Family History Of Keratoconus Research Articles

Association Between Family History and the Corneal Characteristics of Keratoconus in Japan.

The aim of this study was to determine the association between family history and corneal characteristics of keratoconus in Japan. The clinical records of patients with keratoconus who were interviewed regarding family history of keratoconus were retrospectively reviewed. Corneal indices derived from anterior segment optical coherence tomography were compared between the positive and negative family history groups using multiple linear regression analysis adjusted with age, sex, and history of atopy and eye rubbing. A total of 2,701 eyes, including 122 eyes with positive family history, were enrolled. Based on the adjusted multiple linear regression analysis, no significant differences were found between groups with and without a family history except for paracentral and mid-peripheral corneal thickness. The adjusted mean differences in paracentral and mid-peripheral corneal thicknesses between the two groups were -10.33 (95% confidence interval -20.29 to -0.37 P -value <0.05) and -9.78 (95% confidence interval -16.70 to -2.85, P -value <0.01), respectively. There was no significant association between family history and corneal indices in Japanese patients with keratoconus, except for paracentral and mid-peripheral corneal thicknesses. A Japanese patient with keratoconus who had a family history showed significantly lower paracentral and mid-peripheral corneal thicknesses than those with no family history.

AvaGen Genetic Testing versus Ocular Screening Assessments Including the Keratoconus Severity Score (KSS) and Randleman Ectasia Risk Score System (ERSS) in Refractive Surgery Candidates.

To determine whether the AvaGen (AG) Genetic Eye Test provided additional information for screening for the presence of keratoconus (KC) and assessing KC risk in refractive surgery candidates, as compared to the Keratoconus Severity Score (KSS) and Randleman Ectasia Risk Score System (ERSS). This retrospective study analyzed patients seeking refractive surgery at an eye clinic in the United States between January 2022 and July 2023. The inclusion criteria encompassed those with a family history of KC, positive KC indices, or both. Corneal evaluations and demographic information were recorded and analyzed. KSS and ERSS criteria were utilized to evaluate postoperative KC and ectasia risk, respectively. Patients were categorized on how the AG genetic test compared to KSS and ERSS criteria. Clinicians assessed topographic indices, criteria scoring, and AG testing to deliver a definitive surgical recommendation. Among the 19 patients evaluated for ectasia risk, AG testing showed lower KC risk than ocular screening in three patients (15.8%), equal risk in three patients (15.8%), and higher risk in 13 patients (68.4%). The mean AG scores were 45.7 ± 7.0, 49.0 ± 3.46, and 61 ± 13.0 for these respective categories. The most frequently identified KC risk genes were ADAMTS18, COL2A1, and COL4A1. The AG test modified the physician's recommendation for refractive surgery in nine cases (47.4%). Despite the promising application of AG testing for assessing KC risk, further research and development are needed to enhance its applicability for screening refractive surgery candidates, in addition to standard ocular screening approaches.

Prevalence of Keratoconus in the Young Eastern Population of Saudi Arabia.

Keratoconus (KCN) is a progressive corneal ectasia that manifests at a young age and significantly impacts vision and quality of life. Early diagnosis allows for effective treatment with corneal collagen crosslinking, yet there is a lack of screening methods. This research aims to screen adolescents and young adults for this sight-threatening disease using quick corneal tomography mapping. This prospective cross-sectional study is being conducted at Johns Hopkins Aramco Healthcare in Saudi Arabia, focusing on subjects aged 13-23. We are presenting the data from our study as internal pilot study data. Bilateral corneal imaging with Pentacam HR (Oculus, Wetzlar, Germany), utilizing Scheimpflug corneal tomography, was performed. Historical data on allergies, eye rubbing, KCN, family history, previous eye surgery, and contact lens use were collected. The Belin Ambrosio Enhanced Ectasia Display total D value served as an objective criterion for suspect KCN (SKCN) diagnosis. In this study with 110 participants, KCN was identified in 2.75% of participants and SKCNin 11.93%. Systemic allergies or eczema were reported by 2.80%, with no cases in the KCN or SKCN groups. Eye rubbing behavior was observed in 5.50%, with the highest prevalence (33.30%) in the KCN group. A family history of KCN was found in 21.10%, with SKCN having the highest prevalence (30.80%). This restricted population study reveals a significant KCN rate of 2.75%. The condition, easily detected and treatable with corneal collagen crosslinking, highlights the need for larger population studies to determine the disease's true prevalence. Efficient screening programs tailored to regional data are essential for early detection and intervention.

Keratoconus characteristics and associations: A cross-sectional keratoconus study in western India (CKSWI).

To study the clinical and tomographic characteristics and associations of keratoconus (KC) patients visiting a tertiary eye care hospital. This was a cross-sectional, observational study that included 242 newly diagnosed clinical KC patients. Detailed ocular and systemic history, visual complaints, habit of eye rubbing, best spectacle-corrected visual acuity (BSCVA), retinoscopy reflex, detailed slit-lamp examination and tomographic findings, and presence of any ocular and systemic associations were documented for the included patients. Severity of KC was further graded into stages 0, 1, 2, 3, and 4 according to the ABCD grading system. The most common visual complaint was blurred vision (82.64%), followed by itching (48.76%), tearing (43.80%), and photophobia (41.32%). A total of 44.62% of patients had the habit of eye rubbing and 4.54% had a family history of KC. Most common clinical signs were scissor reflex (94.21%), Rizutti's sign (77.27%), corneal protrusion (69.83%), and Fleischer ring (67.35%). A total of 14.05% of patients had stage 0, 42.15% had stage 1, 19.83% had stage 2, 18.60% had stage 3, and 5.37% had stage 4 KC. Of these patients, 70.25% had a BSCVA visual acuity of ≥6/12 or better; 26.45% had a BSCVA of ≥6/60 to <6/12; and 3.30% had a BSCVA of <6/60. Ocular allergies, atopy, and asthma were found in 32.32%, 4.96%, and 2.48% cases, respectively. This study gives an overview of the clinical findings of KC cases in western India. Our results suggest that use of retinoscopy should be promoted in early KC detection in primary eyecare screening programs.

Acute Corneal Hydrops in Keratoconus Coinciding With COVID-19 Infection.

To the Editor: Acute corneal hydrops (AH), characterized by corneal stromal edema after a Descemet membrane rupture that allows aqueous humor entry, is observed in cases of keratoconus. Patients typically present with rapidly deteriorating visual acuity, photophobia, and pain. A timely diagnosis and management are essential to ruling out other vision-threatening pathologies such as corneal edema, infectious keratitis, uveitis, Fuchs endothelial dystrophy, postoperative edema, and acute transplant rejection. Here we describe a case of AH in a patient with keratoconus coinciding with coronavirus disease 2019 (COVID-19) infection and emphasize the importance of patient education in the context-restricted face-to-face consultations. A 20-year-old healthy man was evaluated regularly every 3 months for keratoconus using visual acuity and refraction assessments and anterior segment optical coherence tomography imaging. He wore corneal rigid gas-permeable contact lenses in both eyes. He also had a mild ocular allergy but no atopy or habit of eye-rubbing. There was no family history of keratoconus. A year earlier, he had an episode of AH in his left eye. While his left eye stabilized after pressure patching, the keratoconus progressed in his right eye. Examination findings at his last visit before the COVID-19 diagnosis included: corrected distance visual acuity with a gas-permeable contact lens of 20/30 (right) and 20/16 (left), anterior keratometry of 66.4 D (right) and 43.5 D (left), the thinnest corneal thickness of 264 mm (right) and 468 mm (left), and posterior “best-fit sphere” 9-mm radius values of 4.88 (right) and 6.46 mm (left). Approximately 2 months after the last follow-up, he developed flu-like symptoms (sore throat and fever) and was diagnosed the next day with COVID-19 on polymerase chain reaction. Two days after symptom onset, he noticed sudden deterioration of vision in his right eye and called our hospital. The cornea specialist in the ophthalmology department made a tentative phone diagnosis of AH based on his ocular history and instructed him to apply a pressure patch with ophthalmic ointment. He was examined at our hospital after 10 days of quarantine. The corrected distance visual acuity of the right eye was 20/2000, while a slitlamp examination revealed corneal protrusion and marked corneal epithelial as well as stromal edema in the right eye. Fluorescein corneal observation showed no epithelial abnormality, and a definitive AH diagnosis was made. Optical coherence tomography imaging revealed a break in Descemet membrane with overlying corneal edema (Supplemental Digital Content Fig. 1, https://links.lww.com/APJO/A179). No abnormality was noted in the left eye. He had received the second COVID-19 vaccine dose 1 month before the viral infection and reported experiencing no vaccine-related complications. On examination a month later, the AH in the right eye had remarkably improved. Various ophthalmic management and care delivery experiences have been reported during the COVID-19 pandemic. Perspectives in corneal crosslinking were reported relating to keratoconus in particular.1,2 To the best of our knowledge, our case is the first of AH with concomitant keratoconus and COVID-19 infection, although it was not possible to demonstrate a clear association among them. A previous history of AH in either eye is a predisposing risk factor for AH.3 This case underscores the importance of informing patients of their disease status and the need to undergo regular examinations. However, patients with COVID-19 may not be able to receive a timely ophthalmic examination. This patient was distressed until the postquarantine ophthalmic examination was performed; however, his previous experience with AH including successful pressure patching was helpful for the clinician and patient, who was better able to understand the extent of his condition and follow the provided instructions. In the absence of a clinical history of keratoconus, effectively managing AH before a face-to-face examination could be performed would have been challenging. Here are summary points of consideration when educating a patient with an acute event during a pandemic setting: Recognize the patient’s distress due to being in isolation during the acute event. Provide clear information about the disease and instructions for its independent management during quarantine. Strict hand hygiene should be thoroughly practiced while applying the pressure patch and patients should keep unwashed hands away from their face at times. Remote management may require conservative management methods. This requires careful consideration, particularly in acute ophthalmic cases. Although keratoconus was previously considered a noninflammatory ectatic corneal disease, recent evidence shows a relationship between its pathogenesis and chronic inflammatory events.4,5 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is known to cause a proinflammatory state.6 There are several reports of corneal graft rejection in patients infected with COVID-19.6–8 Large population-based case-control studies are needed to investigate the possible association between AH in keratoconus and the SARS-CoV-2 cytokine response. Shizuka Koh, MD, PhD*† Takeshi Soma, MD, PhD† Vishal Jhanji, MD‡ Kohji Nishida, MD, PhD†

Prevalence and risk factors of keratoconus (including oxidative stress biomarkers) in a cohort study of Shiraz university of medical science employees in Iran

BackgroundTo determine the prevalence of keratoconus in Shiraz University of Medical Sciences Employees and the related risk factors including oxidative stress biomarkers.Methods2546 subjects’ mean age ± SD, 40.35 ± 6.70 (46% male) were recruited. All participants underwent objective refraction using auto-refractometer and retinoscopy, followed by subjective refraction, and bio-microscopy. Pentacam imaging was performed for the detected keratoconus patients. The prevalence of keratoconus and frequency of the visual impairment among keratoconus cases were evaluated. Potential risk factors of sex, age, family history of keratoconus, body mass index ≥ 30 kg/m2, serum levels of glucose ≥ 100 mg/d, low-density-lipoprotein-cholesterol (LDL) ≥ 110 mg/dL, high-density-lipoprotein-cholesterol ≤ 40 mg/d, and triglycerides ≥ 150 mg/dL in the blood were evaluated.ResultsThe prevalence of keratoconus at least in one eye was 0.98% (95% CI: 0.6- 1.4%). The best corrected visual acuity in the keratoconus group was 0.06 ± 0.1 and the rest of the population was 0.01 ± 0.07 logMAR (p < 0.001). The frequency of visual impairment in the keratoconus group was zero. Odds ratios of the family history of keratoconus (21.00, 95% CI: 9.00–48.00, p < 0.001) and LDL ≥ 110 mg/dL (3.00, 95% CI: 1.20–6.40, p = 0.01) were significant.ConclusionsKeratoconus is rare and is not considered a risk factor for visual impairment. A family history of keratoconus and elevated serum LDL levels are contributing risk factors, suggesting an inflammatory background for the disease. Serum levels of LDL ≥ 110 mg/dL in the blood increased the risk of keratoconus three folds.

The association between keratoconus and allergic eye diseases: A systematic review and meta-analysis.

To investigate the association between keratoconus (KC) and allergic eye diseases, eye rubbing, and atopy. PubMed, Web of Science, Scopus, and Cochrane databases were searched for studies investigating eye allergy, atopy, and eye rubbing as risk factors for KC up to April 2021. Two authors independently screened all titles and abstracts against the predefined inclusion and exclusion criteria. The study analysed the prevalence of KC and its risk factors, including eye rubbing, family history of KC, atopy, and allergic eye diseases. The National Institutes of Health Study Quality Assessment Tool was used. Pooled data are presented as odds ratios (OR) and 95% confidence intervals (CI). The analysis was conducted using RevMan version 5.4 software. The initial search yielded 573 articles. After screening, 21 studies were identified for qualitative analysis and 15 for quantitative synthesis. A significant association was found between KC and eye rubbing (OR=5.22, 95% CI [2.80, 9.75], p < 0.00001), family history of KC (OR=6.67, 95% CI [4.77, 9.33], p < 0.00001), and allergies (OR=2.21, 95% CI [1.57, 3.13], p < 0.00001). However, no significant association was found between KC and allergic eye disease (OR=1.82, 95% CI [0.37, 8.97], p=0.46), atopy (OR=1.54, 95% CI [0.58, 4.09], p=0.39), allergic rhinitis (OR=0.85, 95% CI [0.54, 1.33], p=0.47), smoking (OR=0.96, 95% CI [0.76, 1.21], p=0.73), and asthma (OR=1.58, 95% CI [0.99, 2.53], p=0.05). Significant associations were observed between KC and eye rubbing, family history, and allergy, but not with allergic eye disease, atopy, asthma, and allergic rhinitis.

The association between keratoconus and allergic eye diseases: A systematic review and meta-analysis.

To investigate association between keratoconus and allergic eye diseases, eye rubbing, and atopy. PubMed, Web of Science, Scopus, and Cochrane were searched for relevant published studies from inception to April 2021 without restrictions or filters. We included case-control, cohort, and cross-sectional studies that investigated eye allergy, atopy, or eye rubbing as possible risk factors for KC. Two authors independently screened all titles and abstracts against predefined inclusion and exclusion criteria. This study analysed keratoconus prevalence and risk factors including eye rubbing, family history of keratoconus, atopy, and allergic eye diseases. The National Institute of Health Study Quality Assessment tool was utilised. Pooled data were presented as odds ratio (OR) and 95% confidence intervals (CI). Analysis was conducted using RevMan version 5.3 software. Out of 573 articles, we excluded 161 duplicates than 361 articles by title and abstract screening. The remaining 51 articles underwent full-text screening, and 29 articles were excluded. Twenty-one studies were included in the qualitative synthesis and fifteen for quantitative synthesis. There was no significant association found between KC and allergic eye diseases (OR=1.03, 95% CI [0.96, 1.11], p= 0.45), eye rubbing (OR=1.59, 95% CI [0.70, 3.63], p= 0.27), or atopy (OR=1.08, 95% CI [0.80, 1.44], p= 0.62). No significant association was observed between KC and allergic eye disease, eye rubbing, or atopy. Further prospective studies are needed to clarify and validate these findings.

The Characteristics and Risk Factors of Very Asymmetric Keratoconus.

To characterize very asymmetric keratoconus (KC) in terms of clinical demographics and risk factors in the Japanese population. We retrospectively reviewed the clinical records of patients with very asymmetric KC attending a university hospital. Patients with very asymmetric KC had defined clinical KC in one eye and normal topography in the fellow eye. All patients completed a questionnaire on potential risk factors (family history of KC, atopy, asthma, allergy, heart disease, sleep apnea, Down syndrome, eye rubbing, prone sleep position, and dominant hand). These data were compared with those of patients with clinical or topographic KC in both eyes. Subgroup analysis of very asymmetric KC eyes were performed based on the KC status: mild and severe. We retrospectively investigated 66 patients with very asymmetric KC and 505 patients with KC. Patients reported eye rubbing (53%-56%), allergy (62%-63%), and atopy (28%-29%) in both groups. There was no significant difference in terms of risk factors between the two groups. Approximately half of the 66 patients with very asymmetric KC had KC eyes ipsilateral to the dominant hand. Subgroup analysis of very asymmetric KC showed that atopy and asthma were more frequent in the mild KC group than in the severe KC group. Forty-four of 60 patients (73.3%) were using corneal, rigid, gas-permeable contact lenses (corneal GPs) for the KC eye, of which 30 patients (68.2%) were also using a corneal GP for the fellow eye. The patient-reported frequency of eye rubbing, allergy, and atopy were similar between KC and very asymmetric KC. Furthermore, we found no association between hand dominance and KC laterality.

Risk Factors for Development of Keratoconus: A Matched Pair Case-Control Study.

BackgroundKeratoconus, a progressive ectatic corneal disorder, is believed to be multifactorial in etiology with interaction between genetic and environmental factors. To date, risk factors for the development of the disease are extensively debated and need to be identified since they play a critical role in disease prevention and management. This study aimed to analyze associations between several hereditary and environmental predictors and the development of keratoconus.Patients and MethodsThis was a retrospective matched pair case-control study. The study was conducted in Ibn-Alhaitham eye teaching hospital between March 2016 and April 2017. Patients with keratoconus (cases) and their age- and gender-matched controls were asked about childhood and early teenage eye rubbing, ocular trauma, obesity, contact lens wear, smoking and sunlight exposure, family history of keratoconus, parental consanguinity and information related to socio-economic status. Univariable and multivariable conditional logistic regression analyses were used to test the significance of associations.ResultsA total of 166 individuals (83 cases and 83 controls; 60.2% female) were included. On univariable analysis, eye rubbing, family history of keratoconus and parental consanguinity were significant risk factors for keratoconus, whereas all other factors were non-significant. On multivariable analysis, eye rubbing (odds ratio: 4.93; P < 0.01), family history of keratoconus (odds ratio: 25.52; P < 0.01) and parental consanguinity (odds ratio: 2.89; P = 0.02), again, emerged as significant risk factors for disease development.ConclusionFamily history of keratoconus, eye rubbing, and parental consanguinity were significant risk factors for keratoconus development. These results support the evidence for multifactorial etiology, the most important factor being hereditary predisposition.

Efficacité et tolérance du cross-linking cornéen épithélium-off accéléré dans le traitement du kératocône évolutif de l’enfant

In adults, the management of keratoconus has evolved in recent years to achieve a well-codified treatment algorithm. The technique of cross-linking (CXL) has allowed us to stabilize the progression of keratoconus and has been largely developed. It is very effective, with few postoperative complications. Currently, there is no specific keratoconus management protocol for children. As we already know that keratoconus usually evolves more rapidly in children, we might consider whether a stabilizing treatment should be proposed as first-line therapy at the time of diagnosis. We carried out a retrospective study including patients less than 18 years of age with keratoconus who consulted the ophthalmology department at Edouard Herriot hospital in Lyon between 2013 and 2017. The main study parameter was whether or not CXL was performed. The other parameters were gender, age, ethnicity, eye rubbing, presence or absence of atopic disease, maximum keratometry (Kmax), minimal pachymetry, best corrected visual acuity (BCVA) and spherical equivalent. Forty-eight eyes of 34 patients were included. We found that two-thirds of the patients were Caucasian boys. Half of the patients had allergies, and over 60% of patients rubbed their eyes regularly. Only six percent of patients had a family history of keratoconus. The mean age of the patients was 14 (7-18) years at the time of diagnosis. Thirty-four eyes of 22 patients underwent CXL, for a total of 71% of our cohort. No postoperative complications occurred. After CXL, there was no significant difference in minimum pachymetry (455.6±37.25μm vs. 453.45±42.6μm after treatment (P=0.71)) or Kmax (50.23±7.17D vs. 50.99±7.01D after treatment (P=0.058)). There was a significant improvement in BCVA (from 0.30±0.3LogMar to 0.17±0.17LogMar after CXL (P=0.024)) and spherical equivalent (-1.91±2.1D to -2.54±1.89D after treatment (P=0.009)). The mean duration of follow-up was 32.2 months (12-59). CXL shows long-term disease stabilization in children with keratoconus. Nevertheless, this technique is indicated only for progressive keratoconus. Early diagnosis and management are essential in this population where the disease is rapidly changing. Treatment of atopy and performance of corneal topography when a child has irregular astigmatism should become automatic for early detection of this disease.

Characteristics of Keratoconus Patients in Jordan: Hospital-Based Population.

PurposeTo study the demographic, clinical and topographic characteristics of keratoconus patients in Jordan.MethodsA retrospective study which was conducted at King Abdullah University Hospital, Northern Jordan. The patients who visited our outpatient clinic from March 2015 to September 2020 and had a definite diagnosis of keratoconus were included in this study. Demographic and clinical data, including age, gender, family history, past ocular history, ophthalmic examination, and topographic parameters, were collected and analysed. Keratoconus severity was classified according to K mean readings.ResultsA total of 234 patients with keratoconus were evaluated in this study. The majority of patients (73, 31.2%) were between the ages of 20 and 24. Allergic conjunctivitis was the most frequent past ocular history. Fifty-five patients (23.5%) had a family history of keratoconus. Regarding severity, most of the eyes were mild (63.3%), followed by moderate (24.7%), and then severe (11.9%). The severity of keratoconus was significantly associated with gender (p<0.001). No correlation was found between family history and severity.ConclusionMost of the Keratoconus patients were young, with a mean age of 25.9 years. The majority were mild in severity, with more females presented in the severe stage. The study reported high rate of family history (23.5%) in comparison to similar studies. Therefore, screening of family members of Keratoconus patients is advisable.

Incorrect sleeping position and eye rubbing in patients with unilateral or highly asymmetric keratoconus: a case-control study

PurposeTo evaluate eye rubbing and sleeping position in patients with Unilateral or Highly Asymmetric Keratoconus (UHAKC).MethodsCase-control study of consecutive UHAKC patients diagnosed at the Rothschild Foundation. Controls were age- and sex-matched, randomly selected refractive surgery clinic patients. Patients self-administered questionnaires regarding their family history of keratoconus, eye rubbing, and sleeping habits. All the eyes underwent a comprehensive ocular examination. Logistic regression was used to analyze univariate and multivariate data to identify risk factors for keratoconus.ResultsThirty-three UHAKC patients and 64 controls were included. Univariate analyses showed that daytime eye rubbing [OR = 172.78], in the morning [OR = 24.3], or in eyes with the steepest keratometry [OR = 21.7] were significantly different between groups. Allergy [OR = 2.94], red eyes in the morning [OR = 6.36], and sleeping on stomach/sides [OR = 14.31] or on the same side as the steepest keratometry [OR = 94.72] were also significantly different. The multivariate model also showed statistical significance for most factors including daytime eye rubbing [OR = 134.96], in the morning [OR = 24.86], in the steepest eye [OR = 27.56], and sleeping on stomach/sides [OR = 65.02] or on the steepest side [OR = 144.02]. A univariate analysis in UHAKC group, comparing the worse and better eye, showed that eye rubbing [OR = 162.14] and sleeping position [OR = 99.74] were significantly (p < 0.001) associated with the worse eye.ConclusionOur data suggests that vigorous eye rubbing and incorrect sleeping position are associated with UHAKC. This is especially true in rubbing the most afflicted eye, and contributory sleep position, including positions placing pressure on the eye with the steepest keratometry.

Corneal elevation changes after forced eyelid closure in healthy participants and in patients with keratoconus

BackgroundTo assess pointwise corneal elevation changes after forced eyelid closure test (FECT) in the eyes of healthy subjects and in eyes with keratoconus.MethodsTwenty‐nine subjects with keratoconus and 31 healthy volunteers were evaluated. Patients with keratoconus who had corneal hydrops, apical scarring, corneal thickness ≤ 400 μm, ocular surface disease, contact lens wear on the examination day and a history of corneal cross‐linking were excluded. Exclusion criteria for healthy participants were spherical error > +3.00 D and < −3.00 D, corneal astigmatism > 1.50 D, corneal curvature > 47 D, ocular allergy, clinical findings and family history of keratoconus. Pentacam was performed before and after 20-seconds of FECT and raw data were extracted from the built‐in software. Pointwise anterior and posterior elevation changes in the central 8-mm cornea were assessed using paired samples t‐test and heat maps were constructed to reflect mean changes and statistically significant data points. Statistical significance was assumed at p < 0.01.ResultsAge and gender were similar between healthy subjects (24.5 ± 1.6-years, 46.4 per cent female) and subjects with keratoconus (28.6 ± 9.2-years, 46.4 per cent female, p = 0.19, 0.61, respectively). Healthy eyes displayed posterior depression clustering in the inferotemporal and inferonasal areas (mean change: −4.5 ± 7.8 μm and −5.2 ± 9.8 μm, respectively, all p < 0.01). In contrast, keratoconus eyes exhibited a wider area of posterior elevation clustering in the inferior cornea (mean change: 8.1 ± 14.5 μm, all p < 0.01) with a small extension in the inferotemporal cornea (mean change: 12.1 ± 22.3 μm, all p < 0.01).ConclusionFECT elicits corneal elevation changes mainly in the inferior cornea with the change being more pronounced and wider in eyes with keratoconus.

Acute Keratoconus-Like Corneal Hydrops Secondary to Ocular Massage Following Trabeculectomy

Purpose: To report a case of acute keratoconus-like corneal hydrops in a patient with long-term ocular massage following trabeculectomy. Methods: Case report and review of medical literature. Results: A rare complication of acute keratoconus-like corneal hydrops occurred in a patient following the use of ocular massage to maintain satisfactory aqueous humor filtration after trabeculectomy. The patient had a history of high myopia but denied previous ocular trauma, allergic disease and a family history of keratoconus. Slit-lamp examination demonstrated keratoconus-like corneal hydrops with formation of epithelial microcystic, and intrastromal cleft. He was diagnosed with acute corneal hydrops in the right eye and received intracameral gas (16% perfluoropropane) injection. On 5 months follow-up, the corneal edema was significantly improved. Conclusions: There may be a contributory relationship between the long-term post-trabeculectomy massage and the development of acute corneal hydrops. When prescribing therapeutic massage, patients should be followed up carefully to monitor for unexpected complications.

Association between Family History and Keratoconus Severity

ABSTRACTPurpose: The high prevalence of positive family history of keratoconus (KC) in KC patients is well-known. However, the results regarding the association between family history of KC and disease severity are controversial. The aim of this study was to evaluate the possible association between family history and severity of KC.Method: Clinical data of 1496 KC patients were evaluated. All participants were asked if they had had a family member with KC. Topographic and keratometric measurements of KC patients, including central corneal thickness (CCT), thinnest corneal thickness (TCT), mean, flat, and steep keratometry values (K) by the use of Pentacam, best-spectacle corrected visual acuity (BCVA), spherical equivalent (SE), and astigmatism were recorded and compared according to patients with and without a family history of KC, first- or second-degree family members, and the number of family members with KC. Severity of KC was classified according to the Amsler–Krumeich classification.Results: Family history of KC was present in 292 (19.5%) patients. Of those 292 patients who had a family history of KC, 159 (54.5%) had one family member with KC and 133 (45.5%) had two or more family members with KC. There was not a significant difference between corneal pachymetry and K values of the patients with and without a family history of KC (p > 0.05). However, those with a positive family history of KC had more severe disease, according to the Amsler–Krumeich classification (p < 0.05). KC patients who had more family members with KC had significantly lower TCT and significantly higher steep K and astigmatism (p < 0.05), and had more severe disease, according to the Amsler–Krumeich classification (p < 0.05).Conclusion: We suggest that patients with more family members with KC should be subject to screening to identify early disease.

Prevalence and risk factors of vision impairment among children of employees of Telecom, Italy.

To define the prevalence, causes, and risk factors of vision impairment (VI) in children. In this study,relatives of Association for Supplemental Health Insurance to the Employees of Telecom members aged 5-16 years were examined in all Italian regions. A standardized record card was used to collect data on medical history; keratometry; objective refraction; uncorrected, presenting, and best-corrected visual acuity (VA); examination of the pupils, adnexa, and anterior segment; direct ophthalmoscopy; posterior segment and fundus examination; and assessment for ocular pathology. Binocular and monocular VI were defined by a VA &lt;5/10 (or &lt;20/40). The campaign included 17,508 children, 12,798 of whom (73.1%) were examined (and 12,740 on whom all VA data were gathered). The prevalence of uncorrected, presenting, and best-corrected VI in the better eye was 9.0%, 2.51%, and 0.10%, respectively. The following variables were associated with presenting VI: age 10-16 years, family history of myopia, female sex, family history of keratoconus, and hypertension. Myopia is the main cause of VI (82.6%). A total of 96% of children with presenting VI had correctable VI. Correctable VI because of myopia is an important public health problem in school-age children in Italy.

Options for a young patient with considerably high, topographically stable, astigmatism: December consultation #1

A 21-year-old woman was referred for a refractive surgery evaluation. She has no relevant allergies or medical or family history of keratoconus or corneal transplantation. Spectacle dependence is her chief complaint. She occasionally wears contact lenses but wants to have surgery performed. The corrected near visual acuity and the corrected distance visual acuity (CDVA) are 20/20 in both eyes. The manifest refraction is 5.75 3.25 178 in the right eye and 5.00 3.50 170 in the left eye. The intraocular pressure and the results from a slitlamp examination and a fundus retinoscopy are normal. The ultrasound pachymetry shows the central corneal thickness (CCT) to be 505 mm in the right eye and 508 mm in the left eye. Among all devices used tomeasure the CCT, the thinnest measured point is 504 mm in the right eye and 503 mm in the left eye. Placido-disk corneal topography shows a high regular symmetric astigmatism that was stable over 1 year of follow up, with an insignificant change in keratometry (K) values (Figure 1). The 5 topographies were obtained at 3-month intervals. Scheimpflug and dual Scheimpflug tomography (Figures 2, 3, and 4) are normal with no suspicious pattern except a high regular astigmatism. The pachymetry maps show corneas that, although slightly thin, are within normal limits across the diameter. An excimer laser system predicts a stromal ablation of approximately 127 mm in the right eye and 121 mm in the left eye. For laser in situ keratomileusis (LASIK) with a 110 mm flap thickness, the percentage of tissue altered (PTA) would be 47% in the right eye and 46% in the left eye. The residual stromal bed (RSB) would be 267 mm in the right eye and 272 mm in the left eye. For photorefractive keratectomy (PRK), the PTA would be 25% in the right eye and 24% in the left. What kind of refractive surgery (if any) would you recommend to this patient? If none, why? Would you consider LASIK with a thin, predictable LASIK flap? What data helped you most in making your decision? Did the stability shown by the Placido disk–based corneal topography over 1 year significantly affect your surgery decision?What are your limits for treating a cornea with high regular symmetric astigmatism? If you recommend proceeding with surgery, was age a significant factor in that decision?

Keratoconus in Inflammatory Bowel Disease Patients: A Cross-sectional Study

Increasing evidence suggests that keratoconus may have an inflammatory component. The possible association of keratoconus with inflammatory bowel disease (IBD) has yet to be determined. The aim of this study was to determine the prevalence of keratoconus and suspect keratoconus in patients with IBD. All consecutive adult IBD patients seen in the Department of Gastroenterology, Nancy, University Hospital, France, between March 2014 and June 2014 were included. Pregnant women, rigid lens wearers, patients with a family history of keratoconus and patients with a history of refractive surgery were excluded. A control group of healthy subjects was included. All included patients underwent a corneal topography (OPD-Scan III, Nidek) to detect keratoconus or suspect keratoconus. Rabinowitz videokeratographic indices were the basis of corneal topography interpretation. Two hundred and one IBD patients were included, 150 with Crohn's disease and 51 with ulcerative colitis. Mean age was 38.7 years and 121 were women. Mean disease duration was 10.8 years. Two IBD patients were diagnosed with keratoconus (1%) and 38 with suspect keratoconus (18.9%). Overall prevalence of keratoconus and suspect keratoconus was 19.9% (95% confidence interval [CI] 17.5-22.0). None of the 100 healthy subjects had keratoconus, while three were diagnosed with suspect keratoconus (p = 0.0002 versus IBD patients). Only smoking was identified as a risk factor (p = 0.029), especially in Crohn's disease. Inflammatory bowel disease patients may carry an increased risk of keratoconus and suspect keratoconus, smoking further increasing this risk. This supports the hypothesis of an inflammatory origin of keratoconus.

Factors influencing big-bubble formation during deep anterior lamellar keratoplasty in keratoconus

PurposeTo investigate recipient and operative factors that can influence the rate of achieving a bare Descemet’s membrane (DM) during deep anterior lamellar keratoplasty (DALK) for keratoconus.MaterialsIn this retrospective comparative study,...