Muriel Poli

Prospective study of corneal collagen cross-linking efficacy and tolerance in the treatment of keratoconus and corneal ectasia: 3-year results.

Purpose: To assess the efficacy and tolerance of corneal collagen cross-linking with corneal epithelium debridement in the stabilizing treatment of primary or secondary corneal ectasia. Methods: Prospective, comparative, single-center study of patients presenting with progressive primary or secondary corneal ectasia. The control group, comprising the fellow eye of patients with bilateral involvement, was followed up for 6 months and then treated. The parameters examined were the biomicroscopic examination, visual acuity [best spectacle–corrected visual acuity (BSCVA) and uncorrected visual acuity (UCVA)], keratometry of the central 3 mm, intraocular pressure, central pachymetry, endothelial density, and macular profile. Results: Fifty-five eyes of 39 patients were treated; the mean follow-up period was 20.8 ± 6.8 months (range, 12–36 months). The control group comprised 16 eyes. UCVA and BSCVA were significantly improved between 3 and 12 months, reaching their minimum at 6 months, varying from 0.12 UCVA to 0.07 BSCVA (P < 0.05). These values and the keratometry values did not vary significantly after 36 months of follow-up. In contrast, analysis of the control group revealed significant keratometric deterioration of +1.2 diopters at 6 months (P < 0.05), with no further significant variation after treatment. Analysis of the subgroups of patients with post–laser in situ keratomileusis ectasia confirmed these results. At the end of the study, intraocular pressure, pachymetry, and endothelial density were not significantly modified, and no macular profile modification was observed. Conclusion: This study shows that corneal collagen cross-linking can stabilize progressive corneal ectasia, both primary and secondary, with no induced iatrogenic effects.

Keratin 13 immunostaining in corneal impression cytology for the diagnosis of limbal stem cell deficiency.

PURPOSE The aim of this study was to develop a validated, reliable, and minimally invasive technique for diagnosing limbal stem cell deficiency (LSCD) by immunocytochemical detection of conjunctival and corneal keratins on epithelial cells collected by impression cytology (IC). METHODS After validation of labeling techniques on a cohort of 10 healthy control patients, keratins K12, K13, and K19 were labeled on corneal IC of 10 eyes suspected of LSCD. Positive scores for the conjunctival markers K13/K19, coupled with the rarity of the corneal marker K12, were diagnostic proof of LSCD. RESULTS IC is a reliable and noninvasive technique for collecting epithelial cells. The labeling validation phase has permitted K3 labeling to be eliminated due to lack of corneal specificity. Among patients with LSCD, nine samples were diagnosed with LSCD (K13+/K19+), which was severe (K12-) in eight cases and mild (K12+) in one case. One sample could not be analyzed due to lack of cells. CONCLUSIONS K13 has shown to be a new marker of conjunctival differentiation. The immunocytochemical search for the K13/K19 couple by corneal IC provides a simple and reliable method for diagnosing LSCD, whereas the level of K12 could provide a score of disease severity. On the other hand, the authors question the corneal specificity of K3 as conventionally established.

Corneal Collagen Cross-linking for the Treatment of Progressive Corneal Ectasia: 6-Year Prospective Outcome in a French Population

PURPOSE To evaluate 6-year results of standardized epithelium-off corneal collagen cross-linking (CXL) for treatment of progressive corneal ectasia. DESIGN Prospective, consecutive, interventional case series. METHODS Thirty-six eyes of 25 consecutive patients with documented progressive primary or iatrogenic corneal ectasia underwent CXL following the Siena protocol. The main outcome measures included uncorrected (UDVA) and corrected (CDVA) distance visual acuities, biomicroscopy and fundus appearance, topography-derived steep and flat keratometry (Kmax, Kmin), central corneal thickness (CCT), intraocular pressure with Goldmann applanation tonometer (GAT-IOP), and endothelial cell density (ECD), recorded at baseline and months 1, 3, 6, 12, 24, 36, and 72. Bilateral macular optical coherence tomography was performed at the endpoint visit. The mean follow-up was 66 ± 6 months (range, 60-78 months). RESULTS At 6 years, CXL stabilized primary and iatrogenic corneal ectasia in 89% of the patients. In bilateral CXL, the progression of the first eye was highly predictive of the fellow eyes outcome. At the endpoint follow-up, the mean outcome variations were: UDVA: -0.08 ± 0.36 logMAR (P = .2); CDVA: -0.14 ± 0.28 logMAR (P = .004); Kmax: +0.11 ± 1.70 diopters (D) (P = .7); Kmin: -0.25 ± 1.25 D (P = .2); CCT: -16.38 ± 37 μm (P = .01); GAT-IOP: +1.0 ± 2.3 mm Hg (P = .01); ECD: +31 ± 400 cells/mm(2) (P = .6); no cases of macular toxicity or severe adverse events were reported. CONCLUSIONS At 6 years, CXL maintains long-term results in halting the progression of corneal ectasia, with significant improvement in CDVA and long-term stability of keratometry. Further clinical studies with longer follow-up and larger series would be necessary to definitely confirm these results.

Immunocytochemical Diagnosis of Limbal Stem Cell Deficiency: Comparative Analysis of Current Corneal and Conjunctival Biomarkers.

Purpose: To evaluate and compare corneal and conjunctival biomarkers for immunocytochemical diagnosis of limbal stem cell deficiency (LSCD). Methods: In accordance with the current literature, we selected K12 as the corneal biomarker and K7/K13/K19/MUC5AC as the conjunctival ones. The specificity and accuracy for each biomarker were assessed and compared on 10 healthy subjects and tissues of deceased donors. Twelve eyes of 9 patients clinically suspected of LSCD were enrolled. Epithelial cells (ECs) from the central cornea were collected using impression cytology (IC) and assessed for each biomarker. The presence of conjunctival cells in the central cornea was diagnostic proof of LSCD, whereas the detection of corneal residual cells would quantify the degree of LSCD. Results: K12 and K7/K13/MUC5AC are, respectively, highly specific of corneal and conjunctival differentiation, whereas K19 is not. Normal corneal ECs are not desquamative enough to be suitable for IC. Among 12 eyes with suspected LSCD, 84% (10 of 12) of IC samples were suitable for analysis. K3/K7/K19 immunostaining was positive in 100%, MUC5AC in 40%, and K12 was never observed. Conclusions: Clinical examination can lead to misdiagnosis of LSCD. Immunocytochemical detection of K7/K13 on corneal ECs collected by IC is reproducible, noninvasive, and highly effective in this indication, but without any quantification of the degree of the disease. This time-consuming technique requires skilled technicians and laboratory facilities, reserving it for planned limbal reconstruction.

Intérêt de la corticothérapie générale dans la kératoconjonctivite gonococcique de l’adulte : à propos de trois cas

INTRODUCTION adult gonococcal keratoconjunctivitis is a rare disease possibly leading to blindness, whose severity is related to the risk of corneal perforation and whose progression is conditioned by the rapidity of diagnosis and therapeutic management. PURPOSE discuss the value of general corticotherapy in the treatment of scleritis associated with this disease. PATIENTS AND METHODS retrospective analysis of patients with adult gonococcal keratoconjunctivitis managed in an emergency setting in 2007. OBSERVATION three patients aged 22-55 years contracted the disease during unprotected sexual activity. Involvement was bilateral in two cases out of three; the intensity of the signs was always asymmetrical. Each patient underwent stromal melting of the superior limbic structures, with severity proportional to the delay in treatment. For each case, systemic and local antibiotics did not control corneal thinning, which seemed correlated with the intensity of the systematically associated signs of scleral inflammation. Treatment of scleritis with general corticotherapy under antibiotic cover stabilized the corneal thickness. DISCUSSION whether the physiopathology of perilimbic corneal thinning can lead to ocular perforation in this condition is unknown. In our experience, the stabilization of corneal thickness seems correlated with regression of the scleritis observed after introducing general corticotherapy, potentially indicating aseptic inflammatory involvement. CONCLUSION stromal melting of the limbus observed in adult gonococcal keratoconjunctivitis seems to be related to the associated scleritis. Systemic corticotherapy controls progression and reduces the risk of corneal perforation.

Is the Optic Nerve Head Structure Impacted by a Diagnostic Lumbar Puncture in Humans

Purpose: The purpose of this study is to assess in vivo whether diagnostic lumbar puncture (LP) is followed by optic nerve head (ONH) and parapapillary anatomic changes in normal human eyes. Materials and Methods: Prospective, single-center, observational case series. ONH structures (prelaminar tissue surface, anterior surface of the lamina cribrosa, central retinal vessels) and parapapillary structures (internal limiting membrane, posterior surfaces of retinal nerve fiber layer and Bruch membrane/retinal pigment epithelium complex, Bruch membrane opening, posterior surface of the choroid) were quantitatively evaluated by means of swept-source optical coherence tomography (Triton Ver.10.05, Topcon, Tokyo, Japan) before and after LP (5, 60, and 360 min). Each of these structures was manually delineated for measurement before being superimposed to detect any displacement, using peripheral margins of parapapillary structures as a reference plane. Results: A total of 16 eyes of 8 nonglaucomatous patients were evaluated. The CSF volume was median (IQR), 1.65 mL (1.16 to 2.00) and none of the ONH structures showed any anatomic changes at any time point after LP. Conclusions: According to the design of this study, diagnostic LP is a safe procedure regarding deep ONH structures in nonglaucomatous subjects.

605 Kérato-conjonctivite gonococcique de l’adulte : à propos de 3 cas

Introduction La kerato-conjonctivite gonococcique de l’adulte constitue une affection rare et severe, dont la presentation clinique est quasi pathognomonique et qui se complique frequemment de perforation corneenne. Materiels et Methodes Nous rapportons les cas de 3 patients hospitalises en 2007 pour prise en charge d’une kerato-conjonctivite gonococcique. Observation 1er cas : un patient de 22 ans consulte pour un tableau de conjonctivite severe de l’œil gauche dans un contexte d’uretrite. L’evolution sous antibiotherapie locale et orale est marquee a J7 par la constitution d’un amincissement stromal para limbique preperforatif, dont l’aggravation est stoppee par une antibiotherapie intra veineuse associee a une corticotherapie systemique. 2e cas : un patient de 24 ans est transfere du Maroc pour kerato-conjonctivite purulente droite evoluant depuis 10 jours dans les suites de rapports sexuels non proteges. Une perforation corneenne survient a J1 en depit d’une antibiotherapie et d’une corticotherapie systemiques, justifiant la realisation d’une keratoplastie lamellaire profonde. La recuperation fonctionnelle est sub-totale. 3e cas : un patient de 55 ans consulte pour une kerato-conjonctivite severe bilaterale survenue au decours d’un voyage en Thailande. L’examen revele une athalamie sur perforation de l’œil gauche. Le patient est hospitalise pour antibiotherapie et corticotherapie systemiques assorties d’une keratoplastie lamellaire profonde gauche. Le retard au diagnostic se solde par une acuite visuelle finale mediocre. Discussion Les recommandations actuelles preconisent une hospitalisation pour antibiotherapie parenterale (Ceftriaxone IM, 1 g par jour, 5 jours) ; la severite de la sclerite associee justifie a notre sens une corticotherapie systemique. Il n’existe pas de consensus quant a l’adjonction de collyres fortifies, dont l’utilisation pourrait accelerer la guerison. Le traitement chirurgical par keratoplastie est indique en cas de perforation corneenne. Un bilan de MST doit completer la prise en charge de ces patients. Conclusion La keratoconjonctivite gonococcique est une affection stereotypee (amincissement corneen para limbique accompagnant un tableau de kerato-conjonctivite severe), dont la recuperation fonctionnelle est etroitement correlee a la precocite de la prise en charge.