 2023, 12(2), 731; https://doi.org/10.3390/jcm12020731 - 16 Jan 2023

Cited by 2 | Viewed by 2274

Abstract

In the early 2000s, solid-state lasers emerged as an alternative technology to excimer systems in refractive surgery. Despite some technological limits at the time, good clinical results could be achieved with solid-state laser systems. This prospective case series reports clinical outcomes of five [...] Read more.

In the early 2000s, solid-state lasers emerged as an alternative technology to excimer systems in refractive surgery. Despite some technological limits at the time, good clinical results could be achieved with solid-state laser systems. This prospective case series reports clinical outcomes of five eyes treated with a newly developed solid-state laser system (AquariuZ) in three patients. Patients underwent preoperative examination, including corneal topo-and tomography, aberrometry, and confocal microscopy. All patients received a femtosecond LASIK with the Ziemer LDV Z8, a refractive treatment with the AquariuZ solid-state ablation laser, and were then followed up for a period of up to 12 months. The applied aspheric optimized profiles did not induce higher-order aberrations nor spherical aberration in any of these operated subjects. No eye lost BCVA lines throughout the duration of the follow-up. Six months after surgery, the safety index of patient 1 was 5, and for patients 2 and 3, it equaled 1. Confocal laser microscopy imaging findings were comparable to those seen typically for excimer lasers. The obtained results are encouraging and confirm that the new solid-state laser system is safe. Full article

(This article belongs to the Special Issue Corneal Surgery: From Innovation to Clinical Praxis)

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